Committee hears bill to require long-term care insurers to pay claims in North Dakota basic care settings

The House Industry, Business and Labor Committee opened a hearing on Senate Bill 2172 on long-term care insurance and heard that the North Dakota Insurance Department is seeking to codify an interpretation that claim payments be based on medical need, not solely the licensure category of the facility where a claimant resides.

"We respectfully request a due pass recommendation from the committee on Senate bill 21 72," Crystal Bartuska, life and health division director for the North Dakota Insurance Department, told the committee. Bartuska said the department has received numerous complaints from policyholders who paid premiums for decades but had claims denied when they tried to access benefits.

The bill would narrow how insurers may deny payments by emphasizing eligibility criteria in the policy — such as activities of daily living (ADLs) and cognitive impairment — over the facility license type. Bartuska said the change is intended to give the department clearer regulatory authority after insurers pushed back on department bulletins from 1991 and 2023 that urged claims be judged on medical need rather than facility type.

The bill drew support from the North Dakota Long Term Care Association. "Long term care insurance should provide individuals with the flexibility to access care in the appropriate setting of their choice," Deanna Berg, administrator for Cassius Baptist Health and Rehab and a member of the association, told the committee. Berg said basic care is "a cost effective care option" unique to North Dakota and that residents of basic care facilities have faced delayed or denied payments.

Committee members questioned whether the bill would apply to existing policies sold decades ago. Bartuska said the bill is intended to cover both older closed-block policies issued in the 1980s and 1990s and newer products, because the proposed language ties eligibility to the benefit triggers in the contracts (ADLs and cognitive impairment) rather than only to new form filings.

Committee members pressed department staff on additional consumer protections. Representative Casper asked whether insurers could be required to provide insureds with copies of the policy when requested; Bartuska said the department would add language requiring insurers to provide a copy of an in-force long-term care policy to the insured or the insured's representative on request. Representative Schauer also urged adding that requirement.

Bartuska said the department is already using existing prohibited-claims statutes in enforcement but that codifying the requirement would give the department "that little bit more" leverage with insurers. She also described two recent cases the department handled in which families later received back payments of about $65,000 and $42,000 after department intervention.

The committee did not take a final vote on the bill during the hearing. Members discussed a short amendment to require insurers to provide policy copies on request and agreed to consider that language during committee work later the same day. The hearing record showed no formal committee vote on Senate Bill 2172 at this meeting.

Votes at a glance: none recorded for Senate Bill 2172 during the hearing; committee members indicated they planned to consider an amendment and revisit the bill in committee work.

The committee closed the hearing after receiving no opposition testimony. Staff said they would draft the policy-copy language for consideration in committee work later the day of the hearing.