Sen. Scott Meyer presents watered-down prior-authorization amendments; committee schedules more work

State Sen. Scott Meyer, sponsor of legislation aimed at reforming prior authorization, presented two pages of amendments to Senate Bill 22 80 at the Senate Industry and Business Committee meeting, saying the changes strike compromises with insurers while preserving an enforcement mechanism.

Meyer (Scott Meyer, state senator, District 18, Grand Forks) told the committee the amended bill lengthens prior-authorization decision timelines, narrows some original protections and exempts certain state programs while keeping an “auto authorization” enforcement provision. "What you have before you, mister chairman, and members of the committee is a bill that is far more watered down than the patients, physicians, pharmacists, hospitals, mental health advocates would have hoped. However, it is a bill that still makes a meaningful down payment on prior authorization reform," Meyer said.

The amendment package increases decision timelines from the bill’s earlier draft: urgent services would require a decision within 72 hours and nonurgent services within seven calendar days, aligning those deadlines with federal Medicare and Medicaid guidance, Meyer said. The amendment also removes a requirement that denials be discussed in a physician-to-plan conversation before denial, removes a mandate that reviews be by a specialist with the "same or similar" training (while retaining review by a licensed physician), and allows retrospective denials where there is evidence of fraud or where the U.S. Food and Drug Administration has deemed a drug or device unsafe.

Meyer said the amended language explicitly excludes certain state-run insurance programs from the bill’s scope, naming Workforce Safety & Insurance (WSI), the Public Employees Retirement System (PERS) and Medicaid, and argued that the changes reflect compromise between patients’ advocates and insurers.

Sanford Health Plan representative Dylan Wheeler said Sanford appreciates some concessions but remains concerned about the bill’s scope, especially its possible application to self-funded employer plans. "That is why with our initial amendment proposal, we did respectfully ask for a specific exclusion of those markets," Wheeler said, arguing self-funded plans raise enforcement and scope questions for state regulators.

Blue Cross Blue Shield of North Dakota’s Megan Ruby told the committee state law does not apply to ERISA plans and urged removing ERISA-covered plans from the bill rather than risking litigation. Ruby also said the bill keeps longer provider-side timelines—90 days to respond to requests—which she said likely needs tightening to be “patient-centered timely care.” "I think if we're really talking about patient centered care, you know, those timelines are not for emergency situations," Ruby said.

Crystal Bartuska of the North Dakota Insurance Department said the department supports public reporting but asked for clarity about the department’s reporting form and about when a request is "deemed to be in good order" so the statutory clock to decide begins. Bartuska asked that any reference to PERS be tied to the statutory citation (she referenced North Dakota Century Code 54-52.1) to make regulatory authority and scope clear.

Supporters cited examples and data during Meyer’s presentation to illustrate provider burden: Meyer said one large health system processes roughly 20,000 prior-authorizations annually with three doctors, another hospital employs 65 people solely to manage prior authorization across about 470 contracts, providers spend an average of 12 hours per week on prior authorization tasks, and 85% of denials are later approved on appeal.

Committee members and stakeholders agreed work remained. The committee did not take a formal vote on the bill at Wednesday’s meeting; members asked parties to refine language (particularly wording on when a request is "deemed to be in good order") and, in fairness to parties who received amendments late, planned to resume consideration at the committee’s next meeting. Committee discussion also raised the possibility of an effective date of Jan. 1, 2026, requested by insurers if the bill moves forward, though no effective date was adopted.

What happened next: The committee asked proponents and opponents to reconcile remaining points, especially the scope regarding ERISA/self-funded plans, the provider-side timeline language, and the statutory reference for PERS; committee staff planned to take the item up again at the next meeting.