Committee Hears Broad Testimony on Senate Bill 2280 to Reform Prior Authorization for Health and Dental Insurance

Senate Industry and Business Committee Chairman Kentin Barta convened a hearing on Senate Bill 2280, a measure that would regulate prior authorization procedures for health and dental insurance plans in North Dakota, drawing extensive testimony from medical providers, patient advocates, hospitals, insurers and industry groups.

The bill’s sponsor, State Senator Scott Myers, asked the committee for a “due pass recommendation” and said the proposal "aims to reform and streamline the prior authorization process" after an interim study and stakeholder engagement. He circulated one narrow definitional amendment and asked the committee to consider the measure.

The bill would: require insurers or "prior authorization review organizations" to post prior-authorization requirements online in plain language; require that adverse determinations and appeals be made or reviewed by a licensed physician or dentist of the same or similar specialty; set statutory timelines for decisions; deem requests authorized if a reviewer misses the decision deadline; and require annual data reporting to the state insurance department including number of requests, approvals, adverse determinations and appeals overturn rates.

Andy Askew, vice president of public policy for an integrated health system, summarized the bill’s intent: "This bill's approach is simple, implement a reasonable regulatory framework that standardizes the prior authorization process for North Dakotans and align it with the best practices adopted throughout the country." He walked the committee through key provisions including definitions of "medically necessary," the 24-hour (urgent) and two-business-day (nonurgent) decision windows as drafted in the bill, the requirement that reviewers be licensed in the applicable clinical field, and the reporting mandate.

Multiple providers and patient advocates testified in support. Dentist Brad Beckall urged the committee to require that "all adverse determinations are made by a licensed physician or licensed dentist," and emphasized clinician knowledge of treatment context. Dr. J. Patrick Fawn, an adult hospitalist, described treatment delays in oncology attributable to prior authorization and said enforcement of timelines and same-specialty peer-to-peer review are essential: "If you have an orthopedist doing a peer to peer for a gynecological problem...why is somebody who has no knowledge of that particular procedure providing a peer to peer approval for that procedure?"

Rural providers described operational impacts. Marcus Lewis, CEO of First Care Health Center, recounted a patient who waited two weeks for authorization for a mobile MRI and said the delay contributed to pain and lost access to timely care. Lewis also described a swing-bed skilled nursing transfer denied retroactively for a therapy day because required minutes were not met, producing uncompensated claims.

Patient testimony illustrated consequences providers described. Susan Fineman testified her surgery was delayed until she personally identified and reached an insurer medical director; she credited that intervention with obtaining authorization within 30 minutes and said, "I firmly believe that had I not forced the issue, I would not be standing here today."

Supporters cited nationwide momentum: testimony noted at least 23 states have enacted some prior-authorization reforms and pointed to Minnesota as a nearby example with similar elements. Advocates emphasized enforcement, data collection and time limits as the protections that make reform meaningful.

Insurers, pharmacy benefit managers and trade groups opposed the bill in its current form or urged major revisions. Dylan Wheeler, head of government affairs for Sanford Health Plan, said Sanford processes roughly 20,000 prior authorizations annually in state-regulated lines, approved about 12,000 in 2024 and identified roughly 3,700 unnecessary submissions. Sanford proposed an amendment that would: (1) include additional state-regulated markets (Medicaid, PERS) if the law is to be comprehensive, (2) require same-or-similar specialist review only at the appeal level (to avoid large external review costs on initial review), (3) align decision timeframes with recently issued federal rules (proposing 72 hours for urgent, 5 days for nonurgent in their amendment draft), and (4) move automatic-authorization enforcement into market-conduct review by the insurance department rather than automatic deeming.

Blue Cross Blue Shield of North Dakota's testimony said prior authorization already affects a small set of procedure codes and that the carrier has implemented tools reducing unnecessary requests: "On average, 90% of the prior authorizations that Blue Cross receives are approved upon first review." The carrier argued the bill is prescriptive, risks higher costs and may conflict with federal requirements coming into effect.

Pharma and pharmacy-benefit manager representatives sought either carve-outs for prescription drugs or different language for drug benefits, noting clinical differences between one-time medical services and ongoing drug therapies and warning that some strands of the bill (for example, retrospective denial language) do not fit pharmacy operations.

The North Dakota Insurance Department took a neutral stance and offered drafting suggestions; department staff said they have received consumer complaints in the past and can expedite individual urgent cases today, but that the agency sees "both sides" and is willing to help negotiate compromises. Several testifiers urged alignment with the January 2025 CMS prior-authorization interoperability rule and warned of inconsistent timelines or unintended denials if state law sets different deadlines.

Committee members asked detailed operational questions about specialty review availability, the cost and logistics of contracting external reviewers, and whether timelines in the bill (24 hours for urgent decisions as drafted) were feasible in practice; providers generally supported rapid review but many witnesses and carriers favored the 72-hour/7-day windows reflected in the new federal rule or the compromise amendment offered by Sanford.

Votes at a glance SB 2372 — Motion to give a due pass and refer to Appropriations (Senate Bill 23‑72). Motion by Senator Klein; seconded by Senator Ingett. Recorded votes: Senator Klein — Aye; Chairman Barta — Aye; Senator Engott — Aye. Outcome: approved (tally yes 3). (The committee then adjourned.)

What’s next No formal committee vote on Senate Bill 2280 was recorded during the hearing; the sponsor requested a due-pass recommendation but the committee took testimony and heard competing amendment proposals. Several stakeholders asked for the committee to form a working group or subcommittee to refine definitions, align timelines with federal rules, and scope which state-regulated markets (Medicaid, PERS, etc.) the law should cover.

Why it matters Senate Bill 2280 would change how insurers, hospitals, clinics and pharmacies handle prior authorization — a process that supporters say can delay or block medically necessary care and opponents say is an essential cost-control and fraud-prevention tool. The committee’s next steps will determine whether North Dakota moves toward statutory guardrails for timelines, clinician reviewers, transparency and reporting or pursues narrower administrative fixes and coordination with federal interoperability rules.

Ending note Committee members signaled both appetite for reform and caution about unintended costs or operational disruption. Multiple presenters urged legislative action with enforceable timelines and data reporting; carriers and PBMs urged careful drafting, federal alignment and staged implementation to avoid increasing premiums or impairing fraud detection.