Committee backs bill to ensure long‑term care insurance covers residents in North Dakota "basic care" settings

Senate Bill 2172, which clarifies how long‑term care insurance policies apply to certain North Dakota licensed facilities, received a unanimous do‑pass recommendation from the Senate Industry and Business Committee after testimony from the Insurance Department, long‑term care provider groups and industry associations.

Senator Dale Padden introduced the bill, saying it updates Century Code language to reflect modern facility types and to prevent insurers from denying claims on the basis of outdated facility descriptions such as the former generic term “nursing home.” Crystal Bartuska, Life and Health Division Director at the North Dakota Insurance Department, told the committee that the department has received numerous consumer complaints in recent years about denied claims where carriers denied benefits because of the facility licensure designation rather than the consumer’s medical need. The department described a pattern of policies sold decades ago, and changing facility types and licensure (including a unique North Dakota category called “basic care”) have created confusion and inconsistent claim results.

Bartuska said the proposed statutory language would narrow the grounds carriers may use to deny claims and would emphasize that benefit eligibility should be determined by clinical criteria — activities of daily living and cognitive impairment — rather than solely by the facility’s licensure label. She referenced a 1991 bulletin from former Insurance Commissioner Pomeroy and a 2023 reminder bulletin from Commissioner Gottfried that urged claims be evaluated based on medical need. The department has used market conduct exams to investigate carrier practices, Bartuska said.

Nikki Wagner, president of the North Dakota Long Term Care Association, described basic care as an affordable care option unique in North Dakota that serves individuals who need assistance with daily activities but do not require intensive medical oversight. Wagner said basic care helps keep individuals in their communities and can be a lower‑cost alternative to skilled nursing. She said only about 8% of basic care residents currently use long‑term care insurance to pay for care, compared with about 28% of assisted‑living residents.

Committee members raised questions about the prevalence of the claims denials, the fiscal pressures on long‑term care insurers (including historic rate‑setting issues), and the potential impacts of federal staffing mandates on rural facilities. Insurance department witnesses said some carriers have exhibited widespread problematic claim practices and the department has the authority to perform market conduct examinations. Witnesses also noted that the long‑term care market presents balancing issues: policies sold 20–30 years ago were priced for lower costs of care and many policies have seen large rate increases over time.

After testimony and questions, a motion to give Senate Bill 2172 a do‑pass recommendation passed on a roll call. Recorded aye votes included Senator Klein, Senator Kessel, Chairman Barta, Vice Chairman Boehm and Senator Engate. Committee leadership indicated they would carry the measure forward.

Supporters said the bill codifies prior regulatory guidance to ensure consumers who paid decades of premiums receive benefits when they meet policy clinical criteria, and that the measure is targeted at cases where carriers have denied claims by focusing on facility licensure rather than the insured’s functional needs.

No opposition testimony was recorded at the committee hearing.