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Rural Health Transformation committee forwards $198.9M award and five bill drafts to special session
Summary
The Rural Health Transformation Committee recommended forwarding four policy bill drafts and a two-year appropriations draft tied to a roughly $199 million first-year federal award for rural health transformation; committee members stressed CMS approval risk if amendments stray from the state's application.
Legislative Management adopted the Rural Health Transformation Committee's report and agreed to forward five bill drafts — four policy bills and one appropriations bill — to the special session for committee hearings.
Committee chair (reporting) said the committee was tasked with reviewing the federal Rural Health Transformation program and developing legislative input for the state's application. The committee described the federal program as a large, five-year initiative and reported North Dakota's first-year award as $198,936,970. Members emphasized the need to align state statutory policy with the application because substantial amendments could put federal approval at risk and could lead to reduced funding or federal "clawbacks."
The committee recommended forwarding these policy bill drafts: require schools to use the presidential physical fitness test (bill draft 25.1383); require a nutrition component in physician continuing-education requirements (25.1384); join the Physician Assistant licensure compact (25.1385); and expand pharmacists' scope of practice to include specified laboratory testing and limited prescriptive authority (25.1386). The committee also provided an appropriations bill draft (25.1392) intended to appropriate funding for two years (to ensure program continuity until the 2027 regular session), described in committee materials as roughly $398 million to cover the two-year period.
Members questioned how far the legislature can amend the bills without jeopardizing CMS approval; counsel and department staff said every subaward and significant program design would require CMS approval and the more the legislature micromanages the program beyond the application, the greater the risk of denial. Committee members also pressed DHHS on measurement and evaluation: the department said each subaward would include outcome measures, and DHHS would seek CMS pre-approval of templates to speed awards and ensure they meet federal requirements. Officials discussed procurement timing for equipment (for example, ambulances) and warned that ordering and delivery schedules could complicate obligation and liquidation timelines.
Representative Haug moved to adopt the Rural Health Transformation Committee report and forward the bill drafts; Representative Fralick seconded and Mr. Bjornsson recorded the roll. The motion carried.
