Legislative Management forwards Rural Health Transformation report and five bill drafts after $198.9M first‑year award

Legislative Management voted to accept the Rural Health Transformation Committee’s report and forward five bill drafts — four policy measures and an appropriations draft — to the special session, after committee chair Senator Beckettall described the state’s application and award under the federal Rural Health Transformation Program.

Beckettall told the committee the federal program received a $50 billion appropriation nationally and that North Dakota’s award for the first year was $198,936,970. The committee’s application assumed a $200 million annual budget for planning purposes and recommended using at least three of the program’s allowable categories; the state addressed four "pillars" in its application: bringing high‑quality care closer to home, connecting technology and data, strengthening the health workforce, and prevention of chronic disease.

The committee recommended five draft bills to align state policy with the grant application: a school‑fitness requirement using the Presidential Physical Fitness Test (bill draft 25.13.83); a nutrition component for physician continuing‑education requirements (25.13.84); joining a Physician Assistant Licensure Compact (25.13.85); expanding pharmacists’ authority for laboratory testing and certain prescriptive actions (25.13.86); and a two‑year appropriations draft (25.13.92) intended to provide funding continuity across the current and next fiscal years.

Beckettall and staff stressed constraints in the award: funds may not replace existing funding for services and may not be used for new large‑scale construction (minor renovations linked to program goals may be allowable). The presentation outlined percentage ceilings cited in the application (for example, provider payments and infrastructure allocations) and described reporting and subaward approval requirements tied to the Centers for Medicare & Medicaid Services (CMS).

Committee members asked how far the Legislature could amend the forwarded bills without risking CMS disapproval or a clawback of funds. Beckettall said significant departures from the application or the policies CMS expected could jeopardize approval of subawards, because each subaward must be approved at the federal level. He recommended caution: legislators will have opportunities to amend bills during the special session, but major changes could put funding at risk.

Commissioner Treanor (Department of Health and Human Services) addressed monitoring and evaluation: each subaward will include outcome measures tied to the activities and inputs (for example, workforce retention incentives). Treanor said DHHS intends to seek CMS approval of templates in advance where possible, to accelerate subaward approvals and reporting, and emphasized inclusion of physicians, nurses, allied health personnel and behavioral health providers in workforce initiatives.

The committee also discussed procurement timing for equipment (for example, ambulances) and technical assistance for assessing rural providers’ sustainability; DHHS staff said those items were within the application and implementation planning, but the obligation/liquidation windows will affect purchase and delivery timing.

After discussion, the committee moved and carried a motion to adopt the report and forward the five drafts — including the two‑year appropriation draft, which the chair said totals about $398 million to cover both years — to the special session for hearings in the joint policy and joint appropriations committees.

The committee directed Legislative Council and DHHS to schedule hearings and to prepare materials to show how any later amendments would interact with CMS approval requirements.