25.1237.02001
Title.03000
Adopted by the Senate Human Services
Committee
Sixty-ninth
March 25, 2025
Legislative Assembly
of North Dakota
Introduced by
Representatives Hendrix, Conmy, Frelich, Kasper, Koppelman, Rohr, Nelson, D. Johnston
Senators Mathern, Weston, Magrum
A BILL for an Act to create and enact a new section to chapter 23-12 of the North Dakota
Century Code, relating to medical costs transparency for health care facilities; to amend and
reenact section 26.1-47-02 of the North Dakota Century Code, relating to health care facility
and preferred provider compliance with medical cost transparency requirements; and to provide
a penalty.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
SECTION 1. A new section to chapter 23-12 of the North Dakota Century Code is created
and enacted as follows:
Medical costs transparency for health care facilities - Penalty.
1.For purposes of this section:
a."Health care facility" means those facilities licensed under chapter 23 - 16, except
for nursing facilities and , basic care facilities , and the state hospital .
b."Items and services" means any item or service, including individual items or
service packages, which could be provided by a health care facility to a patient in
connection with an inpatient admission or an outpatient visit for which the health
care facility has established a standard charge, including supplies and
procedures, room and board, use of facility, and services performed by health
care facility staff.
2.Health care facilities shall:
a.Make available to the public a list of standard charges for:
Page No. 1 25.1237.02001
ENGROSSED HOUSE BILL NO. 1594
FIRST ENGROSSMENT
PROPOSED AMENDMENTS TO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20 Sixty-ninth
Legislative Assembly
(1)Items and services; and
(2)Shoppable services, as outlined in title 45, Code of Federal Regulations,
part 180, subpart B.
b.Produce the list in a format consistent with rules adopted by the centers for
Medicare and Medicaid services.
3.A health care facility that violates a provision of this section may be assessed a civil
penalty by the insurance commissioner. A penalty for a violation by a health care
facility with more than twenty-five beds must be ten dollars per bed per day, not to
exceed five thousand five hundred dollars per day, for each day the violation
continues. A penalty for a violation by any other health care facility may be up to
one hundred dollars per day for each day the violation continues, plus interest and any
costs incurred by the insurance commissioner to enforce this penalty. The civil penalty
may be imposed by a court in a civil proceeding or by the insurance commissioner
through an administrative hearing under chapter 28 - 32. The assessment of a civil
penalty does not preclude the imposition of other sanctions authorized by rules
adopted under this title.
SECTION 2. AMENDMENT. Section 26.1-47-02 of the North Dakota Century Code is
amended and reenacted as follows:
26.1-47-02. Preferred provider arrangements.
Notwithstanding any provision of law to the contrary, any health care insurer may enter into
preferred provider arrangements.
1.Preferred provider arrangements must:
a.Establish the amount and manner of payment to the preferred provider. The
amount and manner of payment may include capitation payments for preferred
providers.
b.Include mechanisms, subject to the minimum standards imposed by chapter
26.1-26.4, which are designed to review and control the utilization of health care
services and establish a procedure for determining whether health care services
rendered are medically necessary.
c.Include mechanisms which are designed to preserve the quality of health care.
Page No. 2 25.1237.02001
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30 Sixty-ninth
Legislative Assembly
d.With regard to an arrangement in which the preferred provider is placed at risk for
the cost or utilization of health care services, specifically include a description of
the preferred provider's responsibilities with respect to the health care insurer's
applicable administrative policies and programs, including utilization review,
quality assessment and improvement programs, credentialing, grievance
procedures, and data reporting requirements. Any administrative responsibilities
or costs not specifically described or allocated in the contract establishing the
arrangement as the responsibility of the preferred provider are the responsibility
of the health care insurer.
e.Provide that in the event the health care insurer fails to pay for health care
services as set forth in the contract, the covered person is not liable to the
provider for any sums owed by the health care insurer.
f.Provide that in the event of the health care insurer insolvency, services for a
covered person continue for the period for which premium payment has been
made and until the covered person's discharge from inpatient facilities.
g.Provide that either party terminating the contract without cause provide the other
party at least sixty days' advance written notice of the termination.
h.Provide that if a preferred provider has failed to comply with federal transparency
rules and regulations, the health care insurer may terminate the contract without
consent.
2.Preferred provider arrangements may not unfairly deny health benefits to persons for
covered medically necessary services.
3.Preferred provider arrangements may not restrict a health care provider from entering
into preferred provider arrangements or other arrangements with other health care
insurers.
4.A health care insurer must file all its preferred provider arrangements with the
commissioner within ten days of implementing the arrangements. If the preferred
provider arrangement does not meet the requirements of this chapter, the
commissioner may declare the contract void and disapprove the preferred provider
arrangement in accordance with the procedure for policies set out in chapter 26.1-30.
Page No. 3 25.1237.02001
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30 Sixty-ninth
Legislative Assembly
5.A preferred provider arrangement may not offer an inducement to a preferred provider
to provide less than medically necessary services to a covered person. This
subsection does not prohibit a preferred provider arrangement from including
capitation payments or shared-risk arrangements authorized under subdivision a of
subsection 1 which are not tied to specific medical decisions with respect to a patient.
6.A health care insurer may not penalize a provider because the provider, in good faith,
reports to state or federal authorities any act or practice by the health care insurer
which jeopardizes patient health or welfare.
7.A preferred provider arrangement must include an attestation from the preferred
provider that the preferred provider is in compliance with federal transparency rules
and regulations.
Page No. 4 25.1237.02001
1
2
3
4
5
6
7
8
9
10
11