25.1361.02000
Sixty-ninth
Legislative Assembly
of North Dakota
Introduced by
Senators Castaneda, Bekkedahl, Lee, Barta
Representatives Vigesaa, Ostlie
A BILL for an Act to create and enact a new section to chapter 43-28 of the North Dakota
Century Code, relating to joint negotiations by dental providers with dental insurers; to amend
and reenact section 54-57-07 of the North Dakota Century Code, relating to compensation for
the provision of administrative law judges; and to provide a penalty.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
SECTION 1. A new section to chapter 43-28 of the North Dakota Century Code is created
and enacted as follows:
Joint negotiations by dental providers with dental insurers.
1.As authorized under this section, two or more dental providers practicing in the service
area of a dental insurer may jointly negotiate with the dental insurer and engage in
related joint activity regarding non-fee-related matters including:
a.Definition of medical necessity and other conditions of coverage.
b.Utilization management criteria and procedures.
c.Clinical practice guidelines.
d.Preventative care and other medical management policies.
e.Patient referral standards and procedures.
f.Drug formularies and standards for prescribing off-formulary drugs.
g.Quality assurance programs.
h.Liability terms for a dental provider and dental insurer.
i.Methods and timing of payments.
j.Administrative procedures.
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ENGROSSED SENATE BILL NO. 2375
FIRST ENGROSSMENT
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k.Credentialing standards and procedures for selection, retention, and termination
of participating dentists.
l.Mechanisms for resolving disputes between the dental insurer and dental
provider.
m.Dental benefits sold or administered by the dental insurer in which the dental
provider is required to participate.
n.Formulation and application of reimbursement methodology.
o.Inclusion or alteration of a contractual term or condition, except when the
inclusion or alteration is otherwise required by federal or state law.
2.As authorized under this section, upon a finding by the office of administrative
hearings that a dental insurer has substantial market power in a service area and any
of the terms or conditions of the contract with the dental insurer pose an actual or
potential threat to the quality and availability of patient care among covered
individuals, two or more independent dental providers may jointly negotiate with the
dental insurer and engage in related joint activity relating to fees and fee-related
matters, including the:
a.Amount of payment.
b.Amount of discount.
c.Procedure codes or descriptions of services covered by payment.
d.Appropriate grouping of procedure codes.
3.a.The dental providers may communicate with each other and a joint negotiation
representative authorized to negotiate on behalf of the dental providers with the
dental insurer concerning any contractual term or condition to be negotiated. For
purposes of this section, a "joint negotiation representative" means a
representative selected by two or more independent dental providers to engage
in joint negotiations with a dental insurer on behalf of the dental providers.
b.The joint negotiation representative is the only party authorized to negotiate with
the dental insurer on behalf of the dental providers as a group.
c.The dental providers may agree to be bound by the terms and conditions
negotiated by the joint negotiation representative.
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4.A person may not act as a joint negotiation representative without express permission
from the office of administrative hearings.
5.Upon the joint negotiation representative and dental insurer determining an agreement
has been reached on contractual terms or conditions that will be the subject matter of
the negotiations, the joint negotiation representative shall submit to the office of
administrative hearings, for approval, a copy of the proposed contract between the
dental providers and dental insurer.
a.Within thirty days of receipt of the proposed contract, the office of administrative
hearings shall review the proposed contract and provide a determination. If the
office of administrative hearings disapproves the contract, the office of
administrative hearings shall communicate to the joint negotiation representative
any deficiencies and specific remedial measures for the deficiencies.
b.Upon approval of the proposed contract, the dental providers, through the joint
negotiation representative, and the dental insurer may engage in negotiations.
c.The joint negotiation representative shall submit the negotiated contract to the
office of administrative hearings for review.
6.A negotiated contract and any plan of action for implementing a negotiated contract
must be approved by the office of administrative hearings before becoming effective.
Within thirty days of receipt of the negotiated contract, the office of administrative
hearings shall review the proposed contract and provide a determination. If the office
of administrative hearings disapproves the contract, the office of administrative
hearings shall communicate to the joint negotiation representative any deficiencies
and specific remedial measures for the deficiencies.
7.The office of administrative hearings shall adopt rules and procedures as necessary to
carry out the responsibilities of this section.
8.This section does not apply to dental benefit plans providing covered services
exclusively or primarily to individuals who are eligible for medical assistance.
9.Any negotiations under this section must be made in good faith. A person that does
not negotiate in good faith may be subject to sanctions or penalties as determined by
the office of administrative hearings.
10.This section may not be construed to:
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a.Permit a coordinated cessation reduction or limitation of dental services.
b.Affect governmental approval of, or otherwise restrict activity by, dental providers
which is not prohibited under federal antitrust law or require approval of contract
terms to the extent the terms are exempt from state regulation under federal law.
11.The dental insurer is responsible for costs for services rendered by the office of
administrative hearings and shall make payment for costs for services in accordance
with section 54 - 57 - 07 and rules adopted by the office of administrative hearings.
SECTION 2. AMENDMENT. Section 54-57-07 of the North Dakota Century Code is
amended and reenacted as follows:
54-57-07. Compensation for provision of administrative law judges - Special fund
established - Continuing appropriation.
1.The office of administrative hearings shall require payment for services rendered by
any administrative law judge provided by it to anyan agency, to any unit of local
government in this state, to any tribal government in this state, or to the judicial
branch, or a nongovernmental entity, in the conduct of an administrative hearing and
related proceedings, and proceedings under section 1 of this Act, and those entities
must make the required payment to the office. Payment must include payment for
support staff necessary to render administrative law judge services. Moneys received
by the office of administrative hearings in payment for providing an administrative law
judge to conduct an administrative hearing and related proceedings, and proceedings
under section 1 of this Act, must be deposited into the operating fund of the office of
administrative hearings.
2.The office of administrative hearings shall require payment for mileage, meals, and
lodging in connection with services rendered by an administrative law judge provided
to anyan agency, to any unit of local government in this state, to any tribal government
in this state, or to the judicial branch, or a nongovernmental entity, in the conduct of an
administrative hearing and related proceedings, and proceedings under section 1 of
this Act, and those entities must make the required payment to the office. Payment for
meals and lodging must be in the amounts allowable under section 44-08-04. Payment
for mileage when using state vehicles must be in amounts set for user charges under
section 24-02-03.5. All other payments must be in amounts allowed for other state
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officials and employees. Either general fund or special fund moneys, or other income,
may be used for the payment of mileage, meals, and lodging under this subsection.
3.A special fund is established in the state treasury and designated as the administrative
hearings fund. The office of administrative hearings shall deposit in the fund all
moneys received by it in payment for providing services rendered by any
administrative law judge in the conduct of an administrative hearing and related
proceedings, and proceedings under section 1 of this Act, under this chapter, as well
as all moneys received by the office in payment for mileage, meals, and lodging in
connection with providing any administrative law judge to conduct an administrative
hearing and related proceedings, and proceedings under section 1 of this Act . The
moneys in the fund are a standing and continuing appropriation and are appropriated,
as necessary, for the following purposes:
a.For the office of administrative hearings to pay for salaries, wages, benefits,
operating expenses, and equipment, including payment to temporary
administrative law judges, as necessary, for the purpose of providing requested
administrative law judges to agenciesan agency, to any unit of local government
in this state, to any tribal government in this state, or to the judicial branch, or a
nongovernmental entity.
b.For the office of administrative hearings to pay mileage, meals, and lodging to
any administrative law judges, as necessary, in connection with the services to be
provided under this chapter.
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