Sixty-ninth Legislative Assembly of North Dakota
In Regular Session Commencing Tuesday, January 7, 2025
SENATE BILL NO. 2375
(Senators Castaneda, Bekkedahl, Lee, Barta)
(Representatives Vigesaa, Ostlie)
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.
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, a dental provider and a dental insurer may enter into
voluntary non - fee - related joint negotiations. Before commencing voluntary joint negotiations, a
joint negotiation representative shall notify the attorney general of its intent to engage in
voluntary joint negotiations. The notice must be in writing and include:
a.The matters, including terms and conditions, to be negotiated;
b.The identity and location of all dental providers participating in the voluntary joint
negotiations;
c.The identity, location, and market share of the dental insurer the dental providers seek to
engage in voluntary joint negotiations;
d.A statement explaining the circumstances create the need for voluntary joint negotiations
and the benefits anticipated from the voluntary joint negotiations; and
e.The joint negotiation representative's procedures to ensure compliance with this section.
2.At the time of the filing with the attorney general, the joint negotiation representative shall
provide a copy to the dental insurer of its notice and any other materials submitted to the
attorney general. The dental insurer may provide additional information to the attorney general
regarding matters described in this section.
3.The attorney general shall review the notice to determine whether the proposed voluntary joint
negotiations comply with law and public policy, and shall, within ninety days, unless a thirty
day extension is approved by the parties, notify the joint negotiation representative and the
dental insurer whether voluntary joint negotiations are authorized under this section. The
attorney general, in determining whether voluntary joint negotiations are authorized, shall
consider the following factors:
a.The stated necessity and anticipated benefits of voluntary joint negotiations;
b.The market and bargaining power of the parties;
c.A party's ability to control or steer consumers, dictate terms of contracts, impose final or
nonnegotiable terms, or dictate or limit products or services available or offered to
consumers;
d.The contract terms to be negotiated, and the contract terms' potential effect on the ability
to provide quality care or medically appropriate care without delay and difficulty; S. B. NO. 2375 - PAGE 2
e.The risk of anticompetitive effects; and
f.The potential effect on price, quality, choice, or access to products or services for
consumers or others.
4.The attorney general may request additional information from the parties at any point during
the process or during the parties' negotiations.
5.Upon a determination by the attorney general that voluntary joint negotiation is authorized
under this section, and after a duly authorized officer of the dental insurer and all dental
providers seeking voluntary joint negotiations have granted written consent, two or more
dental providers practicing in the service area of the dental insurer may jointly engage in
voluntary negotiations with the dental insurer regarding the following non - fee - related matters:
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.Administrative procedures.
j.Credentialing standards and procedures for selection, retention, and termination of
participating dentists.
k.Mechanisms for resolving disputes between the dental insurer and dental providers.
l.Inclusion or alteration of a contractual term or condition, unless the inclusion or alteration
is otherwise required by federal or state law.
6.As used in this section, "fee - related matters" includes the amount of payment, the amount of
discount, procedure codes or descriptions of services covered by payment, appropriate
grouping of procedure codes, and any other matter directly relating to the amount of
reimbursements paid to or revenue received by dental providers.
7.a.Upon a determination by the attorney general that voluntary joint negotiations are
authorized under this section, 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,
subject to any limitations imposed by the attorney general. As used in this section, a "joint
negotiation representative" means a representative selected by two or more independent
dental providers to engage in voluntary joint negotiations with a dental insurer on behalf
of the dental providers.
b.The dental providers may agree to be bound by the terms and conditions negotiated by
the joint negotiation representative.
8.A person may not act as a joint negotiation representative without express permission from the
office of the attorney general. S. B. NO. 2375 - PAGE 3
9.a.Upon the joint negotiation representative and dental insurer determining a voluntary
agreement has been reached on contractual terms or conditions that are the subject
matter of the negotiations, the joint negotiation representative shall submit to the attorney
general, for its determination, a copy of the proposed contract or agreed upon terms
between the dental providers and the dental insurer. At the time of the submission to the
attorney general, the joint negotiation representative shall provide a copy of the proposed
materials submitted to the attorney general to the dental insurer, which may provide
additional information to the attorney general regarding the matters in this section.
b.Within ninety days of receipt of the proposed contract or agreed upon terms, the attorney
general shall review the proposed contract or agreed upon terms and provide a
determination.
c.The attorney general may consider the following factors in reviewing a proposed contract
or term, a negotiated contract or term, and the plan of action for implementing a
negotiated contract or term under this section:
(1)Fairness of the contract and whether the contract terms are consistent with
applicable laws and regulations;
(2)Details provided about the negotiation process;
(3)The market and bargaining power of the parties;
(4)The contract terms and the benefits achieved by the parties;
(5)Potential benefit to consumers and other purchasers of dental insurance;
(6)Risk of harm to consumers and others, including the likelihood of increase in prices
or reduction in quality, choice, or access to dental care or dental insurance;
(7)Risk of anticompetitive effects and potential effects on third parties, including
creation of barriers to entry for new market participants, unfair competition, or
exclusionary effects; and
(8)Promotion of increased infrastructure and innovation in a market.
d.Upon request from the attorney general, the joint negotiation representative, a
participating dental provider, and the dental insurer shall provide additional information to
inform the attorney general's determination under this section.
10.The attorney general may adopt rules and procedures as necessary to carry out the
responsibilities of this section.
11.This section does not apply to dental benefit plans providing covered services exclusively or
primarily to individuals who are eligible for medical assistance.
12.This section may not be construed to:
a.Permit a coordinated cessation, reduction, or limitation of dental services.
b.Affect government approval of, or otherwise restrict activity by, dental providers which is
not prohibited under federal antitrust law or require approval or contract terms to the
extent the terms are exempt from state regulation under federal law. S. B. NO. 2375 - PAGE 4
____________________________ ____________________________
President of the Senate Speaker of the House
____________________________ ____________________________
Secretary of the Senate Chief Clerk of the House
This certifies that the within bill originated in the Senate of the Sixty-ninth Legislative Assembly of North
Dakota and is known on the records of that body as Senate Bill No. 2375.
Senate Vote:Yeas 44 Nays 2 Absent 1
House Vote: Yeas 78 Nays 14 Absent 2
____________________________
Secretary of the Senate
Received by the Governor at ________M. on _____________________________________, 2025.
Approved at ________M. on __________________________________________________, 2025.
____________________________
Governor
Filed in this office this ___________day of _______________________________________, 2025,
at ________ o’clock ________M.
____________________________
Secretary of State