North Dakota Gov. Kelly Armstrong signs bill to put checks on AI health care decisions
On Wednesday, April 23, Gov. Kelly Armstrong signed
Senate Bill 2280, which aims to reform the "prior authorization" process for patients needing imaging services, medications and surgeries.
Prior authorization is the approval from a patient's health insurance provider that may be required for a service, treatment or prescription to be covered by their plan, if it's not an emergency. Prior authorization does not guarantee payment, but makes it more likely their health plan will cover the cost.
The new North Dakota law puts deadlines on insurance plans for those prior authorization decisions and requires any denials to be made by a licensed physician, not by AI or insurance companies.
The bill passed unanimously in the House and nearly so in the Senate, and with Armstrong's signature, takes effect Jan. 1, 2026.
Sen. Scott Meyer, R-Grand Forks, the bill's lead sponsor, said it passed due to proponents and opponents sitting down and working it out.
"Just because it was a vote that led to almost unanimous support, it was still a lot of work to get to that point," Meyer told The Forum.
Dr. Stefanie Gefroh, president of Essentia Health's West Market, said North Dakota is one of only a few states without statewide oversight of prior authorization.
"It's kind of an open book with no guard rails, essentially, around what is an acceptable time frame for a patient to receive clearance to get services," Gefroh said.
She said some physicians are having to spend up to 14 hours a week trying to justify a medical decision made for a patient.
Meyer said American Medical Association data shows among all of the prior authorization requests in Medicare Advantage plans that were denied and appealed in 2022, more than 83% were overturned.
The result was delays in care, treatment and medications for those patients.
Gefroh said most delays involve higher cost items: MRIs, surgeries, and chemotherapy and immunologic agents.
The law calls for insurance companies to make timely decisions; within seven days for non-urgent requests and 72 hours for urgent ones.
Requests for services that go unmet or unanswered are considered "authorized."
"That's why the default to 'yes' really is quite extraordinary, because the beautiful part of it is we're not holding up patient care," she said.
In addition, any denials for services must be made by licensed physicians experienced in the relevant condition, not by AI or insurance analysts.
Gefroh said insurance companies that don't adhere to the guidelines will likely have to adjust their internal processes.
"I don't think they want to be approving by default," she said.
There was pushback against the bill from representatives of multiple insurance companies, who said it would increase costs.
In the end, the bill prevailed due to support from the North Dakota Hospital Association, and a coalition led by Essentia of 20 health care and patient advocacy organizations representing physicians, pharmacists, hospitals, physical therapists, and advocates for seniors, children, and cancer patients.
"It's doing the right thing and putting the patients at the center and anytime we can put the highlight on that, I'm pleased," Gefroh said.
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