Latest news with #SenateBill2280
Yahoo
07-05-2025
- Health
- Yahoo
Health care legislation will improve access, affordability for North Dakotans
Supporters watch as North Dakota Gov. Kelly Armstrong signs a bill April 23, 2025, with reforms for health insurance prior authorization. (Photo provided by Office of the Governor) North Dakotans want to keep their family members and the state's workforce healthy. When health care isn't prioritized, small issues can quickly turn into large problems and treatable conditions can become life-threatening, such as late-stage cancer. When the time comes to make an appointment, everyone wants the same things: simplicity, accessibility and affordability. All the data indicates, and headlines tell us, that cutting through red tape to ensure health care access and avoiding medical debt are top-of-mind issues. They can be some of the most frustrating parts of our lives. This year the North Dakota Legislature did something about it. By passing laws reforming insurance company practices on prior authorization and copay accumulator adjustments, the North Dakota Legislature made the health care process easier for those who need it most, including cancer patients and others with serious illnesses. Prior authorization reform Prior authorization was once used sparingly by insurers to determine whether costly medical procedures or medications were needed. But the process has devolved into a system requiring providers to get approval to prescribe even the most routine medications and procedures. Physicians report the process can lead to significant delays in care, contributing to negative outcomes for patients, including abandoned treatment altogether. Senate Bill 2280 standardizes the prior authorization process and establishes time limits for review – 72 hours in cases of emergency or seven calendar days for more routine requests — helping those in need of critical medical care avoid prolonged delays in treatment. It also eliminates artificial intelligence and business consultant overview from the process, making sure a doctor is doing the authorization and not a bot or bean counter. We are so grateful to the bill's primary sponsor, Sen. Scott Meyer of Grand Forks, with Sens. Jeff Barta (Grand Forks), Brad Bekkedahl (Williston) and Sean Cleary (Bismarck) co-sponsoring in the Senate and Reps. Jonathan Warrey (Casselton) and Jon Nelson (Rugby) in the House. For the more than 4,500 North Dakotans who will be diagnosed with cancer in 2025, this legislation is a major step forward in making their treatment process less about red tape and more about recovery. Copay accumulator adjustments Legislation sponsored by Rep. Karen Karls of Bismarck, House Bill 1216 requires all prescription drug copayments made by patients, directly or on their behalf, to count toward their overall out-of-pocket maximum or deductible. This law essentially ends an insurance company practice that did not allow payments from outside entities to count toward a patient's out-of-pocket cost obligations. Real life example: A cystic fibrosis patient received $5,000 in copay assistance to help with prescription drug out-of-pocket cost. That amount would cover the patient's copay for the year, saving her $5,000. Under the old rules, the copay assistance would not count, and she would still have to pay $5,000 to meet her deductible or out-of-pocket maximum before her health plan started paying for her subsequent health care costs. It's like getting a scholarship to attend college but having the university keep the money … and your tuition remains the same. That amount of money is life-changing for many, many North Dakotans. The new law will help ease the financial burden of some patients, many of whom are fully inundated with debt already. A 2022 American Cancer Society Cancer Action Network study found 31% of cancer patients noted paying for prescriptions as a challenge and 20% indicated that financial considerations had caused them to skip or delay taking prescribed medication. Missed opportunity As always, we should celebrate the wins, but there is always more that needs doing. One piece of legislation that did not advance this session involved diagnostic and supplemental breast cancer screenings. House Bill 1283 would have required all state-regulated health policies to eliminate patient out-of-pocket costs for medically necessary diagnostic and supplemental breast imaging. Essentially, it would require breast diagnostic mammograms, breast ultrasounds, and breast magnetic resonance imaging (MRI) scans be covered by insurers at no-cost-share when needed after an abnormal initial screening or because of personal risk factors. Mammograms are a great detection tool and, for many, enough to give a full and clear breast cancer screening. But other patients need more and this legislation would have required insurance companies to pay the bill when doctors indicated additional tests were required to get that full and clean bill of health. Legislation around biomarker testing is also in the future here. Biomarker testing is about identifying the most effective treatment for patients with cancer and other serious illnesses. It can open the door to precision treatments that can improve outcomes and quality of life for patients with many diseases and conditions. Biomarker testing can allow some patients to access targeted therapies and avoid more generalized treatments like chemo. It's about precision medicine, making sure folks get the right treatment at the right time. Similar legislation has been enacted in 21 states including Texas and Georgia. North Dakota is falling behind best practices in this regard, a situation that needs remedied. It was a good session for North Dakotans who need health care. Which is to say, for all North Dakotans. We are grateful for the steps taken and look forward to moving ahead further in the months and sessions to come.
Yahoo
25-04-2025
- Health
- Yahoo
North Dakota Gov. Kelly Armstrong signs bill to put checks on AI health care decisions
Apr. 24—BISMARCK — A new North Dakota law is expected to put checks on the influence that artificial intelligence and algorithms have on health care decisions, resulting in fewer delays in treatment and medication for patients. 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.
Yahoo
24-04-2025
- Health
- Yahoo
Bill signed this week seeks to prevent health coverage delays for North Dakota patients
Gov. Kelly Armstrong signs a bill that seeks to prevent insurance prior authorization from blocking patients' access to care in an April, 23, 2025, ceremony at the Capitol. (Mary Steurer/North Dakota Monitor) New legislation signed Wednesday by Gov. Kelly Armstrong aims to protect patients from care-delaying snags in the health insurance prior authorization process. Prior authorization refers to when someone must obtain approval from their insurance company before they can undergo a procedure, obtain medication or receive some other health service. The process allows insurance companies to review whether the service or medication is necessary for the patient. Insurers say prior authorization helps control costs and make sure that patients are getting the best care they can. But some doctors, patients and advocates say the process can be misused in a way that prevents people from accessing necessary services, or that leaves patients and hospitals to foot the bill for expensive treatments. Insulin caps bill headed to North Dakota governor Susan Finneman, a Bismarck resident who testified in favor of the bill, said 10 years ago her insurance company refused to authorize medical scans needed to treat her spine infection, leading her to put off health care and for the infection to fester. She ultimately needed spinal reconstruction surgery — which she said her insurance company took so long to authorize that she nearly had to reschedule the procedure. Finneman said she had to personally call the highest-ranking doctor working at her insurance company to get the surgery approved. 'It's not right that people have to figure out how to navigate it on their own,' she said at a Wednesday ceremonial signing of Senate Bill 2280. The new law sets guidelines for how insurance companies must handle the prior authorization process, including mandatory deadlines for responding to authorization requests and requirements that denials are reviewed by medical professionals. The law does not cover all state-regulated insurance markets, according to testimony from Sanford Health. State employee health insurance plans, for example, are excluded. Other sections direct insurance companies to publicize information about how its prior authorization process works, and to give advance notice to patients and health care providers when the company plans to change this process. Andrew Askew, vice president of public policy for Essentia Health, said in testimony on the bill most large insurers in North Dakota don't cause issues with their prior authorization procedures. But that's not the case with every company, he said. 'There's a lot of insurance companies that are completely unreasonable,' Askew said. States try to rein in health insurers' claim denials, with mixed results In 2024 survey results published by the American Medical Association, 93% of doctors reported the prior authorization process had resulted in care delays to patients that posed significant health risks. Doctors occasionally must provide an emergency procedure on short notice without time to send a request to an insurance company. The prior authorization process in those instances must happen retroactively. Askew said in some cases, the insurance companies don't give medical providers enough time to send this retroactive claim and to supply the backup documentation showing the procedure was necessary. When prior authorization cannot be obtained after a procedure is provided, the patient or hospital may be forced to cover the full cost, he said. 'That's extremely burdensome for hospitals that are trying to make a margin, trying to get patients care when they need it,' Askew said. The new law says that prior authorization may not be required for a patient to receive emergency health care. It also says patients and health care providers have at least two business days after an emergency procedure to notify insurance. North Dakota House approves change to state health insurance plan Insurance companies must also ensure that when they deny health care to someone, that decision is made by a medical doctor or pharmacist, the statute states. The law also mandates that appeals to prior authorization decisions are reviewed by medical doctors. In both cases, the medical professionals must have active, specialized experience in the field of medicine relevant to the health service in question. Several other provisions in the law are intended to prevent patients from being abruptly cut off from their health care. For example, the law states that if an insurance company changes its prior authorization coverage requirements for a medication or health care service, the change generally may not impact those receiving the medication or service until those patients' insurance plans turn over. If an insurance company violates the requirements outlined in the law, any health care services under prior authorization review are automatically granted, it states. A prior authorization decision does not determine whether the insurance will cover something. A patient can be granted pre-authorization for a procedure but then still have to pay for part or all of it, in other words. Some insurers testified in opposition to the law. Megan Hruby of Blue Cross Blue Shield testified that prior authorization only impacts a small number of procedures, and said the requirements would create more bureaucratic barriers, not remove them. She said the law would also increase insurance costs for taxpayers. Hruby noted that the Legislature's Health Care Committee studied prior authorization during the 2023-2025 interim session and didn't end up making any policy recommendations. The law will take effect Jan. 1, 2026. It also requires that covered insurance companies report annual data to the state related to prior authorizations, including the number of approvals and denials, and the reason requests were denied. The statute directs the Legislature to consider two prior authorization-related studies during the interim legislative session. The first will study prior authorization requirements under state employee health insurance, and how those requirements impact patients and health care costs. The study would the require insurance plans to submit data by July 1 to the North Dakota Insurance Commissioner detailing the previous years worth of prior authorization requests granted, denied and appealed. The data would also have to include why any requests were denied, and how many denials were reversed. The second study tasks legislators to research ways to send prior authorization requests electronically, as opposed to through the mail. Any policy recommendations to come out of the studies will be forwarded to lawmakers to consider for the 2027-2029 legislative session. SUPPORT: YOU MAKE OUR WORK POSSIBLE SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
16-03-2025
- Health
- Yahoo
Bill aims to minimize treatment delays for North Dakota patients
(Getty Images) The first thing that came to people's minds about Shanna was her smile. It was warm, inviting and just the right amount of mischievous. Her family didn't think much of her fall in September; maybe she missed a step off the deck. She had a headache but nothing so bad that it needed medical treatment. That changed on Sept. 19 when Shanna was life-flighted from Carrington to Fargo with stroke symptoms. After imaging, a neurosurgeon performed an emergency craniotomy, removing part of a tumor applying pressure to the brain. They saw three more inoperable spots. Initial reports determined it was likely lymphoma, but her care team was optimistic. She was a healthy 40-year-old mother, and lymphoma is treatable. I finished my own cancer treatment a year prior. It was breast cancer spread to lymph nodes, so not the same certainly, but I became fiercely protective of my cousin. I was ready to be involved however she needed me to be. We lost my cousin Shanna Barone on Feb. 6, less than five months after the first sign of trouble. It was grueling and heartbreaking and perhaps there was nothing that could have been done to save her life, but dealing with the insurance company's prior authorization requirements certainly cost us time in a process where – aside from cancer — time was perhaps our greatest adversary. Prior authorization is a practice in which physicians must obtain approval from insurers before prescribing medication or moving forward with treatment for their patients. Insurers use this, in part, to contain costs. Physicians report the process can lead to significant delays in care, contributing to negative outcomes in patients, including abandoned treatment. The process was once used sparingly to determine whether costly medical procedures or medications were needed but now providers often must get approval to prescribe even the most routine medications and procedures. This is why I have testified in support of North Dakota Senate Bill 2280, which will place limits on the amount of time insurers can take to make prior authorization decisions. Such limits could have curtailed at least some of the delays faced by Shanna. Senate Bill 2280 has a hearing at 2:30 p.m. Monday in Room 327C of the Capitol. Testimony can be submitted online until 1:30 p.m. Monday. Her team of oncologists submitted prior authorization requests for aggressive chemotherapy and a PET scan upon admittance. She didn't get approval and receive those services until Oct. 3 – an 11-day wait. The PET scan determined a mass in her abdomen, so a prior authorization request was sent for another chemotherapy regimen that would address that as well. She wasn't approved until Oct. 11 – eight days. Her oncologists remained vigilant and switched the plan on Nov. 18. They wanted a better response, so they switched to R-ICE, a combination of four chemotherapy drugs given over several days. They would follow with CAR-T cell therapy, a process that usually takes between three and four weeks to complete. On Jan. 2, Shanna's oncologists submitted the prior authorization request for CAR-T because they knew she would need it sooner than later. Her symptoms increased daily. She lost vision in her left eye, then movement and feeling on that side, then her speech. Her skull skin was so tight around the growing tumor it was shiny. Radiation began then also to buy time waiting for approval. By Jan. 5, she was admitted to the hospital and would never leave. On Jan. 10 – two weeks after the initial physician request — Shanna got 'soft approval' for CAR-T from the insurance company, but they 'couldn't' sign off by the end of the business day and told us to wait until the next week. Formal approval was received on Jan. 14 and the lab processes were completed by Jan. 29. By then, she had declined, so she had to undergo another surgery to place a shunt in her skull to relieve pressure. We were so encouraged by her response — she was responsive and spoke clearly for the first time in weeks. But two days later she declined again. Additional cancer cells had been allowed to grow during the period she waited for approval. Shanna passed away Feb. 7, 11 days after her 41st birthday. Shanna knew her battle would be hard, but she went into it with fiery determination, an intelligent, compassionate care team and family support. Her life depended on decisions she didn't get to make, ones that increased suffering and anxiety in the interim. If a simple set of laws can prevent this situation from happening to another North Dakotan, the decision to pass this bill is an easy one.
