This bill introduces Chapter 26.1-36.12 to the North Dakota Century Code, establishing comprehensive regulations for prior authorization in health and dental insurance. It defines key terms such as "adverse determination," "authorization," and "medically necessary," and mandates that prior authorization review organizations disclose their requirements online. The bill prohibits prior authorization for emergency health care services and medication-assisted treatment for opioid use disorder, while also setting a validity period for prior authorizations at six months, or twelve months for chronic conditions. It ensures continuity of care by requiring organizations to honor previous authorizations when enrollees change policies and automatically deems services authorized if deadlines are not met.

Additionally, the legislation outlines new appeal procedures for adverse determinations, granting enrollees and their healthcare professionals the right to appeal and review information used in the decision. It protects enrollees from changes in coverage terms during a plan year, except for unsafe drugs or devices. The bill also mandates notification of reversed adverse determinations to claims administrators and requires annual reporting to the insurance commissioner on prior authorization requests. A legislative study will evaluate the impact of these requirements on patient care and costs, with findings due by November 1, 2025. The provisions will take effect on January 1, 2026.