The proposed bill introduces a new chapter, 26.1-36.12, in the North Dakota Century Code, which establishes regulations for prior authorization processes in health insurance. It defines essential terms such as "adverse determination," "appeal," "authorization," and "medically necessary," clarifying the responsibilities of prior authorization review organizations. The bill mandates that these organizations make their prior authorization requirements accessible to enrollees and healthcare professionals, and they must notify providers of any changes to these requirements at least sixty days in advance. It also sets specific timelines for prior authorization decisions, including a seven-day response for nonurgent requests and a seventy-two-hour response for urgent care situations, while prohibiting prior authorization for emergency medical services and medication-assisted treatment for opioid use disorder.

Additionally, the bill stipulates that prior authorization review organizations cannot revoke or limit a prior authorization if care is provided within 45 business days, unless fraud is involved. It establishes that prior authorizations are valid for at least six months, and for chronic or long-term care conditions, they remain valid for 12 months. The bill requires organizations to honor prior authorizations granted by previous organizations for at least the first 60 days of a new policy, provided the service is covered. If organizations fail to comply with deadlines, services are automatically deemed authorized. Furthermore, it mandates written procedures for appeals of adverse determinations, annual reporting to the insurance commissioner, and a study on the impact of prior authorization requirements on patient care and costs. The bill is set to take effect on January 1, 2026.