The proposed bill introduces a new chapter, 26.1-36.12, in the North Dakota Century Code that establishes comprehensive regulations for prior authorization processes in health insurance. It defines key terms such as "adverse determination," "authorization," and "medically necessary," which clarify the criteria for health care services requiring prior authorization. The bill mandates that prior authorization review organizations disclose their requirements on their websites and communicate any new or amended requirements to contracted health care providers at least sixty days prior to implementation. It also sets specific timelines for decisions, requiring notifications within seven days for nonurgent services and within seventy-two hours for urgent services, while prohibiting prior authorization for emergency medical conditions and medication-assisted treatment for opioid use disorder.

Additionally, the bill includes provisions that protect patients and streamline the prior authorization process. It states that prior authorizations cannot be revoked or limited if care is provided within 45 business days, unless fraud is involved, and they will remain valid for at least six months, or 12 months for chronic conditions. The bill requires organizations to honor prior authorizations from previous insurers for the first 60 days of a new policy, provided the service is covered. It also mandates written procedures for appeals of adverse determinations, annual reporting to the insurance commissioner, and a study on the impact of prior authorization on patient care and costs. The legislation is set to take effect on January 1, 2026.