This bill establishes a new chapter, 26.1-36.12, in the North Dakota Century Code that regulates prior authorization processes in health insurance. It defines essential terms such as "adverse determination," "appeal," and "medically necessary," and mandates that prior authorization review organizations make their requirements accessible to enrollees and healthcare professionals. Organizations must provide written notice of any new or amended requirements at least sixty days before implementation. The bill also stipulates that all adverse determinations must be made by licensed physicians or pharmacists with relevant experience, and appeals must be reviewed by qualified medical professionals.

Additionally, the legislation sets specific timelines for prior authorization decisions, prohibits prior authorization for emergency medical services and medication-assisted treatment for opioid use disorder, and ensures that prior authorizations remain valid for extended periods under certain conditions. It requires organizations to honor prior authorizations for at least 60 days when an enrollee changes health insurance policies and mandates automatic authorization if deadlines are not met. The bill also includes provisions for written appeal procedures, annual reporting to the insurance commissioner, and a study on the impact of prior authorization on patient care and costs. The bill is scheduled to take effect on January 1, 2026.