21.0224.01000
Sixty-seventh
Legislative Assembly HOUSE BILL NO. 1203
of North Dakota
Introduced by
Representative Keiser
1 A BILL for an Act to create and enact chapter 26.1-36.8 of the North Dakota Century Code,
2 relating to requirements of health insurance policies; to amend and reenact section 50-24.1-37
3 of the North Dakota Century Code, relating to continuation of Medicaid Expansion; to repeal
4 sections 40 and 41 of chapter 11 of the 2017 Session Laws, relating to repeal of the Medicaid
5 Expansion program; to provide for application; and to provide a contingent effective date.
6 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
7 SECTION 1. Chapter 26.1-36.8 of the North Dakota Century Code is created and enacted
8 as follows:
9 26.1-36.8-01. Definitions.
10 As used in this chapter:
11 1. "Commissioner" means the commissioner of insurance.
12 2. "Cost-sharing" means any copayment, coinsurance, or deductible required by, or on
13 behalf of, a covered individual in order to receive a specific health care item or service
14 covered by a health benefit plan.
15 3. "Drug" has the same meaning as provided under section 19-02.1-01.
16 4. "Health benefit plan" has the same meaning as provided under section 26.1-36.3-01.
17 5. "Pre-existing condition exclusion" means a limitation or exclusion of benefits related to
18 a condition based on the fact the condition was present before the enrollment date for
19 coverage, regardless of whether any medical diagnosis, care, or treatment was
20 recommended or received before the enrollment date.
21 26.1-36.8-02. Grandfathered health benefit plans.
22 This chapter does not apply to a health benefit plan in effect on the effective date of this Act.
23 A plan granted grandfather status under this section loses this status if the plan is amended or
24 adjusted.
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1 26.1-36.8-03. Required policy provisions - Rules.
2 1. The commissioner shall adopt rules that set minimum policy coverage standards
3 applicable to a health benefit plan subject to this chapter. In addition to other
4 requirements provided by law, the standards must require a policy regulated under this
5 chapter to provide as benefits to all enrollees coverage for:
6 a. Ambulatory patient services;
7 b. Emergency services;
8 c. Hospitalization;
9 d. Maternity and newborn care;
10 e. Mental health and substance use disorder services, including behavioral health
11 treatment;
12 f. Drugs;
13 g. Rehabilitative and habilitative services and devices;
14 h. Laboratory services;
15 i. Preventative and wellness services and chronic disease management; and
16 j. Pediatric services, including oral and vision care.
17 2. A health benefit plan subject to this chapter may not establish lifetime or annual limits
18 on the dollar value of benefits described in subsection 1 for any covered individual.
19 3. A health benefit plan subject to this chapter which offers coverage for a child or
20 stepchild of a certificate holder or insured must continue to offer such coverage, at the
21 option of the policyholder or insured, until the unmarried child or stepchild reaches the
22 age of twenty-six.
23 26.1-36.8-04. Limitations on pre-existing condition exclusions for health benefit
24 plans.
25 1. A health benefit plan issuer may not impose a pre-existing condition exclusion and
26 may not deny issuing a policy to a individual on the basis of a pre-existing condition.
27 2. A health benefit plan issuer may:
28 a. Restrict enrollment in a health benefit plan to open enrollment and special
29 enrollment periods in accordance with other provisions of this chapter.
30 b. Use other alternatives approved by the commissioner to address adverse
31 selection.
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Legislative Assembly
1 26.1-36.8-05. Fairness in cost-sharing and ratemaking - Rules.
2 1. A health benefit plan issuer may not require cost-sharing in an amount greater than
3 eight thousand five hundred fifty dollars for self-only coverage and seventeen
4 thousand one hundred dollars for other than self-only coverage. By rule, the
5 commissioner may adjust this cost-sharing limit amount.
6 2. A health benefit plan subject to this chapter may charge different premium rates for
7 each individual covered by that policy; however, the premium rates may vary only in
8 relation to:
9 a. Whether the policy covers an individual or a family;
10 b. Rating area, as established pursuant to subsection 3;
11 c. Age, except that such rate may not vary by more than three to one for adults; and
12 d. Tobacco use, except that such rate may not vary by more than one and one-half
13 to one.
14 3. The commissioner may adopt rules to establish:
15 a. One or more geographic rating areas within the state and the permissible age
16 bands within which premium rates may vary; and
17 b. Minimum standards for ratemaking and cost-sharing, in accordance with
18 accepted actuarial principles and practices.
19 26.1-36.8-06. Rules - Application.
20 1. The commissioner shall adopt rules addressing any standard or practice necessary to
21 effectuate the purposes of this chapter.
22 2. Unless a rule provides a different application date, a rule adopted under this chapter
23 applies beginning six months after the date the rule becomes final.
24 26.1-36.8-07. Conflict of laws.
25 1. A health benefit plan subject to this chapter remains subject to every other
26 requirement and provision of this title which is not inconsistent with this chapter.
27 2. If a provision of this chapter conflicts with another provision of this title, the provision of
28 this chapter controls, unless the application of the other provision would result in more
29 generous coverage.
30 SECTION 2. AMENDMENT. Section 50-24.1-37 of the North Dakota Century Code is
31 amended and reenacted as follows:
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1 50-24.1-37. Medicaid expansion - Legislative management report. (Effective through
2 July 31, 2021 - Contingent repeal - See note)
3 1. The department of human services shall expand medical assistance coverage as
4 authorized by the federal Patient Protection and Affordable Care Act [Pub. L. 111-148],
5 as amended by the Health Care and Education Reconciliation Act of 2010
6 [Pub. L. 111-152] to individuals under sixty-five years of age with income below one
7 hundred thirty-eight percent of the federal poverty line published by the federal office
8 of management and budget applicable to the household size.
9 2. The department shall inform new enrollees in the medical assistance expansion
10 program that benefits may be reduced or eliminated if federal participation decreases
11 or is eliminated.
12 3. Except for pharmacy services, the department shall implement the expansion by
13 bidding through private carriers or utilizing the health insurance exchange.
14 4.3. The contract between the department and the private carrier must provide the
15 department with full access to provider reimbursement rates. The department shall
16 consider provider reimbursement rate information in selecting a private carrier under
17 this section. Before August first of each even-numbered year, the department shall
18 submit a report to the legislative management regarding provider reimbursement rates
19 under the medical assistance expansion program. This report may provide cumulative
20 data and trend data but may not disclose identifiable provider reimbursement rates.
21 5.4. Provider reimbursement rate information received by the department under this
22 section is confidential, except the department may use the reimbursement rate
23 information to prepare the report to the legislative management as required under this
24 section.
25 SECTION 3. REPEAL. Sections 40 and 41 of chapter 11 of the 2017 Session Laws are
26 repealed.
27 SECTION 4. APPLICATION. This Act applies to a health benefit plan delivered, executed,
28 issued, amended, adjusted, or renewed in this state on or after the effective date of this Act.
29 This chapter does not abridge or otherwise affect a health benefit plan already in effect at the
30 time this chapter becomes applicable until that policy is amended or adjusted.
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1 SECTION 5. CONTINGENT EFFECTIVE DATE. This Act becomes effective when the
2 insurance commissioner certifies to the legislative council that a court of competent jurisdiction
3 over the state of North Dakota has ruled all or a significant portion of the federal Patient
4 Protection and Affordable Care Act is unconstitutional and the judgment of that court has
5 become final and definitive.
Page No. 5 21.0224.01000
Statutes affected: INTRODUCED: 50-24.1-37