April 26, 2025

North Dakota Enacts New Law to Streamline Prior Authorizations

Community Resource Consultants Inc. (CRCI)

Community Resource Consultants Inc. (CRCI) is a Michigan-based organization specializing in trauma rehabilitation medical case management. With over 34 years of experience, CRCI is dedicated to empowering survivors of catastrophic auto accidents to regain control of their lives and achieve both physical and emotional well-being. Their team of Licensed Master Social Workers (LMSWs) and Registered Nurses (RNs) are experts in navigating the complexities of today’s healthcare system, ensuring that survivors receive the necessary services for their recovery and rehabilitation. CRCI’s core values include advocacy, people, knowledge, and dependability, reflecting their commitment to being leading advocates and facilitators of long-term collaborative care.

News Summary

Governor Kelly Armstrong has signed Senate Bill 2280 into law, aiming to improve the prior authorization process in North Dakota. The legislation sets clear timelines for insurance companies to respond to requests, with potential automatic approval for delays. It mandates that a licensed physician reviews denied cases, enhancing the decision-making process. While the law has significant support, there are concerns about the impact on insurance costs. This reform is expected to lead to a more efficient healthcare system for residents, with implementation set for January 1, 2026.

Exciting News for Patients: New Law on Prior Authorizations Signed!

In an exciting development for healthcare in North Dakota, Governor Kelly Armstrong officially signed Senate Bill 2280 on April 23, 2024. This newly minted law is all about improving the often frustrating and slow prior authorization process for various health services such as imaging, medications, and surgeries. With this legislation, many residents are hoping for a smoother healthcare experience.

What’s the Deal with Prior Authorization?

So, what exactly is prior authorization? It’s a requirement that many insurance companies impose, meaning that a healthcare provider must get approval from the insurance company before you can receive certain treatments, prescriptions, or services. It’s especially tricky because if you don’t get this approval, you might have to cough up the costs yourself unless it’s an emergency situation. While getting prior authorization doesn’t guarantee payment, it can increase the chances that your health plan will cover the service you need.

Timelines and Deadlines: What to Expect

The new law sets clear deadlines for how long insurance companies can take to make their decisions regarding these prior authorization requests. For non-urgent matters, they now have seven days to respond, while urgent requests must be answered within 72 hours. If an insurance provider doesn’t meet these deadlines, it’s as if the request has been approved automatically. This is a huge step toward reducing the lengthy wait times that have plagued many patients trying to get essential care.

Getting a Fair Hearing

But that’s not all! When a prior authorization request is denied, it’s now completely required that a licensed physician – someone who has experience with the specific medical condition – reviews the case. This means that decisions are made by qualified individuals rather than artificial intelligence algorithms or non-medical insurance employees. This aspect of the law reflects a growing concern about how decisions made by AI and non-medical personnel might be affecting patient outcomes.

Support and Backlash

The overwhelming support for Senate Bill 2280 can be seen in how it passed unanimously in the North Dakota House and nearly unanimously in the Senate. The bill enjoyed the backing of the North Dakota Hospital Association along with a coalition of about 20 health care and patient advocacy organizations. However, it did not come without its critics. Insurance companies expressed concerns that the new law might lead to increased costs, which could then affect the premiums that consumers pay.

Why This Matters

In a world where healthcare decisions often get bogged down by red tape and delays, this law could bring much-needed relief. According to the American Medical Association, a striking 83% of prior authorization requests that were denied in 2022 ended up being overturned upon appeal. This means that countless patients are facing delays, particularly for essential services such as MRIs, surgeries, and chemotherapy treatments. Some doctors reported spending upwards of 14 hours a week justifying medical decisions to insurance companies, which indicates a significant strain on medical professionals and, by extension, their patients.

Looking Ahead

The legislation is set to take effect on January 1, 2026, giving insurance companies time to adapt to these new requirements. It’s part of a broader movement where health experts across the nation are scrutinizing how insurance companies use technology in decision-making. This will hopefully lead to a better healthcare experience for everyone involved.

While healthcare reforms can be a complex topic, they are ultimately about improving patient care and providing timely access to necessary services. With this new law, North Dakotans can look forward to a healthcare system that respects their time and their health. Here’s to making healthcare a bit more user-friendly!