Health Care Committee

Duties and Studies

Contract with a private entity, after receiving recommendations from the Insurance Commissioner, to provide a cost-benefit analysis of every legislative measure mandating health insurance coverage of services or payment for specified providers of services, or an amendment that mandates such coverage or payment. (NDCC § 54-03-28)

(1567 § 1) Consider studying the unmet dental and oral health care needs of low-income children, Native American children, and individuals with disabilities. The study must include an overview of the dental and oral health care status of Medicaid recipients, including low-income children, Native American children, and individuals with disabilities, both on and off reservations; evaluation of the importance of receiving dental and oral health care services, the impacts and outcomes of not receiving services, general health consequences, complications, and expanded costs of future care; review of state and federal regulations, policies, and procedures limiting or perceived as limiting dentist provider enrollment in Medicaid, including impediments to enrollment, length of credentialing and recredentialing, reasons for provider termination, prior authorizations, attachments, appeals, and timely payments; availability of, and access or barriers to, complex dental services for Medicaid recipients with disabilities or dental conditions which might require anesthesia or critical care; review of Medicaid dental reimbursement rates for a selection of preventative and treatment services in this state compared to other states, private payers, and in comparison to real cost for dental teams to determine potential need to increase reimbursement rates; review of barriers and opportunities relating to expanding education for dentists and dental staff, including consideration of a new dental school in this state, long-term partnership with regional dental schools, and increased dental student residencies located in this state; consideration of the expansion or promotion of programs that offer support and resources to enable on-the-job training and apprenticeships for dental assistants, including the visibility of providing state and federal resources to support providers offering such training; consideration of expansion or creation of volunteer and charitable dental programs and nonprofit services; evaluation of ways to improve accessibility to dental and oral health care services for Medicaid recipients, including low-income children, Native American children, and individuals with disabilities, both on and off reservations; exploration of the feasibility of partnerships between state programs and tribal health organizations to enhance delivery; review of programs designed to recruit and retain dental health providers, such as loan forgiveness or incentives for dentists working in underserved communities, including tribal communities; exploration of the use of telehealth solutions to reach rural areas, including tribal communities; review of dental provider participation with dental insurers, including the percentage of dental providers in-network and out-of-network for the largest dental insurers; review of charges covered by dental benefit plans and out-of-pocket costs for dental care; review of dental program preauthorization and service coverage in adherence to clinical guidelines of the American Dental Association and the American Academy of Pediatric Dentistry; review of the provider relations program for answering questions from providers and staff, online and in-person education and training to providers and staff to promote efficiency and effectiveness; consideration of program staff credentials for appropriate oversight of clinical care for claim preauthorizations and approvals; consideration of the administrative system addressing grievances and appeals of submitted claims and preauthorizations to assess the system's responsiveness and review the ability to submit additional documentation, such as x‑rays and photos using an online portal; review of parity in the submission of claims between private offices, nonprofit dental clinics, and federally qualified health centers; consideration of the potential effects of dental Medicaid Expansion and increase in adult Medicaid-eligible enrollees on access to dental care, administrative efficiency, and participation of dentists in the Medicaid program; review of dental claims administration including the percentage of preauthorizations and denials; review of call center management including the number of calls, average hold time, and caller satisfaction; review of cases and decisions by a program administration related to audits and claims review to determine what percentage were completed with a peer review committee that includes a licensed dentist and a licensed dentist of a specialty; review the quality improvement system that assists providers in providing clinically appropriate care in accordance with the guidelines of the American Dental Association and the American Academy of Pediatric Dentistry clinical guidelines; analysis of the information required by Centers for Medicare and Medicaid Services Form 416, in compliance with Medicaid early and periodic screening, diagnostic, and treatment, including the percentage of eligible children receiving any dental service, preventative service, or sealants; analysis of provider participation and recredentialing of dental providers with Medicaid, the average benefit paid per user and beneficiary, the geographical distribution of active providers with active recipients in the state, and provider participation surveys; and a review of ambulatory surgery and hospital facility claims for dental rehabilitation procedures that require monitored anesthesia for children to compare with other medical providers providing similar same-day surgical services. The study may include a focus on solutions to identified needs including a review of scope of practice and additional providers and provider types. The study also may include broader considerations of unmet needs for dental services for all Medicaid recipients, data for those recipients, and any current plans for remediation with goals, objectives, projected costs, and implementation timetables.

(2249 § 1) Consider studying historical health care mandates. The study must include an analysis of current health care mandates, including when the mandates were enacted, the purpose, effectiveness, and present applicability; a history of health care mandates and step therapy protocol; and input from Department of Health and Human Services, the Insurance Department, the Public Employees Retirement System, insurance providers, and other stakeholders.

(2280 § 3) Consider studying the ability for health care systems and providers to submit prior authorization reviews for nonurgent and emergency health care services by secure electronic means. The study must analyze alternatives to facsimile or mail for transmitting prior authorization requests and supporting medical records. The study must include input from stakeholders, including patients, providers, and commercial insurance plans.

(2370 § 1) Study establishing reporting requirements for covered entities in North Dakota which participate in the federal drug discount program under 42 U.S.C. 256b, and how reported data could be used to develop public policy that directly benefits patients in North Dakota. The study must include consideration of the various entities participating in the drug discount program that should be required to report data to this state, including health care facilities, contract pharmacies, federally qualified health centers, drug manufacturers, pharmacy benefits managers, and health insurers; consideration of the specific data elements that each entity should be required to report; exploration of methods of reporting, compiling, and sharing the compiled data which provide the greatest benefit to patients in North Dakota; analysis of issues relating to the confidentiality and disclosure of the data; and consideration of reporting enforcement mechanisms, including civil penalties for failing to report. The study must include input from and consultation with stakeholders, including a professional association representing hospitals in North Dakota, a professional association representing pharmacies in North Dakota, a professional association representing federally qualified health centers in North Dakota, a professional association representing rural health in North Dakota, a professional association representing innovative pharmaceutical manufacturers, the Insurance Department, the Department of Health and Human Services, the State Board of Pharmacy, hospitals participating in the drug discount program, federally qualified health centers, pharmacies that have contracts with covered entities participating in the drug discount program; and health insurers.

Reports

Receive a report from the Insurance Commissioner by November 1, 2025, which compiles data submitted to the Insurance Commissioner by PERS uniform group insurance plans relating to prior authorization. (2025 Senate Bill No. 2280 § 2)

Receive report from the State Fire Marshal each interim on the State Fire Marshal's findings and any recommendation for legislation to improve the effectiveness of the law on reduced ignition propensity standards for cigarettes. (NDCC § 18‑13‑02(6))

Receive a report from the Department of Health and Human Services by November 1 of each year summarizing the number of deaths that occurred in the state caused by or related to fentanyl consumption during the preceding calendar year, including the county in which the deaths occurred and the age and gender of the deceased individuals. (NDCC § 19-03.1-23.5)

Receive report from the Department of Health and Human Services before June 1 of each even-numbered year, regarding progress made toward the recommendations provided in Section 23-43-04 and any recommendations for future legislation. (NDCC § 23‑43‑04)

Receive an annual report from the Maternal Mortality Review Committee regarding the identification of patterns, trends, and policy issues related to maternal mortality. (NDCC § 23-51-08)

Receive a report from the North Dakota Legislative Health Care Task Force by October 1 of each year on its activities and any recommendations to improve health care in the state. (NDCC § 50-06-45)