North Dakota Gov. Kelly Armstrong signed a bill April 23 aimed at reforming the prior authorization process in the state.
The bill requires insurance plans to provide a decision within seven calendar days for nonurgent prior authorization requests and 72 hours for urgent care requests. If the payer misses decision deadlines, services are automatically considered approved.
The bill also requires that all denials must be made by a licensed physician with relevant clinical experience. It also requires that all prior authorization criteria must be posted online in plain language.
The legislation takes effect Jan. 1, 2026.
The bill was supported by Duluth, Minn.-based Essentia Health, which led a coalition of 20 healthcare and patient advocacy organizations, according to an April 24 news release from the health system.
Essentia said that prior to the passage of the legislation, North Dakota was one of the few states where there was no oversight of the prior authorization process under state law.
The health system has also been advocating reforms at the federal level. Essentia operates hospitals in Wisconsin in addition to North Dakota and Minnesota. Andy Askew, Essentia’s vice president of public policy, told Becker’s last year that any variation from state to state creates burden and cost.
