Overview
North Dakota is one of the few states that bans most-favored nation clauses in provider contracts. It is also one of the even fewer states that prohibits most noncompete agreements, by making them generally unenforceable. Specifically, state law provides that a contract by which anyone is restrained from exercising a lawful profession, trade, or business of any kind is void, except in the sale of a business or in dissolution of a partnership. The Supreme Court of North Dakota ruled in a 1992 case that a noncompete agreement between physicians and a group supplying emergency room physicians was void.
In provider merger review authority, North Dakota law requires notice to the attorney general for all transactions involving non-profit hospitals. However, the statute provides limited review and approval authority. In a notable antitrust enforcement challenge, the FTC and North Dakota AG sued to block the merger of Sanford Health of South Dakota and Mid Dakota of North Dakota, challenging the merger of the two hospital systems on the grounds that it would reduce competition for healthcare services in the region, resulting in higher prices and lower quality of services. The district court granted a preliminary injunction and the Eighth Circuit affirmed for the FTC and the hospitals abandoned the merger in 2019.
North Dakota law also provides coverage and reimbursement parity in telehealth services, with additional COVID-19 emergency cost-sharing requirements and coverage expansion. The state applied for and received Section 1332 waiver approval for federal pass through funding to partially finance the Reinsurance Association of North Dakota (RAND), which would reimburse insurers 75% of claims paid between $100,000 and $1,000,000.
See below for an overview of existing North Dakota state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/3/2023 - 4/28/2023 (2023 term. Note: Legislature convenes in odd number years only). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1028 – North Dakota
Introduced: 2019 Status: Enacted
AN ACT to create and enact chapter 26.1-36.6 and a new section to chapter 54-52.1 of the North Dakota Century Code, relating to public employees retirement system self-insurance plans for health benefits coverage; to amend …
HB 1032 – North Dakota
Introduced: 2021 Status: Enacted
AN ACT to create and enact a new chapter to title 26.1 of the North Dakota Century Code, relating to prescription drug cost transparency; to amend and reenact section 43‑15.3‑12 of the North Dakota Century …
HB 1033 – North Dakota
Introduced: 2021 Status: Enacted
AN ACT to amend and reenact section 19‑02.1‑14.3 of the North Dakota Century Code, relating to prescribing of biosimilar drugs, requires a pharmacist or a pharmacist’s designee to notify the prescribing practitioner of a substitution …
HB 1095 – North Dakota
Introduced: 2023 Status: Enacted
AN ACT to create and enact chapter 26.1-36.11 of the North Dakota Century Code, relating to the inclusion of comprehensive medication management services in health benefit plans.
HB 1106 – North Dakota
Introduced: 2019 Status: Enacted
A BILL for an Act to create and enact chapter 26.1-36.7 of the North Dakota Century Code, relating to the establishment of an invisible reinsurance pool for the individual health insurance market; to amend and …
N.D. Cent. Code § 50-24.1-13. Provider reimbursement rates: Medical Assistance for Needy Persons – North Dakota
Introduced: Status: Enacted
If sufficient general fund appropriations are available to increase provider reimbursement rates, the department shall review reimbursement rates paid to providers under this chapter and shall increase the reimbursement rates accordingly.
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N.D. Cent. Code § 50-24.1-16. Reimbursement of ambulance services: Medical Assistance for Needy Persons – North Dakota
Introduced: Status: Enacted
Medical assistance coverage must include reimbursement of ambulance services for responding to calls to assist covered individuals which do not result in transport. The reimbursement must be at a rate negotiated by the department and …
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N.D. Cent. Code § 50-24.1-24. Provider appeals — Definitions: Medical Assistance for Needy Persons – North Dakota
Introduced: Status: Enacted
A provider may request a review of denial of payment under this section by filing within thirty days of the date of the department’s denial of the claim a written notice with the department which …
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N.D. Cent. Code § 50-24.1-27. Medical assistance program management: Medical Assistance for Needy Persons – North Dakota
Introduced: Status: Enacted
Outlines the requirements that the Department of Human Services must follow for the management of the Medical Assistance Program, including procedure codes for medical assitance reimbursement, developing recommendations for mental health treatment, neonatal treatment, out-of-state …
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N.D. Cent. Code § 50-24.1-29. Insurers to provide certain information to the department of human services: Medical Assistance for Needy Persons – North Dakota
Introduced: Status: Enacted
As a condition of doing business in this state, health insurers shall provide to the department upon its request and in a manner prescribed by the department information about individuals who are eligible for medical …
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Pharm. Care Mgmt. Ass’n v. Tufte – North Dakota
District Court: District of North Dakota Status: Pending
Trade association representing pharmacy benefit managers (PBMs) brought action against North Dakota state officials in their official capacities, alleging that Employee Retirement Income Security Act …
Federal Trade Commission and State of North Dakota v. Sanford Health, Sanford Bismarck, and Mid Dakota Clinic, P.C. – North Dakota
District Court: District of North Dakota Western Division Status: Pending
On December 13, 2017, a federal judge for the U.S. District for the District of North Dakota granted the FTC a preliminary injunction to block …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
By the close of each regular legislative session, the Legislative Assembly approves North Dakota’s biennial budget, which takes effect on July 1 of that year and ends on June 30 of the following odd-numbered year. North Dakota enacted its biennial budget during the 2019 Legislative session. To view North Dakota’s Department of Health 2019-2021 spending, visit page 157 here.
KEY RESOURCES