66th Legislative Assembly Roundup
On Friday, April 26, the 66th Legislative Assembly officially adjourned on the 76th day of the session, exiting the Capitol four days prior to the 80-day limit. Throughout the session, NDMA monitored over 150 bills that had the potential to impact physician practices and patient care.
NDMA is pleased to announce that the majority of priority bills had successful outcomes by either passing or failing:
NDMA High-priority Bills
The following NDMA high-priority bills successfully PASSED and will go into effect on August 1st. However, bills passed with an emergency clause go into effect immediately following the governor’s signature.
- Medicaid and Medicaid Expansion: SB 2012
- Passed with emergency clause.
- Medicaid Expansion rates remain the same (current rates)
- Medical Inflator for providers impacted by fee schedules (PPS/Physicians)
- 2% increase July 2019
- 2.5% increase July 2020
- UND School of Medicine and Health Sciences: HB 1003
- Passed with emergency clause.
- Includes the UND SMHS needs-based budget intact.
- Current residencies funded in the base budget.
- Interstate Medical Licensure Compact: SB 2173
- Expedites licensure for physicians. North Dakota now joins 28 other states for expedited licensure and renewal.
- Sports Team Physician Licensure: SB 2059
- Allows an exemption from licensure for sports team physicians traveling with their sports team to North Dakota.
- Maintenance of Certification: HB 1433
- Passed unanimously carrying with it an emergency clause.
- A physician may not be denied staff privileges or employment by a facility based solely on the physician's decision to not participate in maintenance of certification.
- Includes exemptions for health care facilities and does not require a new vote by the medical staff.
- Health care insurers may not deny reimbursement to or prevent a physician from being a preferred provider based solely on a physician's decision to not participate in maintenance of certification.
- Family Planning Nurse Dispensing: SB 2155
- Passed with emergency clause.
- Amends the dispensing law to allow family planning nurses to dispense birth control to family planning patients in rural clinics pursuant to provider order.
The following NDMA priority bill was successfully DEFEATED, which prevents WSI from implementing day limits on medications:
- WSI Prescribing: HB 1063 – Bill Status: FAILED.
- Filed by Workforce Safety Insurance (WSI) to place day limits on opioid, benzodiazepine, and muscle relaxant prescribing.
- Physician Assistants: HB 1175 - Bill Status: PASSED.
- Removes the supervisory agreement requirement for physician assistants.
- Includes a prohibition on practicing in their own clinics.
Although the ND Board of Medicine supported this bill, NDMA held a neutral position.
- Pharmacist Administration of Drugs: HB 1498 – Bill Status: PASSED.
- Expands the right of the pharmacist to give oral medication upon the order of a provider.
- BOM Approval of Pharmacy Collaboration Agreements: HB 2231 – Bill Status: PASSED
- Removes the requirement that pharmacy/physician collaboration agreements be approved by the ND Board of Medicine and the ND Pharmacy Board.
- Telemedicine: SB 2094 – Bill Status – PASSED.
- Filed by the ND Board of Medicine, this bill sets requirements for establishing the patient/physician relationship.
- Amended in the Senate to remove the video requirement for establishing a patient/physician relationship.
- AARP–Caregiver: SB 2154 – Bill Status: PASSED.
- AARP has lobbied multiple times in North Dakota and other states for passage of the CARE Act, which requires hospitals to train lay caregivers for after-care tasks required for a patient being discharged to home.
- NDHA and AARP worked collaboratively on amendments resulting on successful outcomes.
- Infertility Coverage: SB 2233 – Bill Status: FAILED.
- Proposed to provide an insurance mandate of coverage for infertility treatment.
- Prior Authorization: SB 2243 – Bill Status: PASSED.
- Places limited prior authorization on extremely high prescribers for adult ADHD medications under Medicaid.
- NDMA testified against the bill, resulting in a compromised amendment to prior authorize only prescribers who prescribe at a rate two times higher than the rate of the top ten prescribers, for patients 21 years of age and older.
- The exemption excludes the top prescriber and contains a clause stating that restrictions do not apply if prior authorization is required by the CMS.
- Step Therapy:
- HB 1469 – Bill Status: PASSED.
- Prohibits a payor from imposing step therapy when it relates to a recommended prescription drug for treatment of metastatic cancer.
- SB 2290 – Bill Status: FAILED.
- Proposed to allow Medicaid to use step therapy similar to the Medicare part B proposal on the federal level, if adopted by CMS.
- Proposed to remove antineoplastic agents for treatment of cancer from the prior authorization exemption list.
- HB 1469 – Bill Status: PASSED.
- Invisible Reinsurance Pool: HB 1106 – Bill Status: PASSED with emergency clause.
- Filed by the ND Insurance Department relating to the establishment of an invisible reinsurance pool. A study conducted shows this would reduce premiums and provide a low-cost alternative for healthier individuals. This would result in more individuals with health insurance and a more stable individual market, protecting carriers from unpredictable high cost claims. The reinsurance pool is funded by a combination of federal funds and assessments. The assessments will be placed on insurance companies selling in the state’s health insurance market.
- Panel Review of Drug-related Deaths: SB 2196 – Bill Status: PASSED.
- Establishes a Drug Fatalities Review Panel: UND School of Medicine and Health Sciences Forensic Pathology Department will appoint individuals to serve as members on the panel. The panel will review deaths of individuals identified as prescription drug, illicit drug, or alcohol overdoses or deaths that pertain to a trend or pattern of deaths identified as drug or alcohol overdoses.
- Abortion Bills: Bill Status: PASSED.
A total of ten bills had the ability to impact North Dakota’s present marijuana laws. Since the initial medical marijuana law was passed by a vote of the people in 2016, a two-thirds majority vote of both the Senate and House is required to pass bills and implement changes to this law. In addition, most of the bills carried emergency clauses, making them effective immediately once passed and signed.
The following medical marijuana bills PASSED:
- Pharmacy Code Changes: HB 1113
- Updates pharmacy codes to the North Dakota Century Code definitions for medical marijuana and provides exemptions: Marijuana includes cannabis sativa L. and resins extracted from any part of the plant; The term marijuana does not include hemp as defined in section 4.1-18-01; and updates fentanyl derivatives. It also updates the definition of depressants to include cannabidiol drugs and gabapentin.
- Housekeeping: HB 1119
- This bill is a matter of housekeeping for medical marijuana by redacting social security information use and changes payment methods.
- Changes Certification Requirements and Includes Physician Assistants: HB 1283 - This bill was the priority medical marijuana bill for NDMA:
- Removes the requirement for a health care provider to state that, in their professional opinion, the patient is likely to receive a therapeutic or palliative benefit from the medical use of marijuana.
- Language has been shifted from "shall" to "may": A registered qualifying patient's certifying health care provider may notify the department in writing if the health care provider's registered qualifying patient no longer has a debilitating medical condition.
- In lieu of a written certification, a veteran receiving treatment from a federal VA entity may submit a copy of their medical records.
- Physician assistants have been added to the definition of health care provider, allowing a physician assistant to complete a written certification.
- Includes a disclosure that mentions possession of a firearm by a person who possesses marijuana may be in violation of federal law.
- Enhanced Amounts: HB 1417
- Allows an enhanced amount for patients with cancer.
- Also includes some of the same components of HB 1283: removes the professional opinion requirement; language shift from “shall” to “may”; adds physician assistants to the definition of health care provider.
- Expansion of Manufacturing and Grower Facilities: SB 2210
- For medical marijuana growers, the original law was too restrictive in case of crop failure. A manufacturing facility may grow more than 1,000 plants to sufficiently meet the demands of qualifying patients.
- More Conditions and a Study: HB 1519
- Adds 12 conditions to the list of debilitating medical conditions: Anorexia nervosa; Bulimia nervosa; Anxiety disorder; Tourette syndrome; Ehlers-Danlos syndrome; Endometriosis; Interstitial cystitis; Neuropathy; Migraine; Rheumatoid arthritis; Brain Injury and Autism Spectrum Disorder.
- Allows for the addition of a study for conditions
- Criminal Penalties: HB 1050
- This bill was originally proposed as a bill for placement of an individual in a drug and alcohol treatment program by the department of corrections and rehabilitation; however, after cross over, and since HB 1155 failed, some of the components of HB 1155 rolled into HB 1050.
- The passed version of this bill relates to the placement of an individual in a drug and alcohol treatment program by the department of corrections and rehabilitation; Penalties: under age 21 for ingesting, inhaling or injecting a controlled substance that is marijuana is guilty of a Class B misdemeanor; Anyone over age 21 years and over is guilty of a class A misdemeanor (excludes marijuana) over age 21 is guilty of an infraction for marijuana; Possession of marijuana of less than one-half ounce is guilty of an infraction; one-half ounce but not more than 500 grams is guilty of a class B misdemeanor.
- This also proposes that legislative management will consider a study on the implications of the potential adoption of an initiated measure allowing the use of recreational marijuana. The study must consider the potential benefits and detriments of legalizing recreational marijuana
The following medical marijuana bills FAILED:
- Grow Your Own: SB 2134
- Proposed a change related to the cultivation of medical marijuana and would allow users to grow their own.
- Addition of Naturopaths: HB 1272
- Proposed to change the definition of a health care provider by adding physician assistants and naturopaths; in addition, it included additional medical conditions.
- Massage Therapists: HB 1071
- Proposed to prohibit a massage therapist’s use of prescription medication, including medicinal marijuana products for massage therapy.
- Criminal Penalties: HB 1155
- Proposed to change penalties for illegal marijuana use, possession, sale and distribution of marijuana. It reduces some penalties and increases some penalties, particularly for the sale of marijuana to a recipient lacking mental capacity or if the recipient is under age 21.
- Exemption for Possession of Firearms for Medical Marijuana Card Holders: HB 1148
- Edibles: HB 1364
- Proposed to add edibles to the existing medical marijuana laws.
Behavioral Health and Substance Use Disorder
The following items were added into the Human Services Budget bill SB 2012: Bill Status: PASSED
- Adds peer support certification – needed to ensure quality and effective services are provided.
- Expands Free Through Recovery to individuals NOT in the criminal justice system or DOCR custody.
- Creates a mental health voucher program addressing system gaps for young adults between 17-25 with a serious mental illness.
- Continues the work started during last session – developing infrastructure for school to address behavioral health. This funding continues Simle Middle School and expands to include a rural and tribal school next biennium.
- Expands the providers that can provide targeted case management to private providers. Currently tribes and human service centers are approved providers.
- Directs the department to include withdrawal management as a covered service under the Medicaid state plan.
- Continues the Human Services Research Institute (HSRI) recommendation implementation in the state.
- Changes the Substance Use Disorder Voucher system to include age 14.
- Includes Trauma Training funding.
- Includes Prevention and Early Intervention funding.
The following tobacco bills PASSED:
- Study on Impact of Excise Tax Increase on Tobacco: HB 2355
- Initial proposal was to implement a tobacco tax increase; however, this was reduced to a study on the excise tax on liquid nicotine and electronic smoking devices.
- Prohibiting Sale of Flavored e-Liquid to Minors: HB 1477
- Changes the penalty from an infraction to a class B misdemeanor for any person selling or furnishing or procuring for a minor, cigarettes, cigarette papers, cigars, snuff, tobacco in any other form, including electronic smoking devices. In addition selling flavored e-liquid or electronic smoking devices containing flavored e-liquid to minor is subject to a fine of $500 for each individual package of flavored e-liquid product or device sold or offered for sale; a Class B misdemeanor allows a maximum penalty of thirty days imprisonment, a maximum of $1,500, or both may be imposed; an infraction included a maximum fine of $1,000.
The following tobacco bills FAILED:
- Tax on Electronic Smoking Devices: HB 1386
- Proposed to implement taxing of electronic smoking devices; and to provide a penalty.
- Smoking in a Motor Vehicle: HB 1274
- Proposed to prohibit smoking in a motor vehicle with child present.
- Tobacco Use Under Nineteen Years of Age: HB 1236
- Proposed to prohibit an individual under nineteen years of age from purchasing and using tobacco; and to provide a penalty.
- Ingredient Labeling of Nicotine Containers: HB 1446
- Proposed to regulate ingredient labelling on nicotine liquid containers; and to provide a penalty.
- Increase in Tobacco Tax: HB 1450
- Proposed to increase the tobacco products tax rate for cigarettes.
For questions contact NDMA Executive Director Courtney Koebele at 701-223-9475 or email at firstname.lastname@example.org.