67th Legislative Assembly in Action Past Week Activity

67th Legislative Assembly in Action Past Week Activity

QUICK LINK REFERENCE:

JANUARY 11 - 15

JANUARY 18 - 22

JANUARY 25 - 29

FEBRUARY 1 - 5

FEBRUARY 8 - 12

FEBRUARY 15 - 19

FEBRUARY 22 - 26 - CROSSOVER

MARCH 8 - 12

MARCH 15 - 19

MARCH 22 - 26

MARCH 29 - APRIL 2

APRIL 5 - 9

APRIL 12 - 16

APRIL 19 - 23

April 26 - 30

NDMA Legislative Highlights

 

Week of April 26-30


The week lingered on with a few outstanding bills. The predicted session adjournment seems to keep slipping into one more day and most likely - by the time you read this - the session will have come to adjournment.
 

HB 1465 - an interesting turn of events:


HB 1465 - a bill that initially came in the form of "freedom of choice for health care services" - which was amended to a study, then passed the House.

After the bill was returned to the Senate, a conference committee was appointed and the outcome included additional riders that had nothing to do with the initial intent of this bill.

The first amendment was spearheaded by the North Dakota Insurance Department, claiming telehealth language adjustments were needed to safeguard services pending the Centers for Disease Control and Prevention lifts COVID-19 emergency measures. The additions were minor by simply adding definitions, which do not impact how North Dakota law currently oversees telehealth services. Overall, the amendments have no real benefit, but also do not hinder existing telehealth services.

The second amendment, which came as a surprise - was a section dealing with vaccine passports - legislation that prohibits a state government entity or subdivisions from requiring documentation of vaccine status. In addition, it prohibits private businesses from requiring a patron or customer to provide any documentation certifying vaccination.

There are exemptions. The amendment does not apply to a health care provider, including a long-term care provider. The good news is that this amendment is not applicable during a public health disaster or emergency and applies only to a vaccination authorized by the Federal Food and Drug Administration in an emergency use authorization. The bill passed both houses with an emergency clause, meaning it goes into effect immediately after being filed with the secretary of state.
 

Click here to see the complete list of bills tracked by NDMA.

Successful Finishes

NDMA Executive Director Courtney Koebele was asked to participate in the Governor's bill signing of HB 1175

HB 1175 is good for physicians and healthcare systems by providing protections for our health care workforce by reducing unreasonable liability exposure, as current liability standards do not adequately contemplate the extreme circumstances under which care was being provided during the pandemic.


HB 1205 - as it relates to establishing a state funded maternal mortality committee - was given a photo finish with Governor Doug Burgum as the bill is signed into law. Seated to the left of Governor Burgum is Dr. Tom Arnold, who provided compelling testimony to support the bill's passage. 

HB 1205 Maternal Mortality Review Committee (MMCR): North Dakota’s maternal mortality review committee has been conducted by the ND Society OBGYN since 1954. For better communication with CDC, other states, and immunity protections, MMRC is going into statute and housed with the UNDSMHS OB/GYN department. 

 

WEEK OF APRIL 19-23

As the legislative races towards the finish line, issues become more intense. Health care showed some successes as well as some challenges:

HB 1465

HB 1465 - a bill relating to freedom of choice for health care services was amended to a study then passed the House (YEAS 91, NAYS 2).

An interim study will help provide more information on whether the option of patient choice for care can benefit patients, health care providers and the impact on insurance providers.

The study will include:

  • Consideration of the use and regulation of broad and narrow networks in the state by individuals and employers, the sales and marketing of broad and narrow networks, opportunities for consumer choice-of-provider, and premium differentials among states with choice-of-provider laws;
  • A review of legislative and court history regarding the impact of choice-of-provider laws on exclusive provider organizations and preferred provider organizations and how choice-of-provider laws apply to risk-pooled health plans regulated by the federal Employee Retirement Income Security Act of 1974;
  • A comparison of health maintenance organizations provider network designs and other health insurer provider network designs;
  • A review of how vertical integrated networks utilize HMO plans; and
  • A comparison of premiums of health benefit plans offered in the individual and small group markets in relation to the provider network design associated with those plans along with the growth of value-based purchasing.

SB 2124

SB 2124 - this bill took a sudden turn and was amended with a focus on prohibiting vaccine passports. Other portions of the bill - which limited the governor's authority during a declared emergency - were duplicative efforts to another bill HB 1118. This bill was successfully defeated in the Senate (YEAS 10, NAYS 36).

VACCINE PROHIBITION: DELAYED BILL REQUEST - another proposal that focused on vaccine prohibitions was brought to the House floor by Representative Ertelt. Since this proposal missed the deadline for submitting bills, it required a 2/3s floor vote to be brought forward for a hearing. This proposal was successfully defeated on the House floor (YEAS 40, NAYS 53).

SB 1298

SB 1298 - this bill would have prevented anyone under the age of 18 from playing on a gendered sports team that doesn’t match their original birth certificate. The bill passed both the House and Senate but was VETOED by Governor Burgum. Since the bill was VETOED, it required a 2/3s vote to become law. The bill passed the House floor, but was defeated on the Senate floor and will no longer be enacted into law (YEAS 28, NAYS 19).

“To date, there has not been a single recorded incident of a transgender girl attempting to play on a North Dakota girls’ team,” Burgum said.

HB 1323

HB 1323 which strips the Governor and State Health Officer's authority to implement a state-level health intervention mask directive, was amended and passed. The amendment allows local governments, schools and businesses to implement a mask order; but the statewide health authority is no longer allowed.

Last week, the amended bill passed both the Senate and House; then was VETOED by Governor Burgum. Thursday's floor votes required a 2/3s vote to kill the veto; however the veto was overridden by both the Senate (YEAS 32, NAYS 15) and the House (YEAS 66, NAYS 27).

 

Week of April 12-16

As the legislative session rounds the bend to the finish line, many priority bills continue to be debated heavily in conference committees. This 67th legislative session - let's call it the COVID-19 challenge session - has resulted in outcomes that can represent challenges to health care.

HB 1323

HB 1323 which strips the Governor and State Health Officer's authority to implement a state-level health intervention mask directive, was amended and passed. The amendment allows local governments, schools and businesses to implement a mask order; but the statewide health authority is no longer allowed. Last week, the amended bill passed the Senate floor (yeas 30, nays 17);  this week, the bill in its amended state, passed the House floor (yeas 67, nays 24).

WHAT'S NEXT

The governor does have veto authority, but a veto can be over ridden with a  2/3s majority vote of both houses. To encourage a veto, NDMA, along with the North Dakota Hospital Association, and the North Dakota Long Term Care Association, submitted an appeal to Governor Burgum encouraging a VETO.

The letter states HB 1323 puts politics before health. Therefore, the undersigned ask to VETO the passage of this bill to safeguard public health protections.

The governor and state health officer should have the authority to safeguard public health. Without this authority lives are at risk, if not in the pandemic we are still fighting, but future pandemics.

 

HB 1175

HB 1175 The big win for this week was the final passage of HB 1175 - the COIVD-19 Liability Protection bill, relating to business immunity from COVID-19 liability claims.

The bill pushed its way through a conference committee with an amendment that removed the sunset clause, which is an improvement for liability protections. The final bill passed the House (yeas 79, nays 15); and passed the Senate (yeas 40, nays 7). 

HB 1175 is good for physicians and healthcare systems by providing protections for our health care workforce by reducing unreasonable liability exposure, as current liability standards do not adequately contemplate the extreme circumstances under which care was being provided during the pandemic.
 

HB 1418

HB 1418 Relating to qualifications of the state health officer; this bill requires the health officer to be a physician. In February, this bill passed the House (yeas 87, nays 7); the bill passed the Senate on April 14 (yeas 47, nays 0). The bill is now pending the governor's signature.
 

HB 1247

HB 1247 Relating to merging of the state department of health and the department of human services. Although NDMA holds a neutral position on this bill, it is being watched closely, as it does alter the state health officer's authority. This bill passed the House in February (yeas 73, nays 21); and passed the Senate on Thursday, April 15 (yeas 24, nays 28). At this point we are not sure if it will be reconsidered. We will keep you posted.
 

Week of April 5 - 9

This week was another aggressive week on the hill as several priority bills endured some serious challenges:
 

SB 2179

SB 2179 Relating to parity health insurance coverage for telehealth services. The bill was amended by the House - thanks to Representative Greg Westlind (R - Dist. 15), who carried the load in defense of payment parity.

The amendment included payment parity for a two-year period study to see how parity would impact health insurers and extend access to health care.

Representative Westlind introduced the bill to the floor saying that telehealth payment parity is vital for the survival of smaller, rural health care facilities.

An unexpected turn of events occurred when a fiscal note was introduced to the floor, which showed a North Dakota Public Employees Health Plan (NDPERS) financial impact of $2.4 million in additional health care costs to implement payment parity.

This surprise note caused many who were initially in support of the bill to abruptly change direction and vote against it. This bill was defeated on the House floor (YEAS 29, NAYS 64).
 

Take a moment to send a quick "thank you" to Representative Greg Westlind for giving 100% to telemedicine parity.


Representative Greg Westlind
 

Expressing your appreciation is a good gesture and helps cement relationships in place for future causes.


HB 1323

Another bill - HB 1323 which strips state-level government’s public health intervention authority to implement a mask directive, was amended and passed. The amendment allows local governments, schools and businesses to implement a mask order; but the statewide health authority - the Governor and State Health Officer - will no longer be allowed to implement a mask order. The bill passed the Senate floor (YEAS 30, NAYS 17).

The bill needs to be concurred by the House, and the amendment is expected to hold through the committee negotiations.

The governor does have veto authority, but a veto can be over ridden with a  2/3s majority vote.

HB 1465

HB 1465 Relating to freedom of choice for health care services was amended into a study by the Senate. The intent of the bill was to expand patients’ abilities to choose their own health care provider. The study will focus on broad and narrow networks in the state by individuals and employers, the sales and marketing of broad and narrow networks, consumer choice-of-provider implications, and premium differentials offered between broad and narrow networks. This amended bill passed the SENATE floor (YEAS 29, NAYS 17). Since the bill was amended by the Senate, it will need concurrence from the House for final passage and will most likely be headed into the conference committee for further debate. Hang tight for more information.

 

Week of March 29 - April 2


It was a high-intensity week on the hill as several priority bills push towards the finish line.

SB 2274 - which expands the scope of practice for naturopaths was heard on the floor on Wednesday. With the help of good interventional legislators, this bill was SUCCESSFULLY DEFEATED, although the vote was close with 50 YEAS and 43 NAYS.

CHAMPIONS for defeating this bill include House legislators:


 Mike Schatz (Dist. 36)


Todd Porter (Dist. 34)


Karen Karls (Dist. 35)
 
Take a moment to click on each of the legislators links and send a quick "thank you."
 
Expressing your appreciation is a good gesture and helps cement relationships in place for future causes.

The following displays a tally of how each house legislator voted. IF YOUR LEGISLATOR VOTED TO DEFEAT THIS BILL by giving the bill a NAY - A DO NOT PASS VOTE - REACH OUT WITH THANKS.

Legislators who voted AGAINST physicians, by casting a YES or YEA vote are also listed:

 

 

Find Your Legislator

It's easy to find out who your legislators are and how to contact them: use this link here - enter your house number and zip code; then choose your address; this directs you to your district legislators. Contact information is displayed by clicking into the underscored names.

More Success

HB 1205 Maternal Mortality Review Committee: North Dakota’s maternal mortality review committee has been conducted by the ND Society OBGYN since 1954. For better communication with CDC, other states, and immunity protections, MMRC is going into statute and housed with the UNDSMHS OB/GYN department. UPDATE: this bill successfully PASSED the SENATE floor on Friday, March 26 with no opposition (YEAS 47, NAYS 0). This means the bill becomes law on August 1.

Week of March 22 - 26

SB 2205 Relating to Medicaid medical assistance coverage of interpreter services UPDATE: The Human Services Committee reported back with a DO NOT PASS, which also led to the bill failing on the floor on March 25; the achillies' heel to this bill was the $499,200 fiscal note, which legislators felt was not fitting within budgets. The ND Dept. of Human Services estimated that approximately 1% or about 768 recipients of the Traditional Medicaid population could potentially need interpreter services at a minimum of ten occurrences over the course of a biennium at an estimated rate of $65 per hour; half of the funds were slated to come from the general fund and the remaining 50% would have been from the federal Medicaid program.

SB 2334 Licensure of extended stay centers successfully PASSED on 3/24 (YEAS 89, NAYS 4)

HB 1420 Relating to the personal use of marijuana - the intent of this bill was to avoid an initiated measure on personal use. However the bill FAILED on the Senate floor 3/25 (YEAS 10, NAYS 37)

COMMITTEE HEARINGS AND COMMITTEE WORK
HB 1465 Relating to freedom of choice for health care services - this bill is still being worked in committee.

SB 2179 Relating to health insurance coverage of telehealth study. UPDATE: this bill has good news - it was amended and successfully passed out of the House Human Services committee (YEAS 9, NAYS 5); the amendment includes payment parity for a two-year period. This two-year window of payment parity will be used as a study to see how payment parity will impact health insurers and extend access to health care, particularly in rural areas. To pass and become law, the bill needs to pass the House floor.

HB 1205 Maternal Mortality Review Committee: North Dakota’s maternal mortality review committee has been conducted by the ND Society OBGYN since 1954. For better communication with CDC, other states, and immunity protections, MMRC is going into statute and housed with the UNDSMHS OB/GYN department. UPDATE: on 3/24 the Senate Human Services gave this bill a DO PASS recommendation (YEAS 6, NAYS 0); the amendment was passed on 3/25 and the bill is now waiting for a floor vote. NDMA is not expecting any major opposition.

Week of March 15-19

The big win for this week was the passage of HB 1175 - the COIVD-19 Liability Protection bill, relating to business immunity from COVID-19 liability claims.

It took a great deal of effort but the bill successfully passed the Senate on Wednesday with 41 YEAS and 6 NAYS. Because of an amendment, the bill will need to go into a review committee but we are not anticipating any objection to the changes.

HB 1175 is good for physicians and healthcare systems by providing protections for our health care workforce by reducing unreasonable liability exposure, as current liability standards do not adequately contemplate the extreme circumstances under which clinical care was being provided during the pandemic.
 

Thank you to everyone who reached out to legislators asking for a "do pass" vote.


Other priority bills being debated

This week has been busy with many hearings on priority bills. It is important to know that when a committee makes a vote recommendation, the floor vote does not always follow suit. For this reason, it is always good to educate your legislators on issues that make a difference in your practice.

The following are waiting for committee action:
SB 2205 Relating to Medicaid medical assistance coverage of interpreter services.
HB 1465 Relating to freedom of choice for health care services.
SB 2179 Relating to health insurance coverage of telehealth study and possible amendment for a pilot project.
HB 1465 Relating to freedom of choice for health care services.
The following bills have received committee action and waiting for a floor vote - NDMA supports the PASS votes on the following:
SB 2334 Relating to licensure of extended stay centers.: PASSED  House Human Services (Yeas 13, Nays 1).
HB 1205 Relating to establishing the maternal mortality review committee; PASSED Senate Human Services (Yeas 6, Nays 0).
HB 1288 Relating to Medicaid coverage of continuous glucose monitoring devices; PASSED Senate Human Services committee (Yeas 5, Nays 1).

Week of March 8-12

This week involved a great deal of heavy lifting to begin preparing for some priority issues that are sure to surface for a vote soon - either through committees or floor sessions.

One major issue in front of us is HB 1175 - the COIVD-19 Liability Protection bill, relating to business immunity from COVID-19 liability claims.

NDMA supports HB 1175. This bill supports our health care workforce by reducing unreasonable liability exposure, as current liability standards do not adequately contemplate the extreme circumstances under which clinical care was being provided during this pandemic.
 
The COVID-19 pandemic created a public health emergency that is rapidly altering the provision of health care services across the country based on guidance and recommendations from the Centers for Disease Control and Prevention and other federal, state and local government directives. Although necessary, these measures have raised concern about the potential liability of physicians and other health care professionals who are responding to the pandemic and continue to provide high-quality patient care while adhering to these guidance and recommendations. As a result, physicians face an increased threat of medical liability lawsuits due to circumstances that are beyond their control.

Bill Action

On Wednesday, HB 1175 passed out of the Senate Industry, Business, and Labor Committee with a 5-1 DO PASS recommendation, which includes amendments.

The next step is for the full Senate to accept the amendments, then the full bill is expected to move to the Senate floor on Tuesday, March 16. 

Ask for a YES VOTE on HB 1175.

It's easy to find out who your senator is and how to contact them: use this link here - enter your house number and zip code; then choose your address; this directs you to your district legislators. Contact information is displayed by clicking into the underscored names. NOTE: YOU ONLY NEED TO CONTACT YOUR SENATOR, SINCE THIS IS BEING VOTED ON IN THE SENATE.
 

Call to Action for SB 2205 - Coverage for Interpreter Services

On Wednesday, the House Human Services Committee heard testimony for SB 2205; this bill would allow medical assistance coverage for interpreter services, including Medicaid Expansion and would include for payment for sign and oral language interpreter services for assistance in providing covered health care services to a recipient of medical assistance who has limited English proficiency or who has hearing loss and uses interpreting services.

Bill Action

The committee was not very responsive to this bill; therefore, NDMA is asking you to reach out to the House Human Service Committee members this week to ENCOURAGE A DO PASS RECOMMENDATION VOTE FOR COVERAGE.

How to contact the House Human Services Committee: Click here to find the complete listing. Individual email addresses can be found by clicking into each member's profile information.

Week of February 22-26

February 26 marks the official crossover date and although it's hard to believe that we are at the half way point for the 67th Legislative session, we still have much to do.

To summarize the workload, NDMA is tracking 192 bills. Crossover resulted in 53 bills failing and 4 withdrawn for further consideration. This narrows the tracking list by 30 percent - 135 bills - leaving a heavy lift for the second half of the session. The session will reconvene on Wednesday, March 3rd.

Some priority bills on the floor for the final crossover week were as follows:
 

HB 1012 A bill for an Act to provide an appropriation for defraying the expenses of the department of human services as it relates to Medicaid expansion and Medicaid reimbursement.


The Governor’s budget recommendation proposed to transition Medicaid from a managed care program with commercial rates into the traditional Medicaid program. However, the legislature declined the Governor’s recommendation, reauthorizing it for two more years at commercial rates. The only compromise was to remove the nineteen and twenty year-olds from Medicaid expansion and placed them in traditional Medicaid.

The House passed HB 1012 as amended (73 yeas, 21 nays). Overall, there are no decreases to reimbursement expansion rates or funding of the program. The focus now shifts to the Senate regarding the Department of Human Services budget.

The House version of HB 1012 contained 1% x 1% inflators. This means any fee schedule reimbursement will be increased by 1% in July 2021 and July 2022, with an impact to Inpatient Hospital of $2.2 million, Outpatient Hospital $1.0 million and physicians $1.6 million..

NDMA SUPPORTS the Medicaid Expansion and reimbursement components of this bill, which successfully PASSED on the House floor (YEAS 73, NAYS 21).

 

Relating to Marijuana.

Recreational
As medicinal marijuana issues continue to emerge, an interesting development is a proposed bill that would legalize recreational marijuana.

HB 1420 - Use of Recreational Marijuana would legalize adult use of marijuana in North Dakota regulated through the Medical Marijuana Division of the Department of Health, which passed the House floor vote (56 yeas, 38 nays).

Proponents of the bill believe the State needs to take a pro-active approach to get ahead of a potential constitutional ballot measure that would allow home-grown marijuana and marijuana use in public settings. By approving an accepted recreational use approach, it is possible to resist a ballot measure. Here are some limitations to the proposed bill:
  • Adult use only - age 21 and over.
  • May only be used in a private home and not in the presence of minors.
  • Home growing is prohibited - only available through licensed growing/manufacturing facilities.
  • Products can only be purchased from licensed dispensaries regulated through the Medical Marijuana division.
  • Products consist of capsules, solutions, topicals, edibles, concentrates, leaves & flowers that are tested for THC quantity before consistency and safety.
  • Purchase is limited to 300 milligrams of THC product every 15 days per person. Purchases are tracked so users cannot hop from dispensary to dispensary within the 15 days.
HB 1501 - Adult use marijuana tax - This is the companion bill to HB 1420 which applies a 10% tax on the sales of products from a manufacturing facility and a 15% tax on the sale of products from a dispensary. Of the 15% tax on dispensaries, 3% will go back to the political subdivision for enforcement.

NDMA is NEUTRAL on HB 1420, which PASSED on the House floor (YEAS 56, NAYS 38).

Medicinal
HB 1213 Relating to medical marijuana designated caregivers and a waiver of the criminal history check; allows for a grace period if the health care provider moves out of state for the patient to get a new one. STATUS: NEUTRAL; PASSED HOUSE (YEAS 84, NAYS 5)

HB 1359 Removes the application fee for medical marijuana designated caregivers; changes the makeup of the medical marijuana advisory board. STATUS: NEUTRAL; PASSED HOUSE (YEAS 80, NAYS 13)

HB 1391 Relating to regulating edible medical marijuana products – allows edibles that are a soft or hard lozenge. STATUS: NEUTRAL; PASSED HOUSE (YEAS 63, NAYS 31)

HB 1400 Adds to the list of debilitating medical conditions with a catch-all, allows qualifying patient applicants to submit medical records in lieu of a written certification, allows qualifying patients from other states to obtain a temporary card, and requires conducting unannounced sampling at a dispensary. STATUS: NEUTRAL; FAILED HOUSE (YEAS 16, NAYS 76)

SB 2234 Medical marijuana plants. Will allow up to 8 plants to be grown in an enclosed, locked facility, but not within 1,000 feet of a school. STATUS: NEUTRAL; FAILED SENATE (YEAS 4, NAYS 42)

SB 2284 Removes 6% THC cap on pediatric products; allows flower and concentrates not intended for inhalation for minors; caregiver is responsible for ensuring not over 6%. STATUS: OPPOSE; FAILED SENATE (YEAS 0, NAYS 47)

Illegal Use
HB 1201 Relating to violations of marijuana possession – increases the amount allowable for an infraction. STATUS: NEUTRAL; PASSED HOUSE (YEAS 58, NAYS 36)

SB 2059 Definition of marijuana and scheduling of controlled substances. Relating to the definition of marijuana and the scheduling of controlled substances, introduced at the request of the board of pharmacy. STATUS: NEUTRAL; PASSED SENATE (YEAS 47, NAYS 0)

SB 2264 Possession of marijuana by individual under twenty-one. Relating to penalties for the possession of marijuana by an individual under the age of twenty-one; and to amend and re-enact section 5-01-08 of the North Dakota Century Code, relating to prohibiting an individual under the age of twenty-one from using alcoholic beverages; and to provide a penalty. STATUS: NEUTRAL; PASSED SENATE (YEAS 46, NAYS 0)


Relating to Authority of Health Officer and Health Council.

This year's session has been particularly critical of the authority and role of the State's Health Officer, and one bill - HB1247 - proposes to merge the North Dakota Department of Health and North Dakota Human Services. This bill not only impacts the authority of the Health Officer, but also impacts the authority of the Health Council.

Following is a brief summary of some of the bills as well as one resolution:

HB 1118 Relating to the duration of a gubernatorial declaration of disaster or emergency relating to public health and extension requests; and to declare an emergency; limits to geographical area, no state-wide order without governor declaration. STATUS: NEUTRAL; PASSED HOUSE (YEAS 88, NAYS 6)

HB 1418 Relating to qualifications of the state health officer; requires health officer to be a physician. STATUS: SUPPORT; PASSED HOUSE (YEAS 87, NAYS 7)

HB 1495 Relating to the state health officer's authority and the governor's and legislative assembly's authority during a declared state of disaster or emergency; restricts health orders to no longer than thirty days; requires application to district court in judicial district; executive orders limited to thirty days and cannot exceed sixty days; governor may not suspend a regulatory statute, order or rule. STATUS: NEUTRAL; PASSED HOUSE (YEAS 75, NAYS 19)

SB 2124 Relating to permitting a virtual special session of the legislative assembly during an emergency or disaster; and to the state health officer's and governor's authority during a declared disaster or emergency; and to provide a penalty. STATUS: NEUTRAL; PASSED SENATE (YEAS 40, NAYS 7)

HB 1247 Relating to merging of the state department of health and the department of human services. STATUS: NEUTRAL; PASSED (YEAS 73, NAYS 21)

SB 2331 Requires the state health officer to be an elected position. STATUS: OPPOSE; FAILED SENATE (YEAS 3, NAYS 44)

SCR 4015 Changes the constitution to require the state health officer be an elected position. STATUS: OPPOSE; PENDING – Note that resolutions have until March 10

 

 

 

 

Week of February 15-19

It has been an aggressive week on both the House and Senate floors as legislators scramble to meet the crossover deadline of Friday, February 26th. The Senate is expected to get through bills by mid-week, with the House expecting to take the full week.

It's important to know that bills that get a PASS will transition to the next half of the second half of the session. Bills that are DEFEATED are no longer considered and are officially dead.

Although this summary is not inclusive, some of this week's priorities included:

SB 2331 Relating to election of the state health officer and human services commissioner.

NDMA opposed SB 2331 - a bill that would make the state health officer an elected position. Making the health officer position elected, rather than appointed, changes the essence of the role of a physician.

Many physicians who would be excellent health officers may not have political interests, experience or skills. Public health, like other health professions, requires a life-time commitment and focus to acquire and maintain expertise. Having to engage in the politics of elections would greatly detract from the time required to focus on the ever­changing science of public health.

Furthermore, concepts of election and constituency have the potential to sway focus away from medical expertise and best-practice.

NDMA OPPOSED this bill, which was successfully DEFEATED on the Senate floor (YEAS 3, NAYS 44).

SB 2224 Relating to medical assistance coverage of metabolic supplements.

NDMA supported HB 2224 - a bill the provides reimbursement for metabolic supplements by North Dakota Medicaid.

NDMA Executive Director Courtney Koebele serves on the the subcommittee of the Medicaid Medical Advisory Committee (MMAC), which offers recommendations for Medicaid coverage. The subcommittee established a scoring process to determine need and found that coverage for metabolic supplements scored high as they are life sustaining.

NDMA SUPPORTED this bill, which successfully PASSED on the Senate floor (YEAS 46, NAYS 1).

SB 2179 Relating to health insurance coverage of telehealth: payment parity.

NDMA along with some of its partners supported efforts for telehealth payment parity; however, because of opposition from health insurance companies as well as the North Dakota Insurance Commission, this bill was amended and reduced to a mandatory study.

Payment parity – or equal reimbursement rates - would ensure patients have increased access to timely, value-based, and integrated care, especially for rural and underserved communities throughout the state. Under current law, health plans reimburse telehealth services 20% to 40% lower than in-person services.

Although the bill was amended, NDMA SUPPORTED this bill, which PASSED on the Senate floor (YEAS 44, NAYS 3) - This provides an opportunity for NDMA and its partners to continue pushing forward by encouraging amendment action to bring it back to coverage.

SB 2284 Pediatric prescribing of medical marijuana.

Another bill successfully defeated this week was SB 2284 - a bill that would have expanded medical marijuana pediatric use to include cannabis in a combustible form.

Though anecdotal accounts have shown that certain cannabinoids could benefit children with certain chronic debilitating diseases, there are no published studies on the effects on cannabinoids on the pediatric population.

NDMA OPPOSED the bill, which was successfully defeated on the Senate floor (YEAS 0, NAYS 47).

HB 1472 Relating to unlicensed, certified or registered alternative health care practitioner: not in violation of a law for services.

Another bill successfully defeated this week was HB 1472, which would have allowed alternative medicine practitioners to engage in treatment. Alternative health care is largely based on natural products and how they interact with and heal your body. Much of alternative medicine isn’t approved by the U.S. Food and Drug Administration.

NDMA OPPOSSED the bill, which was successfully defeated on the House floor (YEAS 16, NAYS 72).

Week of February 8-12

The battle of the bills has been intense as legislators push to address the remaining bills during the next two weeks to crossover. Monday, February 15th marks the twenty-eighth day of the session leaving only 10 days of work to the February 26 crossover deadline.

Although this summary is not inclusive, some of this week's priorities included:

Tobacco bills

As in previous years, bills have come forward to increase the tobacco tax. NDMA supports efforts to increase tobacco taxes, based on the 2013 resolution that sites increasing the price of tobacco is a proven way to prevent youth tobacco initiation, encourage a reduction of adult tobacco use, reduce health care costs and provide an overall benefit to public health.

As in previous years, these bills failed to pass in spite of support from many health-related entities: NDMA, NDHA, Sanford Health and more.  

HB 1403 Relating to an increase in the tax on cigarettes; and to provide an effective date. Increase on cigarettes from seventeen to seventy-two mills. FAILED (YEAS 25, NAYS 66)

HB 1422 Relating to the tax imposed on cigarettes and tobacco products; and to provide an effective date. Increase from twenty-eight to ninety-two percent of wholesale purchase price; snuff from sixty cents to one dollar and ninety-six cents; chewing tobacco sixteen cents to fifty-two cents. Removes transfer to state general fund and creates a community health trust fund. FAILED (YEAS 33, NAYS 58)

HB 1205 Relating to establishing the maternal mortality review committee and to provide for a continuing appropriation.

HB 1205 is a priority bill for NDMA. The bill establishes a maternal mortality review committee along with an appropriation. In January, Dr. Tom Arnold of the North Dakota Maternal Mortality Review Committee (MMRC) and the Vice Chair of the University of North Dakota School of Medicine and Health Sciences Department of Obstetrics and Gynecology provided testimony in support of the bill.

Dr. Arnold testified that the existing ability of the ND MMRC to investigate the cause of these type of maternal deaths is less than optimal and outlined how the proposed changes would enhance the committee's ability to reduce future maternal mortality.

NDMA SUPPORTED this bill, which successfully PASSED on the House floor (YEAS 93, NAYS 1)

SB 2274 Relating to the scope of practice of a naturopath; authorizes naturopaths to prescribe, dispense or administer prescription drugs.

A bill that was successfully defeated in two prior legislative sessions - 2015 and 2017 - has once again surfaced for this session. The bill allows naturopaths to prescribe legend medications and testosterone.

NDMA OPPOSES the bill for the following reasons:

  • Naturopaths are not trained to prescribe medications safely and effectively. Patients can easily be misled into thinking that an ND (naturopathic doctor) license is the same as an MD, especially if naturopaths are allowed to prescribe medicine without sufficient medical training.
  • Naturopath education is fundamentally different from a NP, PA, and dentists in that they don’t follow the medical model. They use numerous unproven therapies, diagnose illnesses not accepted by the medical mainstream, and don’t have the same patient encounters in training and lack oversight. Pharmacology classes aren’t a barometer for the ability to prescribe meds.
  • Furthermore, the naturopath licensing board is not equipped to regulate prescribers. This bill would allow them to do this without supervision.

Senate legislators were met with a great deal of force from naturopaths as legislators were bombarded with email messages asking for naturopath prescribing privileges.

NDMA and many members provided testimony in OPPOSITION; however the bill PASSED on the Senate floor on Thursday, February 11th with 31 yeas and 16 nays.

SB 2284 Pediatric prescribing of medical marijuana.

Another hearing on Monday dealt with pediatric medical marijuana use. The bill is proposing to expand pediatric use to include cannabis in a combustible form. NDMA believes in using the usual Food and Drug Administration process instead of medical marijuana laws. Though anecdotal accounts have shown that certain cannabinoids could benefit children with certain chronic debilitating diseases, there are no published studies on the effects on cannabinoids on the pediatric population.

NDMA testified in OPPOSITION to the bill. The bill is still in committee.


WEEK OF FEBRUARY 1-5

Monday, February 8th marks the twenty-third day of North Dakota's 2021 67th Legislative Session leaving only 15 days of work to get to crossover, which is February 26. To make the time frame even tighter, committees have only 12 working days - until February 23 - to review and vote on the remaining bills.

The lengthy list of bills being tracked by NDMA is narrowing, as this week many of the bills being tracked had met their fate on the floor - take a look at this weeks summary:

VACCINE BILLS


If you've been following the session closely, it is obvious to see that the pandemic has brought vaccine issues into the limelight. On Thursday, February 4th, six vaccine priority bills were heard on the House floor resulting in all six bills failing.

With the exception of HB 1469, NDMA OPPOSED all vaccine bills, since many interfered with patient care and went against the standard of practice for recommending vaccines. Here is the summary:

HB 1468 Relating to informed consent and notice of risks associated with vaccines. When providing immunizations, the vaccine information statements and exemption information must be provided. Upon request, the package inserts must be provided: FAILED (YEAS 46, NAYS 47)

HB 1377 Relating to immunization exemptions. Creates vaccine safety standards at an unreasonable level; eliminates vaccine requirements for school age children and health care institutions; requires posting vaccine injuries by ND Dept. of Health: FAILED (YEAS 21, NAYS 72)

HB 1469 Relating to exemptions from vaccine requirements before admission to school. Creates an allowance to present a state dept. of health immunization exemption form and develop an online vaccination education module; rules will be adopted by the ND Health Council: FAILED (YEAS 14, NAYS 80)

HB 1306 Interrelationship between sudden infant death syndrome, vaccines, and autism. A bill to provide a legislative management study of the interrelationship between sudden infant death syndrome, vaccines, and autism spectrum disorder in children: FAILED (YEAS 11, NAYS 82)

HB 1307 A bill for an act to prohibit public accommodations from refusing services to an individual because the individual has not been vaccinated; and to provide a penalty. Public accommodation may not refuse service for failure to vaccinate: FAILED (YEAS 24, NAYS 68)

HB 1320 Relating to limitations on vaccinations requirements. A state or local elected official, the state, or a political subdivision of the state may not mandate an individual in this state receive a vaccination including for school or daycare: FAILED (YEAS 8, NAYS 84)

Many of the vaccine bills opposed by NDMA would not make good policy for these reasons:
  • Bills dictated how healthcare providers must practice and is an overreach of government into the practice of medicine.
  • Healthcare providers recommend vaccines for patients; they do not force patients to be vaccinated.
  • The federal government already requires informed consent for vaccination through the use of the Vaccine Information Statement.
  • Package inserts are readily available online, yet many providers will provide the package insert, when asked, without hesitation. Requiring healthcare providers to provide them to patients who request them is not needed.
  • Requiring healthcare providers to mention exemptions goes against the standard of practice for recommending vaccines.
  • Certain vaccines are recommended for pregnant women. The safety of vaccines during pregnancy has been studied.
 

SB 2274 RELATING TO THE SCOPE OF PRACTICE OF A NATUROPATH; AUTHORIZES NATUROPATHS TO PRESCRIBE, DISPENSE OR ADMINISTER PRESCRIPTION DRUGS.

Monday kept NDMA juggling between hearings. SB 2274 - which would allow naturopaths to prescribe prescription drugs - was met with a great deal of testimony both in support and opposition.

NDMA spoke in opposition of SB 2274.

In addition to NDMA Executive Director Courtney Koebele providing testimony, NDMA Members present and providing opposition testimony were Dr. Parag Kumar, Dr. Gabriela Balf-Soran, and Dr. Michael Quast.

NDMA supports licensure of professions within the scope of their training and to do so otherwise endangers the safety of patients. NDMA takes the position that naturopaths are not adequately trained to prescribe.

ACTION: URGE A DO NOT PASS

This bill is still in committee - NDMA urges you to contact the Senate Human Services Committee and request a DO NOT PASS. You can find contact information here.

SB 2334 RELATING TO THE LICENSURE OF EXTENDED STAY CENTERS.

As surgical techniques improve, surgery centers move toward increasingly complex procedures in patients that require longer recovery times. This bill allows surgery centers to keep patients for up to 48 hours.

There is a continuing trend shifting from inpatient to outpatient procedures, and the extended care center model allows for parallel care in a safe setting.

NDMA provided testimony and SUPPORTED this bill, which successfully PASSED on the Senate floor on Thursday, February 4 with 44 yeas, and 3 nays.

HB 1415 RELATING TO END-OF-LIFE HEALTH CARE DECISIONS; AND TO PROVIDE A PENALTY. 

Another hearing on Monday dealt with physician assisted suicide. In 2017, the NDMA House of Delegates adopted a resolution formally adopting the position against physician-assisted suicide and euthanasia stating this act is fundamentally incompatible with the physician’s role as healer.

In adopting this position, NDMA determined that allowing physicians to engage in either would ultimately cause more harm than good, sending a message that suicide or euthanasia is a socially acceptable response to aging, terminal illness, disabilities, depression, and financial burdens.

NDMA testified in OPPOSITION to the bill. The bill is still in committee.

HB 1472 RELATING TO COMPLEMENTARY AND ALTERNATIVE HEALTH CARE; A NOT LICENSED, CERTIFIED OR REGISTERED AS A HEALTH CARE PROFESSIONAL OR PRACTITIONER IS NOT IN VIOLATION OF A LAW FOR PROVISION OF SERVICES.

Another bill addressed this week was HB 1472 which would allow alternative medicine practitioners to engage in treatment. Alternative health care is largely based on natural products and how they interact with and heal your body. Much of alternative medicine isn’t approved by the U.S. Food and Drug Administration.

NDMA provided testimony in OPPOSITION to HB 1472. This bill is still in committee.
 

SB 2205 RELATING TO MEDICAID MEDICAL ASSISTANCE COVERAGE OF INTERPRETER SERVICES.

SB 2205 - coverage for Medicaid medical assistance of interpreter services - is essential to the safety, health and wellbeing for the patients that do not speak English or have hearing impairments.  Although professional providers and community agencies are legally and ethically required to provide interpreter services for their patients, currently there is no direct cost reimbursement for this service provision.  This becomes a significant barrier for smaller clinics and rural portions of the state in order to provide appropriate care to all.  Without this reimbursement, access to basic medical, dental and mental health care could be severely compromised in our state.  

NDMA provided testimony in SUPPORT of this bill, which successfully PASSED on the Senate floor on Wednesday, February 3 with 42 yeas, and 5 nays.
 

HB 1465 RELATING TO FREEDOM OF CHOICE FOR HEALTH CARE SERVICES.

NDMA supports HB 1465 which provides that an insurer may not deliver, issue, execute, or renew a policy if that policy denies a health care provider the right to participate as a participating provider for any policy on the same terms and conditions as are offered to any other provider of health care services under the policy. Similar legislation has been enacted in several states. This legislation supports the idea that any provider willing to meet reasonable standards of care and quality set by the insurance plan should be able to care for the plan's beneficiaries.

NDMA provided testimony in SUPPORT of this bill. The bill is still in committee.


Week of January 25 - 29

Monday, February 1st marks the eighteenth day of North Dakota's 2021 67th Legislative Session and NDMA is extremely busy tracking 185 bills. Typically, we track roughly 150 bills each session, but this year's anomaly has brought an increase in requests - many of which are the result of the pandemic.

NDMA encourages you to take a look at the NDMA BILL TRACKER and familiarize yourselves with what we are up against. This session is proving to be eventful in several areas. When it comes to marijuana, there are six bills to contend with - and one bill - HB 1420 is proposing is legalize recreational marijuana. Some priority Medicaid bills include SB 2205 - requesting coverage of interpreter services; HB 1288 requests coverage of continuous glucose monitors; and SB 2224 requests coverage of metabolic supplements.

Following are some of this weeks highlights:

SB 2224 Relating to medical assistance coverage of metabolic supplements

On Monday, January 25, NDMA Executive Director Courtney Koebele testified on the importance of Medicaid coverage for children needing metabolic supplements. Ms. Koebele serves on the the subcommittee of the Medicaid Medical Advisory Committee (MMAC), which offers recommendations for Medicaid coverage. The subcommittee established a scoring process to determine need and found that coverage for metabolic supplements scored high as they are life sustaining.
 

SB 2205 Relating to Medicaid and medical assistance coverage of interpreter services



Gabriela Balf-Soran, MD

Anne Keating, MD

Another bill heard on Monday was SB 2205. Dr. Gabriela Balf-Soran and Dr. Anne Keating testified in support of the bill as well as NDMA Executive Director Courtney Koebele.

Koebele, Keating and Balf-Soran all testified that service is essential to the safety, health and wellbeing for patients that do not speak English or have hearing impairments. Although professional providers and community agencies are legally and ethically required to provide interpreter services for their patients, currently there is no direct cost reimbursement for this service provision.

This becomes a significant barrier for smaller clinics and rural portions of the state in order to provide appropriate care to all. Without this reimbursement, access to basic medical, dental and mental health care could be severely compromised in our state. Not only does the provider receive no reimbursement, but many times it costs them to see Medicaid patients that require interpretation services.

HB 1205 Relating to establishing the maternal mortality review committee

Tom Arnold, MD
Representative Vicky Steiner

Another hearing on Monday dealt with HB 1205 -establishing the maternal mortality review committee and to provide a continuing appropriation.

Dr. Tom Arnold, Chair of the North Dakota Maternal Mortality Review Committee (MMRC) and the Vice Chair of the University of North Dakota School of Medicine and Health Sciences Department of Obstetrics and Gynecology provided testimony in support of the bill. He testified that the existing ability of the ND MMRC to investigate the cause of these type of maternal deaths is less than optimal. He outlined how the proposed changes would enhance the committee's ability to reduce future maternal mortality in North Dakota by enhancing the ability to identify, explain, and categorize maternal deaths, which would initiate corrective measures to reduce maternal mortality.

Vaccine Bills

NDMA President Misty Anderson, DO

As we had mentioned in last week's update, there are at least eight bills that impact vaccines - some of which have the potential to undo North Dakota's progress on protecting children from being subjected to a lifetime of debilitating disease.

Three bills were heard this week. NDMA testified against HB 1377 and HB 1468, and testified in support of HB 1469. 

HB 1377 Relating to immunization exemptions. This bill creates vaccine safety standards at an unreasonable level; eliminates vaccine requirements for school age children and health care institutions; requires posting vaccine injuries by ND Dept. of Health.

HB 1468 Relating to informed consent and notice of risks associated with vaccines. Requires the whole package insert to be given to patients; does not allow for vaccine mandates; repeals sec.23-07-17.1 of NDCC as it relates to tuberculosis treatment and care.

HB 1469 Relating to exemptions from vaccine requirements before admission to school; and to provide an appropriation. NDCC reference to 23-07-16.1 which adds advanced practice registered nurse, or physician assistant; also makes allowances to present a state dept. of health immunization exemption form and develop an online vaccination education module; rules will be adopted by the ND Health Council.

Three bills were heard last week:

HB 1306 Interrelationship between sudden infant death syndrome, vaccines, and autism. A bill for an act to provide for a legislative management study of the interrelationship between sudden infant death syndrome, vaccines, and autism spectrum disorder in children.

HB 1307 A bill for an act to prohibit public accommodations from refusing services to an individual because the individual has not been vaccinated; and to provide a penalty. Public accommodation may not refuse service for failure to vaccinate.

HB 1320 Relating to limitations on vaccinations requirements. A state or local elected official, the state, or a political subdivision of the state may not mandate an individual in this state receive a vaccination including for school or daycare.

All of these bills are still in the House Human Services Committee, but we expect them to be voted on next week. Watch for an action alert for when the vote will occur so you can urge a DO NOT PASS on these bills.


Week of January 18 - 22

NDMA encourages you to take a look at our NDMA BILL TRACKER and familiarize yourselves with what we are up against. This session is proving to be eventful in the vaccine area, as there are seven bills that we are paying attention towards. One bill in particular is concerning - HB 1468. This bill is a very concerning interference between the physician/patient relationship and dictates how physicians must practice. The bill requires detailed informed consent that MUST mention exemptions and offer the exemption form. Physicians MUST talk about vaccine safety studies in pregnant women with a witness present. Anyone who deviates from the requirements will be guilty of an infraction.

Many more intense weeks are sure to follow, as the session is expected to continue for 80 days, scheduled to convene on April 30th.

Following are some of this weeks highlights:


HB 1139 - Relating to Workforce Safety & Insurance (WSI) Opioid Therapy.




On Monday, January 18, Dr. Michael Booth provided testimony to the House Industry Business and Labor Committee in opposition to the proposed bill relating to duration limits for opioid therapy and termination of coverage of WSI.

Dr. Booth testified that stating that rather than imposing arbitrary statutory limits on opioid and benzodiazepine prescriptions, WSI - empowered through its existing formulary and case review program - should develop guidelines for the use and regulation of these medications, with appropriate input from medical professionals.

Prior authorization and PDMP reviews can and should be put in place to identify potential situations where diversion of drugs may be happening. These measures may also be used to encourage providers to consider alternate pain management strategies to hopefully steer patients away from courses of treatment that might be more likely to eventuate in addiction or abuse.

For the record, a similar bill was defeated in 2019 during the 66th legislative session by the good work done by NDMA member Dr. Booth.

In spite of our efforts, this bill received a 'do not pass' recommendation from the House Human Services Committee.


HB 1320  Relating to Limitations on Vaccinations Requirements.




On Tuesday, January 19 HB 1320 was heard in front of the House Human Services Committee. Dr. Paul Carson and NDMA, along with others provided testimony in opposition to the bill. The bill would remove immunization requirements for entry to school or day care.

Dr. Carson testified that it is imperative that North Dakota continues to require immunizations for school entry. Vaccines protect those being vaccinated, and very importantly, also protect children who cannot be vaccinated. Vaccines prevent disease from spreading in schools and daycares. If immunization requirements are removed for school and daycare entry, North Dakota would become the only state in the country that doesn’t require immunizations for school.


SB 2179 Relating to Health Insurance Coverage of Telehealth: Payment Parity.

On Wednesday, January 20, NDMA along with some its partners provided support testimony on SB 2179 to the House Human Services Committee. This bill requires health plans to reimburse providers for all covered telehealth services delivered to patients at reimbursement rates not less than in-person services.

Due to the pandemic, increased flexibilities and broader insurance coverage for telehealth services made it possible for health care professionals to continue treating patients and increase access to care.

  • Payment parity – or equal reimbursement rates - would ensure patients have increased access to timely, value-based, and integrated care, especially for rural and underserved communities throughout the state. Under current law, health plans reimburse telehealth services 20% to 40% lower than in-person services.

While telehealth cannot replace all patient care, the extension of telehealth benefits in recent months has rapidly changed the way health care professionals see patients. The advancements provided a push for innovation that now allow health care providers to safely increase access to high quality care, particularly in the rural health care setting.

A list of 16 organizations signed onto a letter in support of telehealth payment parity; those organizations include: ND Psychiatric Society, Essentia Health, CHI St. Alexius, Trinity Health, Altru Health, Mid Dakota Clinic, The Bone and Joint Center, ND Academy of Physician Assistants, Physical Therapy Association of North Dakota, ND Federation of Families for Children’s Mental Health, Mental Health America of North Dakota, the Mental Health Advocacy Network and NDMA.

Together, this group supports telehealth payment parity legislation that will require health plans to reimburse providers for covered telehealth services delivered to patients at reimbursement rates not less than in-person services.

 

Week of January 11-15
SB 2060 Sports Physicals.
On Monday, January 11, Dr. Parag Kumar and Dr. Dawn Mattern testified against SB 2060.

Section 12 of SB 2060 would allow chiropractors to conduct sports physicals. The North Dakota High School Activities Association (NDHSAA) by-laws provide for MD/DO/NP/PA right now. However, if this bill passes, the chiropractors could petition the NDHSAA to conduct sports physicals.

Dr. Kumar testified that NDMA members are concerned that many adolescent medical issues could be missed if the preparticipation physical is not conducted by a physician or other qualified medical provider. He educated the committee that a good preparticipation physical includes screening for heart disease and performing a cardiovascular exam, screening for neurologic, musculoskeletal and genetic disorders that may affect an athlete’s ability to safely participate in sports.

The bill is still in committee, but will likely be voted on next week. Because chiropractors may conduct FAA and DOT physicals, the committee found their request to be reasonable. NDMA is working very hard to sway that opinion.

 

SB 2004 ND Dept. of Health Budget.
On Thursday, January 14, NDMA submitted written testimony on the ND Department of Health budget, urging the appropriations committee to include medical student loan repayment for the next biennium.

The state needs to continue this program to support our healthcare workforce.

As of June 2020, about 94% of counties in North Dakota are fully or partially designated as health professional shortage areas for primary care. Without continued funding for new slots to be awarded to physicians, there will not be any incentives to offer in recruiting physicians in our rural and defined health professional shortage areas and physician shortages will remain in underserved areas. 66% of physicians that received student loan repayment have stayed in the state after their contracts were concluded.
 

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