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HB 1594

Crimes and punishments; assault and battery; clarifying scope of certain unlawful act; effective date.

2025 Regular Session Introduced by John George and 1 co-sponsor

Requires health care facilities to publish standard charges in CMS-like, machine-readable format and lets penalties apply; insurers must attest and can terminate noncompliant provi

Coauthored by Representative Wolfley
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Bill Summary · HB 1594

Summary — HB 1594 (North Dakota)

A bill to require medical cost transparency by health care facilities and to add federal-transparency compliance requirements to preferred provider arrangements; establishes penalties and enforcement.

Purpose

To improve price transparency in health care by requiring facilities to publish standard charges (including federally defined “shoppable services”) in a Centers for Medicare & Medicaid Services (CMS)-consistent format, and to ensure insurer/provider contracts include attestation of compliance with federal transparency rules. The bill creates civil penalties for noncompliance and clarifies insurer/provider contract obligations and consumer protections.

Key provisions

  • Definitions

    • “Health care facility”: facilities licensed under chapter 23‑16, excluding nursing facilities, basic care facilities, and the state hospital (per the Senate-amended engrossment).
    • “Items and services”: any item/service a facility may provide related to inpatient or outpatient care for which a standard charge is established (supplies, procedures, room/board, facility use, staff services, etc.).

  • Transparency requirements for health care facilities

    • Must make publicly available a list of standard charges for:
    • All items and services; and
    • “Shoppable services” as defined in 45 C.F.R. Part 180, Subpart B.
    • Must produce the list in a format consistent with CMS rules (machine‑readable format per federal guidance).

  • Enforcement and penalties

    • Civil penalties may be assessed by the Insurance Commissioner (or imposed by a court). Penalty structure in the Senate‑amended engrossment:
    • Facilities with more than 25 beds: $10 per bed per day, capped at $5,500 per day.
    • Other facilities: up to $100 per day for each day the violation continues, plus interest and enforcement costs.
    • Penalties may be imposed by administrative hearing (chapter 28‑32) or civil action; assessment does not preclude other sanctions.

  • Preferred provider arrangements (amendment to NDCC 26.1‑47‑02)

    • Required contract elements: payment terms (may include capitation), utilization review/medical necessity procedures, quality preservation mechanisms, responsibilities if provider is at risk, grievance/credentialing/reporting processes.
    • New/focused provisions:
    • Contract must include an attestation from the preferred provider that it complies with federal transparency rules and regulations.
    • If a preferred provider fails to comply with federal transparency rules, the insurer may terminate the contract without the provider’s consent.
    • Protections: covered persons are not liable to providers for insurer payment failures; continuity of services in insurer insolvency for paid periods; 60 days’ notice for termination without cause.
    • Prohibits inducements tied to providing less-than-medically-necessary care and forbids penalizing providers who in good faith report insurer conduct jeopardizing patient health.

Who is affected

  • Health care facilities licensed under chapter 23‑16 (excluding certain long‑term care and the state hospital as amended) — required to publish charges and face penalties for noncompliance.
  • Health care insurers and preferred providers — must include specified contract terms and provider attestation of federal transparency compliance; insurers gain termination authority for noncompliant providers.
  • Patients/consumers — greater access to standard charge information for price shopping; protections against balance billing/consumer liability when insurers fail to pay (per contract terms).
  • Regulators — Insurance Commissioner gains enforcement authority and administrative workload to review and assess penalties.

Procedural / timeline notes

  • Introduced in the North Dakota Legislative Assembly (filed Dec 12, 2024).
  • Committee and floor actions occurred through early 2025; multiple engrossed versions and Senate amendments refined definitions, enforcement authority, and penalties.
  • Motion to reconsider failed (3/31/2025 per provided actions). The bill progressed through readings, committee reports, and amendments as documented in the legislative history.

Potential impacts / considerations

  • Operational burden on facilities to compile and publish machine‑readable price lists consistent with CMS requirements; compliance costs vary by facility size.
  • Contractual and administrative adjustments for insurers and providers to add attestation language and ensure federal rule compliance; potential for contract terminations where providers fail to comply.
  • Penalty structure creates ongoing daily exposure for noncompliance, scaled by facility size.

(Prepared from the bill text, committee report, engrossments, and legislative history provided.)

Compiled from official sources — confirm details with the bill’s official record.

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