[{"_1":2,"_88":-5,"_89":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6326955,"mediaKeyId","2323580-c87569279975cb620857dfe72f3f8636","parentId",2323580,"title","Committee adopts amendment to HB1454 on notice-before-requirement; AG warns of broad public-health conflicts","audioSeconds",1171,"startMs",477300,"endMs",1648495,"viewUrl","/Search/View?dp=1&key=2323580-c87569279975cb620857dfe72f3f8636&start=477&end=1648","thumbnailUrl","https://assets.pipeline.soar.com/2323580-c87569279975cb620857dfe72f3f8636/thumbnail_477300.jpg","articleUrl","/articles/6326955/North-Dakota/Committee-adopts-amendment-to-HB1454-on-notice-before-requirement-AG-warns-of-broad-public-health-conflicts","mediaUrl","https://secure.pipeline.soar.com/6326955-de518c5ec05845c9857974daf4092b90/orig.mp4?Expires=1771183350&Signature=loVVkPfZwZGrmS8-~qqgUQ5A5HmOudWfe9upkSiarKMBEQajF2h20Mnq4uacDDqQ08z~jpT1nDyqRobUlUf99lG~HoCScESYAdGFPW3WeiemyZ5n0Wf29RAapCyi31FUB2HVF7IWj9YCODjmVx5fTt-AZS~SYy6NyJqHT6RQxXmTHcmAWIH02l4KN7~iWwy1R4mugivBsq6VgFvzo8hPqLTDs0f0gukUfo5SWiwyOmAs2mxvm1FkbUk-IV0NJZykacnP0P5KaV6moCH22QENTnUVpARuoP3lQlqEBtYblb9UuTECYHCzjy-gGhXIWQl0r~e4Tz83vLClJRLmlGucNA__&Key-Pair-Id=KUT5TJCACFTXG","author","North Dakota State Legislature","date","2025-02-17T00:00:00Z","article","Committee action: The House Industry, Business and Labor Committee adopted an amendment to House Bill 1454 that would bar state agencies and political subdivisions from requiring an individual to take, receive or disclose whether they have taken a “medical product” unless the person was first notified and given an opportunity to decline and failed to exercise that opportunity.

Why it matters: The amendment, offered by Representative Kent Koppelman and seconded by Representative Schatz, attempts to write an opt-out requirement into law for state-mandated medical products. The committee then paused further action on the bill after the Office of the Attorney General raised legal and public-health concerns about the amendment’s breadth and lack of exceptions.

What the amendment would do: Representative Koppelman told the committee the language was intended to “get to the heart” of the sponsor’s goal while reducing objections, placing the onus on individuals to opt out after being notified rather than on government to mandate medical products. He moved the amendment and it was adopted by voice vote.

Legal and public-health concerns: Allison Hicks, general counsel to the Public Health Division of the Department of Health and Human Services, told the committee the division “does still have a lot of concerns about this bill.” Hicks said the amendment’s definitions and phrasing raise immediate operational conflicts because the language appears to cover all “medical products” and “state agencies and political subdivisions.” Hicks gave specific examples:
- Emergency medical services treating unconscious patients could be covered by the bill’s prohibition but would be unable to meet the notice-and-decline requirement for an unconscious person.
- Law enforcement use of naloxone (Narcan) after an officer receives a needle stick could be impeded if disclosure or prior notice were required.
- Corrections and state hospitals that administer court-ordered medical treatment could be precluded from following court orders because affected individuals may lack the capacity to decline.

Hicks also flagged the bill’s use of “disclose” as problematic, saying it could impede normal workplace protections (for example, protecting first responders who need to know certain vaccination or immunity status after a needle stick). She warned the amendment would “hamper the ability of the department to address a public health emergency,” citing scenarios such as managing active tuberculosis cases where quarantine or forced treatment typically depend on public-health authority and, in some cases, court orders.

Committee response and next steps: Representative Koppelman said adding an exception for “unless court-ordered” could be an easy fix and asked if removing the disclosure sentence would address some concerns. Hicks offered to consult with her client and pull the legislative history of the health officer’s powers and the orders issued during the COVID response timeline. The committee agreed to hold the bill over for further work and for Hicks to return with additional language or analysis.

Context and background: Committee members noted that current state law does not generally require adult vaccination and that school immunization statutes already include exemptions. Hicks cautioned that prior special-session language related to COVID may no longer be operative. Committee members asked for a summary of what was authorized through the governor and joint command during the COVID response; Hicks said she would gather legislative history and a synopsis of orders.

Ending: The amendment to HB1454 was adopted by the committee, but members agreed to hold the bill for further legal review to resolve the department’s concerns and potential exceptions before advancing it.

Quotes (selected):
“Allison Hicks, Office of the Attorney General and general counsel to the Public Health Division: ‘…this is just very problematic because of the broad nature and the broad strokes of it. The department and myself individually as their general counsel, I have significant concerns about the language.’”

“Representative Kent Koppelman: ‘When we were in the hearing, many objected to the language that was in here… I think what the bill sponsor is trying to do here is say, you know, the state should not be the muscle behind forcing something…’”

","mediaType","Video","parentTitle","House Industry, Business and Labor Mon, Feb 17, 2025 2:30 PM-5:00 PM","oneSentenceSummary","Committee action: The House Industry, Business and Labor Committee adopted an amendment to House Bill 1454 that would bar state agencies and political subdivisions from requiring an individual to take, receive or disclose whether they have taken a “medical product” unless the person was first notified and given an opportunity to decline and failed to exercise that opportunity.","taxTitle","Industry, Business and Labor, House of Representatives, Legislative, North Dakota","taxId",28894,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6326951,"Committee amends HB1216 to protect patients’ point-of-sale copay assistance, votes due pass",1509,1614630,3123755,"/Search/View?dp=1&key=2323580-c87569279975cb620857dfe72f3f8636&start=1614&end=3123","https://assets.pipeline.soar.com/2323580-c87569279975cb620857dfe72f3f8636/thumbnail_1614630.jpg","/articles/6326951/North-Dakota/Committee-amends-HB1216-to-protect-patients-point-of-sale-copay-assistance-votes-due-pass","https://secure.pipeline.soar.com/6326951-78ab2b4ae0082af9499bdc87ba3c44a6/orig.mp4?Expires=1771183350&Signature=UpBtqCas1tDTI4xz0zb-sjCKQ0e3PhA23tycbI6OyYSx4zlTPFKS8l6jC8UTEnxNGw5OMz-xo-dxTdGSg5HMObfOmThbTvEsHvmiMRMY8TYGHMhURZKVS7wERnjqfQZaHZiSTsgqXZHTk0oLrlvqPO~Ef4Znn9dde6MQwCplYtelZaQJIJtWxJQju-8oW-ndzUHtCH~zl18AhM4j-7NQwBMahYBC1idytG3Y6cY1~8DOZUUsNREgBjhFizfVJGz5IZrpgTd5PIMDjfkgQNUzuX-14Gq3QoNqxHZnu6~enltwH1yEONUOip~qnFnXM0xmh-f5Jp8CBZMKfOieULsN2Q__&Key-Pair-Id=KUT5TJCACFTXG","What happened: The House Industry, Business and Labor Committee approved a further-amended version of House Bill 1216 that, in its amended form, (1) prevents contributions from cost‑sharing assistance programs from being counted toward an enrollee’s deductible or maximum out‑of‑pocket, (2) allows copay assistance to be applied at the pharmacy counter to reduce the patient’s out‑of‑pocket cost at point of sale, and (3) requires the enrollee to notify the health benefit plan of any cost‑sharing assistance used to reduce copayments. The committee then voted to give the bill a due pass in committee.

Why it matters: Sponsors and patient advocates described cases in which patients receiving manufacturer or foundation assistance for high-cost specialty drugs were later billed by insurers that treated the third‑party assistance as the patient’s payment and clawed it back. The amendment is a compromise intended to preserve patient access to assistance programs while limiting how insurers may use that third‑party assistance to alter deductibles and maximum out‑of‑pocket calculations.

Key points of the amendment: Representative Kent Koppelman, who explained the amendment, said it would (a) change certain drafting terms (for example, using “individual” instead of “person” to make clear human patients are meant), (b) add language that ‘‘contributions made by a cost sharing assistance program are not calculated as part of the enrollee’s deductible or maximum out of pocket,’’ and (c) require notification from enrollees to plans about use of cost‑sharing assistance. The amendment retains a provision allowing copay assistance to offset the point‑of‑sale copayment for the drug but not to be counted toward the patient’s deductible.

Sponsor and committee discussion: Representative Carls, the bill sponsor, said the amendment “pretty much negates the bill” from his original intent (which had aimed to require third‑party assistance be counted toward deductibles). Carls emphasized patients ‘‘navigate years of misdiagnosis…only to have the therapies co payment deductible become a barrier to access’’ and noted 19 states have adopted bans on accumulator practices. Representative Koppelman and others said the amendment is a compromise between patient access and insurer actuarial concerns. Representative Casper urged additional PBM transparency bills as a separate step.

Vote and outcome: Representative Shower (Shower) moved a due pass on House Bill 1216 as amended; Representative Casper seconded. The committee recorded a roll-call vote in which the clerk read members’ names; the roll-call as recorded in the transcript shows a majority in favor. The clerk then assigned the bill a carrier in the House.

Implementation notes and exemptions: Committee members confirmed the amendment exempts grandfathered plans. Members also noted the amendment will require a fiscal note. Representative Koppelman and others said details about how insurers or plans will operationalize enrollee notification and tracking of cost‑sharing assistance may be resolved after the bill advances.

Ending: Committee voted to give the further-amended HB1216 a due pass; sponsor and committee members said the amendment was a compromise and that additional PBM‑transparency work remains to be done.

Quotes (selected):
“Representative Kent Koppelman, on the goal of the amendment: ‘We’re saying…they can use copayment assistance…at the same time we not apply that to the deductible of the insured.’”

“Representative Thomas Carls, bill sponsor: ‘This bill is for the patient…Plans often require higher co pays for specialty and rare medicines… I don’t think this amendment accomplishes [the original goal]. It pretty much negates the bill.’”

","The House Industry, Business and Labor Committee further amended House Bill 1216 to prevent insurer ‘claw back’ of third‑party copay assistance toward a patient’s deductible and approved a motion for a due pass in committee after a roll-call vote.","actionData","errors"]

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Committee adopts amendment to HB1454 on notice-before-requirement; AG warns of broad public-health conflicts

Committee amends HB1216 to protect patients’ point-of-sale copay assistance, votes due pass