North Dakota
North Dakota Gov. Kelly Armstrong signs bill to put checks on AI health care decisions
BISMARCK — A new North Dakota law is expected to put checks on the influence that artificial intelligence and algorithms have on health care decisions, resulting in fewer delays in treatment and medication for patients.
On Wednesday, April 23, Gov. Kelly Armstrong signed
Senate Bill 2280, which aims to reform the “prior authorization” process for patients needing imaging services, medications and surgeries.
Prior authorization is the approval from a patient’s health insurance provider that may be required for a service, treatment or prescription to be covered by their plan, if it’s not an emergency. Prior authorization does not guarantee payment, but makes it more likely their health plan will cover the cost.
The new North Dakota law puts deadlines on insurance plans for those prior authorization decisions and requires any denials to be made by a licensed physician, not by AI or insurance companies.
The bill passed unanimously in the House and nearly so in the Senate, and with Armstrong’s signature, takes effect Jan. 1, 2026.
Sen. Scott Meyer, R-Grand Forks, the bill’s lead sponsor, said it passed due to proponents and opponents sitting down and working it out.
“Just because it was a vote that led to almost unanimous support, it was still a lot of work to get to that point,” Meyer told The Forum.
Dr. Stefanie Gefroh, president of Essentia Health’s West Market, said North Dakota is one of only a few states without statewide oversight of prior authorization.
“It’s kind of an open book with no guard rails, essentially, around what is an acceptable time frame for a patient to receive clearance to get services,” Gefroh said.
She said some physicians are having to spend up to 14 hours a week trying to justify a medical decision made for a patient.
Meyer said American Medical Association data shows among all of the prior authorization requests in Medicare Advantage plans that were denied and appealed in 2022, more than 83% were overturned.
The result was delays in care, treatment and medications for those patients.
Gefroh said most delays involve higher cost items: MRIs, surgeries, and chemotherapy and immunologic agents.
The law calls for insurance companies to make timely decisions; within seven days for non-urgent requests and 72 hours for urgent ones.
Requests for services that go unmet or unanswered are considered “authorized.”
“That’s why the default to ‘yes’ really is quite extraordinary, because the beautiful part of it is we’re not holding up patient care,” she said.
In addition, any denials for services must be made by licensed physicians experienced in the relevant condition, not by AI or insurance analysts.
Gefroh said insurance companies that don’t adhere to the guidelines will likely have to adjust their internal processes.
“I don’t think they want to be approving by default,” she said.
There was pushback against the bill from representatives of multiple insurance companies, who said it would increase costs.
In the end, the bill prevailed due to support from the North Dakota Hospital Association, and a coalition led by Essentia of 20 health care and patient advocacy organizations representing physicians, pharmacists, hospitals, physical therapists, and advocates for seniors, children, and cancer patients.
“It’s doing the right thing and putting the patients at the center and anytime we can put the highlight on that, I’m pleased,” Gefroh said.
Activists steal wax figure of Emmanuel Macron
Greenpeace activists stole a wax figure of French President Emmanuel Macron to protest France’s trade with Russia.
Greenpeace has asked for a second trial after a judge entered a $345 million judgment against the organization in a landmark case brought by the developer of the Dakota Access Pipeline.
The case “threatens to result in one of the largest miscarriages of justice in North Dakota’s history,” attorneys for the environmental group wrote in a brief filed last week.
After a three-week trial roughly a year ago, a Morton County jury directed Greenpeace to pay Energy Transfer about $667 million, finding the environmental group at fault for inciting illegal acts against the company during anti-pipeline protests in North Dakota in 2016 and 2017 and for publishing false statements that harmed Energy Transfer’s reputation.
Greenpeace denies Energy Transfer’s claims and maintains that it brought the lawsuit to hurt the environmental movement.
Southwest Judicial District Judge James Gion in October slashed the jury’s award to $345 million, though he didn’t finalize the award until late February.
Greenpeace is now taking steps to fight the judgment, which includes its motion for a new trial.
The environmental group’s reasons for the request include claims that the jury instructions and verdict form contained errors, and that Energy Transfer was allowed to present unfair and irrelevant evidence to jurors. The group also alleges the jury pool was biased.
Greenpeace says the jury’s award assumes that Greenpeace was entirely responsible for any injury Energy Transfer sustained related to the protests. Jurors were not given the opportunity to consider whether Greenpeace was only at fault for a portion of the damages, the organization wrote in its brief.
Attorneys for Greenpeace also referenced the mailers and other media circulated to Mandan and Bismarck residents before the trial that contained anti-Dakota Access Pipeline protest and pro-energy industry content.
The environmental group seeks a new trial in Cass County, arguing in part that the jury pool in the Fargo area would be more fair because its residents did not directly experience the Dakota Access Pipeline protests and because the local economy is less dependent on the energy industry.
If Greenpeace’s request for a new trial is denied, it plans to appeal the case to the North Dakota Supreme Court, the organization has said.
Greenpeace previously asked for the trial to be moved from Morton County to Cass County in early 2025, which Gion and the North Dakota Supreme Court denied.
The lawsuit is against three separate Greenpeace organizations — Greenpeace USA, Greenpeace International and Greenpeace Fund.
Energy Transfer as of Wednesday morning had not submitted a response to Greenpeace’s motion for a new trial. Previously, the company has defended the jury’s verdict and disputed Greenpeace’s claims that the court proceedings were not fair.
Energy Transfer has indicated it may appeal Gion’s decision to reduce the award to $345 million.
Greenpeace will not have to pay any of the $345 million judgment for at least a couple of months, Gion ruled Tuesday.
Court documents indicate that the organization could have to pay a bond of up to $25 million while appeals proceed, though the environmental group has asked the judge to waive or reduce this amount. Gion has not decided on this motion.
He noted that obtaining such a large bond will be challenging.
“The magnitude of this matter defies simple decisions,” Gion wrote.
Energy Transfer in court filings urged the judge to require Greenpeace to post the full $25 million.
Any bond money Greenpeace provides would be held by a third party while the appeals proceed, according to Greenpeace USA.
Greenpeace International has filed a separate lawsuit in the Netherlands that accuses Energy Transfer of weaponizing the U.S. legal system against the environmental group. Energy Transfer asked Gion to order that the overseas suit be paused while the North Dakota case is still active, which Gion denied. The company appealed his ruling to the North Dakota Supreme Court, which has yet to make a decision on the matter.
North Dakota Monitor is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
BISMARCK, ND (KXNET) — Drivers in parts North Dakota are being urged to use caution as drifting snow continues to impact road conditions.
According to the National Weather Service, strong northwest winds are creating areas of blowing and drifting snow.
That snow is sticking to previously plowed roadways, leading to slick and potentially hazardous travel conditions.
The advisory includes Burleigh County, Emmons County, Kidder County, Logan County, and McIntosh County.
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