By: Mary Steurer
BISMARCK, N.D. (North Dakota Monitor) – A committee of North Dakota lawmakers will decide next week whether to endorse four bill drafts that could help the state get more money from a sweeping federal rural health care grant.
Congress created the $50 billion Rural Health Transformation Program this summer as part of its 10-year budget reconciliation law. The program was advertised as a way to support rural states in light of cuts to Medicaid in the bill.
The grant money is intended to go toward areas like behavioral health, workforce, infrastructure development and disease prevention.
North Dakota by Nov. 5 must submit an application to the Centers for Medicare and Medicaid Services that includes a detailed plan for how it will use its share of the funding.
Every state will get at least $500 million, though the federal government has identified ways states can get additional funds — including by adopting certain health policies.
A 33-member committee met this week to help the state prepare its application.
On Wednesday, the committee asked Legislative Council to draft four bills to implement some of the policies singled out as favorable by the federal government.
The Department of Health and Human Services told lawmakers at the meeting that the state could get more funding by including the bill drafts in their application, which would signal to the federal government that the Legislature intends to adopt the policies.
The policies would require schools to participate in a federal fitness test, make doctors receive ongoing nutrition education, have North Dakota join a physician assistant licensure compact and to expand what kinds of services pharmacists are legally allowed to provide.
The committee will weigh the merits of the bill drafts when it reconvenes next Tuesday. Committee members will vote on whether to forward the legislation for consideration by the full Legislature, which is expected to hold a special session in January or February.
The first bill draft would make schools in North Dakota conduct the Presidential Fitness Test. The test was retired by President Barack Obama in 2012, but Trump revived it in a July executive order.
The federal government has not yet announced what would be required under the new Presidential Fitness Test, but in 2012 it included a mile run, a sit-up test, a sitting flexibility test, a shuttle run and a push-up or pull-up test.
Another proposal the committee will consider next week is to require doctors to have continuing education on nutrition.
Sarah Aker, executive director of medical services for the Department of Health and Human Services, told lawmakers that the federal government is incentivizing this policy based on research that shows doctors often lack sufficient nutrition education.
Sen. Jeff Magrum, R-Hazelton, was the only lawmaker to vote against drafting the bill Wednesday.
“It seems like a person that’s gone to medical school would have had plenty of training in nutrition,” he said.
The third bill draft that the committee will vote on next week is a proposal to have North Dakota join a multi-state physician assistant licensure compact.
The idea is to make it easier for North Dakota physician assistants to practice in other states.
A bill to have North Dakota join the licensure compact was considered during the 2025 legislative session, though it died in the Senate.
The last bill draft would give pharmacists more authority to conduct laboratory tests and issue prescriptions.
North Dakota Pharmacists Association Executive Vice President Mike Schwab told lawmakers that this policy could improve access to health care in rural areas of the state that don’t have full-time medical clinics.
“I can think of a few communities where the clinic’s only open a couple days — outside of that they have to travel 30 to 50 miles to the nearest clinic,” Schwab said.
The Rural Health Transformation Program created incentives for some policies that the committee declined to take up.
One of them would have involved lifting the state’s nursing home bed moratorium.
The Legislature adopted the moratorium in 1995 and most recently renewed it during the 2025 legislative session.
The reason for the moratorium is partly to prevent the number of beds across the state from growing to an extent that could threaten the financial stability of rural providers, including by diluting federal subsidies.
“I’ve always believed that the moratorium helps keep beds in rural areas, and by opening this up we could do damage to that situation,” said Rep. Kathy Frelich, R-Devils Lake.
Supporters also argue the moratorium helps promote senior care alternatives most aging Americans prefer, like home health services.
Opponents of the moratorium during the session criticized it as overregulation.
The committee on Wednesday decided against taking another look at the moratorium after some lawmakers expressed that reviving the debate was unlikely to be productive.
“This discussion would take us weeks,” Senate Minority Leader Kathy Hogan, D-Fargo, said during the meeting.
The committee also decided against drafting bills that would expand services that dental hygienists could provide, and creating a license and registration process for telehealth providers.
The Rural Health Transformation Committee will reconvene Tuesday at 12:30 p.m.
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