Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

North Dakota program

Deadlines your plan must meet for approvals

North Dakota deadlines for certain health plans to decide requests for treatment approval.

What it is

North Dakota deadlines for certain health plans to decide requests for treatment approval.

Waiting for approval can hold up treatment. This law gives covered plans a decision deadline after they have the required information. Missing the deadline can count as approval.

Eligibility rules
  • The law applies from January 1, 2026 to covered state-regulated health benefit plans under NDCC chapter 26.1-36.12.
What you get
  • A seven-calendar-day standard decision deadline.
  • A 72-hour urgent decision deadline when the urgent rules apply.
What the help includes
  • The law includes a 60-day transition for an existing approval into a new policy.
  • The clock starts when the plan has everything it asked for. If it misses the deadline, the request counts as approved. When you change insurers, an approval already in hand carries over for 60 days. Medicaid and the state employee plan follow different rules.
If you decide to apply
  1. Ask the clinic and plan to identify the submission date and any information still missing.
  2. Have the treatment request and plan correspondence ready to discuss an urgent review if delay would harm your child.

Your health plan · Official page ↗

After you ask
  • The clinic supplies medical information and the reason an urgent decision is needed. The plan’s receipt and completeness dates matter.
Good to know

NDPERS uniform group plans are expressly excluded. Private self-funded plans also sit outside state regulation.

Other details
  • A decision deadline does not replace the separate process for appealing a denial.
Official sources
Ask your social worker

“If an approval is holding up treatment, which deadline applies to our plan? Could you help us confirm what is missing and whether an urgent request or review would help?”

Why I’m asking: I want to know when the plan must answer so care is not delayed unnecessarily.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask in writing what is outstanding and note the date.

Your social worker

The clinic sends the clinical information and can mark the request urgent.

The care team

The team states why a delay would harm the child.

Who decides
Your health plan, inside the statutory deadline.
Ask your social worker
“What information is the plan still waiting for on this approval, and what date does the North Dakota deadline fall on?”

How to apply

First step: When something is waiting on approval, ask the plan in writing what it is still waiting for and when its deadline falls.

  1. Ask the plan what information it is still waiting for and from whom.
  2. Ask the clinic to mark the request urgent when a delay would harm your child.
  3. If the deadline passes, say so in writing and ask for the request to be treated as authorised.

Official application / program page ↗

Where it starts: Ask the plan, in writing, for the decision date and what information it is still waiting for.

What to gather

  • The date the clinic sent the request
  • The plan’s reference number

How long: Seven calendar days, or 72 hours for an urgent request.

What a yes looks like

An authorisation number and the dates it covers.

What a no looks like, and the next move

Appeal inside the plan first, then ask for an outside review.

Watch out

  • The clock starts when the plan has everything it needs, so ask what is outstanding.
  • NDPERS plans, which cover many state and school employees, are expressly outside this law.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Seven calendar days for a standard approval, 72 hours for an urgent one, and missing the deadline counts as approval.

  • $7 — Standard prior authorisation decision
  • $72 — Urgent prior authorisation decision
  • $60 — Conditional transition period for documented prior approval under a new policy

Legal protection: A plan that misses the deadlines can be treated as having authorised the request · Documented prior approval can carry into a new policy for up to 60 days, subject to statutory transition and safety conditions

What it costs the family: Nothing.

The eligibility facts, as published

Plan type
state-regulated health benefit plans; NDPERS uniform group plans are expressly excluded, and private self-funded plans are outside state regulation
Effective
2026-01-01
Statute
NDCC ch. 26.1-36.12; SB 2280 (2025)

The trap: The clock starts when the plan has all the information it needs, so the useful question is "what are you still waiting for, and who from?" rather than "how long will this take?".

Where I read this

← Back to your options