North Dakota Legislature passes all rural health bills to close special session

The North Dakota Legislature on Friday passed all bills needed to accept federal Rural Health Transformation Program funding, closing the state's special session.

The Rural Health Transformation Program, created under the One Big Beautiful Bill Act, allocates $50 billion over five years nationwide to improve rural health care systems. States receive a minimum of $100 million each year under the program, with more money available based on the strength of their application.

In December, North Dakota was awarded $199 million in funding for 2026. HHS Commissioner Pat Traynor said the state will need to resubmit its application for funding to the Centers for Medicare and Medicaid Services, which administers the program, because the Legislature amended three policy bills that some of the state's awarded funding was contingent upon.

Sen. Kristin Roers, R-Fargo, who was responsible for the amendments to two of the rural health policy bills, said she was "very confident" that the amendments will not risk North Dakota's funding.

Roers said she was glad the lawmakers and HHS staff did the work to "really dig in and understand" the program. She said she felt that understanding would help the state moving into future sessions where the program will be discussed.

Once the state has received approval from the Centers for Medicare and Medicaid Services, HHS plans to start rolling out grant opportunities in February. Traynor encouraged providers, faith communities, schools and others to apply.

The funding must be spent by September 2027, and the deadline to allocate it is October.

Traynor said he was grateful to the coalition of lawmakers, HHS staff and Governor's Office staff that came together to get the bills passed and secure the funding for North Dakota.

"You can certainly feel the spirit and the energy ... the desire to help our neighbors become much healthier," Traynor said Friday at the end of the three-day special session.

The four policy bills drafted in the fall to ensure North Dakota received the maximum funding possible through the federal program passed through both chambers with overwhelming support and little debate. They were: 

• House Bill 1621 requires all schools to administer the Presidential Physical Fitness Test.

• Senate Bill 2401 requires physicians to have metabolic nutritional training -- training on how nutrition strategies and exercise improve health -- as part of their continuing education requirements.

• House Bill 1622 allows the state to join a physician assistant licensure compact, making it easier for physician assistants from other states in the compact to practice in North Dakota and vice versa.

• Senate Bill 2402 expands the scope of practice for pharmacists relating to laboratory testing and prescriptive authority.

House Bill 1623 appropriates the nearly $400 million in federal funding for 2026 and 2027, and lays out how much of the funding will be allocated to the state's four focus areas.

The only bill to draw debate Friday was Senate Bill 2402. Some House lawmakers said they were concerned about the power it gives pharmacists and stressed that testing and oversight would be necessary, but they still supported the bill.

Gov. Kelly Armstrong signed the five bills dealing with the program into law just after noon on Friday and lauded the efforts of everyone involved in applying for the program so far.

He said the bill signings were just the beginning.

"Nothing that the federal government gives you with a $200 million price tag ever moves this fast," he said. "Now it's our job to deliver. I think North Dakota can show the absolute model (of) how to implement this."

Armstrong said the speed and responsiveness of the federal government gave him hope for the allocation and implementation of the funding in the next year to go smoothly.

He said the program will change slightly in years to come as the internal infrastructure for the program is established and more opportunities arise that are not ready yet.

Armstrong said he was especially excited about funding telehealth infrastructure, mobile clinics in rural parts of the state, and promoting healthier lifestyles to combat chronic disease and support mental health.