Bills: SB2401, SB2402, SB2403, SB2404

Keywords: SB 2401, North Dakota, Century Code, occupational therapy, occupational therapy board, criminal history record check, background check, licensee investigation, physician continuing education, medical license renewal, nutrition education, metabolic health, chronic disease prevention, health occupation boards, medical board, licensure fee, audit response, disciplinary action, Title 43, board of medicine

Summary: The Senate convened with prayer, the Pledge of Allegiance, and a quorum present. It adopted the procedural employment committee report naming Senate staff for the special session. The chamber then took up several health-care and appropriations measures, first adopting amendments to Senate Bills 2401, 2402, and 2403 before moving them to final passage. Senate Bill 2401 passed 44-2 and requires physicians to complete at least one hour of continuing education in nutrition and metabolic health, part of a broader rural health care package. Senate Bill 2402 passed 46-0 after major amendments negotiated between the medical and pharmacy boards; as amended, it expands pharmacists’ prescriptive authority and therapeutic substitution in limited areas while excluding categories such as antidepressants, antipsychotics, chemotherapy agents, Schedule II drugs, biological products, and narrow therapeutic index drugs. Supporters said it would improve rural access and help secure rural health transformation funding, while questions focused on how pharmacist competence would be measured and enforced. Senate Bill 2403, also passed 46-0, creates a short-term medical facility emergency operating loan program through the Bank of North Dakota, reduced by amendment from $10 million to $5 million, to help a financially distressed rural hospital. Senators discussed the hospital’s mismanagement, the need for a bridge loan, and safeguards including a limited application window and expiration in 2027. Senate Bill 2404 passed 46-0 and provides supplemental appropriations to the Information Technology Department for ADA-related website accessibility compliance and to the Public Service Commission for additional legal costs in federal energy-rate litigation. The Senate then made announcements about a Highway Patrol safety presentation and filing deadlines, excused an absent member, and adjourned until the next morning.

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Summary: The committee first took up Senate Bill 2401, which would require physicians to complete continuing education on nutrition and metabolic health as part of the state’s rural health transformation effort. HHS supported the bill, saying it would help physicians better address chronic disease and preserve federal grant points tied to the state’s application. A member of the public also testified in favor, arguing that better nutrition education could improve diabetes outcomes and reduce costs. The committee then adopted an amendment to add the Board of Occupational Therapy Practice to the background-check statute so the occupational therapy compact could proceed, and it passed the bill as amended on a roll call vote. The committee next heard House Bill 1621, which would require the Presidential Fitness Physical Fitness Test in elementary, middle, and high school physical education courses. HHS said the bill was part of the rural health transformation application and could help preserve federal funding, but members raised many questions about the test’s criteria, adaptive options for students with disabilities, equipment needs, and whether the bill should apply to non-public schools. Senator Clemens offered an amendment to limit the requirement to public schools, but it failed. Senator Hogan then offered an amendment to clarify exemptions and allow DPI to align implementation with federal guidance; that amendment passed. A further amendment adding language allowing DPI to establish criteria for and exceptions to the test also passed. The committee then approved the bill as amended on a roll call vote. The committee also considered House Bill 1622, which joins North Dakota to the physician assistant licensure compact. HHS said the compact would improve access to care, especially in rural areas, support military families, and help preserve rural health transformation funding. Members noted the compact had been discussed in a prior session and that many earlier concerns had been resolved. After brief discussion about the compact process and its consistency with other interstate compacts, the committee voted to do pass the bill. Finally, the committee began Senate Bill 2402, which expands pharmacists’ prescriptive authority and therapeutic substitution powers. HHS and the Board of Pharmacy supported the bill as a way to improve access to care and maintain rural health transformation funding. Senator Roers introduced a detailed amendment negotiated with the Board of Medicine and Board of Pharmacy to narrow and clarify the bill, including notification requirements, limits on certain drug categories, and patient-protection language for therapeutic substitution. The Board of Pharmacy then testified in support of the broader bill and explained the CLIA-waived testing provisions and the repeal of the older, narrower pharmacist-testing language. The hearing and amendment discussion were still underway when the transcript ended.

Bills: HB1623

Keywords: HB 1623, North Dakota, rural health, rural health transformation program, medical facility infrastructure loan fund, medical facility infrastructure loan program, rural health loan program, Bank of North Dakota, Department of Health and Human Services, HHS, federal grant, health care infrastructure, rural hospitals, critical access hospitals, nonprofit health care providers, gap financing, loan fund, public health funding, healthcare financing, Medicaid

Summary: The committee first heard House Bill 1624, the “Universal Lunch Bill,” from Rep. Mike Nathie. He argued the proposal should be placed in Century Code rather than the Constitution so future legislatures can adjust it if state finances tighten, and said the bill would start the program a year earlier with a $65 million appropriation for one school year. DPI testified that the estimate did not include nonpublic schools that do not participate, and members questioned the impact on Title I, free-and-reduced applications, private-school accountability, breakfast mandates for schools that do not currently serve breakfast, and whether the funding could come from the DPI budget or other sources. Supporters, including North Dakota United, the North Dakota Catholic Conference, a pediatrician, and the American Heart Association, said universal meals improve student health and learning, reduce family costs, and are better handled in statute than by constitutional amendment. No opposition testimony was offered, and the chair closed the hearing for later work-session action. The committee then took up House Bill 1627, introduced by Rep. Tye Dressler, which would raise the income threshold for the state-funded school lunch program from 225% to 300% of poverty, with an estimated cost of about $7 million for 2026-27. Dressler said the bill is intended as a targeted, budget-friendly alternative to the ballot measure and emphasized that the state should maximize federal meal dollars while improving participation in the current program. Members questioned whether raising the threshold would actually increase utilization, whether a dollar amount would be clearer than a percentage, and how the change would affect federal reimbursements and application rates. DPI said it could quickly calculate additional percentage levels, and the chair closed the hearing, directing DPI to prepare more numbers for the work session. Finally, the committee opened Senate Bill 2403, presented by Sen. Schiable, to create a short-term bridge-loan program for financially distressed hospitals, centered on Jacobson Memorial Hospital in Elgin. The bill would authorize up to $5 million per loan, with a $10 million appropriation available on a first-come, first-served basis, and would run only through June 30, 2027. Schiable said the hospital’s debt and operating problems threaten local health care, ambulance service, and the community’s economy, and that the proposal was designed narrowly with Bank of North Dakota review to avoid creating a broad precedent. Committee members asked whether the appropriation could be reduced and whether the bank would still apply commercial feasibility and repayment standards; Schiable said yes, the bank would still evaluate the loan and could reject it if it was not sound.

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Summary: The Joint Policy Committee met to hear an overview of North Dakota’s Rural Health Transformation Program before taking up the related policy bills. Department of Health and Human Services staff explained that the state received a $198.9 million CMS award, with funding focused on four pillars: strengthening rural workforce, bringing care closer to home, connecting technology and data, and improving population health through prevention. They emphasized that the program is intended to benefit rural and frontier residents statewide, including areas near urban centers when the project serves rural patients, and that CMS approval, provider readiness, and sustainability will drive what can be funded. Committee members asked about how the program would treat border communities, frontier counties, urban providers serving rural patients, multilingual outreach, tribal consultation, and whether there would be information sessions for applicants. HHS said the website will include sign-up and translation features, more listening sessions and training will be offered, and a rural health tribal liaison will work alongside the existing Medicaid tribal liaison. Members also raised concerns about reimbursement timing, cash flow for providers, and whether projects in urban areas could qualify; HHS responded that urban projects may be eligible if they clearly benefit rural residents. The department then outlined the four policy bills tied to the grant scoring: nutrition continuing medical education for physicians, the presidential fitness test, the physician assistant compact, and pharmacist scope of practice. HHS said these policy actions were incentivized in the federal funding opportunity and that failure to pass them could reduce future funding. The committee did not take final action on the bills in this portion of the transcript and recessed for lunch before moving on.

Bills: HB1623

Keywords: HB 1623, North Dakota, rural health, rural health transformation program, medical facility infrastructure loan fund, medical facility infrastructure loan program, rural health loan program, Bank of North Dakota, Department of Health and Human Services, HHS, federal grant, health care infrastructure, rural hospitals, critical access hospitals, nonprofit health care providers, gap financing, loan fund, public health funding, healthcare financing, Medicaid

Summary: The committee heard House Bill 1623, the appropriations bill tied to North Dakota’s Rural Health Transformation Program, which is funded through a new federal rural health care grant. Senator Bekkedahl explained the bill’s background, the interim committee process that developed it, and the federal conditions attached to the award, including spending deadlines, administrative cost limits, and restrictions on uses such as new construction, supplanting existing funding, and certain other costs. Legislative staff then walked through the seven sections of the bill, including appropriation authority, transfer authority, contingent appropriations for pass-through grants, procurement and public improvement exemptions, recipient reporting, legislative reporting, and immediate effective date. Commissioner Traynor and HHS staff described how the department plans to implement the program, emphasizing that the funding is intended to improve rural access, workforce recruitment and retention, technology and data connectivity, and community health initiatives. They said the department will rely on local applications, technical assistance, templates, listening sessions, and partnerships with providers, schools, public health units, tribal entities, and other community groups. Members asked about reimbursement timing, upfront costs, administrative expenses, sustainability after the five-year grant period, and whether CTE centers, public health units, gyms, grocery stores, and other community partners could participate; the department said yes, within program rules and with a focus on measurable outcomes and sustainability. Several supporters testified in favor. Mental Health America of North Dakota and the Mental Health Advocacy Network supported the bill and urged investment in community-based mental health, crisis response, children’s services, peer support, and mobile crisis teams. HIA Health described the grant as a chance to expand home-based and hospice care, noting that rural providers already have workable models but need funding to scale them. A cybersecurity representative also supported the bill, warning that the large amount of health data and AI-related tools will require strong data protection and professional support. The hearing was closed with no opposition testimony, and the committee announced it would return later in the day for further work on the bill and other measures.

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Summary: The House convened in joint session for the special session of the 69th Legislative Assembly, with introductions of visiting officials and a moment of silence for former Governor Alan Olson. The chamber then escorted Lieutenant Governor Michelle Strind and Governor Kelly Armstrong, along with First Lady Kirstie Armstrong, to the rostrum. The governor’s remarks were ordered printed in the journal. Governor Armstrong addressed the special session’s single purpose: considering North Dakota’s $199 million first-year federal award under the rural health transformation program. He thanked legislators, HHS, tribal partners, providers, and community leaders for their work on the state’s CMS application, and said four bills helped improve the application score: requiring the presidential fitness test in PE courses, adding nutrition education to physicians’ continuing education, joining the physician assistant licensure compact, and expanding pharmacists’ scope of practice. He said he looked forward to signing those bills and the accompanying appropriation measure. The governor described the rural health plan as focused on four pillars: promoting wellness and healthy lifestyles, stabilizing the rural health workforce, expanding access through telehealth and mobile services, and using technology and data to improve care. He emphasized that the plan would avoid new buildings and unsustainable programs, and instead use federal funds for lasting, scalable reforms. He said the state could receive at least $500 million over five years, possibly more, and urged quick authorization and appropriation so the funding could be deployed responsibly. After the governor and lieutenant governor were escorted out, the joint session was dissolved. The House then returned to regular business, announced committee meetings, excused absent members, and adjourned until 8:30 a.m. on Thursday, January 22, 2026.

Bills: HB1621, HB1624, HB1623, HB1622, HB1625, HB1626, HB1627, HCR3038

Keywords: presidential physical fitness test, physical education, fitness assessment, student fitness, school curriculum, graduation requirements, elementary school, middle school, high school, public schools, nonpublic schools, superintendent of public instruction, exceptions, disability accommodations, North Dakota studies, computer science, cybersecurity, health education, concept-based fitness class, school standards

Summary: The North Dakota House convened in special session with prayer, the Pledge of Allegiance, and the reading of communications from the Secretary of State and Governor Kelly Armstrong certifying the special session call. The governor’s executive order said the session was called to act on funding for the Rural Health Transformation Program so the state could accept and appropriate federal funds and avoid interruptions to government services. Three new members, Representatives McNally, Scraw, and Timmons, were sworn in, and the roll showed 91 members present, establishing a quorum. The main business was a Rules Committee report outlining temporary special-session rules. The changes were designed to speed up floor action, including allowing second reading the same day a bill is reported from committee, final passage one day after first reading, and immediate transmission to the other chamber unless reconsideration is noticed. The report also replaced the regular standing committee structure with two joint committees: Joint Appropriations and Joint Policy, allowed remote testimony and remote member participation with approval, and limited bill introduction to Legislative Management-approved bills or bills approved by a two-thirds vote. Several deadline changes for resolutions and bill filing were also described, with some provisions delayed until the special session ends. The House adopted the Rules Committee report after a motion by Representative Bosch and no opposition. During announcements, the clerk listed the membership of the Joint Appropriations and Joint Policy committees, and the Highway Patrol announced safety sessions for legislators in the Rough Rider Room at 11 a.m. that day and the next day. The House then recessed until the joint session scheduled for 10 a.m. the following day.

Bills: SB2401, SB2402, SB2403, SB2404

Keywords: SB 2401, North Dakota, Century Code, occupational therapy, occupational therapy board, criminal history record check, background check, licensee investigation, physician continuing education, medical license renewal, nutrition education, metabolic health, chronic disease prevention, health occupation boards, medical board, licensure fee, audit response, disciplinary action, Title 43, board of medicine

Summary: The Senate convened in special session with prayer, the Pledge of Allegiance, and roll call establishing a quorum of 45 members present and two absent. The chamber received certification from the Secretary of State and the governor’s executive order calling the special session to address funding for the Rural Health Transformation Program and to act quickly to accept and appropriate federal funds. The main action was adoption of the procedural rules for the extraordinary session. Senator Klein explained the proposed rule changes, which were designed to speed up consideration of bills during the short session, including limits on bill introduction, same-day second reading and final passage, elimination of standing committees for the session, creation of a Joint Policy Committee and Joint Appropriations Committee, and authorization for remote testimony and limited remote participation. The procedural committee’s report on these rules was adopted without opposition. The Senate also adopted reports naming members to the Joint Policy Committee and Joint Appropriations Committee. Announcements noted that the Senate Employment Committee, Joint Policy Committee, and Joint Appropriations Committee would meet later that morning, that the Senate would not reconvene at 4 p.m., and that a Highway Patrol presentation on legislator safety would be held. The Senate then moved through the listed orders of business and recessed, planning to meet in joint session with the House before adjourning until Thursday, January 22, 2026.

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Summary: The committee opened with roll call and a review of special-session procedure: bills would be heard in filing order, with related school-lunch bills grouped together, and any bill advancing would require a motion, second, and majority vote to be introduced. Members also discussed that the committee was functioning much like a delayed-bills committee, with final referral to either Appropriations or Policy depending on the bill’s fiscal impact. The first major proposal was Senator Schibley’s bill to create a narrow, statewide Bank of North Dakota bridge-loan program for struggling nonprofit medical facilities, prompted by Jacobson Memorial Hospital’s financial crisis. He argued the hospital and surrounding EMS services could close without short-term help, while committee members questioned the added language, the population cap, the $10 million fund with $5 million per applicant limit, and whether the program could open the door to future requests. Representative Headland then presented two cleanup bills from the prior property-tax session: one to fix notice and tax-certification issues for local taxing districts, and another to correct how the primary residence credit is applied so taxpayers receive the full benefit rather than counties retaining part of the reimbursement. Members asked about township hearing timing, the estimated $10–15 million annual impact, and whether the credit issue could be fixed retroactively; Headland said the bill was intended to correct the problem going forward. Three school-lunch bills drew extensive discussion. Representative Vetter proposed a small administrative appropriation to add an FTE to help eligible families enroll in the existing free/reduced lunch program, saying the goal was to ensure needy children are signed up and that the state should not subsidize meals for wealthy families. Representative Nathe offered a broader bill mirroring the pending initiated measure but placing the program in statute instead of the Constitution, moving implementation up a year, and funding it with a one-time $65 million from the strategic investment fund; he said this would preserve legislative flexibility and avoid constitutional entrenchment. Representative Dressler proposed raising the state-funded eligibility threshold from 225% to 300% of poverty, arguing it would expand access while still preserving federal reimbursements and encouraging better enrollment systems. Members debated costs, future budget pressure, whether the bills set a precedent for responding to ballot measures, and whether the program should include breakfast and other operational details. Other proposals included Senator Powers’ bill to create a hyperbaric oxygen board and support rural access to hyperbaric chambers for wounds, concussions, PTSD, and other conditions; Representative Tolman’s reporting-requirements bill to force new or expanded programs to justify purpose, alternatives, evaluation methods, and full implementation costs; Representative Frelich’s bill addressing the ongoing redistricting litigation and what happens if the Supreme Court or lower courts alter the current map; and a bill requested by the Public Service Commission and ITD for FERC litigation support and ADA website/document compliance. The committee also heard a rural-health eligibility bill from Representative Twait aimed at steering federal rural health dollars toward rural providers, with questions focused on whether the mileage limits would exclude some communities. One Holocaust education item was deferred until the sponsor could be located.

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Summary: The committee first reviewed the 2024-25 tuition waiver report for the North Dakota University System. Staff explained that waivers were reported for degree-seeking students and broken out by residency, institution, and waiver type. Members asked about partial versus full waivers, institutional discretion, athletic waivers, and whether campuses have published guardrails or transparency requirements. Staff said most waivers are set by institutions, with some statutory and board-required categories, and that athletic waivers are a small share of total waiver dollars. The report showed total gross tuition of $354.5 million, tuition waived of $38.9 million, and 11,193 of 42,040 students receiving some waiver. Members also discussed how waivers affect net tuition revenue, housing and food collections, and whether campuses are using waivers strategically compared with scholarships and other funding sources. The committee then heard a presentation on tuition rates by campus and State Board policy. Staff explained the board’s tuition factors for resident, Minnesota reciprocity, contiguous-state/U.S. nonresident, and international students, and noted that campuses often seek exceptions based on program-specific competition and enrollment goals. Members asked whether rates are based on cost or competition, and staff said campuses typically bring forward estimates and market comparisons when requesting special rates. The presentation also reviewed general fund appropriations versus net tuition revenue by campus, and members discussed how local tuition decisions and waivers do not directly affect the state funding formula, though they do affect institutional revenue and reserves. Questions were also raised about the Higher Learning Commission’s financial composite indicator and how it differs from the more intuitive reserve and revenue figures. The committee next received a broad overview of non-higher-education entities affiliated with the State Board of Higher Education, beginning with NDSU agriculture-related units. Dr. Greg Lardy described the State Board of Agricultural Research and Education, the NDSU Extension Service, the Agricultural Experiment Station, and the branch research centers, emphasizing their statewide role in crop and livestock research, extension education, and county-based outreach. He outlined funding mixes for extension, the experiment station, and branch stations, noting that grants and contracts support both research and education, while the agronomy seed farm is self-funded through seed sales. Members asked about the new and vacant FTE pool, R1 research status, matching requirements for grants, and whether state appropriations count toward research expenditures. Dr. Lardy also highlighted major research impacts, including crop varieties, virtual fencing, AI-assisted weed control, and NDAWN weather data. The Northern Crops Institute and the Upper Great Plains Transportation Institute also presented. NCI described its role in market development, technical services, and education for regional agriculture, its governance through the Northern Crops Council, and its funding from state appropriations, other states, and earned revenue. Members asked about the source of out-of-state funding, intellectual property, and the institute’s international reach. UGPTI then outlined its transportation research, federal and state funding structure, and work on road and bridge condition assessments, travel demand modeling, and workforce training. No votes were taken during the portion of the meeting reflected in the transcript.

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Summary: Legislative Management met with a quorum, approved the July 11, 2025 minutes, and then considered recommendations from the Legislative Procedures and Arrangements Committee. Beth Dittes explained proposed special session rule changes, which largely mirror prior special session rules and are intended to speed floor action. The changes would allow faster second readings and transmission between chambers, replace regular standing committees with two joint committees for the special session—Joint Appropriations and Joint Policy—and limit bill introduction methods. The package also included delayed-effective-date changes for the next regular session, such as moving the agency and Supreme Court prefile deadline earlier and advancing several resolution deadlines. Liz Fordall then reviewed revisions to the legislative workplace harassment policy, including clarified definitions, longer intake and review deadlines, an option for informal resolution before a review panel, and clearer disclosure rules. The committee adopted the report and forwarded the rules and policy changes. The committee also approved tentative first-day special session agendas for both chambers, with a Speaker-requested revision to allow time to swear in new House members. Megan Gordon outlined the schedule: early Rules Committee meetings, morning floor sessions, a joint session for the governor’s State of the State, then meetings of the joint appropriations and policy committees, with optional later floor and committee time. Members discussed how the joint committees would handle bills and confirmed the process would mirror the prior special session. The agendas were adopted. Chairman Bekkedahl then reported for the Rural Health Transformation Committee, which had completed its work and recommended five bill drafts for the special session: a Presidential Physical Fitness Test requirement for schools, a nutrition component for physician continuing education, joining a physician assistant licensure compact, expanding pharmacist scope for lab testing and prescribing, and a two-year appropriations bill to cover the program through the next regular session. He explained the federal rural health transformation grant, the state’s application, funding restrictions, and the need to keep the bills aligned with CMS requirements to avoid funding reductions or clawbacks. DHS officials said the department would measure outcomes through required metrics, use templates for awards, and set up an Office of Health Transformation to track long-term impacts. The committee adopted the rural health report and forwarded the bills. Finally, members discussed special-session logistics. Legislative staff said employment committees would approve a limited number of staff, Legislative Management would serve as the delayed-bills committee, and a letter would be sent to legislators explaining the process and a suggested Friday noon drafting deadline for bills to be considered at the January 20 meeting. The committee also discussed how many bills might be introduced and how to assign the rural health bills to the House or Senate for origin. No formal vote was taken on those logistics, and the meeting adjourned with plans to reconvene on January 20.

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Summary: The Health Care Task Force reconvened to hear reports from its divisions. The Appropriations Division reviewed a draft bill appropriating $198 million in federal grant funds for the current year and another $198 million for the next grant year, authorizing DHS to transfer funds within its budget, allowing OMB to adjust federal fund authority for related grants, speeding procurement and bulk purchasing, requiring grant recipients to acknowledge the temporary nature of the funding, and mandating periodic reporting. After questions were answered to the division’s satisfaction, the committee voted to forward the appropriations bill draft to Legislative Management. The Policy Division then reviewed four bills. One would require the presidential physical fitness test to be included in high school physical education; another would require physicians to complete one hour of continuing education on nutrition and metabolic health each renewal cycle; a third would add physician assistants to the interstate licensure compact framework; and a fourth would authorize limited pharmacist prescriptive authority and therapeutic substitution. Members generally supported the first three measures and noted that the pharmacist bill had been amended in discussion but was left in its current form so stakeholders could comment before the special session. The division also discussed that all four policy bills were tied to the federal grant funding and that failure to pass them, or changing them in a way that reduced CMS scoring, could reduce or eliminate funding. Department officials confirmed that if any of the bills failed or were altered in a way that lowered the score, the state could lose money and could not make up the points elsewhere. Members raised concerns about the physical fitness bill, including possible exemptions for students with severe illnesses or physical limitations, and noted the need for DPI input. Leadership indicated the special session hearings would likely begin Wednesday morning. The committee then approved a motion for Legislative Council to prepare a committee report for Legislative Management and adjourned, noting the task force may need to remain available during the special session.

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Summary: The Higher Education Funding Committee met to discuss possible changes to North Dakota’s higher education funding formula, with a particular focus on separating the UND School of Medicine and Health Sciences MD program from the general formula. Dr. Jenkins outlined several options for the MD program, including a fixed-funding model, a hybrid model, or keeping it in the formula, and emphasized the need to preserve strong support for medical education while making future funding clearer. He also discussed efforts to increase the share of North Dakota students in the MD program through ND85, expanded recruiting, early acceptance pathways, MCAT prep, a four-plus-one program, and the Primary Care Accelerated Track, along with future cost pressures such as AI licensing and residency growth. The committee then reviewed a simplified funding model from the University System Office that would base funding more heavily on student FTE, credentials awarded, and a few incentive factors such as small institution and research adjustments. Members questioned the use of placeholder numbers, the lack of a clear methodology for the small institution and research factors, and whether the model would adequately account for differences among institutions, high-cost programs, and graduate education. Several members raised concerns that arbitrary factors would be hard to defend politically and could distort funding or create competition between schools, while others said the exercise was useful as a starting point for discussion. Alex presented a second alternative that kept the current SIP-code structure but increased CTE weighting, added a progressive economic size factor, and separated out the MD program. His model also added an on-campus face-to-face headcount component and a credentials component, with the intent of rewarding in-person enrollment and completions. Members questioned the use of headcount instead of FTE, how hybrid, online, dual-credit, and off-campus students would be treated, and why face-to-face enrollment was weighted more heavily than completion. No formal votes or final actions were taken; the committee instead continued discussion and asked members to provide direction on which elements, if any, should be developed further.

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Summary: The Appropriations Division met in a work session on the draft Rural Health Transformation appropriations bill, 25.1392.01000, with no public testimony taken. Legislative Council and the Department of Health and Human Services walked through the bill, which would appropriate about $397.8 million in federal grant funds over two federal fiscal years, provide transfer authority, allow certain federal funds to be used for salaries and wages without counting against existing transfer limits, and authorize OMB to adjust other agencies’ spending authority if they receive grant awards through HHS. The bill also includes several temporary statutory exemptions to help implement the program, plus recipient acknowledgement/reporting requirements, periodic reports to Legislative Management, and an immediate effective date upon filing. Committee discussion focused heavily on how the federal rural health transformation money can be used and administered. Department officials explained that CMS will review projects for allowability and sustainability, that the state has flexibility to move funds among categories, and that the grant is limited to 10% administrative costs. Members asked about whether the funding could support renovations, equipment, ambulances, bulk purchasing, food distribution, and other rural health ideas, and were told many details will depend on CMS approval and the eventual applications. Questions also addressed cash flow, timing of obligations and reimbursements, FTE funding, and whether grant recipients should be told the program will not continue beyond the federal period; officials said the language is meant to prevent expectations of automatic continuation, not to bar future legislative action. The committee also discussed the bill’s use of a two-year appropriation amount, with staff explaining that the state must appropriate enough authority to cover the federal grant cycle and that unused authority would lapse if the full amount is not received or spent. Members raised concerns about whether the bill’s language could limit creativity or future program design, but department officials and several members emphasized the need for flexibility because CMS may reject overly specific directives. After discussion, the committee voted to recommend the bill draft to the full committee; the motion carried on a roll call vote, and the chair said the full Joint Appropriations Committee would take up the bill at the special session next week.

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Summary: The committee reviewed four bill drafts for the Rural Health Transformation effort. The first required the presidential physical fitness test in PE classes; members asked about DPI and school support, then moved and approved the draft. The second required physicians to complete one hour of continuing education on nutrition and metabolic health each renewal cycle and included legislative intent encouraging other health boards to consider nutrition-related CE; it was approved after brief discussion. The third bill adopted the Physician Assistant Licensure Compact. Members discussed a separate issue involving occupational therapy compact background checks and whether that fix could be added now or would need to wait until later; the committee also discussed Board of Medicine input and the compact’s workforce benefits. The draft was moved forward to the full committee. The fourth bill expanded pharmacists’ prescriptive authority and therapeutic substitution. Legislative Council explained the draft, and Senator Roars proposed substantial amendments to narrow motion sickness, UTI, diabetes supply, and substitution provisions. Members debated whether to vote on amendments now or wait for the special session public hearing; concerns were raised about transparency, stakeholder input, and avoiding premature action. No amendment vote was taken, and the bill was left for later consideration. The committee then recessed until the next day.