# Title 23 — Health and Safety

## Chapter 23-16 — Licensing Medical Hospitals

### § 23-16-01. Licensure of medical hospitals and state hospitals.

After July 1, 1947, no person, partnership, association, corporation, limited liability company,
county or municipal corporation, or agency thereof, which maintains and operates organized
facilities for the diagnosis, treatment, or care of two or more nonrelated persons suffering from
illness, injury, or deformity or where obstetrical or other care is rendered over a period
exceeding twenty-four hours, may be established, conducted, or maintained in the state of North
Dakota without obtaining annually a license therefor in the manner hereinafter provided in
sections 23-16-02 and 23-16-03. Chiropractic hospitals, sanatoriums, American society of
addiction medicine level 3.7 substance use treatment programs licensed by the department of
health and human services that are independent from a medical hospital, and hospitals such as
those for unmarried mothers maintained and operated by the department of health and human
services are not required to obtain a license under this chapter.
In the case of emergency or transfer beds attached to and forming a part of a licensed
medical doctor's office, the department of health and human services has the right of inspection,
but no license may be required under the provisions of this chapter when the number of such
beds does not exceed four.
### § 23-16-01.1. Moratorium on expansion of long-term care bed capacity.

1. Notwithstanding sections 23-16-06 and 23-16-10, except when a facility reverts basic
care beds to nursing facility beds or relicenses nursing facility beds delicensed after
July 31, 2011, nursing facility beds may not be added to the state's licensed bed
capacity during the period between August 1, 2025, and July 31, 2029. A nursing
facility may not delicense nursing facility bed capacity, relicense nursing facility bed
capacity, convert licensed nursing bed capacity to basic care bed capacity, revert
licensed basic care bed capacity back to nursing facility bed capacity, or otherwise
reconfigure licensed nursing facility bed capacity more than two times in a
twelve-month period.
2. Transfer of licensed nursing facility bed capacity from a nursing facility to another
entity is permitted. The nursing facility may transfer the bed capacity either as nursing
facility bed capacity or basic care bed capacity. Transferred bed capacity must become
licensed by an entity within seventy-two months of transfer. Bed capacity transferred
as basic care bed capacity may not be reverted to nursing facility bed capacity at any
time. A receiving entity may transfer the received bed capacity to another entity within
the seventy-two-month period originally established at the time the nursing facility first
transferred the licensed nursing facility bed capacity. The subsequent receiving entity
must license the received bed capacity within the seventy-two-month period originally
established at the time of the first transfer.
3. A nursing facility may convert licensed nursing facility bed capacity to basic care. If the
converted beds remain in the same facility and are not transferred, the beds may
revert to nursing facility status after one year of licensure as basic care beds.
4. Nursing facility beds that are converted to basic care may be transferred as basic care
beds. However, upon the transfer, the basic care beds may not be relicensed as
nursing facility beds.
5. If a federally recognized tribal nation acquires nursing facility beds, the tribal facility
must meet state licensing requirements for those beds within seventy-two months of
acquisition. A tribal facility may seek to participate in the medical assistance programs.
Medical assistance payments may only be made to a Medicaid certified tribal facility
that agrees to participate and adhere to all federal and state requirements of the
medical assistance program, including participation, screening, ratesetting, and
licensing requirements.
6. A nursing facility, upon prior written notice to the department of health and human
services, may delicense a maximum of thirty percent of its licensed nursing facility bed
capacity and have the delicensed nursing facility held for a period of forty-eight

months. The total delicensed nursing facility bed capacity that may be held for a
nursing facility at no time may be greater than fifty percent of the number of currently
licensed beds in the nursing facility. Delicensed nursing facility bed capacity in excess
of fifty percent of the nursing facility's licensed capacity may not be held and is not
eligible for the provisions of subsection 7. Delicensed bed capacity not sold or
relicensed at the conclusion of the forty-eight-month holding period ceases to exist.
7. During the forty-eight-month holding period established at the time of delicensure,
delicensed nursing facility bed capacity that is being held for the nursing facility may
be:
a. Relicensed by the nursing facility. Relicensing of nursing facility bed capacity may
not occur for six months from the time of delicensure.
b. Transferred to another entity as nursing facility bed capacity or basic care bed
capacity. The receiving entity must license the transferred bed capacity as the
type of bed capacity transferred within a seventy-two-month period established at
the time of transfer. Bed capacity transferred as basic care bed capacity may not
be reverted to nursing facility bed capacity at any time. A receiving entity may
transfer the received bed capacity to another entity within the seventy-two-month
period established at the time of transfer. The subsequent receiving entity must
license the received bed capacity within the seventy-two-month period
established at the time of transfer.
c. Licensed as basic care beds by the same facility. If the licensed basic care beds
remain in the same facility and are not transferred, the beds may be reverted to
licensed nursing facility bed capacity after twelve months.
8. Notwithstanding any other provision of this section, a nursing facility bed transferred
before July 1, 2019, must be relicensed by the receiving entity within a
seventy-two-month period established at the time of transfer.
9. Notwithstanding any other provision of this section, a nursing facility bed in the
layaway program before July 1, 2019, may remain in the program for forty-eight
months from the time the bed was first laid away.
### § 23-16-02. Existing medical hospitals.

Institutions subject to this chapter which are already in operation at the time of enactment of
this chapter must be given a reasonable time, not to exceed one year from the date of the
enactment of this chapter, within which to comply with the rules, regulations, and minimum
standards provided for herein.
### § 23-16-03. Application for license - License fee.

Applicants for license shall file applications under oath with the department of health and
human services upon forms prescribed. Applications must be signed by the owner, or in the
case of a corporation by two of its officers, or in the case of a county or municipal unit by the
head of the governmental department having jurisdiction over it. Applications must set forth the
full name and address of the owner of the institution for which license is sought, the names of
the persons in control thereof, and such additional information as the department of health and
human services may require, including affirmative evidence of ability to comply with such
minimum standards, rules, and regulations as may be lawfully prescribed pursuant to this
section. An application for a license for facilities not owned by the state or its political
subdivisions must be accompanied by the following fees:
1. For each licensed acute care bed, ten dollars.
2. For each licensed skill care bed, ten dollars.
License fees collected pursuant to this section must be deposited in the department of health
and human services services operating fund in the state treasury and any expenditure from the
fund is subject to appropriation by the legislative assembly.

### § 23-16-04. Licenses.

Licenses issued hereunder expire one year after date of issuance or upon such uniform
dates annually, as the department of health and human services may prescribe by rule.
Licenses must be issued only for the premises and persons named in the application and are
not transferable or assignable. Licenses must be posted in a conspicuous place on the licensed
premises.
### § 23-16-05. Inspections, consultations, and approval of plans.

The department of health and human services shall make or cause to be made such
inspections as may be prescribed by regulation. The department of health and human services
may prescribe by regulations that any licensee or prospective applicant desiring to make a
substantial alteration or addition to its facilities or to construct new facilities shall, before
commencing such alteration, addition, or new construction, submit plans and specifications
therefor to the department of health and human services for preliminary inspection,
recommendation, and approval.
### § 23-16-06. Authority to issue, deny, suspend, or revoke licenses.

1. The department of health and human services shall issue licenses for the operation of
institutions subject to this chapter which are found to comply with the provisions of this
chapter and rules adopted by the department. The department of health and human
services may suspend or revoke licenses issued hereunder on any of the following
grounds:
a. Violation of any of the provisions of this chapter or the rules and regulations
promulgated pursuant thereto.
b. Permitting, aiding, or abetting the commission of any unlawful act.
c. Conduct or practices detrimental to the health or safety of patients and
employees of said institutions; provided that this provision may not be construed
to have any reference to practices authorized by law; and provided further that no
license may be suspended or revoked for any trivial violation.
2. No application for a license may be denied, or any licenses suspended or revoked,
except after a written notice to the applicant or licensee, served by registered or
certified mail, which notice must concisely state the grounds for such denial or for such
proposed suspension or revocation.
### § 23-16-07. Not applicable to certain laws.

This chapter may not be construed in any way to restrict or modify any law pertaining to the
placement and adoption of children or the care of unmarried mothers.
### § 23-16-08. Offering or advertising to dispose of infants prohibited.

No hospital providing maternity care may in any way offer to dispose of any child or
advertise that it will give children for adoption or hold itself out, directly or indirectly, as being
able to dispose of children, however, such hospitals may inform an unmarried mother of
child-placing agencies licensed by the department of health and human services.
### § 23-16-08.1. Access to pharmacist.

Irrespective of the type of distribution system used, no person may refuse to allow a
resident of a nursing home, as defined in subsection 3 of section 43-34-01, to choose a
pharmacist of the resident's choice for the compounding and dispensing of drugs pursuant to
chapter 43-15.
### § 23-16-09. Information confidential.

Information other than reports relating to vital statistics received by the department of health
and human services through inspection or otherwise, authorized under this chapter are
confidential and may not be disclosed publicly except in a proceeding involving the question of
license. No agent of the department of health and human services or of any board of health,

may disclose individually identifiable health information of such an institution obtained in the
course of a survey or inspection except in a judicial or administrative proceeding in response to
an order of a court or administrative tribunal.
### § 23-16-10. Appeal.

An appeal denying an application for a license to operate a medical hospital or related
institution, or suspending or revoking a license, or denying an application for a construction
project must be taken to the office of administrative hearings in the manner provided in chapter
28-32.
### § 23-16-11. Penalties.

1. Any person establishing, conducting, managing, or operating any institution subject to
this chapter, without first obtaining a license as required by this chapter, or who
violates any of the provisions of this chapter is guilty of an infraction.
2. In addition to any criminal sanctions that may be imposed pursuant to law, any person
maintaining or operating a nursing facility licensed by the department of health and
human services who is found guilty of knowingly violating any provision of this title or
any rules adopted under this title, or any person maintaining or operating a nursing
facility found to have deficiencies during a survey of the nursing facility, may be
assessed a civil penalty not to exceed one thousand dollars for each violation and for
each day the violation continues plus interest and any costs incurred by the
department of health and human services to enforce this penalty. This civil penalty
may be imposed by a court in a civil proceeding or by the department of health and
human services through an administrative hearing under chapter 28-32. If a civil
penalty levied by the department of health and human services after an administrative
hearing is not paid within thirty days after a final determination that a civil penalty is
owed, unless the determination of a civil penalty is appealed to a district court, the civil
penalty and any costs incurred by the department of health and human services to
enforce the penalty may be withheld from payments due to the person or nursing
facility from the department of health and human services. Any funds received as
penalties must be applied to protect residents of the nursing facility, to relocate
residents, to maintain operation of the nursing facility, and to reimburse residents for
loss of personal funds.
### § 23-16-12. Injunction.

The department of health and human services, in accordance with the laws of the state
governing injunctions and other process, may maintain an action in the name of the state
against any person, partnership, association, corporation, or limited liability company for
establishing, conducting, managing, or operating any hospital within the meaning of the chapter
without first having a license therefor as herein provided or without first obtaining from the
department of health and human services written approval of plans and specifications for major
alterations of, additions to, or construction of health facilities.
### § 23-16-13. Appropriation.

Repealed by omission from this code.
### § 23-16-14. Participation in abortion - Not mandatory.

No hospital, physician, nurse, hospital employee, nor any other person is under any duty, by
law or contract, nor may such hospital or person in any circumstances be required to participate
in the performance of an abortion, if such hospital or person objects to such abortion. No such
person or institution may be discriminated against because the person or institution so objects.
For purposes of this section, "abortion" means the act of using or prescribing any instrument,
medicine, drug, or any other substance, device, or means with the intent to terminate the
clinically diagnosable intrauterine pregnancy of a woman, including the elimination of one or
more unborn children in a multifetal pregnancy, with knowledge that the termination by those

means will with reasonable likelihood cause the death of the unborn child. Such use,
prescription, or means is not an abortion if done with the intent to save the life or preserve the
health of the unborn child; remove a dead unborn child caused by spontaneous abortion; or
treat a woman for an ectopic pregnancy.
### § 23-16-15. Umbilical cord blood donation.

1. Unless it is medically inadvisable, a hospital shall allow a pregnant patient to arrange
for the blood extracted from the umbilical cord of the patient's newborn child to be
donated to a public cord blood bank. A patient who agrees to donate cord blood to a
public cord blood bank may not be charged for the costs of collecting, storing, or
transporting the cord blood.
2. A hospital is not required to collect cord blood if in the professional judgment of a
licensed physician the collection of the cord blood would threaten the health of the
mother or newborn child. This section does not require a hospital or hospital
employee, including a physician, nurse, or other medical staff, to collect cord blood if
the collection of cord blood conflicts with the bona fide religious practices and beliefs
of the hospital or hospital employee. This section does not require a hospital to
arrange for the donation of blood extracted from umbilical cords.
### § 23-16-16. Treatment of victims of sexual assault.

1. As used in this section:
a. "Hospital" means an entity required to obtain a license under section 23-16-01.
b. "Sexual assault" has the same meaning as provided under section 12.1-20-07.
c. "Victim of sexual assault" means an individual who:
(1) States a sexual assault has been committed against the individual;
(2) Is accompanied by another individual who states a sexual assault has been
committed against the accompanied individual; or
(3) Hospital personnel or a sexual assault nurse examiner have reason to
believe is a victim of sexual assault.
2. A hospital may not require a victim of sexual assault to submit to a forensic
examination or to report the alleged sexual assault to law enforcement.
3. A hospital without staff specially trained to perform a sexual assault forensic
examination may coordinate with a community-based sexual assault nurse examiner
nurse program or develop a sexual assault examiner nurse program to ensure all
victims of sexual assault who want a sexual assault forensic examination or sexually
transmitted infection treatment receive that examination or treatment.
### § 23-16-17. Air ambulances - Informed Decisions - Publication.

1. Before a hospital refers a patient to an air ambulance service provider or initiates
contact with an air ambulance service provider for air transport of the patient, the
hospital shall inform the patient, or the patient's representative, of the air ambulance
service provider's health insurance network status for the purpose of allowing the
patient or the patient's representative to make an informed decision on choosing an air
ambulance service provider or form of transportation.
2. A hospital is presumed in compliance with subsection 1 if the hospital provides the
patient, or the patient's representative, the health insurance network status published
by the insurance department under subsection 4.
3. A hospital is exempt from complying with this section if the hospital determines and
documents that due to emergency circumstances, compliance might jeopardize the
health or safety of the patient.
4. At least quarterly, the insurance department shall publish on the insurance
department's website data regarding the health insurance network status of each air
ambulance service provider authorized to operate in the state.

### § 23-16-18. Maintenance of certification.

1. As used in this section:
a. "Continuing medical education" means continued postgraduate medical
education required by the North Dakota board of medicine intended to educate
medical professionals about new developments in the medical field.
b. "Maintenance of certification" means a process requiring periodic recertification
examinations or other activities to maintain specialty medical board certification.
Recertification may be provided by a medical professional organization, such as
one or more of the medical specialty boards of the American board of medical
specialties, the American osteopathic association, the national board of
physicians and surgeons, or any other board a credentialing entity recognizes.
c. "Physician" means a physician licensed under chapter 43-17.
d. "Specialty medical board certification" means certification by a board specializing
in one particular area of medicine and having requirements in addition to those
the North Dakota board of medicine requires to practice medicine.
2. Except as provided in subsection 5, a physician may not be denied staff privileges or
employment by a facility licensed under this chapter based solely on the physician's
decision to not participate in maintenance of certification.
3. This section does not prevent a facility's credentialing committee from requiring a
physician meet continuing medical education requirements as set by the physician's
licensing board.
4. This section does not prohibit a facility licensed under this chapter from requiring a
physician to undergo remedial or corrective courses or training as may be required by
a quality improvement committee.
5. A facility licensed under this chapter may differentiate between physicians based on a
physician's maintenance of certification if:
a. The facility's designation, certification, or accreditation is contingent on the facility
requiring a specific maintenance of certification by physicians seeking staff
privileges or credentialing at the facility and the differentiation is limited to those
physicians whose maintenance of certification is required for the facility's
designation, certification, or accreditation; or
b. The voting physician members of the facility's organized medical staff vote to
authorize the differentiation and the facility's governing body approves the vote.
(1) The facility may establish terms applicable to the facility's differentiation,
including appropriate grandfathering provisions, and allowing the
differentiation to be rescinded at any time by a vote of the voting physician
members of the facility's organized medical staff.
(2) This section may not be construed to require a new vote by the facility's
medical staff.
(3) Notwithstanding paragraph 2, this section may not be construed to abrogate
or supersede the ability of an organized medical staff and governing board
of an individual facility to determine the facility's credentialing and privileging
criteria with respect to board certification and the maintenance of
certification requirements.
6. A facility licensed under this chapter may not consider maintenance of certification
participation or status as a standard of care consideration in the course of a quality
improvement assessment.
### § 23-16-19. COVID-19 vaccination status - Access to care.

A hospital may not deny health care treatment or services to an individual based on that
individual's severe acute respiratory syndrome coronavirus 2, identified as SARS-CoV-2
(COVID-19) vaccination status.
