HB 1623

               Sixty-ninth Legislative Assembly of North Dakota
         In Special Session Commencing Wednesday, January 21, 2026
                                         HOUSE BILL NO. 1623
                                        (Legislative Management)
                                    (Joint Appropriations Committee)
AN ACT to provide an appropriation to the department of health and human services for federal rural
     health transformation program grant funds; to provide an appropriation to the Bank of North
     Dakota to administer a loan program; to provide for a transfer; to amend and reenact section
     6-09-47 of the North Dakota Century Code, relating to a rural health loan program under the
     medical facility infrastructure loan fund; to provide an exemption; to provide for a legislative
     management report; to provide for application; to provide a report; and to provide an effective
     date.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
    SECTION 1. APPROPRIATION - DEPARTMENT OF HEALTH AND HUMAN SERVICES -
FEDERAL RURAL HEALTH TRANSFORMATION PROGRAM. There is appropriated from other funds
derived from federal funds, not otherwise appropriated, the sum of $397,873,940, or so much of the
sum as may be necessary, to the department of health and human services for the federal rural health
transformation program, for the period beginning with the effective date of this Act and ending June 30,
2027.
     SECTION 2. EXEMPTION - LINE ITEM TRANSFERS. Notwithstanding section 54-16-04, the
director of the office of management and budget shall transfer funds between section 1 of this Act and
subdivisions 1, 2, 3, 4, 5, and 6 of section 1 of House Bill No. 1012, as approved by the sixty-ninth
legislative assembly, as requested by the department of health and human services. Any transfers from
section 1 of this Act to the salaries and wages block grant line item in subdivision 1 of section 1 of
House Bill No. 1012, as approved by the sixty-ninth legislative assembly, are not subject to the transfer
limitation provisions in section 4 of House Bill No. 1012. The department of health and human services
shall notify the legislative council of any transfer made pursuant to this section.
    SECTION 3. APPROPRIATION - BANK OF NORTH DAKOTA - FULL-TIME EQUIVALENT
POSITIONS. There is appropriated out of any moneys in the Bank of North Dakota operating fund in the
state treasury, not otherwise appropriated, the sum of $600,000, or so much of the sum as may be
necessary, to the Bank of North Dakota for the purpose of administering a rural health loan program for
the period beginning with the effective date of this Act and ending June 30, 2027. The Bank is
authorized four full-time equivalent positions to administer the rural health loan program.
     SECTION 4. TRANSFER - BANK OF NORTH DAKOTA PROFITS TO MEDICAL FACILITY
INFRASTRUCTURE LOAN FUND. The Bank of North Dakota shall transfer up to $40,000,000 from the
Bank's current earnings and undivided profits to the medical facility infrastructure loan fund during the
period beginning with the effective date of this Act and ending June 30, 2027. Funding transferred under
this section may be used only for the rural health loan program.
    SECTION 5. EXEMPTION - CONTINGENT AUTHORIZATION TO INCREASE APPROPRIATION
AUTHORITY. If the department of health and human services awards federal rural health
transformation program funds appropriated in section 1 of this Act to another state agency or institution,
notwithstanding any other provision of law, the office of management and budget may adjust the state
agency or institution's federal funds appropriation authority by the amount of the award during the
period beginning with the effective date of this Act and ending June 30, 2027. The office of
management and budget shall notify the legislative council of any appropriation adjustments made
pursuant to this section.
                                       H. B. NO. 1623 - PAGE 2
    SECTION 6. AMENDMENT. Section 6-09-47 of the North Dakota Century Code is amended and
reenacted as follows:
   6-09-47. Medical facility infrastructure loan fund - Medical facility infrastructure loan
program - Rural health loan program - Continuing appropriation - Audit and costs of
administration.
   1.   The Bank of North Dakota shall administer a medical facility infrastructure loan program to
        provide loans to medical facilities to conduct construction that improves the health care
        infrastructure in the state or improves access to existing nonprofit health care providers in the
        state. The construction project may include land purchases and may include purchase, lease,
        erection, or improvement of any structure or facility to the extent the governing board of the
        health care facility has the authority to authorize such activity.
   2.   In order to be eligible under thisthe medical facility infrastructure loan program, the applicant
        must be the governing board of the health care facility which shall submit an application to the
        Bank. The application must:
        a.   Detail the proposed construction project, which must be a project of at least one million
             dollars and which is expected to be utilized for at least thirty years;
        b.   Demonstrate the need and long-term viability of the construction project; and
        c.   Include financial information as the Bank may determine appropriate to determine
             eligibility, such as whether there are alternative financing methods.
   3.   A medical facility infrastructure loan provided under this section:
        a.   May not exceed the lesser of fifteen million dollars or seventy-five percent of the actual
             cost of the project;
        b.   Must have an interest rate equal to two percent; and
        c.   Must provide a repayment schedule of no longer than twenty-five years.
   4.   A recipient of a medical facility infrastructure loan under this section shall complete the
        financed construction project within twenty-four months of approval of the loan. Failure to
        comply with this subsection may result in forfeiture of the entire loan received under this
        section.
   5.   The Bank shall administer a rural health loan program to provide short-term gap financing to
        grant recipients under the federal rural health transformation program with approved projects
        and a demonstrated financial need.
        a.   To be eligible for a rural health loan under this subsection, the applicant:
             (1)   Must be approved for a grant by the department of health and human services and
                   the centers for Medicare and Medicaid services, as applicable, under the federal
                   rural health transformation program based on policies developed by the department
                   of health and human services.
             (2)   Provide information as requested by the Bank, including information substantiating
                   a demonstrated financial need and evidence of project approval from the
                   department of health and human services under the federal rural health
                   transformation program.
        b.   A loan under this subsection must have:
             (1)   An annual interest rate that does not exceed two percent;
                                        H. B. NO. 1623 - PAGE 3
              (2)   A term that complies with the criteria established by the department of health and
                    human services, in accordance with the federal rural health transformation program,
                    and does not exceed three years.
         c.   From the repayment of loans under this subsection, the principal portion must be used to
              replenish the Bank's profits which were transferred to the fund for the loans under this
              program, and interest portion must be deposited in the fund.
    6.   The medical facility infrastructure loan fund is a special fund in the state treasury. This fund is
         a revolving fund. All moneys transferred into the medical facility infrastructure fund, interest on
         moneys in the fund, and collections of principal and interest on loans from the fund are
         appropriated to the Bank on a continuing basis for the purpose of providing loans under this
         section.
    6.   Funds in the medical facility infrastructure
    7.   Moneys in the fund may be used for loans as provided under this section and to pay the costs
         of administration of the fund. Annually, the Bank may deduct a service fee for administering
         the medical facility infrastructure fund maintained under this section.
  7.8.   The medical facility infrastructure fund must be audited in accordance with section 6-09-29.
         The cost of the audit and any other actual costs incurred by the Bank on behalf of the fund
         must be paid from the fund.
  8.9.   The Bank shall deposit medical facility infrastructure loan repayment fundsrepayments in the
         medical facility infrastructure fund.
   SECTION 7. APPLICATION - EXEMPTION - FEDERAL RURAL HEALTH TRANSFORMATION
PROGRAM.
    1.   Section 54-27-12 does not apply to the erection or improvement of any public building or
         structure or the purchase of real property utilizing funding appropriated in section 1 of this Act.
    2.   Notwithstanding chapter 54-44.7, an agency or governing body may use the process outlined
         in section 37-10-03.6 for consultants in the areas of architecture, engineering, construction
         management, land surveying, and related matters when using the funding appropriated in
         section 1 of this Act for public improvements to meet the requirements of section 48-01.2-02.
    3.   Equipment or supplies purchased by the state with the funding appropriated in section 1 of this
         Act may be transferred to other entities or individuals in accordance with the requirements of
         the federal rural health transformation program.
    4.   Notwithstanding subsection 7 of section 54-44.4-13, cooperative purchasing may be made
         available to entities eligible to receive funding appropriated in section 1 of this Act in
         accordance with the requirements of the federal rural health transformation program.
    5.   Section 32-12.2-15 does not apply to any routine or standardized products that contain
         adhesive contract terms in shrink wrap documents, third-party end user licenses, or click-
         through agreements that are not consistent with section 32-12.2-15 for purchases using
         funding appropriated in section 1 of this Act if the purchase involves training, training and
         testing materials, reference materials, access to online information, online services,
         memberships, licensure, conferences, or travel, and the purchase or use does not require the
         disclosure of confidential information or personally identifiable information as defined in
         chapter 51-30 and does not impact data or system security. For purposes of this section,
         "routine or standardized products" means products commercially available to the public.
   SECTION 8. GRANT RECIPIENT ACKNOWLEDGMENT AND REPORTING. The funds
appropriated in section 1 of this Act are limited duration federal funds allocated to the state through the
                                       H. B. NO. 1623 - PAGE 4
federal rural health transformation program. The department of health and human services shall require
grant recipients to acknowledge in any grant agreement that the funding awarded is from funding that
will not continue beyond the duration of the federal rural health transformation program. The department
may require grant recipients to submit process and outcome measures to the department for programs
and services receiving funds appropriated in section 1 of this Act.
     SECTION 9. LEGISLATIVE MANAGEMENT REPORT. During the remainder of the 2025-26
interim, the department of health and human services shall provide periodic reports to the legislative
management regarding the status of funding allocations, programs, outcomes, and other requested
information associated with the federal rural health transformation program grant.
    SECTION 10. EFFECTIVE DATE. This Act becomes effective immediately upon its filing with the
secretary of state.
                                         H. B. NO. 1623 - PAGE 5
                        ____________________________  ____________________________
                        Speaker of the House  President of the Senate
                        ____________________________  ____________________________
                        Chief Clerk of the House  Secretary of the Senate
This certifies that the within bill originated in the House of Representatives of the Sixty-ninth Legislative
Assembly of North Dakota and is known on the records of that body as House Bill No. 1623.
House Vote:       Yeas 90  Nays 2  Absent 2
Senate Vote:      Yeas 46  Nays 0  Absent 1
                                                                      ____________________________
                                                                      Chief Clerk of the House
Received by the Governor at ________M. on _____________________________________, 2026.
Approved at ________M. on __________________________________________________, 2026.
                                                                      ____________________________
                                                                      Governor
Filed in this office this ___________day of _______________________________________, 2026,
at ________ o’clock ________M.
                                                                      ____________________________
                                                                      Secretary of State