House File 2635 - Introduced HOUSE FILE 2635 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HF 2438) A BILL FOR An Act relating to health carriers and payment of claims, 1 audits, and standards of conduct; prior authorizations 2 and utilization review organizations; and providing civil 3 penalties and including applicability provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5772HV (1) 91 nls/ko

H.F. 2635 DIVISION I 1 HEALTH INSURANCE TRADE PRACTICES 2 Section 1. Section 507B.4, subsection 3, paragraph j, 3 subparagraph (15), Code 2026, is amended to read as follows: 4 (15) Failing to comply with the procedures for auditing 5 claims submitted by health care providers as set forth in 6 section 507B.15 or as otherwise provided by rule of the 7 commissioner. However, this subparagraph shall have no 8 applicability to liability insurance, workers’ compensation or 9 similar insurance, automobile or homeowners’ medical payment 10 insurance, disability income, or long-term care insurance. 11 Sec. 2. Section 507B.4, subsection 3, Code 2026, is amended 12 by adding the following new paragraphs: 13 NEW PARAGRAPH . w. Standards of conduct. Any violation of 14 section 507B.16 by a health carrier. 15 NEW PARAGRAPH . x. Prior authorization —— peer review. Any 16 violation of section 514F.8A by a utilization review 17 organization or a health carrier. 18 Sec. 3. Section 507B.4A, subsection 2, paragraph a, Code 19 2026, is amended by striking the paragraph and inserting in 20 lieu thereof the following: 21 a. An insurer shall comply with all of the following: 22 (1) An insurer shall either accept and pay or deny a clean 23 claim no later than thirty calendar days after the date the 24 insurer receives an electronic claim submission, or no later 25 than forty-five calendar days after the date the insurer 26 receives a claim submitted on paper. 27 (2) After the date of payment of a clean claim, an insurer 28 shall not retroactively deny, reduce, or recoup payment of the 29 claim unless the insurer first provides written notice and 30 evidence of any of the following to the health care provider 31 that submitted the claim: 32 (a) The claim submission included a misrepresentation. 33 (b) The claim submission was fraudulent. 34 (c) The claim submission was a duplicate submission of a 35 -1- LSB 5772HV (1) 91 nls/ko 1/ 16

H.F. 2635 claim for which the insurer previously paid. 1 Sec. 4. Section 507B.4A, subsection 2, Code 2026, is amended 2 by adding the following new paragraph: 3 NEW PARAGRAPH . 0c. For purposes of this subsection, 4 “insurer” includes all of the following: 5 (1) An insurer providing accident and sickness insurance 6 under chapter 509, 514, or 514A; a health maintenance 7 organization; or another entity providing health insurance or 8 health benefits subject to state insurance regulation. 9 (2) The medical assistance program under chapter 249A and 10 the healthy and well kids in Iowa (Hawki) program under chapter 11 514I. 12 (3) A managed care organization acting pursuant to a 13 contract with the department of health and human services to 14 administer the medical assistance program under chapter 249A, 15 or the healthy and well kids in Iowa (Hawki) program under 16 chapter 514I. 17 Sec. 5. NEW SECTION . 507B.15 Health carriers —— audits and 18 claim submissions. 19 1. As used in this section, unless the context otherwise 20 requires: 21 a. “Audit” means a review, investigation, or request for 22 additional documentation by a health carrier before or after 23 issuing payment on a clean claim to a health care provider. 24 b. “Clean claim” means a properly completed paper or 25 electronic billing instrument containing all reasonably 26 necessary information that does not involve coordination of 27 benefits for third-party liability, preexisting condition 28 investigations, or subrogation, and that does not involve 29 the existence of particular circumstances requiring special 30 treatment that prevents a prompt payment from being made. 31 c. “Health care provider” means the same as defined in 32 section 514J.102. 33 d. “Health carrier” means an entity subject to the 34 insurance laws and regulations of this state, or subject 35 -2- LSB 5772HV (1) 91 nls/ko 2/ 16

H.F. 2635 to the jurisdiction of the commissioner, including an 1 insurance company offering sickness and accident plans, a 2 health maintenance organization, a nonprofit health service 3 corporation, a plan established pursuant to chapter 509A 4 for public employees, or any other entity providing a plan 5 of health insurance, health care benefits, or health care 6 services. “Health carrier” includes the following: 7 (1) The medical assistance program under chapter 249A and 8 the healthy and well kids in Iowa (Hawki) program under chapter 9 514I. 10 (2) A managed care organization acting pursuant to a 11 contract with the department of health and human services to 12 administer the medical assistance program under chapter 249A, 13 or the healthy and well kids in Iowa (Hawki) program under 14 chapter 514I. 15 2. If a health carrier conducts an audit of a clean claim 16 submitted by a health care provider, the health carrier 17 shall reimburse the health care provider for the reasonable 18 administrative costs incurred and documented by the health care 19 provider to respond to the audit, including but not limited to 20 staff time, copying, and record retrieval. 21 3. a. A health carrier that conducts an audit shall notify 22 the health care provider that submitted the clean claim of the 23 initiation of the audit no later than fifteen calendar days 24 after the date the health carrier selects the clean claim for 25 audit. 26 b. A health carrier shall complete an audit of a clean claim 27 and issue a determination on the clean claim to the health 28 care provider that submitted the clean claim no later than 29 forty-five calendar days after the date that the health carrier 30 receives all requested documentation regarding the clean claim 31 from the health care provider. 32 c. A health care provider that submitted a clean claim 33 that is the subject of an audit by a health carrier, and that 34 receives an adverse determination regarding the clean claim, 35 -3- LSB 5772HV (1) 91 nls/ko 3/ 16

H.F. 2635 may appeal the adverse determination no later than thirty 1 calendar days after the date the health care provider receives 2 the audit determination. 3 d. A health carrier shall consider an appeal under 4 subparagraph “c” , and issue a final determination on the clean 5 claim that is the subject of the appeal, no later than fourteen 6 calendar days after the date the health carrier receives notice 7 of the appeal. 8 e. If a health carrier violates this subsection, the clean 9 claim shall be automatically approved by the health carrier and 10 promptly paid, including interest at the rate of ten percent 11 per annum. 12 4. a. A violation of this section by a health carrier 13 shall constitute an unfair method of competition or unfair or 14 deceptive act or practice under section 507B.4. 15 b. A health carrier that violates this section shall be 16 subject to civil penalties under section 505.7A. 17 c. In any action brought by a health care provider for a 18 violation of this section, the health care provider shall be 19 entitled to recover costs of litigation, including reasonable 20 attorney fees and other litigation expenses incurred by the 21 health care provider, regardless of whether the health care 22 provider prevails in such action. 23 5. The commissioner shall adopt rules pursuant to chapter 24 17A to administer and enforce this section. 25 6. a. This section shall not apply to a claim that is under 26 active fraud investigation by a state or federal authority. 27 b. This section shall not apply to a federal program where 28 audits are mandated by federal law. 29 Sec. 6. NEW SECTION . 507B.16 Health carriers —— standards 30 of conduct. 31 1. As used in this section: 32 a. “Health care provider” means the same as defined in 33 section 514J.102. 34 b. “Health carrier” means an entity subject to the 35 -4- LSB 5772HV (1) 91 nls/ko 4/ 16

H.F. 2635 insurance laws and regulations of this state, or subject 1 to the jurisdiction of the commissioner, including an 2 insurance company offering sickness and accident plans, a 3 health maintenance organization, a nonprofit health service 4 corporation, a plan established pursuant to chapter 509A 5 for public employees, or any other entity providing a plan 6 of health insurance, health care benefits, or health care 7 services. “Health carrier” includes the following: 8 (1) The medical assistance program under chapter 249A and 9 the healthy and well kids in Iowa (Hawki) program under chapter 10 514I. 11 (2) A managed care organization acting pursuant to a 12 contract with the department of health and human services to 13 administer the medical assistance program under chapter 249A, 14 or the healthy and well kids in Iowa (Hawki) program under 15 chapter 514I. 16 2. A health carrier shall not impose on a health care 17 provider, directly or indirectly, any financial penalty, 18 reimbursement reduction, or administrative fee, or terminate a 19 health care provider’s participation in the health carrier’s 20 network, based on the health care provider’s referral to, or 21 affiliation with, an out-of-network health care provider. 22 3. A health carrier shall not interfere with, or participate 23 in any capacity in, a health care provider’s decisions 24 regarding staffing and referral, except as otherwise provided 25 by law. 26 4. A health carrier shall not offer, attempt to enforce, 27 or enforce an agreement, or an amendment to an agreement, with 28 a health care provider without providing an opportunity for 29 negotiation. A contract term that imposes an unreasonable or 30 unconscionable obligation on a health care provider shall be 31 void and unenforceable. 32 5. a. A violation of this section by a health carrier 33 shall constitute an unfair method of competition or unfair or 34 deceptive act or practice under section 507B.4. 35 -5- LSB 5772HV (1) 91 nls/ko 5/ 16

H.F. 2635 b. A health carrier that violates this section shall be 1 subject to civil penalties according to section 505.7A. 2 c. In any action brought by a health care provider against 3 a health carrier for a violation of this section, the health 4 care provider shall be entitled to recover costs of litigation, 5 including reasonable attorney fees and other expenses incurred 6 by the health care provider in the course of the litigation, 7 regardless of whether the health care provider prevails in such 8 action. 9 6. The commissioner shall adopt rules pursuant to chapter 10 17A to administer and enforce this section. 11 DIVISION II 12 PRIOR AUTHORIZATIONS 13 Sec. 7. NEW SECTION . 514F.8A Prior authorizations —— peer 14 review. 15 1. For purposes of this section: 16 a. “Clinical peer” means a health care professional that 17 meets all of the following requirements: 18 (1) The health care professional practices in the same or 19 similar specialty as the health care provider that requested 20 a prior authorization. 21 (2) The health care professional has experience managing 22 the specific medical condition or administering the health care 23 service that is the subject of the prior authorization request. 24 (3) The health care professional is employed by or 25 contracted with the utilization review organization or health 26 carrier to which a health care provider submitted a request for 27 prior authorization. 28 b. “Covered person” means the same as defined in section 29 514F.8. 30 c. “Downgrade” means a decision by a health carrier 31 or utilization review organization to change an expedited 32 or urgent request for prior authorization to a standard 33 determination, or otherwise modify a health care service that 34 is the subject of a request for prior authorization to a 35 -6- LSB 5772HV (1) 91 nls/ko 6/ 16

H.F. 2635 lower-level health care service. 1 d. “Health care professional” means the same as defined in 2 section 514J.102. 3 e. “Health care provider” means the same as defined in 4 section 514F.8. 5 f. “Health care services” means the same as defined in 6 section 514F.8. 7 g. “Health carrier” means an entity subject to the 8 insurance laws and regulations of this state, or subject 9 to the jurisdiction of the commissioner, including an 10 insurance company offering sickness and accident plans, a 11 health maintenance organization, a nonprofit health service 12 corporation, a plan established pursuant to chapter 509A 13 for public employees, or any other entity providing a plan 14 of health insurance, health care benefits, or health care 15 services. “Health carrier” includes the following: 16 (1) The medical assistance program under chapter 249A and 17 the healthy and well kids in Iowa (Hawki) program under chapter 18 514I. 19 (2) A managed care organization acting pursuant to a 20 contract with the department of health and human services to 21 administer the medical assistance program under chapter 249A, 22 or the healthy and well kids in Iowa (Hawki) program under 23 chapter 514I. 24 h. “Physician” means a doctor of medicine and surgery, or a 25 doctor of osteopathic medicine and surgery, licensed in this 26 state. 27 i. “Prior authorization” means the same as defined in 28 section 514F.8. 29 j. “Qualified reviewer” means a physician that meets all of 30 the following requirements: 31 (1) The physician practices in the same or a similar 32 specialty as the health care provider that requested a prior 33 authorization. 34 (2) The physician has the training and expertise to treat 35 -7- LSB 5772HV (1) 91 nls/ko 7/ 16

H.F. 2635 the specific medical condition that is the subject of a 1 request for prior authorization, including sufficient knowledge 2 to determine whether the health care service that is the 3 subject of the request is medically necessary or clinically 4 appropriate. 5 (3) The physician is employed by or contracted with 6 the utilization review organization or health carrier to 7 which a health care provider submitted a request for prior 8 authorization. 9 k. “Utilization review organization” means the same as 10 defined in section 514F.8. 11 2. A utilization review organization shall not deny or 12 downgrade a request for prior authorization unless all of the 13 following requirements are met: 14 a. The decision to deny or downgrade the request is made by 15 either of the following: 16 (1) A qualified reviewer, if the health care provider 17 requesting prior authorization is a physician. 18 (2) A clinical peer, if the health care provider requesting 19 prior authorization is not a physician. 20 b. The utilization review organization provides the health 21 care provider that requested the prior authorization all of the 22 following: 23 (1) A written statement that cites the specific reasons 24 for the denial or downgrade, including any coverage criteria 25 or limits, or clinical criteria, that the utilization review 26 organization considered or that was the basis for the denial 27 or downgrade. The written statement shall be signed by either 28 of the following: 29 (a) The qualified reviewer that made the denial or downgrade 30 determination, if the health care provider that requested prior 31 authorization is a physician. 32 (b) The clinical peer that made the denial or downgrade 33 determination, if the health care provider that requested prior 34 authorization is not a physician. 35 -8- LSB 5772HV (1) 91 nls/ko 8/ 16

H.F. 2635 (2) A written explanation of the utilization review 1 organization’s appeals process. The utilization review 2 organization shall also provide the written explanation to the 3 covered person for whom prior authorization was requested. 4 (3) A written attestation that is either of the following: 5 (a) If the health care provider that requested prior 6 authorization is a physician, a written attestation that 7 the qualified reviewer who made the denial or downgrade 8 determination practices in the same or a similar specialty as 9 the health care provider, and has the requisite training and 10 expertise to treat the medical condition that is the subject 11 of the request for prior authorization, including sufficient 12 knowledge to determine whether the health care service is 13 medically necessary or clinically appropriate. The attestation 14 shall include the qualified reviewer’s name, national provider 15 identifier, state medical license number, board certifications, 16 specialty expertise, and educational background. 17 (b) If the health care provider that requested prior 18 authorization is not a physician, a written attestation 19 that the clinical peer who made the denial or downgrade 20 determination practices in the same or a similar specialty as 21 the health care provider, and the clinical peer has experience 22 managing the specific medical condition or administering 23 the health care service that is the subject of the request 24 for prior authorization. The attestation shall include the 25 clinical peer’s name, national provider identifier, state 26 medical license number, board certifications, specialty 27 expertise, and educational background. 28 3. At the request of the requesting health care provider, a 29 utilization review organization that denies a request for prior 30 authorization shall, no later than seven business days after 31 the date that the utilization review organization notifies 32 the requesting health care provider of the denial, conduct a 33 consultation either in person or remotely, as follows: 34 a. Between the health care provider and a qualified 35 -9- LSB 5772HV (1) 91 nls/ko 9/ 16

H.F. 2635 reviewer, if the health care provider requesting prior 1 authorization is a physician. 2 b. Between the health care provider and a clinical peer, if 3 the health care provider requesting prior authorization is not 4 a physician. 5 4. a. If a utilization review organization’s decision to 6 deny or downgrade a request for prior authorization is appealed 7 by the requesting health care provider or covered person, the 8 appeal shall be conducted by either of the following: 9 (1) A qualified reviewer, if the health care provider 10 requesting prior authorization is a physician. 11 (2) A clinical peer, if the health care provider requesting 12 prior authorization is not a physician. 13 b. A qualified reviewer or clinical peer involved in the 14 initial denial or downgrade determination of a request for 15 prior authorization that is the subject of an appeal shall not 16 conduct the appeal. 17 c. When conducting an appeal of a request for prior 18 authorization, the qualified reviewer or clinical peer shall 19 consider the known clinical aspects of the health care services 20 under review, including but not limited to medical records 21 relevant to the covered person’s medical condition that 22 is the subject of the health care services for which prior 23 authorization is requested, and any relevant medical literature 24 submitted by the health care provider as part of the appeal. 25 5. a. A violation of this section by a utilization review 26 organization or a health carrier shall constitute an unfair 27 method of competition or unfair or deceptive act or practice 28 under section 507B.4. 29 b. A utilization review organization or a health carrier 30 that violates this section shall be subject to civil penalties 31 according to section 505.7A. 32 c. In any action brought by a health care provider against 33 a utilization review organization or a health carrier for a 34 violation of this section, the health care provider shall be 35 -10- LSB 5772HV (1) 91 nls/ko 10/ 16

H.F. 2635 entitled to recover costs of litigation, including reasonable 1 attorney fees and other expenses incurred by the health care 2 provider in the course of the litigation, regardless of whether 3 the health care provider prevails in such action. 4 6. The commissioner of insurance may adopt rules pursuant to 5 chapter 17A to administer this section. 6 Sec. 8. NEW SECTION . 514F.8B Prior authorizations —— 7 exemptions. 8 1. For purposes of this section: 9 a. “Covered person” means the same as defined in section 10 514F.8. 11 b. “Health benefit plan” means the same as defined in 12 section 514J.102. 13 c. “Health care professional” means the same as defined in 14 section 514J.102. 15 d. “Health carrier” means an entity subject to the 16 insurance laws and regulations of this state, or subject 17 to the jurisdiction of the commissioner, including an 18 insurance company offering sickness and accident plans, a 19 health maintenance organization, a nonprofit health service 20 corporation, a plan established pursuant to chapter 509A 21 for public employees, or any other entity providing a plan 22 of health insurance, health care benefits, or health care 23 services. “Health carrier” includes the following: 24 (1) The medical assistance program under chapter 249A and 25 the healthy and well kids in Iowa (Hawki) program under chapter 26 514I. 27 (2) A managed care organization acting pursuant to a 28 contract with the department of health and human services to 29 administer the medical assistance program under chapter 249A, 30 or the healthy and well kids in Iowa (Hawki) program under 31 chapter 514I. 32 e. “Prior authorization” means the same as defined in 33 section 514F.8. 34 f. “Utilization review” means the same as defined in section 35 -11- LSB 5772HV (1) 91 nls/ko 11/ 16

H.F. 2635 514F.4, subsection 3. 1 2. A health carrier shall not require prior authorization 2 for, or impose additional utilization review requirements on, a 3 covered person for any of the following: 4 a. A cancer-related screening or cancer-related preventative 5 health care service if the cancer-related screening or 6 cancer-related service is recommended by the covered person’s 7 health care professional based on the most recently updated 8 national comprehensive cancer network clinical practice 9 guidelines in oncology. 10 b. Diagnosis and treatment of a health condition that 11 develops or becomes evident in a covered person while the 12 covered person is receiving treatment at an inpatient facility, 13 and the health condition is reasonably determined by a health 14 care professional to be a life threatening condition unless the 15 covered person receives immediate assessment and treatment. 16 3. The commissioner of insurance may adopt rules pursuant to 17 chapter 17A to administer this section. 18 Sec. 9. APPLICABILITY. This division of this Act applies 19 to all of the following: 20 1. Health benefit plans delivered, issued for delivery, 21 continued, or renewed in this state on or after January 1, 22 2027. 23 2. Requests for prior authorization for a health care 24 service, if the request is made before January 1, 2027, and the 25 request has not been finally determined on or before that date. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill relates to health carriers and payment of claims, 30 audits, and standards of conduct, prior authorizations, and 31 utilization review organizations. 32 DIVISION I —— HEALTH INSURANCE TRADE PRACTICES. Under 33 current law, an insurer shall either accept and pay or deny 34 a clean claim. Under the bill, an insurer shall either 35 -12- LSB 5772HV (1) 91 nls/ko 12/ 16

H.F. 2635 accept and pay or deny a clean claim no later than 30 days 1 after receiving an electronic claim submission, or 45 days 2 after receiving a claim submitted on paper. After paying 3 a clean claim, the insurer shall not retroactively deny, 4 reduce, or recoup payment of the claim, except if the claim 5 submission included a misrepresentation, was fraudulent, or 6 was a duplicate submission, and the insurer first provides 7 written notice including evidence to the health care provider 8 (provider) that submitted the claim of the misrepresentation, 9 fraud, or duplicate submission. 10 If a health carrier (carrier) conducts an audit of a clean 11 claim, the carrier shall reimburse the provider for the 12 reasonable administrative costs incurred by the provider to 13 respond to the audit. “Audit” and “clean claim” are defined 14 in the bill. 15 A carrier that conducts an audit shall notify the provider 16 of the initiation of the audit no later than 15 days after 17 selecting the clean claim for audit. A carrier shall complete 18 an audit and issue a determination on the clean claim within 19 45 days of receiving all requested documentation from the 20 provider. A provider that submitted a clean claim subject 21 to an audit, and that receives an adverse determination, may 22 appeal the determination within 30 days. A carrier shall 23 consider an appeal and issue a final determination on the clean 24 claim no later than 14 days after receiving notice of the 25 appeal. If a carrier violates the audit timeline requirements, 26 the clean claim shall be automatically approved and promptly 27 paid, including interest at the rate of 10 percent per annum. 28 The audit requirements shall not apply to a claim that 29 is under active fraud investigation by a state or federal 30 authority, or to a federal program where audits are mandated 31 by federal law. 32 Under the bill, a carrier shall not: (1) impose on a 33 provider any financial penalty, reimbursement reduction, or 34 administrative fee, or terminate a provider’s participation 35 -13- LSB 5772HV (1) 91 nls/ko 13/ 16

H.F. 2635 in the carrier’s network, based on the provider’s referral to 1 or affiliation with an out-of-network provider; (2) interfere 2 with, or participate in any capacity in, a provider’s decisions 3 regarding staffing and referral, except as otherwise provided 4 by law; and (3) offer, attempt to enforce, or enforce an 5 agreement or amendment to an agreement with a provider without 6 providing an opportunity for negotiation, and a contract term 7 that violates the bill shall be void and unenforceable. 8 A violation of this division of the bill by a carrier 9 shall constitute an unfair method of competition or unfair or 10 deceptive act or practice. The carrier shall be subject to 11 civil penalties. In any action brought by a provider against 12 a carrier, the provider shall be entitled to recover costs 13 of litigation, including reasonable attorney fees and other 14 expenses, regardless of whether the provider prevails in such 15 action. 16 The commissioner shall adopt rules to administer and enforce 17 this division. 18 The bill makes conforming changes to Code sections 19 507B.4(3)(j)(15) and 507B.4(3). 20 DIVISION II —— PRIOR AUTHORIZATIONS. A utilization review 21 organization (URO) shall not deny or downgrade a request for 22 authorization unless: (1) the decision is made by a qualified 23 reviewer or clinical peer; and (2) the URO provides the 24 provider requesting authorization a written statement citing 25 the reasons for the decision, explaining the appeals process, 26 and a written attestation as described by the bill. If a 27 request for authorization is denied, the URO shall notify 28 the provider within seven days and conduct a consultation 29 as described by the bill. “Clinical peer” and “qualified 30 reviewer” are defined in the bill. 31 If a URO’s decision to deny or downgrade a request for 32 authorization is appealed by the requesting provider or covered 33 person, the appeal shall be conducted by a qualified reviewer 34 or clinical peer who was not involved in the initial denial 35 -14- LSB 5772HV (1) 91 nls/ko 14/ 16

H.F. 2635 or downgrade. When conducting an appeal of a request for 1 authorization, the qualified reviewer or clinical peer shall 2 consider the known clinical aspects of the health care services 3 (services) under review, including but not limited to medical 4 records relevant to the medical condition and any relevant 5 medical literature submitted by the provider. 6 A violation of the bill’s requirements for denial or 7 downgrade of an authorization by a URO or a carrier shall 8 constitute an unfair method of competition or unfair or 9 deceptive act or practice. The carrier shall be subject to 10 civil penalties. In any action brought by a provider against 11 a carrier, the provider shall be entitled to recover costs 12 of litigation, including reasonable attorney fees and other 13 expenses, regardless of whether the provider prevails in such 14 action. 15 The commissioner may adopt rules to administer this division 16 of the bill. 17 A carrier shall not require authorization for, or impose 18 additional utilization review requirements on, a covered 19 person for: (1) a cancer-related screening or cancer-related 20 preventative service recommended by the covered person’s 21 professional based on the national comprehensive cancer network 22 clinical practice guidelines in oncology; or (2) the diagnosis 23 and treatment of a health condition that develops or becomes 24 evident in a covered person while receiving treatment at an 25 inpatient facility, and the health condition is reasonably 26 determined by a professional to be a life threatening condition 27 unless the covered person receives immediate assessment and 28 treatment. 29 This division of the bill applies to health benefit plans 30 delivered, issued for delivery, continued, or renewed on or 31 after January 1, 2027, and requests for prior authorization 32 for a cancer-related screening or cancer-related preventative 33 health care service if the screening or service is recommended 34 by the covered person’s professional, the request is made 35 -15- LSB 5772HV (1) 91 nls/ko 15/ 16