SB 1624, the Protecting Access To Care in Hawaii Act or PATCH Act, would amend the Medicare physician fee schedule to create a minimum floor for the work geographic index used to pay physicians for services furnished in Hawaii. Under the bill, if the calculated work geographic index for Hawaii would be below 1.5, the Secretary of Health and Human Services would be required to raise it to 1.5 for services provided on or after January 1, 2026. The bill targets the Medicare payment formula for physician services and is designed to address Hawaii’s unique cost and workforce conditions.
The measure would change federal law in Title XVIII of the Social Security Act by adding Hawaii-specific language to the geographic adjustment rules in section 1848(e). It would affect Medicare reimbursement for physicians and other practitioners whose payments are tied to the work geographic index in Hawaii, likely increasing payments in the state relative to current law when the index would otherwise fall below the new floor. The bill also specifies that the adjustment would not be applied in a budget-neutral manner, meaning the higher payments would not be offset by reductions elsewhere under the same payment system.
Impact
The bill would amend the Medicare physician payment statute to establish a Hawaii-only floor of 1.5 on the work geographic index for physician services, beginning in 2026. This would directly affect federal Medicare reimbursement calculations for services furnished in Hawaii and could increase payments to physicians and other providers paid under the fee schedule. Because the bill states the change would not be budget neutral, it would likely increase federal Medicare spending rather than redistribute payments within the program.
Sentiment
Available context suggests the bill was introduced as a targeted access-to-care measure and referred to the Senate Finance Committee without recorded opposition or vote history in the provided materials. The title and structure indicate support from Hawaii’s senators for addressing provider payment adequacy in the state. With no committee transcript or vote data available, the overall sentiment can only be characterized as favorable or at least supportive at introduction, with the bill framed as a remedy for access challenges in Hawaii.
Contention
The main policy issue is whether Hawaii should receive a special Medicare payment floor that exceeds the standard geographic adjustment formula. Supporters are likely to argue that Hawaii’s high costs and provider access challenges justify a higher floor to protect access to care. Potential concerns would center on the bill’s non-budget-neutral design, since it would increase Medicare spending, and on whether creating a state-specific exception is appropriate within a national payment system. No explicit opposition is documented in the provided record.