The PATCH Act would modify the Medicare physician payment formula to guarantee a floor for Hawaii’s work geographic index (WGI). Starting January 1, 2026, if Hawaii’s calculated WGI would be less than 1.5, the Secretary of Health and Human Services must raise it to 1.5 for purposes of paying for physician services furnished in Hawaii. The floor is explicitly not budget neutral, meaning it would increase federal Medicare spending rather than offsetting the cost elsewhere. The change is limited to Hawaii and is enacted by amending the Social Security Act (title XVIII), specifically section 1848(e). In plain terms, this bill aims to ensure physicians in Hawaii are compensated at a higher minimum level under Medicare, with the goal of protecting access to care in the state, even if that requires additional federal spending.
Key Points
- 1Establishes a floor of 1.5 for Hawaii’s work geographic index (WGI) for Medicare physician payments, effective for services furnished on or after January 1, 2026.
- 2The floor applies after the standard WGI calculation is completed under the existing rules (subparagraph A(iii)).
- 3If Hawaii’s WGI would otherwise be below 1.5, the Secretary must increase it to 1.5; this change is expressly not budget neutral.
- 4The provision only affects services furnished in Hawaii; it does not change WGI values or payments in other states.
- 5The change is enacted by amending Section 1848(e) of the Social Security Act and is titled the “Protecting Access To Care in Hawaii Act” or “PATCH Act.”