This bill, introduced by Hawaii senators in May 2024, modifies how Medicare pays physicians in Hawaii by establishing a minimum payment level based on geographic factors. Currently, Medicare adjusts physician payment rates based on a "work geographic index" that accounts for regional differences in practice costs and other factors. The legislation ensures that Hawaii's work geographic index will not fall below 1.5, which would increase payments to Hawaii physicians if their index would otherwise be calculated lower. The change takes effect January 1, 2025, and importantly, it is not required to be "budget neutral," meaning it could increase overall Medicare spending rather than offsetting costs elsewhere. The bill aims to protect physician access and care availability in Hawaii by ensuring adequate reimbursement rates for medical services in the state.