PATCH Act
- Bill Number
- H.R. 3263
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-05-07: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2025-12-05T22:08:28Z
AI-Generated Summary
Purpose
The Protecting Access To Care in Hawaii Act (PATCH Act), H.R. 3263, aims to improve Medicare reimbursements for physicians' services in Hawaii by establishing a minimum adjustment factor for regional cost differences. This is intended to address lower payment rates in Hawaii, helping to maintain access to healthcare services in the state.
Key Provisions
- Amendment to Medicare Payment Formula: The bill modifies Section 1848(e) of the Social Security Act, which governs the Medicare physician fee schedule.
- Work Geographic Index Floor: For physician services provided in Hawaii starting January 1, 2026, the "work geographic index" (a factor that adjusts Medicare payments based on regional differences in the cost of physician labor) must be set to at least 1.5 if the calculated value is lower.
- Non-Budget Neutral Application: This adjustment does not require offsetting reductions in payments elsewhere to maintain overall budget neutrality, meaning it could increase total Medicare spending.
Significant Changes to Existing Law
- Previously, the work geographic index for Hawaii was calculated based on standard formulas without a guaranteed minimum, often resulting in values below 1.0, which reduced reimbursements compared to the national average.
- The bill introduces a Hawaii-specific floor of 1.5, explicitly overriding lower calculations, and adds this as a new subparagraph (J) to the existing law.
- It also updates the introductory language in paragraph (1)(A) to reference the new provision, ensuring its integration into the payment system.
Potential Impacts
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to implement and administer the new index floor, potentially increasing federal Medicare expenditures without corresponding savings elsewhere.
- On Citizens: Medicare beneficiaries in Hawaii may benefit from improved access to physicians, as higher reimbursements could help retain or attract doctors in the state, reducing shortages in rural or isolated areas.
- On International Relations: No direct impacts, as the bill is domestic and focused on U.S. territories.
- Overall, it could enhance healthcare affordability and availability in Hawaii but may strain the national Medicare budget.
Main Stakeholders Affected
- Physicians in Hawaii: Primary beneficiaries, as they will receive higher Medicare payments (potentially 50% above the national average for the work component), encouraging more providers to practice there.
- Medicare Enrollees in Hawaii: Patients, including seniors and those with disabilities, who rely on the program for care.
- Federal Government and Taxpayers: Bear the cost through increased Medicare outlays.
- Hawaiian Healthcare Providers and Facilities: Indirectly supported by better physician compensation, potentially stabilizing the local healthcare workforce.
Notable Legal, Constitutional, or Political Implications
- Legal: The change is straightforward and within Congress's authority to adjust Medicare payments under the Social Security Act; however, the non-budget neutral clause could face scrutiny in budget reconciliation processes or future fiscal reviews.
- Constitutional: No apparent issues, as it involves spending under enumerated powers (e.g., general welfare clause).
- Political: Highlights regional equity concerns for states like Hawaii, which face unique geographic and economic challenges; it may set a precedent for similar "floor" protections in other underserved areas, influencing bipartisan support for healthcare funding in Congress.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Recent Actions
- 2025-05-07: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-05-07: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-05-07: Introduced in House
- 2025-05-07: Introduced in House
Bill Versions
- Protecting Access To Care in Hawaii Act — issued 2025-05-07 — PDF (2 pages)