HB1965 HD1

SECTION 1. The legislature finds that a strong primary care system is the foundation of affordable, high-quality health care. Better access to, and utilization of, primary care improves chronic disease management, increases life expectancies, reduces avoidable healthcare visits, and lowers health care costs. However, the legislature recognizes that Hawaii currently faces an acute primary care access crisis. According to the university of Hawaii's most recent workforce assessment, the State has a shortage of approximately seven hundred sixty-eight full-time equivalent providers, with the single largest shortage being in primary care. According to the assessment, approximately one hundred fifty-two additional primary care providers are needed statewide.

The legislature also recognizes that while the costs of operating a business in Hawaii, including rent, staffing, overhead, and insurance, have increased significantly, primary care reimbursements have remained stagnant. As a result, providers are leaving insurance networks, retiring early, or closing their practices due to unsustainable financial pressures.

The legislature believes that abusive insurance practices, such as blanket utilization reviews, downcoding, and restrictive prior authorization, undermine the sustainability of primary care practices and restrict patients' access to timely and necessary care.

Accordingly, the purpose of this Act is to establish a primary care provider working group to address issues relating to, and develop recommendations for, the stabilization of primary care health services in Hawaii, including:

(1) Reimbursements to primary care providers;

(2) Health insurance practices relating to downcoding and claim modifications;

(3) Health carrier reporting requirements; and

(4) Rural access to primary care health services.

SECTION 2. (a) There is established within the state health planning and development agency a primary care provider working group to address issues relating to, and develop recommendations for, the stabilization of primary care health services in Hawaii. The working group shall consider:

(1) Setting minimum percentage expenditures on primary care reimbursements by health carriers;

(2) The prevalence and use of downcoding and inappropriate modifications to submitted claims;

(3) New reporting requirements for health carriers;

(4) Enforcement mechanisms;

(5) Whether a primary care stabilization special fund should be created to stabilize and expand access to primary care services;

(6) The needs of residents and health care providers in the State's rural areas; and

(7) Any necessary federal approvals needed to align the State's medicaid managed care plans with any recommended actions proposed by the working group.

(b) The task force shall consist of the following members:

(1) The administrator of the state health planning and development agency, who shall serve as chairperson of the task force;

(2) The director of health, or the director's designee;

(3) The insurance commissioner, or the insurance commissioner's designee; and

(4) The administrator of the med-QUEST division of the department of human services, or the administrator's designee.

(c) The administrator of the state health planning and development agency shall invite the following to be members of the working group:

(1) Five members representing the insurance industry, to be selected by the Hawaii Association of Health Plans;

(2) Five members representing licensed health care professionals, two of whom shall be selected by the Hawaii Medical Association, two of whom shall be selected by the Healthcare Association of Hawaii, and one of whom shall be selected by the university of Hawaii at Manoa John A. Burns school of medicine;

(3) Five members representing consumers of health care or employers, two of whom shall be selected by the board of trustees of the Hawaii employer-union health benefits trust fund, one of whom shall be a consumer selected by the statewide health coordinating council, one of whom shall be selected by the Hawaii Primary Care Association, and one of whom shall be selected by Papa Ola Lokahi; and

(4) Any others as recommended by the working group.

(d) Members of the working group shall serve without compensation but shall be reimbursed for expenses, including travel expenses, necessary for the performance of their duties.

(e) The working group shall submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2027.

(f) The working group shall cease to exist on June 30, 2027.

SECTION 3. This Act shall take effect on July 1, 3000.

HOUSE OF REPRESENTATIVES	H.B. NO.	1965
THIRTY-THIRD LEGISLATURE, 2026		H.D. 1
STATE OF HAWAII