Bill > SB2690

This bill mandates that health carriers, which are companies providing health insurance, must allocate an increasing percentage of their total medical expenditures, starting at 6% and rising to 12% by 2029, directly to primary care providers, ensuring these funds reach the doctors and nurses directly rather than being absorbed by administrative processes. It also prohibits health carriers from unfairly altering or reducing claims submitted by primary care providers, known as "downcoding," unless they can provide clear clinical evidence and proper notification, and requires prompt payment of claims. The bill aims to improve access to primary care, especially in rural areas, by recognizing and supporting "Primary Care Access Visits" (urgent or same-day appointments for those without a regular doctor) and "Community Access Primary Care Sites" (clinics offering immediate primary care with follow-up capabilities). The Insurance Commissioner will oversee these requirements, and the Department of Human Services' Med-QUEST Division will apply similar rules to Medicaid managed care organizations, where permitted by federal law. Furthermore, health carriers must report detailed data on their primary care spending and practices, and the Auditor will evaluate the bill's impact three years after it becomes law, with a special fund established to support primary care stabilization efforts.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=2690&year=2026