This bill proposes to amend Title XVIII of the Social Security Act to establish a floor for the work geographic index, which impacts Medicare payments for physicians' services provided in Hawaii. The primary objective is to ensure that the unique economic factors affecting healthcare providers in Hawaii are adequately reflected in their reimbursement rates, thereby protecting access to care. Specifically, for physicians' services furnished in Hawaii on or after January 1, 2026 , the bill mandates that if the calculated work geographic index is less than 1.5 , it shall be increased to 1.5. This adjustment aims to prevent the index from falling below a critical threshold, supporting the financial viability of medical practices in the state. A significant provision is that this increase in the work geographic index will not be applied in a budget-neutral manner , meaning the additional costs will not be offset by reductions in other Medicare payments.