HI SB2690

Requires health carriers to allocate at least 6% of total medical expenditures directly to primary care providers starting January 1, 2027, increasing to 9% by 2028 and 12% by 2029, with payments made directly to providers rather than through intermediaries

Prohibits health carriers from downcoding or modifying claims unless supported by documented clinical evidence, with written notice required within 5 days and expedited external review completed within 15 calendar days

Mandates prompt payment of electronic claims within 15 business days and paper claims within 30 business days, with late payments accruing 10% annual interest plus $25 per day after 30 days

Establishes enforcement penalties up to $5,000 per initial violation, $10,000 for repeated violations, and $500,000 annually for systemic violations, with fines deposited into a new Primary Care Stabilization Special Fund

Creates annual transparency reporting requirements for health carriers including primary care spending percentages, downcoding rates, prior authorization data, and provider network participation by island