Carter Introduces Bill to Impose New Reporting Requirement on 340B DSH
Rep. Buddy Carter
(R-Ga.) has introduced legislation to require 340B disproportionate share (DSH)
hospitals to submit outpatient charity care and outpatient revenue data to the
federal government for the parent hospital and all of its 340B-registered child
sites. The data would be part of hospitals’ annual recertification of
eligibility for the drug discount program by the Health Resources and Services
Administration (HRSA). HRSA would submit an annual report about the data to
Rep. Carter, a
member of the House Energy & Commerce Committee, announced his 340B
Optimization Act (H.R.
5598) in a
press release. He said his bill would add “an additional layer of
transparency to allow us to better understand the patient makeup of DSH
hospitals to improve the program and ensure it is truly being used in the most
effective way for our nation's most vulnerable patients." The release also
included support for the bill from the Community Oncology Alliance, AIR 340B,
the Biotechnology Innovation Organization (BIO), and the U.S. Oncology Network.
Interim President and Chief Executive Officer Maureen Testoni said, in a
statement, that while we welcome discussing transparency in 340B, we are
concerned that H.R. 5598’s narrow focus on outpatient care “would paint an
incomplete picture of the role 340B hospitals play in caring for low-income and
rural patients and communities.”
already report a significant amount of data and information to the federal
government that speaks to both the inpatient and outpatient services they
provide to low-income patients,” Testoni said. As our
March 12 analysis of 340B DSH hospital services to low-income patients
shows, “340B hospitals provide 60 percent of all uncompensated care in the U.S.
but only represent 38 percent of acute care hospitals in the country.
Uncompensated care is provided across inpatient and outpatient areas of the
hospital. Low-income patients make up 42 percent of 340B hospitals’ patient
load compared with 27 percent for non-340B hospitals. These hospitals are much
more likely to provide vital services including HIV/AIDS care, trauma care, and
treatment for opioid addiction and other substance abuse conditions.”
“The bill's focus
on charity care would ignore significant amounts of uncompensated and
under-reimbursed care that 340B hospitals provide to low-income patients,”
Testoni continued. “And some of the requirements would also impose a heavy,
unnecessary burden on 340B hospitals without providing useful data to
understand the scope of the program.”
the 340B drug pricing program to help safety net providers that serve
low-income patients," she concluded. “We look forward to discussing this
proposal, and others, with members of Congress, as we look for ways to ensure
the 340B program continues to meet its critical mission.”
These are some of
our concerns about H.R. 5598:
for participation in 340B is currently based on a hospital’s inpatient DSH
percentage. The bill’s focus on outpatient measures could signal a
complete overhaul of current 340B hospital eligibility requirements.
- The bill
would require data from only 340B hospitals—and as such would not
demonstrate how 340B hospitals compare with non-340B hospitals.
- The bill
would determine a 340B hospital’s low-income utilization rate by looking
at Medicaid outpatient revenue and
outpatient charity care. Charity care is a problematic metric and not
indicative of a hospital’s level of care to low-income patients.
- It would
be difficult for hospitals to collect this information on an individual
child-site basis. Moreover, child sites themselves are considered to be an
integral part of the covered entity.
H.R. 5598 is the
fourth bill to be introduced during the current Congress that would make
changes to the 340B program statute enacted in 1992. Other bills include:
- S. 2453 –
Sen. Chuck Grassley’s (R-Iowa) Ensuring the Value of the 340B Program Act
- S. 2312 –
Sen. Bill Cassidy’s (R-La.) Helping Ensure Low-Income Patients have Access
to Care and Treatment (HELP) Act
- H.R. 4710
– Rep. Larry Bucshon’s (R-Ind.) 340B Protecting Access for Underserved and
Safety-Net Entities Act (PAUSE)
bill may not be the final word on the 340B program this year. Additional
hearings are expected this year in both the House and Senate.