A bill to give critical access hospitals priority in receiving grants to implement health information technology, to expand participation in the drug pricing agreement program under section 340B of the Public Health Service Act, to provide for a study and report on pharmacy dispensing fees under Medicaid, to provide for continuing funding for operation of State offices of rural health, and for other purposes.

Summary: Rural Health Access and Improvement Act of 2009 - Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS) to give priority to critical access hospitals in awarding grants to facilitate and expand the electronic movement and use of health information among organizations according to nationally recognized standards.

Expands the 340B drug discount program to allow participation as a covered entity by certain children's hospitals, critical access hospitals, rural referral centers, sole community hospitals, and rural health clinics.

Directs the Comptroller General to study and report on the cost in each state of dispensing prescription drugs under the Medicaid program. Requires states to use the report to assess the adequacy of Medicaid pharmacy dispensing fees.

Repeals provisions terminating the grant program for the operation of state offices of rural health.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Health Access and Improvement 
Act of 2009''.

SEC. 2. GRANTS TO PROMOTE HOSPITAL HEALTH INFORMATION TECHNOLOGY.

    Section 3013 of the Public Health Service Act (42 U.S.C. 300jj-33) 
is amended by adding at the end the following:
    ``(j) Priority.--In awarding a grant under this section, the 
Secretary shall give priority to qualified State-designated entities 
that are critical access hospitals, as defined in section 1861(mm) of 
the Social Security Act.''.

SEC. 3. EXPANDED PARTICIPATION IN SECTION 340B PROGRAM.

    Section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 
256b(a)(4)) is amended by adding at the end the following:
                    ``(M) A children's hospital excluded from the 
                Medicare prospective payment system pursuant to section 
                1886(d)(1)(B)(iii) of the Social Security Act, or a 
                free-standing cancer hospital excluded from the 
                Medicare prospective payment system pursuant to section 
                1886(d)(1)(B)(v) of the Social Security Act, that would 
                meet the requirements of subparagraph (L), including 
                the disproportionate share adjustment percentage 
                requirement under clause (ii) of such subparagraph, if 
                the hospital were a subsection (d) hospital as defined 
                by section 1886(d)(1)(B) of the Social Security Act.
                    ``(N) An entity that is a critical access hospital 
                (as determined under section 1820(c)(2) of the Social 
                Security Act), and that meets the requirements of 
                subparagraph (L)(i).
                    ``(O) An entity that is a rural referral center, as 
                defined in section 1886(d)(5)(C)(i) of the Social 
                Security Act, or a sole community hospital, as defined 
                by section 1886(d)(5)(C)(iii) of such Act, and that 
                both meets the requirements of subparagraph (L)(i) and 
                has a disproportionate share adjustment percentage 
                equal to or greater than 8 percent.
                    ``(P) An entity that is a rural health clinic, as 
                defined in section 1861(aa)(2) of the Social Security 
                Act.''.

SEC. 4. GAO STUDY AND REPORT ON DISPENSING FEES.

    (a) Study.--The Comptroller General of the United States shall 
conduct a study of the cost in each State of dispensing prescription 
drugs under the Medicaid program under title XIX of the Social Security 
Act (42 U.S.C. 1396a et seq.), which shall consider--
            (1) any reasonable costs associated with pharmacists--
                    (A) checking for information regarding Medicaid 
                coverage of individuals; and
                    (B) performing necessary clinical review and 
                quality assurance activities, such as--
                            (i) activities to identify and reduce the 
                        frequency of patterns of fraud, abuse, gross 
                        overuse, and inappropriate or medically 
                        unnecessary care among physicians, pharmacists, 
                        and patients;
                            (ii) activities associated with specific 
                        drugs or groups of drugs, including potential 
                        and actual severe adverse reactions to drugs, 
                        including education on therapeutic 
                        appropriateness, over-utilization and under-
                        utilization of drugs, appropriate use of 
                        generic products, therapeutic duplication, 
                        drug-disease contraindications, drug 
                        interactions, incorrect drug dosage or duration 
                        of drug treatment, drug-allergy interactions, 
                        and clinical abuse or misuse; and
                            (iii) any other clinical review and quality 
                        assurance activities required under Federal or 
                        State law;
            (2) the costs incurred by a pharmacy that are associated 
        with--
                    (A) the measurement or mixing of a drug covered by 
                Medicaid;
                    (B) filling the container for such a drug;
                    (C) physically transferring the prescription to the 
                patient, including any costs of delivering the 
                medication to the home of such patient;
                    (D) special packaging of drugs;
                    (E) overhead costs of the pharmacy, or the section 
                of the facility that is devoted to a pharmacy, and 
                maintenance of the pharmacy or section of the facility 
                (including the equipment necessary to operate such 
                pharmacy or such section and the salaries of 
                pharmacists and other pharmacy workers);
                    (F) geographic factors that impact operational 
                costs;
                    (G) compounding such prescription if necessary; and
                    (H) uncollectability of Medicaid prescription 
                copayments;
            (3) the variation in costs described in paragraph (2) based 
        on--
                    (A) whether a product dispensed is a rural or urban 
                pharmacy;
                    (B) whether the product dispensed is a specialty 
                pharmacy product; and
                    (C) whether the pharmacy is located in, or 
                contracts with, a long-term care facility; and
            (4) the increase in dispensing fees, including the costs 
        described in paragraphs (1), (2), and (3), that would be 
        sufficient to create an incentive for a pharmacist to promote 
        the substitution of covered general alternative therapies.
    (b) Report.--Not later than December 1, 2010, the Comptroller 
General of the United States shall submit to the Secretary of Health 
and Human Services and to each State a report describing the study 
conducted under subsection (a). The report shall include--
            (1) the average cost in each State of dispensing a 
        prescription drug under Medicaid;
            (2) the findings of the study conducted under subsection 
        (a) with respect to--
                    (A) the variation in costs studied under 
                subparagraphs (A) and (B) of paragraph (3) of such 
                subsection; and
                    (B) the increase in dispensing fees described in 
                paragraph (4) of such subsection.
    (c) Use of Study.--Each State shall use the report described in 
subsection (b) to assess the adequacy of Medicaid pharmacy dispensing 
fees. The Secretary of Health and Human Services shall use such report 
to approve State plan amendments for States that submit such amendments 
for the purposes of increasing Medicaid pharmacy dispensing fees.

SEC. 5. STATE OFFICES OF RURAL HEALTH.

    Section 338J of the Public Health Service Act (42 U.S.C. 254r) is 
amended by striking subsection (k).