II 

111TH CONGRESS 

1ST SESSION S. 2838 

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. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 4, 2009 

Mr. BENNET introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Rural Health Access 

3 and Improvement Act of 2009’’. 

4 SEC. 2. GRANTS TO PROMOTE HOSPITAL HEALTH INFOR5 MATION TECHNOLOGY. 

6 Section 3013 of the Public Health Service Act (42 

7 U.S.C. 300jj–33) is amended by adding at the end the 

8 following: 

9 ‘‘(j) PRIORITY.—In awarding a grant under this sec10 tion, the Secretary shall give priority to qualified State11 designated entities that are critical access hospitals, as de12 fined in section 1861(mm) of the Social Security Act.’’. 

13 SEC. 3. EXPANDED PARTICIPATION IN SECTION 340B PRO14 GRAM. 

15 Section 340B(a)(4) of the Public Health Service Act 

16 (42 U.S.C. 256b(a)(4)) is amended by adding at the end 

17 the following: 

18 ‘‘(M) A children’s hospital excluded from 

19 the Medicare prospective payment system pur20 suant to section 1886(d)(1)(B)(iii) of the Social 

21 Security Act, or a free-standing cancer hospital 

22 excluded from the Medicare prospective pay23 ment system pursuant to section 

24 1886(d)(1)(B)(v) of the Social Security Act, 

25 that would meet the requirements of subpara26 graph (L), including the disproportionate share 


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1 adjustment percentage requirement under 

2 clause (ii) of such subparagraph, if the hospital 

3 were a subsection (d) hospital as defined by sec4 tion 1886(d)(1)(B) of the Social Security Act. 

5 ‘‘(N) An entity that is a critical access hos6 pital (as determined under section 1820(c)(2) 

7 of the Social Security Act), and that meets the 

8 requirements of subparagraph (L)(i). 

9 ‘‘(O) An entity that is a rural referral cen10 ter, as defined in section 1886(d)(5)(C)(i) of 

11 the Social Security Act, or a sole community 

12 hospital, as defined by section 

13 1886(d)(5)(C)(iii) of such Act, and that both 

14 meets the requirements of subparagraph (L)(i) 

15 and has a disproportionate share adjustment 

16 percentage equal to or greater than 8 percent. 

17 ‘‘(P) An entity that is a rural health clinic, 

18 as defined in section 1861(aa)(2) of the Social 

19 Security Act.’’. 

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

21 (a) STUDY.—The Comptroller General of the United 

22 States shall conduct a study of the cost in each State of 

23 dispensing prescription drugs under the Medicaid program 

24 under title XIX of the Social Security Act (42 U.S.C. 

25 1396a et seq.), which shall consider— 


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1 (1) any reasonable costs associated with phar2 macists— 

3 (A) checking for information regarding 

4 Medicaid coverage of individuals; and 

5 (B) performing necessary clinical review 

6 and quality assurance activities, such as— 

7 (i) activities to identify and reduce the 

8 frequency of patterns of fraud, abuse, 

9 gross overuse, and inappropriate or medi10 cally unnecessary care among physicians, 

11 pharmacists, and patients; 

12 (ii) activities associated with specific 

13 drugs or groups of drugs, including poten14 tial and actual severe adverse reactions to 

15 drugs, including education on therapeutic 

16 appropriateness, over-utilization and 

17 under-utilization of drugs, appropriate use 

18 of generic products, therapeutic duplica19 tion, drug-disease contraindications, drug 

20 interactions, incorrect drug dosage or du21 ration of drug treatment, drug-allergy 

22 interactions, and clinical abuse or misuse; 

23 and 


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1 (iii) any other clinical review and 

2 quality assurance activities required under 

3 Federal or State law; 

4 (2) the costs incurred by a pharmacy that are 

5 associated with— 

6 (A) the measurement or mixing of a drug 

7 covered by Medicaid; 

8 (B) filling the container for such a drug; 

9 (C) physically transferring the prescription 

10 to the patient, including any costs of delivering 

11 the medication to the home of such patient; 

12 (D) special packaging of drugs; 

13 (E) overhead costs of the pharmacy, or the 

14 section of the facility that is devoted to a phar15 macy, and maintenance of the pharmacy or sec16 tion of the facility (including the equipment 

17 necessary to operate such pharmacy or such 

18 section and the salaries of pharmacists and 

19 other pharmacy workers); 

20 (F) geographic factors that impact oper21 ational costs; 

22 (G) compounding such prescription if nec23 essary; and 

24 (H) uncollectability of Medicaid prescrip25 tion copayments; 


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1 (3) the variation in costs described in para2 graph (2) based on— 

3 (A) whether a product dispensed is a rural 

4 or urban pharmacy; 

5 (B) whether the product dispensed is a 

6 specialty pharmacy product; and 

7 (C) whether the pharmacy is located in, or 

8 contracts with, a long-term care facility; and 

9 (4) the increase in dispensing fees, including 

10 the costs described in paragraphs (1), (2), and (3), 

11 that would be sufficient to create an incentive for a 

12 pharmacist to promote the substitution of covered 

13 general alternative therapies. 

14 (b) REPORT.—Not later than December 1, 2010, the 

15 Comptroller General of the United States shall submit to 

16 the Secretary of Health and Human Services and to each 

17 State a report describing the study conducted under sub18 section (a). The report shall include— 

19 (1) the average cost in each State of dispensing 

20 a prescription drug under Medicaid; 

21 (2) the findings of the study conducted under 

22 subsection (a) with respect to— 

23 (A) the variation in costs studied under 

24 subparagraphs (A) and (B) of paragraph (3) of 

25 such subsection; and 


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1 (B) the increase in dispensing fees de2 scribed in paragraph (4) of such subsection. 

3 (c) USE OF STUDY.—Each State shall use the report 

4 described in subsection (b) to assess the adequacy of Med5 icaid pharmacy dispensing fees. The Secretary of Health 

6 and Human Services shall use such report to approve 

7 State plan amendments for States that submit such 

8 amendments for the purposes of increasing Medicaid phar9 macy dispensing fees. 

10 SEC. 5. STATE OFFICES OF RURAL HEALTH. 

11 Section 338J of the Public Health Service Act (42 

12 U.S.C. 254r) is amended by striking subsection (k). 

Æ 


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