I 
116TH CONGRESS 
1ST SESSION H. R. 1323 
To amend title XVIII of the Social Security Act to extend the floor on 
the area wage index under the inpatient prospective payment system 
to certain sole community hospitals and to amend the Public Health 
Service Act to provide eligibility for certain sole community hospitals 
to discounted drug prices under the 340B drug pricing program. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 22, 2019 
Mr. PETERSON (for himself and Mr. TIPTON) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to extend 
the floor on the area wage index under the inpatient 
prospective payment system to certain sole community 
hospitals and to amend the Public Health Service Act 
to provide eligibility for certain sole community hospitals 
to discounted drug prices under the 340B drug pricing 
program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Hospital Fron-
tier Fairness Act’’. 
SEC. 2. EXTENDING FLOOR ON AREA WAGE INDEX TO CER-
TAIN SOLE COMMUNITY HOSPITALS. 
Section 1886(d)(3)(E)(iii) of the Social Security Act 
(42 U.S.C. 1395ww(d)(3)(E)(iii)) is amended— 
(1) in subclause (I), by inserting before the pe-
riod at the end the following: ‘‘and, for discharges 
occurring on or after October 1, 2019, the area 
wage index applicable under this subparagraph to 
any sole community hospital that is located not more 
than 75 miles from the closest frontier State and 
that makes an election under subclause (V) may not 
be less than 1.00’’; and 
(2) by adding at the end the following new sub-
clause: 
‘‘(V) SOLE
COMMUNITY
HOS-
PITAL
ELECTION.—The 
Secretary 
shall provide for a process under 
which a sole community hospital de-
scribed in subclause (I) may elect, at 
such time and in such manner as 
specified by the Secretary, to apply 
subclause (I) to such sole community 
hospital.’’. 
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SEC. 3. ELIGIBILITY OF CERTAIN SOLE COMMUNITY HOS-
PITALS 
FOR 
DISCOUNTED 
DRUG 
PRICES 
UNDER THE 340B DRUG PRICING PROGRAM. 
(a) IN GENERAL.—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 new subparagraph: 
‘‘(P) An entity that is a sole community 
hospital 
(as 
defined 
in 
section 
1886(d)(5)(C)(iii) of the Social Security Act), 
that was classified as such a hospital before Oc-
tober 1, 2015, and that is located not more 
than 75 miles from the closest frontier State 
(as defined in section 1886(d)(3)(E)(iii)(II) of 
such Act).’’. 
(b) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendment made by 
subsection (a) shall apply to drugs purchased on or 
after the first day of the first month that begins 
more than 60 days after the date of the enactment 
of this Act. 
(2) CONFORMING
340B
AGREEMENTS.—The 
Secretary of Health and Human Services shall pro-
vide for such timely modification of agreements en-
tered into under section 340B of the Public Health 
Service Act (42 U.S.C. 256b) as is necessary to pro-
vide for the application of the amendment made by 
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