data from unauthorized disclosure or re- 
disclosure.’’. 
(e) PRIVATE NON-PROFIT DSH HOSPITALS
AND 
OUTPATIENT HOSPITAL FACILITIES.— 
(1) DEFINITION.—Subparagraph (L) of section 
340B(a)(4) of the Public Health Service Act (42 
U.S.C. 256b(a)(4)) is amended to read as follows: 
‘‘(L) A subsection (d) hospital (as defined 
in section 1886(d)(1)(B) of the Social Security 
Act) that— 
‘‘(i) is— 
‘‘(I) owned or operated by a unit 
of State or local government; 
‘‘(II) a public or private non- 
profit corporation which is formally 
granted governmental powers by a 
unit of State or local government; or 
‘‘(III) a private non-profit hos-
pital which has a contract with a 
State or local government to provide 
health care services, which include the 
ordering or prescribing of covered out-
patient drugs that are subject to an 
agreement under this section, to low- 
income individuals who are not enti-
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tled to benefits under title XVIII of 
the Social Security Act or eligible for 
assistance under the State plan for 
medical assistance under title XIX of 
such Act; 
‘‘(ii) for the most recent cost report-
ing period that ended before the calendar 
quarter involved, had a disproportionate 
share adjustment percentage (as deter-
mined under section 1886(d)(5)(F) of the 
Social Security Act) greater than 11.75 
percent or was described in section 
1886(d)(5)(F)(i)(II) of such Act; and 
‘‘(iii) does not obtain covered out-
patient drugs through a group purchasing 
organization or other group purchasing ar-
rangement. 
If the Secretary determines that a hospital that 
is eligible for participation in the 340B pro-
gram under this subparagraph obtained covered 
outpatient drugs through a group purchasing 
organization or another group purchasing ar-
rangement while that hospital was participating 
in the drug discount program under this sec-
tion, then the Secretary shall remove such hos-
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pital from such program and the hospital shall 
not be permitted to seek re-enrollment for a pe-
riod of at least 12 months after its removal 
from the program.’’. 
(2) STUDY AND REPORT; MORATORIUM; OUT-
PATIENT
HOSPITAL
FACILITIES; 
AUDITS.—Sub-
section (c) of section 340B of the Public Health 
Service Act (42 U.S.C. 256b) is amended to read as 
follows: 
‘‘(c) COVERED ENTITIES THAT ARE PRIVATE, NON- 
PROFIT DSH HOSPITALS.— 
‘‘(1) STUDY AND REPORT.— 
‘‘(A) STUDY.—The Comptroller General of 
the United States shall conduct a study on the 
relationship between the disproportionate share 
adjustment percentages of private covered enti-
ties described in subclauses (II) and (III) of 
subsection (a)(4)(L)(i) and the levels of charity 
care provided by such entities to outpatients. 
‘‘(B) REPORT.—Not later than 180 days 
after the date of enactment of the 340B Protec-
tion and Accountability Act of 2019, the Comp-
troller General shall submit to the appropriate 
committees of Congress a report on the results 
of the study conducted under subparagraph 
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(A), including recommendations on a metric 
that, as applied to a private covered entity de-
scribed in such subparagraph, reflects a high 
level of charity care provided to outpatients as 
a percentage of the covered entity’s overall ex-
penses for outpatient care, and could replace 
the metric described in subclause (ii) of sub-
section (a)(4)(L). The Comptroller General 
shall recommend the metric that best aligns 
with the level of charity care provided to out-
patients as a percentage of overall hospital op-
erating expenses on outpatient care if no metric 
is identified that provides a precise measure of 
such percentage. 
‘‘(2) MORATORIUM.— 
‘‘(A) IN
GENERAL.—For the period de-
scribed in subparagraph (B)— 
‘‘(i) a private covered entity described 
in subclauses (II) or (III) of subsection 
(a)(4)(L)(i) may participate in the drug 
discount program under this section as a 
covered entity only if it was properly en-
rolled as a covered entity in the drug dis-
count program under this section as of the 
date of the enactment of the 340B Protec-
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tion and Accountability Act of 2019 and 
continuously enrolled thereafter; and 
‘‘(ii) with respect to a facility or orga-
nization described in paragraph (3) of this 
subsection that is wholly owned by a pri-
vate covered entity described in subclause 
(II) or (III) of subsection (a)(4)(L)(i), only 
a facility or organization that was properly 
enrolled as a child site in the drug discount 
program under this section as of the date 
of the enactment of the 340B Protection 
and Accountability Act of 2019 and con-
tinuously enrolled thereafter may partici-
pate in the drug discount program under 
this section. 
‘‘(B) PERIOD DESCRIBED.—For purposes 
of subparagraph (A), the period described in 
this subparagraph is the period beginning on 
the date of enactment of the 340B Protection 
and Accountability Act of 2019 and ending on 
the effective date described in subparagraph 
(C). 
‘‘(C) EFFECTIVE DATE OF REPLACEMENT 
METRIC.— 
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‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (B), subject to clause (ii), 
the effective date described in this sub-
paragraph is the effective date specified in 
legislation that, with respect to private cov-
ered entities described in subclauses (II) 
and (III) of subsection (a)(4)(L)(i)— 
‘‘(I) replaces the metric described 
in clause (ii) of subsection (a)(4)(L) 
with a metric that more accurately re-
flects the levels of outpatient charity 
care as a percentage of overall ex-
penses for outpatient care provided by 
such entities; and 
‘‘(II) takes into account the re-
port submitted under paragraph (1), 
including by addressing the Comp-
troller General’s recommendations in-
cluded in such report. 
‘‘(ii) EXCEPTION.—If legislation de-
scribed in clause (i) is not enacted by the 
date that is one year after the date of sub-
mission of the report under paragraph 
(1)— 
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