I 
115TH CONGRESS 
2D SESSION 
H. R. 5598 
To amend the Public Health Service Act to require certain disproportionate 
share hospital covered entities under the 340B drug discount program 
to submit to the Secretary of Health and Human Services reports on 
low-income utilization rates of outpatient hospital services furnished by 
such entities. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 24, 2018 
Mr. CARTER of Georgia (for himself and Mr. COLLINS of New York) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce 
A BILL 
To amend the Public Health Service Act to require certain 
disproportionate share hospital covered entities under the 
340B drug discount program to submit to the Secretary 
of Health and Human Services reports on low-income 
utilization rates of outpatient hospital services furnished 
by such entities. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘340B Optimization 
Act’’. 
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SEC. 2. REQUIRING 340B DRUG DISCOUNT PROGRAM RE-
PORTS BY DSH HOSPITAL COVERED ENTITIES 
ON LOW-INCOME UTILIZATION RATE OF OUT-
PATIENT HOSPITAL SERVICES. 
(a) IN GENERAL.—Section 340B(d)(2) of the Public 
Health Service Act (42 U.S.C. 256b(d)(2)) is amended— 
(1) in subparagraph (B)(i), by inserting before 
the period at the end the following: ‘‘, including, 
with respect to such updates made on or after Janu-
ary 1, 2020, by requiring covered entities described 
in subsection (a)(4)(L) to submit (and to so regu-
larly update) information described in subparagraph 
(C)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) INFORMATION ON LOW-INCOME UTI-
LIZATION
RATE
OF
OUTPATIENT
HOSPITAL 
SERVICES.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (B)(i), the information de-
scribed in this subparagraph, with respect 
to a covered entity described in subsection 
(a)(4)(L) and an update under such sub-
paragraph (B)(i), is— 
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‘‘(I) the low-income outpatient 
utilization rate of such covered entity 
for the most recent fiscal year; and 
‘‘(II) the low-income outpatient 
utilization rate of off-site outpatient 
facilities, clinics, eligible off-site loca-
tions, and associated sites of such en-
tity identified as child sites of such 
entity pursuant to the identification 
system under subparagraph (B)(iv) 
for the most recent fiscal year. 
‘‘(ii) LOW-INCOME OUTPATIENT UTI-
LIZATION
RATE
DEFINED.—In this sub-
paragraph, the term ‘low-income outpatient 
utilization rate’ has the meaning given the 
term ‘low-income utilization rate’ under 
paragraph (3) of section 1923(b) of the 
Social Security Act, except that— 
‘‘(I) clauses (i) and (ii) of sub-
paragraph (A) of such paragraph 
shall be applied as if— 
‘‘(aa) each reference to ‘pa-
tient services’ were a reference to 
‘patient services furnished on an 
outpatient basis’; and 
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‘‘(bb) for purposes of clause 
(i)(II) of this subparagraph, each 
reference to ‘hospital’ were a ref-
erence to ‘off-site outpatient fa-
cilities, clinics, eligible off-site lo-
cations, and associated sites of 
the hospital that are identified as 
child sites of the hospital pursu-
ant to the identification system 
under section 340B(d)(2)(B)(iv) 
of the Public Health Service Act’; 
and 
‘‘(II) clauses (i) and (ii) of sub-
paragraph (B) of such paragraph 
shall be applied as if— 
‘‘(aa) each reference to ‘in-
patient hospital services’ were a 
reference to ‘outpatient hospital 
services’; and 
‘‘(bb) for purposes of clause 
(i)(II) each reference to ‘hos-
pital’s charges’ were a reference 
to ‘charges of the off-site out-
patient facilities, clinics, eligible 
off-site locations, and associated 
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sites of the hospital that are 
identified as child sites of the 
hospital pursuant to the identi-
fication system under section 
340B(d)(2)(B)(iv) of the Public 
Health Service Act’.’’. 
(b) ANNUAL REPORTS.—Not later than January 1, 
2021, and annually thereafter, the Administrator of the 
Health Resources and Services Administration shall sub-
mit to Congress a report on information submitted by cov-
ered entities for the previous year pursuant to the amend-
ments made by subsection (a). 
Æ 
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