1.This Act may be cited as
the Rural Health Access and
Improvement Act of 2009
.
2.Grants to
promote hospital health information technologySection 3013 of the Public Health Service
Act (42 U.S.C. 300jj–33) is amended by adding at the end the following:
(j)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.
.
3.Expanded
participation in section 340B programSection 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.
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4.GAO study and
report on dispensing fees
(a)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)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)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.
5.State offices of
rural healthSection 338J of
the Public Health Service Act (42 U.S.C. 254r) is amended by striking
subsection (k).