December 1 , 2009 – The latest health care reform bill unveiled by the Senate leadership brought some welcome news to 340B hospitals who had been riding a roller-coaster in recent months as their key legislative proposals were tossed in and out of different versions of the reform bill.
The new legislation, expected to be considered by the full Senate in early December, retained the reform provisions that 340B hospitals had pushed for, including the all-important extension of the 340B drug discount program to the hospital inpatient setting.December 1 , 2009 – The latest health care reform bill unveiled by the Senate leadership brought some welcome news to 340B hospitals who had been riding a roller-coaster in recent months as their key legislative proposals were tossed in and out of different versions of the reform bill.
The House bill passed Nov. 7 was stripped of that language, upsetting financially pressured safety-net providers who would stand to gain millions of dollars in savings with the extended discount.
The Senate bill also makes freestanding children’s and cancer hospitals, and certain rural hospitals, eligible to join the 340B program, and creates new rules and guidelines to ensure the integrity of the program.
“We’re extremely pleased,” said Robert Whitler, vice president of government and community affairs at Charleston Area Medical Center, a tertiary care safety-net hospital serving southern and central West Virginia. “The extension of 340B discounts in inpatient drugs will save our hospital an estimated $5 million to $7 million annually, and this additional cost saving is critical. It allows us to continue our safety-net mission here.”
Whitler’s hospital picks up one-quarter of the acute hospital charity care in West Virginia, a state where more than 21 percent of adults lack health insurance, according to the Kaiser Family Foundation. It’s a constant struggle to meet the needs of patients, Whitler said.
Bill expands, strengthens 340B program
During a rare Saturday session Nov. 21, the Senate overcame an important hurdle in its effort to enact health reform, passing a measure that allows the legislation to be considered on the Senate floor.
The motion, called a “cloture vote”, required the support of three-fifths of senators and passed by a party-line vote of 60 to 39 — without a single vote to spare for the Democrats pushing for the bill. The Senate was set to begin its consideration of the health care reform bill on Nov. 30.
Along with the 340B inpatient language and the provisions extending the 340B discount to new covered entities, the current Senate bill would lower the threshold for sole community hospitals and rural referral hospitals interested in joining the program. Today, sole community hospitals and rural referral hospitals must meet a disproportionate-share (DSH) adjustment percentage of 11.75 percent. The Senate bill proposes to drop the DSH adjustment down to 8 percent.
Rural hospitals advocates have argued that while their facilities may not serve as many Medicaid patients as urban hospitals, they’re often the only hospital within a large geographic area.
The legislation would require the government to post 340B prices on a password-protected Web site and, for the first time, impose sanctions on drug manufacturers and covered entities that violate 340B program rules. The dispute resolution process managed by the U.S. Health Resources Services Administration (HRSA) would also be strengthened. The goal of this provision is to ensure that HRSA acts on disagreements between manufacturers and covered entities in a timely manner.
The Senate bill would also require 340B-covered entities to update their contact information on the Office of Pharmacy Affairs’ Web site at least once a year.
Congress faces tight deadlines before 2010 election year
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Other 340B Measures in the Senate bill
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Lawmakers want to avoid dragging the controversial reform debate into next year’s congressional re-election campaigns. So congressional leaders hope to vote on the final health care reform bill before the end of the year.
After the Senate passage, the House can either adopt the Senate health care reform bill and send it on to the White House for the president’s signature — or choose to negotiate with the Senate to reconcile the differences between that legislation and the bill the House passed early November. If House and Senate negotiations produce a new health bill, it must be passed by both houses of Congress before being signed into law by the president, a process certain to delay things.
When the full Senate considers the health reform bill in early December, lawmakers will have the opportunity to amend and change anything in the bill. This fact has intensified advocacy from virtually all groups with a stake in the legislation, including the 340B community.
During the Senate Health, Education, Labor & Pensions Committee’s consideration of the bill in July, two lawmakers proposed amendments that would have stripped the 340B inpatient extension from the bill. One lawmaker even recommended sunsetting the program altogether for many 340B providers if the number of uninsured were to drop significantly.
While these amendments received a lot of attention when first drafted, they were dropped before the committee had a chance to vote on the bill.