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SECOND REGULAR SESSION
SENATE BILL NO. 1178
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR FITZWATER.
3818S.01I KRISTINA MARTIN, Secretary
AN ACT
To amend chapter 191, RSMo, by adding thereto one new section relating to the 340B drug
program.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapter 191, RSMo, is amended by adding thereto 1
one new section, to be known as section 191.1067, to read as 2
follows:3
191.1067. 1. As used in this section, the following 1
terms mean: 2
(1) "340B covered hospital", an entity described in 42 3
U.S.C. Section 256b(a)(4)(L) to 42 U.S.C. Section 4
256b(a)(4)(O) that: 5
(a) Is authorized to participate in the federal 340B 6
Drug Pricing Program under Section 340B of the federal 7
Public Health Service Act, 42 U.S.C. Section 256b(a)(4), and 8
has a service address in this state as of January first of 9
the reporting year; or 10
(b) Any offsite outpatient facility affiliated under 11
the 340B program with an entity described in this 12
subdivision; 13
(2) "340B program" or "340B drug pricing program", the 14
federal 340B Drug Pricing Program established under 42 15
U.S.C. Section 256b; 16
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(3) "Charity care", the unreimbursed cost to a 17
hospital of providing, funding, or otherwise financially 18
supporting health care services: 19
(a) To a person classified by the hospital as 20
financially indigent or medically indigent on an inpatient 21
or outpatient basis; or 22
(b) To financially indigent patients through other 23
nonprofit or public outpatient clinics, hospitals, or health 24
care organizations; 25
(4) "Financially indigent", an uninsured or 26
underinsured person who is accepted for care with no 27
obligation or a discounted obligation to pay for the 28
services rendered based on the hospital's financial criteria 29
and procedures used to determine if a patient is eligible 30
for charity care, provided that the criteria and procedures 31
include income levels and means testing indexed to the 32
federal poverty guidelines. A hospital may determine that a 33
person is financially or medically indigent under the 34
hospital's eligibility system after health care services are 35
provided; 36
(5) "Medically indigent", a person whose medical or 37
hospital bills after payment by third-party payers exceed a 38
specified percentage of the patient's annual gross income as 39
determined in accordance with the hospital's eligibility 40
system, and who is financially unable to pay the remaining 41
bill. 42
2. Before April first of each year, a 340B covered 43
hospital shall report to the department of health and senior 44
services the following information and transactions 45
concerning the 340B covered hospital's participation in, or 46
participation on behalf of the 340B covered hospital in, the 47
federal 340B program for the previous calendar year: 48
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(1) The 340B covered hospital's: 49
(a) Name; 50
(b) Service address; 51
(c) 340B program identification number; and 52
(d) Designation of entity type as specified in 42 53
U.S.C. Section 256b(a)(4); 54
(2) The aggregate acquisition cost for all 55
prescription drugs obtained under the 340B program and 56
dispensed or administered to patients; 57
(3) The aggregate payment amount received for all 58
drugs obtained under the 340B program and dispensed or 59
administered to patients; 60
(4) The aggregate payment made to pharmacies under 61
contract to dispense drugs obtained under the 340B program; 62
(5) The number of claims for prescription drugs 63
described in subdivision (3) of this subsection; 64
(6) How the 340B covered hospital uses any savings 65
from participating in the 340B program, including the amount 66
of savings used for the provision of charity care, community 67
benefits, or a similar program of providing unreimbursed or 68
subsidized health care; 69
(7) The aggregate payments made to any other entity 70
that is not a 340B covered hospital and is not a contract 71
pharmacy, as described in subdivision (4) of this 72
subsection, for managing any aspect of the 340B covered 73
hospital's utilization of the 340B program; 74
(8) The aggregate payment made for any other 75
administering expense for the 340B program; 76
(9) The aggregate number of prescription drugs 77
dispensed or administered to patients for which a payment 78
was reported under subdivision (3) of this subsection; 79
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(10) The percentage of the 340B covered hospital's 80
claims that were for prescription drugs obtained under the 81
340B program; 82
(11) The number and percentage of low income patients 83
of the 340B covered hospital that were served by a sliding 84
fee scale for a prescription drug dispensed or administered 85
under the 340B program; 86
(12) The 340B covered hospital's total operating costs; 87
(13) The 340B covered hospital's total costs for 88
charity care; and 89
(14) A copy of the 340B covered hospital's financial 90
assistance policy for the reporting year. 91
3. The information required to be reported under 92
subdivisions (3) to (5) of subsection 2 of this section 93
shall, to the extent feasible, be reported by payer type, 94
including the following: 95
(1) Commercial; 96
(2) Medicaid or MO HealthNet; 97
(3) Medicare; and 98
(4) Uninsured. 99
4. The data submitted in the reports required under 100
subsection 2 of this section shall be closed records under 101
chapter 610. 102
5. Before November fifteenth of each year, the 103
department of health and senior services shall prepare a 104
report that aggregates the data submitted under subsections 105
2 and 3 of this section, shall provide the report to the 106
general assembly in electronic format, and shall publish the 107
report on the department's publicly accessible website. 108
6. A 340B covered hospital that fails to provide the 109
information required under subsection 2 or 3 of this section 110
by the date required in this section shall be subject to a 111
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civil penalty of one thousand dollars per day the 112
information is past due. 113
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