What Are the Different Hospital Types in the 340B Program? DSH Requirement: > 11.75% If the children’s hospital doesn’t file a Medicare cost report, your hospital needs an independent audit showing a disproportionate share adjustment percentage that meets the requirement. Review the Guidelines for Children's Hospitals. (PDF - 157 KB).

Rural Referral Centers are defined in Section 1886 (d) (5) (C ) (i) of the Social Security Act; requirements for Rural Referral Centers can be found at 42 CFR 412.96. Rural Referral Centers are high-volume acute care rural hospitals that treat a large number of complicated cases.

Disproportionate Share Hospitals serve low-income patients and receive payments from the Centers for Medicare & Medicaid Services to cover the costs of providing care to uninsured patients. To be eligible to participate in the 340B Drug Pricing Program, Disproportionate Share Hospitals must meet the requirements of 42 USC 256b(a)(4)(L).

The RRC pathway to 340B eligibility provides an alternative for urban hospitals that do not exceed the disproportionate share adjustment percentage threshold for eligibility as a DSH. Figure 1 illustrates this for a hypothetical hospital in a large US city.

Section 340B requires pharmaceutical manufacturers that participate in the Medicaid and Medicare Part B programs to enter into a contract with the Secretary of Health and Human Services (HHS) requiring them, among other things, to give specified discounts on covered outpatient drugs purchased by certain “covered entities.” 1 The definition ...

Hospitals whose DSH patient percentage exceeds 15 percent are eligible for a DSH payment adjustment based on another statutory formula. The formula varies for urban hospitals with 100 or more beds and rural hospitals with 500 or more beds, hospital that qualify as rural referral centers or sole community hospitals, and other hospitals.

2021年10月25日 · 3) DSH hospitals, children’s hospitals and free-standing cancer hospitals meeting the first two criteria. These hospitals are eligible to participate in the 340B program if they do not obtain covered outpatient drugs through Group Purchasing Organizations (GPOs), or through other group purchasing arrangements.

The RRC program offers two other special payment provisions. First, qualifying RRCs receive a higher DSH adjustment than do other rural hospitals. Most rural hospitals’ DSH add-ons are capped at 5.25 percent, but RRCs receive an additional 0.6 percent adjustment for every percentage point that their disproportionate patient percentage

In general, a Medicare participating acute care hospital is classified as a RRC if it is located in a rural area and it meets one of the following criteria: It has 275 or more beds available for use during its most recently completed cost reporting period.

2013年8月2日 · A DSH may not purchase covered outpatient drugs through a GPO but is not subject to the orphan drug exclusion, while an RRC is not subject to the GPO prohibition but is subject to the orphan drug exclusion.