Bergman Introduces Bill to Improve Rural Emergency Hospital Designation and Keep Rural ERs Open

On Monday, Reps. Jack Bergman (MI-01) and Debbie Dingell (MI-06) introduced the bipartisan Rural 340B Access Act of 2024, legislation to improve the Rural Emergency Hospital (REH) designation and keep emergency departments in rural areas open.

The REH designation was created by Congress in 2020 to address rural hospital closures and ensure remote communities maintain access to emergency health facilities. Under this designation, rural hospitals receive direct financial support and increased Medicare reimbursement if they maintain 24-hour emergency departments, observation beds, and other key health services.

Unfortunately, when Congress created the designation, REHs were not included as eligible facilities under the 340B drug discount program, which provides rural hospitals and health clinics with discounted prescription drugs. 340B is a critical source of income for rural providers, including for 20 hospitals in Michigan’s First District. This has created a gap where facilities that might otherwise keep their ERs open under the REH designation instead opt to close hospital services entirely and transition into a rural health clinic to maintain 340B eligibility – as was recently the case with Aspirus Ontonagon Hospital.

The Rural 340B Access Act will correct this oversight by including REHs as eligible for 340B, making it a more viable option for providers and helping to keep rural ERs operational.

The National Rural Health Association, the Michigan Health & Hospital Association, and the American Hospital Association are all supportive of the legislation.

Rep. Jack Bergman stated, “The REH designation was created to keep rural emergency rooms open. Unfortunately, the closure of Aspirus Ontonagon Hospital has made it clear that REH isn’t doing enough to stop hospital closures in places like Northern Michigan and the UP. The Rural 340B Access Act will fix the current gap in 340B eligibility for hospitals that close their inpatient services but keep emergency rooms open, helping ensure patients in rural and remote areas can continue to receive essential emergency care. I’m grateful to Representative Dingell for joining me in introducing this important legislation.”

Rep. Debbie Dingell stated, “The closing of rural hospitals seriously impacts residents in remote areas who depend on their emergency rooms, in and outpatient care, and other critical services. I’m proud to introduce this legislation with Rep. Bergman to update the Rural Emergency Hospital designation to help ensure rural ERs have access to 340B, a critical federal resource that will help them remain open to serve the communities that rely on them.”

“The National Rural Health Association thanks Representatives Bergman and Dingell for their work on the Rural 340B Access Act. 340B is a critical program that helps rural hospitals stretch scarce federal resources. Making REHs eligible for the program will allow more vulnerable hospitals to take advantage of the REH designation and keep their doors open for their communities.” – Alan Morgan, Chief Executive Officer, NRHA

“The Michigan Health & Hospital Association applauds Representatives Bergman and Dingell for introducing legislation to strengthen the 340B program by allowing rural emergency hospitals to maintain 340B eligibility so they can continue offering important services to Michiganders throughout the state. The 340B program is essential for safety net hospitals serving Michigan’s most vulnerable communities, and this legislation will bridge a gap to ensure patients in rural areas will continue to have access to high-quality care.” – Brian Peters, CEO, Michigan Health & Hospital Association

Read the full text of the bill here.

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