Rural Referral Centers

Eligibility

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. The Centers for Medicare and Medicaid Services classifies hospitals as Rural Referral Centers. 

To be eligible to participate in the 340B Drug Pricing Program, Rural Referral Centers must meet the requirements of 42 USC 256b(a)(4)(L)(i).

To be eligible to participate in the 340B Program and purchase outpatient drugs at significantly discounted prices, Rural Referral Centers must be one of the following classifications:

• A private nonprofit hospital under contract with state or local government to provide health care services to low income individuals who are not eligible for Medicare or Medicaid; or
• Owned or operated by a unit of state or local government; or
• A public or private nonprofit corporation that is formally granted governmental powers by a unit of state or local government.

For-profit hospitals are not eligible to participate in the 340B program.

To be eligible to participate in the 340B Drug Pricing Program, Rural Referral Centers must:

• Have a disproportionate share adjustment percentage greater than or equal to 8% for the most-recently filed cost report

Eligible in Multiple Categories

Hospitals that are eligible to participate in the 340B Drug Pricing Program in more than one category may select one. For example, a hospital that is both as a Disproportionate Share Hospital and a Sole Community Hospital may choose either type of eligibility and must abide by requirements and guidelines for that type of eligible organization/covered entity once enrolled.