The 340B patient definition is kind of intimidating. Here it is, and below, a brief translation of it in plain english!

According to HRSA

An individual is a patient of a 340B covered entity (with the exception of State-operated or funded AIDS drug purchasing assistance programs) only if:

the covered entity has established a relationship with the individual, such that the covered entity maintains records of the individual’s health care;  and

the individual receives health care services from a health care professional who is either employed by the covered entity or provides health care under contractual or other arrangements (e.g. referral for consultation) such that responsibility for the care provided remains with the covered entity;  and

the individual receives a health care service or range of services from the covered entity which is consistent with the service or range of services for which grant funding or Federally-qualified health center look-alike status has been provided to the entity. Disproportionate share hospitals are exempt from this requirement.

Three Basic Components

First, you have a Medical Record of care. Do you have an EMR record with a visit for this patient?

Next, the provider caring for the patient must have a relationship with you. Notice, it indicates a variety of relationships, including a referral for consultation.

Finally, for grant-funded participants (FQHC’s) , the services you provide must be consistent with the services you receive grant funding for. For example, if you are funded to provide Women’s Health services, theoretically you should only qualify prescriptions related to Women’s health services. This might be entirely true if you re providing Women’s health services and refer the patient to a specialist and send a referral order.

Conclusion

That is a quick description of the 340B patient definition. Drop me a comment if you have further questions or comments!

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