[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3414 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 3414
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions to help combat the
opioid crisis.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 21, 2019
Mr. Schneider (for himself, Mrs. Brooks of Indiana, Ms. Kuster of New
Hampshire, and Ms. Stefanik) introduced the following bill; which was
referred to the Committee on Ways and Means, and in addition to the
Committee on Energy and Commerce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions to help combat the
opioid crisis.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Opioid Workforce Act of 2019''.
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS TO HELP COMBAT
OPIOID CRISIS.
(a) In General.--Section 1886(h) of the Social Security Act (42
U.S.C. 1395ww(h)) is amended--
(1) in paragraph (4)(F)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(2) in paragraph (4)(H)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(3) in paragraph (7)(E), by inserting ``paragraph (9),''
after ``paragraph (8),''; and
(4) by adding at the end the following new paragraph:
``(9) Distribution of additional residency positions to
help combat opioid crisis.--
``(A) Additional residency positions.--For each of
fiscal years 2022 through 2026 (and succeeding fiscal
years if the Secretary determines that there are
additional full-time equivalent residency positions
available to distribute under subparagraph (D)), the
Secretary shall increase the otherwise applicable
resident limit for each qualifying hospital that
submits a timely application under this paragraph by
such number as the Secretary may approve, effective for
portions of cost reporting periods occurring on or
after July 1 of the fiscal year of the increase. The
aggregate number of additional full-time equivalent
resident positions available for distribution under
this paragraph shall be equal to 1,000, distributed in
accordance with the succeeding subparagraphs of this
paragraph.
``(B) Distribution for fiscal year 2022.--
``(i) In general.--For fiscal year 2022,
500 of the positions described in subparagraph
(A) may only be distributed to hospitals that
have established (as of the date of the
enactment of this paragraph) approved programs
in addiction medicine, addiction psychiatry, or
pain medicine, as determined by the Secretary.
``(ii) Considerations in distribution.--The
Secretary shall distribute additional residency
positions under this subparagraph based on the
demonstrated likelihood (as determined by the
Secretary) of the hospital filling such
positions.
``(iii) Requirements.--A hospital that
receives an increase in the otherwise
applicable resident limit under this
subparagraph shall ensure, during the 5-year
period beginning after the date of such
increase, that the hospital uses the positions
made available under this subparagraph for a
program described in clause (i) or a program
that is a prerequisite (as determined by the
Secretary) for such a program so described,
such as internal medicine. The Secretary may
determine whether a hospital has met the
requirements under this clause during such 5-
year period in such manner and at such time as
the Secretary determines appropriate, including
at the end of such 5-year period.
``(iv) Redistribution of positions if
hospital no longer meets certain
requirements.--In the case in which the
Secretary determines that a hospital described
in clause (iii) does not meet the requirements
of such clause, the Secretary shall--
``(I) reduce the otherwise
applicable resident limit of the
hospital by the amount by which such
limit was increased under this
subparagraph; and
``(II) provide for the distribution
of positions attributable to such
reduction in accordance with the
requirements of this paragraph.
``(C) Distribution for fiscal years 2023 through
2026.--
``(i) In general.--For the period of fiscal
years 2023 through 2026, 500 of the positions
available for distribution under subparagraph
(A) shall be distributed to hospitals which
demonstrate to the Secretary that the hospital
has established or will establish an approved
residency training program in addiction
medicine, addiction psychiatry, or pain
medicine.
``(ii) Considerations in distribution.--The
Secretary shall distribute additional residency
positions under this subparagraph based on the
demonstrated likelihood, as determined by the
Secretary, of the hospital filling such
positions within the first 4 training years (as
specified by the Secretary) after the increase
would be effective.
``(iii) Requirements.--A hospital that
receives an increase in the otherwise
applicable resident limit under this
subparagraph shall ensure, during the 5-year
period beginning after the date of such
increase, that the hospital uses the positions
made available under this subparagraph for a
program described in clause (i) or a program
that is a prerequisite (as determined by the
Secretary) for such a program so described,
such as internal medicine. The Secretary may
determine whether a hospital has met the
requirements under this clause during such 5-
year period in such manner and at such time as
the Secretary determines appropriate, including
at the end of such 5-year period.
``(iv) Redistribution of positions if
hospital no longer meets certain
requirements.--In the case where the Secretary
determines that a hospital described in clause
(iii) does not meet the requirements of such
clause, the Secretary shall--
``(I) reduce the otherwise
applicable resident limit of the
hospital by the amount by which such
limit was increased under this
subparagraph; and
``(II) provide for the distribution
of positions attributable to such
reduction in accordance with the
requirements of this paragraph.
``(D) Distribution of remaining positions.--If the
aggregate number of positions distributed under
subparagraphs (B) and (C) during the period of fiscal
years 2022 through 2026 is less than 500, the Secretary
shall distribute the remaining residency positions in
succeeding fiscal years according to criteria
consistent with this paragraph until such time as the
aggregate amount of positions distributed under this
paragraph is equal to 500.
``(E) Limitation.--An individual hospital may not
receive more than 25 full-time-equivalent residency
positions under this paragraph.
``(F) Notification.--The Secretary shall notify
hospitals of the number of positions distributed to the
hospital under this paragraph as a result of an
increase in the otherwise applicable resident limit by
January 1 of the fiscal year of the increase. Such
increase shall be effective for portions of cost
reporting periods beginning on or after July 1 of that
fiscal year.
``(G) Application of per resident amounts for
primary care and nonprimary care.--With respect to
additional residency positions in a hospital
attributable to the increase provided under this
paragraph, the approved FTE per resident amounts are
deemed to be equal to the hospital per resident amounts
for primary care and nonprimary care computed under
paragraph (2)(D) for that hospital.
``(H) Permitting facilities to apply aggregation
rules.--The Secretary shall permit hospitals receiving
additional residency positions attributable to the
increase provided under this paragraph to, beginning in
the fifth year after the effective date of such
increase, apply such positions to the limitation amount
under paragraph (4)(F) that may be aggregated pursuant
to paragraph (4)(H) among members of the same
affiliated group.
``(I) Clarification.--Chapter 35 of title 44,
United States Code, shall not apply to implementation
of this paragraph.
``(J) Definitions.--In this paragraph:
``(i) Otherwise applicable resident
limit.--The term `otherwise applicable resident
limit' means, with respect to a hospital, the
limit otherwise applicable under paragraph
(4)(F)(i) on the resident level for the
hospital determined without regard to this
paragraph but taking into account paragraphs
(7)(A), (7)(B), (8)(A), and (8)(B).
``(ii) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).''.
(b) IME.--
(1) In general.--Section 1886(d)(5)(B)(v) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the third
sentence, is amended by striking ``and (h)(8)'' and inserting
``(h)(8), and (h)(9)''.
(2) Conforming provision.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended--
(A) by redesignating clause (x), as added by
section 5505(b) of the Patient Protection and
Affordable Care Act (Public Law 111-148), as clause
(xi) and moving such clause 4 ems to the left; and
(B) by adding after clause (xi), as redesignated by
subparagraph (A), the following new clause:
``(xii) For discharges occurring on or after July 1, 2022,
insofar as an additional payment amount under this subparagraph
is attributable to resident positions distributed to a hospital
under subsection (h)(9), the indirect teaching adjustment
factor shall be computed in the same manner as provided under
clause (ii) with respect to such resident positions.''.
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