[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3414 Reported in House (RH)]

<DOC>





                                                 Union Calendar No. 573
116th CONGRESS
  2d Session
                                H. R. 3414

                      [Report No. 116-690, Part I]

  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

                           December 24, 2020

     Additional sponsors: Mr. King of New York, Ms. Houlahan, Mr. 
 Fitzpatrick, Mr. Kilmer, Mr. Delgado, Mr. Larson of Connecticut, Mr. 
 Morelle, Mr. Krishnamoorthi, Ms. Slotkin, Mr. Trone, Miss Rice of New 
 York, Ms. Clark of Massachusetts, Mr. Danny K. Davis of Illinois, Mr. 
Collins of New York, Ms. Hill of California, Mr. Rouda, Mr. Meeks, Mr. 
Suozzi, Mr. Stivers, Mr. Rose of New York, Ms. Meng, Ms. Velazquez, Mr. 
 Katko, Mr. Higgins of New York, Ms. Wild, Mr. Tonko, Mr. Raskin, Mr. 
Pappas, Mrs. Carolyn B. Maloney of New York, Mr. Kim, Mr. Sean Patrick 
Maloney of New York, Mr. Van Drew, Mrs. Axne, Mr. Kennedy, Ms. Stevens, 
     Mr. Rutherford, Mr. Evans, Ms. Dean, Mr. Brendan F. Boyle of 
   Pennsylvania, Ms. Scanlon, Mr. Sarbanes, Ms. Blunt Rochester, Mr. 
 McGovern, Mr. Balderson, Mr. Butterfield, Ms. Sewell of Alabama, Mr. 
Engel, Mr. Brindisi, Ms. Underwood, Mr. Lynch, Ms. Clarke of New York, 
    Mr. Connolly, Mr. Cisneros, Mr. Panetta, Mr. Reschenthaler, Mr. 
  Cuellar, Mrs. Murphy of Florida, Mr. Visclosky, Mr. Espaillat, Mr. 
  Hastings, Mr. Lamb, Mr. Sires, Mr. Rogers of Alabama, Ms. Kelly of 
Illinois, Mr. Gallego, Mr. Ted Lieu of California, Mr. Rush, Mr. Lujan, 
   Mr. Gonzalez of Texas, Mr. Thompson of Mississippi, and Mr. Welch


                           December 24, 2020

    Reported from the Committee on Ways and Means with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

                           December 24, 2020

Committee on Energy and Commerce discharged; committed to the Committee 
 of the Whole House on the State of the Union and ordered to be printed
 [For text of introduced bill, see copy of bill as introduced on June 
                               21, 2019]

_______________________________________________________________________

                                 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.--During the 
                period 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 distribute 
                additional full-time-equivalent residency positions to 
                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 beginning July 1 of 
                the fiscal year of the increase. The aggregate number 
                of additional full-time-equivalent residency positions 
                available for distribution under this paragraph shall 
                be equal to 500 in fiscal year 2022 and 500 over the 
                period of fiscal years 2023 through 2026, distributed 
                in accordance with the succeeding subparagraphs of this 
                paragraph.
                    ``(B) Distribution for fiscal year 2022.--
                            ``(i) In general.--For fiscal year 2022, 
                        the positions available for distribution for 
                        such fiscal year (as 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 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 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.
                            ``(v) Positions not distributed during 
                        fiscal year 2022.--If the number of full-time-
                        equivalent residency positions distributed 
                        under this subparagraph is less than the 
                        aggregate number of positions available for 
                        distribution for fiscal year 2022 (as described 
                        in subparagraph (A)), the difference between 
                        such number distributed and such number 
                        available for distribution shall be added to 
                        the aggregate number of positions available for 
                        distribution under subparagraph (C).
                    ``(C) Distribution for fiscal years 2023 through 
                2026.--
                            ``(i) In general.--For the period of fiscal 
                        years 2023 through 2026, the positions 
                        available for distribution for such period (as 
                        described in subparagraph (A)), and any 
                        positions made available pursuant to 
                        subparagraph (B)(v), 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 1000, 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 1000.
                    ``(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 beginning 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 the 
                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 residency 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 residency 
        positions.''.
                                                 Union Calendar No. 573

116th CONGRESS

  2d Session

                               H. R. 3414

                      [Report No. 116-690, Part I]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                           December 24, 2020

    Reported from the Committee on Ways and Means with an amendment

                           December 24, 2020

Committee on Energy and Commerce discharged; committed to the Committee 
 of the Whole House on the State of the Union and ordered to be printed