[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3441 Introduced in House (IH)]

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117th CONGRESS
  1st Session
                                H. R. 3441

  To amend title XVIII of the Social Security Act to provide for the 
   distribution of additional residency positions to help combat the 
                     substance use disorder crisis.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 20, 2021

 Mr. Schneider (for himself, Mr. McKinley, and Ms. Kuster) 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 
                     substance use disorder 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 ``Substance Use Disorder Workforce 
Act''.

SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS TO HELP COMBAT 
              SUBSTANCE USE DISORDER 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), 
        (8), and (9)'' and inserting ``paragraphs (7), (8), (9), and 
        (10)'';
            (2) in paragraph (4)(H)(i), by striking ``paragraphs (7), 
        (8), and (9)'' and inserting ``paragraphs (7), (8), (9), and 
        (10)'';
            (3) in paragraph (7)(E), by striking ``paragraph (8)'' and 
        all that follows through ``clause (i)'' and inserting 
        ``paragraph (8), paragraph (9), paragraph (10), clause (i)''; 
        and
            (4) by adding at the end the following new paragraph:
            ``(10) Distribution of additional residency positions to 
        help combat substance use disorder crisis.--
                    ``(A) Additional residency positions.--During the 
                period of fiscal years 2024 through 2028 (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 2024 and 500 over the 
                period of fiscal years 2025 through 2028, distributed 
                in accordance with the succeeding subparagraphs of this 
                paragraph.
                    ``(B) Distribution for fiscal year 2024.--
                            ``(i) In general.--For fiscal year 2024, 
                        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 2024.--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 2024 (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 2025 through 
                2028.--
                            ``(i) In general.--For the period of fiscal 
                        years 2025 through 2028, 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 2024 through 2028 is less than 1,000, 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 1,000.
                    ``(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), (8)(B), and (9)(A).
                            ``(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)(9)'' and inserting 
        ``(h)(9), and (h)(10)''.
            (2) Conforming provision.--Section 1886(d)(5)(B) of the 
        Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by 
        adding after clause (xi) the following new clause:
                    ``(xiii) For discharges occurring on or after July 
                1, 2024, insofar as an additional payment amount under 
                this subparagraph is attributable to residency 
                positions distributed to a hospital under subsection 
                (h)(10), the indirect teaching adjustment factor shall 
                be computed in the same manner as provided under clause 
                (ii) with respect to such residency positions.''.
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