,,ii  #aae? ,,congress  #b;d ,session   
,s4 #bhdc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ae1 #bjah ,mr4   
,nelson 7= himself & ,mr4 ,hell]7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = ! di/ribution ( additional    
resid5cy positions to help combat !     
opioid crisis4  #a4 ,%ort title ,?is    
,act may be cit$ z ! ,opioid ,work=ce   
,act ( #bjah4  #b4 ,di/ribution (       
additional resid5cy positions to help   
combat opioid crisis  7a7 ,9 g5]al      
,section #ahhf7;h7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acieww7h77 is     
am5d$--  7#a7 9 p>agraph 7#d77;,f77i71  
by /rik+ p>agraphs 7#g7 & 7#h7 & ins]t+ 
p>agraphs 7#g71 7#h71 & 7#i72  7#b7 9   
p>agraph 7#d77;,h77i71 by /rik+         
p>agraphs 7#g7 & 7#h7 & ins]t+ p>agraphs
 7#g71 7#h71 & 7#i72  7#c7 9 p>agraph   
7#g77;,e71 by ins]t+ p>agraph 7#i71 aft]
 p>agraph 7#h712 &  7#d7 by add+ at !   

end ! foll[+ new p>agraph3  7#i7        
,di/ribution ( additional resid5cy      
positions to help combat opioid crisis  
7,a7 ,additional resid5cy positions ,=  
ea* ( fiscal ye>s #bjai ?r\gh #bjbc 7&  
succe$+ fiscal ye>s if ! ,secret>y      
det]m9es t !re are additional resid5cy  
positions available to di/ribute "u     
subp>agraph 7,d771 ! ,secret>y %all     
increase ! o!rwise applicable resid5t   
limit = ea* qualify+ hospital t submits 
a timely application "u ?is subp>agraph 
by su* numb] z ! ,secret>y may approve =
 portions ( co/ report+ p]iods occurr+  
on or aft] ,july #a ( ! fiscal ye> ( !  
increase4 ,except z provid$ 9           
subp>agraph 7,b77iv7 or 7,d71 !         
aggregate numb] ( increases 9 ! o!rwise 
applicable resid5t limit "u ?is         
subp>agraph %all be equal to #ejj 9     
fiscal ye> #bjai & #ejj ov] ! p]iod (   
fiscal ye>s #bjbj ?r\gh #bjbc1 di/ribut$
 9 accordance ) ! succe$+ subp>agraphs (
 ?is p>agraph4  7,b7 ,di/ribution =     
fiscal ye> #bjai  7i7 ,9 g5]al ,= fiscal

 ye> #bjai1 ! positions available =     
di/ribution ) respect to ! fiscal ye> z 
describ$ 9 subp>agraph 7,a7 %all be     
di/ribut$ to hospitals t h exi/+        
e/abli%$ approv$ programs 9 addiction   
m$ic9e1 addiction psy*iatry1 or pa9     
managem5t z det]m9$ by ! ,secret>y4     
7ii7 ,numb] ( positions hospital        
eligible to receive ,subject to clauses 
7iii7 & 7iv71 ! aggregate numb] (       
positions a hospital may receive "u ?is 
subp>agraph ) respect to fiscal ye>     
#bjai is equal to ! sum ( ! foll[+3 7,i7
 ,! numb] ( full-"t-equival5t resid5ts t
 w be tra9+ 9 addiction m$ic9e1         
addiction psy*iatry1 or pa9 managem5t z 
det]m9$ by ! ,secret>y ) respect to !   
fiscal ye>4  7,,ii7 ,! associat$ numb] (
 resid5ts tra9+ 9 a pre-requisite       
program1 su* z int]nal m$ic9e1 necess>y 
= ! numb] ( full-"t resid5ts = !        
programs describ$ 9 subclause 7,i74     
7iii7 ,additional positions = expansion 
( exi/+ program ,if a hospital          
demon/rates to ! ,secret>y t ! hospital 

is plann+ to increase ! numb] (         
full-"t-equival5t resid5ts 9 exi/+      
programs describ$ 9 clause 7i71 !       
,secret>y may increase ! numb] (        
positions a hospital is eligible to     
receive "u clause 7ii7 9 ord] to        
accommodate t expansion1 z det]m9$ by ! 
,secret>y4  7iv7 ,consid]ations 9       
di/ribution ,! ,secret>y %all di/ribute 
additional resid5cy positions "u ?is    
subp>agraph bas$ on-- 7,i7 9 ! case (   
positions made available "u clause 7ii71
 ! demon/rat$ likelihood ( ! hospital   
fill+ su* positions by ,july #a1 #bjai2 
&  7,,ii7 9 ! case ( positions made     
available "u clause 7iii71 ! demon/rat$ 
likelihood ( ! hospital fill+ su*       
positions )9 ! fir/ ?ree co/ report+    
p]iods beg9n+ on or aft] ,july #a1      
#bjai4  7v7 ,limitation ,not)/&+ clauses
 7ii7 & 7iv71 an individual hospital may
 n receive m ?an #be full-"t-equival5t  
resid5cy positions "u ?is subp>agraph4  
7vi7 ,cl>ification reg>d+ availability (
 additional positions 9 subsequ5t fiscal

 ye>s ,no?+ 9 ?is subp>agraph %all      
preclude a hospital f receiv+ additional
 resid5cy positions "u subp>agraph 7,c74
  7vii7 ,positions n di/ribut$ dur+ !   
fiscal ye> ,if ! numb] ( resid5t        
full-"t-equival5t positions di/ribut$ "u
 ?is subp>agraph is less ?an ! aggregate
 numb] ( positions available =          
di/ribution 9 ! fiscal ye> 7z describ$ 9
 subp>agraph 7,a771 ! diff]5ce betwe5   
su* numb] di/ribut$ & su* numb]         
available = di/ribution %all be add$ to 
! aggregate numb] ( positions available 
= di/ribution "u subp>agraph 7,c74  7,c7
 ,di/ribution = fiscal ye>s #bjbj ?r\gh 
#bjbc  7i7 ,9 g5]al ,= ! p]iod ( fiscal 
ye>s #bjbj ?r\gh #bjbc1 ! positions     
available = di/ribution ) respect to su*
 p]iod 7z describ$ 9 subp>agraph 7,a71  
includ+ aft] application ( subp>agraph  
7,b77vi77 %all be di/ribut$ to hospitals
 :i* demon/rate to ! ,secret>y t !      
hospital-- 7,i7 w e/abli% an approv$    
program 9 addiction m$ic9e1 addiction   
psy*iatry1 or pa9 managem5t2 &  7,,ii7 w

 use all ( ! additional positions made  
available "u ?is subp>agraph 9 su*      
program or a pr]equisite resid5cy       
program = su* program )9 ! fir/ f\r co/ 
report+ p]iods aft] ! increase w\ld be  
effective4  7ii7 ,requirem5ts ,subject  
to clause 7iii71 a hospital t receives  
an increase 9 ! o!rwise applicable      
resid5t limit "u ?is subp>agraph %all   
ensure1 dur+ ! #e-ye> p]iod beg9n+ aft] 
! date ( su* increase1 t ! hospital uses
 ! positions receiv$ "u clauses 7i77,i7 
& 7i77,,ii7 = ! programs = :i* !        
positions 7 di/ribut$1 or simil>        
programs 7z det]m9$ by ! ,secret>y74 ,! 
,secret>y may det]m9e :e!r a hospital   
has met ! requirem5ts "u ?is clause dur+
 su* #e-ye> p]iod 9 su* mann] & at su*  
"t z ! ,secret>y det]m9es appropriate1  
includ+ at ! end ( su* #e-ye> p]iod4    
7iii7 ,r$i/ribution ( positions if      
hospital no long] meets c]ta9           
requirem5ts ,9 ! case :]e ! ,secret>y   
det]m9es t a hospital describ$ 9 clause 
7ii7 does n meet ! requirem5ts ( su*    

clause1 ! ,secret>y %all-- 7,i7 r$uce ! 
o!rwise applicable resid5t limit ( !    
hospital by ! am\nt by :i* su* limit 0  
increas$ "u ?is subp>agraph2 &  7,,ii7  
provide = ! di/ribution ( positions     
attributable to su* r$uction 9          
accordance ) ! requirem5ts ( ?is        
p>agraph4  7iv7 ,limitation ,an         
individual hospital may n receive m ?an 
#be full-"t-equival5t resid5cy positions
 "u ?is subp>agraph4  7,d7 ,di/ribution 
( rema9+ positions ,if ! aggregate numb]
 ( positions di/ribut$ "u subp>agraphs  
7,b7 & 7,c7 dur+ ! p]iod ( fiscal ye>s  
#bjai ?r\gh #bjbc is less ?an #a1jjj1 ! 
,secret>y %all di/ribute ! rema9+       
resid5cy positions 9 succe$+ fiscal ye>s
 accord+ to crit]ia consi/5t ) ?is      
p>agraph until su* "t z ! aggregate     
am\nt ( positions di/ribut$ "u ?is      
p>agraph is equal to #a1jjj4  7,e7      
,notification ,! ,secret>y %all notify  
hospitals ( ! numb] ( positions         
di/ribut$ to ! hospital "u ?is p>agraph 
z a result ( an increase 9 ! o!rwise    

applicable resid5t limit by ,janu>y #a (
 ! fiscal ye> ( ! increase4 ,su*        
increase %all be effective = portions ( 
co/ report+ p]iods beg9n+ on or aft]    
,july #a ( t fiscal ye>4  7,f7          
,application ( p] resid5t am\nts =      
prim>y c>e & non-prim>y c>e ,) respect  
to additional resid5cy positions 9 a    
hospital attributable to ! increase     
provid$ "u ?is p>agraph1 ! approv$ ,,fte
 p] resid5t am\nts are deem$ to be equal
 to ! hospital p] resid5t am\nts =      
prim>y c>e & non-prim>y c>e comput$ "u  
p>agraph 7#b77;,d7 = t hospital4  7,g7  
,p]mitt+ facilities to apply aggregation
 rules ,! ,secret>y %all p]mit hospitals
 receiv+ additional resid5cy positions  
attributable to ! increase provid$ "u   
?is p>agraph to1 beg9n+ 9 ! fif? ye>    
aft] ! effective date ( su* increase1   
apply su* positions to ! limitation     
am\nt "u p>agraph 7#d77;,f7 t may be    
aggregat$ pursuant to p>agraph 7#d77;,h7
 among memb]s ( ! same affiliat$ gr\p4  
7,h7 ,def9itions ,9 ?is p>agraph3 7i7   

,o!rwise applicable resid5t limit ,! t]m
 o!rwise applicable resid5t limit means1
 ) respect to a hospital1 ! limit       
o!rwise applicable "u subp>agraphs      
7,f77i7 & 7,h7 ( p>agraph 7#d7 on !     
resid5t level = ! hospital det]m9$ )\t  
reg>d to ?is p>agraph b tak+ into acc\nt
 p>agraphs 7#g77;,a71 7#g77;,b71        
7#h77;,a71 & 7#h77;,b74  7ii7 ,resid5t  
level ,! t]m resid5t level has ! mean+  
giv5 su* t]m 9 p>agraph 7#g77;,c77i74  4
  7b7 ,,ime  7#a7 ,9 g5]al ,section     
#ahhf7;d77#e77;,b77v7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77;,b77v771 9 ! ?ird       
s5t5ce1 is am5d$ by /rik+ & 7h77#h7 &   
ins]t+ 7h77#h71 & 7h77#i74  7#b7 ,con=m+
 provision ,section #ahhf7;d77#e77;,b7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww7d77#e77;,b77 is am5d$-- 7,a7 by
 r$esignat+ clause 7x71 z add$ by       
section #eeje7;b7 ( ! ,pati5t           
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh71 z clause 7xi7 &
 mov+ su* clause #d ems to ! left2 &    

7,b7 by add+ aft] clause 7xi71 z        
r$esignat$ by subp>agraph 7,a71 ! foll[+
 new clause3  7xii7 ,= dis*>ges occurr+ 
on or aft] ,july #a1 #bjai1 ins(> z an  
additional paym5t am\nt "u ?is          
subp>agraph is attributable to resid5t  
positions di/ribut$ to a hospital "u    
subsection 7h77#i71 ! indirect tea*+    
adju/m5t factor %all be comput$ 9 ! same
 mann] z provid$ "u clause 7ii7 )       
respect to su* resid5t positions4  4