,i #aafth ,,congress #ast ,session ,h4 ,r4 #bdci ,,in ,,the ,,house ,,of ,,representatives ,may #a1 #bjai,mr4 ,schneider 7for himself1 ,mrs4 ,brooks of ,indiana1 ,ms4 ,kuster of ,new ,hampshire1 and ,ms4 ,stefanik7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 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 crisis4 #a4 ,short title ,this ,act may be cited as the ,opioid ,workforce ,act of #bjai4 #b4 ,distribution of additional residency positions to help combat opioid crisis 7a7 ,in general ,section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77 is amended-- 7#a7 in paragraph 7#d77;,f77i71 by striking paragraphs 7#g7 and 7#h7 and inserting paragraphs 7#g71 7#h71 and 7#i72 7#b7 in paragraph 7#d77;,h77i71 by striking paragraphs 7#g7 and 7#h7 and inserting paragraphs 7#g71 7#h71 and 7#i72 7#c7 in paragraph 7#g77;,e71 by inserting paragraph 7#i71 after paragraph 7#h712 and 7#d7 by adding at the end the following new paragraph3 7#i7 ,distribution of additional residency positions to help combat opioid crisis 7,a7 ,additional residency positions ,for each of fiscal years #bjba through #bjbe 7and succeeding fiscal years if the ,secretary determines that there are additional residency positions available to distribute under subparagraph 7,e771 the ,secretary shall increase the otherwise applicable resident limit for each qualifying hospital that submits a timely application under this subparagraph by such number as the ,secretary may approve for portions of cost reporting periods occurring on or after ,july #a of the fiscal year of the increase4 ,except as provided in subparagraph 7,b77iv7 or 7,e71 the aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to #ejj in fiscal year #bjba and #ejj over the period of fiscal years #bjbb through #bjbe1 distributed in accordance with the succeeding subparagraphs of this paragraph4 7,b7 ,distribution for fiscal year #bjba 7i7 ,in general ,for fiscal year #bjba1 the positions available for distribution with respect to the fiscal year as described in subparagraph 7,a7 shall be distributed to hospitals that have existing established approved programs in addiction medicine1 addiction psychiatry1 or pain management as determined by the ,secretary4 7ii7 ,number of positions hospital eligible to receive ,subject to clauses 7iii7 and 7iv7 and subparagraph 7,d71 the aggregate number of positions a hospital may receive under this subparagraph with respect to fiscal year #bjba is equal to the sum of the following3 7,i7 ,the number of full-time-equivalent residents that will be training in addiction medicine1 addiction psychiatry1 or pain management as determined by the ,secretary with respect to the fiscal year4 7,,ii7 ,the associated number of residents training in a pre-requisite program1 such as internal medicine1 necessary for the number of full-time residents for the programs described in subclause 7,i74 7iii7 ,additional positions for expansion of existing program ,if a hospital demonstrates to the ,secretary that the hospital is planning to increase the number of full-time-equivalent residents in existing programs described in clause 7i71 the ,secretary may increase the number of positions a hospital is eligible to receive under clause 7ii7 in order to accommodate that expansion1 as determined by the ,secretary4 7iv7 ,considerations in distribution ,the ,secretary shall distribute additional residency positions under this subparagraph based on-- 7,i7 in the case of positions made available under clause 7ii71 the demonstrated likelihood of the hospital filling such positions by ,july #a1 #bjba2 and 7,,ii7 in the case of positions made available under clause 7iii71 the demonstrated likelihood of the hospital filling such positions within the first three cost reporting periods beginning on or after ,july #a1 #bjba4 7v7 ,clarification regarding availability of additional positions in subsequent fiscal years ,nothing in this subparagraph shall preclude a hospital from receiving additional residency positions under subparagraph 7,c74 7vi7 ,positions not distributed during the fiscal year ,if the number of resident full-time-equivalent positions distributed under this subparagraph is less than the aggregate number of positions available for distribution in the fiscal year 7as described in subparagraph 7,a771 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 7,c74 7,c7 ,distribution for fiscal years #bjbb through #bjbe 7i7 ,in general ,for the period of fiscal years #bjbb through #bjbe1 the positions available for distribution with respect to such period 7as described in subparagraph 7,a71 including after application of subparagraph 7,b77vi77 shall be distributed1 subject to subparagraph 7,d71 to hospitals which demonstrate to the ,secretary that the hospital-- 7,i7 will establish an approved program in addiction medicine1 addiction psychiatry1 or pain management2 and 7,,ii7 will use all of the additional positions made available under this subparagraph in such program or a prerequisite residency program for such program within the first four cost reporting periods after the increase would be effective4 7ii7 ,requirements ,subject to clause 7iii71 a hospital that receives an increase in the otherwise applicable resident limit under this subparagraph shall ensure1 during the #e-year period beginning after the date of such increase1 that the hospital uses the positions received under clauses 7i77,i7 and 7i77,,ii7 for the programs for which the positions were distributed1 or similar programs 7as determined by the ,secretary74 ,the ,secretary may determine whether a hospital has met the requirements under this clause during such #e-year period in such manner and at such time as the ,secretary determines appropriate1 including at the end of such #e-year period4 7iii7 ,redistribution of positions if hospital no longer meets certain requirements ,in the case where the ,secretary determines that a hospital described in clause 7ii7 does not meet the requirements of such clause1 the ,secretary shall-- 7,i7 reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this subparagraph2 and 7,,ii7 provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph4 7,d7 ,limitation ,the aggregate number of positions distributed under subparagraphs 7,b7 and 7,c7 to an individual hospital during the period of fiscal years #bjba through #bjbe may not exceed #be4 7,e7 ,distribution of remaining positions ,if the aggregate number of positions distributed under subparagraphs 7,b7 and 7,c7 during the period of fiscal years #bjba through #bjbe is less than #a1jjj1 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 #a1jjj4 7,f7 ,notification ,the ,secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as a result on an increase in the otherwise applicable resident limit by ,january #a of the fiscal year of the increase4 ,such increase shall be effective for portions of cost reporting periods beginning on or after ,july #a of that fiscal year4 7,g7 ,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 paragraph1 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 7#b77;,d7 for that hospital4 7,h7 ,permitting facilities to apply aggregation rules ,the ,secretary shall permit hospitals receiving additional residency positions attributable to the increase provided under this paragraph to1 beginning in the fifth year after the effective date of such increase1 apply such positions to the limitation amount under paragraph 7#d77;,f7 that may be aggregated pursuant to paragraph 7#d77;,h7 among members of the same affiliated group4 7,i7 ,definitions ,in this paragraph3 7i7 ,otherwise applicable resident limit ,the term otherwise applicable resident limit means1 with respect to a hospital1 the limit otherwise applicable under subparagraphs 7,f77i7 and 7,h7 of paragraph 7#d7 on the resident level for the hospital determined without regard to this paragraph but taking into account paragraphs 7#g77;,a71 7#g77;,b71 7#h77;,a71 and 7#h77;,b74 7ii7 ,resident level ,the term resident level has the meaning given such term in paragraph 7#g77;,c77i74 4 7b7 ,,ime 7#a7 ,in general ,section #ahhf7;d77#e77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77v771 in the third sentence1 is amended by striking and 7h77#h7 and inserting 7h77#h71 and 7h77#i74 7#b7 ,conforming provision ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended-- 7,a7 by redesignating clause 7x71 as added by section #eeje7;b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 as clause 7xi7 and moving such clause #d ems to the left2 and 7,b7 by adding after clause 7xi71 as redesignated by subparagraph 7,a71 the following new clause3 7xii7 ,for discharges occurring on or after ,july #a1 #bjba1 insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection 7h77#i71 the indirect teaching adjustment factor shall be computed in the same manner as provided under clause 7ii7 with respect to such resident positions4 4