,,ii  #aafth ,,congress  #ast ,session  
,s4 #bhib  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #ai1 
#bjai,ms4 ,hassan 7for herself and ,ms4 
,collins7 introduced the following bill2
 which was read twice and referred to   
the ,committee on ,finance  ,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 #bjbb through 
#bjbf 7and succeeding fiscal years if   
the ,secretary determines that there are
 additional full-time equivalent        
residency positions available to        
distribute under subparagraph 7,d771 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    
approve1 effective for portions of cost 
reporting periods occurring on or after 
,july #a of the fiscal year of the      
increase4 ,the aggregate number of      
additional full-time equivalent resident
 positions available for distribution   
under this paragraph shall be equal to  

#a1jjj1 distributed in accordance with  
the succeeding subparagraphs of this    
paragraph4  7,b7 ,distribution for      
fiscal year #bjbb  7i7 ,in general ,for 
fiscal year #bjbb1 #ejj of the positions
 described in subparagraph 7,a7 may only
 be distributed to hospitals that have  
established 7as of the date of the      
enactment of this paragraph7 approved   
programs in addiction medicine1         
addiction psychiatry1 or pain medicine1 
as determined by the ,secretary4  7ii7  
,considerations in distribution ,the    
,secretary shall distribute additional  
residency positions under this          
subparagraph based on the demonstrated  
likelihood 7as determined by the        
,secretary7 of the hospital filling such
 positions4  7iii7 ,requirements ,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 made    

available under this subparagraph for a 
program described in clause 7i7 or a    
program that is a prerequisite 7as      
determined by the ,secretary7 for such a
 program so described1 such as internal 
medicine4 ,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  7iv7      
,redistribution of positions if hospital
 no longer meets certain requirements   
,in the case in which the ,secretary    
determines that a hospital described in 
clause 7iii7 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,c7 ,distribution for     
fiscal years #bjbc through #bjbf  7i7   
,in general ,for the period of fiscal   
years #bjbc through #bjbf1 #ejj of the  
positions available for distribution    
under subparagraph 7,a7 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 medicine1         
addiction psychiatry1 or pain medicine4 
7ii7 ,considerations in distribution    
,the ,secretary shall distribute        
additional residency positions under    
this subparagraph based on the          
demonstrated likelihood1 as determined  
by the ,secretary1 of the hospital      
filling such positions within the first 
#d training years 7as specified by the  
,secretary7 after the increase would be 
effective4  7iii7 ,requirements ,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 made    
available under this subparagraph for a 
program described in clause 7i7 or a    
program that is a prerequisite 7as      
determined by the ,secretary7 for such a
 program so described1 such as internal 
medicine4 ,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  7iv7      
,redistribution of positions if hospital
 no longer meets certain requirements   
,in the case where the ,secretary       
determines that a hospital described in 
clause 7iii7 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 ,distribution of      
remaining positions ,if the aggregate   
number of positions distributed under   
subparagraphs 7,b7 and 7,c7 during the  
period of fiscal years #bjbb through    
#bjbf is less than #ejj1 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 #ejj4  7,e7 ,limitation ,an    
individual hospital may not receive more
 than #be full-time equivalent residency
 positions under this paragraph4  7,f7  
,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 #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 ,clarification ,chapter #ce of     
title #dd1 ,united ,states ,code1 shall 
not apply to implementation of this     
paragraph4  7,j7 ,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 paragraph    
7#d77;,f77i7 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 #bjbb1 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