,i #aagth ,,congress #ast ,session ,h4 ,r4 #cdda ,,in ,,the ,,house ,,of ,,representatives ,may #bj1 #bjba,mr4 ,schneider 7for himself1 ,mr4 ,mc,kinley1 and ,ms4 ,kuster7 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 substance use disorder crisis4 #a4 ,short title ,this ,act may be cited as the ,substance ,use ,disorder ,workforce ,act4 #b4 ,distribution of additional residency positions to help combat substance use disorder 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#g71 7#h71 and 7#i7 and inserting paragraphs 7#g71 7#h71 7#i71 and 7#aj72 7#b7 in paragraph 7#d77;,h77i71 by striking paragraphs 7#g71 7#h71 and 7#i7 and inserting paragraphs 7#g71 7#h71 7#i71 and 7#aj72 7#c7 in paragraph 7#g77;,e71 by striking paragraph 7#h7 and all that follows through clause 7i7 and inserting paragraph 7#h71 paragraph 7#i71 paragraph 7#aj71 clause 7i72 and 7#d7 by adding at the end the following new paragraph3 7#aj7 ,distribution of additional residency positions to help combat substance use disorder crisis 7,a7 ,additional residency positions ,during the period of fiscal years #bjbd through #bjbh 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 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 approve1 effective beginning ,july #a of the fiscal year of the increase4 ,the aggregate number of additional full-time-equivalent residency positions available for distribution under this paragraph shall be equal to #ejj in fiscal year #bjbd and #ejj over the period of fiscal years #bjbe through #bjbh1 distributed in accordance with the succeeding subparagraphs of this paragraph4 7,b7 ,distribution for fiscal year #bjbd 7i7 ,in general ,for fiscal year #bjbd1 the positions available for distribution for such fiscal year 7as described in subparagraph 7,a77 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 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 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 7v7 ,positions not distributed during fiscal year #bjbd ,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 #bjbd 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 #bjbe through #bjbh 7i7 ,in general ,for the period of fiscal years #bjbe through #bjbh1 the positions available for distribution for such period 7as described in subparagraph 7,a771 and any positions made available pursuant to subparagraph 7,b77v71 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 #bjbd through #bjbh 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,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 beginning ,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 the 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 7#h77;,b71 and 7#i77;,a74 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#i7 and inserting 7h77#i71 and 7h77#aj74 7#b7 ,conforming provision ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended by adding after clause 7xi7 the following new clause3 7xiii7 ,for discharges occurring on or after ,july #a1 #bjbd1 insofar as an additional payment amount under this subparagraph is attributable to residency positions distributed to a hospital under subsection 7h77#aj71 the indirect teaching adjustment factor shall be computed in the same manner as provided under clause 7ii7 with respect to such residency positions4 4