,i  #aag? ,,congress  #a/ ,session  ,h4 
,r4 #cdda  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #bj1 #bjba,mr4   
,s*neid] 7= himself1 ,mr4 ,mc,kinley1 & 
,ms4 ,ku/]7 introduc$ ! foll[+ bill2 :i*
 0 ref]r$ to ! ,committee on ,ways &    
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = ! di/ribution ( additional    
resid5cy positions to help combat !     
sub/ance use disord] crisis4  #a4 ,%ort 
title ,?is ,act may be cit$ z !         
,sub/ance ,use ,disord] ,work=ce ,act4  
#b4 ,di/ribution ( additional resid5cy  
positions to help combat sub/ance use   
disord] 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#g71 7#h71 & 7#i7 & ins]t+   

p>agraphs 7#g71 7#h71 7#i71 & 7#aj72    
7#b7 9 p>agraph 7#d77;,h77i71 by /rik+  
p>agraphs 7#g71 7#h71 & 7#i7 & ins]t+   
p>agraphs 7#g71 7#h71 7#i71 & 7#aj72    
7#c7 9 p>agraph 7#g77;,e71 by /rik+     
p>agraph 7#h7 & all t foll[s ?r\gh      
clause 7i7 & ins]t+ p>agraph 7#h71      
p>agraph 7#i71 p>agraph 7#aj71 clause   
7i72 &  7#d7 by add+ at ! end ! foll[+  
new p>agraph3  7#aj7 ,di/ribution (     
additional resid5cy positions to help   
combat sub/ance use disord] crisis  7,a7
 ,additional resid5cy positions ,dur+ ! 
p]iod ( fiscal ye>s #bjbd ?r\gh #bjbh 7&
 succe$+ fiscal ye>s if ! ,secret>y     
det]m9es t !re are additional           
full-"t-equival5t resid5cy positions    
available to di/ribute "u subp>agraph   
7,d771 ! ,secret>y %all di/ribute       
additional full-"t-equival5t resid5cy   
positions to increase ! o!rwise         
applicable resid5t limit = ea* qualify+ 
hospital t submits a timely application 
"u ?is p>agraph by su* numb] z !        
,secret>y may approve1 effective beg9n+ 

,july #a ( ! fiscal ye> ( ! increase4 ,!
 aggregate numb] ( additional           
full-"t-equival5t resid5cy positions    
available = di/ribution "u ?is p>agraph 
%all be equal to #ejj 9 fiscal ye> #bjbd
 & #ejj ov] ! p]iod ( fiscal ye>s #bjbe 
?r\gh #bjbh1 di/ribut$ 9 accordance ) ! 
succe$+ subp>agraphs ( ?is p>agraph4    
7,b7 ,di/ribution = fiscal ye> #bjbd    
7i7 ,9 g5]al ,= fiscal ye> #bjbd1 !     
positions available = di/ribution = su* 
fiscal ye> 7z describ$ 9 subp>agraph    
7,a77 may only be di/ribut$ to hospitals
 t h e/abli%$ 7z ( ! date ( ! enactm5t (
 ?is p>agraph7 approv$ programs 9       
addiction m$ic9e1 addiction psy*iatry1  
or pa9 m$ic9e1 z det]m9$ by ! ,secret>y4
  7ii7 ,consid]ations 9 di/ribution ,!  
,secret>y %all di/ribute additional     
resid5cy positions "u ?is subp>agraph   
bas$ on ! demon/rat$ likelihood1 z      
det]m9$ by ! ,secret>y1 ( ! hospital    
fill+ su* positions )9 ! fir/ #d tra9+  
ye>s 7z specifi$ by ! ,secret>y7 aft] ! 
increase w\ld be effective4  7iii7      

,requirem5ts ,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 made available "u ?is         
subp>agraph = a program describ$ 9      
clause 7i7 or a program t is a          
pr]equisite 7z det]m9$ by ! ,secret>y7 =
 su* a program s describ$1 su* z int]nal
 m$ic9e4 ,! ,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  7iv7 ,r$i/ribution (     
positions if hospital no long] meets    
c]ta9 requirem5ts ,9 ! case 9 :i* !     
,secret>y det]m9es t a hospital describ$
 9 clause 7iii7 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$uction 9 accordance ) !           
requirem5ts ( ?is p>agraph4  7v7        
,positions n di/ribut$ dur+ fiscal ye>  
#bjbd ,if ! numb] ( full-"t-equival5t   
resid5cy positions di/ribut$ "u ?is     
subp>agraph is less ?an ! aggregate     
numb] ( positions available =           
di/ribution = fiscal ye> #bjbd 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 #bjbe ?r\gh 
#bjbh  7i7 ,9 g5]al ,= ! p]iod ( fiscal 
ye>s #bjbe ?r\gh #bjbh1 ! positions     
available = di/ribution = su* p]iod 7z  
describ$ 9 subp>agraph 7,a771 & any     
positions made available pursuant to    
subp>agraph 7,b77v71 %all be di/ribut$  
to hospitals :i* demon/rate to !        
,secret>y t ! hospital has e/abli%$ or w
 e/abli% an approv$ resid5cy tra9+      
program 9 addiction m$ic9e1 addiction   

psy*iatry1 or pa9 m$ic9e4  7ii7         
,consid]ations 9 di/ribution ,!         
,secret>y %all di/ribute additional     
resid5cy positions "u ?is subp>agraph   
bas$ on ! demon/rat$ likelihood1 z      
det]m9$ by ! ,secret>y1 ( ! hospital    
fill+ su* positions )9 ! fir/ #d tra9+  
ye>s 7z specifi$ by ! ,secret>y7 aft] ! 
increase w\ld be effective4  7iii7      
,requirem5ts ,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 made available "u ?is         
subp>agraph = a program describ$ 9      
clause 7i7 or a program t is a          
pr]equisite 7z det]m9$ by ! ,secret>y7 =
 su* a program s describ$1 su* z int]nal
 m$ic9e4 ,! ,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  7iv7 ,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 7iii7 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$uction 9 accordance ) !           
requirem5ts ( ?is p>agraph4  7,d7       
,di/ribution ( rema9+ positions ,if !   
aggregate numb] ( positions di/ribut$ "u
 subp>agraphs 7,b7 & 7,c7 dur+ ! p]iod (
 fiscal ye>s #bjbd ?r\gh #bjbh 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 
,limitation ,an individual hospital may 
n receive m ?an #be full-"t-equival5t   
resid5cy positions "u ?is p>agraph4     

7,f7 ,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 beg9n+ ,july 
#a ( t fiscal ye>4  7,g7 ,application ( 
p] resid5t am\nts = prim>y c>e &        
nonprim>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 
& nonprim>y c>e comput$ "u p>agraph     
7#b77;,d7 = t hospital4  7,h7 ,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,i7 ,cl>ification ,*apt] #ce ( title   
#dd1 ,unit$ ,/ates ,code1 %all n apply  
to ! implem5tation ( ?is p>agraph4  7,j7
 ,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 p>agraph          
7#d77;,f77i7 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;,b71 & 7#i77;,a74  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#i7 &   
ins]t+ 7h77#i71 & 7h77#aj74  7#b7       
,con=m+ provision ,section              
#ahhf7;d77#e77;,b7 ( ! ,social ,security

 ,act 7#db ,u4,s4,c4                    
#acieww7d77#e77;,b77 is am5d$ by add+   
aft] clause 7xi7 ! foll[+ new clause3   
7xiii7 ,= dis*>ges occurr+ on or aft]   
,july #a1 #bjbd1 ins(> z an additional  
paym5t am\nt "u ?is subp>agraph is      
attributable to resid5cy positions      
di/ribut$ to a hospital "u subsection   
7h77#aj71 ! indirect tea*+ adju/m5t     
factor %all be comput$ 9 ! same mann] z 
provid$ "u clause 7ii7 ) respect to su* 
resid5cy positions4  4