IB 

Union Calendar No. 573 

116TH CONGRESS 

2D SESSION H. R. 3414 

[Report No. 116–690, Part I] 

To amend title XVIII of the Social Security Act to provide for the distribution 

of additional residency positions to help combat the opioid crisis. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 21, 2019 

Mr. SCHNEIDER (for himself, Mrs. BROOKS of Indiana, Ms. KUSTER of New 

Hampshire, and Ms. STEFANIK) introduced the following bill; which was 

referred to the Committee on Ways and Means, and in addition to the 

Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

DECEMBER 24, 2020 

Additional sponsors: Mr. KING of New York, Ms. HOULAHAN, Mr. 

FITZPATRICK, Mr. KILMER, Mr. DELGADO, Mr. LARSON of Connecticut, 

Mr. MORELLE, Mr. KRISHNAMOORTHI, Ms. SLOTKIN, Mr. TRONE, Miss 

RICE of New York, Ms. CLARK of Massachusetts, Mr. DANNY K. DAVIS

of Illinois, Mr. COLLINS of New York, Ms. HILL of California, Mr. 

ROUDA, Mr. MEEKS, Mr. SUOZZI, Mr. STIVERS, Mr. ROSE of New York, 

Ms. MENG, Ms. VELA ́ZQUEZ, Mr. KATKO, Mr. HIGGINS of New York, Ms. 

WILD, Mr. TONKO, Mr. RASKIN, Mr. PAPPAS, Mrs. CAROLYN B. MALONEY of New York, Mr. KIM, Mr. SEAN PATRICK MALONEY of New York, 

Mr. VAN DREW, Mrs. AXNE, Mr. KENNEDY, Ms. STEVENS, Mr. RUTHERFORD, Mr. EVANS, Ms. DEAN, Mr. BRENDAN F. BOYLE of Pennsylvania, 

Ms. SCANLON, Mr. SARBANES, Ms. BLUNT ROCHESTER, Mr. MCGOVERN, 

Mr. BALDERSON, Mr. BUTTERFIELD, Ms. SEWELL of Alabama, Mr. 

ENGEL, Mr. BRINDISI, Ms. UNDERWOOD, Mr. LYNCH, Ms. CLARKE of 

New York, Mr. CONNOLLY, Mr. CISNEROS, Mr. PANETTA, Mr. 

RESCHENTHALER, Mr. CUELLAR, Mrs. MURPHY of Florida, Mr. VISCLOSKY, Mr. ESPAILLAT, Mr. HASTINGS, Mr. LAMB, Mr. SIRES, Mr. 

ROGERS of Alabama, Ms. KELLY of Illinois, Mr. GALLEGO, Mr. TED

LIEU of California, Mr. RUSH, Mr. LUJA ́N, Mr. GONZALEZ of Texas, Mr. 

THOMPSON of Mississippi, and Mr. WELCH


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DECEMBER 24, 2020 

Reported from the Committee on Ways and Means with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

DECEMBER 24, 2020 

Committee on Energy and Commerce discharged; committed to the Committee 

of the Whole House on the State of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on June 21, 2019] 

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 crisis. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Opioid Workforce Act 

5 of 2019’’. 

6 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI7 TIONS TO HELP COMBAT OPIOID CRISIS. 

8 (a) IN GENERAL.—Section 1886(h) of the Social Secu9 rity Act (42 U.S.C. 1395ww(h)) is amended— 

10 (1) in paragraph (4)(F)(i), by striking ‘‘para11 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

12 (8), and (9)’’; 

13 (2) in paragraph (4)(H)(i), by striking ‘‘para14 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

15 (8), and (9)’’; 

16 (3) in paragraph (7)(E), by inserting ‘‘para17 graph (9),’’ after ‘‘paragraph (8),’’; and 

18 (4) by adding at the end the following new para19 graph: 

20 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY

21 POSITIONS TO HELP COMBAT OPIOID CRISIS.— 

22 ‘‘(A) ADDITIONAL RESIDENCY POSITIONS.— 

23 During the period of fiscal years 2022 through 

24 2026 (and succeeding fiscal years if the Sec25 retary determines that there are additional fullVerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414

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1 time-equivalent residency positions available to 

2 distribute under subparagraph (D)), the Sec3 retary shall distribute additional full-time-equiv4 alent residency positions to increase the other5 wise applicable resident limit for each qualifying 

6 hospital that submits a timely application under 

7 this paragraph by such number as the Secretary 

8 may approve, effective beginning July 1 of the 

9 fiscal year of the increase. The aggregate number 

10 of additional full-time-equivalent residency posi11 tions available for distribution under this para12 graph shall be equal to 500 in fiscal year 2022 

13 and 500 over the period of fiscal years 2023 

14 through 2026, distributed in accordance with the 

15 succeeding subparagraphs of this paragraph. 

16 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR

17 2022.— 

18 ‘‘(i) IN GENERAL.—For fiscal year 

19 2022, the positions available for distribu20 tion for such fiscal year (as described in 

21 subparagraph (A)) may only be distributed 

22 to hospitals that have established (as of the 

23 date of the enactment of this paragraph) 

24 approved programs in addiction medicine, 


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1 addiction psychiatry, or pain medicine, as 

2 determined by the Secretary. 

3 ‘‘(ii) CONSIDERATIONS IN DISTRIBU4 TION.—The Secretary shall distribute addi5 tional residency positions under this sub6 paragraph based on the demonstrated likeli7 hood, as determined by the Secretary, of the 

8 hospital filling such positions within the 

9 first 4 training years (as specified by the 

10 Secretary) after the increase would be effec11 tive. 

12 ‘‘(iii) REQUIREMENTS.—A hospital 

13 that receives an increase in the otherwise 

14 applicable resident limit under this sub15 paragraph shall ensure, during the 5-year 

16 period beginning after the date of such in17 crease, that the hospital uses the positions 

18 made available under this subparagraph for 

19 a program described in clause (i) or a pro20 gram that is a prerequisite (as determined 

21 by the Secretary) for such a program so de22 scribed, such as internal medicine. The Sec23 retary may determine whether a hospital 

24 has met the requirements under this clause 

25 during such 5-year period in such manner 


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1 and at such time as the Secretary deter2 mines appropriate, including at the end of 

3 such 5-year period. 

4 ‘‘(iv) REDISTRIBUTION OF POSITIONS

5 IF HOSPITAL NO LONGER MEETS CERTAIN

6 REQUIREMENTS.—In the case in which the 

7 Secretary determines that a hospital de8 scribed in clause (iii) does not meet the re9 quirements of such clause, the Secretary 

10 shall— 

11 ‘‘(I) reduce the otherwise applica12 ble resident limit of the hospital by the 

13 amount by which such limit was in14 creased under this subparagraph; and 

15 ‘‘(II) provide for the distribution 

16 of positions attributable to such reduc17 tion in accordance with the require18 ments of this paragraph. 

19 ‘‘(v) POSITIONS NOT DISTRIBUTED

20 DURING FISCAL YEAR 2022.—If the number 

21 of full-time-equivalent residency positions 

22 distributed under this subparagraph is less 

23 than the aggregate number of positions 

24 available for distribution for fiscal year 

25 2022 (as described in subparagraph (A)), 


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1 the difference between such number distrib2 uted and such number available for dis3 tribution shall be added to the aggregate 

4 number of positions available for distribu5 tion under subparagraph (C). 

6 ‘‘(C) DISTRIBUTION FOR FISCAL YEARS 2023

7 THROUGH 2026.— 

8 ‘‘(i) IN GENERAL.—For the period of 

9 fiscal years 2023 through 2026, the posi10 tions available for distribution for such pe11 riod (as described in subparagraph (A)), 

12 and any positions made available pursuant 

13 to subparagraph (B)(v), shall be distributed 

14 to hospitals which demonstrate to the Sec15 retary that the hospital has established or 

16 will establish an approved residency train17 ing program in addiction medicine, addic18 tion psychiatry, or pain medicine. 

19 ‘‘(ii) CONSIDERATIONS IN DISTRIBU20 TION.—The Secretary shall distribute addi21 tional residency positions under this sub22 paragraph based on the demonstrated likeli23 hood, as determined by the Secretary, of the 

24 hospital filling such positions within the 

25 first 4 training years (as specified by the 


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1 Secretary) after the increase would be effec2 tive. 

3 ‘‘(iii) REQUIREMENTS.—A hospital 

4 that receives an increase in the otherwise 

5 applicable resident limit under this sub6 paragraph shall ensure, during the 5-year 

7 period beginning after the date of such in8 crease, that the hospital uses the positions 

9 made available under this subparagraph for 

10 a program described in clause (i) or a pro11 gram that is a prerequisite (as determined 

12 by the Secretary) for such a program so de13 scribed, such as internal medicine. The Sec14 retary may determine whether a hospital 

15 has met the requirements under this clause 

16 during such 5-year period in such manner 

17 and at such time as the Secretary deter18 mines appropriate, including at the end of 

19 such 5-year period. 

20 ‘‘(iv) REDISTRIBUTION OF POSITIONS

21 IF HOSPITAL NO LONGER MEETS CERTAIN

22 REQUIREMENTS.—In the case where the Sec23 retary determines that a hospital described 

24 in clause (iii) does not meet the require25 ments of such clause, the Secretary shall— 


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1 ‘‘(I) reduce the otherwise applica2 ble resident limit of the hospital by the 

3 amount by which such limit was in4 creased under this subparagraph; and 

5 ‘‘(II) provide for the distribution 

6 of positions attributable to such reduc7 tion in accordance with the require8 ments of this paragraph. 

9 ‘‘(D) DISTRIBUTION OF REMAINING POSI10 TIONS.—If the aggregate number of positions dis11 tributed under subparagraphs (B) and (C) dur12 ing the period of fiscal years 2022 through 2026 

13 is less than 1000, the Secretary shall distribute 

14 the remaining residency positions in succeeding 

15 fiscal years according to criteria consistent with 

16 this paragraph until such time as the aggregate 

17 amount of positions distributed under this para18 graph is equal to 1000. 

19 ‘‘(E) LIMITATION.—An individual hospital 

20 may not receive more than 25 full-time-equiva21 lent residency positions under this paragraph. 

22 ‘‘(F) NOTIFICATION.—The Secretary shall 

23 notify hospitals of the number of positions dis24 tributed to the hospital under this paragraph as 

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1 ble resident limit by January 1 of the fiscal year 

2 of the increase. Such increase shall be effective 

3 beginning July 1 of that fiscal year. 

4 ‘‘(G) APPLICATION OF PER RESIDENT

5 AMOUNTS FOR PRIMARY CARE AND NONPRIMARY

6 CARE.—With respect to additional residency po7 sitions in a hospital attributable to the increase 

8 provided under this paragraph, the approved 

9 FTE per resident amounts are deemed to be 

10 equal to the hospital per resident amounts for 

11 primary care and nonprimary care computed 

12 under paragraph (2)(D) for that hospital. 

13 ‘‘(H) PERMITTING FACILITIES TO APPLY AG14 GREGATION RULES.—The Secretary shall permit 

15 hospitals receiving additional residency positions 

16 attributable to the increase provided under this 

17 paragraph to, beginning in the fifth year after 

18 the effective date of such increase, apply such po19 sitions to the limitation amount under para20 graph (4)(F) that may be aggregated pursuant to 

21 paragraph (4)(H) among members of the same 

22 affiliated group. 

23 ‘‘(I) CLARIFICATION.—Chapter 35 of title 

24 44, United States Code, shall not apply to the 

25 implementation of this paragraph. 


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1 ‘‘(J) DEFINITIONS.—In this paragraph: 

2 ‘‘(i) OTHERWISE APPLICABLE RESI3 DENT LIMIT.—The term ‘otherwise applica4 ble resident limit’ means, with respect to a 

5 hospital, the limit otherwise applicable 

6 under paragraph (4)(F)(i) on the resident 

7 level for the hospital determined without re8 gard to this paragraph but taking into ac9 count paragraphs (7)(A), (7)(B), (8)(A), 

10 and (8)(B). 

11 ‘‘(ii) RESIDENT LEVEL.—The term 

12 ‘resident level’ has the meaning given such 

13 term in paragraph (7)(C)(i).’’. 

14 (b) IME.— 

15 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 

16 the Social Security Act (42 U.S.C. 

17 1395ww(d)(5)(B)(v)), in the third sentence, is amend18 ed by striking ‘‘and (h)(8)’’ and inserting ‘‘(h)(8), 

19 and (h)(9)’’. 

20 (2) CONFORMING PROVISION.—Section 

21 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

22 1395ww(d)(5)(B)) is amended— 

23 (A) by redesignating clause (x), as added by 

24 section 5505(b) of the Patient Protection and Af25 fordable Care Act (Public Law 111–148), as 


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1 clause (xi) and moving such clause 4 ems to the 

2 left; and 

3 (B) by adding after clause (xi), as redesig4 nated by subparagraph (A), the following new 

5 clause: 

6 ‘‘(xii) For discharges occurring on or after July 

7 1, 2022, insofar as an additional payment amount 

8 under this subparagraph is attributable to residency 

9 positions distributed to a hospital under subsection 

10 (h)(9), the indirect teaching adjustment factor shall be 

11 computed in the same manner as provided under 

12 clause (ii) with respect to such residency positions.’’. 


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Union Calendar No. 573 

116TH CONGRESS 

2D SESSION H. R. 3414 

[Report No. 116–690, Part I] 

A BILL 

To amend title XVIII of the Social Security Act to 

dency positions to help combat the opioid crisis. provide for the distribution of additional resiDECEMBER 24, 2020 

Reported from the Committee on Ways and Means with 

an amendment 

DECEMBER 24, 2020 

Committee on Energy and Commerce discharged; comState of the Union and ordered to be printed mitted to the Committee of the Whole House on the 


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