I 

116TH CONGRESS 

1ST SESSION H. R. 3414 

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 

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. 

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’’. 


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1 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI2 TIONS TO HELP COMBAT OPIOID CRISIS. 

3 (a) IN GENERAL.—Section 1886(h) of the Social Se4 curity Act (42 U.S.C. 1395ww(h)) is amended— 

5 (1) in paragraph (4)(F)(i), by striking ‘‘para6 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

7 (8), and (9)’’; 

8 (2) in paragraph (4)(H)(i), by striking ‘‘para9 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

10 (8), and (9)’’; 

11 (3) in paragraph (7)(E), by inserting ‘‘para12 graph (9),’’ after ‘‘paragraph (8),’’; and 

13 (4) by adding at the end the following new 

14 paragraph: 

15 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY

16 POSITIONS TO HELP COMBAT OPIOID CRISIS.— 

17 ‘‘(A) ADDITIONAL RESIDENCY POSI18 TIONS.—For each of fiscal years 2022 through 

19 2026 (and succeeding fiscal years if the Sec20 retary determines that there are additional full21 time equivalent residency positions available to 

22 distribute under subparagraph (D)), the Sec23 retary shall increase the otherwise applicable 

24 resident limit for each qualifying hospital that 

25 submits a timely application under this para26 graph by such number as the Secretary may apVerDate Sep 11 2014 00:28 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3414.IH H3414

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1 prove, effective for portions of cost reporting 

2 periods occurring on or after July 1 of the fis3 cal year of the increase. The aggregate number 

4 of additional full-time equivalent resident posi5 tions available for distribution under this para6 graph shall be equal to 1,000, distributed in ac7 cordance with the succeeding subparagraphs of 

8 this paragraph. 

9 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR

10 2022.— 

11 ‘‘(i) IN GENERAL.—For fiscal year 

12 2022, 500 of the positions described in 

13 subparagraph (A) may only be distributed 

14 to hospitals that have established (as of 

15 the date of the enactment of this para16 graph) approved programs in addiction 

17 medicine, addiction psychiatry, or pain 

18 medicine, as determined by the Secretary. 

19 ‘‘(ii) CONSIDERATIONS IN DISTRIBU20 TION.—The Secretary shall distribute addi21 tional residency positions under this sub22 paragraph based on the demonstrated like23 lihood (as determined by the Secretary) of 

24 the hospital filling such positions. 


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1 ‘‘(iii) REQUIREMENTS.—A hospital 

2 that receives an increase in the otherwise 

3 applicable resident limit under this sub4 paragraph shall ensure, during the 5-year 

5 period beginning after the date of such in6 crease, that the hospital uses the positions 

7 made available under this subparagraph 

8 for a program described in clause (i) or a 

9 program that is a prerequisite (as deter10 mined by the Secretary) for such a pro11 gram so described, such as internal medi12 cine. The Secretary may determine wheth13 er a hospital has met the requirements 

14 under this clause during such 5-year pe15 riod in such manner and at such time as 

16 the Secretary determines appropriate, in17 cluding at the end of such 5-year period. 

18 ‘‘(iv) REDISTRIBUTION OF POSITIONS

19 IF HOSPITAL NO LONGER MEETS CERTAIN

20 REQUIREMENTS.—In the case in which the 

21 Secretary determines that a hospital de22 scribed in clause (iii) does not meet the re23 quirements of such clause, the Secretary 

24 shall— 


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

3 the amount by which such limit was 

4 increased under this subparagraph; 

5 and 

6 ‘‘(II) provide for the distribution 

7 of positions attributable to such re8 duction in accordance with the re9 quirements of this paragraph. 

10 ‘‘(C) DISTRIBUTION FOR FISCAL YEARS

11 2023 THROUGH 2026.— 

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

13 fiscal years 2023 through 2026, 500 of the 

14 positions available for distribution under 

15 subparagraph (A) shall be distributed to 

16 hospitals which demonstrate to the Sec17 retary that the hospital has established or 

18 will establish an approved residency train19 ing program in addiction medicine, addic20 tion psychiatry, or pain medicine. 

21 ‘‘(ii) CONSIDERATIONS IN DISTRIBU22 TION.—The Secretary shall distribute addi23 tional residency positions under this sub24 paragraph based on the demonstrated like25 lihood, as determined by the Secretary, of 


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1 the hospital filling such positions within 

2 the first 4 training years (as specified by 

3 the Secretary) after the increase would be 

4 effective. 

5 ‘‘(iii) REQUIREMENTS.—A hospital 

6 that receives an increase in the otherwise 

7 applicable resident limit under this sub8 paragraph shall ensure, during the 5-year 

9 period beginning after the date of such in10 crease, that the hospital uses the positions 

11 made available under this subparagraph 

12 for a program described in clause (i) or a 

13 program that is a prerequisite (as deter14 mined by the Secretary) for such a pro15 gram so described, such as internal medi16 cine. The Secretary may determine wheth17 er a hospital has met the requirements 

18 under this clause during such 5-year pe19 riod in such manner and at such time as 

20 the Secretary determines appropriate, in21 cluding at the end of such 5-year period. 

22 ‘‘(iv) REDISTRIBUTION OF POSITIONS

23 IF HOSPITAL NO LONGER MEETS CERTAIN

24 REQUIREMENTS.—In the case where the 

25 Secretary determines that a hospital deVerDate Sep 11 2014 00:28 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3414.IH H3414

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1 scribed in clause (iii) does not meet the re2 quirements of such clause, the Secretary 

3 shall— 

4 ‘‘(I) reduce the otherwise applica5 ble resident limit of the hospital by 

6 the amount by which such limit was 

7 increased under this subparagraph; 

8 and 

9 ‘‘(II) provide for the distribution 

10 of positions attributable to such re11 duction in accordance with the re12 quirements of this paragraph. 

13 ‘‘(D) DISTRIBUTION OF REMAINING POSI14 TIONS.—If the aggregate number of positions 

15 distributed under subparagraphs (B) and (C) 

16 during the period of fiscal years 2022 through 

17 2026 is less than 500, the Secretary shall dis18 tribute the remaining residency positions in suc19 ceeding fiscal years according to criteria con20 sistent with this paragraph until such time as 

21 the aggregate amount of positions distributed 

22 under this paragraph is equal to 500. 

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

24 may not receive more than 25 full-time-equiva25 lent residency positions under this paragraph. 


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

2 notify hospitals of the number of positions dis3 tributed to the hospital under this paragraph as 

4 a result of an increase in the otherwise applica5 ble resident limit by January 1 of the fiscal 

6 year of the increase. Such increase shall be ef7 fective for portions of cost reporting periods be8 ginning on or after July 1 of that fiscal year. 

9 ‘‘(G) APPLICATION OF PER RESIDENT

10 AMOUNTS FOR PRIMARY CARE AND NONPRI11 MARY CARE.—With respect to additional resi12 dency positions in a hospital attributable to the 

13 increase provided under this paragraph, the ap14 proved FTE per resident amounts are deemed 

15 to be equal to the hospital per resident amounts 

16 for primary care and nonprimary care com17 puted under paragraph (2)(D) for that hospital. 

18 ‘‘(H) PERMITTING FACILITIES TO APPLY

19 AGGREGATION RULES.—The Secretary shall 

20 permit hospitals receiving additional residency 

21 positions attributable to the increase provided 

22 under this paragraph to, beginning in the fifth 

23 year after the effective date of such increase, 

24 apply such positions to the limitation amount 

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1 gated pursuant to paragraph (4)(H) among 

2 members of the same affiliated group. 

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

4 44, United States Code, shall not apply to im5 plementation of this paragraph. 

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

7 ‘‘(i) OTHERWISE APPLICABLE RESI8 DENT LIMIT.—The term ‘otherwise appli9 cable resident limit’ means, with respect to 

10 a hospital, the limit otherwise applicable 

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

12 level for the hospital determined without 

13 regard to this paragraph but taking into 

14 account paragraphs (7)(A), (7)(B), (8)(A), 

15 and (8)(B). 

16 ‘‘(ii) RESIDENT LEVEL.—The term 

17 ‘resident level’ has the meaning given such 

18 term in paragraph (7)(C)(i).’’. 

19 (b) IME.— 

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

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

22 1395ww(d)(5)(B)(v)), in the third sentence, is 

23 amended by striking ‘‘and (h)(8)’’ and inserting 

24 ‘‘(h)(8), and (h)(9)’’. 


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1 (2) CONFORMING PROVISION.—Section 

2 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

3 1395ww(d)(5)(B)) is amended— 

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

5 by section 5505(b) of the Patient Protection 

6 and Affordable Care Act (Public Law 111– 

7 148), as clause (xi) and moving such clause 4 

8 ems to the left; and 

9 (B) by adding after clause (xi), as redesig10 nated by subparagraph (A), the following new 

11 clause: 

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

13 1, 2022, insofar as an additional payment amount 

14 under this subparagraph is attributable to resident 

15 positions distributed to a hospital under subsection 

16 (h)(9), the indirect teaching adjustment factor shall 

17 be computed in the same manner as provided under 

18 clause (ii) with respect to such resident positions.’’. 

Æ 


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