I 

116TH CONGRESS 

1ST SESSION H. R. 2439 

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 

MAY 1, 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’’. 


kjohnson on DSK79L0C42 with BILLS
2 

•HR 2439 IH

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 2021 through 

19 2025 (and succeeding fiscal years if the Sec20 retary determines that there are additional resi21 dency positions available to distribute under 

22 subparagraph (E)), the Secretary shall increase 

23 the otherwise applicable resident limit for each 

24 qualifying hospital that submits a timely appli25 cation under this subparagraph by such number 

26 as the Secretary may approve for portions of 


kjohnson on DSK79L0C42 with BILLS
3 

•HR 2439 IH

1 cost reporting periods occurring on or after 

2 July 1 of the fiscal year of the increase. Except 

3 as provided in subparagraph (B)(iv) or (E), the 

4 aggregate number of increases in the otherwise 

5 applicable resident limit under this subpara6 graph shall be equal to 500 in fiscal year 2021 

7 and 500 over the period of fiscal years 2022 

8 through 2025, distributed in accordance with 

9 the succeeding subparagraphs of this para10 graph. 

11 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR

12 2021.— 

13 ‘‘(i) IN GENERAL.—For fiscal year 

14 2021, the positions available for distribu15 tion with respect to the fiscal year as de16 scribed in subparagraph (A) shall be dis17 tributed to hospitals that have existing es18 tablished approved programs in addiction 

19 medicine, addiction psychiatry, or pain 

20 management as determined by the Sec21 retary. 

22 ‘‘(ii) NUMBER OF POSITIONS HOS23 PITAL ELIGIBLE TO RECEIVE.—Subject to 

24 clauses (iii) and (iv) and subparagraph 

25 (D), the aggregate number of positions a 


kjohnson on DSK79L0C42 with BILLS
4 

•HR 2439 IH

1 hospital may receive under this subpara2 graph with respect to fiscal year 2021 is 

3 equal to the sum of the following: 

4 ‘‘(I) The number of full-time5 equivalent residents that will be train6 ing in addiction medicine, addiction 

7 psychiatry, or pain management as 

8 determined by the Secretary with re9 spect to the fiscal year. 

10 ‘‘(II) The associated number of 

11 residents training in a pre-requisite 

12 program, such as internal medicine, 

13 necessary for the number of full-time 

14 residents for the programs described 

15 in subclause (I). 

16 ‘‘(iii) ADDITIONAL POSITIONS FOR EX17 PANSION OF EXISTING PROGRAM.—If a 

18 hospital demonstrates to the Secretary that 

19 the hospital is planning to increase the 

20 number of full-time-equivalent residents in 

21 existing programs described in clause (i), 

22 the Secretary may increase the number of 

23 positions a hospital is eligible to receive 

24 under clause (ii) in order to accommodate 


kjohnson on DSK79L0C42 with BILLS
5 

•HR 2439 IH

1 that expansion, as determined by the Sec2 retary. 

3 ‘‘(iv) CONSIDERATIONS IN DISTRIBU4 TION.—The Secretary shall distribute addi5 tional residency positions under this sub6 paragraph based on— 

7 ‘‘(I) in the case of positions made 

8 available under clause (ii), the dem9 onstrated likelihood of the hospital 

10 filling such positions by July 1, 2021; 

11 and 

12 ‘‘(II) in the case of positions 

13 made available under clause (iii), the 

14 demonstrated likelihood of the hos15 pital filling such positions within the 

16 first three cost reporting periods be17 ginning on or after July 1, 2021. 

18 ‘‘(v) CLARIFICATION REGARDING

19 AVAILABILITY OF ADDITIONAL POSITIONS

20 IN SUBSEQUENT FISCAL YEARS.—Nothing 

21 in this subparagraph shall preclude a hos22 pital from receiving additional residency 

23 positions under subparagraph (C). 

24 ‘‘(vi) POSITIONS NOT DISTRIBUTED

25 DURING THE FISCAL YEAR.—If the number 


kjohnson on DSK79L0C42 with BILLS
6 

•HR 2439 IH

1 of resident full-time-equivalent positions 

2 distributed under this subparagraph is less 

3 than the aggregate number of positions 

4 available for distribution in the fiscal year 

5 (as described in subparagraph (A)), the 

6 difference between such number distrib7 uted and such number available for dis8 tribution shall be added to the aggregate 

9 number of positions available for distribu10 tion under subparagraph (C). 

11 ‘‘(C) DISTRIBUTION FOR FISCAL YEARS

12 2022 THROUGH 2025.— 

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

14 fiscal years 2022 through 2025, the posi15 tions available for distribution with respect 

16 to such period (as described in subpara17 graph (A), including after application of 

18 subparagraph (B)(vi)) shall be distributed, 

19 subject to subparagraph (D), to hospitals 

20 which demonstrate to the Secretary that 

21 the hospital— 

22 ‘‘(I) will establish an approved 

23 program in addiction medicine, addic24 tion psychiatry, or pain management; 

25 and 


kjohnson on DSK79L0C42 with BILLS
7 

•HR 2439 IH

1 ‘‘(II) will use all of the additional 

2 positions made available under this 

3 subparagraph in such program or a 

4 prerequisite residency program for 

5 such program within the first four 

6 cost reporting periods after the in7 crease would be effective. 

8 ‘‘(ii) REQUIREMENTS.—Subject to 

9 clause (iii), a hospital that receives an in10 crease in the otherwise applicable resident 

11 limit under this subparagraph shall ensure, 

12 during the 5-year period beginning after 

13 the date of such increase, that the hospital 

14 uses the positions received under clauses 

15 (i)(I) and (i)(II) for the programs for 

16 which the positions were distributed, or 

17 similar programs (as determined by the 

18 Secretary). The Secretary may determine 

19 whether a hospital has met the require20 ments under this clause during such 5-year 

21 period in such manner and at such time as 

22 the Secretary determines appropriate, in23 cluding at the end of such 5-year period. 

24 ‘‘(iii) REDISTRIBUTION OF POSITIONS

25 IF HOSPITAL NO LONGER MEETS CERTAIN


kjohnson on DSK79L0C42 with BILLS
8 

•HR 2439 IH

1 REQUIREMENTS.—In the case where the 

2 Secretary determines that a hospital de3 scribed in clause (ii) does not meet the re4 quirements of such clause, the Secretary 

5 shall— 

6 ‘‘(I) reduce the otherwise applica7 ble resident limit of the hospital by 

8 the amount by which such limit was 

9 increased under this subparagraph; 

10 and 

11 ‘‘(II) provide for the distribution 

12 of positions attributable to such re13 duction in accordance with the re14 quirements of this paragraph. 

15 ‘‘(D) LIMITATION.—The aggregate number 

16 of positions distributed under subparagraphs 

17 (B) and (C) to an individual hospital during the 

18 period of fiscal years 2021 through 2025 may 

19 not exceed 25. 

20 ‘‘(E) DISTRIBUTION OF REMAINING POSI21 TIONS.—If the aggregate number of positions 

22 distributed under subparagraphs (B) and (C) 

23 during the period of fiscal years 2021 through 

24 2025 is less than 1,000, the Secretary shall dis25 tribute the remaining residency positions in sucVerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439

kjohnson on DSK79L0C42 with BILLS
9 

•HR 2439 IH

1 ceeding fiscal years according to criteria con2 sistent with this paragraph until such time as 

3 the aggregate amount of positions distributed 

4 under this paragraph is equal to 1,000. 

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

6 notify hospitals of the number of positions dis7 tributed to the hospital under this paragraph as 

8 a result on an increase in the otherwise applica9 ble resident limit by January 1 of the fiscal 

10 year of the increase. Such increase shall be ef11 fective for portions of cost reporting periods be12 ginning on or after July 1 of that fiscal year. 

13 ‘‘(G) APPLICATION OF PER RESIDENT

14 AMOUNTS FOR PRIMARY CARE AND NONPRI15 MARY CARE.—With respect to additional resi16 dency positions in a hospital attributable to the 

17 increase provided under this paragraph, the ap18 proved FTE per resident amounts are deemed 

19 to be equal to the hospital per resident amounts 

20 for primary care and nonprimary care com21 puted under paragraph (2)(D) for that hospital. 

22 ‘‘(H) PERMITTING FACILITIES TO APPLY

23 AGGREGATION RULES.—The Secretary shall 

24 permit hospitals receiving additional residency 

25 positions attributable to the increase provided 


kjohnson on DSK79L0C42 with BILLS
10 

•HR 2439 IH

1 under this paragraph to, beginning in the fifth 

2 year after the effective date of such increase, 

3 apply such positions to the limitation amount 

4 under paragraph (4)(F) that may be aggre5 gated pursuant to paragraph (4)(H) among 

6 members of the same affiliated group. 

7 ‘‘(I) DEFINITIONS.—In this paragraph: 

8 ‘‘(i) OTHERWISE APPLICABLE RESI9 DENT LIMIT.—The term ‘otherwise appli10 cable resident limit’ means, with respect to 

11 a hospital, the limit otherwise applicable 

12 under subparagraphs (F)(i) and (H) of 

13 paragraph (4) on the resident level for the 

14 hospital determined without regard to this 

15 paragraph but taking into account para16 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 

17 ‘‘(ii) RESIDENT LEVEL.—The term 

18 ‘resident level’ has the meaning given such 

19 term in paragraph (7)(C)(i).’’. 

20 (b) IME.— 

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

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

23 1395ww(d)(5)(B)(v)), in the third sentence, is 

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

25 ‘‘(h)(8), and (h)(9)’’. 


kjohnson on DSK79L0C42 with BILLS
11 

•HR 2439 IH

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, 2021, 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 


kjohnson on DSK79L0C42 with BILLS