I 

115TH CONGRESS 

2D SESSION H. R. 5818 

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 15, 2018 

Mr. CROWLEY (for himself and Mr. COSTELLO of Pennsylvania) 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 2018’’. 


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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 2019 through 

19 2023 (and succeeding fiscal years if the Sec20 retary determines that there are additional resi21 dency positions available to distribute under 

22 subparagraph (D)), 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 


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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 (D), 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 2019 

7 and 500 over the period of fiscal years 2020 

8 through 2023, distributed in accordance with 

9 the succeeding subparagraphs of this para10 graph. 

11 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR

12 2019.— 

13 ‘‘(i) IN GENERAL.—For fiscal year 

14 2019, 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), the aggregate number 

25 of positions a hospital may receive under 


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1 this subparagraph with respect to fiscal 

2 year 2019 is equal to the sum of the fol3 lowing: 

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 


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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, 2019; 

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, 2019. 

18 ‘‘(v) LIMITATION.—Notwithstanding 

19 clauses (ii) and (iv), an individual hospital 

20 may not receive more than 25 full-time21 equivalent residency positions under this 

22 subparagraph. 

23 ‘‘(vi) CLARIFICATION REGARDING

24 AVAILABILITY OF ADDITIONAL POSITIONS

25 IN SUBSEQUENT FISCAL YEARS.—Nothing 


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1 in this subparagraph shall preclude a hos2 pital from receiving additional residency 

3 positions under subparagraph (C). 

4 ‘‘(vii) POSITIONS NOT DISTRIBUTED

5 DURING THE FISCAL YEAR.—If the number 

6 of resident full-time-equivalent positions 

7 distributed under this subparagraph is less 

8 than the aggregate number of positions 

9 available for distribution in the fiscal year 

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

11 difference between such number distrib12 uted and such number available for dis13 tribution shall be added to the aggregate 

14 number of positions available for distribu15 tion under subparagraph (C). 

16 ‘‘(C) DISTRIBUTION FOR FISCAL YEARS

17 2020 THROUGH 2023.— 

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

19 fiscal years 2020 through 2023, the posi20 tions available for distribution with respect 

21 to such period (as described in subpara22 graph (A), including after application of 

23 subparagraph (B)(vi)) shall be distributed 

24 to hospitals which demonstrate to the Sec25 retary that the hospital— 


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1 ‘‘(I) will establish an approved 

2 program in addiction medicine, addic3 tion psychiatry, or pain management; 

4 and 

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

6 positions made available under this 

7 subparagraph in such program or a 

8 prerequisite residency program for 

9 such program within the first four 

10 cost reporting periods after the in11 crease would be effective. 

12 ‘‘(ii) REQUIREMENTS.—Subject to 

13 clause (iii), a hospital that receives an in14 crease in the otherwise applicable resident 

15 limit under this subparagraph shall ensure, 

16 during the 5-year period beginning after 

17 the date of such increase, that the hospital 

18 uses the positions received under clauses 

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

20 which the positions were distributed, or 

21 similar programs (as determined by the 

22 Secretary). The Secretary may determine 

23 whether a hospital has met the require24 ments under this clause during such 5-year 

25 period in such manner and at such time as 


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1 the Secretary determines appropriate, in2 cluding at the end of such 5-year period. 

3 ‘‘(iii) REDISTRIBUTION OF POSITIONS

4 IF HOSPITAL NO LONGER MEETS CERTAIN

5 REQUIREMENTS.—In the case where the 

6 Secretary determines that a hospital de7 scribed in clause (ii) does not meet the re8 quirements of such clause, the Secretary 

9 shall— 

10 ‘‘(I) reduce the otherwise applica11 ble resident limit of the hospital by 

12 the amount by which such limit was 

13 increased under this subparagraph; 

14 and 

15 ‘‘(II) provide for the distribution 

16 of positions attributable to such re17 duction in accordance with the re18 quirements of this paragraph. 

19 ‘‘(iv) LIMITATION.—An individual 

20 hospital may not receive more than 25 full21 time-equivalent residency positions under 

22 this subparagraph. 

23 ‘‘(D) DISTRIBUTION OF REMAINING POSI24 TIONS.—If the aggregate number of positions 

25 distributed under subparagraphs (B) and (C) 


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1 during the period of fiscal years 2019 through 

2 2023 is less than 1,000, the Secretary shall dis3 tribute the remaining residency positions in suc4 ceeding fiscal years according to criteria con5 sistent with this paragraph until such time as 

6 the aggregate amount of positions distributed 

7 under this paragraph is equal to 1,000. 

8 ‘‘(E) NOTIFICATION.—The Secretary shall 

9 notify hospitals of the number of positions dis10 tributed to the hospital under this paragraph as 

11 a result on an increase in the otherwise applica12 ble resident limit by January 1 of the fiscal 

13 year of the increase. Such increase shall be ef14 fective for portions of cost reporting periods be15 ginning on or after July 1 of that fiscal year. 

16 ‘‘(F) APPLICATION OF PER RESIDENT

17 AMOUNTS FOR PRIMARY CARE AND NONPRI18 MARY CARE.—With respect to additional resi19 dency positions in a hospital attributable to the 

20 increase provided under this paragraph, the ap21 proved FTE per resident amounts are deemed 

22 to be equal to the hospital per resident amounts 

23 for primary care and nonprimary care com24 puted under paragraph (2)(D) for that hospital. 


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1 ‘‘(G) PERMITTING FACILITIES TO APPLY

2 AGGREGATION RULES.—The Secretary shall 

3 permit hospitals receiving additional residency 

4 positions attributable to the increase provided 

5 under this paragraph to, beginning in the fifth 

6 year after the effective date of such increase, 

7 apply such positions to the limitation amount 

8 under paragraph (4)(F) that may be aggre9 gated pursuant to paragraph (4)(H) among 

10 members of the same affiliated group. 

11 ‘‘(H) DEFINITIONS.—In this paragraph: 

12 ‘‘(i) OTHERWISE APPLICABLE RESI13 DENT LIMIT.—The term ‘otherwise appli14 cable resident limit’ means, with respect to 

15 a hospital, the limit otherwise applicable 

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

17 paragraph (4) on the resident level for the 

18 hospital determined without regard to this 

19 paragraph but taking into account para20 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 

21 ‘‘(ii) RESIDENT LEVEL.—The term 

22 ‘resident level’ has the meaning given such 

23 term in paragraph (7)(C)(i).’’. 

24 (b) IME.— 


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

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

3 1395ww(d)(5)(B)(v)), in the third sentence, is 

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

5 ‘‘(h)(8), and (h)(9)’’. 

6 (2) CONFORMING PROVISION.—Section 

7 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

8 1395ww(d)(5)(B)) is amended— 

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

10 by section 5505(b) of the Patient Protection 

11 and Affordable Care Act (Public Law 111– 

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

13 ems to the left; and 

14 (B) by adding after clause (xi), as redesig15 nated by subparagraph (A), the following new 

16 clause: 

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

18 1, 2019, insofar as an additional payment amount 

19 under this subparagraph is attributable to resident 

20 positions distributed to a hospital under subsection 

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

22 be computed in the same manner as provided under 

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

Æ 


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