I 

117TH CONGRESS 

1ST SESSION H. R. 3441 

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

of additional residency positions to help combat the substance use disorder crisis. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 20, 2021 

Mr. SCHNEIDER (for himself, Mr. MCKINLEY, and Ms. KUSTER) 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 substance use disorder 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 ‘‘Substance Use Dis5 order Workforce Act’’. 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•HR 3441 IH

1 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI2 TIONS TO HELP COMBAT SUBSTANCE USE 

3 DISORDER CRISIS. 

4 (a) IN GENERAL.—Section 1886(h) of the Social Se5 curity Act (42 U.S.C. 1395ww(h)) is amended— 

6 (1) in paragraph (4)(F)(i), by striking ‘‘para7 graphs (7), (8), and (9)’’ and inserting ‘‘paragraphs 

8 (7), (8), (9), and (10)’’; 

9 (2) in paragraph (4)(H)(i), by striking ‘‘para10 graphs (7), (8), and (9)’’ and inserting ‘‘paragraphs 

11 (7), (8), (9), and (10)’’; 

12 (3) in paragraph (7)(E), by striking ‘‘para13 graph (8)’’ and all that follows through ‘‘clause (i)’’ 

14 and inserting ‘‘paragraph (8), paragraph (9), para15 graph (10), clause (i)’’; and 

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

17 paragraph: 

18 ‘‘(10) DISTRIBUTION OF ADDITIONAL RESI19 DENCY POSITIONS TO HELP COMBAT SUBSTANCE

20 USE DISORDER CRISIS.— 

21 ‘‘(A) ADDITIONAL RESIDENCY POSI22 TIONS.—During the period of fiscal years 2024 

23 through 2028 (and succeeding fiscal years if the 

24 Secretary determines that there are additional 

25 full-time-equivalent residency positions available 

26 to distribute under subparagraph (D)), the SecVerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441

pamtmann on DSKBC07HB2PROD with BILLS
3 

•HR 3441 IH

1 retary shall distribute additional full-time-equiv2 alent residency positions to increase the other3 wise applicable resident limit for each qualifying 

4 hospital that submits a timely application under 

5 this paragraph by such number as the Sec6 retary may approve, effective beginning July 1 

7 of the fiscal year of the increase. The aggregate 

8 number of additional full-time-equivalent resi9 dency positions available for distribution under 

10 this paragraph shall be equal to 500 in fiscal 

11 year 2024 and 500 over the period of fiscal 

12 years 2025 through 2028, distributed in accord13 ance with the succeeding subparagraphs of this 

14 paragraph. 

15 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR

16 2024.— 

17 ‘‘(i) IN GENERAL.—For fiscal year 

18 2024, the positions available for distribu19 tion for such fiscal year (as described in 

20 subparagraph (A)) may only be distributed 

21 to hospitals that have established (as of 

22 the date of the enactment of this para23 graph) approved programs in addiction 

24 medicine, addiction psychiatry, or pain 

25 medicine, as determined by the Secretary. 


pamtmann on DSKBC07HB2PROD with BILLS
4 

•HR 3441 IH

1 ‘‘(ii) CONSIDERATIONS IN DISTRIBU2 TION.—The Secretary shall distribute addi3 tional residency positions under this sub4 paragraph based on the demonstrated like5 lihood, as determined by the Secretary, of 

6 the hospital filling such positions within 

7 the first 4 training years (as specified by 

8 the Secretary) after the increase would be 

9 effective. 

10 ‘‘(iii) REQUIREMENTS.—A hospital 

11 that receives an increase in the otherwise 

12 applicable resident limit under this sub13 paragraph shall ensure, during the 5-year 

14 period beginning after the date of such in15 crease, that the hospital uses the positions 

16 made available under this subparagraph 

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

18 program that is a prerequisite (as deter19 mined by the Secretary) for such a pro20 gram so described, such as internal medi21 cine. The Secretary may determine wheth22 er a hospital has met the requirements 

23 under this clause during such 5-year pe24 riod in such manner and at such time as 


pamtmann on DSKBC07HB2PROD with BILLS
5 

•HR 3441 IH

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

3 ‘‘(iv) REDISTRIBUTION OF POSITIONS

4 IF HOSPITAL NO LONGER MEETS CERTAIN

5 REQUIREMENTS.—In the case in which the 

6 Secretary determines that a hospital de7 scribed in clause (iii) 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 ‘‘(v) POSITIONS NOT DISTRIBUTED

20 DURING FISCAL YEAR 2024.—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 2024 (as described in subparagraph (A)), 


pamtmann on DSKBC07HB2PROD with BILLS
6 

•HR 3441 IH

1 the difference between such number dis2 tributed 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

7 2025 THROUGH 2028.— 

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

9 fiscal years 2025 through 2028, 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 distrib14 uted to hospitals which demonstrate to the 

15 Secretary that the hospital has established 

16 or will establish an approved residency 

17 training program in addiction medicine, 

18 addiction 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 like23 lihood, as determined by the Secretary, of 

24 the hospital filling such positions within 

25 the first 4 training years (as specified by 


pamtmann on DSKBC07HB2PROD with BILLS
7 

•HR 3441 IH

1 the Secretary) after the increase would be 

2 effective. 

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 

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

11 program that is a prerequisite (as deter12 mined by the Secretary) for such a pro13 gram so described, such as internal medi14 cine. The Secretary may determine wheth15 er a hospital has met the requirements 

16 under this clause during such 5-year pe17 riod in such manner and at such time as 

18 the Secretary determines appropriate, in19 cluding at the end of such 5-year period. 

20 ‘‘(iv) REDISTRIBUTION OF POSITIONS

21 IF HOSPITAL NO LONGER MEETS CERTAIN

22 REQUIREMENTS.—In the case where the 

23 Secretary determines that a hospital de24 scribed in clause (iii) does not meet the reVerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441

pamtmann on DSKBC07HB2PROD with BILLS
8 

•HR 3441 IH

1 quirements of such clause, the Secretary 

2 shall— 

3 ‘‘(I) reduce the otherwise applica4 ble resident limit of the hospital by 

5 the amount by which such limit was 

6 increased under this subparagraph; 

7 and 

8 ‘‘(II) provide for the distribution 

9 of positions attributable to such re10 duction in accordance with the re11 quirements of this paragraph. 

12 ‘‘(D) DISTRIBUTION OF REMAINING POSI13 TIONS.—If the aggregate number of positions 

14 distributed under subparagraphs (B) and (C) 

15 during the period of fiscal years 2024 through 

16 2028 is less than 1,000, the Secretary shall dis17 tribute the remaining residency positions in suc18 ceeding fiscal years according to criteria con19 sistent with this paragraph until such time as 

20 the aggregate amount of positions distributed 

21 under this paragraph is equal to 1,000. 

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

23 may not receive more than 25 full-time-equiva24 lent residency positions under this paragraph. 


pamtmann on DSKBC07HB2PROD with BILLS
9 

•HR 3441 IH

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 beginning July 1 of that fiscal year. 

8 ‘‘(G) APPLICATION OF PER RESIDENT

9 AMOUNTS FOR PRIMARY CARE AND NONPRI10 MARY CARE.—With respect to additional resi11 dency positions in a hospital attributable to the 

12 increase provided under this paragraph, the ap13 proved FTE per resident amounts are deemed 

14 to be equal to the hospital per resident amounts 

15 for primary care and nonprimary care com16 puted under paragraph (2)(D) for that hospital. 

17 ‘‘(H) PERMITTING FACILITIES TO APPLY

18 AGGREGATION RULES.—The Secretary shall 

19 permit hospitals receiving additional residency 

20 positions attributable to the increase provided 

21 under this paragraph to, beginning in the fifth 

22 year after the effective date of such increase, 

23 apply such positions to the limitation amount 

24 under paragraph (4)(F) that may be aggreVerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441

pamtmann on DSKBC07HB2PROD with BILLS
10 

•HR 3441 IH

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 the 

5 implementation 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 (8)(B), and (9)(A). 

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)(9)’’ and inserting 

24 ‘‘(h)(9), and (h)(10)’’. 


pamtmann on DSKBC07HB2PROD with BILLS
11 

•HR 3441 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 by adding after 

4 clause (xi) the following new clause: 

5 ‘‘(xiii) For discharges occurring on or after 

6 July 1, 2024, insofar as an additional payment 

7 amount under this subparagraph is attributable 

8 to residency positions distributed to a hospital 

9 under subsection (h)(10), the indirect teaching 

10 adjustment factor shall be computed in the 

11 same manner as provided under clause (ii) with 

12 respect to such residency positions.’’. 

Æ 


pamtmann on DSKBC07HB2PROD with BILLS