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 com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Opioid Workforce Act 
of 2018’’. 
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SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI-
TIONS TO HELP COMBAT OPIOID CRISIS. 
(a) IN GENERAL.—Section 1886(h) of the Social Se-
curity Act (42 U.S.C. 1395ww(h)) is amended— 
(1) in paragraph (4)(F)(i), by striking ‘‘para-
graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 
(8), and (9)’’; 
(2) in paragraph (4)(H)(i), by striking ‘‘para-
graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 
(8), and (9)’’; 
(3) in paragraph (7)(E), by inserting ‘‘para-
graph (9),’’ after ‘‘paragraph (8),’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS TO HELP COMBAT OPIOID CRISIS.— 
‘‘(A) 
ADDITIONAL
RESIDENCY
POSI-
TIONS.—For each of fiscal years 2019 through 
2023 (and succeeding fiscal years if the Sec-
retary determines that there are additional resi-
dency positions available to distribute under 
subparagraph (D)), the Secretary shall increase 
the otherwise applicable resident limit for each 
qualifying hospital that submits a timely appli-
cation under this subparagraph by such number 
as the Secretary may approve for portions of 
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cost reporting periods occurring on or after 
July 1 of the fiscal year of the increase. Except 
as provided in subparagraph (B)(iv) or (D), the 
aggregate number of increases in the otherwise 
applicable resident limit under this subpara-
graph shall be equal to 500 in fiscal year 2019 
and 500 over the period of fiscal years 2020 
through 2023, distributed in accordance with 
the succeeding subparagraphs of this para-
graph. 
‘‘(B) DISTRIBUTION
FOR
FISCAL
YEAR 
2019.— 
‘‘(i) IN
GENERAL.—For fiscal year 
2019, the positions available for distribu-
tion with respect to the fiscal year as de-
scribed in subparagraph (A) shall be dis-
tributed to hospitals that have existing es-
tablished approved programs in addiction 
medicine, addiction psychiatry, or pain 
management as determined by the Sec-
retary. 
‘‘(ii) NUMBER
OF
POSITIONS
HOS-
PITAL ELIGIBLE TO RECEIVE.—Subject to 
clauses (iii) and (iv), the aggregate number 
of positions a hospital may receive under 
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this subparagraph with respect to fiscal 
year 2019 is equal to the sum of the fol-
lowing: 
‘‘(I) The number of full-time- 
equivalent residents that will be train-
ing in addiction medicine, addiction 
psychiatry, or pain management as 
determined by the Secretary with re-
spect to the fiscal year. 
‘‘(II) The associated number of 
residents training in a pre-requisite 
program, such as internal medicine, 
necessary for the number of full-time 
residents for the programs described 
in subclause (I). 
‘‘(iii) ADDITIONAL POSITIONS FOR EX-
PANSION
OF
EXISTING
PROGRAM.—If a 
hospital demonstrates to the Secretary that 
the hospital is planning to increase the 
number of full-time-equivalent residents in 
existing programs described in clause (i), 
the Secretary may increase the number of 
positions a hospital is eligible to receive 
under clause (ii) in order to accommodate 
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that expansion, as determined by the Sec-
retary. 
‘‘(iv) CONSIDERATIONS IN DISTRIBU-
TION.—The Secretary shall distribute addi-
tional residency positions under this sub-
paragraph based on— 
‘‘(I) in the case of positions made 
available under clause (ii), the dem-
onstrated likelihood of the hospital 
filling such positions by July 1, 2019; 
and 
‘‘(II) in the case of positions 
made available under clause (iii), the 
demonstrated likelihood of the hos-
pital filling such positions within the 
first three cost reporting periods be-
ginning on or after July 1, 2019. 
‘‘(v) 
LIMITATION.—Notwithstanding 
clauses (ii) and (iv), an individual hospital 
may not receive more than 25 full-time- 
equivalent residency positions under this 
subparagraph. 
‘‘(vi) 
CLARIFICATION
REGARDING 
AVAILABILITY OF ADDITIONAL POSITIONS 
IN SUBSEQUENT FISCAL YEARS.—Nothing 
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in this subparagraph shall preclude a hos-
pital from receiving additional residency 
positions under subparagraph (C). 
‘‘(vii) POSITIONS
NOT
DISTRIBUTED 
DURING THE FISCAL YEAR.—If the number 
of resident full-time-equivalent positions 
distributed under this subparagraph is less 
than the aggregate number of positions 
available for distribution in the fiscal year 
(as described in subparagraph (A)), the 
difference between such number distrib-
uted and such number available for dis-
tribution shall be added to the aggregate 
number of positions available for distribu-
tion under subparagraph (C). 
‘‘(C) DISTRIBUTION
FOR
FISCAL
YEARS 
2020 THROUGH 2023.— 
‘‘(i) IN GENERAL.—For the period of 
fiscal years 2020 through 2023, the posi-
tions available for distribution with respect 
to such period (as described in subpara-
graph (A), including after application of 
subparagraph (B)(vi)) shall be distributed 
to hospitals which demonstrate to the Sec-
retary that the hospital— 
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‘‘(I) will establish an approved 
program in addiction medicine, addic-
tion psychiatry, or pain management; 
and 
‘‘(II) will use all of the additional 
positions made available under this 
subparagraph in such program or a 
prerequisite residency program for 
such program within the first four 
cost reporting periods after the in-
crease would be effective. 
‘‘(ii) 
REQUIREMENTS.—Subject 
to 
clause (iii), a hospital that receives an in-
crease in the otherwise applicable resident 
limit under this subparagraph shall ensure, 
during the 5-year period beginning after 
the date of such increase, that the hospital 
uses the positions received under clauses 
(i)(I) and (i)(II) for the programs for 
which the positions were distributed, or 
similar programs (as determined by the 
Secretary). The Secretary may determine 
whether a hospital has met the require-
ments under this clause during such 5-year 
period in such manner and at such time as 
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the Secretary determines appropriate, in-
cluding at the end of such 5-year period. 
‘‘(iii) REDISTRIBUTION OF POSITIONS 
IF HOSPITAL NO LONGER MEETS CERTAIN 
REQUIREMENTS.—In the case where the 
Secretary determines that a hospital de-
scribed in clause (ii) does not meet the re-
quirements of such clause, the Secretary 
shall— 
‘‘(I) reduce the otherwise applica-
ble resident limit of the hospital by 
the amount by which such limit was 
increased under this subparagraph; 
and 
‘‘(II) provide for the distribution 
of positions attributable to such re-
duction in accordance with the re-
quirements of this paragraph. 
‘‘(iv) 
LIMITATION.—An 
individual 
hospital may not receive more than 25 full- 
time-equivalent residency positions under 
this subparagraph. 
‘‘(D) DISTRIBUTION OF REMAINING POSI-
TIONS.—If the aggregate number of positions 
distributed under subparagraphs (B) and (C) 
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during the period of fiscal years 2019 through 
2023 is less than 1,000, the Secretary shall dis-
tribute the remaining residency positions in suc-
ceeding fiscal years according to criteria con-
sistent with this paragraph until such time as 
the aggregate amount of positions distributed 
under this paragraph is equal to 1,000. 
‘‘(E) NOTIFICATION.—The Secretary shall 
notify hospitals of the number of positions dis-
tributed to the hospital under this paragraph as 
a result on an increase in the otherwise applica-
ble resident limit by January 1 of the fiscal 
year of the increase. Such increase shall be ef-
fective for portions of cost reporting periods be-
ginning on or after July 1 of that fiscal year. 
‘‘(F) APPLICATION
OF
PER
RESIDENT 
AMOUNTS
FOR
PRIMARY
CARE
AND
NONPRI-
MARY CARE.—With respect to additional resi-
dency positions in a hospital attributable to the 
increase provided under this paragraph, the ap-
proved FTE per resident amounts are deemed 
to be equal to the hospital per resident amounts 
for primary care and nonprimary care com-
puted under paragraph (2)(D) for that hospital. 
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‘‘(G) PERMITTING
FACILITIES
TO
APPLY 
AGGREGATION
RULES.—The Secretary shall 
permit hospitals receiving additional residency 
positions attributable to the increase provided 
under this paragraph to, beginning in the fifth 
year after the effective date of such increase, 
apply such positions to the limitation amount 
under paragraph (4)(F) that may be aggre-
gated pursuant to paragraph (4)(H) among 
members of the same affiliated group. 
‘‘(H) DEFINITIONS.—In this paragraph: 
‘‘(i) OTHERWISE
APPLICABLE
RESI-
DENT LIMIT.—The term ‘otherwise appli-
cable resident limit’ means, with respect to 
a hospital, the limit otherwise applicable 
under subparagraphs (F)(i) and (H) of 
paragraph (4) on the resident level for the 
hospital determined without regard to this 
paragraph but taking into account para-
graphs (7)(A), (7)(B), (8)(A), and (8)(B). 
‘‘(ii) RESIDENT
LEVEL.—The term 
‘resident level’ has the meaning given such 
term in paragraph (7)(C)(i).’’. 
(b) IME.— 
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(1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(5)(B)(v)), in the third sentence, is 
amended by striking ‘‘and (h)(8)’’ and inserting 
‘‘(h)(8), and (h)(9)’’. 
(2) 
CONFORMING
PROVISION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended— 
(A) by redesignating clause (x), as added 
by section 5505(b) of the Patient Protection 
and Affordable Care Act (Public Law 111– 
148), as clause (xi) and moving such clause 4 
ems to the left; and 
(B) by adding after clause (xi), as redesig-
nated by subparagraph (A), the following new 
clause: 
‘‘(xii) For discharges occurring on or after July 
1, 2019, insofar as an additional payment amount 
under this subparagraph is attributable to resident 
positions distributed to a hospital under subsection 
(h)(9), the indirect teaching adjustment factor shall 
be computed in the same manner as provided under 
clause (ii) with respect to such resident positions.’’. 
Æ 
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