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 dis-
order 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 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 substance use disorder 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 ‘‘Substance Use Dis-
order Workforce Act’’. 
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SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI-
TIONS TO HELP COMBAT SUBSTANCE USE 
DISORDER 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), (8), and (9)’’ and inserting ‘‘paragraphs 
(7), (8), (9), and (10)’’; 
(2) in paragraph (4)(H)(i), by striking ‘‘para-
graphs (7), (8), and (9)’’ and inserting ‘‘paragraphs 
(7), (8), (9), and (10)’’; 
(3) in paragraph (7)(E), by striking ‘‘para-
graph (8)’’ and all that follows through ‘‘clause (i)’’ 
and inserting ‘‘paragraph (8), paragraph (9), para-
graph (10), clause (i)’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(10) DISTRIBUTION
OF
ADDITIONAL
RESI-
DENCY
POSITIONS
TO
HELP
COMBAT
SUBSTANCE 
USE DISORDER CRISIS.— 
‘‘(A) 
ADDITIONAL
RESIDENCY
POSI-
TIONS.—During the period of fiscal years 2024 
through 2028 (and succeeding fiscal years if the 
Secretary determines that there are additional 
full-time-equivalent residency positions available 
to distribute under subparagraph (D)), the Sec-
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retary shall distribute additional full-time-equiv-
alent residency positions to increase the other-
wise applicable resident limit for each qualifying 
hospital that submits a timely application under 
this paragraph by such number as the Sec-
retary may approve, effective beginning July 1 
of the fiscal year of the increase. The aggregate 
number of additional full-time-equivalent resi-
dency positions available for distribution under 
this paragraph shall be equal to 500 in fiscal 
year 2024 and 500 over the period of fiscal 
years 2025 through 2028, distributed in accord-
ance with the succeeding subparagraphs of this 
paragraph. 
‘‘(B) DISTRIBUTION
FOR
FISCAL
YEAR 
2024.— 
‘‘(i) IN
GENERAL.—For fiscal year 
2024, the positions available for distribu-
tion for such fiscal year (as described in 
subparagraph (A)) may only be distributed 
to hospitals that have established (as of 
the date of the enactment of this para-
graph) approved programs in addiction 
medicine, addiction psychiatry, or pain 
medicine, as determined by the Secretary. 
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‘‘(ii) CONSIDERATIONS IN DISTRIBU-
TION.—The Secretary shall distribute addi-
tional residency positions under this sub-
paragraph based on the demonstrated like-
lihood, as determined by the Secretary, of 
the hospital filling such positions within 
the first 4 training years (as specified by 
the Secretary) after the increase would be 
effective. 
‘‘(iii) 
REQUIREMENTS.—A 
hospital 
that receives an increase in the otherwise 
applicable resident limit under this sub-
paragraph shall ensure, during the 5-year 
period beginning after the date of such in-
crease, that the hospital uses the positions 
made available under this subparagraph 
for a program described in clause (i) or a 
program that is a prerequisite (as deter-
mined by the Secretary) for such a pro-
gram so described, such as internal medi-
cine. The Secretary may determine wheth-
er a hospital has met the requirements 
under this clause during such 5-year pe-
riod 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. 
‘‘(iv) REDISTRIBUTION OF POSITIONS 
IF HOSPITAL NO LONGER MEETS CERTAIN 
REQUIREMENTS.—In the case in which the 
Secretary determines that a hospital de-
scribed in clause (iii) 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. 
‘‘(v) POSITIONS
NOT
DISTRIBUTED 
DURING FISCAL YEAR 2024.—If the number 
of full-time-equivalent residency positions 
distributed under this subparagraph is less 
than the aggregate number of positions 
available for distribution for fiscal year 
2024 (as described in subparagraph (A)), 
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the difference between such number dis-
tributed 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 
2025 THROUGH 2028.— 
‘‘(i) IN GENERAL.—For the period of 
fiscal years 2025 through 2028, the posi-
tions available for distribution for such pe-
riod (as described in subparagraph (A)), 
and any positions made available pursuant 
to subparagraph (B)(v), shall be distrib-
uted to hospitals which demonstrate to the 
Secretary that the hospital has established 
or will establish an approved residency 
training program in addiction medicine, 
addiction psychiatry, or pain medicine. 
‘‘(ii) CONSIDERATIONS IN DISTRIBU-
TION.—The Secretary shall distribute addi-
tional residency positions under this sub-
paragraph based on the demonstrated like-
lihood, as determined by the Secretary, of 
the hospital filling such positions within 
the first 4 training years (as specified by 
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the Secretary) after the increase would be 
effective. 
‘‘(iii) 
REQUIREMENTS.—A 
hospital 
that receives an increase in the otherwise 
applicable resident limit under this sub-
paragraph shall ensure, during the 5-year 
period beginning after the date of such in-
crease, that the hospital uses the positions 
made available under this subparagraph 
for a program described in clause (i) or a 
program that is a prerequisite (as deter-
mined by the Secretary) for such a pro-
gram so described, such as internal medi-
cine. The Secretary may determine wheth-
er a hospital has met the requirements 
under this clause during such 5-year pe-
riod in such manner and at such time as 
the Secretary determines appropriate, in-
cluding at the end of such 5-year period. 
‘‘(iv) REDISTRIBUTION OF POSITIONS 
IF HOSPITAL NO LONGER MEETS CERTAIN 
REQUIREMENTS.—In the case where the 
Secretary determines that a hospital de-
scribed in clause (iii) does not meet the re-
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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. 
‘‘(D) DISTRIBUTION OF REMAINING POSI-
TIONS.—If the aggregate number of positions 
distributed under subparagraphs (B) and (C) 
during the period of fiscal years 2024 through 
2028 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) LIMITATION.—An individual hospital 
may not receive more than 25 full-time-equiva-
lent residency positions under this paragraph. 
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‘‘(F) NOTIFICATION.—The Secretary shall 
notify hospitals of the number of positions dis-
tributed to the hospital under this paragraph as 
a result of 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 beginning July 1 of that fiscal year. 
‘‘(G) 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. 
‘‘(H) 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-
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gated pursuant to paragraph (4)(H) among 
members of the same affiliated group. 
‘‘(I) CLARIFICATION.—Chapter 35 of title 
44, United States Code, shall not apply to the 
implementation of this paragraph. 
‘‘(J) 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 paragraph (4)(F)(i) on the resident 
level for the hospital determined without 
regard to this paragraph but taking into 
account paragraphs (7)(A), (7)(B), (8)(A), 
(8)(B), and (9)(A). 
‘‘(ii) RESIDENT
LEVEL.—The term 
‘resident level’ has the meaning given such 
term in paragraph (7)(C)(i).’’. 
(b) IME.— 
(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)(9)’’ and inserting 
‘‘(h)(9), and (h)(10)’’. 
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(2) 
CONFORMING
PROVISION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended by adding after 
clause (xi) the following new clause: 
‘‘(xiii) For discharges occurring on or after 
July 1, 2024, insofar as an additional payment 
amount under this subparagraph is attributable 
to residency positions distributed to a hospital 
under subsection (h)(10), the indirect teaching 
adjustment factor shall be computed in the 
same manner as provided under clause (ii) with 
respect to such residency positions.’’. 
Æ 
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