IB 
Union Calendar No. 573 
116TH CONGRESS 
2D SESSION 
H. R. 3414 
[Report No. 116–690, Part I] 
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 
JUNE 21, 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 de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
DECEMBER 24, 2020 
Additional sponsors: Mr. KING
of New York, Ms. HOULAHAN, Mr. 
FITZPATRICK, Mr. KILMER, Mr. DELGADO, Mr. LARSON of Connecticut, 
Mr. MORELLE, Mr. KRISHNAMOORTHI, Ms. SLOTKIN, Mr. TRONE, Miss 
RICE of New York, Ms. CLARK of Massachusetts, Mr. DANNY K. DAVIS 
of Illinois, Mr. COLLINS of New York, Ms. HILL of California, Mr. 
ROUDA, Mr. MEEKS, Mr. SUOZZI, Mr. STIVERS, Mr. ROSE of New York, 
Ms. MENG, Ms. VELA´ZQUEZ, Mr. KATKO, Mr. HIGGINS of New York, Ms. 
WILD, Mr. TONKO, Mr. RASKIN, Mr. PAPPAS, Mrs. CAROLYN B. MALO-
NEY of New York, Mr. KIM, Mr. SEAN PATRICK MALONEY of New York, 
Mr. VAN DREW, Mrs. AXNE, Mr. KENNEDY, Ms. STEVENS, Mr. RUTHER-
FORD, Mr. EVANS, Ms. DEAN, Mr. BRENDAN F. BOYLE of Pennsylvania, 
Ms. SCANLON, Mr. SARBANES, Ms. BLUNT ROCHESTER, Mr. MCGOVERN, 
Mr. BALDERSON, Mr. BUTTERFIELD, Ms. SEWELL of Alabama, Mr. 
ENGEL, Mr. BRINDISI, Ms. UNDERWOOD, Mr. LYNCH, Ms. CLARKE of 
New York, Mr. CONNOLLY, Mr. CISNEROS, Mr. PANETTA, Mr. 
RESCHENTHALER, Mr. CUELLAR, Mrs. MURPHY of Florida, Mr. VIS-
CLOSKY, Mr. ESPAILLAT, Mr. HASTINGS, Mr. LAMB, Mr. SIRES, Mr. 
ROGERS of Alabama, Ms. KELLY of Illinois, Mr. GALLEGO, Mr. TED 
LIEU of California, Mr. RUSH, Mr. LUJA´N, Mr. GONZALEZ of Texas, Mr. 
THOMPSON of Mississippi, and Mr. WELCH 
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DECEMBER 24, 2020 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 24, 2020 
Committee on Energy and Commerce discharged; committed to the Committee 
of the Whole House on the State of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on June 21, 2019] 
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. 
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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 2019’’. 
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI-
TIONS TO HELP COMBAT OPIOID CRISIS. 
(a) IN GENERAL.—Section 1886(h) of the Social Secu-
rity 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 para-
graph: 
‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS TO HELP COMBAT OPIOID CRISIS.— 
‘‘(A) ADDITIONAL RESIDENCY POSITIONS.— 
During the period of fiscal years 2022 through 
2026 (and succeeding fiscal years if the Sec-
retary determines that there are additional full- 
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time-equivalent residency positions available to 
distribute under subparagraph (D)), the Sec-
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 Secretary 
may approve, effective beginning July 1 of the 
fiscal year of the increase. The aggregate number 
of additional full-time-equivalent residency posi-
tions available for distribution under this para-
graph shall be equal to 500 in fiscal year 2022 
and 500 over the period of fiscal years 2023 
through 2026, distributed in accordance with the 
succeeding subparagraphs of this paragraph. 
‘‘(B) DISTRIBUTION
FOR
FISCAL
YEAR 
2022.— 
‘‘(i) IN
GENERAL.—For fiscal year 
2022, 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 paragraph) 
approved programs in addiction medicine, 
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addiction psychiatry, or pain medicine, as 
determined by the Secretary. 
‘‘(ii) CONSIDERATIONS
IN
DISTRIBU-
TION.—The Secretary shall distribute addi-
tional residency positions under this sub-
paragraph based on the demonstrated likeli-
hood, 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 effec-
tive. 
‘‘(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 pro-
gram that is a prerequisite (as determined 
by the Secretary) for such a program so de-
scribed, such as internal medicine. The Sec-
retary may determine whether a hospital 
has met the requirements under this clause 
during such 5-year period in such manner 
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and at such time as the Secretary deter-
mines appropriate, including 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 in-
creased under this subparagraph; and 
‘‘(II) provide for the distribution 
of positions attributable to such reduc-
tion in accordance with the require-
ments of this paragraph. 
‘‘(v) POSITIONS
NOT
DISTRIBUTED 
DURING FISCAL YEAR 2022.—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 
2022 (as described in subparagraph (A)), 
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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 2023 
THROUGH 2026.— 
‘‘(i) IN GENERAL.—For the period of 
fiscal years 2023 through 2026, 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 distributed 
to hospitals which demonstrate to the Sec-
retary that the hospital has established or 
will establish an approved residency train-
ing program in addiction medicine, addic-
tion 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 likeli-
hood, as determined by the Secretary, of the 
hospital filling such positions within the 
first 4 training years (as specified by the 
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Secretary) after the increase would be effec-
tive. 
‘‘(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 pro-
gram that is a prerequisite (as determined 
by the Secretary) for such a program so de-
scribed, such as internal medicine. The Sec-
retary may determine whether a hospital 
has met the requirements under this clause 
during such 5-year period in such manner 
and at such time as the Secretary deter-
mines appropriate, including at the end of 
such 5-year period. 
‘‘(iv) REDISTRIBUTION
OF
POSITIONS 
IF HOSPITAL NO LONGER MEETS CERTAIN 
REQUIREMENTS.—In the case where the Sec-
retary determines that a hospital described 
in clause (iii) does not meet the require-
ments of such clause, the Secretary shall— 
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‘‘(I) reduce the otherwise applica-
ble resident limit of the hospital by the 
amount by which such limit was in-
creased under this subparagraph; and 
‘‘(II) provide for the distribution 
of positions attributable to such reduc-
tion in accordance with the require-
ments of this paragraph. 
‘‘(D) DISTRIBUTION
OF
REMAINING
POSI-
TIONS.—If the aggregate number of positions dis-
tributed under subparagraphs (B) and (C) dur-
ing the period of fiscal years 2022 through 2026 
is less than 1000, the Secretary shall distribute 
the remaining residency positions in succeeding 
fiscal years according to criteria consistent with 
this paragraph until such time as the aggregate 
amount of positions distributed under this para-
graph is equal to 1000. 
‘‘(E) LIMITATION.—An individual hospital 
may not receive more than 25 full-time-equiva-
lent residency positions under this paragraph. 
‘‘(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-
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ble resident limit by January 1 of the fiscal year 
of the increase. Such increase shall be effective 
beginning July 1 of that fiscal year. 
‘‘(G) 
APPLICATION
OF
PER
RESIDENT 
AMOUNTS FOR PRIMARY CARE AND NONPRIMARY 
CARE.—With respect to additional residency po-
sitions in a hospital attributable to the increase 
provided under this paragraph, the approved 
FTE per resident amounts are deemed to be 
equal to the hospital per resident amounts for 
primary care and nonprimary care computed 
under paragraph (2)(D) for that hospital. 
‘‘(H) PERMITTING FACILITIES TO APPLY AG-
GREGATION 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 po-
sitions to the limitation amount under para-
graph (4)(F) that may be aggregated 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. 
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‘‘(J) DEFINITIONS.—In this paragraph: 
‘‘(i) OTHERWISE
APPLICABLE
RESI-
DENT LIMIT.—The term ‘otherwise applica-
ble 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 re-
gard to this paragraph but taking into ac-
count paragraphs (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.— 
(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 amend-
ed 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 Af-
fordable Care Act (Public Law 111–148), as 
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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, 2022, insofar as an additional payment amount 
under this subparagraph is attributable to residency 
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 residency positions.’’. 
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Union Calendar No. 573 
116TH CONGRESS 
2D SESSION 
H. R. 3414 
[Report No. 116–690, Part I] 
A BILL 
To amend title XVIII of the Social Security Act to 
provide for the distribution of additional resi-
dency positions to help combat the opioid crisis. 
DECEMBER 24, 2020 
Reported from the Committee on Ways and Means with 
an amendment 
DECEMBER 24, 2020 
Committee on Energy and Commerce discharged; com-
mitted to the Committee of the Whole House on the 
State of the Union and ordered to be printed 
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