Opioid Workforce Act of 2018

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Opioid Workforce Act of 2018''.

SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS TO HELP COMBAT 
              OPIOID CRISIS.

    (a) In General.--Section 1886(h) of the Social Security Act (42 
U.S.C. 1395ww(h)) is amended--
            (1) in paragraph (4)(F)(i), by striking ``paragraphs (7) 
        and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
            (2) in paragraph (4)(H)(i), by striking ``paragraphs (7) 
        and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
            (3) in paragraph (7)(E), by inserting ``paragraph (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 positions.--For each of 
                fiscal years 2019 through 2023 (and succeeding fiscal 
                years if the Secretary determines that there are 
                additional residency positions available to distribute 
                under subparagraph (D)), the Secretary shall increase 
                the otherwise applicable resident limit for each 
                qualifying hospital that submits a timely application 
                under this subparagraph by such number as the Secretary 
                may approve for portions of 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 subparagraph 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 
                paragraph.
                    ``(B) Distribution for fiscal year 2019.--
                            ``(i) In general.--For fiscal year 2019, 
                        the positions available for distribution with 
                        respect to the fiscal year as described in 
                        subparagraph (A) shall be distributed to 
                        hospitals that have existing established 
                        approved programs in addiction medicine, 
                        addiction psychiatry, or pain management as 
                        determined by the Secretary.
                            ``(ii) Number of positions hospital 
                        eligible to receive.--Subject to clauses (iii) 
                        and (iv), the aggregate number of positions a 
                        hospital may receive under this subparagraph 
                        with respect to fiscal year 2019 is equal to 
                        the sum of the following:
                                    ``(I) The number of full-time-
                                equivalent residents that will be 
                                training in addiction medicine, 
                                addiction psychiatry, or pain 
                                management as determined by the 
                                Secretary with respect 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 expansion 
                        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 that expansion, as determined by 
                        the Secretary.
                            ``(iv) Considerations in distribution.--The 
                        Secretary shall distribute additional residency 
                        positions under this subparagraph based on--
                                    ``(I) in the case of positions made 
                                available under clause (ii), the 
                                demonstrated 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 hospital 
                                filling such positions within the first 
                                three cost reporting periods beginning 
                                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 in this subparagraph shall 
                        preclude a hospital 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 distributed and such number 
                        available for distribution shall be added to 
                        the aggregate number of positions available for 
                        distribution under subparagraph (C).
                    ``(C) Distribution for fiscal years 2020 through 
                2023.--
                            ``(i) In general.--For the period of fiscal 
                        years 2020 through 2023, the positions 
                        available for distribution with respect to such 
                        period (as described in subparagraph (A), 
                        including after application of subparagraph 
                        (B)(vi)) shall be distributed to hospitals 
                        which demonstrate to the Secretary that the 
                        hospital--
                                    ``(I) will establish an approved 
                                program in addiction medicine, 
                                addiction 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 increase 
                                would be effective.
                            ``(ii) Requirements.--Subject to clause 
                        (iii), a hospital that receives an increase 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 requirements 
                        under this clause during such 5-year period in 
                        such manner and at such time as the Secretary 
                        determines appropriate, including 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 described in clause 
                        (ii) does not meet the requirements of such 
                        clause, the Secretary shall--
                                    ``(I) reduce the otherwise 
                                applicable 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 
                                reduction in accordance with the 
                                requirements 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 positions.--If the 
                aggregate number of positions distributed under 
                subparagraphs (B) and (C) during the period of fiscal 
                years 2019 through 2023 is less than 1,000, 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 paragraph is equal to 1,000.
                    ``(E) Notification.--The Secretary shall notify 
                hospitals of the number of positions distributed to the 
                hospital under this paragraph as a result on an 
                increase in the otherwise applicable resident limit by 
                January 1 of the fiscal year of the increase. Such 
                increase shall be effective for portions of cost 
                reporting periods beginning on or after July 1 of that 
                fiscal year.
                    ``(F) Application of per resident amounts for 
                primary care and nonprimary care.--With respect to 
                additional residency positions 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.
                    ``(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 aggregated pursuant 
                to paragraph (4)(H) among members of the same 
                affiliated group.
                    ``(H) Definitions.--In this paragraph:
                            ``(i) Otherwise applicable resident 
                        limit.--The term `otherwise applicable 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 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 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 redesignated 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.''.

Summary: Opioid Workforce Act of 2018 This bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period.