Opioid Workforce Act of 2021
Bill: S.1438 | Sponsor: Sen. Hassan, Margaret Wood (D-NH)
Policy area: Health

Summary:
Opioid Workforce Act of 2021
This bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain medicine programs, with an aggregate increase of 1,000 positions over a five-year period.

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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Opioid Workforce Act of 2021''.

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 ``and (9)'' and 
        inserting ``(9), and (10)'';
            (2) in paragraph (4)(H)(i), by striking ``and (9)'' and 
        inserting ``(9), and (10)'';
            (3) in paragraph (7)(E), by inserting ``paragraph (10),'' 
        after ``paragraph (9),''; and
            (4) by adding at the end the following new paragraph:
            ``(10) Distribution of additional residency positions to 
        help combat opioid crisis.--
                    ``(A) Additional residency positions.--For each 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 
                Secretary shall increase the otherwise applicable 
                resident limit for each qualifying hospital that 
                submits a timely application under this paragraph by 
                such number as the Secretary may approve, effective for 
                portions of cost reporting periods occurring on or 
                after July 1 of the fiscal year of the increase. The 
                aggregate number of additional full-time equivalent 
                resident positions available for distribution under 
                this paragraph shall be equal to 1,000, distributed in 
                accordance with the succeeding subparagraphs of this 
                paragraph.
                    ``(B) Distribution for fiscal year 2024.--
                            ``(i) In general.--For fiscal year 2024, 
                        500 of the positions 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, addiction psychiatry, or 
                        pain medicine, as determined by the Secretary.
                            ``(ii) Considerations in distribution.--The 
                        Secretary shall distribute additional residency 
                        positions under this subparagraph based on the 
                        demonstrated likelihood (as determined by the 
                        Secretary) of the hospital filling such 
                        positions.
                            ``(iii) Requirements.--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 
                        made available under this subparagraph for a 
                        program described in clause (i) or a program 
                        that is a prerequisite (as determined by the 
                        Secretary) for such a program so described, 
                        such as internal medicine. 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.
                            ``(iv) Redistribution of positions if 
                        hospital no longer meets certain 
                        requirements.--In the case in which the 
                        Secretary determines that a hospital described 
                        in clause (iii) 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.
                    ``(C) Distribution for fiscal years 2025 through 
                2028.--
                            ``(i) In general.--For the period of fiscal 
                        years 2025 through 2028, 500 of the positions 
                        available for distribution under subparagraph 
                        (A) shall be distributed 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 distribution.--The 
                        Secretary shall distribute additional residency 
                        positions under this subparagraph based on the 
                        demonstrated likelihood, 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 
                        subparagraph shall ensure, during the 5-year 
                        period beginning after the date of such 
                        increase, 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 determined by the 
                        Secretary) for such a program so described, 
                        such as internal medicine. 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.
                            ``(iv) Redistribution of positions if 
                        hospital no longer meets certain 
                        requirements.--In the case where the Secretary 
                        determines that a hospital described in clause 
                        (iii) 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.
                    ``(D) Distribution of remaining positions.--If the 
                aggregate number of positions distributed under 
                subparagraphs (B) and (C) during the period of fiscal 
                years 2024 through 2028 is less than 500, 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 500.
                    ``(E) Limitation.--An individual hospital may not 
                receive more than 25 full-time equivalent residency 
                positions under this paragraph.
                    ``(F) Notification.--The Secretary shall notify 
                hospitals of the number of positions distributed to the 
                hospital under this paragraph as a result of 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.
                    ``(G) 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.
                    ``(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 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 implementation 
                of this paragraph.
                    ``(J) 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 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)''.
            (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 (xii) 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 resident 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 resident positions.''.
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