Substance Use Disorder Workforce Act

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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Substance Use Dis- 4 order Workforce Act’’. 5 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 3441 IH SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI- 1 TIONS TO HELP COMBAT SUBSTANCE USE 2 DISORDER CRISIS. 3 (a) IN GENERAL.—Section 1886(h) of the Social Se- 4 curity Act (42 U.S.C. 1395ww(h)) is amended— 5 (1) in paragraph (4)(F)(i), by striking ‘‘para- 6 graphs (7), (8), and (9)’’ and inserting ‘‘paragraphs 7 (7), (8), (9), and (10)’’; 8 (2) in paragraph (4)(H)(i), by striking ‘‘para- 9 graphs (7), (8), and (9)’’ and inserting ‘‘paragraphs 10 (7), (8), (9), and (10)’’; 11 (3) in paragraph (7)(E), by striking ‘‘para- 12 graph (8)’’ and all that follows through ‘‘clause (i)’’ 13 and inserting ‘‘paragraph (8), paragraph (9), para- 14 graph (10), clause (i)’’; and 15 (4) by adding at the end the following new 16 paragraph: 17 ‘‘(10) DISTRIBUTION OF ADDITIONAL RESI- 18 DENCY POSITIONS TO HELP COMBAT SUBSTANCE 19 USE DISORDER CRISIS.— 20 ‘‘(A) ADDITIONAL RESIDENCY POSI- 21 TIONS.—During the period of fiscal years 2024 22 through 2028 (and succeeding fiscal years if the 23 Secretary determines that there are additional 24 full-time-equivalent residency positions available 25 to distribute under subparagraph (D)), the Sec- 26 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 3441 IH retary shall distribute additional full-time-equiv- 1 alent residency positions to increase the other- 2 wise applicable resident limit for each qualifying 3 hospital that submits a timely application under 4 this paragraph by such number as the Sec- 5 retary may approve, effective beginning July 1 6 of the fiscal year of the increase. The aggregate 7 number of additional full-time-equivalent resi- 8 dency positions available for distribution under 9 this paragraph shall be equal to 500 in fiscal 10 year 2024 and 500 over the period of fiscal 11 years 2025 through 2028, distributed in accord- 12 ance with the succeeding subparagraphs of this 13 paragraph. 14 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR 15 2024.— 16 ‘‘(i) IN GENERAL.—For fiscal year 17 2024, the positions available for distribu- 18 tion for such fiscal year (as described in 19 subparagraph (A)) may only be distributed 20 to hospitals that have established (as of 21 the date of the enactment of this para- 22 graph) approved programs in addiction 23 medicine, addiction psychiatry, or pain 24 medicine, as determined by the Secretary. 25 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 3441 IH ‘‘(ii) CONSIDERATIONS IN DISTRIBU- 1 TION.—The Secretary shall distribute addi- 2 tional residency positions under this sub- 3 paragraph based on the demonstrated like- 4 lihood, as determined by the Secretary, of 5 the hospital filling such positions within 6 the first 4 training years (as specified by 7 the Secretary) after the increase would be 8 effective. 9 ‘‘(iii) REQUIREMENTS.—A hospital 10 that receives an increase in the otherwise 11 applicable resident limit under this sub- 12 paragraph shall ensure, during the 5-year 13 period beginning after the date of such in- 14 crease, that the hospital uses the positions 15 made available under this subparagraph 16 for a program described in clause (i) or a 17 program that is a prerequisite (as deter- 18 mined by the Secretary) for such a pro- 19 gram so described, such as internal medi- 20 cine. The Secretary may determine wheth- 21 er a hospital has met the requirements 22 under this clause during such 5-year pe- 23 riod in such manner and at such time as 24 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 3441 IH the Secretary determines appropriate, in- 1 cluding at the end of such 5-year period. 2 ‘‘(iv) REDISTRIBUTION OF POSITIONS 3 IF HOSPITAL NO LONGER MEETS CERTAIN 4 REQUIREMENTS.—In the case in which the 5 Secretary determines that a hospital de- 6 scribed in clause (iii) does not meet the re- 7 quirements of such clause, the Secretary 8 shall— 9 ‘‘(I) reduce the otherwise applica- 10 ble resident limit of the hospital by 11 the amount by which such limit was 12 increased under this subparagraph; 13 and 14 ‘‘(II) provide for the distribution 15 of positions attributable to such re- 16 duction in accordance with the re- 17 quirements of this paragraph. 18 ‘‘(v) POSITIONS NOT DISTRIBUTED 19 DURING FISCAL YEAR 2024.—If the number 20 of full-time-equivalent residency positions 21 distributed under this subparagraph is less 22 than the aggregate number of positions 23 available for distribution for fiscal year 24 2024 (as described in subparagraph (A)), 25 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 3441 IH the difference between such number dis- 1 tributed and such number available for dis- 2 tribution shall be added to the aggregate 3 number of positions available for distribu- 4 tion under subparagraph (C). 5 ‘‘(C) DISTRIBUTION FOR FISCAL YEARS 6 2025 THROUGH 2028.— 7 ‘‘(i) IN GENERAL.—For the period of 8 fiscal years 2025 through 2028, the posi- 9 tions available for distribution for such pe- 10 riod (as described in subparagraph (A)), 11 and any positions made available pursuant 12 to subparagraph (B)(v), shall be distrib- 13 uted to hospitals which demonstrate to the 14 Secretary that the hospital has established 15 or will establish an approved residency 16 training program in addiction medicine, 17 addiction psychiatry, or pain medicine. 18 ‘‘(ii) CONSIDERATIONS IN DISTRIBU- 19 TION.—The Secretary shall distribute addi- 20 tional residency positions under this sub- 21 paragraph based on the demonstrated like- 22 lihood, as determined by the Secretary, of 23 the hospital filling such positions within 24 the first 4 training years (as specified by 25 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 3441 IH the Secretary) after the increase would be 1 effective. 2 ‘‘(iii) REQUIREMENTS.—A hospital 3 that receives an increase in the otherwise 4 applicable resident limit under this sub- 5 paragraph shall ensure, during the 5-year 6 period beginning after the date of such in- 7 crease, that the hospital uses the positions 8 made available under this subparagraph 9 for a program described in clause (i) or a 10 program that is a prerequisite (as deter- 11 mined by the Secretary) for such a pro- 12 gram so described, such as internal medi- 13 cine. The Secretary may determine wheth- 14 er a hospital has met the requirements 15 under this clause during such 5-year pe- 16 riod in such manner and at such time as 17 the Secretary determines appropriate, in- 18 cluding at the end of such 5-year period. 19 ‘‘(iv) REDISTRIBUTION OF POSITIONS 20 IF HOSPITAL NO LONGER MEETS CERTAIN 21 REQUIREMENTS.—In the case where the 22 Secretary determines that a hospital de- 23 scribed in clause (iii) does not meet the re- 24 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 3441 IH quirements of such clause, the Secretary 1 shall— 2 ‘‘(I) reduce the otherwise applica- 3 ble resident limit of the hospital by 4 the amount by which such limit was 5 increased under this subparagraph; 6 and 7 ‘‘(II) provide for the distribution 8 of positions attributable to such re- 9 duction in accordance with the re- 10 quirements of this paragraph. 11 ‘‘(D) DISTRIBUTION OF REMAINING POSI- 12 TIONS.—If the aggregate number of positions 13 distributed under subparagraphs (B) and (C) 14 during the period of fiscal years 2024 through 15 2028 is less than 1,000, the Secretary shall dis- 16 tribute the remaining residency positions in suc- 17 ceeding fiscal years according to criteria con- 18 sistent with this paragraph until such time as 19 the aggregate amount of positions distributed 20 under this paragraph is equal to 1,000. 21 ‘‘(E) LIMITATION.—An individual hospital 22 may not receive more than 25 full-time-equiva- 23 lent residency positions under this paragraph. 24 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 3441 IH ‘‘(F) NOTIFICATION.—The Secretary shall 1 notify hospitals of the number of positions dis- 2 tributed to the hospital under this paragraph as 3 a result of an increase in the otherwise applica- 4 ble resident limit by January 1 of the fiscal 5 year of the increase. Such increase shall be ef- 6 fective beginning July 1 of that fiscal year. 7 ‘‘(G) APPLICATION OF PER RESIDENT 8 AMOUNTS FOR PRIMARY CARE AND NONPRI- 9 MARY CARE.—With respect to additional resi- 10 dency positions in a hospital attributable to the 11 increase provided under this paragraph, the ap- 12 proved FTE per resident amounts are deemed 13 to be equal to the hospital per resident amounts 14 for primary care and nonprimary care com- 15 puted under paragraph (2)(D) for that hospital. 16 ‘‘(H) PERMITTING FACILITIES TO APPLY 17 AGGREGATION RULES.—The Secretary shall 18 permit hospitals receiving additional residency 19 positions attributable to the increase provided 20 under this paragraph to, beginning in the fifth 21 year after the effective date of such increase, 22 apply such positions to the limitation amount 23 under paragraph (4)(F) that may be aggre- 24 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 3441 IH gated pursuant to paragraph (4)(H) among 1 members of the same affiliated group. 2 ‘‘(I) CLARIFICATION.—Chapter 35 of title 3 44, United States Code, shall not apply to the 4 implementation of this paragraph. 5 ‘‘(J) DEFINITIONS.—In this paragraph: 6 ‘‘(i) OTHERWISE APPLICABLE RESI- 7 DENT LIMIT.—The term ‘otherwise appli- 8 cable resident limit’ means, with respect to 9 a hospital, the limit otherwise applicable 10 under paragraph (4)(F)(i) on the resident 11 level for the hospital determined without 12 regard to this paragraph but taking into 13 account paragraphs (7)(A), (7)(B), (8)(A), 14 (8)(B), and (9)(A). 15 ‘‘(ii) RESIDENT LEVEL.—The term 16 ‘resident level’ has the meaning given such 17 term in paragraph (7)(C)(i).’’. 18 (b) IME.— 19 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 20 the Social Security Act (42 U.S.C. 21 1395ww(d)(5)(B)(v)), in the third sentence, is 22 amended by striking ‘‘and (h)(9)’’ and inserting 23 ‘‘(h)(9), and (h)(10)’’. 24 VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 3441 IH (2) CONFORMING PROVISION.—Section 1 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 2 1395ww(d)(5)(B)) is amended by adding after 3 clause (xi) the following new clause: 4 ‘‘(xiii) For discharges occurring on or after 5 July 1, 2024, insofar as an additional payment 6 amount under this subparagraph is attributable 7 to residency positions distributed to a hospital 8 under subsection (h)(10), the indirect teaching 9 adjustment factor shall be computed in the 10 same manner as provided under clause (ii) with 11 respect to such residency positions.’’. 12 Æ VerDate Sep 11 2014 19:32 Jul 07, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H3441.IH H3441 pamtmann on DSKBC07HB2PROD with BILLS