Opioid Workforce Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 2439 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 MAY 1, 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 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. 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 ‘‘Opioid Workforce Act 4 of 2019’’. 5 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 2 •HR 2439 IH SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI- 1 TIONS TO HELP COMBAT OPIOID CRISIS. 2 (a) IN GENERAL.—Section 1886(h) of the Social Se- 3 curity Act (42 U.S.C. 1395ww(h)) is amended— 4 (1) in paragraph (4)(F)(i), by striking ‘‘para- 5 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 6 (8), and (9)’’; 7 (2) in paragraph (4)(H)(i), by striking ‘‘para- 8 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 9 (8), and (9)’’; 10 (3) in paragraph (7)(E), by inserting ‘‘para- 11 graph (9),’’ after ‘‘paragraph (8),’’; and 12 (4) by adding at the end the following new 13 paragraph: 14 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 15 POSITIONS TO HELP COMBAT OPIOID CRISIS.— 16 ‘‘(A) ADDITIONAL RESIDENCY POSI- 17 TIONS.—For each of fiscal years 2021 through 18 2025 (and succeeding fiscal years if the Sec- 19 retary determines that there are additional resi- 20 dency positions available to distribute under 21 subparagraph (E)), the Secretary shall increase 22 the otherwise applicable resident limit for each 23 qualifying hospital that submits a timely appli- 24 cation under this subparagraph by such number 25 as the Secretary may approve for portions of 26 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 3 •HR 2439 IH cost reporting periods occurring on or after 1 July 1 of the fiscal year of the increase. Except 2 as provided in subparagraph (B)(iv) or (E), the 3 aggregate number of increases in the otherwise 4 applicable resident limit under this subpara- 5 graph shall be equal to 500 in fiscal year 2021 6 and 500 over the period of fiscal years 2022 7 through 2025, distributed in accordance with 8 the succeeding subparagraphs of this para- 9 graph. 10 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR 11 2021.— 12 ‘‘(i) IN GENERAL.—For fiscal year 13 2021, the positions available for distribu- 14 tion with respect to the fiscal year as de- 15 scribed in subparagraph (A) shall be dis- 16 tributed to hospitals that have existing es- 17 tablished approved programs in addiction 18 medicine, addiction psychiatry, or pain 19 management as determined by the Sec- 20 retary. 21 ‘‘(ii) NUMBER OF POSITIONS HOS- 22 PITAL ELIGIBLE TO RECEIVE.—Subject to 23 clauses (iii) and (iv) and subparagraph 24 (D), the aggregate number of positions a 25 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 4 •HR 2439 IH hospital may receive under this subpara- 1 graph with respect to fiscal year 2021 is 2 equal to the sum of the following: 3 ‘‘(I) The number of full-time- 4 equivalent residents that will be train- 5 ing in addiction medicine, addiction 6 psychiatry, or pain management as 7 determined by the Secretary with re- 8 spect to the fiscal year. 9 ‘‘(II) The associated number of 10 residents training in a pre-requisite 11 program, such as internal medicine, 12 necessary for the number of full-time 13 residents for the programs described 14 in subclause (I). 15 ‘‘(iii) ADDITIONAL POSITIONS FOR EX- 16 PANSION OF EXISTING PROGRAM.—If a 17 hospital demonstrates to the Secretary that 18 the hospital is planning to increase the 19 number of full-time-equivalent residents in 20 existing programs described in clause (i), 21 the Secretary may increase the number of 22 positions a hospital is eligible to receive 23 under clause (ii) in order to accommodate 24 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 5 •HR 2439 IH that expansion, as determined by the Sec- 1 retary. 2 ‘‘(iv) CONSIDERATIONS IN DISTRIBU- 3 TION.—The Secretary shall distribute addi- 4 tional residency positions under this sub- 5 paragraph based on— 6 ‘‘(I) in the case of positions made 7 available under clause (ii), the dem- 8 onstrated likelihood of the hospital 9 filling such positions by July 1, 2021; 10 and 11 ‘‘(II) in the case of positions 12 made available under clause (iii), the 13 demonstrated likelihood of the hos- 14 pital filling such positions within the 15 first three cost reporting periods be- 16 ginning on or after July 1, 2021. 17 ‘‘(v) CLARIFICATION REGARDING 18 AVAILABILITY OF ADDITIONAL POSITIONS 19 IN SUBSEQUENT FISCAL YEARS.—Nothing 20 in this subparagraph shall preclude a hos- 21 pital from receiving additional residency 22 positions under subparagraph (C). 23 ‘‘(vi) POSITIONS NOT DISTRIBUTED 24 DURING THE FISCAL YEAR.—If the number 25 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 6 •HR 2439 IH of resident full-time-equivalent positions 1 distributed under this subparagraph is less 2 than the aggregate number of positions 3 available for distribution in the fiscal year 4 (as described in subparagraph (A)), the 5 difference between such number distrib- 6 uted and such number available for dis- 7 tribution shall be added to the aggregate 8 number of positions available for distribu- 9 tion under subparagraph (C). 10 ‘‘(C) DISTRIBUTION FOR FISCAL YEARS 11 2022 THROUGH 2025.— 12 ‘‘(i) IN GENERAL.—For the period of 13 fiscal years 2022 through 2025, the posi- 14 tions available for distribution with respect 15 to such period (as described in subpara- 16 graph (A), including after application of 17 subparagraph (B)(vi)) shall be distributed, 18 subject to subparagraph (D), to hospitals 19 which demonstrate to the Secretary that 20 the hospital— 21 ‘‘(I) will establish an approved 22 program in addiction medicine, addic- 23 tion psychiatry, or pain management; 24 and 25 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 7 •HR 2439 IH ‘‘(II) will use all of the additional 1 positions made available under this 2 subparagraph in such program or a 3 prerequisite residency program for 4 such program within the first four 5 cost reporting periods after the in- 6 crease would be effective. 7 ‘‘(ii) REQUIREMENTS.—Subject to 8 clause (iii), a hospital that receives an in- 9 crease in the otherwise applicable resident 10 limit under this subparagraph shall ensure, 11 during the 5-year period beginning after 12 the date of such increase, that the hospital 13 uses the positions received under clauses 14 (i)(I) and (i)(II) for the programs for 15 which the positions were distributed, or 16 similar programs (as determined by the 17 Secretary). The Secretary may determine 18 whether a hospital has met the require- 19 ments under this clause during such 5-year 20 period in such manner and at such time as 21 the Secretary determines appropriate, in- 22 cluding at the end of such 5-year period. 23 ‘‘(iii) REDISTRIBUTION OF POSITIONS 24 IF HOSPITAL NO LONGER MEETS CERTAIN 25 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 8 •HR 2439 IH REQUIREMENTS.—In the case where the 1 Secretary determines that a hospital de- 2 scribed in clause (ii) does not meet the re- 3 quirements of such clause, the Secretary 4 shall— 5 ‘‘(I) reduce the otherwise applica- 6 ble resident limit of the hospital by 7 the amount by which such limit was 8 increased under this subparagraph; 9 and 10 ‘‘(II) provide for the distribution 11 of positions attributable to such re- 12 duction in accordance with the re- 13 quirements of this paragraph. 14 ‘‘(D) LIMITATION.—The aggregate number 15 of positions distributed under subparagraphs 16 (B) and (C) to an individual hospital during the 17 period of fiscal years 2021 through 2025 may 18 not exceed 25. 19 ‘‘(E) DISTRIBUTION OF REMAINING POSI- 20 TIONS.—If the aggregate number of positions 21 distributed under subparagraphs (B) and (C) 22 during the period of fiscal years 2021 through 23 2025 is less than 1,000, the Secretary shall dis- 24 tribute the remaining residency positions in suc- 25 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 9 •HR 2439 IH ceeding fiscal years according to criteria con- 1 sistent with this paragraph until such time as 2 the aggregate amount of positions distributed 3 under this paragraph is equal to 1,000. 4 ‘‘(F) NOTIFICATION.—The Secretary shall 5 notify hospitals of the number of positions dis- 6 tributed to the hospital under this paragraph as 7 a result on an increase in the otherwise applica- 8 ble resident limit by January 1 of the fiscal 9 year of the increase. Such increase shall be ef- 10 fective for portions of cost reporting periods be- 11 ginning on or after July 1 of that fiscal year. 12 ‘‘(G) APPLICATION OF PER RESIDENT 13 AMOUNTS FOR PRIMARY CARE AND NONPRI- 14 MARY CARE.—With respect to additional resi- 15 dency positions in a hospital attributable to the 16 increase provided under this paragraph, the ap- 17 proved FTE per resident amounts are deemed 18 to be equal to the hospital per resident amounts 19 for primary care and nonprimary care com- 20 puted under paragraph (2)(D) for that hospital. 21 ‘‘(H) PERMITTING FACILITIES TO APPLY 22 AGGREGATION RULES.—The Secretary shall 23 permit hospitals receiving additional residency 24 positions attributable to the increase provided 25 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 10 •HR 2439 IH under this paragraph to, beginning in the fifth 1 year after the effective date of such increase, 2 apply such positions to the limitation amount 3 under paragraph (4)(F) that may be aggre- 4 gated pursuant to paragraph (4)(H) among 5 members of the same affiliated group. 6 ‘‘(I) DEFINITIONS.—In this paragraph: 7 ‘‘(i) OTHERWISE APPLICABLE RESI- 8 DENT LIMIT.—The term ‘otherwise appli- 9 cable resident limit’ means, with respect to 10 a hospital, the limit otherwise applicable 11 under subparagraphs (F)(i) and (H) of 12 paragraph (4) on the resident level for the 13 hospital determined without regard to this 14 paragraph but taking into account para- 15 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 16 ‘‘(ii) RESIDENT LEVEL.—The term 17 ‘resident level’ has the meaning given such 18 term in paragraph (7)(C)(i).’’. 19 (b) IME.— 20 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 21 the Social Security Act (42 U.S.C. 22 1395ww(d)(5)(B)(v)), in the third sentence, is 23 amended by striking ‘‘and (h)(8)’’ and inserting 24 ‘‘(h)(8), and (h)(9)’’. 25 VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS 11 •HR 2439 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— 3 (A) by redesignating clause (x), as added 4 by section 5505(b) of the Patient Protection 5 and Affordable Care Act (Public Law 111– 6 148), as clause (xi) and moving such clause 4 7 ems to the left; and 8 (B) by adding after clause (xi), as redesig- 9 nated by subparagraph (A), the following new 10 clause: 11 ‘‘(xii) For discharges occurring on or after July 12 1, 2021, insofar as an additional payment amount 13 under this subparagraph is attributable to resident 14 positions distributed to a hospital under subsection 15 (h)(9), the indirect teaching adjustment factor shall 16 be computed in the same manner as provided under 17 clause (ii) with respect to such resident positions.’’. 18 Æ VerDate Sep 11 2014 00:52 May 04, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H2439.IH H2439 kjohnson on DSK79L0C42 with BILLS