Opioid Workforce Act of 2019

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 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 3414 RH 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. VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 3414 RH 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 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI- 6 TIONS TO HELP COMBAT OPIOID CRISIS. 7 (a) IN GENERAL.—Section 1886(h) of the Social Secu- 8 rity Act (42 U.S.C. 1395ww(h)) is amended— 9 (1) in paragraph (4)(F)(i), by striking ‘‘para- 10 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 11 (8), and (9)’’; 12 (2) in paragraph (4)(H)(i), by striking ‘‘para- 13 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 14 (8), and (9)’’; 15 (3) in paragraph (7)(E), by inserting ‘‘para- 16 graph (9),’’ after ‘‘paragraph (8),’’; and 17 (4) by adding at the end the following new para- 18 graph: 19 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 20 POSITIONS TO HELP COMBAT OPIOID CRISIS.— 21 ‘‘(A) ADDITIONAL RESIDENCY POSITIONS.— 22 During the period of fiscal years 2022 through 23 2026 (and succeeding fiscal years if the Sec- 24 retary determines that there are additional full- 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 3414 RH time-equivalent residency positions available to 1 distribute under subparagraph (D)), the Sec- 2 retary shall distribute additional full-time-equiv- 3 alent residency positions to increase the other- 4 wise applicable resident limit for each qualifying 5 hospital that submits a timely application under 6 this paragraph by such number as the Secretary 7 may approve, effective beginning July 1 of the 8 fiscal year of the increase. The aggregate number 9 of additional full-time-equivalent residency posi- 10 tions available for distribution under this para- 11 graph shall be equal to 500 in fiscal year 2022 12 and 500 over the period of fiscal years 2023 13 through 2026, distributed in accordance with the 14 succeeding subparagraphs of this paragraph. 15 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR 16 2022.— 17 ‘‘(i) IN GENERAL.—For fiscal year 18 2022, the positions available for distribu- 19 tion for such fiscal year (as described in 20 subparagraph (A)) may only be distributed 21 to hospitals that have established (as of the 22 date of the enactment of this paragraph) 23 approved programs in addiction medicine, 24 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 3414 RH addiction psychiatry, or pain medicine, as 1 determined by the Secretary. 2 ‘‘(ii) CONSIDERATIONS IN DISTRIBU- 3 TION.—The Secretary shall distribute addi- 4 tional residency positions under this sub- 5 paragraph based on the demonstrated likeli- 6 hood, as determined by the Secretary, of the 7 hospital filling such positions within the 8 first 4 training years (as specified by the 9 Secretary) after the increase would be effec- 10 tive. 11 ‘‘(iii) REQUIREMENTS.—A hospital 12 that receives an increase in the otherwise 13 applicable resident limit under this sub- 14 paragraph shall ensure, during the 5-year 15 period beginning after the date of such in- 16 crease, that the hospital uses the positions 17 made available under this subparagraph for 18 a program described in clause (i) or a pro- 19 gram that is a prerequisite (as determined 20 by the Secretary) for such a program so de- 21 scribed, such as internal medicine. The Sec- 22 retary may determine whether a hospital 23 has met the requirements under this clause 24 during such 5-year period in such manner 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 3414 RH and at such time as the Secretary deter- 1 mines appropriate, including at the end of 2 such 5-year period. 3 ‘‘(iv) REDISTRIBUTION OF POSITIONS 4 IF HOSPITAL NO LONGER MEETS CERTAIN 5 REQUIREMENTS.—In the case in which the 6 Secretary determines that a hospital de- 7 scribed in clause (iii) does not meet the re- 8 quirements of such clause, the Secretary 9 shall— 10 ‘‘(I) reduce the otherwise applica- 11 ble resident limit of the hospital by the 12 amount by which such limit was in- 13 creased under this subparagraph; and 14 ‘‘(II) provide for the distribution 15 of positions attributable to such reduc- 16 tion in accordance with the require- 17 ments of this paragraph. 18 ‘‘(v) POSITIONS NOT DISTRIBUTED 19 DURING FISCAL YEAR 2022.—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 2022 (as described in subparagraph (A)), 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 3414 RH the difference between such number distrib- 1 uted 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 2023 6 THROUGH 2026.— 7 ‘‘(i) IN GENERAL.—For the period of 8 fiscal years 2023 through 2026, 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 distributed 13 to hospitals which demonstrate to the Sec- 14 retary that the hospital has established or 15 will establish an approved residency train- 16 ing program in addiction medicine, addic- 17 tion 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 likeli- 22 hood, as determined by the Secretary, of the 23 hospital filling such positions within the 24 first 4 training years (as specified by the 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 3414 RH Secretary) after the increase would be effec- 1 tive. 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 for 9 a program described in clause (i) or a pro- 10 gram that is a prerequisite (as determined 11 by the Secretary) for such a program so de- 12 scribed, such as internal medicine. The Sec- 13 retary may determine whether a hospital 14 has met the requirements under this clause 15 during such 5-year period in such manner 16 and at such time as the Secretary deter- 17 mines appropriate, including at the end of 18 such 5-year period. 19 ‘‘(iv) REDISTRIBUTION OF POSITIONS 20 IF HOSPITAL NO LONGER MEETS CERTAIN 21 REQUIREMENTS.—In the case where the Sec- 22 retary determines that a hospital described 23 in clause (iii) does not meet the require- 24 ments of such clause, the Secretary shall— 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 3414 RH ‘‘(I) reduce the otherwise applica- 1 ble resident limit of the hospital by the 2 amount by which such limit was in- 3 creased under this subparagraph; and 4 ‘‘(II) provide for the distribution 5 of positions attributable to such reduc- 6 tion in accordance with the require- 7 ments of this paragraph. 8 ‘‘(D) DISTRIBUTION OF REMAINING POSI- 9 TIONS.—If the aggregate number of positions dis- 10 tributed under subparagraphs (B) and (C) dur- 11 ing the period of fiscal years 2022 through 2026 12 is less than 1000, the Secretary shall distribute 13 the remaining residency positions in succeeding 14 fiscal years according to criteria consistent with 15 this paragraph until such time as the aggregate 16 amount of positions distributed under this para- 17 graph is equal to 1000. 18 ‘‘(E) LIMITATION.—An individual hospital 19 may not receive more than 25 full-time-equiva- 20 lent residency positions under this paragraph. 21 ‘‘(F) NOTIFICATION.—The Secretary shall 22 notify hospitals of the number of positions dis- 23 tributed to the hospital under this paragraph as 24 a result of an increase in the otherwise applica- 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 3414 RH ble resident limit by January 1 of the fiscal year 1 of the increase. Such increase shall be effective 2 beginning July 1 of that fiscal year. 3 ‘‘(G) APPLICATION OF PER RESIDENT 4 AMOUNTS FOR PRIMARY CARE AND NONPRIMARY 5 CARE.—With respect to additional residency po- 6 sitions in a hospital attributable to the increase 7 provided under this paragraph, the approved 8 FTE per resident amounts are deemed to be 9 equal to the hospital per resident amounts for 10 primary care and nonprimary care computed 11 under paragraph (2)(D) for that hospital. 12 ‘‘(H) PERMITTING FACILITIES TO APPLY AG- 13 GREGATION RULES.—The Secretary shall permit 14 hospitals receiving additional residency positions 15 attributable to the increase provided under this 16 paragraph to, beginning in the fifth year after 17 the effective date of such increase, apply such po- 18 sitions to the limitation amount under para- 19 graph (4)(F) that may be aggregated pursuant to 20 paragraph (4)(H) among members of the same 21 affiliated group. 22 ‘‘(I) CLARIFICATION.—Chapter 35 of title 23 44, United States Code, shall not apply to the 24 implementation of this paragraph. 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 3414 RH ‘‘(J) DEFINITIONS.—In this paragraph: 1 ‘‘(i) OTHERWISE APPLICABLE RESI- 2 DENT LIMIT.—The term ‘otherwise applica- 3 ble resident limit’ means, with respect to a 4 hospital, the limit otherwise applicable 5 under paragraph (4)(F)(i) on the resident 6 level for the hospital determined without re- 7 gard to this paragraph but taking into ac- 8 count paragraphs (7)(A), (7)(B), (8)(A), 9 and (8)(B). 10 ‘‘(ii) RESIDENT LEVEL.—The term 11 ‘resident level’ has the meaning given such 12 term in paragraph (7)(C)(i).’’. 13 (b) IME.— 14 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 15 the Social Security Act (42 U.S.C. 16 1395ww(d)(5)(B)(v)), in the third sentence, is amend- 17 ed by striking ‘‘and (h)(8)’’ and inserting ‘‘(h)(8), 18 and (h)(9)’’. 19 (2) CONFORMING PROVISION.—Section 20 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 21 1395ww(d)(5)(B)) is amended— 22 (A) by redesignating clause (x), as added by 23 section 5505(b) of the Patient Protection and Af- 24 fordable Care Act (Public Law 111–148), as 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 3414 RH clause (xi) and moving such clause 4 ems to the 1 left; and 2 (B) by adding after clause (xi), as redesig- 3 nated by subparagraph (A), the following new 4 clause: 5 ‘‘(xii) For discharges occurring on or after July 6 1, 2022, insofar as an additional payment amount 7 under this subparagraph is attributable to residency 8 positions distributed to a hospital under subsection 9 (h)(9), the indirect teaching adjustment factor shall be 10 computed in the same manner as provided under 11 clause (ii) with respect to such residency positions.’’. 12 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6203 E:\BILLS\H3414.RH H3414 pbinns on DSKJLVW7X2PROD with BILLS VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 01920 [Text truncated for display. 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