Opioid Workforce Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2892 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 SENATE OF THE UNITED STATES NOVEMBER 19, 2019 Ms. HASSAN (for herself and Ms. COLLINS) introduced the following bill; which was read twice and referred to the Committee on Finance 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 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI- 6 TIONS TO HELP COMBAT OPIOID CRISIS. 7 (a) IN GENERAL.—Section 1886(h) of the Social Se- 8 curity Act (42 U.S.C. 1395ww(h)) is amended— 9 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 2892 IS (1) in paragraph (4)(F)(i), by striking ‘‘para- 1 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 2 (8), and (9)’’; 3 (2) in paragraph (4)(H)(i), by striking ‘‘para- 4 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 5 (8), and (9)’’; 6 (3) in paragraph (7)(E), by inserting ‘‘para- 7 graph (9),’’ after ‘‘paragraph (8),’’; and 8 (4) by adding at the end the following new 9 paragraph: 10 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 11 POSITIONS TO HELP COMBAT OPIOID CRISIS.— 12 ‘‘(A) ADDITIONAL RESIDENCY POSI- 13 TIONS.—For each of fiscal years 2022 through 14 2026 (and succeeding fiscal years if the Sec- 15 retary determines that there are additional full- 16 time equivalent residency positions available to 17 distribute under subparagraph (D)), the Sec- 18 retary shall increase the otherwise applicable 19 resident limit for each qualifying hospital that 20 submits a timely application under this para- 21 graph by such number as the Secretary may ap- 22 prove, effective for portions of cost reporting 23 periods occurring on or after July 1 of the fis- 24 cal year of the increase. The aggregate number 25 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 2892 IS of additional full-time equivalent resident posi- 1 tions available for distribution under this para- 2 graph shall be equal to 1,000, distributed in ac- 3 cordance with the succeeding subparagraphs of 4 this paragraph. 5 ‘‘(B) DISTRIBUTION FOR FISCAL YEAR 6 2022.— 7 ‘‘(i) IN GENERAL.—For fiscal year 8 2022, 500 of the positions described in 9 subparagraph (A) may only be distributed 10 to hospitals that have established (as of 11 the date of the enactment of this para- 12 graph) approved programs in addiction 13 medicine, addiction psychiatry, or pain 14 medicine, as determined by the Secretary. 15 ‘‘(ii) CONSIDERATIONS IN DISTRIBU- 16 TION.—The Secretary shall distribute addi- 17 tional residency positions under this sub- 18 paragraph based on the demonstrated like- 19 lihood (as determined by the Secretary) of 20 the hospital filling such positions. 21 ‘‘(iii) REQUIREMENTS.—A hospital 22 that receives an increase in the otherwise 23 applicable resident limit under this sub- 24 paragraph shall ensure, during the 5-year 25 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 2892 IS period beginning after the date of such in- 1 crease, that the hospital uses the positions 2 made available under this subparagraph 3 for a program described in clause (i) or a 4 program that is a prerequisite (as deter- 5 mined by the Secretary) for such a pro- 6 gram so described, such as internal medi- 7 cine. The Secretary may determine wheth- 8 er a hospital has met the requirements 9 under this clause during such 5-year pe- 10 riod in such manner and at such time as 11 the Secretary determines appropriate, in- 12 cluding at the end of such 5-year period. 13 ‘‘(iv) REDISTRIBUTION OF POSITIONS 14 IF HOSPITAL NO LONGER MEETS CERTAIN 15 REQUIREMENTS.—In the case in which the 16 Secretary determines that a hospital de- 17 scribed in clause (iii) does not meet the re- 18 quirements of such clause, the Secretary 19 shall— 20 ‘‘(I) reduce the otherwise applica- 21 ble resident limit of the hospital by 22 the amount by which such limit was 23 increased under this subparagraph; 24 and 25 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 2892 IS ‘‘(II) provide for the distribution 1 of positions attributable to such re- 2 duction in accordance with the re- 3 quirements of this paragraph. 4 ‘‘(C) DISTRIBUTION FOR FISCAL YEARS 5 2023 THROUGH 2026.— 6 ‘‘(i) IN GENERAL.—For the period of 7 fiscal years 2023 through 2026, 500 of the 8 positions available for distribution under 9 subparagraph (A) shall be distributed to 10 hospitals which demonstrate to the Sec- 11 retary that the hospital has established or 12 will establish an approved residency train- 13 ing program in addiction medicine, addic- 14 tion psychiatry, or pain medicine. 15 ‘‘(ii) CONSIDERATIONS IN DISTRIBU- 16 TION.—The Secretary shall distribute addi- 17 tional residency positions under this sub- 18 paragraph based on the demonstrated like- 19 lihood, as determined by the Secretary, of 20 the hospital filling such positions within 21 the first 4 training years (as specified by 22 the Secretary) after the increase would be 23 effective. 24 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 2892 IS ‘‘(iii) REQUIREMENTS.—A hospital 1 that receives an increase in the otherwise 2 applicable resident limit under this sub- 3 paragraph shall ensure, during the 5-year 4 period beginning after the date of such in- 5 crease, that the hospital uses the positions 6 made available under this subparagraph 7 for a program described in clause (i) or a 8 program that is a prerequisite (as deter- 9 mined by the Secretary) for such a pro- 10 gram so described, such as internal medi- 11 cine. The Secretary may determine wheth- 12 er a hospital has met the requirements 13 under this clause during such 5-year pe- 14 riod in such manner and at such time as 15 the Secretary determines appropriate, in- 16 cluding at the end of such 5-year period. 17 ‘‘(iv) REDISTRIBUTION OF POSITIONS 18 IF HOSPITAL NO LONGER MEETS CERTAIN 19 REQUIREMENTS.—In the case where the 20 Secretary determines that a hospital de- 21 scribed in clause (iii) does not meet the re- 22 quirements of such clause, the Secretary 23 shall— 24 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 2892 IS ‘‘(I) reduce the otherwise applica- 1 ble resident limit of the hospital by 2 the amount by which such limit was 3 increased under this subparagraph; 4 and 5 ‘‘(II) provide for the distribution 6 of positions attributable to such re- 7 duction in accordance with the re- 8 quirements of this paragraph. 9 ‘‘(D) DISTRIBUTION OF REMAINING POSI- 10 TIONS.—If the aggregate number of positions 11 distributed under subparagraphs (B) and (C) 12 during the period of fiscal years 2022 through 13 2026 is less than 500, the Secretary shall dis- 14 tribute the remaining residency positions in suc- 15 ceeding fiscal years according to criteria con- 16 sistent with this paragraph until such time as 17 the aggregate amount of positions distributed 18 under this paragraph is equal to 500. 19 ‘‘(E) LIMITATION.—An individual hospital 20 may not receive more than 25 full-time equiva- 21 lent residency positions under this paragraph. 22 ‘‘(F) NOTIFICATION.—The Secretary shall 23 notify hospitals of the number of positions dis- 24 tributed to the hospital under this paragraph as 25 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 2892 IS a result of an increase in the otherwise applica- 1 ble resident limit by January 1 of the fiscal 2 year of the increase. Such increase shall be ef- 3 fective for portions of cost reporting periods be- 4 ginning on or after July 1 of that fiscal year. 5 ‘‘(G) APPLICATION OF PER RESIDENT 6 AMOUNTS FOR PRIMARY CARE AND NONPRI- 7 MARY CARE.—With respect to additional resi- 8 dency positions in a hospital attributable to the 9 increase provided under this paragraph, the ap- 10 proved FTE per resident amounts are deemed 11 to be equal to the hospital per resident amounts 12 for primary care and nonprimary care com- 13 puted under paragraph (2)(D) for that hospital. 14 ‘‘(H) PERMITTING FACILITIES TO APPLY 15 AGGREGATION RULES.—The Secretary shall 16 permit hospitals receiving additional residency 17 positions attributable to the increase provided 18 under this paragraph to, beginning in the fifth 19 year after the effective date of such increase, 20 apply such positions to the limitation amount 21 under paragraph (4)(F) that may be aggre- 22 gated pursuant to paragraph (4)(H) among 23 members of the same affiliated group. 24 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 2892 IS ‘‘(I) CLARIFICATION.—Chapter 35 of title 1 44, United States Code, shall not apply to im- 2 plementation of this paragraph. 3 ‘‘(J) DEFINITIONS.—In this paragraph: 4 ‘‘(i) OTHERWISE APPLICABLE RESI- 5 DENT LIMIT.—The term ‘otherwise appli- 6 cable resident limit’ means, with respect to 7 a hospital, the limit otherwise applicable 8 under paragraph (4)(F)(i) on the resident 9 level for the hospital determined without 10 regard to this paragraph but taking into 11 account paragraphs (7)(A), (7)(B), (8)(A), 12 and (8)(B). 13 ‘‘(ii) RESIDENT LEVEL.—The term 14 ‘resident level’ has the meaning given such 15 term in paragraph (7)(C)(i).’’. 16 (b) IME.— 17 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 18 the Social Security Act (42 U.S.C. 19 1395ww(d)(5)(B)(v)), in the third sentence, is 20 amended by striking ‘‘and (h)(8)’’ and inserting 21 ‘‘(h)(8), and (h)(9)’’. 22 (2) CONFORMING PROVISION.—Section 23 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 24 1395ww(d)(5)(B)) is amended— 25 VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 2892 IS (A) by redesignating clause (x), as added 1 by section 5505(b) of the Patient Protection 2 and Affordable Care Act (Public Law 111– 3 148), as clause (xi) and moving such clause 4 4 ems to the left; and 5 (B) by adding after clause (xi), as redesig- 6 nated by subparagraph (A), the following new 7 clause: 8 ‘‘(xii) For discharges occurring on or after July 9 1, 2022, insofar as an additional payment amount 10 under this subparagraph is attributable to resident 11 positions distributed to a hospital under subsection 12 (h)(9), the indirect teaching adjustment factor shall 13 be computed in the same manner as provided under 14 clause (ii) with respect to such resident positions.’’. 15 Æ VerDate Sep 11 2014 01:07 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S2892.IS S2892 pamtmann on DSKBC07HB2PROD with BILLS