Substance Use Disorder Workforce Act
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.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7050 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 7050
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 18, 2024
Mr. Schneider (for himself, Ms. Kuster, Mr. Valadao, Mr. Carey, and Mr.
Kelly of Pennsylvania) 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 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
substance use disorder 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 ``Substance Use Disorder Workforce
Act''.
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS TO HELP COMBAT
SUBSTANCE USE DISORDER 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 ``paragraphs (7),
(8), (9), and (10)'' and inserting ``paragraphs (7), (8), (9),
(10), and (11)'';
(2) in paragraph (4)(H)(i)(I), by striking ``paragraphs
(7), (8), (9), and (10)'' and inserting ``paragraphs (7), (8),
(9), (10), and (11)'';
(3) in paragraph (7)(E), by striking ``paragraph (10)'' and
inserting ``paragraph (10), paragraph (11)''; and
(4) by adding at the end the following new paragraph:
``(11) Distribution of additional residency positions to
help combat substance use disorder crisis.--
``(A) Additional residency positions.--During the
period 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 distribute
additional full-time-equivalent residency positions to
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 beginning July 1 of
the fiscal year of the increase. The aggregate number
of additional full-time-equivalent residency positions
available for distribution under this paragraph shall
be equal to 500 in fiscal year 2024 and 500 over the
period of fiscal years 2025 through 2028, distributed
in accordance with the succeeding subparagraphs of this
paragraph.
``(B) Distribution for fiscal year 2024.--
``(i) In general.--For fiscal year 2024,
the positions available for distribution for
such fiscal year (as 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 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 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.
``(v) Positions not distributed during
fiscal year 2024.--If the number of full-time-
equivalent residency positions distributed
under this subparagraph is less than the
aggregate number of positions available for
distribution for fiscal year 2024 (as described
in subparagraph (A)), the difference between
such number distributed and such number
available for distribution shall be added to
the aggregate number of positions available for
distribution under subparagraph (C).
``(C) Distribution for fiscal years 2025 through
2028.--
``(i) In general.--For the period of fiscal
years 2025 through 2028, the positions
available for distribution for such period (as
described in subparagraph (A)), and any
positions made available pursuant to
subparagraph (B)(v), 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 1,000, 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 1,000.
``(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 beginning 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 the
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)(10)'' and inserting
``(h)(10), and (h)(11)''.
(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 (xiii) the following new clause:
``(xiv) For discharges occurring on or after July
1, 2024, insofar as an additional payment amount under
this subparagraph is attributable to residency
positions distributed to a hospital under subsection
(h)(11), the indirect teaching adjustment factor shall
be computed in the same manner as provided under clause
(ii) with respect to such residency positions.''.
<all>
Introduced in House
Introduced in House
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 committee concerned.
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 committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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