A new, bipartisan bill was introduced in both houses of Congress on May 15, 2018, to support the creation of new Medicare-funded direct and indirect graduate medical education (DGME and IME) residency training slots specifically to help combat the opioid crisis. The Opioid Workforce Act of 2018 (H.R. 5818, S. 2843) would increase the number of available full-time equivalent (FTE) cap slots beginning in federal fiscal year (FY) 2019 for hospitals that have, or are working to build, approved residency programs in (i) addiction medicine, (ii) addiction psychiatry, or (iii) pain management (the "target specialties"). The bill would create 1,000 new cap slots, to be awarded in two distribution cycles, as described below.
In FY 2019, CMS would award up to 500 new cap slots to accommodate residents training in one of the three target specialties, or in a prerequisite program(such as internal medicine), but only in such numbers as are needed to support the full complement of residents projected to be training in the target specialties. Awardee-hospitals must be able to demonstrate a likelihood that the applicable training positions will be filled by July 1, 2019. Under certain circumstances, additional slots may be available to a hospital that demonstrates a plan to expand existing programs within the first three cost years beginning on or after July 1, 2019. Under the proposed legislation, no single hospital would be eligible to receive more than 25 FTE cap slots in the FY 2019 distribution cycle.
During FYs 2020 through 2023, another 500 cap slots—or possibly more, if the full allotment of slots is not awarded in FY 2019 (i.e., up to 1,000 slots total)—would become available to be distributed to hospitals in the process of establishing new residency training programs in the target specialties. For at least the first five years after these slots are awarded, awardee-hospitals would be required to use the new cap slots only for residents training in the programs for which the slots were originally awarded (or similar programs, as determined by the agency), or risk losing the slots. During this latter distribution cycle, a given hospital could receive at most (another) 25 FTE cap slots, bringing to 50 the total number of cap slots that potentially could be awarded under both slot distribution provisions.
Of potential interest, too, the proposed legislation would make the newly awarded cap slots eligible for sharing under a Medicare GME affiliation agreement, beginning five years after the slot award.
If this legislation passes both houses of Congress and is signed into law by the President, CMS will issue detailed proposed regulations outlining how the agency will implement the slot distribution process.
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