; and (II) provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph. (C) Distribution for fiscal years 2023 through 2026 (i) In general For the period of fiscal years 2023 through 2026, 500 of the positions available for distribution under subparagraph (A) 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