; and (4) by adding at the end the following new paragraph: (9) Distribution of additional residency positions to help combat opioid crisis (A) Additional residency positions For each of fiscal years 2022 through 2026 (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 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 for portions of cost reporting periods occurring on or after July 1 of the fiscal year of the increase. The aggregate number of additional full-time equivalent resident positions available for distribution under this paragraph shall be equal to 1,000, distributed in accordance with the succeeding subparagraphs of this paragraph. (B) Distribution for fiscal year 2022 (i) In general For fiscal year 2022, 500 of the positions 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. (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