; 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