108th CONGRESS
1st Session
H. R. 1863
To declare adequate pain care research, education, and treatment as
national public health priorities, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
April 29, 2003
Mr. ROGERS of Michigan introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Committees on Ways
and Means, Armed Services, and Veterans' Affairs, 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 declare adequate pain care research, education, and treatment as
national public health priorities, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
SEC. 2. WHITE HOUSE CONFERENCE ON PAIN CARE.
(a) CONVENING- Not later than June 30, 2004, the President shall convene a
conference to be known as the White House Conference on Pain Care (in this
section referred to as the `Conference').
(2) assess the adequacy of diagnosis and treatment for primary and
secondary pain, including acute, chronic, intractable, and end-of-life
pain;
(A) lack of understanding and education among patients, providers,
regulators, and third-party payors;
(4) establish an agenda for action in both the public and private
sectors that will reduce such barriers and significantly improve the state
of pain care research, education, and clinical care in the United States by
2010.
(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there are authorized to be appropriated such sums as shall be
necessary for fiscal year 2004.
SEC. 3. NATIONAL CENTER FOR PAIN AND PALLIATIVE CARE RESEARCH.
(a) ESTABLISHMENT- Section 401(b)(2) of the Public Health Service Act (42
U.S.C. 281(b)(2)) is amended by adding at the end the following:
(b) OPERATION- Part E of title IV of the Public Health Service Act (42
U.S.C. 287 et seq.) is amended by adding at the end the following:
`Subpart 7--National Center for Pain and Palliative Care Research
`SEC. 485I. ESTABLISHMENT.
`(a) ESTABLISHMENT- The Secretary shall establish within the National
Institutes of Health a center to be known as the National Center for Pain and
Palliative Care Research (referred to in this subpart as the `Center').
`(b) DIRECTOR- The Center shall be headed by a Director (referred to in
this subpart as the `Director of the Center'), who shall be appointed by the
Director of NIH after consultation with experts in the fields of pain and
palliative care research and treatment.
`(c) POWERS OF SECRETARY AND DIRECTOR- For purposes of section 405, the
Center shall be treated as a national research institute.
`(3) to identify, coordinate, and support research, research training,
and related activities (including the development of new and the refinement
of existing treatments) with respect to both primary and secondary pain,
including--
`(4) to identify, coordinate, and support research, research training,
and related activities with respect to palliative care;
`(5) to conduct and support pain and palliative care research, research
training, and related activities that have been identified as requiring
additional, special priority as determined appropriate by the Director of
the Center and the Advisory Board established under subsection (e);
`(8) to initiate a comprehensive program of collaborative
interdisciplinary research among schools, colleges, and universities,
including schools of medicine and osteopathy, schools of pharmacy and
pharmacology, schools of nursing, schools of dentistry, schools of physical
therapy, schools of occupational therapy, and schools of clinical
psychology, comprehensive health care centers and systems, and specialized
centers of pain research or treatment; and
`(i) representatives of the broad range of medical, health, and
scientific disciplines involved in research and treatment related to the
categories of pain and palliative care described in paragraphs (3) and
(4) of subsection (d), including individuals with expertise and training
in pain medicine, clinical psychology, physical medicine, and
rehabilitative services (including physical therapy and occupational
therapy), pharmacy and pharmacology, nursing, and dentistry;
and
`(3) DUTIES- The Advisory Board shall advise, assist, consult with, and
make recommendations to the Director of the Center regarding the matters set
forth in subsection (d), including coordination, research, funding, and
purposes.
`(1) ESTABLISHMENT- To facilitate and enhance the research, research
training, and related activities to be carried out by the Center, the
Director of NIH, in consultation with the Director of the Center and the
Advisory Board, shall establish not less than 6 regional pain research
centers, which shall operate as part of the Center.
`(A) FOCUS- Not less than 4 of the regional centers established under
paragraph (1) shall have as their primary focus 1 of the categories of
pain described in subparagraphs (A), (B), and (C) of subsection
(d)(3).
`(g) ANNUAL CONSENSUS CONFERENCE ON PAIN AND PALLIATIVE CARE RESEARCH- To
assist the Center in the establishment and maintenance of a national agenda
for pain and palliative care research, and to ensure that the Center remains
abreast of research and clinical developments in both the public and private
sectors, the Director of the Center shall convene each year a consensus
conference of prominent researchers and clinicians in the field of pain and
palliative care research and treatment.
`(1) IN GENERAL- For the purpose of carrying out this section, there are
authorized to be appropriated $40,000,000 for each of fiscal years 2004,
2005, and 2006, and such sums as may be necessary thereafter.
`(2) REGIONAL CENTERS- Of the amount appropriated under paragraph (1)
for fiscal year 2005 and each subsequent fiscal year, not less than
$1,500,000 shall be made available to each of the regional centers
established under subsection (f).'.
SEC. 4. PAIN CARE EDUCATION AND TRAINING.
(a) PAIN AND PALLIATIVE CARE RESEARCH AND QUALITY- Part A of title IX of
the Public Health Service Act (42 U.S.C. 299 et seq.) is amended by adding at
the end the following:
`SEC. 904. PROGRAM FOR PAIN AND PALLIATIVE CARE RESEARCH AND QUALITY.
`(2) collect and disseminate protocols and evidence-based practices
regarding pain and palliative care, including pain care for terminally ill
patients, and make such information available to Federal, State, and local
regulatory and enforcement agencies, public and private health care
programs, payors and providers, health professions schools, hospices, and
the general public.
`(1) The term `palliative care' means the comprehensive active, total
care of patients whose disease or medical condition is not responsive to
curative treatment or whose prognosis is limited due to progressive,
far-advanced disease. Palliative care includes treatment to reduce or
alleviate pain and other distressing signs and symptoms. The purpose of such
care is to eliminate, alleviate, or manage the patient's pain and suffering
and thereby enhance the quality of life.
`(2) The term `pain care' means the evaluation, diagnosis, treatment,
and management of primary and secondary pain, whether acute, chronic,
persistent, intractable, or associated with the end of life.'.
(b) EDUCATION AND TRAINING IN PAIN AND PALLIATIVE CARE- Part D of title
VII of the Public Health Service Act (42 U.S.C. 294 et seq.) is amended--
`SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN AND PALLIATIVE
CARE.
`(a) IN GENERAL- The Secretary, in consultation with the Director of the
Agency for Healthcare Research and Quality, may make awards of grants,
cooperative agreements, and contracts to health professions schools, hospices,
and other public and private entities for the development and implementation
of programs to provide education and training to health care professionals in
pain and palliative care.
`(b) PRIORITIES- In making awards under subsection (a), the Secretary
shall give priority to awards for the implementation of programs under such
subsection.
`(c) CERTAIN TOPICS- An award may be made under subsection (a) only if the
applicant for the award agrees that the program carried out with the award
will include information and education on--
`(d) PROGRAM SITES- Education and training under subsection (a) may be
provided at or through health professions schools, residency training
programs, and other graduate programs in the health professions, entities that
provide continuing medical and pharmacy education, hospices, and such other
programs or sites as the Secretary determines to be appropriate.
`(e) EVALUATION OF PROGRAMS- The Secretary shall (directly or through
grants or contracts) provide for the evaluation of programs implemented under
subsection
(a) in order to determine the effect of such programs on knowledge and
practice regarding pain and palliative care.
`(f) PEER REVIEW GROUPS- In carrying out section 799(f) with respect to
this section, the Secretary shall ensure that the membership of each peer
review group involved includes individuals with expertise and experience in
pain and palliative care.
`(1) The term `palliative care' means the comprehensive active, total
care of patients whose disease or medical condition is not responsive to
curative treatment or whose prognosis is limited due to progressive,
far-advanced disease. Palliative care includes treatment to reduce or
alleviate pain and other distressing signs and symptoms. The purpose of such
care is to eliminate, alleviate, or manage the patient's pain and suffering
and thereby enhance the quality of life.
`(2) The term `pain care' means the evaluation, diagnosis, treatment,
and management of primary and secondary pain, whether acute, chronic,
persistent, intractable, or associated with the end of life.'.
(c) AUTHORIZATION OF APPROPRIATIONS- Section 758 of the Public Health
Service Act (as redesignated by subsection (a)(1) of this section) is amended
in subsection (b)(1)(C)--
(1) by striking `sections 753, 754, and 755' and inserting `section 753,
754, 755, and 756'; and
(2) by striking `$22,631,000' and inserting `$37,631,000'.
(d) TECHNICAL AMENDMENT- Paragraph (2) of section 757(b) of the Public
Health Service Act (as redesignated by subsection (a)(1)) is amended by
striking `754(3)(A), and 755(b)' and inserting `755(3)(A), and 756(b)'.
SEC. 5. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGEMENT.
Part B of title II of the Public Health Service Act (42 U.S.C. 238 et
seq.) is amended by adding at the end the following:
`NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN MANAGEMENT
`SEC. 249. (a) ESTABLISHMENT- Not later than June 30, 2004, the Secretary
shall establish and implement a national education outreach and awareness
campaign described in subsection (b) to provide information to the public on
responsible pain management, related symptom management, and palliative
care.
`(b) REQUIREMENTS- The Secretary shall design the public awareness
campaign under this section to educate consumers, patients, their families,
and other caregivers with respect to--
`(4) the right of patients to have their pain promptly assessed,
appropriately treated, and regularly reassessed, and to have their treatment
adjusted if needed;
`(5) the availability in the public, non-profit, and private sectors of
pain management-related information, services and resources for consumers,
patients, their families, and other caregivers, including information
on--
`(2) AGENCY COORDINATION- The Secretary shall ensure the involvement in
the public awareness campaign under this section of the Surgeon General of
the Public Health Service, the Director of the Centers for Disease Control
and Prevention, and such other representatives of offices and agencies of
the Department of Health and Human Services as the Secretary determines
appropriate.
`(d) UNDERSERVED POPULATIONS- In designing the public awareness campaign
under this section, the Secretary shall take into account the need to reach
underserved populations who are disproportionately under-treated for pain.
`(e) GRANTS AND CONTRACTS- The Secretary may make awards of grants,
cooperative agreements, and contracts to public agencies and private
non-profit organizations to assist with the development and implementation of
the public awareness campaign under this section.
`(f) AUTHORIZATION OF APPROPRIATIONS- For purposes of carrying out this
section, there are authorized to be appropriated $3,000,000 for each of fiscal
years 2004, 2005 and 2006.'.
SEC. 6. PAIN CARE INITIATIVE IN MILITARY HEALTH CARE FACILITIES.
(a) REQUIREMENT- Chapter 55 of title 10, United States Code, is amended by
adding at the end the following new section:
`Sec. 1111. Pain care
`The administering Secretaries shall develop and implement a pain care
initiative in all health care facilities of the uniformed services.
Implementation shall occur no later than January 1, 2004, in the case of
inpatient care, and January 1, 2005, in the case of outpatient care. The
initiative shall be designed to ensure that all members of the uniformed
services and their dependents receiving treatment in health care facilities of
the uniformed services--
for the assessment and treatment of primary and secondary pain, including
acute, chronic, and intractable pain.'.
(b) CLERICAL AMENDMENT- The table of sections at the beginning of such
chapter is amended by adding at the end the following new item:
SEC. 7. PAIN CARE STANDARDS IN MEDICARE+CHOICE PLANS.
(a) IN GENERAL- Section 1852(a) of the Social Security Act (42 U.S.C.
1395w-22(a)) is amended by adding at the end the following new paragraph:
`(i) is consistent with recognized guidelines and practice
parameters for the assessment and treatment of primary and secondary
pain, including acute, chronic, and intractable pain;
`(ii) includes evaluation and treatment of illnesses that frequently
accompany serious pain, including depression, other mental health
disorders, sleep disturbance, and substance abuse;
`(iv) provides for referral of patients with chronic pain as defined
in subparagraph (B)(i) to specialists, and, where appropriate, to a
comprehensive multidisciplinary pain management program as defined in
subparagraph (B)(ii);
`(i) CHRONIC PAIN- The term `chronic pain' means severe, persistent,
or recurrent pain that interferes with the activities of daily living,
and has not been significantly reduced or ameliorated despite reasonable
treatment efforts for a period of 6 months.
`(I) provides at least medical, nursing, mental health, and
rehabilitation services through licensed health care
professionals;
`(II) provides or arranges for the provision of inpatient and
outpatient hospital and rehabilitation facility services, drugs,
devices, and other items and services required for the treatment of
chronic pain;
`(V) is directed by 1 or more physicians credentialed in pain
medicine, or, where appropriate, dentistry, by a board or boards
approved by the Secretary, which shall include the American Board of
Pain Medicine and boards recognized by the American Board of Medical
Specialists.
`(C) COMPLIANCE- A Medicare+Choice organization may comply with the
requirements set forth in this paragraph by providing care through its own
network of participating providers, or under arrangement with
out-of-network providers, but in no event may an organization impose
higher costs on its enrollees in the form of deductibles, copayments,
premiums, or otherwise in the event appropriate pain care in accordance
with the standards set forth in this paragraph is provided
out-of-network.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
contracts with Medicare+Choice organizations as of January 1, 2004.
SEC. 8. PAIN CARE STANDARDS IN TRICARE PLANS.
(a) IN GENERAL- Section 1097 of title 10, United States Code, is amended
by adding at the end the following new subsection:
`(A) is consistent with recognized guidelines and practice parameters
for the assessment and treatment of primary and secondary pain, including
acute, chronic, and intractable pain;
`(B) includes evaluation and treatment of illnesses that frequently
accompany serious pain, including depression, other mental health
disorders, sleep disturbance, and substance abuse;
`(D) provides for referral of patients with chronic pain to
specialists, and, where appropriate, to a comprehensive multidisciplinary
pain management program;
`(A) The term `chronic pain' means severe, persistent, or recurrent pain
that interferes with the activities of daily living, and has not been
significantly reduced or ameliorated despite reasonable treatment efforts
for a period of 6 months.
`(i) provides at least medical, nursing, mental health, and
rehabilitation services through licensed health care
professionals;
`(ii) provides or arranges for the provision of inpatient and
outpatient hospital and rehabilitation facility services, drugs, devices,
and other items and services required for the treatment of chronic
pain;
`(v) is directed by 1 or more physicians credentialed in pain
medicine, or, where appropriate, dentistry, by a board or boards approved
by the Secretary, which shall include the American Board of Pain Medicine
and boards recognized by the American Board of Medical
Specialists.
`(3) COMPLIANCE- A contractor may comply with the requirements set forth
in this subsection by providing care through its own network of participating
providers, or under arrangement with out-of-network providers, but in no event
may a contractor impose higher costs on its enrollees in the form of
deductibles, copayments, premiums, or otherwise in the event appropriate pain
care in accordance with the standards set forth in this subsection is provided
out of network.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
contracts as of January 1, 2004.
SEC. 9. ANNUAL REPORT ON MEDICARE EXPENDITURES FOR PAIN CARE SERVICES.
Not later than December 31, 2004, and annually thereafter, the
Administrator of the Centers for Medicare & Medicaid Services shall
prepare and submit to the Congress a report on medicare expenditures for pain
care during the preceding fiscal year. The report shall include the
following:
SEC. 10. PAIN CARE INITIATIVE IN VETERANS HEALTH CARE ----FACILITIES.
(a) REQUIREMENT- Subchapter II of chapter 17 of title 38, United States
Code, is amended by adding at the end the following new section:
`Sec. 1720F. Pain care
`The Secretary shall develop and implement a pain care initiative in all
health care facilities of the Department. The initiative shall be designed to
ensure that each individual receiving treatment in a health care facility
under the jurisdiction of the Secretary--
`(2) receives appropriate pain care consistent with recognized
guidelines and practice parameters for the diagnosis and treatment of
primary and secondary-pain, including acute, chronic, and intractable
pain.'.
(b) CLERICAL AMENDMENT- The table of sections at the beginning of such
chapter is amended by inserting after the item relating to section 1720E the
following new item:
(c) IMPLEMENTATION- The Secretary of Veterans Affairs shall implement the
pain care initiative required by section 1720F of title 38, United States
Code, as added by subsection (a) not later than--
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