I 

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘National Pain Care Policy Act of 2003’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows:

Sec. 1. Short title; table of contents. 
2

•HR 1863 IH 

Sec. 2. White House Conference on Pain Care. 

Sec. 3. National Center for Pain and Palliative Care Research. 

Sec. 4. Pain care education and training. 

Sec. 5. Public awareness campaign on pain management. 

Sec. 6. Pain care initiative in military health care facilities. 

Sec. 7. Pain care standards in Medicare+Choice plans. 

Sec. 8. Pain care standards in TRICARE plans. 

Sec. 9. Annual report on medicare expenditures for pain care services. 

Sec. 10. Pain care initiative in veterans health care facilities.

1 SEC. 2. WHITE HOUSE CONFERENCE ON PAIN CARE. 

2 (a) CONVENING.—Not later than June 30, 2004, the 

3 President shall convene a conference to be known as the 

4 White House Conference on Pain Care (in this section re5 ferred to as the ‘‘Conference’’). 

6 (b) PURPOSES.—The purposes of the Conference 

7 shall be to—

8 (1) increase the recognition of pain as a signifi9 cant public health problem in the United States; 

10 (2) assess the adequacy of diagnosis and treat11 ment for primary and secondary pain, including 

12 acute, chronic, intractable, and end-of-life pain; 

13 (3) identify barriers to appropriate pain care, 

14 including—

15 (A) lack of understanding and education 

16 among patients, providers, regulators, and 

17 third-party payors; 

18 (B) barriers to access to care at the pri19 mary, specialty, and tertiary care levels; and 
3

•HR 1863 IH 

1 (C) gaps in basic and clinical research on 

2 the symptoms and causes of, and potential 

3 treatments to improve, pain care; and 

4 (4) establish an agenda for action in both the 

5 public and private sectors that will reduce such bar6 riers and significantly improve the state of pain care 

7 research, education, and clinical care in the United 

8 States by 2010. 

9 (c) CHAIR.—The Secretary of Health and Human 

10 Services shall serve as the chair of the Conference. 

11 (d) AUTHORIZATION OF APPROPRIATIONS.—For the 

12 purpose of carrying out this section, there are authorized 

13 to be appropriated such sums as shall be necessary for 

14 fiscal year 2004. 

15 SEC. 3. NATIONAL CENTER FOR PAIN AND PALLIATIVE 

16 CARE RESEARCH. 

17 (a) ESTABLISHMENT.—Section 401(b)(2) of the Pub18 lic Health Service Act (42 U.S.C. 281(b)(2)) is amended 

19 by adding at the end the following: 

20 ‘‘(H) The National Center for Pain and Pallia21 tive Care Research.’’. 

22 (b) OPERATION.—Part E of title IV of the Public 

23 Health Service Act (42 U.S.C. 287 et seq.) is amended 

24 by adding at the end the following: 
4

•HR 1863 IH 

1 ‘‘Subpart 7—National Center for Pain and Palliative 

2 Care Research 

3 ‘‘SEC. 485I. ESTABLISHMENT. 

4 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab5 lish within the National Institutes of Health a center to 

6 be known as the National Center for Pain and Palliative 

7 Care Research (referred to in this subpart as the ‘Cen8 ter’). 

9 ‘‘(b) DIRECTOR.—The Center shall be headed by a 

10 Director (referred to in this subpart as the ‘Director of 

11 the Center’), who shall be appointed by the Director of 

12 NIH after consultation with experts in the fields of pain 

13 and palliative care research and treatment. 

14 ‘‘(c) POWERS OF SECRETARY AND DIRECTOR.—For 

15 purposes of section 405, the Center shall be treated as 

16 a national research institute. 

17 ‘‘(d) GENERAL PURPOSES.—The general purposes of 

18 the Center are—

19 ‘‘(1) to improve the quality of life of individuals 

20 suffering from pain by fostering clinical and basic 

21 science research into the biology of pain and the 

22 causes of and effective treatments for pain; 

23 ‘‘(2) to establish a national agenda for con24 ducting and supporting pain and palliative care re-
5

•HR 1863 IH 

1 search in the specific categories described in para2 graphs (3) and (4); 

3 ‘‘(3) to identify, coordinate, and support re4 search, research training, and related activities (in5 cluding the development of new and the refinement 

6 of existing treatments) with respect to both primary 

7 and secondary pain, including—

8 ‘‘(A) acute pain; 

9 ‘‘(B) cancer and HIV-related pain, particu10 larly at the end of life; 

11 ‘‘(C) back pain, headache pain, and other 

12 chronic and intractable pain; and 

13 ‘‘(D) other painful conditions; 

14 ‘‘(4) to identify, coordinate, and support re15 search, research training, and related activities with 

16 respect to palliative care; 

17 ‘‘(5) to conduct and support pain and palliative 

18 care research, research training, and related activi19 ties that have been identified as requiring additional, 

20 special priority as determined appropriate by the Di21 rector of the Center and the Advisory Board estab22 lished under subsection (e);

23 ‘‘(6) to coordinate all pain and palliative care 

24 research, research training, and related activities 
6

•HR 1863 IH 

1 being carried out among the national research insti2 tutes or in any such institute; 

3 ‘‘(7) to ensure the prompt and effective dis4 semination of current and future research results to 

5 improve patient access to and provider delivery of 

6 pain and palliative care; 

7 ‘‘(8) to initiate a comprehensive program of col8 laborative interdisciplinary research among schools, 

9 colleges, and universities, including schools of medi10 cine and osteopathy, schools of pharmacy and phar11 macology, schools of nursing, schools of dentistry, 

12 schools of physical therapy, schools of occupational 

13 therapy, and schools of clinical psychology, com14 prehensive health care centers and systems, and spe15 cialized centers of pain research or treatment; and 

16 ‘‘(9) to report not less than annually on the 

17 state of public and private funding for pain and pal18 liative care research and the adequacy of such fund19 ing, taking into account the specific categories de20 scribed in paragraphs (3) and (4). 

21 ‘‘(e) ADVISORY COUNCIL.—

22 ‘‘(1) IN GENERAL.—The Center shall have an 

23 advisory council to be known as the National Pain 

24 and Palliative Care Research Center Advisory Board 

25 (in this section referred to as the ‘Advisory Board’). 
7

•HR 1863 IH 

1 ‘‘(2) MEMBERSHIP.—The Advisory Board shall 

2 be established and maintained in accordance with 

3 section 406, except that—

4 ‘‘(A) the appointed voting members shall 

5 include—

6 ‘‘(i) representatives of the broad range 

7 of medical, health, and scientific disciplines 

8 involved in research and treatment related 

9 to the categories of pain and palliative care 

10 described in paragraphs (3) and (4) of 

11 subsection (d), including individuals with 

12 expertise and training in pain medicine, 

13 clinical psychology, physical medicine, and 

14 rehabilitative services (including physical 

15 therapy and occupational therapy), phar16 macy and pharmacology, nursing, and den17 tistry; and 

18 ‘‘(ii) representatives of painful pa19 tients; and 

20 ‘‘(B) the nonvoting ex officio members 

21 shall include—

22 ‘‘(i) the Director of the National Can23 cer Institute; 
8

•HR 1863 IH 

1 ‘‘(ii) the Director of the National In2 stitute of Dental and Craniofacial Re3 search; 

4 ‘‘(iii) the Director of the National In5 stitute of Child Health and Human Devel6 opment; 

7 ‘‘(iv) the Director of the National In8 stitute of Nursing Research; 

9 ‘‘(v) the Director of the National In10 stitute of Allergy and Infectious Diseases; 

11 ‘‘(vi) the Director of the National In12 stitute of Arthritis and Musculoskeletal 

13 and Skin Diseases; 

14 ‘‘(vii) the Director of the National In15 stitute of Mental Health; 

16 ‘‘(viii) the Director of the National In17 stitute of Neurological Disorders and 

18 Stroke; 

19 ‘‘(ix) the Director of the National In20 stitute on Drug Abuse; 

21 ‘‘(x) the Director of the National In22 stitute on Disability and Rehabilitation Re23 search; 
9

•HR 1863 IH 

1 ‘‘(xi) the Director of the National In2 stitute of Biomedical Imaging and Bio3 engineering; and 

4 ‘‘(xii) the Director of the National 

5 Bioethics Advisory Commission. 

6 ‘‘(3) DUTIES.—The Advisory Board shall ad7 vise, assist, consult with, and make recommenda8 tions to the Director of the Center regarding the 

9 matters set forth in subsection (d), including coordi10 nation, research, funding, and purposes. 

11 ‘‘(f) ESTABLISHMENT OF REGIONAL PAIN RESEARCH

12 CENTERS.—

13 ‘‘(1) ESTABLISHMENT.—To facilitate and en14 hance the research, research training, and related 

15 activities to be carried out by the Center, the Direc16 tor of NIH, in consultation with the Director of the 

17 Center and the Advisory Board, shall establish not 

18 less than 6 regional pain research centers, which 

19 shall operate as part of the Center. 

20 ‘‘(2) FOCUS AND DISTRIBUTION.—

21 ‘‘(A) FOCUS.—Not less than 4 of the re22 gional centers established under paragraph (1) 

23 shall have as their primary focus 1 of the cat24 egories of pain described in subparagraphs (A), 

25 (B), and (C) of subsection (d)(3).
10

•HR 1863 IH 

1 ‘‘(B) DISTRIBUTION.—One regional pain 

2 research center shall be established in each of 

3 the following regions of the United States (as 

4 such regions are determined by the Director of 

5 the Center): 

6 ‘‘(i) The Northeast region. 

7 ‘‘(ii) The Southeast region. 

8 ‘‘(iii) The Midwest region. 

9 ‘‘(iv) The Southwest region. 

10 ‘‘(v) The West region, including Ha11 waii. 

12 ‘‘(vi) The Pacific Northwest region, 

13 including Alaska. 

14 ‘‘(3) SELECTION.—The regional centers shall be 

15 selected through a competitive process from among 

16 institutions and centers of the type described in sub17 section (d)(8). 

18 ‘‘(g) ANNUAL CONSENSUS CONFERENCE ON PAIN

19 AND PALLIATIVE CARE RESEARCH.—To assist the Center 

20 in the establishment and maintenance of a national agen21 da for pain and palliative care research, and to ensure that 

22 the Center remains abreast of research and clinical devel23 opments in both the public and private sectors, the Direc24 tor of the Center shall convene each year a consensus con-
11

•HR 1863 IH 

1 ference of prominent researchers and clinicians in the field 

2 of pain and palliative care research and treatment. 

3 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—

4 ‘‘(1) IN GENERAL.—For the purpose of car5 rying out this section, there are authorized to be ap6 propriated $40,000,000 for each of fiscal years 

7 2004, 2005, and 2006, and such sums as may be 

8 necessary thereafter. 

9 ‘‘(2) REGIONAL CENTERS.—Of the amount ap10 propriated under paragraph (1) for fiscal year 2005 

11 and each subsequent fiscal year, not less than 

12 $1,500,000 shall be made available to each of the re13 gional centers established under subsection (f).’’. 

14 SEC. 4. PAIN CARE EDUCATION AND TRAINING. 

15 (a) PAIN AND PALLIATIVE CARE RESEARCH AND

16 QUALITY.—Part A of title IX of the Public Health Service 

17 Act (42 U.S.C. 299 et seq.) is amended by adding at the 

18 end the following: 

19 ‘‘SEC. 904. PROGRAM FOR PAIN AND PALLIATIVE CARE RE20 SEARCH AND QUALITY. 

21 ‘‘(a) IN GENERAL.—The Director shall carry out a 

22 program to—

23 ‘‘(1) develop and advance the quality, appro24 priateness, and effectiveness of pain and palliative 

25 care; and 
12

•HR 1863 IH 

1 ‘‘(2) collect and disseminate protocols and evi2 dence-based practices regarding pain and palliative 

3 care, including pain care for terminally ill patients, 

4 and make such information available to Federal, 

5 State, and local regulatory and enforcement agen6 cies, public and private health care programs, payors 

7 and providers, health professions schools, hospices, 

8 and the general public. 

9 ‘‘(b) DEFINITIONS.—For purposes of this section: 

10 ‘‘(1) The term ‘palliative care’ means the com11 prehensive active, total care of patients whose dis12 ease or medical condition is not responsive to cura13 tive treatment or whose prognosis is limited due to 

14 progressive, far-advanced disease. Palliative care in15 cludes treatment to reduce or alleviate pain and 

16 other distressing signs and symptoms. The purpose 

17 of such care is to eliminate, alleviate, or manage the 

18 patient’s pain and suffering and thereby enhance the 

19 quality of life. 

20 ‘‘(2) The term ‘pain care’ means the evaluation, 

21 diagnosis, treatment, and management of primary 

22 and secondary pain, whether acute, chronic, per23 sistent, intractable, or associated with the end of 

24 life.’’. 
13

•HR 1863 IH 

1 (b) EDUCATION AND TRAINING IN PAIN AND PALLIA2 TIVE CARE.—Part D of title VII of the Public Health 

3 Service Act (42 U.S.C. 294 et seq.) is amended—

4 (1) by redesignating sections 754 through 757 

5 as sections 755 through 758, respectively; and 

6 (2) by inserting after section 753 the following: 

7 ‘‘SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN 

8 PAIN AND PALLIATIVE CARE. 

9 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

10 with the Director of the Agency for Healthcare Research 

11 and Quality, may make awards of grants, cooperative 

12 agreements, and contracts to health professions schools, 

13 hospices, and other public and private entities for the de14 velopment and implementation of programs to provide 

15 education and training to health care professionals in pain 

16 and palliative care. 

17 ‘‘(b) PRIORITIES.—In making awards under sub18 section (a), the Secretary shall give priority to awards for 

19 the implementation of programs under such subsection. 

20 ‘‘(c) CERTAIN TOPICS.—An award may be made 

21 under subsection (a) only if the applicant for the award 

22 agrees that the program carried out with the award will 

23 include information and education on—

24 ‘‘(1) professionally recognized means for diag25 nosing and treating pain and related signs and 
14

•HR 1863 IH 

1 symptoms, including the medically appropriate use 

2 of controlled substances; 

3 ‘‘(2) applicable laws on controlled substances, 

4 including the degree to which misconceptions con5 cerning such laws or the enforcement thereof may 

6 create barriers to patient access to appropriate and 

7 effective pain care; 

8 ‘‘(3) comprehensive interdisciplinary approaches 

9 to the delivery of pain and palliative care, including 

10 delivery through specialized centers of pain care 

11 treatment expertise; and 

12 ‘‘(4) recent findings, developments, and im13 provements in the provision of pain and palliative 

14 care. 

15 ‘‘(d) PROGRAM SITES.—Education and training 

16 under subsection (a) may be provided at or through health 

17 professions schools, residency training programs, and 

18 other graduate programs in the health professions, entities 

19 that provide continuing medical and pharmacy education, 

20 hospices, and such other programs or sites as the Sec21 retary determines to be appropriate. 

22 ‘‘(e) EVALUATION OF PROGRAMS.—The Secretary 

23 shall (directly or through grants or contracts) provide for 

24 the evaluation of programs implemented under subsection
15

•HR 1863 IH 

1 (a) in order to determine the effect of such programs on 

2 knowledge and practice regarding pain and palliative care. 

3 ‘‘(f) PEER REVIEW GROUPS.—In carrying out section 

4 799(f) with respect to this section, the Secretary shall en5 sure that the membership of each peer review group in6 volved includes individuals with expertise and experience 

7 in pain and palliative care. 

8 ‘‘(g) DEFINITIONS.—For purposes of this section: 

9 ‘‘(1) The term ‘palliative care’ means the com10 prehensive active, total care of patients whose dis11 ease or medical condition is not responsive to cura12 tive treatment or whose prognosis is limited due to 

13 progressive, far-advanced disease. Palliative care in14 cludes treatment to reduce or alleviate pain and 

15 other distressing signs and symptoms. The purpose 

16 of such care is to eliminate, alleviate, or manage the 

17 patient’s pain and suffering and thereby enhance the 

18 quality of life. 

19 ‘‘(2) The term ‘pain care’ means the evaluation, 

20 diagnosis, treatment, and management of primary 

21 and secondary pain, whether acute, chronic, per22 sistent, intractable, or associated with the end of 

23 life.’’. 

24 (c) AUTHORIZATION OF APPROPRIATIONS.—Section 

25 758 of the Public Health Service Act (as redesignated by 
16

•HR 1863 IH 

1 subsection (a)(1) of this section) is amended in subsection 

2 (b)(1)(C)—

3 (1) by striking ‘‘sections 753, 754, and 755’’ 

4 and inserting ‘‘section 753, 754, 755, and 756’’; and 

5 (2) by striking ‘‘$22,631,000’’ and inserting 

6 ‘‘$37,631,000’’. 

7 (d) TECHNICAL AMENDMENT.—Paragraph (2) of 

8 section 757(b) of the Public Health Service Act (as redes9 ignated by subsection (a)(1)) is amended by striking 

10 ‘‘754(3)(A), and 755(b)’’ and inserting ‘‘755(3)(A), and 

11 756(b)’’. 

12 SEC. 5. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGE13 MENT. 

14 Part B of title II of the Public Health Service Act 

15 (42 U.S.C. 238 et seq.) is amended by adding at the end 

16 the following: 

17 ‘‘NATIONAL EDUCATION OUTREACH AND AWARENESS

18 CAMPAIGN ON PAIN MANAGEMENT

19 ‘‘SEC. 249. (a) ESTABLISHMENT.—Not later than 

20 June 30, 2004, the Secretary shall establish and imple21 ment a national education outreach and awareness cam22 paign described in subsection (b) to provide information 

23 to the public on responsible pain management, related 

24 symptom management, and palliative care. 

25 ‘‘(b) REQUIREMENTS.—The Secretary shall design 

26 the public awareness campaign under this section to edu-
17

•HR 1863 IH 

1 cate consumers, patients, their families, and other care2 givers with respect to—

3 ‘‘(1) the incidence and importance of pain as a 

4 national public health problem; 

5 ‘‘(2) the adverse physical, psychological, and fi6 nancial consequences that can result if pain is not 

7 appropriately diagnosed or treated; 

8 ‘‘(3) the availability, benefits, and risks of all 

9 pain management and palliative care treatment op10 tions; 

11 ‘‘(4) the right of patients to have their pain 

12 promptly assessed, appropriately treated, and regu13 larly reassessed, and to have their treatment ad14 justed if needed; 

15 ‘‘(5) the availability in the public, non-profit, 

16 and private sectors of pain management-related in17 formation, services and resources for consumers, pa18 tients, their families, and other caregivers, including 

19 information on—

20 ‘‘(i) appropriate assessment, diagnosis 

21 and treatment options for all types of pain 

22 and pain-related symptoms; and 

23 ‘‘(ii) conditions for which no widely 

24 accepted treatment options are yet avail25 able; and 
18

•HR 1863 IH 

1 ‘‘(6) other issues the Secretary deems appro2 priate. 

3 ‘‘(c) COORDINATION.—

4 ‘‘(1) LEAD OFFICIAL.—The Secretary shall des5 ignate one official in the Department of Health and 

6 Human Services to oversee the campaign established 

7 under this section. 

8 ‘‘(2) AGENCY COORDINATION.—The Secretary 

9 shall ensure the involvement in the public awareness 

10 campaign under this section of the Surgeon General 

11 of the Public Health Service, the Director of the 

12 Centers for Disease Control and Prevention, and 

13 such other representatives of offices and agencies of 

14 the Department of Health and Human Services as 

15 the Secretary determines appropriate. 

16 ‘‘(d) UNDERSERVED POPULATIONS.—In designing 

17 the public awareness campaign under this section, the Sec18 retary shall take into account the need to reach under19 served populations who are disproportionately under-treat20 ed for pain. 

21 ‘‘(e) GRANTS AND CONTRACTS.—The Secretary may 

22 make awards of grants, cooperative agreements, and con23 tracts to public agencies and private non-profit organiza24 tions to assist with the development and implementation 

25 of the public awareness campaign under this section. 
19

•HR 1863 IH 

1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 

2 purposes of carrying out this section, there are authorized 

3 to be appropriated $3,000,000 for each of fiscal years 

4 2004, 2005 and 2006.’’.

5 SEC. 6. PAIN CARE INITIATIVE IN MILITARY HEALTH CARE 

6 FACILITIES. 

7 (a) REQUIREMENT.—Chapter 55 of title 10, United 

8 States Code, is amended by adding at the end the fol9 lowing new section:

10 ‘‘§ 1111. Pain care 

11 ‘‘The administering Secretaries shall develop and im12 plement a pain care initiative in all health care facilities 

13 of the uniformed services. Implementation shall occur no 

14 later than January 1, 2004, in the case of inpatient care, 

15 and January 1, 2005, in the case of outpatient care. The 

16 initiative shall be designed to ensure that all members of 

17 the uniformed services and their dependents receiving 

18 treatment in health care facilities of the uniformed serv19 ices—

20 ‘‘(1) are assessed for pain at the time of admis21 sion or initial treatment, and periodically thereafter, 

22 using a professionally recognized pain assessment 

23 tool or process; and 

24 ‘‘(2) receive appropriate pain care consistent 

25 with recognized guidelines and practice parameters
20

•HR 1863 IH 

1 for the assessment and treatment of primary and 

2 secondary pain, including acute, chronic, and intrac3 table pain.’’.

4 (b) CLERICAL AMENDMENT.—The table of sections 

5 at the beginning of such chapter is amended by adding 

6 at the end the following new item:

‘‘1111. Pain care.’’.

7 SEC. 7. PAIN CARE STANDARDS IN MEDICARE+CHOICE 

8 PLANS. 

9 (a) IN GENERAL.—Section 1852(a) of the Social Se10 curity Act (42 U.S.C. 1395w–22(a)) is amended by adding 

11 at the end the following new paragraph: 

12 ‘‘(6) PAIN CARE STANDARDS.—

13 ‘‘(A) IN GENERAL.—Each 

14 Medicare+Choice organization shall provide ap15 propriate care for the treatment of patients in 

16 pain that—

17 ‘‘(i) is consistent with recognized 

18 guidelines and practice parameters for the 

19 assessment and treatment of primary and 

20 secondary pain, including acute, chronic, 

21 and intractable pain; 

22 ‘‘(ii) includes evaluation and treat23 ment of illnesses that frequently accom24 pany serious pain, including depression, 
21

•HR 1863 IH 

1 other mental health disorders, sleep dis2 turbance, and substance abuse; 

3 ‘‘(iii) provides medical and other 

4 health services through physicians and 

5 other practitioners credentialed or experi6 enced in pain medicine; 

7 ‘‘(iv) provides for referral of patients 

8 with chronic pain as defined in subpara9 graph (B)(i) to specialists, and, where ap10 propriate, to a comprehensive multidisci11 plinary pain management program as de12 fined in subparagraph (B)(ii); 

13 ‘‘(v) continues treatment for as long 

14 as treatment is required to maximize the 

15 quality of life and functional capacity of 

16 the patient; and 

17 ‘‘(vi) permits physicians and other 

18 practitioners experienced or credentialed in 

19 pain medicine to make clinical decisions 

20 with respect to the need for and the extent 

21 and duration of pain care services. 

22 ‘‘(B) DEFINITIONS.—For purposes of this 

23 paragraph: 

24 ‘‘(i) CHRONIC PAIN.—The term 

25 ‘chronic pain’ means severe, persistent, or 
22

•HR 1863 IH 

1 recurrent pain that interferes with the ac2 tivities of daily living, and has not been 

3 significantly reduced or ameliorated despite 

4 reasonable treatment efforts for a period of 

5 6 months. 

6 ‘‘(ii) COMPREHENSIVE MULTIDISCI7 PLINARY PAIN MANAGEMENT PROGRAM.—

8 The term ‘comprehensive multidisciplinary 

9 pain management program’ means an in10 patient or outpatient health care facility or 

11 program that—

12 ‘‘(I) provides at least medical, 

13 nursing, mental health, and rehabilita14 tion services through licensed health 

15 care professionals; 

16 ‘‘(II) provides or arranges for the 

17 provision of inpatient and outpatient 

18 hospital and rehabilitation facility 

19 services, drugs, devices, and other 

20 items and services required for the 

21 treatment of chronic pain; 

22 ‘‘(III) provides ongoing patient 

23 and professional education for pain 

24 management; 
23

•HR 1863 IH 

1 ‘‘(IV) is accredited as a com2 prehensive pain management program 

3 by an accrediting organization ap4 proved by the Secretary, including the 

5 Joint Commission on the Accredita6 tion of Health Care Organizations or 

7 the Rehabilitation Accreditation Com8 mission; and 

9 ‘‘(V) is directed by 1 or more 

10 physicians credentialed in pain medi11 cine, or, where appropriate, dentistry, 

12 by a board or boards approved by the 

13 Secretary, which shall include the 

14 American Board of Pain Medicine and 

15 boards recognized by the American 

16 Board of Medical Specialists. 

17 ‘‘(C) COMPLIANCE.—A Medicare+Choice 

18 organization may comply with the requirements 

19 set forth in this paragraph by providing care 

20 through its own network of participating pro21 viders, or under arrangement with out-of-net22 work providers, but in no event may an organi23 zation impose higher costs on its enrollees in 

24 the form of deductibles, copayments, premiums, 

25 or otherwise in the event appropriate pain care 
24

•HR 1863 IH 

1 in accordance with the standards set forth in 

2 this paragraph is provided out-of-network.’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 subsection (a) shall apply to contracts with 

5 Medicare+Choice organizations as of January 1, 2004. 

6 SEC. 8. PAIN CARE STANDARDS IN TRICARE PLANS. 

7 (a) IN GENERAL.—Section 1097 of title 10, United 

8 States Code, is amended by adding at the end the fol9 lowing new subsection: 

10 ‘‘(f) PAIN CARE STANDARDS.—

11 ‘‘(1) IN GENERAL.—Any health care services 

12 provided pursuant to any contract entered into 

13 under this section shall include the provision of ap14 propriate care for the treatment of patients in pain 

15 that—

16 ‘‘(A) is consistent with recognized guide17 lines and practice parameters for the assess18 ment and treatment of primary and secondary 

19 pain, including acute, chronic, and intractable 

20 pain; 

21 ‘‘(B) includes evaluation and treatment of 

22 illnesses that frequently accompany serious 

23 pain, including depression, other mental health 

24 disorders, sleep disturbance, and substance 

25 abuse;
25

•HR 1863 IH 

1 ‘‘(C) provides medical and other health 

2 services through physicians and other practi3 tioners credentialed or experienced in pain med4 icine; 

5 ‘‘(D) provides for referral of patients with 

6 chronic pain to specialists, and, where appro7 priate, to a comprehensive multidisciplinary 

8 pain management program; 

9 ‘‘(E) continues treatment for as long as 

10 treatment is required to maximize the quality of 

11 life and functional capacity of the patient; and 

12 ‘‘(F) permits physicians and other practi13 tioners experienced or credentialed in pain med14 icine to make clinical decisions with respect to 

15 the need for and the extent and duration of 

16 pain care services. 

17 ‘‘(2) DEFINITIONS.—For purposes of this sub18 section—

19 ‘‘(A) The term ‘chronic pain’ means severe, per20 sistent, or recurrent pain that interferes with the ac21 tivities of daily living, and has not been significantly 

22 reduced or ameliorated despite reasonable treatment 

23 efforts for a period of 6 months. 
26

•HR 1863 IH 

1 ‘‘(B) The term ‘comprehensive multidisciplinary 

2 pain management program’ means an inpatient or 

3 outpatient health care facility or program that—

4 ‘‘(i) provides at least medical, nursing, 

5 mental health, and rehabilitation services 

6 through licensed health care professionals; 

7 ‘‘(ii) provides or arranges for the provision 

8 of inpatient and outpatient hospital and reha9 bilitation facility services, drugs, devices, and 

10 other items and services required for the treat11 ment of chronic pain; 

12 ‘‘(iii) provides ongoing patient and profes13 sional education for pain management; 

14 ‘‘(iv) is accredited as a comprehensive pain 

15 management program by an accrediting organi16 zation approved by the Secretary, including the 

17 Joint Commission on the Accreditation of 

18 Health Care Organizations or the Rehabilita19 tion Accreditation Commission; and 

20 ‘‘(v) is directed by 1 or more physicians 

21 credentialed in pain medicine, or, where appro22 priate, dentistry, by a board or boards approved 

23 by the Secretary, which shall include the Amer24 ican Board of Pain Medicine and boards recog-
27

•HR 1863 IH 

1 nized by the American Board of Medical Spe2 cialists. 

3 ‘‘(3) COMPLIANCE.—A contractor may comply with 

4 the requirements set forth in this subsection by providing 

5 care through its own network of participating providers, 

6 or under arrangement with out-of-network providers, but 

7 in no event may a contractor impose higher costs on its 

8 enrollees in the form of deductibles, copayments, pre9 miums, or otherwise in the event appropriate pain care 

10 in accordance with the standards set forth in this sub11 section is provided out of network.’’. 

12 (b) EFFECTIVE DATE.—The amendment made by 

13 subsection (a) shall apply to contracts as of January 1, 

14 2004. 

15 SEC. 9. ANNUAL REPORT ON MEDICARE EXPENDITURES 

16 FOR PAIN CARE SERVICES. 

17 Not later than December 31, 2004, and annually 

18 thereafter, the Administrator of the Centers for Medicare 

19 & Medicaid Services shall prepare and submit to the Con20 gress a report on medicare expenditures for pain care dur21 ing the preceding fiscal year. The report shall include the 

22 following: 

23 (1) An estimate of total payments made under 

24 part B of the medicare program to physicians spe25 cializing in pain medicine. 
28

•HR 1863 IH 

1 (2) An estimate of payments made under such 

2 part B to other providers and suppliers for the pro3 vision of pain care items and services. 

4 (3) An estimate of expenditures made under 

5 part A of the medicare program for the diagnosis 

6 and treatment of pain of inpatients, and an estimate 

7 of the percentage of such care that relates to end8 of-life care. 

9 (4) An estimate of expenditures under part C 

10 of the medicare program for the provision of pain 

11 care items and services through the 

12 Medicare+Choice program. 

13 (5) An estimate of out-of-pocket expenditures 

14 by medicare beneficiaries for both prescription and 

15 nonprescription pain medications not covered by the 

16 medicare program. 

17 (6) An analysis of trends in both medicare pro18 gram and medicare beneficiary expenditures for pain 

19 care items and services.

20 SEC. 10. PAIN CARE INITIATIVE IN VETERANS HEALTH 

21 CARE FACILITIES. 

22 (a) REQUIREMENT.—Subchapter II of chapter 17 of 

23 title 38, United States Code, is amended by adding at the 

24 end the following new section: 
29

•HR 1863 IH 

1 ‘‘§ 1720F. Pain care 

2 ‘‘The Secretary shall develop and implement a pain 

3 care initiative in all health care facilities of the Depart4 ment. The initiative shall be designed to ensure that each 

5 individual receiving treatment in a health care facility 

6 under the jurisdiction of the Secretary—

7 ‘‘(1) is assessed for pain at the time of admis8 sion or initial treatment, and periodically thereafter, 

9 using a professionally recognized pain assessment 

10 tool or process; and 

11 ‘‘(2) receives appropriate pain care consistent 

12 with recognized guidelines and practice parameters 

13 for the diagnosis and treatment of primary and 

14 secondarypain, including acute, chronic, and intrac15 table pain.’’. 

16 (b) CLERICAL AMENDMENT.—The table of sections 

17 at the beginning of such chapter is amended by inserting 

18 after the item relating to section 1720E the following new 

19 item:

‘‘1720F. Pain care.’’.

20 (c) IMPLEMENTATION.—The Secretary of Veterans 

21 Affairs shall implement the pain care initiative required 

22 by section 1720F of title 38, United States Code, as added 

23 by subsection (a) not later than—

24 (1) January 1, 2004, in the case of inpatient 

25 care; and 
30

•HR 1863 IH 

1 (2) January 1, 2005, in the case of outpatient 

2 care.

Æ