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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1863 Introduced in House (IH)]

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.

    (a) Short Title.--This Act may be cited as the ``National Pain Care 
Policy Act of 2003''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

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

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'').
    (b) Purposes.--The purposes of the Conference shall be to--
            (1) increase the recognition of pain as a significant 
        public health problem in the United States;
            (2) assess the adequacy of diagnosis and treatment for 
        primary and secondary pain, including acute, chronic, 
        intractable, and end-of-life pain;
            (3) identify barriers to appropriate pain care, including--
                    (A) lack of understanding and education among 
                patients, providers, regulators, and third-party 
                payors;
                    (B) barriers to access to care at the primary, 
                specialty, and tertiary care levels; and
                    (C) gaps in basic and clinical research on the 
                symptoms and causes of, and potential treatments to 
                improve, pain care; and
            (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.
    (c) Chair.--The Secretary of Health and Human Services shall serve 
as the chair of the Conference.
    (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:
            ``(H) The National Center for Pain and Palliative Care 
        Research.''.
    (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.
    ``(d) General Purposes.--The general purposes of the Center are--
            ``(1) to improve the quality of life of individuals 
        suffering from pain by fostering clinical and basic science 
        research into the biology of pain and the causes of and 
        effective treatments for pain;
            ``(2) to establish a national agenda for conducting and 
        supporting pain and palliative care research in the specific 
        categories described in paragraphs (3) and (4);
            ``(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--
                    ``(A) acute pain;
                    ``(B) cancer and HIV-related pain, particularly at 
                the end of life;
                    ``(C) back pain, headache pain, and other chronic 
                and intractable pain; and
                    ``(D) other painful conditions;
            ``(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);
            ``(6) to coordinate all pain and palliative care research, 
        research training, and related activities being carried out 
        among the national research institutes or in any such 
        institute;
            ``(7) to ensure the prompt and effective dissemination of 
        current and future research results to improve patient access 
        to and provider delivery of pain and palliative care;
            ``(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
            ``(9) to report not less than annually on the state of 
        public and private funding for pain and palliative care 
        research and the adequacy of such funding, taking into account 
        the specific categories described in paragraphs (3) and (4).
    ``(e) Advisory Council.--
            ``(1) In general.--The Center shall have an advisory 
        council to be known as the National Pain and Palliative Care 
        Research Center Advisory Board (in this section referred to as 
        the `Advisory Board').
            ``(2) Membership.--The Advisory Board shall be established 
        and maintained in accordance with section 406, except that--
                    ``(A) the appointed voting members shall include--
                            ``(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
                            ``(ii) representatives of painful patients; 
                        and
                    ``(B) the nonvoting ex officio members shall 
                include--
                            ``(i) the Director of the National Cancer 
                        Institute;
                            ``(ii) the Director of the National 
                        Institute of Dental and Craniofacial Research;
                            ``(iii) the Director of the National 
                        Institute of Child Health and Human 
                        Development;
                            ``(iv) the Director of the National 
                        Institute of Nursing Research;
                            ``(v) the Director of the National 
                        Institute of Allergy and Infectious Diseases;
                            ``(vi) the Director of the National 
                        Institute of Arthritis and Musculoskeletal and 
                        Skin Diseases;
                            ``(vii) the Director of the National 
                        Institute of Mental Health;
                            ``(viii) the Director of the National 
                        Institute of Neurological Disorders and Stroke;
                            ``(ix) the Director of the National 
                        Institute on Drug Abuse;
                            ``(x) the Director of the National 
                        Institute on Disability and Rehabilitation 
                        Research;
                            ``(xi) the Director of the National 
                        Institute of Biomedical Imaging and 
                        Bioengineering; and
                            ``(xii) the Director of the National 
                        Bioethics Advisory Commission.
            ``(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.
    ``(f) Establishment of Regional Pain Research Centers.--
            ``(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.
            ``(2) Focus and distribution.--
                    ``(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).
                    ``(B) Distribution.--One regional pain research 
                center shall be established in each of the following 
                regions of the United States (as such regions are 
                determined by the Director of the Center):
                            ``(i) The Northeast region.
                            ``(ii) The Southeast region.
                            ``(iii) The Midwest region.
                            ``(iv) The Southwest region.
                            ``(v) The West region, including Hawaii.
                            ``(vi) The Pacific Northwest region, 
                        including Alaska.
            ``(3) Selection.--The regional centers shall be selected 
        through a competitive process from among institutions and 
        centers of the type described in subsection (d)(8).
    ``(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.
    ``(h) Authorization of Appropriations.--
            ``(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.

    ``(a) In General.--The Director shall carry out a program to--
            ``(1) develop and advance the quality, appropriateness, and 
        effectiveness of pain and palliative care; and
            ``(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.
    ``(b) Definitions.--For purposes of this section:
            ``(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--
            (1) by redesignating sections 754 through 757 as sections 
        755 through 758, respectively; and
            (2) by inserting after section 753 the following:

``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--
            ``(1) professionally recognized means for diagnosing and 
        treating pain and related signs and symptoms, including the 
        medically appropriate use of controlled substances;
            ``(2) applicable laws on controlled substances, including 
        the degree to which misconceptions concerning such laws or the 
        enforcement thereof may create barriers to patient access to 
        appropriate and effective pain care;
            ``(3) comprehensive interdisciplinary approaches to the 
        delivery of pain and palliative care, including delivery 
        through specialized centers of pain care treatment expertise; 
        and
            ``(4) recent findings, developments, and improvements in 
        the provision of pain and palliative care.
    ``(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.
    ``(g) Definitions.--For purposes of this section:
            ``(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--
            ``(1) the incidence and importance of pain as a national 
        public health problem;
            ``(2) the adverse physical, psychological, and financial 
        consequences that can result if pain is not appropriately 
        diagnosed or treated;
            ``(3) the availability, benefits, and risks of all pain 
        management and palliative care treatment options;
            ``(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--
                            ``(i) appropriate assessment, diagnosis and 
                        treatment options for all types of pain and 
                        pain-related symptoms; and
                            ``(ii) conditions for which no widely 
                        accepted treatment options are yet available; 
                        and
            ``(6) other issues the Secretary deems appropriate.
    ``(c) Coordination.--
            ``(1) Lead official.--The Secretary shall designate one 
        official in the Department of Health and Human Services to 
        oversee the campaign established under this section.
            ``(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--
            ``(1) are assessed for pain at the time of admission or 
        initial treatment, and periodically thereafter, using a 
        professionally recognized pain assessment tool or process; and
            ``(2) receive appropriate pain care consistent with 
        recognized guidelines and practice parameters 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:

``1111. Pain care.''.

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:
            ``(6) Pain care standards.--
                    ``(A) In general.--Each Medicare+Choice 
                organization shall provide appropriate care for the 
                treatment of patients in pain that--
                            ``(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;
                            ``(iii) provides medical and other health 
                        services through physicians and other 
                        practitioners credentialed or experienced in 
                        pain medicine;
                            ``(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);
                            ``(v) continues treatment for as long as 
                        treatment is required to maximize the quality 
                        of life and functional capacity of the patient; 
                        and
                            ``(vi) permits physicians and other 
                        practitioners experienced or credentialed in 
                        pain medicine to make clinical decisions with 
                        respect to the need for and the extent and 
                        duration of pain care services.
                    ``(B) Definitions.--For purposes of this paragraph:
                            ``(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.
                            ``(ii) Comprehensive multidisciplinary pain 
                        management program.--The term `comprehensive 
                        multidisciplinary pain management program' 
                        means an inpatient or outpatient health care 
                        facility or program that--
                                    ``(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;
                                    ``(III) provides ongoing patient 
                                and professional education for pain 
                                management;
                                    ``(IV) is accredited as a 
                                comprehensive pain management program 
                                by an accrediting organization approved 
                                by the Secretary, including the Joint 
                                Commission on the Accreditation of 
                                Health Care Organizations or the 
                                Rehabilitation Accreditation 
                                Commission; and
                                    ``(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:
    ``(f) Pain Care Standards.--
            ``(1) In general.--Any health care services provided 
        pursuant to any contract entered into under this section shall 
        include the provision of appropriate care for the treatment of 
        patients in pain that--
                    ``(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;
                    ``(C) provides medical and other health services 
                through physicians and other practitioners credentialed 
                or experienced in pain medicine;
                    ``(D) provides for referral of patients with 
                chronic pain to specialists, and, where appropriate, to 
                a comprehensive multidisciplinary pain management 
                program;
                    ``(E) continues treatment for as long as treatment 
                is required to maximize the quality of life and 
                functional capacity of the patient; and
                    ``(F) permits physicians and other practitioners 
                experienced or credentialed in pain medicine to make 
                clinical decisions with respect to the need for and the 
                extent and duration of pain care services.
    ``(2) Definitions.--For purposes of this subsection--
            ``(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.
            ``(B) The term `comprehensive multidisciplinary pain 
        management program' means an inpatient or outpatient health 
        care facility or program that--
                    ``(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;
                    ``(iii) provides ongoing patient and professional 
                education for pain management;
                    ``(iv) is accredited as a comprehensive pain 
                management program by an accrediting organization 
                approved by the Secretary, including the Joint 
                Commission on the Accreditation of Health Care 
                Organizations or the Rehabilitation Accreditation 
                Commission; and
                    ``(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:
            (1) An estimate of total payments made under part B of the 
        medicare program to physicians specializing in pain medicine.
            (2) An estimate of payments made under such part B to other 
        providers and suppliers for the provision of pain care items 
        and services.
            (3) An estimate of expenditures made under part A of the 
        medicare program for the diagnosis and treatment of pain of 
        inpatients, and an estimate of the percentage of such care that 
        relates to end-of-life care.
            (4) An estimate of expenditures under part C of the 
        medicare program for the provision of pain care items and 
        services through the Medicare+Choice program.
            (5) An estimate of out-of-pocket expenditures by medicare 
        beneficiaries for both prescription and nonprescription pain 
        medications not covered by the medicare program.
            (6) An analysis of trends in both medicare program and 
        medicare beneficiary expenditures for pain care items and 
        services.

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--
            ``(1) is assessed for pain at the time of admission or 
        initial treatment, and periodically thereafter, using a 
        professionally recognized pain assessment tool or process; and
            ``(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:

``1720F. Pain care.''.
    (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--
            (1) January 1, 2004, in the case of inpatient care; and
            (2) January 1, 2005, in the case of outpatient care.
                                 <all>
```