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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2507 Introduced in House (IH)]

108th CONGRESS
  1st Session
                                H. R. 2507

To amend the Public Health Service Act to provide for a public response 
      to the public health crisis of pain, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 18, 2003

Ms. Hooley of Oregon introduced the following bill; which was referred 
    to the Committee on Energy and Commerce, and in addition to the 
Committee on Ways and Means, 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 amend the Public Health Service Act to provide for a public response 
      to the public health crisis of pain, 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 ``Conquering Pain 
Act of 2003''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Definitions.
    TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN

Sec. 101. Guidelines for the treatment of pain.
Sec. 102. Patient expectations to have pain and symptom management.
Sec. 103. Quality improvement projects.
Sec. 104. Pain coverage quality evaluation and information.
Sec. 105. Surgeon General's report.
                TITLE II--DEVELOPING COMMUNITY RESOURCES

Sec. 201. Family support networks in pain and symptom management.
                   TITLE III--REIMBURSEMENT BARRIERS

Sec. 301. Reimbursement barriers report.
Sec. 302. Insurance coverage of pain and symptom management.
   TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND 
                              INFORMATION

Sec. 401. Advisory Committee on Pain and Symptom Management.
Sec. 402. Institutes of Medicine report on controlled substance 
                            regulation and the use of pain medications.
Sec. 403. Conference on pain research and care.
                    TITLE V--DEMONSTRATION PROJECTS

Sec. 501. Provider performance standards for improvement in pain and 
                            symptom management.
Sec. 502. End of life care demonstration projects.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) pain is often left untreated or under-treated 
        especially among older patients, African Americans, Hispanics 
        and other minorities, and children;
            (2) chronic pain is a public health problem affecting at 
        least 50,000,000 Americans through some form of persisting or 
        recurring symptom;
            (3) 40 to 50 percent of patients experience moderate to 
        severe pain at least half the time in their last days of life;
            (4) 70 to 80 percent of cancer patients experience 
        significant pain during their illness;
            (5) one in 7 nursing home residents experience persistent 
        pain that may diminish their quality of life;
            (6) despite the best intentions of physicians, nurses, 
        pharmacists, and other health care professionals, pain is often 
        under-treated because of the inadequate training of clinicians 
        in pain management;
            (7) despite the best intentions of physicians, nurses, 
        pharmacists, mental health professionals, and other health care 
        professionals, pain and symptom management is often suboptimal 
        because the health care system has focused on cure of disease 
        rather than the management of a patient's pain and other 
        symptoms;
            (8) the technology and scientific basis to adequately 
        manage most pain is known;
            (9) pain should be considered the fifth vital sign; and
            (10) coordination of Federal efforts is needed to improve 
        access to high quality effective pain and symptom management in 
        order to assure the needs of chronic pain patients and those 
        who are terminally ill are met.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Chronic pain.--The term ``chronic pain'' means a pain 
        state that is persistent and in which the cause of the pain 
        cannot be removed or otherwise alleviated. Such term includes 
        pain that may be associated with long-term incurable or 
        intractable medical conditions or disease.
            (2) End of life care.--The term ``end of life care'' means 
        a range of services, including hospice care, provided to a 
        patient, in the final stages of his or her life, who is 
        suffering from 1 or more conditions for which treatment toward 
        a cure or reasonable improvement is not possible, and whose 
        focus of care is palliative rather than curative.
            (3) Family support network.--The term ``family support 
        network'' means an association of 2 or more individuals or 
        entities in a collaborative effort to develop multi-
        disciplinary integrated patient care approaches that involve 
        medical staff and ancillary services to provide support to 
        chronic pain patients and patients at the end of life and their 
        caregivers across a broad range of settings in which pain 
        management might be delivered.
            (4) Hospice.--The term ``hospice care'' has the meaning 
        given such term in section 1861(dd)(1) of the Social Security 
        Act (42 U.S.C. 1395x(dd)(1)).
            (5) Medication therapy management services.--The term 
        ``medication therapy management services'' means consultations 
        with a physician or other health care professional (including a 
        pharmacist) who is practicing within the scope of the 
        professional's license, concerning a patient which results in--
                    (A) a change in the drug regimen of the patient to 
                avoid an adverse drug interaction with another drug or 
                disease state;
                    (B) a change in inappropriate drug dosage or dosage 
                form with respect to the patient;
                    (C) discontinuing an unnecessary or harmful 
                medication with respect to the patient;
                    (D) an initiation of medication therapy for a 
                medical condition of the patient;
                    (E) consultation with the patient or a caregiver in 
                a manner that results in a significant improvement in 
                drug regimen compliance; or
                    (F) patient and caregiver understanding of the 
                appropriate use and adherence to medication therapy.
            (6) Pain and symptom management.--The term ``pain and 
        symptom management'' means services provided to relieve 
        physical or psychological pain or suffering, including any 1 or 
        more of the following physical complaints--
                    (A) weakness and fatigue;
                    (B) shortness of breath;
                    (C) nausea and vomiting;
                    (D) diminished appetite;
                    (E) wasting of muscle mass;
                    (F) difficulty in swallowing;
                    (G) bowel problems;
                    (H) dry mouth;
                    (I) failure of lymph drainage resulting in tissue 
                swelling;
                    (J) confusion;
                    (K) dementia;
                    (L) delirium;
                    (M) anxiety;
                    (N) depression; and
                    (O) other related symptoms
            (7) Palliative care.--The term ``palliative care'' means 
        the total care of patients whose disease is not responsive to 
        curative treatment, the goal of which is to provide the best 
        quality of life for such patients and their families. Such 
        care--
                    (A) may include the control of pain and of other 
                symptoms, including psychological, social and spiritual 
                problems;
                    (B) affirms life and regards dying as a normal 
                process;
                    (C) provides relief from pain and other distressing 
                symptoms;
                    (D) integrates the psychological and spiritual 
                aspects of patient care;
                    (E) offers a support system to help patients live 
                as actively as possible until death; and
                    (F) offers a support system to help the family cope 
                during the patient's illness and in their own 
                bereavement.
            (8) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

    TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN

SEC. 101. GUIDELINES FOR THE TREATMENT OF PAIN.

    (a) Development of Website.--Not later than 2 months after the date 
of enactment of this Act, the Secretary, acting through the Agency for 
Healthcare Research and Quality, shall develop and maintain an Internet 
website to provide information to individuals, health care 
practitioners, and health facilities concerning evidence-based practice 
guidelines developed for the treatment of physical and psychological 
pain. Websites in existence on such date may be used if such websites 
meet the requirements of this section.
    (b) Requirements.--The website established under subsection (a) 
shall--
            (1) be designed to be quickly referenced by health care 
        practitioners; and
            (2) provide for the updating of guidelines as scientific 
        data warrants.
    (c) Provider Access to Guidelines.--
            (1) In general.--In establishing the website under 
        subsection (a), the Secretary shall ensure that health care 
        facilities have made the website known to health care 
        practitioners and that the website is easily available to all 
        health care personnel providing care or services at a health 
        care facility.
            (2) Use of certain equipment.--In making the information 
        described in paragraph (1) available to health care personnel, 
        the facility involved shall--
                    (A) ensure that such personnel have access to the 
                website through the computer equipment of the facility;
                    (B) carry out efforts to inform personnel at the 
                facility of the location of such equipment; and
                    (C) ensure that patients, caregivers, and support 
                groups are provided with access to the website.
            (3) Rural areas.--
                    (A) In general.--A health care facility, 
                particularly a facility located in a rural or 
                underserved area, without access to the Internet shall 
                provide an alternative means of providing practice 
                guideline information to all health care personnel.
                    (B) Alternative means.--The Secretary shall 
                determine appropriate alternative means by which a 
                health care facility may make available practice 
                guideline information on a 24-hour basis, 7 days a week 
                if the facility does not have Internet access. The 
                criteria for adopting such alternative means should be 
                clear in permitting facilities to develop alternative 
                means without placing a significant financial burden on 
                the facility and in permitting flexibility for 
                facilities to develop alternative means of making 
                guidelines available. Such criteria shall be published 
                in the Federal Register.

SEC. 102. PATIENT EXPECTATIONS TO HAVE PAIN AND SYMPTOM MANAGEMENT.

    (a) In General.--The administrator of each of the programs 
described in subsection (b) shall ensure that, as part of any 
informational materials provided to individuals under such programs, 
such materials shall include information, where relevant, to inform 
such individuals that they should expect to have their pain assessed 
and should expect to be provided with effective pain and symptom 
relief, when receiving benefits under such program.
    (b) Programs.--The programs described in this subsection shall 
include--
            (1) the medicare and medicaid programs under titles XIX and 
        XXI of the Social Security Act (42 U.S.C. 1935 et seq., 1936 et 
        seq.);
            (2) programs carried out through the Public Health Service;
            (3) programs carried out through the Indian Health Service;
            (4) programs carried out through health centers under 
        section 330 of the Public Health Service Act (42 U.S.C. 254b);
            (5) the Federal Employee Health Benefits Program under 
        title 5, United States Code;
            (6) the Civilian Health and Medical Program of the 
        Uniformed Services (CHAMPUS) as defined in section 1073(4) of 
        title 10, United States Code; and
            (7) other programs administered by the Secretary.

SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS.

    The Secretary shall provide funds for the implementation of special 
education projects, in as many States as is practicable, to be carried 
out by peer review organizations of the type described in section 1152 
of the Social Security Act (42 U.S.C. 1320c-1) to improve the quality 
of pain and symptom management. Such projects shall place an emphasis 
on improving pain and symptom management at the end of life, and may 
also include efforts to increase the quality of services delivered to 
chronic pain patients and the chronically ill for whom pain may be a 
significant symptom.

SEC. 104. PAIN COVERAGE QUALITY EVALUATION AND INFORMATION.

    (a) In General.--Section 1851(d)(4) of the Social Security Act (42 
U.S.C. 1395w-21(d)(4)) is amended--
            (1) in subparagraph (A), by adding at the end the 
        following:
                            ``(ix) The organization's coverage of pain 
                        and symptom management.''; and
            (2) in subparagraph (D)--
                    (A) in clause (iii), by striking ``and'' at the 
                end;
                    (B) in clause (iv), by striking the period and 
                inserting ``, and''; and
                    (C) by adding at the end the following:
                            ``(v) not later than 2 years after the date 
                        of enactment of this clause, an evaluation 
                        (which may be made part of any other relevant 
                        report of quality evaluation that the plan is 
                        required to prepare) for the plan (updated 
                        annually) that indicates the performance of the 
                        plan with respect to access to, and quality of, 
                        pain and symptom management, including such 
                        management as part of end of life care. Data 
                        shall be posted in a comparable manner for 
                        consumer use on www.medicare.gov.''.
    (b) Effective Date.--The amendments made by paragraph (1) apply to 
information provided with respect to annual, coordinated election 
periods (as defined in section 1851(e)(3)(B) of the Social Security Act 
(42 U.S.C. 1395-21(e)(3)(B)) beginning after the date of enactment of 
this Act.

SEC. 105. SURGEON GENERAL'S REPORT.

    Not later than October 1, 2004, the Surgeon General shall prepare 
and submit to the appropriate committees of Congress and the public, a 
report concerning the state of pain and symptom management in the 
United States. The report shall include--
            (1) a description of the legal and regulatory barriers that 
        may exist at the Federal and State levels to providing adequate 
        pain and symptom management;
            (2) an evaluation of provider competency in providing pain 
        and symptom management;
            (3) an identification of vulnerable populations, including 
        children, advanced elderly, non-English speakers, and 
        minorities, who may be likely to be underserved or may face 
        barriers to access to pain management and recommendations to 
        improve access to pain management for these populations;
            (4) an identification of barriers that may exist in 
        providing pain and symptom management in health care settings, 
        including assisted living facilities;
            (5) an identification of patient and family attitudes that 
        may exist which pose barriers in accessing pain and symptom 
        management or in the proper use of pain medications;
            (6) an evaluation of medical, nursing, and pharmacy school 
        training and residency training for pain and symptom 
        management;
            (7) a review of continuing medical education programs in 
        pain and symptom management; and
            (8) a description of the use of and access to mental health 
        services for patients in pain and patients at the end of life.

                TITLE II--DEVELOPING COMMUNITY RESOURCES

SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMPTOM MANAGEMENT.

    (a) Establishment.--The Secretary, acting through the Public Health 
Service, shall award grants for the establishment of 6 National Family 
Support Networks in Pain and Symptom Management (in this section 
referred to as the ``Networks'') to serve as national models for 
improving the access and quality of pain and symptom management to 
chronic pain patients (including chronically ill patients for whom pain 
is a significant symptom) and those individuals in need of pain and 
symptom management at the end of life and to provide assistance to 
family members and caregivers.
    (b) Eligibility and Distribution.--
            (1) Eligibility.--To be eligible to receive a grant under 
        subsection (a), an entity shall--
                    (A) be an academic facility or other entity that 
                has demonstrated an effective approach to training 
                health care providers including mental health 
                professionals concerning pain and symptom management 
                and palliative care services; and
                    (B) prepare and submit to the Secretary an 
                application (to be peer reviewed by a committee 
                established by the Secretary), at such time, in such 
                manner, and containing such information as the 
                Secretary may require.
            (2) Distribution.--In providing for the establishment of 
        Networks under subsection (a), the Secretary shall ensure 
        that--
                    (A) the geographic distribution of such Networks 
                reflects a balance between rural and urban needs; and
                    (B) at least 3 Networks are established at academic 
                facilities.
    (c) Activities of Networks.--A Network that is established under 
this section--
            (1) shall provide for an integrated interdisciplinary 
        approach, that includes psychological and counseling services, 
        to the delivery of pain and symptom management;
            (2) shall provide community leadership in establishing and 
        expanding public access to appropriate pain care, including 
        pain care at the end of life;
            (3) shall provide assistance, through caregiver supportive 
        services, that include counseling and education services;
            (4) shall develop a research agenda to promote effective 
        pain and symptom management for the broad spectrum of patients 
        in need of access to such care that can be implemented by the 
        Network;
            (5) shall provide for coordination and linkages between 
        clinical services in academic centers and surrounding 
        communities to assist in the widespread dissemination of 
        provider and patient information concerning how to access 
        options for pain management;
            (6) shall establish telemedicine links to provide education 
        and for the delivery of services in pain and symptom 
        management;
            (7) shall develop effective means of providing assistance 
        to providers and families for the management of a patient's 
        pain 24 hours a day, 7 days a week; and
            (8) may include complimentary medicine provided in 
        conjunction with traditional medical services.
    (d) Provider Pain and Symptom Management Communications Projects.--
            (1) In general.--Each Network shall establish a process to 
        provide health care personnel with information 24 hours a day, 
        7 days a week, concerning pain and symptom management. Such 
        process shall be designed to test the effectiveness of specific 
        forms of communications with health care personnel so that such 
        personnel may obtain information to ensure that all appropriate 
        patients are provided with pain and symptom management.
            (2) Termination.--The requirement of paragraph (1) shall 
        terminate with respect to a Network on the day that is 2 years 
        after the date on which the Network has established the 
        communications method.
            (3) Evaluation.--Not later than 60 days after the 
        expiration of the 2-year period referred to in paragraph (2), a 
        Network shall conduct an evaluation and prepare and submit to 
        the Secretary a report concerning the costs of operation and 
        whether the form of communication can be shown to have had a 
        positive impact on the care of patients in chronic pain or on 
        patients with pain at the end of life.
            (4) Rule of construction.--Nothing in this subsection shall 
        be construed as limiting a Network from developing other ways 
        in which to provide support to families and providers, 24 hours 
        a day, 7 days a week.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $18,000,000 for fiscal years 
2004 through 2006.

                   TITLE III--REIMBURSEMENT BARRIERS

SEC. 301. REIMBURSEMENT BARRIERS REPORT.

    The Medicare Payment Advisory Commission (MedPac) established under 
section 1805 of the Social Security Act (42 U.S.C. 1396b-6) shall 
conduct a study, and prepare and submit to the appropriate committees 
of Congress a report, concerning--
            (1) the manner in which medicare policies may pose barriers 
        in providing pain and symptom management and palliative care 
        services in different settings, including a focus on payment 
        for nursing home and home health services;
            (2) the identification of any financial barriers that may 
        exist within the medicare and medicaid programs under titles 
        XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et 
        seq., 1396 et seq.) that interfere with continuity of care and 
        interdisciplinary care or supportive care for the broad range 
        of chronic pain patients (including patients who are 
        chronically ill for whom pain is a significant symptom), and 
        for those who are terminally ill, and include the 
        recommendations of the Commission on ways to eliminate those 
        barriers that the Commission may identify;
            (3) the reimbursement barriers that exist, if any, in 
        providing pain and symptom management through hospice care, 
        particularly in rural areas, and if barriers exist, 
        recommendations concerning adjustments that would assist in 
        assuring patient access to pain and symptom management through 
        hospice care in rural areas;
            (4) whether the medicare reimbursement system provides 
        incentives to providers to delay informing terminally ill 
        patients of the availability of hospice and palliative care; 
        and
            (5) the impact of providing payments for medication therapy 
        management services in pain and symptom management and 
        palliative care services.

SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM MANAGEMENT.

    (a) In General.--The General Accounting Office shall conduct a 
survey of public and private health insurance providers, including 
managed care entities, to determine whether the reimbursement policies 
of such insurers inhibit the access of chronic pain patients to pain 
and symptom management and pain and symptom management for those in 
need of end-of-life care (including patients who are chronically ill 
for whom pain is a significant symptom). The survey shall include a 
review of formularies for pain medication and the effect of such 
formularies on pain and symptom management.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the General Accounting Office shall prepare and submit to the 
appropriate committees of Congress a report concerning the survey 
conducted under subsection (a).

   TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND 
                              INFORMATION

SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM MANAGEMENT.

    (a) Establishment.--The Secretary shall establish an advisory 
committee, to be known as the Advisory Committee on Pain and Symptom 
Management, to make recommendations to the Secretary concerning a 
coordinated Federal agenda on pain and symptom management.
    (b) Membership.--The Advisory Committee established under 
subsection (a) shall be comprised of 11 individuals to be appointed by 
the Secretary, of which at least 1 member shall be a representative 
of--
            (1) physicians (medical doctors or doctors of osteopathy) 
        who treat chronic pain patients or the terminally ill;
            (2) nurses who treat chronic pain patients or the 
        terminally ill;
            (3) pharmacists;
            (4) hospice;
            (5) pain researchers;
            (6) patient advocates;
            (7) caregivers; and
            (8) mental health providers.
The members of the Committee shall designate 1 member to serve as the 
chairperson of the Committee.
    (c) Meetings.--The Advisory Committee shall meet at the call of the 
chairperson of the Committee.
    (d) Agenda.--The agenda of the Advisory Committee established under 
subsection (a) shall include--
            (1) the development of recommendations to create a 
        coordinated Federal agenda on pain and symptom management;
            (2) the development of proposals to ensure that pain is 
        considered as the fifth vital sign for all patients;
            (3) the identification of research needs in pain and 
        symptom management, including gaps in pain and symptom 
        management guidelines;
            (4) the identification and dissemination of pain and 
        symptom management practice guidelines, research information, 
        and best practices;
            (5) proposals for patient education concerning how to 
        access pain and symptom management across health care settings;
            (6) the manner in which to measure improvement in access to 
        pain and symptom management and improvement in the delivery of 
        care;
            (7) the development of ongoing strategies to assure the 
        aggressive use of pain medications, including opiods, 
        regardless of health care setting; and
            (8) the development of an ongoing mechanism to identify 
        barriers or potential barriers to pain and symptom management 
        created by Federal policies.
    (e) Recommendation.--Not later than 2 years after the date of 
enactment of this Act, the Advisory Committee established under 
subsection (a) shall prepare and submit to the Secretary 
recommendations concerning a prioritization of the need for a Federal 
agenda on pain and symptom management, and ways in which to better 
coordinate the activities of entities within the Department of Health 
and Human Services, and other Federal entities charged with the 
responsibility for the delivery of health care services or research on 
pain and symptom management with respect to pain management.
    (f) Consultation.--In carrying out this section, the Advisory 
Committee shall consult with all Federal agencies that are responsible 
for providing health care services or access to health services to 
determine the best means to ensure that all Federal activities are 
coordinated with respect to research and access to pain and symptom 
management.
    (g) Administrative Support; Terms of Service; Other Provisions.--
The following shall apply with respect to the Advisory Committee:
            (1) The Committee shall receive necessary and appropriate 
        administrative support, including appropriate funding, from the 
        Department of Health and Human Services.
            (2) The Committee shall hold open meetings and meet not 
        less than 4 times per year.
            (3) Members of the Committee shall not receive additional 
        compensation for their service. Such members may receive 
        reimbursement for appropriate and additional expenses that are 
        incurred through service on the Committee which would not have 
        incurred had they not been a member of the Committee.
            (4) The requirements of Appendix 2 of title 5, United 
        States Code.

SEC. 402. INSTITUTES OF MEDICINE REPORT ON CONTROLLED SUBSTANCE 
              REGULATION AND THE USE OF PAIN MEDICATIONS.

    (a) In General.--The Secretary, acting through a contract entered 
into with the Institute of Medicine, shall review findings that have 
been developed through research conducted concerning--
            (1) the effects of controlled substance regulation on 
        patient access to effective care;
            (2) factors, if any, that may contribute to the underuse of 
        pain medications, including opiods;
            (3) the identification of State legal and regulatory 
        barriers, if any, that may impact patient access to medications 
        used for pain and symptom management; and
            (4) strategies to assure the aggressive use of pain 
        medications, including opiods, regardless of health care 
        setting.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Secretary shall prepare and submit to the appropriate 
committees of Congress a report concerning the findings described in 
subsection (a).

SEC. 403. CONFERENCE ON PAIN RESEARCH AND CARE.

    Not later than December 31, 2007, the Secretary, acting through the 
National Institutes of Health, shall convene a national conference to 
discuss the translation of pain research into the delivery of health 
services including mental health services to chronic pain patients and 
those needing end-of-life care. The Secretary shall use unobligated 
amounts appropriated for the Department of Health and Human Services to 
carry out this section.

                    TITLE V--DEMONSTRATION PROJECTS

SEC. 501. PROVIDER PERFORMANCE STANDARDS FOR IMPROVEMENT IN PAIN AND 
              SYMPTOM MANAGEMENT.

    (a) In General.--The Secretary, acting through the Health Resources 
Services Administration, shall award grants for the establishment of 
not less than 5 demonstration projects to determine effective methods 
to measure improvement in the skills, knowledge, and attitudes and 
beliefs of health care personnel in pain and symptom management as such 
skill, knowledge, and attitudes and beliefs apply to providing services 
to chronic pain patients and those patients requiring pain and symptom 
management at the end of life.
    (b) Evaluation.--Projects established under subsection (a) shall be 
evaluated to determine patient and caregiver knowledge and attitudes 
toward pain and symptom management.
    (c) Application.--To be eligible to receive a grant under 
subsection (a), an entity shall prepare and submit to the Secretary an 
application at such time, in such manner and containing such 
information as the Secretary may require.
    (d) Termination.--A project established under subsection (a) shall 
terminate after the expiration of the 2-year period beginning on the 
date on which such project was established.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 502. END OF LIFE CARE DEMONSTRATION PROJECTS.

    The Secretary, acting through the Health Resources and Services 
Administration, shall--
            (1) not later than January 1, 2006, carry out not less than 
        5 demonstration and evaluation projects that implement care 
        models for individuals at the end of life, at least one of 
        which shall be developed to assist those individuals who are 
        terminally ill and have no family or extended support, and each 
        of which may be carried out in collaboration with domestic and 
        international entities to gain and share knowledge and 
        experience on end of life care;
            (2) conduct 3 demonstration and evaluation activities 
        concerning the education and training of clinicians in end of 
        life care, and assist in the development and distribution of 
        accurate educational materials on both pain and symptom 
        management and end of life care;
            (3) in awarding grants for the training of health 
        professionals, give priority to awarding grants to entities 
        that will provide training for health professionals in pain and 
        symptom management and in end-of-life care at the undergraduate 
        level;
            (4) shall evaluate demonstration projects carried out under 
        this section within the 5-year period beginning on the 
        commencement of each such project; and
            (5) develop a strategy and make recommendations to Congress 
        to ensure that the United States health care system--
                    (A) has a meaningful, comprehensive, and effective 
                approach to meet the needs of individuals and their 
                caregivers as the patient approaches death; and
                    (B) integrates broader supportive services.
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