II

107TH CONGRESS

1ST SESSION S. 1024

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 SENATE OF THE UNITED STATES

JUNE 13, 2001

Mr. WYDEN (for himself, Mr. SMITH of Oregon, Mr. ROCKEFELLER, and Mr.

BREAUX) introduced the following bill; which was read twice and referred

to the Committee on Health, Education, Labor, and Pensions

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.

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 ‘‘Conquering Pain Act of 2001’’.

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

7 this Act is as follows:

Sec. 1. Short title.

Sec. 2. Findings.

Sec. 3. Definitions.
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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.

1 SEC. 2. FINDINGS.

2 Congress finds that—

3 (1) pain is often left untreated or under-treated

4 especially among older patients, African Americans,

5 Hispanics and other minorities, and children;

6 (2) chronic pain is a public health problem af7 fecting at least 50,000,000 Americans through some

8 form of persisting or recurring symptom;

9 (3) 40 to 50 percent of patients experience

10 moderate to severe pain at least half the time in

11 their last days of life;
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1 (4) 70 to 80 percent of cancer patients experi2 ence significant pain during their illness;

3 (5) one in 7 nursing home residents experience

4 persistent pain that may diminish their quality of

5 life;

6 (6) despite the best intentions of physicians,

7 nurses, pharmacists, and other health care profes8 sionals, pain is often under-treated because of the

9 inadequate training of clinicians in pain manage10 ment;

11 (7) despite the best intentions of physicians,

12 nurses, pharmacists, mental health professionals,

13 and other health care professionals, pain and symp14 tom management is often suboptimal because the

15 health care system has focused on cure of disease

16 rather than the management of a patient’s pain and

17 other symptoms;

18 (8) the technology and scientific basis to ade19 quately manage most pain is known;

20 (9) pain should be considered the fifth vital

21 sign; and

22 (10) coordination of Federal efforts is needed to

23 improve access to high quality effective pain and

24 symptom management in order to assure the needs
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1 of chronic pain patients and those who are termi2 nally ill are met.

3 SEC. 3. DEFINITIONS.

4 In this Act:

5 (1) CHRONIC PAIN.—The term ‘‘chronic pain’’

6 means a pain state that is persistent and in which

7 the cause of the pain cannot be removed or other8 wise alleviated. Such term includes pain that may be

9 associated with long-term incurable or intractable

10 medical conditions or disease.

11 (2) END OF LIFE CARE.—The term ‘‘end of life

12 care’’ means a range of services, including hospice

13 care, provided to a patient, in the final stages of his

14 or her life, who is suffering from 1 or more condi15 tions for which treatment toward a cure or reason16 able improvement is not possible, and whose focus of

17 care is palliative rather than curative.

18 (3) FAMILY SUPPORT NETWORK.—The term

19 ‘‘family support network’’ means an association of 2

20 or more individuals or entities in a collaborative ef21 fort to develop multi-disciplinary integrated patient

22 care approaches that involve medical staff and ancil23 lary services to provide support to chronic pain pa24 tients and patients at the end of life and their care-
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1 givers across a broad range of settings in which pain

2 management might be delivered.

3 (4) HOSPICE.—The term ‘‘hospice care’’ has

4 the meaning given such term in section 1861(dd)(1)

5 of the Social Security Act (42 U.S.C. 1395x(dd)(1)).

6 (5) MEDICATION THERAPY MANAGEMENT SERV7 ICES.—The term ‘‘medication therapy management

8 services’’ means consultations with a physician or

9 other health care professional (including a phar10 macist) who is practicing within the scope of the

11 professional’s license, concerning a patient which re12 sults in—

13 (A) a change in the drug regimen of the

14 patient to avoid an adverse drug interaction

15 with another drug or disease state;

16 (B) a change in inappropriate drug dosage

17 or dosage form with respect to the patient;

18 (C) discontinuing an unnecessary or harm19 ful medication with respect to the patient;

20 (D) an initiation of medication therapy for

21 a medical condition of the patient;

22 (E) consultation with the patient or a care23 giver in a manner that results in a significant

24 improvement in drug regimen compliance; or
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1 (F) patient and caregiver understanding of

2 the appropriate use and adherence to medica3 tion therapy.

4 (6) PAIN AND SYMPTOM MANAGEMENT.—The

5 term ‘‘pain and symptom management’’ means serv6 ices provided to relieve physical or psychological pain

7 or suffering, including any 1 or more of the fol8 lowing physical complaints—

9 (A) weakness and fatigue;

10 (B) shortness of breath;

11 (C) nausea and vomiting;

12 (D) diminished appetite;

13 (E) wasting of muscle mass;

14 (F) difficulty in swallowing;

15 (G) bowel problems;

16 (H) dry mouth;

17 (I) failure of lymph drainage resulting in

18 tissue swelling;

19 (J) confusion;

20 (K) dementia;

21 (L) delirium;

22 (M) anxiety;

23 (N) depression; and

24 (O) other related symptoms
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1 (7) PALLIATIVE CARE.—The term ‘‘palliative

2 care’’ means the total care of patients whose disease

3 is not responsive to curative treatment, the goal of

4 which is to provide the best quality of life for such

5 patients and their families. Such care—

6 (A) may include the control of pain and of

7 other symptoms, including psychological, social

8 and spiritual problems;

9 (B) affirms life and regards dying as a

10 normal process;

11 (C) provides relief from pain and other dis12 tressing symptoms;

13 (D) integrates the psychological and spir14 itual aspects of patient care;

15 (E) offers a support system to help pa16 tients live as actively as possible until death;

17 and

18 (F) offers a support system to help the

19 family cope during the patient’s illness and in

20 their own bereavement.

21 (8) SECRETARY.—The term ‘‘Secretary’’ means

22 the Secretary of Health and Human Services.
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1 TITLE I—EMERGENCY RE2 SPONSE TO THE PUBLIC

3 HEALTH CRISIS OF PAIN

4 SEC. 101. GUIDELINES FOR THE TREATMENT OF PAIN.

5 (a) DEVELOPMENT OF WEBSITE.—Not later than 2

6 months after the date of enactment of this Act, the Sec7 retary, acting through the Agency for Healthcare Re8 search and Quality, shall develop and maintain an Internet

9 website to provide information to individuals, health care

10 practitioners, and health facilities concerning evidence11 based practice guidelines developed for the treatment of

12 physical and psychological pain. Websites in existence on

13 such date may be used if such websites meet the require14 ments of this section.

15 (b) REQUIREMENTS.—The website established under

16 subsection (a) shall—

17 (1) be designed to be quickly referenced by

18 health care practitioners; and

19 (2) provide for the updating of guidelines as

20 scientific data warrants.

21 (c) PROVIDER ACCESS TO GUIDELINES.—

22 (1) IN GENERAL.—In establishing the website

23 under subsection (a), the Secretary shall ensure that

24 health care facilities have made the website known

25 to health care practitioners and that the website is
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1 easily available to all health care personnel providing

2 care or services at a health care facility.

3 (2) USE OF CERTAIN EQUIPMENT.—In making

4 the information described in paragraph (1) available

5 to health care personnel, the facility involved shall—

6 (A) ensure that such personnel have access

7 to the website through the computer equipment

8 of the facility;

9 (B) carry out efforts to inform personnel

10 at the facility of the location of such equipment;

11 and

12 (C) ensure that patients, caregivers, and

13 support groups are provided with access to the

14 website.

15 (3) RURAL AREAS.—

16 (A) IN GENERAL.—A health care facility,

17 particularly a facility located in a rural or un18 derserved area, without access to the Internet

19 shall provide an alternative means of providing

20 practice guideline information to all health care

21 personnel.

22 (B) ALTERNATIVE MEANS.—The Secretary

23 shall determine appropriate alternative means

24 by which a health care facility may make avail25 able practice guideline information on a 24-hour
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1 basis, 7 days a week if the facility does not

2 have Internet access. The criteria for adopting

3 such alternative means should be clear in per4 mitting facilities to develop alternative means

5 without placing a significant financial burden

6 on the facility and in permitting flexibility for

7 facilities to develop alternative means of making

8 guidelines available. Such criteria shall be pub9 lished in the Federal Register.

10 SEC. 102. PATIENT EXPECTATIONS TO HAVE PAIN AND

11 SYMPTOM MANAGEMENT.

12 (a) IN GENERAL.—The administrator of each of the

13 programs described in subsection (b) shall ensure that, as

14 part of any informational materials provided to individuals

15 under such programs, such materials shall include infor16 mation, where relevant, to inform such individuals that

17 they should expect to have their pain assessed and should

18 expect to be provided with effective pain and symptom re19 lief, when receiving benefits under such program.

20 (b) PROGRAMS.—The programs described in this sub21 section shall include—

22 (1) the medicare and medicaid programs under

23 titles XIX and XXI of the Social Security Act (42

24 U.S.C. 1935 et seq., 1936 et seq.);
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1 (2) programs carried out through the Public

2 Health Service;

3 (3) programs carried out through the Indian

4 Health Service;

5 (4) programs carried out through health centers

6 under section 330 of the Public Health Service Act

7 (42 U.S.C. 254b);

8 (5) the Federal Employee Health Benefits Pro9 gram under title 5, United States Code;

10 (6) the Civilian Health and Medical Program of

11 the Uniformed Services (CHAMPUS) as defined in

12 section 1073(4) of title 10, United States Code; and

13 (7) other programs administered by the Sec14 retary.

15 SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS.

16 The Secretary shall provide funds for the implemen17 tation of special education projects, in as many States as

18 is practicable, to be carried out by peer review organiza19 tions of the type described in section 1152 of the Social

20 Security Act (42 U.S.C. 1320c–1) to improve the quality

21 of pain and symptom management. Such projects shall

22 place an emphasis on improving pain and symptom man23 agement at the end of life, and may also include efforts

24 to increase the quality of services delivered to chronic pain
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1 patients and the chronically ill for whom pain may be a

2 significant symptom.

3 SEC. 104. PAIN COVERAGE QUALITY EVALUATION AND IN4 FORMATION.

5 (a) IN GENERAL.—Section 1851(d)(4) of the Social

6 Security Act (42 U.S.C. 42 U.S.C. 1395w–21(d)(4)) is

7 amended—

8 (1) in subparagraph (A), by adding at the end

9 the following:

10 ‘‘(ix) The organization’s coverage of

11 pain and symptom management.’’; and

12 (2) in subparagraph (D)—

13 (A) in clause (iii), by striking ‘‘and’’ at the

14 end;

15 (B) in clause (iv), by striking the period

16 and inserting ‘‘, and’’; and

17 (C) by adding at the end the following:

18 ‘‘(v) not later than 2 years after the

19 date of enactment of this clause, an eval20 uation (which may be made part of any

21 other relevant report of quality evaluation

22 that the plan is required to prepare) for

23 the plan (updated annually) that indicates

24 the performance of the plan with respect to

25 access to, and quality of, pain and symp-
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1 tom management, including such manage2 ment as part of end of life care. Data shall

3 be posted in a comparable manner for con4 sumer use on www.medicare.gov.’’.

5 (b) EFFECTIVE DATE.—The amendments made by

6 paragraph (1) apply to information provided with respect

7 to annual, coordinated election periods (as defined in sec8 tion 1851(e)(3)(B) of the Social Security Act (42 U.S.C.

9 1395–21(e)(3)(B)) beginning after the date of enactment

10 of this Act.

11 SEC. 105. SURGEON GENERAL’S REPORT.

12 Not later than October 1, 2002, the Surgeon General

13 shall prepare and submit to the appropriate committees

14 of Congress and the public, a report concerning the state

15 of pain and symptom management in the United States.

16 The report shall include—

17 (1) a description of the legal and regulatory

18 barriers that may exist at the Federal and State lev19 els to providing adequate pain and symptom man20 agement;

21 (2) an evaluation of provider competency in

22 providing pain and symptom management;

23 (3) an identification of vulnerable populations,

24 including children, advanced elderly, non-English

25 speakers, and minorities, who may be likely to be
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1 underserved or may face barriers to access to pain

2 management and recommendations to improve ac3 cess to pain management for these populations;

4 (4) an identification of barriers that may exist

5 in providing pain and symptom management in

6 health care settings, including assisted living facili7 ties;

8 (5) an identification of patient and family atti9 tudes that may exist which pose barriers in access10 ing pain and symptom management or in the proper

11 use of pain medications;

12 (6) an evaluation of medical, nursing, and phar13 macy school training and residency training for pain

14 and symptom management;

15 (7) a review of continuing medical education

16 programs in pain and symptom management; and

17 (8) a description of the use of and access to

18 mental health services for patients in pain and pa19 tients at the end of life.

20 TITLE II—DEVELOPING

21 COMMUNITY RESOURCES

22 SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMP23 TOM MANAGEMENT.

24 (a) ESTABLISHMENT.—The Secretary, acting

25 through the Public Health Service, shall award grants for
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1 the establishment of 6 National Family Support Networks

2 in Pain and Symptom Management (in this section re3 ferred to as the ‘‘Networks’’) to serve as national models

4 for improving the access and quality of pain and symptom

5 management to chronic pain patients (including chron6 ically ill patients for whom pain is a significant symptom)

7 and those individuals in need of pain and symptom man8 agement at the end of life and to provide assistance to

9 family members and caregivers.

10 (b) ELIGIBILITY AND DISTRIBUTION.—

11 (1) ELIGIBILITY.—To be eligible to receive a

12 grant under subsection (a), an entity shall—

13 (A) be an academic facility or other entity

14 that has demonstrated an effective approach to

15 training health care providers including mental

16 health professionals concerning pain and symp17 tom management and palliative care services;

18 and

19 (B) prepare and submit to the Secretary

20 an application (to be peer reviewed by a com21 mittee established by the Secretary), at such

22 time, in such manner, and containing such in23 formation as the Secretary may require.
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1 (2) DISTRIBUTION.—In providing for the estab2 lishment of Networks under subsection (a), the Sec3 retary shall ensure that—

4 (A) the geographic distribution of such

5 Networks reflects a balance between rural and

6 urban needs; and

7 (B) at least 3 Networks are established at

8 academic facilities.

9 (c) ACTIVITIES OF NETWORKS.—A Network that is

10 established under this section—

11 (1) shall provide for an integrated interdiscipli12 nary approach, that includes psychological and coun13 seling services, to the delivery of pain and symptom

14 management;

15 (2) shall provide community leadership in estab16 lishing and expanding public access to appropriate

17 pain care, including pain care at the end of life;

18 (3) shall provide assistance, through caregiver

19 supportive services, that include counseling and edu20 cation services;

21 (4) shall develop a research agenda to promote

22 effective pain and symptom management for the

23 broad spectrum of patients in need of access to such

24 care that can be implemented by the Network;
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1 (5) shall provide for coordination and linkages

2 between clinical services in academic centers and

3 surrounding communities to assist in the widespread

4 dissemination of provider and patient information

5 concerning how to access options for pain manage6 ment;

7 (6) shall establish telemedicine links to provide

8 education and for the delivery of services in pain and

9 symptom management;

10 (7) shall develop effective means of providing

11 assistance to providers and families for the manage12 ment of a patient’s pain 24 hours a day, 7 days a

13 week; and

14 (8) may include complimentary medicine pro15 vided in conjunction with traditional medical serv16 ices.

17 (d) PROVIDER PAIN AND SYMPTOM MANAGEMENT

18 COMMUNICATIONS PROJECTS.—

19 (1) IN GENERAL.—Each Network shall estab20 lish a process to provide health care personnel with

21 information 24 hours a day, 7 days a week, con22 cerning pain and symptom management. Such proc23 ess shall be designed to test the effectiveness of spe24 cific forms of communications with health care per25 sonnel so that such personnel may obtain informa-
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1 tion to ensure that all appropriate patients are pro2 vided with pain and symptom management.

3 (2) TERMINATION.—The requirement of para4 graph (1) shall terminate with respect to a Network

5 on the day that is 2 years after the date on which

6 the Network has established the communications

7 method.

8 (3) EVALUATION.—Not later than 60 days after

9 the expiration of the 2-year period referred to in

10 paragraph (2), a Network shall conduct an evalua11 tion and prepare and submit to the Secretary a re12 port concerning the costs of operation and whether

13 the form of communication can be shown to have

14 had a positive impact on the care of patients in

15 chronic pain or on patients with pain at the end of

16 life.

17 (4) RULE OF CONSTRUCTION.—Nothing in this

18 subsection shall be construed as limiting a Network

19 from developing other ways in which to provide sup20 port to families and providers, 24 hours a day, 7

21 days a week.

22 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

23 authorized to be appropriated to carry out this section,

24 $18,000,000 for fiscal years 2002 through 2004.
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1 TITLE III—REIMBURSEMENT

2 BARRIERS

3 SEC. 301. REIMBURSEMENT BARRIERS REPORT.

4 The Medicare Payment Advisory Commission

5 (MedPac) established under section 1805 of the Social Se6 curity Act (42 U.S.C. 1396b–6) shall conduct a study, and

7 prepare and submit to the appropriate committees of Con8 gress a report, concerning—

9 (1) the manner in which medicare policies may

10 pose barriers in providing pain and symptom man11 agement and palliative care services in different set12 tings, including a focus on payment for nursing

13 home and home health services;

14 (2) the identification of any financial barriers

15 that may exist within the medicare and medicaid

16 programs under titles XVIII and XIX of the Social

17 Security Act (42 U.S.C. 1395 et seq., 1396 et seq.)

18 that interfere with continuity of care and inter19 disciplinary care or supportive care for the broad

20 range of chronic pain patients (including patients

21 who are chronically ill for whom pain is a significant

22 symptom), and for those who are terminally ill, and

23 include the recommendations of the Commission on

24 ways to eliminate those barriers that the Commis25 sion may identify;
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1 (3) the reimbursement barriers that exist, if

2 any, in providing pain and symptom management

3 through hospice care, particularly in rural areas, and

4 if barriers exist, recommendations concerning ad5 justments that would assist in assuring patient ac6 cess to pain and symptom management through hos7 pice care in rural areas;

8 (4) whether the medicare reimbursement system

9 provides incentives to providers to delay informing

10 terminally ill patients of the availability of hospice

11 and palliative care; and

12 (5) the impact of providing payments for medi13 cation therapy management services in pain and

14 symptom management and palliative care services.

15 SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM

16 MANAGEMENT.

17 (a) IN GENERAL.—The General Accounting Office

18 shall conduct a survey of public and private health insur19 ance providers, including managed care entities, to deter20 mine whether the reimbursement policies of such insurers

21 inhibit the access of chronic pain patients to pain and

22 symptom management and pain and symptom manage23 ment for those in need of end-of-life care (including pa24 tients who are chronically ill for whom pain is a significant

25 symptom). The survey shall include a review of
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1 formularies for pain medication and the effect of such

2 formularies on pain and symptom management.

3 (b) REPORT.—Not later than 1 year after the date

4 of enactment of this Act, the General Accounting Office

5 shall prepare and submit to the appropriate committees

6 of Congress a report concerning the survey conducted

7 under subsection (a).

8 TITLE IV—IMPROVING FEDERAL

9 COORDINATION OF POLICY,

10 RESEARCH, AND INFORMA11 TION

12 SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM

13 MANAGEMENT.

14 (a) ESTABLISHMENT.—The Secretary shall establish

15 an advisory committee, to be known as the Advisory Com16 mittee on Pain and Symptom Management, to make rec17 ommendations to the Secretary concerning a coordinated

18 Federal agenda on pain and symptom management.

19 (b) MEMBERSHIP.—The Advisory Committee estab20 lished under subsection (a) shall be comprised of 11 indi21 viduals to be appointed by the Secretary, of which at least

22 1 member shall be a representative of—

23 (1) physicians (medical doctors or doctors of os24 teopathy) who treat chronic pain patients or the ter25 minally ill;
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1 (2) nurses who treat chronic pain patients or

2 the terminally ill;

3 (3) pharmacists;

4 (4) hospice;

5 (5) pain researchers;

6 (6) patient advocates;

7 (7) caregivers; and

8 (8) mental health providers.

9 The members of the Committee shall designate 1 member

10 to serve as the chairperson of the Committee.

11 (c) MEETINGS.—The Advisory Committee shall meet

12 at the call of the chairperson of the Committee.

13 (d) AGENDA.—The agenda of the Advisory Com14 mittee established under subsection (a) shall include—

15 (1) the development of recommendations to cre16 ate a coordinated Federal agenda on pain and symp17 tom management;

18 (2) the development of proposals to ensure that

19 pain is considered as the fifth vital sign for all pa20 tients;

21 (3) the identification of research needs in pain

22 and symptom management, including gaps in pain

23 and symptom management guidelines;
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1 (4) the identification and dissemination of pain

2 and symptom management practice guidelines, re3 search information, and best practices;

4 (5) proposals for patient education concerning

5 how to access pain and symptom management across

6 health care settings;

7 (6) the manner in which to measure improve8 ment in access to pain and symptom management

9 and improvement in the delivery of care;

10 (7) the development of ongoing strategies to as11 sure the aggressive use of pain medications, includ12 ing opiods, regardless of health care setting; and

13 (8) the development of an ongoing mechanism

14 to identify barriers or potential barriers to pain and

15 symptom management created by Federal policies.

16 (e) RECOMMENDATION.—Not later than 2 years after

17 the date of enactment of this Act, the Advisory Committee

18 established under subsection (a) shall prepare and submit

19 to the Secretary recommendations concerning a

20 prioritization of the need for a Federal agenda on pain

21 and symptom management, and ways in which to better

22 coordinate the activities of entities within the Department

23 of Health and Human Services, and other Federal entities

24 charged with the responsibility for the delivery of health
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1 care services or research on pain and symptom manage2 ment with respect to pain management.

3 (f) CONSULTATION.—In carrying out this section, the

4 Advisory Committee shall consult with all Federal agen5 cies that are responsible for providing health care services

6 or access to health services to determine the best means

7 to ensure that all Federal activities are coordinated with

8 respect to research and access to pain and symptom man9 agement.

10 (g) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE;

11 OTHER PROVISIONS.—The following shall apply with re12 spect to the Advisory Committee:

13 (1) The Committee shall receive necessary and

14 appropriate administrative support, including appro15 priate funding, from the Department of Health and

16 Human Services.

17 (2) The Committee shall hold open meetings

18 and meet not less than 4 times per year.

19 (3) Members of the Committee shall not receive

20 additional compensation for their service. Such

21 members may receive reimbursement for appropriate

22 and additional expenses that are incurred through

23 service on the Committee which would not have in24 curred had they not been a member of the Com25 mittee.
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1 (4) The requirements of Appendix 2 of title 5,

2 United States Code.

3 SEC. 402. INSTITUTES OF MEDICINE REPORT ON CON4 TROLLED SUBSTANCE REGULATION AND THE

5 USE OF PAIN MEDICATIONS.

6 (a) IN GENERAL.—The Secretary, acting through a

7 contract entered into with the Institute of Medicine, shall

8 review findings that have been developed through research

9 conducted concerning—

10 (1) the effects of controlled substance regula11 tion on patient access to effective care;

12 (2) factors, if any, that may contribute to the

13 underuse of pain medications, including opiods;

14 (3) the identification of State legal and regu15 latory barriers, if any, that may impact patient ac16 cess to medications used for pain and symptom man17 agement; and

18 (4) strategies to assure the aggressive use of

19 pain medications, including opiods, regardless of

20 health care setting.

21 (b) REPORT.—Not later than 18 months after the

22 date of enactment of this Act, the Secretary shall prepare

23 and submit to the appropriate committees of Congress a

24 report concerning the findings described in subsection (a).
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1 SEC. 403. CONFERENCE ON PAIN RESEARCH AND CARE.

2 Not later than December 31, 2005, the Secretary,

3 acting through the National Institutes of Health, shall

4 convene a national conference to discuss the translation

5 of pain research into the delivery of health services includ6 ing mental health services to chronic pain patients and

7 those needing end-of-life care. The Secretary shall use un8 obligated amounts appropriated for the Department of

9 Health and Human Services to carry out this section.

10 TITLE V—DEMONSTRATION

11 PROJECTS

12 SEC. 501. PROVIDER PERFORMANCE STANDARDS FOR IM13 PROVEMENT IN PAIN AND SYMPTOM MAN14 AGEMENT.

15 (a) IN GENERAL.—The Secretary, acting through the

16 Health Resources Services Administration, shall award

17 grants for the establishment of not less than 5 demonstra18 tion projects to determine effective methods to measure

19 improvement in the skills, knowledge, and attitudes and

20 beliefs of health care personnel in pain and symptom man21 agement as such skill, knowledge, and attitudes and beliefs

22 apply to providing services to chronic pain patients and

23 those patients requiring pain and symptom management

24 at the end of life.

25 (b) EVALUATION.—Projects established under sub26 section (a) shall be evaluated to determine patient and
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1 caregiver knowledge and attitudes toward pain and symp2 tom management.

3 (c) APPLICATION.—To be eligible to receive a grant

4 under subsection (a), an entity shall prepare and submit

5 to the Secretary an application at such time, in such man6 ner and containing such information as the Secretary may

7 require.

8 (d) TERMINATION.—A project established under sub9 section (a) shall terminate after the expiration of the 2-

10 year period beginning on the date on which such project

11 was established.

12 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

13 authorized to be appropriated such sums as may be nec14 essary to carry out this section.

15 SEC. 502. END OF LIFE CARE DEMONSTRATION PROJECTS.

16 The Secretary, acting through the Health Resources

17 and Services Administration, shall—

18 (1) not later than January 1, 2004, carry out

19 not less than 5 demonstration and evaluation

20 projects that implement care models for individuals

21 at the end of life, at least one of which shall be de22 veloped to assist those individuals who are terminally

23 ill and have no family or extended support, and each

24 of which may be carried out in collaboration with do-
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1 mestic and international entities to gain and share

2 knowledge and experience on end of life care;

3 (2) conduct 3 demonstration and evaluation ac4 tivities concerning the education and training of cli5 nicians in end of life care, and assist in the develop6 ment and distribution of accurate educational mate7 rials on both pain and symptom management and

8 end of life care;

9 (3) in awarding grants for the training of

10 health professionals, give priority to awarding grants

11 to entities that will provide training for health pro12 fessionals in pain and symptom management and in

13 end-of-life care at the undergraduate level;

14 (4) shall evaluate demonstration projects car15 ried out under this section within the 5-year period

16 beginning on the commencement of each such

17 project; and

18 (5) develop a strategy and make recommenda19 tions to Congress to ensure that the United States

20 health care system—

21 (A) has a meaningful, comprehensive, and

22 effective approach to meet the needs of individ23 uals and their caregivers as the patient ap24 proaches death; and
29

•S 1024 IS

1 (B) integrates broader supportive services.

Æ