I

106TH CONGRESS

1ST SESSION H. R. 2188

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 14, 1999

Ms. HOOLEY of Oregon (for herself, Mr. GREENWOOD, Mr. LEVIN, Mrs.

JOHNSON of Connecticut, and Mrs. MALONEY of New York) introduced

the following bill; which was referred to the Committee on 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.

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 1999’’.

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

7 this Act is as follows:
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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.

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 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) despite the best intentions of physicians,

4 nurses, pharmacists, and other health care profes5 sionals, pain is often under-treated because of the

6 inadequate training of physicians in pain manage7 ment;

8 (6) despite the best intentions of physicians,

9 nurses, pharmacists, and other health care profes10 sionals, pain and symptom management is often

11 suboptimal because the health care system has fo12 cused on cure of disease rather than the manage13 ment of a patient’s pain and other symptoms;

14 (7) the technology and scientific basis to ade15 quately manage most pain is known;

16 (8) pain should be considered the fifth vital

17 sign; and

18 (9) coordination of Federal efforts is needed to

19 improve access to high quality effective pain and

20 symptom management in order to assure the needs

21 of chronic pain patients and those who are termi22 nally ill are met.

23 SEC. 3. DEFINITIONS.

24 In this Act:
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1 (1) CHRONIC PAIN.—The term ‘‘chronic pain’’

2 means a pain state that is persistent and in which

3 the cause of the pain cannot be removed or other4 wise treated. Such term includes pain that may be

5 associated with long-term incurable or intractable

6 medical conditions or disease.

7 (2) DRUG THERAPY MANAGEMENT SERVICES.—

8 The term ‘‘drug therapy management services’’

9 means consultations with a physician concerning a

10 patient which results in the physician—

11 (A) changing the drug regimen of the pa12 tient to avoid an adverse drug interaction with

13 another drug or disease state;

14 (B) changing an inappropriate drug dosage

15 or dosage form with respect to the patient;

16 (C) discontinuing an unnecessary or harm17 ful medication with respect to the patient;

18 (D) initiating drug therapy for a medical

19 condition of the patient; or

20 (E) consulting with the patient or a care21 giver in a manner that results in a significant

22 improvement in drug regimen compliance.

23 Such term includes services provided by a physician,

24 pharmacist, or other health care professional who is

25 legally authorized to furnish such services under the
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1 law of the State in which such services are fur2 nished.

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

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

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

6 or her life, who is suffering from 1 or more condi7 tions for which treatment toward a cure or reason8 able improvement is not possible, and whose focus of

9 care is palliative rather than curative.

10 (4) FAMILY SUPPORT NETWORK.—The term

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

12 or more individuals or entities in a collaborative ef13 fort to develop multi-disciplinary integrated patient

14 care approaches that involve medical staff and ancil15 lary services to provide support to chronic pain pa16 tients and patients at the end of life and their care17 givers across a broad range of settings in which pain

18 management might be delivered.

19 (5) HOSPICE.—The term ‘‘hospice care’’ has

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

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

22 (6) PAIN AND SYMPTOM MANAGEMENT.—The

23 term ‘‘pain and symptom management’’ means serv24 ices provided to relieve physical or psychological pain
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1 or suffering, including any 1 or more of the fol2 lowing physical complaints—

3 (A) weakness and fatigue;

4 (B) shortness of breath;

5 (C) nausea and vomiting;

6 (D) diminished appetite;

7 (E) wasting of muscle mass;

8 (F) difficulty in swallowing;

9 (G) bowel problems;

10 (H) dry mouth;

11 (I) failure of lymph drainage resulting in

12 tissue swelling;

13 (J) confusion;

14 (K) dementia;

15 (L) anxiety; and

16 (M) depression.

17 (7) PALLIATIVE CARE.—The term ‘‘palliative

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

19 is not responsive to curative treatment, the goal of

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

21 patients and their families. Such care—

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

23 other symptoms, including psychological, social

24 and spiritual problems;
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1 (B) affirms life and regards dying as a

2 normal process;

3 (C) provides relief from pain and other dis4 tressing symptoms;

5 (D) integrates the psychological and spir6 itual aspects of patient care;

7 (E) offers a support system to help pa8 tients live as actively as possible until death;

9 and

10 (F) offers a support system to help the

11 family cope during the patient’s illness and in

12 their own bereavement.

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

14 the Secretary of Health and Human Services.

15 TITLE I—EMERGENCY RE16 SPONSE TO THE PUBLIC

17 HEALTH CRISIS OF PAIN

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

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

20 months after the date of enactment of this Act, the Sec21 retary, acting through the Agency for Health Care Policy

22 Research, shall develop and maintain an Internet website

23 to provide information to individuals, health care practi24 tioners, and health facilities concerning evidence-based

25 practice guidelines developed for the treatment of pain.
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1 (b) REQUIREMENTS.—The website established under

2 subsection (a) shall—

3 (1) be designed to be quickly referenced by

4 health care practitioners; and

5 (2) provide for the updating of guidelines as

6 scientific data warrants.

7 (c) PROVIDER ACCESS TO GUIDELINES.—

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

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

10 health care facilities have made the website known

11 to health care practitioners and that the website is

12 easily available to all health care personnel providing

13 care or services at a health care facility.

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

15 the information described in paragraph (1) available

16 to health care personnel, the facility involved shall

17 ensure that such personnel have access to the

18 website through the computer equipment of the facil19 ity and shall carry out efforts to inform personnel at

20 the facility of the location of such equipment.

21 (3) RURAL AREAS.—

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

23 particularly a facility located in a rural or un24 derserved area, without access to the Internet

25 shall provide an alternative means of providing
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1 practice guideline information to health care

2 personnel.

3 (B) ALTERNATIVE MEANS.—The Secretary

4 shall determine appropriate alternative means

5 by which a health care facility may make avail6 able practice guideline information on a 24-hour

7 basis, 7 days a week if the facility does not

8 have Internet access. The criteria for adopting

9 such alternative means should be clear in per10 mitting facilities to develop alternative means

11 without placing a significant financial burden

12 on the facility and in permitting flexibility for

13 facilities to develop alternative means of making

14 guidelines available. Such criteria shall be pub15 lished in the Federal Register.

16 SEC. 102. PATIENT EXPECTATIONS TO HAVE PAIN AND

17 SYMPTOM MANAGEMENT.

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

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

20 part of any informational materials provided to individuals

21 under such programs, such materials shall include infor22 mation, where relevant, to inform such individuals that

23 they should expect to have their pain managed, an addi24 tion to other symptom management, when receiving bene25 fits under such program.
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1 (b) PROGRAMS.—The programs described in this sub2 section shall include—

3 (1) the medicare and medicaid programs under

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

5 U.S.C. 1935 et seq., 1936 et seq.);

6 (2) programs carried out through the Public

7 Health Service;

8 (3) programs carried out through the Indian

9 Health Service;

10 (4) programs carried out through health centers

11 under section 330 of the Public Health Service Act

12 (42 U.S.C. 254b);

13 (4) the Federal Employee Health Benefits Pro14 gram under title 5, United States Code;

15 (5) the Civilian Health and Medical Program of

16 the Uniformed Services (CHAMPUS) as defined in

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

18 (6) other programs administered by the Sec19 retary.

20 SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS.

21 The Secretary shall provide funds for the implemen22 tation of special education projects, in as many States as

23 is practicable, to be carried out by peer review organiza24 tions of the type described in section 1152 of the Social

25 Security Act (42 U.S.C. 1320c–1) to improve the quality
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1 of pain and symptom management. Such projects shall

2 place an emphasis on improving pain and symptom man3 agement at the end of life, and may also include efforts

4 to increase the quality of services delivered to chronic pain

5 patients.

6 SEC. 105. PAIN COVERAGE QUALITY EVALUATION AND IN7 FORMATION.

8 (a) MEDICARE+CHOICE PLANS.—

9 (1) IN GENERAL.—Section 1851(d)(4) of the

10 Social Security Act (42 U.S.C. 42 U.S.C. 1395w–

11 21(d)(4)) is amended—

12 (A) in subparagraph (A), by adding at the

13 end the following:

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

15 pain and symptom management.’’; and

16 (B) in subparagraph (D)—

17 (i) in clause (iii), by striking ‘‘and’’ at

18 the end;

19 (ii) in clause (iv), by striking the pe20 riod and inserting ‘‘, and’’; and

21 (iii) by adding at the end the fol22 lowing:

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

24 date of enactment of this clause, an eval25 uation (which may be made part of any
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1 other relevant report of quality evaluation

2 that the plan is required to prepare) for

3 the plan (updated annually) that indicates

4 the performance of the plan with respect to

5 access to, and quality of, pain and symp6 tom management, including such manage7 ment as part of end of life care.’’.

8 (2) EFFECTIVE DATE.—The amendments made

9 by paragraph (1) apply to information provided with

10 respect to annual, coordinated election periods (as

11 defined in section 1851(e)(3)(B) of the Social Secu12 rity Act (42 U.S.C. 1395–21(e)(3)(B)) beginning

13 after the date of enactment of this Act.

14 (b) INCLUSION OF PAIN MEASUREMENTS IN FED15 ERAL HEALTH PROGRAMS.—

16 (1) IN GENERAL.—Not later than 1 year after

17 the date of enactment of this Act, the Secretary

18 shall make a determination as to the manner in

19 which to include measurements of pain and symptom

20 management in the programs under titles XVIII and

21 XIX of the Social Security Act (42 U.S.C. 1395 et

22 seq. and 1396 et seq.) and in other appropriate Fed23 eral program.

24 (2) DEVELOPMENT OF MEASUREMENTS.—The

25 determination required under paragraph (1) shall be
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1 developed in consultation with the Administrator of

2 the Agency for Health Care Policy and Research

3 and the Director of the National Institutes of

4 Health.

5 SEC. 106. SURGEON GENERAL’S REPORT.

6 Not later than October 1, 2000, the Surgeon General

7 shall prepare and submit to the appropriate committees

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

9 of pain and symptom management in the United States.

10 The report shall include—

11 (1) a description of the legal and regulatory

12 barriers that may exist at the Federal and State lev13 els to providing adequate pain and symptom man14 agement;

15 (2) an evaluation of provider competency in

16 providing pain and symptom management;

17 (3) an identification of vulnerable populations,

18 including children, advanced elderly, non-English

19 speakers, and minorities, who may be likely to be

20 underserved or may face barriers to access to pain

21 management and recommendations to improve ac22 cess to pain management for these populations;

23 (4) an identification of barriers that may exist

24 in providing pain and symptom management in
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1 health care settings, including assisted living facili2 ties;

3 (5) and identification of patient and family atti4 tudes that may exist which pose barriers in access5 ing pain and symptom management or in the proper

6 use of pain medications;

7 (6) an evaluation of medical school training and

8 residency training for pain and symptom manage9 ment; and

10 (7) a review of continuing medical education

11 programs in pain and symptom management.

12 TITLE II—DEVELOPING

13 COMMUNITY RESOURCES

14 SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMP15 TOM MANAGEMENT.

16 (a) ESTABLISHMENT.—The Secretary, acting

17 through the Public Health Service, shall award grants for

18 the establishment of 6 National Family Support Networks

19 in Pain and Symptom Management (in this section re20 ferred to as the ‘‘Networks’’) to serve as national models

21 for improving the access and quality of pain and symptom

22 management to chronic pain patients and those individ23 uals in need of pain and symptom management at the end

24 of life and to provide assistance to family members and

25 caregivers.
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1 (b) ELIGIBILITY AND DISTRIBUTION.—

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

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

4 (A) be an academic facility or other entity

5 that has demonstrated an effective approach to

6 training health care providers concerning pain

7 and symptom management and palliative care

8 services; and

9 (B) prepare and submit to the Secretary

10 an application (to be peer reviewed by a com11 mittee established by the Secretary), at such

12 time, in such manner, and containing such in13 formation as the Secretary may require.

14 (2) DISTRIBUTION.—In providing for the estab15 lishment of Networks under subsection (a), the Sec16 retary shall ensure that—

17 (A) the geographic distribution of such

18 Networks reflects a balance between rural and

19 urban needs; and

20 (B) at least 3 Networks are established at

21 academic facilities.

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

23 established under this section shall—
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1 (1) provide for an integrated interdisciplinary

2 approach to the delivery of pain and symptom man3 agement;

4 (2) provide community leadership in estab5 lishing and expanding public access to appropriate

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

7 (3) provide assistance through caregiver and be8 reavement supportive services;

9 (4) develop a research agenda to promote effec10 tive pain and symptom management for the broad

11 spectrum of patients in need of access to such care

12 that can be implemented by the Network;

13 (5) provide for coordination and linkages be14 tween clinical services in academic centers and sur15 rounding communities to assist in the widespread

16 dissemination of provider and patient information

17 concerning how to access options for pain manage18 ment;

19 (6) establish telemedicine links to provide edu20 cation and for the delivery of services in pain and

21 symptom management; and

22 (7) develop effective means of providing assist23 ance to providers and families for the management

24 of a patient’s pain 24 hours a day, 7 days a week.
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1 (d) PROVIDER PAIN AND SYMPTOM MANAGEMENT

2 COMMUNICATIONS PROJECTS.—

3 (1) IN GENERAL.—Each Network shall estab4 lish a process to provide health care personnel with

5 information 24 hours a day, 7 days a week, con6 cerning pain and symptom management. Such proc7 ess shall be designed to test the effectiveness of spe8 cific forms of communications with health care per9 sonnel so that such personnel may obtain informa10 tion to ensure that all appropriate patients are pro11 vided with pain and symptom management.

12 (2) TERMINATION.—The requirement of para13 graph (1) shall terminate with respect to a Network

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

15 the Network has established the communications

16 method.

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

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

19 paragraph (2), a Network shall conduct an evalua20 tion and prepare and submit to the Secretary a re21 port concerning the costs of operation and whether

22 the form of communication can be shown to have

23 had a positive impact on the care of patients in

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

25 life.
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1 (4) RULE OF CONSTRUCTION.—Nothing in this

2 subsection shall be construed as limiting a Network

3 from developing other ways in which to provide sup4 port to families and providers, 24 hours a day, 7

5 days a week.

6 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

7 authorized to be appropriated to carry out this section,

8 $18,000,000 for fiscal years 2000 through 2002.

9 TITLE III—REIMBURSEMENT

10 BARRIERS

11 SEC. 301. REIMBURSEMENT BARRIERS REPORT.

12 The Medicare Payment Advisory Commission

13 (MedPac) established under section 1805 of the Social Se14 curity Act (42 U.S.C. 1396b–6) shall conduct a study, and

15 prepare and submit to the appropriate committees of Con16 gress a report, concerning—

17 (1) the manner in which medicare policies may

18 pose barriers in providing pain and symptom man19 agement and palliative care services in different set20 tings, including a focus on payment for nursing

21 home and home health services;

22 (2) the identification of any financial barriers

23 that may exist within the medicare and medicaid

24 programs under titles XVIII and XIX of the Social

25 Security Act (42 U.S.C. 1395 et seq., 1396 et seq.)
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1 that interfere with continuity of care and inter2 disciplinary care or supportive care for the broad

3 range of chronic pain patients and for those who are

4 terminally ill, and include the recommendations of

5 the Commission on ways to eliminate those barriers

6 that the Commission may identify;

7 (3) the reimbursement barriers that exist, if

8 any, in providing pain and symptom management

9 through hospice care, particularly in rural areas, and

10 if barriers exist, recommendations concerning ad11 justments that would assist in assuring patient ac12 cess to pain and symptom management through hos13 pice care in rural areas;

14 (4) whether the medicare reimbursement system

15 provides incentives to providers to delay informing

16 terminally ill patients of the availability of hospice

17 and palliative care; and

18 (5) the impact of providing payments for drug

19 therapy management services in pain and symptom

20 management and palliative care services.

21 SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM

22 MANAGEMENT.

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

24 shall conduct a survey of public and private health insur25 ance providers, including managed care entities, to deter-
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1 mine whether the reimbursement policies of such insurers

2 inhibit the access of chronic pain patients to pain and

3 symptom management and pain and symptom manage4 ment for those in need of end-of-life care. The survey shall

5 include a review of formularies for pain medication and

6 the effect of such formularies on pain and symptom man7 agement.

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

9 of enactment of this Act, the General Accounting Office

10 shall prepare and submit to the appropriate committees

11 of Congress a report concerning the survey conducted

12 under subsection (a).

13 TITLE IV—IMPROVING FEDERAL

14 COORDINATION OF POLICY,

15 RESEARCH, AND INFORMA16 TION

17 SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM

18 MANAGEMENT.

19 (a) ESTABLISHMENT.—The Secretary shall establish

20 an advisory committee, to be known as the Advisory Com21 mittee on Pain and Symptom Management, to make rec22 ommendations to the Secretary concerning a coordinated

23 Federal agenda on pain and symptom management.

24 (b) MEMBERSHIP.—The Advisory Committee estab25 lished under subsection (a) shall be comprised of 11 indi-
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1 viduals to be appointed by the Secretary, of which at least

2 1 member shall be a representative of—

3 (1) physicians (medical doctors or doctors of os4 teopathy) who treat chronic pain patients or the ter5 minally ill;

6 (2) nurses who treat chronic pain patients or

7 the terminally ill;

8 (3) pharmacists who treat chronic pain patients

9 or the terminally ill;

10 (4) hospice;

11 (5) pain researchers;

12 (6) patient advocates;

13 (7) caregivers; and

14 (8) health insurance issuers (as such term is

15 defined in section 2791(b) of the Public Health

16 Service Act (42 U.S.C. 300gg–91(b))).

17 The members of the Committee shall designate 1 member

18 to serve as the chairperson of the Committee.

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

20 at the call of the chairperson of the Committee.

21 (d) AGENDA.—The agenda of the Advisory Com22 mittee established under subsection (a) shall include—

23 (1) the development of recommendations to cre24 ate a coordinated Federal agenda on pain and symp25 tom management;
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1 (2) the development of proposals to ensure that

2 pain is considered as the fifth vital sign for all pa3 tients;

4 (3) the identification of research needs in pain

5 and symptom management, including gaps in pain

6 and symptom management guidelines;

7 (4) the identification and dissemination of pain

8 and symptom management practice guidelines, re9 search information, and best practices;

10 (5) proposals for patient education concerning

11 how to access pain and symptom management across

12 health care settings;

13 (6) the manner in which to measure improve14 ment in access to pain and symptom management

15 and improvement in the delivery of care; and

16 (7) the development of an ongoing mechanism

17 to identify barriers or potential barriers to pain and

18 symptom management created by Federal policies.

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

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

21 established under subsection (a) shall prepare and submit

22 to the Secretary recommendations concerning a

23 prioritization of the need for a Federal agenda on pain,

24 and ways in which to better coordinate the activities of

25 entities within the Department of Health and Human
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1 Services, and other Federal entities charged with the re2 sponsibility for the delivery of health care services or re3 search on pain, with respect to pain management.

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

5 Advisory Committee shall consult with all Federal agen6 cies that are responsible for providing health care services

7 or access to health services to determine the best means

8 to ensure that all Federal activities are coordinated with

9 respect to research and access to pain and symptom man10 agement.

11 (g) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE;

12 OTHER PROVISIONS.—The following shall apply with re13 spect to the Advisory Committee:

14 (1) The Committee shall receive necessary and

15 appropriate administrative support, including appro16 priate funding, from the Department of Health and

17 Human Services.

18 (2) The Committee shall hold open meetings

19 and meet not less than 4 times per year.

20 (3) Members of the Committee shall not receive

21 additional compensation for their service. Such

22 members may receive reimbursement for appropriate

23 and additional expenses that are incurred through

24 service on the Committee which would not have in-
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1 curred had they not been a member of the Com2 mittee.

3 (4) The requirements of appendix 2 of title 5,

4 United States Code.

5 SEC. 402. INSTITUTES OF MEDICINE REPORT ON CON6 TROLLED SUBSTANCE REGULATION AND THE

7 USE OF PAIN MEDICATIONS.

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

9 contract entered into with the Institute of Medicine, shall

10 review findings that have been developed through research

11 conducted concerning—

12 (1) the effects of controlled substance regula13 tion on patient access to effective care;

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

15 underuse of pain medications, including opioids; and

16 (3) the identification of State legal and regu17 latory barriers, if any, that may impact patient ac18 cess to medications used for pain and symptom man19 agement.

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

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

22 and submit to the appropriate committees of Congress a

23 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, 2003, 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 to

6 chronic pain patients and those needing end-of-life care.

7 The Secretary shall use unobligated amounts appropriated

8 for the Department of Health and Human Services to

9 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 Public Health Service, shall award grants for the estab17 lishment of not less than 5 demonstration projects to de18 termine effective methods to measure improvement in the

19 skills and knowledge of health care personnel in pain and

20 symptom management as such skill and knowledge applies

21 to providing services to chronic pain patients and those

22 patients requiring pain and symptom management at the

23 end of life.

24 (b) EVALUATION.—Projects established under sub25 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 (d) AUTHORIZATION OF APPROPRIATIONS.—There is

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

Æ