I 

110TH CONGRESS 

2D SESSION H. R. 5465 

To require the Department of Defense to implement a pain care initiative, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 14, 2008 

Mr. LOEBSACK (for himself, Mr. GILCHREST, Mr. BISHOP of Georgia, Mr. 

JOHNSON of Georgia, Mr. BRADY of Pennsylvania, Mr. ABERCROMBIE, 

Mr. BRALEY of Iowa, Ms. HOOLEY, and Ms. SHEA-PORTER) introduced 

the following bill; which was referred to the Committee on Armed Services 

A BILL 

To require the Department of Defense to implement a pain 

care initiative, 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 AND TABLE OF CONTENTS. 

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

5 ‘‘Military Pain Care Act of 2008’’. 

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

7 this Act is as follows: 

Sec. 1. Short title and table of contents. 

Sec. 2. Findings. 

Sec. 3. Pain care initiative in military health care facilities. 

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Sec. 4. Pain care standards in TRICARE plans. 

Sec. 5. Report of Comptroller General. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Acute and chronic pain are prevalent condi4 tions among active duty and retired military per5 sonnel. 

6 (2) Characteristics of modern warfare, includ7 ing the use of improvised explosive devices, produce 

8 substantial numbers of battlefield casualties with 

9 significant damage to both the central and periph10 eral nervous systems. 

11 (3) The successes of military health care both 

12 on and off the battlefield result in high survival 

13 rates of severely injured military personnel who will 

14 be afflicted with significant pain disorders on either 

15 an acute or chronic basis. 

16 (4) Failure to treat acute pain promptly and 

17 appropriately at the time of injury, during initial 

18 medical and surgical care, and at the time of transi19 tion to community-based care, contributes to the de20 velopment of long-term chronic pain syndromes, in 

21 some cases accompanied by long-term mental health 

22 and substance abuse disorders. 

23 (5) Pain is a leading cause of short- and long24 term disability among military personnel. 

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1 (6) The military health care systems have im2 plemented important pain care programs at some fa3 cilities and in some areas, but comprehensive pain 

4 care is not consistently provided on a uniform basis 

5 throughout the systems to all patients in need of 

6 such care. 

7 (7) Inconsistent and ineffective pain care leads 

8 to pain-related impairments, occupational disability, 

9 and medical and mental complications with long10 term costs for the military health and disability sys11 tems, and for society at large. 

12 (8) Research, diagnosis, treatment, and man13 agement of acute and chronic pain in the active duty 

14 and retired military populations constitute health 

15 care priorities of the United States. 

16 SEC. 3. PAIN CARE INITIATIVE IN MILITARY HEALTH CARE 

17 FACILITIES. 

18 (a) REQUIREMENT.— 

19 (1) IN GENERAL.—Chapter 55 of title 10, 

20 United States Code, is amended by adding at the 

21 end the following new section: 

22 ‘‘§ 1110a. Pain care 

23 ‘‘(a) PAIN CARE INITIATIVE REQUIREMENT.—The 

24 Secretary of Defense, in coordination with the Secretary 

25 of Veterans Affairs, the Secretary of Health and Human 

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1 Services, and the Surgeon General of the United States, 

2 shall develop and implement a pain care initiative in all 

3 health care facilities of the uniformed services. 

4 ‘‘(b) MATTERS COVERED.—(1) The initiative shall be 

5 designed to ensure that all active and retired members of 

6 the uniformed services and their dependents receiving 

7 treatment in health care facilities of the uniformed serv8 ices— 

9 ‘‘(A) are assessed for pain at the time of admis10 sion or initial treatment, and periodically thereafter, 

11 using a professionally recognized pain assessment 

12 tool or process; and 

13 ‘‘(B) receive appropriate pain care consistent 

14 with recognized means for assessment, diagnosis, 

15 treatment and management of acute and chronic 

16 pain, including, in appropriate cases, access to spe17 cialty pain management services. 

18 ‘‘(2) The initiative shall include the training and de19 ployment of acute pain personnel and services at all Level 

20 III care facilities, and, to the extent feasible, on the battle21 field. 

22 ‘‘(c) IMPLEMENTATION.—The Secretary of Defense 

23 shall implement the pain care initiative— 

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1 ‘‘(1) in the case of inpatient care, not later than 

2 12 months after the date of the enactment of this 

3 section; and 

4 ‘‘(2) in the case of outpatient care, not later 

5 than 18 months after the date of the enactment of 

6 this section.’’. 

7 (2) CLERICAL AMENDMENT.—The table of sec8 tions at the beginning of such chapter is amended 

9 by adding at the end the following new item: 

‘‘1110a. Pain care.’’. 

10 (b) REPORT.—Not later than nine months after the 

11 date of the enactment of this Act, the administering Secre12 taries (as defined in section 1072(3) of title 10, United 

13 States Code), shall submit to the congressional defense 

14 committees a report on the status of the development and 

15 implementation of the pain care initiative required under 

16 section 1110a of title 10, United States Code, as added 

17 by subsection (a). 

18 SEC. 4. PAIN CARE STANDARDS IN TRICARE PLANS. 

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

20 States Code, is amended by adding at the end the fol21 lowing new subsection: 

22 ‘‘(f) PAIN CARE STANDARDS.—(1) Any contract en23 tered into under this section shall include the provision 

24 of appropriate care for the treatment of patients in pain 

25 that— 

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1 ‘‘(A) is consistent with recognized means for as2 sessment, diagnosis, treatment, and management of 

3 acute and chronic pain; 

4 ‘‘(B) includes evaluation and treatment of ac5 companying illnesses, including depression, other 

6 mental health disorders, sleep disturbance, and sub7 stance abuse; 

8 ‘‘(C) provides medical and other health services 

9 through physicians and other practitioners appro10 priately credentialed or experienced in pain manage11 ment; 

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

13 chronic pain to specialists, and, in appropriate cases, 

14 to a comprehensive multidisciplinary pain manage15 ment program; 

16 ‘‘(E) continues treatment for as long as treat17 ment is required to maximize the quality of life and 

18 functional capacity of the patient; and 

19 ‘‘(F) permits physicians and other practitioners 

20 appropriately credentialed or experienced in pain 

21 management to make clinical decisions with respect 

22 to the need for and the extent and duration of pain 

23 care services. 

24 ‘‘(2) In this subsection: 

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1 ‘‘(A) The term ‘chronic pain’ means severe, per2 sistent, or recurrent pain, regardless of causation or 

3 body location, that interferes with the activities of 

4 daily living, and has not been significantly reduced 

5 or ameliorated despite reasonable treatment efforts. 

6 ‘‘(B) The term ‘comprehensive multidisciplinary 

7 pain management program’ means an inpatient or 

8 outpatient health care facility or program that— 

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

10 mental health, and rehabilitation services 

11 through licensed health care professionals; 

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

13 of inpatient and outpatient hospital and reha14 bilitation facility services, drugs, devices, and 

15 other items and services required for the treat16 ment of chronic pain; 

17 ‘‘(iii) provides ongoing patient and profes18 sional education for pain management; 

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

20 management program by an accrediting organi21 zation approved by the Secretary, including the 

22 Joint Commission on the Accreditation of 

23 Health Care Organizations or the Rehabilita24 tion Accreditation Commission; and 

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

2 credentialed in pain management (or, in appro3 priate cases, dentistry) by a board or boards 

4 approved by the Secretary, which shall include 

5 the American Board of Pain Medicine and 

6 boards recognized by the American Board of 

7 Medical Specialties. 

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

9 the requirements set forth in this subsection by providing 

10 care through its own network of participating providers, 

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

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

13 enrollees in the form of deductibles, copayments, pre14 miums, or otherwise, in the event appropriate pain care 

15 in accordance with the standards set forth in this sub16 section is provided out-of-network.’’. 

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

18 subsection (a) shall apply to contracts entered into on or 

19 after the date occurring one year after the date of the en20 actment of this Act. 

21 SEC. 5. REPORT OF COMPTROLLER GENERAL. 

22 (a) REPORT.—The Comptroller General shall conduct 

23 a study of, and deliver to the congressional defense com24 mittees not later than six months after the date of the 

25 enactment of this Act a report on, the adequacy of pain 

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1 care in the health care facilities, services, and programs 

2 of the Department of Defense. 

3 (b) PURPOSES.—The purposes of the study and re4 port shall be to evaluate the consistency, across programs, 

5 facilities, relevant demographic groups, and geographic re6 gions, with which— 

7 (1) patients are initially assessed and periodi8 cally reassessed for pain; 

9 (2) both acute and chronic pain are promptly 

10 and appropriately diagnosed, treated, and managed; 

11 (3) patients and their families or other care12 givers are included as active participants in pain 

13 management; 

14 (4) pain care is provided in a comprehensive 

15 and interdisciplinary manner where appropriate; and 

16 (5) health care professionals in military facili17 ties are adequately trained in pain management. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—For pur19 poses of carrying out this section, there is authorized to 

20 be appropriated such sums as may be necessary for fiscal 

21 years 2009 through 2011. 

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