II 

109TH CONGRESS 

1ST SESSION S. 999

To provide for a public response to the public health crisis of pain, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 11, 2005

Mr. WYDEN (for himself and Mr. SMITH) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL

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 2005’’. 

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. 

TITLE I—EMERGENCY RESPONSE TO THE PUBLIC HEALTH 

CRISIS OF PAIN 
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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; 

12 (4) 70 to 80 percent of cancer patients experi13 ence significant pain during their illness; 
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1 (5) one in 7 nursing home residents experience 

2 persistent pain that may diminish their quality of 

3 life; 

4 (6) despite the best intentions of physicians, 

5 nurses, pharmacists, and other health care profes6 sionals, pain is often under-treated because of the 

7 inadequate training of clinicians in pain manage8 ment; 

9 (7) despite the best intentions of physicians, 

10 nurses, pharmacists, mental health professionals, 

11 and other health care professionals, pain and symp12 tom management is often suboptimal because the 

13 health care system has focused on cure of disease 

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

15 other symptoms; 

16 (8) the technology and scientific basis to ade17 quately manage most pain is known; 

18 (9) pain should be considered the fifth vital 

19 sign; and 

20 (10) coordination of Federal efforts is needed to 

21 improve access to high quality effective pain and 

22 symptom management in order to assure the needs 

23 of chronic pain patients and those who are termi24 nally ill are met. 
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1 SEC. 3. DEFINITIONS. 

2 In this Act: 

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

4 means a pain state that is persistent and in which 

5 the cause of the pain cannot be removed or other6 wise alleviated. Such term includes pain that may be 

7 associated with long-term incurable or intractable 

8 medical conditions or disease. 

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

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

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

12 or her life, who is suffering from 1 or more condi13 tions for which treatment toward a cure or reason14 able improvement is not possible, and whose focus of 

15 care is palliative rather than curative. 

16 (3) FAMILY SUPPORT NETWORK.—The term 

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

18 or more individuals or entities in a collaborative ef19 fort to develop multi-disciplinary integrated patient 

20 care approaches that involve medical staff and ancil21 lary services to provide support to chronic pain pa22 tients and patients at the end of life and their care23 givers across a broad range of settings in which pain 

24 management might be delivered. 
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1 (4) HOSPICE.—The term ‘‘hospice care’’ has 

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

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

4 (5) MEDICATION THERAPY MANAGEMENT SERV5 ICES.—The term ‘‘medication therapy management 

6 services’’ means consultations with a physician or 

7 other health care professional (including a phar8 macist) who is practicing within the scope of the 

9 professional’s license, concerning a patient which re10 sults in—

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

12 patient to avoid an adverse drug interaction 

13 with another drug or disease state; 

14 (B) a change in 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) an initiation of medication therapy for 

19 a medical condition of the patient; 

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

22 improvement in drug regimen compliance; or

23 (F) patient and caregiver understanding of 

24 the appropriate use and adherence to medica25 tion therapy.
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1 (6) PAIN AND SYMPTOM MANAGEMENT.—The 

2 term ‘‘pain and symptom management’’ means serv3 ices provided to relieve physical or psychological pain 

4 or suffering, including any 1 or more of the fol5 lowing physical complaints—

6 (A) weakness and fatigue; 

7 (B) shortness of breath; 

8 (C) nausea and vomiting; 

9 (D) diminished appetite; 

10 (E) wasting of muscle mass; 

11 (F) difficulty in swallowing; 

12 (G) bowel problems; 

13 (H) dry mouth; 

14 (I) failure of lymph drainage resulting in 

15 tissue swelling; 

16 (J) confusion; 

17 (K) dementia; 

18 (L) delirium; 

19 (M) anxiety; 

20 (N) depression; and 

21 (O) other related symptoms. 

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

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

24 is not responsive to curative treatment, the goal of 
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1 which is to provide the best quality of life for such 

2 patients and their families. Such care—

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

4 other symptoms, including psychological, social 

5 and spiritual problems; 

6 (B) affirms life and regards dying as a 

7 normal process; 

8 (C) provides relief from pain and other dis9 tressing symptoms; 

10 (D) integrates the psychological and spir11 itual aspects of patient care; 

12 (E) offers a support system to help pa13 tients live as actively as possible until death; 

14 and 

15 (F) offers a support system to help the 

16 family cope during the patient’s illness and in 

17 their own bereavement. 

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

19 the Secretary of Health and Human Services. 

20 TITLE I—EMERGENCY RE21 SPONSE TO THE PUBLIC 

22 HEALTH CRISIS OF PAIN 

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

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

25 months after the date of enactment of this Act, the Sec-
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1 retary, acting through the Agency for Healthcare Re2 search and Quality, shall develop and maintain an Internet 

3 website to provide information to individuals, health care 

4 practitioners, and health facilities concerning evidence5 based practice guidelines developed for the treatment of 

6 physical and psychological pain. Websites in existence on 

7 such date may be used if such websites meet the require8 ments of this section. 

9 (b) REQUIREMENTS.—The website established under 

10 subsection (a) shall—

11 (1) be designed to be quickly referenced by 

12 health care practitioners; and 

13 (2) provide for the updating of guidelines as 

14 scientific data warrants. 

15 (c) PROVIDER ACCESS TO GUIDELINES.—

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

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

18 health care facilities have made the website known 

19 to health care practitioners and that the website is 

20 easily available to all health care personnel providing 

21 care or services at a health care facility. 

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

23 the information described in paragraph (1) available 

24 to health care personnel, the facility involved shall—
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1 (A) ensure that such personnel have access 

2 to the website through the computer equipment 

3 of the facility; 

4 (B) carry out efforts to inform personnel 

5 at the facility of the location of such equipment; 

6 and 

7 (C) ensure that patients, caregivers, and 

8 support groups are provided with access to the 

9 website. 

10 (3) RURAL AREAS.—

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

12 particularly a facility located in a rural or un13 derserved area, without access to the Internet 

14 shall provide an alternative means of providing 

15 practice guideline information to all health care 

16 personnel. 

17 (B) ALTERNATIVE MEANS.—The Secretary 

18 shall determine appropriate alternative means 

19 by which a health care facility may make avail20 able practice guideline information on a 24-hour 

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

22 have Internet access. The criteria for adopting 

23 such alternative means should be clear in per24 mitting facilities to develop alternative means 

25 without placing a significant financial burden 
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1 on the facility and in permitting flexibility for 

2 facilities to develop alternative means of making 

3 guidelines available. Such criteria shall be pub4 lished in the Federal Register. 

5 SEC. 102. PATIENT EXPECTATIONS TO HAVE PAIN AND 

6 SYMPTOM MANAGEMENT. 

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

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

9 part of any informational materials provided to individuals 

10 under such programs, such materials shall include infor11 mation, where relevant, to inform such individuals that 

12 they should expect to have their pain assessed and should 

13 expect to be provided with effective pain and symptom re14 lief, when receiving benefits under such program. 

15 (b) PROGRAMS.—The programs described in this sub16 section shall include—

17 (1) the medicare and medicaid programs under 

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

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

20 (2) programs carried out through the Public 

21 Health Service; 

22 (3) programs carried out through the Indian 

23 Health Service;
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1 (4) programs carried out through health centers 

2 under section 330 of the Public Health Service Act 

3 (42 U.S.C. 254b); 

4 (5) the Federal Employee Health Benefits Pro5 gram under title 5, United States Code; 

6 (6) the Civilian Health and Medical Program of 

7 the Uniformed Services (CHAMPUS) as defined in 

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

9 (7) other programs administered by the Sec10 retary. 

11 SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS. 

12 The Secretary shall provide funds for the implemen13 tation of special education projects, in as many States as 

14 is practicable, to be carried out by peer review organiza15 tions of the type described in section 1152 of the Social 

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

17 of pain and symptom management. Such projects shall 

18 place an emphasis on improving pain and symptom man19 agement at the end of life, and may also include efforts 

20 to increase the quality of services delivered to chronic pain 

21 patients and the chronically ill for whom pain may be a 

22 significant symptom. 
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1 SEC. 104. PAIN COVERAGE QUALITY EVALUATION AND IN2 FORMATION. 

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

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

5 amended—

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

7 the following: 

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

9 pain and symptom management.’’; and 

10 (2) in subparagraph (D)—

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

12 end; 

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

14 and inserting ‘‘, and’’; and 

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

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

17 date of enactment of this clause, an eval18 uation (which may be made part of any 

19 other relevant report of quality evaluation 

20 that the plan is required to prepare) for 

21 the plan (updated annually) that indicates 

22 the performance of the plan with respect to 

23 access to, and quality of, pain and symp24 tom management, including such manage25 ment as part of end of life care. Data shall 
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1 be posted in a comparable manner for con2 sumer use on www.medicare.gov.’’. 

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

4 paragraph (1) apply to information provided with respect 

5 to annual, coordinated election periods (as defined in sec6 tion 1851(e)(3)(B) of the Social Security Act (42 U.S.C. 

7 1395–21(e)(3)(B)) beginning after the date of enactment 

8 of this Act. 

9 SEC. 105. SURGEON GENERAL’S REPORT. 

10 Not later than October 1, 2006, the Surgeon General 

11 shall prepare and submit to the appropriate committees 

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

13 of pain and symptom management in the United States. 

14 The report shall include—

15 (1) a description of the legal and regulatory 

16 barriers that may exist at the Federal and State lev17 els to providing adequate pain and symptom man18 agement; 

19 (2) an evaluation of provider competency in 

20 providing pain and symptom management; 

21 (3) an identification of vulnerable populations, 

22 including children, advanced elderly, non-English 

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

24 underserved or may face barriers to access to pain 
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1 management and recommendations to improve ac2 cess to pain management for these populations; 

3 (4) an identification of barriers that may exist 

4 in providing pain and symptom management in 

5 health care settings, including assisted living facili6 ties; 

7 (5) an identification of patient and family atti8 tudes that may exist which pose barriers in access9 ing pain and symptom management or in the proper 

10 use of pain medications; 

11 (6) an evaluation of medical, nursing, and phar12 macy school training and residency training for pain 

13 and symptom management; 

14 (7) a review of continuing medical education 

15 programs in pain and symptom management; and 

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

17 mental health services for patients in pain and pa18 tients at the end of life.

19 TITLE II—DEVELOPING 

20 COMMUNITY RESOURCES 

21 SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMP22 TOM MANAGEMENT. 

23 (a) ESTABLISHMENT.—The Secretary, acting 

24 through the Public Health Service, shall award grants for 

25 the establishment of 6 National Family Support Networks 
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1 in Pain and Symptom Management (in this section re2 ferred to as the ‘‘Networks’’) to serve as national models 

3 for improving the access and quality of pain and symptom 

4 management to chronic pain patients (including chron5 ically ill patients for whom pain is a significant symptom) 

6 and those individuals in need of pain and symptom man7 agement at the end of life and to provide assistance to 

8 family members and caregivers. 

9 (b) ELIGIBILITY AND DISTRIBUTION.—

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

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

12 (A) be an academic facility or other entity 

13 that has demonstrated an effective approach to 

14 training health care providers including mental 

15 health professionals concerning pain and symp16 tom management and palliative care services; 

17 and 

18 (B) prepare and submit to the Secretary 

19 an application (to be peer reviewed by a com20 mittee established by the Secretary), at such 

21 time, in such manner, and containing such in22 formation as the Secretary may require.

23 (2) DISTRIBUTION.—In providing for the estab24 lishment of Networks under subsection (a), the Sec25 retary shall ensure that—
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1 (A) the geographic distribution of such 

2 Networks reflects a balance between rural and 

3 urban needs; and 

4 (B) at least 3 Networks are established at 

5 academic facilities. 

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

7 established under this section— 

8 (1) shall provide for an integrated interdiscipli9 nary approach, that includes psychological and coun10 seling services, to the delivery of pain and symptom 

11 management; 

12 (2) shall provide community leadership in estab13 lishing and expanding public access to appropriate 

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

15 (3) shall provide assistance, through caregiver 

16 supportive services, that include counseling and edu17 cation services; 

18 (4) shall develop a research agenda to promote 

19 effective pain and symptom management for the 

20 broad spectrum of patients in need of access to such 

21 care that can be implemented by the Network; 

22 (5) shall provide for coordination and linkages 

23 between clinical services in academic centers and 

24 surrounding communities to assist in the widespread 

25 dissemination of provider and patient information 
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1 concerning how to access options for pain manage2 ment; 

3 (6) shall establish telemedicine links to provide 

4 education and for the delivery of services in pain and 

5 symptom management; 

6 (7) shall develop effective means of providing 

7 assistance to providers and families for the manage8 ment of a patient’s pain 24 hours a day, 7 days a 

9 week; and 

10 (8) may include complimentary medicine pro11 vided in conjunction with traditional medical serv12 ices. 

13 (d) PROVIDER PAIN AND SYMPTOM MANAGEMENT

14 COMMUNICATIONS PROJECTS.—

15 (1) IN GENERAL.—Each Network shall estab16 lish a process to provide health care personnel with 

17 information 24 hours a day, 7 days a week, con18 cerning pain and symptom management. Such proc19 ess shall be designed to test the effectiveness of spe20 cific forms of communications with health care per21 sonnel so that such personnel may obtain informa22 tion to ensure that all appropriate patients are pro23 vided with pain and symptom management. 

24 (2) TERMINATION.—The requirement of para25 graph (1) shall terminate with respect to a Network 
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1 on the day that is 2 years after the date on which 

2 the Network has established the communications 

3 method. 

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

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

6 paragraph (2), a Network shall conduct an evalua7 tion and prepare and submit to the Secretary a re8 port concerning the costs of operation and whether 

9 the form of communication can be shown to have 

10 had a positive impact on the care of patients in 

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

12 life. 

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

14 subsection shall be construed as limiting a Network 

15 from developing other ways in which to provide sup16 port to families and providers, 24 hours a day, 7 

17 days a week. 

18 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

19 authorized to be appropriated to carry out this section, 

20 $18,000,000 for fiscal years 2005 through 2007. 

21 TITLE III—REIMBURSEMENT 

22 BARRIERS 

23 SEC. 301. REIMBURSEMENT BARRIERS REPORT. 

24 The Medicare Payment Advisory Commission 

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

2 prepare and submit to the appropriate committees of Con3 gress a report, concerning—

4 (1) the manner in which medicare policies may 

5 pose barriers in providing pain and symptom man6 agement and palliative care services in different set7 tings, including a focus on payment for nursing 

8 home and home health services; 

9 (2) the identification of any financial barriers 

10 that may exist within the medicare and medicaid 

11 programs under titles XVIII and XIX of the Social 

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

13 that interfere with continuity of care and inter14 disciplinary care or supportive care for the broad 

15 range of chronic pain patients (including patients 

16 who are chronically ill for whom pain is a significant 

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

18 include the recommendations of the Commission on 

19 ways to eliminate those barriers that the Commis20 sion may identify; 

21 (3) the reimbursement barriers that exist, if 

22 any, in providing pain and symptom management 

23 through hospice care, particularly in rural areas, and 

24 if barriers exist, recommendations concerning ad25 justments that would assist in assuring patient ac-
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1 cess to pain and symptom management through hos2 pice care in rural areas; 

3 (4) whether the medicare reimbursement system 

4 provides incentives to providers to delay informing 

5 terminally ill patients of the availability of hospice 

6 and palliative care; and 

7 (5) the impact of providing payments for medi8 cation therapy management services in pain and 

9 symptom management and palliative care services. 

10 SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM 

11 MANAGEMENT. 

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

13 shall conduct a survey of public and private health insur14 ance providers, including managed care entities, to deter15 mine whether the reimbursement policies of such insurers 

16 inhibit the access of chronic pain patients to pain and 

17 symptom management and pain and symptom manage18 ment for those in need of end-of-life care (including pa19 tients who are chronically ill for whom pain is a significant 

20 symptom). The survey shall include a review of

21 formularies for pain medication and the effect of such 

22 formularies on pain and symptom management. 

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

24 of enactment of this Act, the General Accounting Office 

25 shall prepare and submit to the appropriate committees
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1 of Congress a report concerning the survey conducted 

2 under subsection (a). 

3 TITLE IV—IMPROVING FEDERAL 

4 COORDINATION OF POLICY, 

5 RESEARCH, AND INFORMA6 TION 

7 SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM 

8 MANAGEMENT. 

9 (a) ESTABLISHMENT.—The Secretary shall establish 

10 an advisory committee, to be known as the Advisory Com11 mittee on Pain and Symptom Management, to make rec12 ommendations to the Secretary concerning a coordinated 

13 Federal agenda on pain and symptom management. 

14 (b) MEMBERSHIP.—The Advisory Committee estab15 lished under subsection (a) shall be comprised of 11 indi16 viduals to be appointed by the Secretary, of which at least 

17 1 member shall be a representative of—

18 (1) physicians (medical doctors or doctors of os19 teopathy) who treat chronic pain patients or the ter20 minally ill; 

21 (2) nurses who treat chronic pain patients or 

22 the terminally ill; 

23 (3) pharmacists; 

24 (4) hospice; 

25 (5) pain researchers; 
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1 (6) patient advocates; 

2 (7) caregivers; and 

3 (8) mental health providers. 

4 The members of the Committee shall designate 1 member 

5 to serve as the chairperson of the Committee. 

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

7 at the call of the chairperson of the Committee. 

8 (d) AGENDA.—The agenda of the Advisory Com9 mittee established under subsection (a) shall include—

10 (1) the development of recommendations to cre11 ate a coordinated Federal agenda on pain and symp12 tom management; 

13 (2) the development of proposals to ensure that 

14 pain is considered as the fifth vital sign for all pa15 tients; 

16 (3) the identification of research needs in pain 

17 and symptom management, including gaps in pain 

18 and symptom management guidelines; 

19 (4) the identification and dissemination of pain 

20 and symptom management practice guidelines, re21 search information, and best practices; 

22 (5) proposals for patient education concerning 

23 how to access pain and symptom management across 

24 health care settings; 
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1 (6) the manner in which to measure improve2 ment in access to pain and symptom management 

3 and improvement in the delivery of care; 

4 (7) the development of ongoing strategies to as5 sure the aggressive use of pain medications, includ6 ing opiods, regardless of health care setting; and 

7 (8) the development of an ongoing mechanism 

8 to identify barriers or potential barriers to pain and 

9 symptom management created by Federal policies. 

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

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

12 established under subsection (a) shall prepare and submit 

13 to the Secretary recommendations concerning a 

14 prioritization of the need for a Federal agenda on pain 

15 and symptom management, and ways in which to better 

16 coordinate the activities of entities within the Department 

17 of Health and Human Services, and other Federal entities 

18 charged with the responsibility for the delivery of health 

19 care services or research on pain and symptom manage20 ment with respect to pain management. 

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

22 Advisory Committee shall consult with all Federal agen23 cies that are responsible for providing health care services 

24 or access to health services to determine the best means 

25 to ensure that all Federal activities are coordinated with 
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1 respect to research and access to pain and symptom man2 agement. 

3 (g) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE; 

4 OTHER PROVISIONS.—The following shall apply with re5 spect to the Advisory Committee: 

6 (1) The Committee shall receive necessary and 

7 appropriate administrative support, including appro8 priate funding, from the Department of Health and 

9 Human Services. 

10 (2) The Committee shall hold open meetings 

11 and meet not less than 4 times per year. 

12 (3) Members of the Committee shall not receive 

13 additional compensation for their service. Such 

14 members may receive reimbursement for appropriate 

15 and additional expenses that are incurred through 

16 service on the Committee which would not have in17 curred had they not been a member of the Com18 mittee.

19 (4) The requirements of Appendix 2 of title 5, 

20 United States Code. 

21 SEC. 402. INSTITUTES OF MEDICINE REPORT ON CON22 TROLLED SUBSTANCE REGULATION AND THE 

23 USE OF PAIN MEDICATIONS. 

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

25 contract entered into with the Institute of Medicine, shall
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1 review findings that have been developed through research 

2 conducted concerning—

3 (1) the effects of controlled substance regula4 tion on patient access to effective care; 

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

6 underuse of pain medications, including opiods; 

7 (3) the identification of State legal and regu8 latory barriers, if any, that may impact patient ac9 cess to medications used for pain and symptom man10 agement; and 

11 (4) strategies to assure the aggressive use of 

12 pain medications, including opiods, regardless of 

13 health care setting. 

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

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

16 and submit to the appropriate committees of Congress a 

17 report concerning the findings described in subsection (a). 

18 SEC. 403. CONFERENCE ON PAIN RESEARCH AND CARE. 

19 Not later than December 31, 2007, the Secretary, 

20 acting through the National Institutes of Health, shall 

21 convene a national conference to discuss the translation 

22 of pain research into the delivery of health services includ23 ing mental health services to chronic pain patients and 

24 those needing end-of-life care. The Secretary shall use un-
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1 obligated amounts appropriated for the Department of 

2 Health and Human Services to carry out this section. 

3 TITLE V—DEMONSTRATION 

4 PROJECTS 

5 SEC. 501. PROVIDER PERFORMANCE STANDARDS FOR IM6 PROVEMENT IN PAIN AND SYMPTOM MAN7 AGEMENT. 

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

9 Health Resources Services Administration, shall award 

10 grants for the establishment of not less than 5 demonstra11 tion projects to determine effective methods to measure 

12 improvement in the skills, knowledge, and attitudes and 

13 beliefs of health care personnel in pain and symptom man14 agement as such skill, knowledge, and attitudes and beliefs 

15 apply to providing services to chronic pain patients and 

16 those patients requiring pain and symptom management 

17 at the end of life. 

18 (b) EVALUATION.—Projects established under sub19 section (a) shall be evaluated to determine patient and 

20 caregiver knowledge and attitudes toward pain and symp21 tom management. 

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

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

24 to the Secretary an application at such time, in such man-
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1 ner and containing such information as the Secretary may 

2 require. 

3 (d) TERMINATION.—A project established under sub4 section (a) shall terminate after the expiration of the 2-

5 year period beginning on the date on which such project 

6 was established. 

7 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

8 authorized to be appropriated such sums as may be nec9 essary to carry out this section. 

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

11 The Secretary, acting through the Health Resources 

12 and Services Administration, shall—

13 (1) not later than January 1, 2007, carry out 

14 not less than 5 demonstration and evaluation 

15 projects that implement care models for individuals 

16 at the end of life, at least one of which shall be de17 veloped to assist those individuals who are terminally 

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

19 of which may be carried out in collaboration with do20 mestic and international entities to gain and share 

21 knowledge and experience on end of life care; 

22 (2) conduct 3 demonstration and evaluation ac23 tivities concerning the education and training of cli24 nicians in end of life care, and assist in the develop25 ment and distribution of accurate educational mate-
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1 rials on both pain and symptom management and 

2 end of life care; 

3 (3) in awarding grants for the training of 

4 health professionals, give priority to awarding grants 

5 to entities that will provide training for health pro6 fessionals in pain and symptom management and in 

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

8 (4) shall evaluate demonstration projects car9 ried out under this section within the 5-year period 

10 beginning on the commencement of each such 

11 project; and 

12 (5) develop a strategy and make recommenda13 tions to Congress to ensure that the United States 

14 health care system—

15 (A) has a meaningful, comprehensive, and 

16 effective approach to meet the needs of individ17 uals and their caregivers as the patient ap18 proaches death; and 

19 (B) integrates broader supportive services.

Æ