I
107TH CONGRESS
1ST SESSION
H. R. 2156
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 13, 2001
Ms. HOOLEY of Oregon (for herself and Mrs. JOHNSON of Connecticut) intro-
duced the following bill; which was referred to the Committee on Energy
and Commerce, and in addition to the Committee on Ways and Means,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
Amend the Public Health Service Act to provide for a public
response to the public health crisis of pain, and for
other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Conquering Pain Act of 2001’’.
(b) TABLE OF CONTENTS.—The table of contents for
this Act is as follows:
Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Definitions.
TITLE I—EMERGENCY RESPONSE TO THE PUBLIC HEALTH
CRISIS OF PAIN
Sec. 101. Guidelines for the treatment of pain.
Sec. 102. Patient expectations to have pain and symptom management.
Sec. 103. Quality improvement projects.
Sec. 104. Pain coverage quality evaluation and information.
Sec. 105. Surgeon General’s report.
TITLE II—DEVELOPING COMMUNITY RESOURCES
Sec. 201. Family support networks in pain and symptom management.
TITLE III—REIMBURSEMENT BARRIERS
Sec. 301. Reimbursement barriers report.
Sec. 302. Insurance coverage of pain and symptom management.
TITLE IV—IMPROVING FEDERAL COORDINATION OF POLICY,
RESEARCH, AND INFORMATION
Sec. 401. Advisory Committee on Pain and Symptom Management.
Sec. 402. Institutes of Medicine report on controlled substance regulation and
the use of pain medications.
Sec. 403. Conference on pain research and care.
TITLE V—DEMONSTRATION PROJECTS
Sec. 501. Provider performance standards for improvement in pain and symp-
tom management.
Sec. 502. End of life care demonstration projects.
SEC. 2. FINDINGS.
Congress finds that—
(1) pain is often left untreated or under-treated
especially among older patients, African Americans,
Hispanics and other minorities, and children;
(2) chronic pain is a public health problem af-
fecting at least 50,000,000 Americans through some
form of persisting or recurring symptom;
(3) 40 to 50 percent of patients experience
moderate to severe pain at least half the time in
their last days of life;
(4) 70 to 80 percent of cancer patients experi-
ence significant pain during their illness;
(5) one in 7 nursing home residents experience
persistent pain that may diminish their quality of
life;
(6) despite the best intentions of physicians,
nurses, pharmacists, and other health care profes-
sionals, pain is often under-treated because of the
inadequate training of clinicians in pain manage-
ment;
(7) despite the best intentions of physicians,
nurses, pharmacists, mental health professionals,
and other health care professionals, pain and symp-
tom management is often suboptimal because the
health care system has focused on cure of disease
rather than the management of a patient’s pain and
other symptoms;
(8) the technology and scientific basis to ade-
quately manage most pain is known;
(9) pain should be considered the fifth vital
sign; and
(10) coordination of Federal efforts is needed to
improve access to high quality effective pain and
symptom management in order to assure the needs
of chronic pain patients and those who are termi-
nally ill are met.
SEC. 3. DEFINITIONS.
In this Act:
(1) CHRONIC PAIN.—The term ‘‘chronic pain’’
means a pain state that is persistent and in which
the cause of the pain cannot be removed or other-
wise alleviated. Such term includes pain that may be
associated with long-term incurable or intractable
medical conditions or disease.
(2) END OF LIFE CARE.—The term ‘‘end of life
care’’ means a range of services, including hospice
care, provided to a patient, in the final stages of his
or her life, who is suffering from 1 or more condi-
tions for which treatment toward a cure or reason-
able improvement is not possible, and whose focus of
care is palliative rather than curative.
(3) FAMILY
SUPPORT
NETWORK.—The term
‘‘family support network’’ means an association of 2
or more individuals or entities in a collaborative ef-
fort to develop multi-disciplinary integrated patient
care approaches that involve medical staff and ancil-
lary services to provide support to chronic pain pa-
tients and patients at the end of life and their care-
givers across a broad range of settings in which pain
management might be delivered.
(4) HOSPICE.—The term ‘‘hospice care’’ has
the meaning given such term in section 1861(dd)(1)
of the Social Security Act (42 U.S.C. 1395x(dd)(1)).
(5) MEDICATION THERAPY MANAGEMENT SERV-
ICES.—The term ‘‘medication therapy management
services’’ means consultations with a physician or
other health care professional (including a phar-
macist) who is practicing within the scope of the
professional’s license, concerning a patient which re-
sults in—
(A) a change in the drug regimen of the
patient to avoid an adverse drug interaction
with another drug or disease state;
(B) a change in inappropriate drug dosage
or dosage form with respect to the patient;
(C) discontinuing an unnecessary or harm-
ful medication with respect to the patient;
(D) an initiation of medication therapy for
a medical condition of the patient;
(E) consultation with the patient or a care-
giver in a manner that results in a significant
improvement in drug regimen compliance; or
(F) patient and caregiver understanding of
the appropriate use and adherence to medica-
tion therapy.
(6) PAIN AND SYMPTOM MANAGEMENT.—The
term ‘‘pain and symptom management’’ means serv-
ices provided to relieve physical or psychological pain
or suffering, including any 1 or more of the fol-
lowing physical complaints—
(A) weakness and fatigue;
(B) shortness of breath;
(C) nausea and vomiting;
(D) diminished appetite;
(E) wasting of muscle mass;
(F) difficulty in swallowing;
(G) bowel problems;
(H) dry mouth;
(I) failure of lymph drainage resulting in
tissue swelling;
(J) confusion;
(K) dementia;
(L) delirium;
(M) anxiety;
(N) depression; and
(O) other related symptoms
(7) PALLIATIVE
CARE.—The term ‘‘palliative
care’’ means the total care of patients whose disease
is not responsive to curative treatment, the goal of
which is to provide the best quality of life for such
patients and their families. Such care—
(A) may include the control of pain and of
other symptoms, including psychological, social
and spiritual problems;
(B) affirms life and regards dying as a
normal process;
(C) provides relief from pain and other dis-
tressing symptoms;
(D) integrates the psychological and spir-
itual aspects of patient care;
(E) offers a support system to help pa-
tients live as actively as possible until death;
and
(F) offers a support system to help the
family cope during the patient’s illness and in
their own bereavement.
(8) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
TITLE 
I—EMERGENCY 
RE-
SPONSE 
TO 
THE 
PUBLIC
HEALTH CRISIS OF PAIN
SEC. 101. GUIDELINES FOR THE TREATMENT OF PAIN.
(a) DEVELOPMENT OF WEBSITE.—Not later than 2
months after the date of enactment of this Act, the Sec-
retary, acting through the Agency for Healthcare Re-
search and Quality, shall develop and maintain an Internet
website to provide information to individuals, health care
practitioners, and health facilities concerning evidence-
based practice guidelines developed for the treatment of
physical and psychological pain. Websites in existence on
such date may be used if such websites meet the require-
ments of this section.
(b) REQUIREMENTS.—The website established under
subsection (a) shall—
(1) be designed to be quickly referenced by
health care practitioners; and
(2) provide for the updating of guidelines as
scientific data warrants.
(c) PROVIDER ACCESS TO GUIDELINES.—
(1) IN GENERAL.—In establishing the website
under subsection (a), the Secretary shall ensure that
health care facilities have made the website known
to health care practitioners and that the website is
easily available to all health care personnel providing
care or services at a health care facility.
(2) USE OF CERTAIN EQUIPMENT.—In making
the information described in paragraph (1) available
to health care personnel, the facility involved shall—
(A) ensure that such personnel have access
to the website through the computer equipment
of the facility;
(B) carry out efforts to inform personnel
at the facility of the location of such equipment;
and
(C) ensure that patients, caregivers, and
support groups are provided with access to the
website.
(3) RURAL AREAS.—
(A) IN GENERAL.—A health care facility,
particularly a facility located in a rural or un-
derserved area, without access to the Internet
shall provide an alternative means of providing
practice guideline information to all health care
personnel.
(B) ALTERNATIVE MEANS.—The Secretary
shall determine appropriate alternative means
by which a health care facility may make avail-
able practice guideline information on a 24-hour
basis, 7 days a week if the facility does not
have Internet access. The criteria for adopting
such alternative means should be clear in per-
mitting facilities to develop alternative means
without placing a significant financial burden
on the facility and in permitting flexibility for
facilities to develop alternative means of making
guidelines available. Such criteria shall be pub-
lished in the Federal Register.
SEC. 102. PATIENT EXPECTATIONS TO HAVE PAIN AND
SYMPTOM MANAGEMENT.
(a) IN GENERAL.—The administrator of each of the
programs described in subsection (b) shall ensure that, as
part of any informational materials provided to individuals
under such programs, such materials shall include infor-
mation, where relevant, to inform such individuals that
they should expect to have their pain assessed and should
expect to be provided with effective pain and symptom re-
lief, when receiving benefits under such program.
(b) PROGRAMS.—The programs described in this sub-
section shall include—
(1) the medicare and medicaid programs under
titles XIX and XXI of the Social Security Act (42
U.S.C. 1935 et seq., 1936 et seq.);
(2) programs carried out through the Public
Health Service;
(3) programs carried out through the Indian
Health Service;
(4) programs carried out through health centers
under section 330 of the Public Health Service Act
(42 U.S.C. 254b);
(4) the Federal Employee Health Benefits Pro-
gram under title 5, United States Code;
(5) the Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS) as defined in
section 1073(4) of title 10, United States Code; and
(6) other programs administered by the Sec-
retary.
SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS.
The Secretary shall provide funds for the implemen-
tation of special education projects, in as many States as
is practicable, to be carried out by peer review organiza-
tions of the type described in section 1152 of the Social
Security Act (42 U.S.C. 1320c–1) to improve the quality
of pain and symptom management. Such projects shall
place an emphasis on improving pain and symptom man-
agement at the end of life, and may also include efforts
to increase the quality of services delivered to chronic pain
patients and the chronically ill for whom pain may be a
significant symptom.
SEC. 104. PAIN COVERAGE QUALITY EVALUATION AND IN-
FORMATION.
(a) IN GENERAL.—Section 1851(d)(4) of the Social
Security Act (42 U.S.C. 42 U.S.C. 1395w–21(d)(4)) is
amended—
(1) in subparagraph (A), by adding at the end
the following:
‘‘(ix) The organization’s coverage of
pain and symptom management.’’; and
(2) in subparagraph (D)—
(A) in clause (iii), by striking ‘‘and’’ at the
end;
(B) in clause (iv), by striking the period
and inserting ‘‘, and’’; and
(C) by adding at the end the following:
‘‘(v) not later than 2 years after the
date of enactment of this clause, an eval-
uation (which may be made part of any
other relevant report of quality evaluation
that the plan is required to prepare) for
the plan (updated annually) that indicates
the performance of the plan with respect to
access to, and quality of, pain and symp-
tom management, including such manage-
ment as part of end of life care. Data shall
be posted in a comparable manner for con-
sumer use on www.medicare.gov.’’.
(b) EFFECTIVE DATE.—The amendments made by
paragraph (1) apply to information provided with respect
to annual, coordinated election periods (as defined in sec-
tion 1851(e)(3)(B) of the Social Security Act (42 U.S.C.
1395–21(e)(3)(B)) beginning after the date of enactment
of this Act.
SEC. 105. SURGEON GENERAL’S REPORT.
Not later than October 1, 2002, the Surgeon General
shall prepare and submit to the appropriate committees
of Congress and the public, a report concerning the state
of pain and symptom management in the United States.
The report shall include—
(1) a description of the legal and regulatory
barriers that may exist at the Federal and State lev-
els to providing adequate pain and symptom man-
agement;
(2) an evaluation of provider competency in
providing pain and symptom management;
(3) an identification of vulnerable populations,
including children, advanced elderly, non-English
speakers, and minorities, who may be likely to be
underserved or may face barriers to access to pain
management and recommendations to improve ac-
cess to pain management for these populations;
(4) an identification of barriers that may exist
in providing pain and symptom management in
health care settings, including assisted living facili-
ties;
(5) an identification of patient and family atti-
tudes that may exist which pose barriers in access-
ing pain and symptom management or in the proper
use of pain medications;
(6) an evaluation of medical, nursing, and phar-
macy school training and residency training for pain
and symptom management;
(7) a review of continuing medical education
programs in pain and symptom management; and
(8) a description of the use of and access to
mental health services for patients in pain and pa-
tients at the end of life.
TITLE II—DEVELOPING
COMMUNITY RESOURCES
SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMP-
TOM MANAGEMENT.
(a) 
ESTABLISHMENT.—The 
Secretary, 
acting
through the Public Health Service, shall award grants for
the establishment of 6 National Family Support Networks
in Pain and Symptom Management (in this section re-
ferred to as the ‘‘Networks’’) to serve as national models
for improving the access and quality of pain and symptom
management to chronic pain patients (including chron-
ically ill patients for whom pain is a significant symptom)
and those individuals in need of pain and symptom man-
agement at the end of life and to provide assistance to
family members and caregivers.
(b) ELIGIBILITY AND DISTRIBUTION.—
(1) ELIGIBILITY.—To be eligible to receive a
grant under subsection (a), an entity shall—
(A) be an academic facility or other entity
that has demonstrated an effective approach to
training health care providers including mental
health professionals concerning pain and symp-
tom management and palliative care services;
and
(B) prepare and submit to the Secretary
an application (to be peer reviewed by a com-
mittee established by the Secretary), at such
time, in such manner, and containing such in-
formation as the Secretary may require.
(2) DISTRIBUTION.—In providing for the estab-
lishment of Networks under subsection (a), the Sec-
retary shall ensure that—
(A) the geographic distribution of such
Networks reflects a balance between rural and
urban needs; and
(B) at least 3 Networks are established at
academic facilities.
(c) ACTIVITIES OF NETWORKS.—A Network that is
established under this section—
(1) shall provide for an integrated interdiscipli-
nary approach, that includes psychological and coun-
seling services, to the delivery of pain and symptom
management;
(2) shall provide community leadership in estab-
lishing and expanding public access to appropriate
pain care, including pain care at the end of life;
(3) shall provide assistance, through caregiver
supportive services, that include counseling and edu-
cation services;
(4) shall develop a research agenda to promote
effective pain and symptom management for the
broad spectrum of patients in need of access to such
care that can be implemented by the Network;
(5) shall provide for coordination and linkages
between clinical services in academic centers and
surrounding communities to assist in the widespread
dissemination of provider and patient information
concerning how to access options for pain manage-
ment;
(6) shall establish telemedicine links to provide
education and for the delivery of services in pain and
symptom management;
(7) shall develop effective means of providing
assistance to providers and families for the manage-
ment of a patient’s pain 24 hours a day, 7 days a
week; and
(8) may include complimentary medicine pro-
vided in conjunction with traditional medical serv-
ices.
(d) PROVIDER PAIN AND SYMPTOM MANAGEMENT
COMMUNICATIONS PROJECTS.—
(1) IN GENERAL.—Each Network shall estab-
lish a process to provide health care personnel with
information 24 hours a day, 7 days a week, con-
cerning pain and symptom management. Such proc-
ess shall be designed to test the effectiveness of spe-
cific forms of communications with health care per-
sonnel so that such personnel may obtain informa-
tion to ensure that all appropriate patients are pro-
vided with pain and symptom management.
(2) TERMINATION.—The requirement of para-
graph (1) shall terminate with respect to a Network
on the day that is 2 years after the date on which
the Network has established the communications
method.
(3) EVALUATION.—Not later than 60 days after
the expiration of the 2-year period referred to in
paragraph (2), a Network shall conduct an evalua-
tion and prepare and submit to the Secretary a re-
port concerning the costs of operation and whether
the form of communication can be shown to have
had a positive impact on the care of patients in
chronic pain or on patients with pain at the end of
life.
(4) RULE OF CONSTRUCTION.—Nothing in this
subsection shall be construed as limiting a Network
from developing other ways in which to provide sup-
port to families and providers, 24 hours a day, 7
days a week.
(e) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
$18,000,000 for fiscal years 2002 through 2004.
TITLE III—REIMBURSEMENT
BARRIERS
SEC. 301. REIMBURSEMENT BARRIERS REPORT.
The 
Medicare 
Payment 
Advisory 
Commission
(MedPac) established under section 1805 of the Social Se-
curity Act (42 U.S.C. 1396b–6) shall conduct a study, and
prepare and submit to the appropriate committees of Con-
gress a report, concerning—
(1) the manner in which medicare policies may
pose barriers in providing pain and symptom man-
agement and palliative care services in different set-
tings, including a focus on payment for nursing
home and home health services;
(2) the identification of any financial barriers
that may exist within the medicare and medicaid
programs under titles XVIII and XIX of the Social
Security Act (42 U.S.C. 1395 et seq., 1396 et seq.)
that interfere with continuity of care and inter-
disciplinary care or supportive care for the broad
range of chronic pain patients (including patients
who are chronically ill for whom pain is a significant
symptom), and for those who are terminally ill, and
include the recommendations of the Commission on
ways to eliminate those barriers that the Commis-
sion may identify;
(3) the reimbursement barriers that exist, if
any, in providing pain and symptom management
through hospice care, particularly in rural areas, and
if barriers exist, recommendations concerning ad-
justments that would assist in assuring patient ac-
cess to pain and symptom management through hos-
pice care in rural areas;
(4) whether the medicare reimbursement system
provides incentives to providers to delay informing
terminally ill patients of the availability of hospice
and palliative care; and
(5) the impact of providing payments for medi-
cation therapy management services in pain and
symptom management and palliative care services.
SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM
MANAGEMENT.
(a) IN GENERAL.—The General Accounting Office
shall conduct a survey of public and private health insur-
ance providers, including managed care entities, to deter-
mine whether the reimbursement policies of such insurers
inhibit the access of chronic pain patients to pain and
symptom management and pain and symptom manage-
ment for those in need of end-of-life care (including pa-
tients who are chronically ill for whom pain is a significant
symptom). The survey shall include a review of
formularies for pain medication and the effect of such
formularies on pain and symptom management.
(b) REPORT.—Not later than 1 year after the date
of enactment of this Act, the General Accounting Office
shall prepare and submit to the appropriate committees
of Congress a report concerning the survey conducted
under subsection (a).
TITLE IV—IMPROVING FEDERAL
COORDINATION OF POLICY,
RESEARCH, 
AND 
INFORMA-
TION
SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM
MANAGEMENT.
(a) ESTABLISHMENT.—The Secretary shall establish
an advisory committee, to be known as the Advisory Com-
mittee on Pain and Symptom Management, to make rec-
ommendations to the Secretary concerning a coordinated
Federal agenda on pain and symptom management.
(b) MEMBERSHIP.—The Advisory Committee estab-
lished under subsection (a) shall be comprised of 11 indi-
viduals to be appointed by the Secretary, of which at least
1 member shall be a representative of—
(1) physicians (medical doctors or doctors of os-
teopathy) who treat chronic pain patients or the ter-
minally ill;
(2) nurses who treat chronic pain patients or
the terminally ill;
(3) pharmacists;
(4) hospice;
(5) pain researchers;
(6) patient advocates;
(7) caregivers; and
(8) mental health providers.
The members of the Committee shall designate 1 member
to serve as the chairperson of the Committee.
(c) MEETINGS.—The Advisory Committee shall meet
at the call of the chairperson of the Committee.
(d) AGENDA.—The agenda of the Advisory Com-
mittee established under subsection (a) shall include—
(1) the development of recommendations to cre-
ate a coordinated Federal agenda on pain and symp-
tom management;
(2) the development of proposals to ensure that
pain is considered as the fifth vital sign for all pa-
tients;
(3) the identification of research needs in pain
and symptom management, including gaps in pain
and symptom management guidelines;
(4) the identification and dissemination of pain
and symptom management practice guidelines, re-
search information, and best practices;
(5) proposals for patient education concerning
how to access pain and symptom management across
health care settings;
(6) the manner in which to measure improve-
ment in access to pain and symptom management
and improvement in the delivery of care;
(7) the development of ongoing strategies to as-
sure the aggressive use of pain medications, includ-
ing opiods, regardless of health care setting; and
(8) the development of an ongoing mechanism
to identify barriers or potential barriers to pain and
symptom management created by Federal policies.
(e) RECOMMENDATION.—Not later than 2 years after
the date of enactment of this Act, the Advisory Committee
established under subsection (a) shall prepare and submit
to 
the 
Secretary 
recommendations 
concerning 
a
prioritization of the need for a Federal agenda on pain
and symptom management, and ways in which to better
coordinate the activities of entities within the Department
of Health and Human Services, and other Federal entities
charged with the responsibility for the delivery of health
care services or research on pain and symptom manage-
ment with respect to pain management.
(f) CONSULTATION.—In carrying out this section, the
Advisory Committee shall consult with all Federal agen-
cies that are responsible for providing health care services
or access to health services to determine the best means
to ensure that all Federal activities are coordinated with
respect to research and access to pain and symptom man-
agement.
(g) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE;
OTHER PROVISIONS.—The following shall apply with re-
spect to the Advisory Committee:
(1) The Committee shall receive necessary and
appropriate administrative support, including appro-
priate funding, from the Department of Health and
Human Services.
(2) The Committee shall hold open meetings
and meet not less than 4 times per year.
(3) Members of the Committee shall not receive
additional compensation for their service. Such
members may receive reimbursement for appropriate
and additional expenses that are incurred through
service on the Committee which would not have in-
curred had they not been a member of the Com-
mittee.