(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.
SEC. 105. PAIN COVERAGE QUALITY EVALUATION AND IN-
FORMATION.
(a) MEDICARE+CHOICE PLANS.—
(1) 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—
(A) in subparagraph (A), by adding at the
end the following:
‘‘(ix) The organization’s coverage of
pain and symptom management.’’; and
(B) in subparagraph (D)—
(i) in clause (iii), by striking ‘‘and’’ at
the end;
(ii) in clause (iv), by striking the pe-
riod and inserting ‘‘, and’’; and
(iii) by adding at the end the fol-
lowing:
‘‘(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.’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) apply to information provided with
respect to annual, coordinated election periods (as
defined in section 1851(e)(3)(B) of the Social Secu-
rity Act (42 U.S.C. 1395–21(e)(3)(B)) beginning
after the date of enactment of this Act.
(b) INCLUSION OF PAIN MEASUREMENTS IN FED-
ERAL HEALTH PROGRAMS.—
(1) IN GENERAL.—Not later than 1 year after
the date of enactment of this Act, the Secretary
shall make a determination as to the manner in
which to include measurements of pain and symptom
management in the programs under titles XVIII and
XIX of the Social Security Act (42 U.S.C. 1395 et
seq. and 1396 et seq.) and in other appropriate Fed-
eral program.
(2) DEVELOPMENT OF MEASUREMENTS.—The
determination required under paragraph (1) shall be
developed in consultation with the Administrator of
the Agency for Health Care Policy and Research
and the Director of the National Institutes of
Health.
SEC. 106. SURGEON GENERAL’S REPORT.
Not later than October 1, 2000, 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) and 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 school training and
residency training for pain and symptom manage-
ment; and
(7) a review of continuing medical education
programs in pain and symptom management.
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 and those individ-
uals in need of pain and symptom management 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 concerning pain
and symptom 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 shall—
(1) provide for an integrated interdisciplinary
approach to the delivery of pain and symptom man-
agement;
(2) provide community leadership in estab-
lishing and expanding public access to appropriate
pain care, including pain care at the end of life;
(3) provide assistance through caregiver and be-
reavement supportive services;
(4) develop a research agenda to promote effec-
tive 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) provide for coordination and linkages be-
tween clinical services in academic centers and sur-
rounding communities to assist in the widespread
dissemination of provider and patient information
concerning how to access options for pain manage-
ment;
(6) establish telemedicine links to provide edu-
cation and for the delivery of services in pain and
symptom management; and
(7) develop effective means of providing assist-
ance to providers and families for the management
of a patient’s pain 24 hours a day, 7 days a week.
(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 2000 through 2002.
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 and for those who are
terminally ill, and include the recommendations of
the Commission on ways to eliminate those barriers
that the Commission 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 drug
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. The survey shall
include a review of formularies for pain medication and
the effect of such formularies on pain and symptom man-
agement.
(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 who treat chronic pain patients
or the terminally ill;
(4) hospice;
(5) pain researchers;
(6) patient advocates;
(7) caregivers; and
(8) health insurance issuers (as such term is
defined in section 2791(b) of the Public Health
Service Act (42 U.S.C. 300gg–91(b))).
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; and
(7) 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 ways in which to better coordinate the activities of
entities within the Department of Health and Human