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 Serv-
ices 
A BILL 
To require the Department of Defense to implement a pain 
care initiative, 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 AND TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Military Pain Care Act of 2008’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Acute and chronic pain are prevalent condi-
tions among active duty and retired military per-
sonnel. 
(2) Characteristics of modern warfare, includ-
ing the use of improvised explosive devices, produce 
substantial numbers of battlefield casualties with 
significant damage to both the central and periph-
eral nervous systems. 
(3) The successes of military health care both 
on and off the battlefield result in high survival 
rates of severely injured military personnel who will 
be afflicted with significant pain disorders on either 
an acute or chronic basis. 
(4) Failure to treat acute pain promptly and 
appropriately at the time of injury, during initial 
medical and surgical care, and at the time of transi-
tion to community-based care, contributes to the de-
velopment of long-term chronic pain syndromes, in 
some cases accompanied by long-term mental health 
and substance abuse disorders. 
(5) Pain is a leading cause of short- and long- 
term disability among military personnel. 
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(6) The military health care systems have im-
plemented important pain care programs at some fa-
cilities and in some areas, but comprehensive pain 
care is not consistently provided on a uniform basis 
throughout the systems to all patients in need of 
such care. 
(7) Inconsistent and ineffective pain care leads 
to pain-related impairments, occupational disability, 
and medical and mental complications with long- 
term costs for the military health and disability sys-
tems, and for society at large. 
(8) Research, diagnosis, treatment, and man-
agement of acute and chronic pain in the active duty 
and retired military populations constitute health 
care priorities of the United States. 
SEC. 3. PAIN CARE INITIATIVE IN MILITARY HEALTH CARE 
FACILITIES. 
(a) REQUIREMENT.— 
(1) IN
GENERAL.—Chapter 55 of title 10, 
United States Code, is amended by adding at the 
end the following new section: 
‘‘§ 1110a. Pain care 
‘‘(a) PAIN CARE INITIATIVE REQUIREMENT.—The 
Secretary of Defense, in coordination with the Secretary 
of Veterans Affairs, the Secretary of Health and Human 
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Services, and the Surgeon General of the United States, 
shall develop and implement a pain care initiative in all 
health care facilities of the uniformed services. 
‘‘(b) MATTERS COVERED.—(1) The initiative shall be 
designed to ensure that all active and retired members of 
the uniformed services and their dependents receiving 
treatment in health care facilities of the uniformed serv-
ices— 
‘‘(A) are assessed for pain at the time of admis-
sion or initial treatment, and periodically thereafter, 
using a professionally recognized pain assessment 
tool or process; and 
‘‘(B) receive appropriate pain care consistent 
with recognized means for assessment, diagnosis, 
treatment and management of acute and chronic 
pain, including, in appropriate cases, access to spe-
cialty pain management services. 
‘‘(2) The initiative shall include the training and de-
ployment of acute pain personnel and services at all Level 
III care facilities, and, to the extent feasible, on the battle-
field. 
‘‘(c) IMPLEMENTATION.—The Secretary of Defense 
shall implement the pain care initiative— 
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‘‘(1) in the case of inpatient care, not later than 
12 months after the date of the enactment of this 
section; and 
‘‘(2) in the case of outpatient care, not later 
than 18 months after the date of the enactment of 
this section.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by adding at the end the following new item: 
‘‘1110a. Pain care.’’. 
(b) REPORT.—Not later than nine months after the 
date of the enactment of this Act, the administering Secre-
taries (as defined in section 1072(3) of title 10, United 
States Code), shall submit to the congressional defense 
committees a report on the status of the development and 
implementation of the pain care initiative required under 
section 1110a of title 10, United States Code, as added 
by subsection (a). 
SEC. 4. PAIN CARE STANDARDS IN TRICARE PLANS. 
(a) IN GENERAL.—Section 1097 of title 10, United 
States Code, is amended by adding at the end the fol-
lowing new subsection: 
‘‘(f) PAIN CARE STANDARDS.—(1) Any contract en-
tered into under this section shall include the provision 
of appropriate care for the treatment of patients in pain 
that— 
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‘‘(A) is consistent with recognized means for as-
sessment, diagnosis, treatment, and management of 
acute and chronic pain; 
‘‘(B) includes evaluation and treatment of ac-
companying illnesses, including depression, other 
mental health disorders, sleep disturbance, and sub-
stance abuse; 
‘‘(C) provides medical and other health services 
through physicians and other practitioners appro-
priately credentialed or experienced in pain manage-
ment; 
‘‘(D) provides for referral of patients with 
chronic pain to specialists, and, in appropriate cases, 
to a comprehensive multidisciplinary pain manage-
ment program; 
‘‘(E) continues treatment for as long as treat-
ment is required to maximize the quality of life and 
functional capacity of the patient; and 
‘‘(F) permits physicians and other practitioners 
appropriately credentialed or experienced in pain 
management to make clinical decisions with respect 
to the need for and the extent and duration of pain 
care services. 
‘‘(2) In this subsection: 
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‘‘(A) The term ‘chronic pain’ means severe, per-
sistent, or recurrent pain, regardless of causation or 
body location, that interferes with the activities of 
daily living, and has not been significantly reduced 
or ameliorated despite reasonable treatment efforts. 
‘‘(B) The term ‘comprehensive multidisciplinary 
pain management program’ means an inpatient or 
outpatient health care facility or program that— 
‘‘(i) provides at least medical, nursing, 
mental 
health, 
and 
rehabilitation 
services 
through licensed health care professionals; 
‘‘(ii) provides or arranges for the provision 
of inpatient and outpatient hospital and reha-
bilitation facility services, drugs, devices, and 
other items and services required for the treat-
ment of chronic pain; 
‘‘(iii) provides ongoing patient and profes-
sional education for pain management; 
‘‘(iv) is accredited as a comprehensive pain 
management program by an accrediting organi-
zation approved by the Secretary, including the 
Joint Commission on the Accreditation of 
Health Care Organizations or the Rehabilita-
tion Accreditation Commission; and 
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‘‘(v) is directed by one or more physicians 
credentialed in pain management (or, in appro-
priate cases, dentistry) by a board or boards 
approved by the Secretary, which shall include 
the American Board of Pain Medicine and 
boards recognized by the American Board of 
Medical Specialties. 
‘‘(3) COMPLIANCE.—A contractor may comply with 
the requirements set forth in this subsection by providing 
care through its own network of participating providers, 
or under arrangement with out-of-network providers, but 
in no event may a contractor impose higher costs on its 
enrollees in the form of deductibles, copayments, pre-
miums, or otherwise, in the event appropriate pain care 
in accordance with the standards set forth in this sub-
section is provided out-of-network.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to contracts entered into on or 
after the date occurring one year after the date of the en-
actment of this Act. 
SEC. 5. REPORT OF COMPTROLLER GENERAL. 
(a) REPORT.—The Comptroller General shall conduct 
a study of, and deliver to the congressional defense com-
mittees not later than six months after the date of the 
enactment of this Act a report on, the adequacy of pain 
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care in the health care facilities, services, and programs 
of the Department of Defense. 
(b) PURPOSES.—The purposes of the study and re-
port shall be to evaluate the consistency, across programs, 
facilities, relevant demographic groups, and geographic re-
gions, with which— 
(1) patients are initially assessed and periodi-
cally reassessed for pain; 
(2) both acute and chronic pain are promptly 
and appropriately diagnosed, treated, and managed; 
(3) patients and their families or other care-
givers are included as active participants in pain 
management; 
(4) pain care is provided in a comprehensive 
and interdisciplinary manner where appropriate; and 
(5) health care professionals in military facili-
ties are adequately trained in pain management. 
(c) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of carrying out this section, there is authorized to 
be appropriated such sums as may be necessary for fiscal 
years 2009 through 2011. 
Æ 
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