‘‘(f) AUTHORIZATION
OF
APPROPRIATIONS.—For 
purposes of carrying out this section, there are authorized 
to be appropriated $3,000,000 for each of fiscal years 
2004, 2005 and 2006.’’.
SEC. 6. PAIN CARE INITIATIVE IN MILITARY HEALTH CARE 
FACILITIES. 
(a) REQUIREMENT.—Chapter 55 of title 10, United 
States Code, is amended by adding at the end the fol-
lowing new section:
‘‘§ 1111. Pain care 
‘‘The administering Secretaries shall develop and im-
plement a pain care initiative in all health care facilities 
of the uniformed services. Implementation shall occur no 
later than January 1, 2004, in the case of inpatient care, 
and January 1, 2005, in the case of outpatient care. The 
initiative shall be designed to ensure that all members of 
the uniformed services and their dependents receiving 
treatment in health care facilities of the uniformed serv-
ices—
‘‘(1) 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 
‘‘(2) receive appropriate pain care consistent 
with recognized guidelines and practice parameters
for the assessment and treatment of primary and 
secondary pain, including acute, chronic, and intrac-
table pain.’’.
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by adding 
at the end the following new item:
‘‘1111. Pain care.’’.
SEC. 7. PAIN CARE STANDARDS IN MEDICARE+CHOICE 
PLANS. 
(a) IN GENERAL.—Section 1852(a) of the Social Se-
curity Act (42 U.S.C. 1395w–22(a)) is amended by adding 
at the end the following new paragraph: 
‘‘(6) PAIN CARE STANDARDS.—
‘‘(A) 
IN
GENERAL.—Each 
Medicare+Choice organization shall provide ap-
propriate care for the treatment of patients in 
pain that—
‘‘(i) is consistent with recognized 
guidelines and practice parameters for the 
assessment and treatment of primary and 
secondary pain, including acute, chronic, 
and intractable pain; 
‘‘(ii) includes evaluation and treat-
ment of illnesses that frequently accom-
pany serious pain, including depression,
other mental health disorders, sleep dis-
turbance, and substance abuse; 
‘‘(iii) provides medical and other 
health services through physicians and 
other practitioners credentialed or experi-
enced in pain medicine; 
‘‘(iv) provides for referral of patients 
with chronic pain as defined in subpara-
graph (B)(i) to specialists, and, where ap-
propriate, to a comprehensive multidisci-
plinary pain management program as de-
fined in subparagraph (B)(ii); 
‘‘(v) continues treatment for as long 
as treatment is required to maximize the 
quality of life and functional capacity of 
the patient; and 
‘‘(vi) permits physicians and other 
practitioners experienced or credentialed in 
pain medicine to make clinical decisions 
with respect to the need for and the extent 
and duration of pain care services. 
‘‘(B) DEFINITIONS.—For purposes of this 
paragraph: 
‘‘(i) 
CHRONIC
PAIN.—The 
term 
‘chronic pain’ means severe, persistent, or
recurrent pain that interferes with the ac-
tivities of daily living, and has not been 
significantly reduced or ameliorated despite 
reasonable treatment efforts for a period of 
6 months. 
‘‘(ii) COMPREHENSIVE
MULTIDISCI-
PLINARY PAIN MANAGEMENT PROGRAM.—
The term ‘comprehensive multidisciplinary 
pain management program’ means an in-
patient or outpatient health care facility or 
program that—
‘‘(I) provides at least medical, 
nursing, mental health, and rehabilita-
tion services through licensed health 
care professionals; 
‘‘(II) provides or arranges for the 
provision of inpatient and outpatient 
hospital and rehabilitation facility 
services, drugs, devices, and other 
items and services required for the 
treatment of chronic pain; 
‘‘(III) provides ongoing patient 
and professional education for pain 
management;
‘‘(IV) is accredited as a com-
prehensive pain management program 
by an accrediting organization ap-
proved by the Secretary, including the 
Joint Commission on the Accredita-
tion of Health Care Organizations or 
the Rehabilitation Accreditation Com-
mission; and 
‘‘(V) is directed by 1 or more 
physicians credentialed in pain medi-
cine, or, where appropriate, 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 Specialists. 
‘‘(C) COMPLIANCE.—A Medicare+Choice 
organization may comply with the requirements 
set forth in this paragraph by providing care 
through its own network of participating pro-
viders, or under arrangement with out-of-net-
work providers, but in no event may an organi-
zation impose higher costs on its enrollees in 
the form of deductibles, copayments, premiums, 
or otherwise in the event appropriate pain care
in accordance with the standards set forth in 
this paragraph is provided out-of-network.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection 
(a) 
shall 
apply 
to 
contracts 
with 
Medicare+Choice organizations as of January 1, 2004. 
SEC. 8. 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) IN
GENERAL.—Any health care services 
provided pursuant to any contract entered into 
under this section shall include the provision of ap-
propriate care for the treatment of patients in pain 
that—
‘‘(A) is consistent with recognized guide-
lines and practice parameters for the assess-
ment and treatment of primary and secondary 
pain, including acute, chronic, and intractable 
pain; 
‘‘(B) includes evaluation and treatment of 
illnesses that frequently accompany serious 
pain, including depression, other mental health 
disorders, sleep disturbance, and substance 
abuse;
‘‘(C) provides medical and other health 
services through physicians and other practi-
tioners credentialed or experienced in pain med-
icine; 
‘‘(D) provides for referral of patients with 
chronic pain to specialists, and, where appro-
priate, to a comprehensive multidisciplinary 
pain management program; 
‘‘(E) continues treatment for as long as 
treatment is required to maximize the quality of 
life and functional capacity of the patient; and 
‘‘(F) permits physicians and other practi-
tioners experienced or credentialed in pain med-
icine to make clinical decisions with respect to 
the need for and the extent and duration of 
pain care services. 
‘‘(2) DEFINITIONS.—For purposes of this sub-
section—
‘‘(A) The term ‘chronic pain’ means severe, per-
sistent, or recurrent pain that interferes with the ac-
tivities of daily living, and has not been significantly 
reduced or ameliorated despite reasonable treatment 
efforts for a period of 6 months.
nized by the American Board of Medical Spe-
cialists. 
‘‘(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 as of January 1, 
2004. 
SEC. 9. ANNUAL REPORT ON MEDICARE EXPENDITURES 
FOR PAIN CARE SERVICES. 
Not later than December 31, 2004, and annually 
thereafter, the Administrator of the Centers for Medicare 
& Medicaid Services shall prepare and submit to the Con-
gress a report on medicare expenditures for pain care dur-
ing the preceding fiscal year. The report shall include the 
following: 
(1) An estimate of total payments made under 
part B of the medicare program to physicians spe-
cializing in pain medicine.
(2) An estimate of payments made under such 
part B to other providers and suppliers for the pro-
vision of pain care items and services. 
(3) An estimate of expenditures made under 
part A of the medicare program for the diagnosis 
and treatment of pain of inpatients, and an estimate 
of the percentage of such care that relates to end-
of-life care. 
(4) An estimate of expenditures under part C 
of the medicare program for the provision of pain 
care 
items 
and 
services 
through 
the 
Medicare+Choice program. 
(5) An estimate of out-of-pocket expenditures 
by medicare beneficiaries for both prescription and 
nonprescription pain medications not covered by the 
medicare program. 
(6) An analysis of trends in both medicare pro-
gram and medicare beneficiary expenditures for pain 
care items and services.
SEC. 10. PAIN CARE INITIATIVE IN VETERANS HEALTH 
CARE FACILITIES. 
(a) REQUIREMENT.—Subchapter II of chapter 17 of 
title 38, United States Code, is amended by adding at the 
end the following new section:
‘‘§ 1720F. Pain care 
‘‘The Secretary shall develop and implement a pain 
care initiative in all health care facilities of the Depart-
ment. The initiative shall be designed to ensure that each 
individual receiving treatment in a health care facility 
under the jurisdiction of the Secretary—
‘‘(1) is 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 
‘‘(2) receives appropriate pain care consistent 
with recognized guidelines and practice parameters 
for the diagnosis and treatment of primary and 
secondarypain, including acute, chronic, and intrac-
table pain.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 1720E the following new 
item:
‘‘1720F. Pain care.’’.
(c) IMPLEMENTATION.—The Secretary of Veterans 
Affairs shall implement the pain care initiative required 
by section 1720F of title 38, United States Code, as added 
by subsection (a) not later than—
(1) January 1, 2004, in the case of inpatient 
care; and
(2) January 1, 2005, in the case of outpatient 
care.
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