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H.R. 2508 (eh) To amend the Federal Food, Drug, and Cosmetic Act to provide for improvements in the process of approving and using animal drugs, and for other purposes. [Engrossed in House] ...


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108th CONGRESS
  1st Session
                                H. R. 2507

To 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 18, 2003

Ms. Hooley of Oregon introduced 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


 
To 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 Representatives 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 2003''.
    (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 
                            symptom 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 affecting 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 experience 
        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 professionals, pain is often 
        under-treated because of the inadequate training of clinicians 
        in pain management;
            (7) despite the best intentions of physicians, nurses, 
        pharmacists, mental health professionals, and other health care 
        professionals, pain and symptom 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 adequately 
        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 terminally 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 otherwise 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 conditions for which treatment toward 
        a cure or reasonable 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 effort to develop multi-
        disciplinary integrated patient care approaches that involve 
        medical staff and ancillary services to provide support to 
        chronic pain patients and patients at the end of life and their 
        caregivers 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 services.--The term 
        ``medication therapy management services'' means consultations 
        with a physician or other health care professional (including a 
        pharmacist) who is practicing within the scope of the 
        professional's license, concerning a patient which results 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 harmful 
                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 caregiver 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 medication therapy.
            (6) Pain and symptom management.--The term ``pain and 
        symptom management'' means services provided to relieve 
        physical or psychological pain or suffering, including any 1 or 
        more of the following 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 distressing 
                symptoms;
                    (D) integrates the psychological and spiritual 
                aspects of patient care;
                    (E) offers a support system to help patients 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 RESPONSE 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 Secretary, acting through the Agency for 
Healthcare Research 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 requirements 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 
                underserved 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 available 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 permitting 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 published 
                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 information, 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 
relief, when receiving benefits under such program.
    (b) Programs.--The programs described in this subsection 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);
            (5) the Federal Employee Health Benefits Program under 
        title 5, United States Code;
            (6) the Civilian Health and Medical Program of the 
        Uniformed Services (CHAMPUS) as defined in section 1073(4) of 
        title 10, United States Code; and
            (7) other programs administered by the Secretary.

SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS.

    The Secretary shall provide funds for the implementation of special 
education projects, in as many States as is practicable, to be carried 
out by peer review organizations 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 management 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 INFORMATION.

    (a) In General.--Section 1851(d)(4) of the Social Security Act (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:

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