HR 1863 IH
108th CONGRESS
1st Session
H. R. 1863
To declare adequate pain care research, education, and treatment as national
public health priorities, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
April 29, 2003
Mr. ROGERS of
Michigan
introduced the
following bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committees on Ways and Means, Armed Services, and Veterans'
Affairs, 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 declare adequate pain care research, education, and treatment as national
public health priorities, 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 `National Pain Care Policy Act
of 2003'.
(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. White House Conference on Pain Care.
Sec. 3.
National
Center
for Pain and Palliative Care
Research.
Sec. 4. Pain care education and training.
Sec. 5. Public awareness campaign on pain management.
Sec. 6. Pain care initiative in military health care facilities.
Sec. 7. Pain care standards in Medicare+Choice plans.
Sec. 8. Pain care standards in TRICARE plans.
Sec. 9. Annual report on medicare expenditures for pain care services.
Sec. 10. Pain care initiative in veterans health care ----facilities.
SEC. 2. WHITE HOUSE CONFERENCE ON PAIN CARE.
(a) CONVENING- Not later than June 30, 2004, the President shall convene a
conference to be known as the White House Conference on Pain Care (in this
section referred to as the `Conference').
(b) PURPOSES- The purposes of the Conference shall be to--
(1) increase the recognition of pain as a significant public health problem
in the United
States;
(2) assess the adequacy of diagnosis and treatment for primary and secondary
pain, including acute, chronic, intractable, and end-of-life pain;
(3) identify barriers to appropriate pain care, including--
(A) lack of understanding and education among patients, providers,
regulators, and third-party payors;
(B) barriers to access to care at the primary, specialty, and tertiary care
levels; and
(C) gaps in basic and clinical research on the symptoms and causes of, and
potential treatments to improve, pain care; and
(4) establish an agenda for action in both the public and private sectors
that will reduce such barriers and significantly improve the state of pain care
research, education, and clinical care in the
United
States
by
2010.
(c) CHAIR- The Secretary of Health and Human Services shall serve as the
chair of the Conference.
(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there are authorized to be appropriated such sums as shall be necessary
for fiscal year 2004.
SEC. 3.
NATIONAL
CENTER
FOR PAIN AND PALLIATIVE CARE
RESEARCH.
(a) ESTABLISHMENT- Section 401(b)(2) of the Public Health Service Act (42
U.S.C. 281(b)(2)) is amended by adding at the end the following:
`(H) The
National
Center
for Pain and Palliative Care
Research.'.
(b) OPERATION- Part E of title IV of the Public Health Service Act (42 U.S.C.
287 et seq.) is amended by adding at the end the following:
`Subpart 7--
National
Center
for Pain and Palliative Care
Research
`SEC. 485I. ESTABLISHMENT.
`(a) ESTABLISHMENT- The Secretary shall establish within the National
Institutes of Health a center to be known as the
National
Center
for Pain and Palliative Care
Research (referred to in this subpart as the `Center').
`(b) DIRECTOR- The Center shall be headed by a Director (referred to in this
subpart as the `Director of the Center'), who shall be appointed by the Director
of NIH after consultation with experts in the fields of pain and palliative care
research and treatment.
`(c) POWERS OF SECRETARY AND DIRECTOR- For purposes of section 405, the
Center shall be treated as a national research institute.
`(d) GENERAL PURPOSES- The general purposes of the Center are--
`(1) to improve the quality of life of individuals suffering from pain by
fostering clinical and basic science research into the biology of pain and the
causes of and effective treatments for pain;
`(2) to establish a national agenda for conducting and supporting pain and
palliative care research in the specific categories described in paragraphs (3)
and (4);
`(3) to identify, coordinate, and support research, research training, and
related activities (including the development of new and the refinement of
existing treatments) with respect to both primary and secondary pain,
including--
`(A) acute pain;
`(B) cancer and HIV-related pain, particularly at the end of life;
`(C) back pain, headache pain, and other chronic and intractable pain;
and
`(D) other painful conditions;
`(4) to identify, coordinate, and support research, research training, and
related activities with respect to palliative care;
`(5) to conduct and support pain and palliative care research, research
training, and related activities that have been identified as requiring
additional, special priority as determined appropriate by the Director of the
Center and the Advisory Board established under subsection (e);
`(6) to coordinate all pain and palliative care research, research training,
and related activities being carried out among the national research institutes
or in any such institute;
`(7) to ensure the prompt and effective dissemination of current and future
research results to improve patient access to and provider delivery of pain and
palliative care;
`(8) to initiate a comprehensive program of collaborative interdisciplinary
research among schools, colleges, and universities, including schools of
medicine and osteopathy, schools of pharmacy and pharmacology, schools of
nursing, schools of dentistry, schools of physical therapy, schools of
occupational therapy, and schools of clinical psychology, comprehensive health
care centers and systems, and specialized centers of pain research or treatment;
and
`(9) to report not less than annually on the state of public and private
funding for pain and palliative care research and the adequacy of such funding,
taking into account the specific categories described in paragraphs (3) and
(4).
`(e) ADVISORY COUNCIL-
`(1) IN GENERAL- The Center shall have an advisory council to be known as the
National Pain and Palliative Care Research Center Advisory Board (in this
section referred to as the `Advisory Board').
`(2) MEMBERSHIP- The Advisory Board shall be established and maintained in
accordance with section 406, except that--
`(A) the appointed voting members shall include--
`(i) representatives of the broad range of medical, health, and scientific
disciplines involved in research and treatment related to the categories of pain
and palliative care described in paragraphs (3) and (4) of subsection (d),
including individuals with expertise and training in pain medicine, clinical
psychology, physical medicine, and rehabilitative services (including physical
therapy and occupational therapy), pharmacy and pharmacology, nursing, and
dentistry; and
`(ii) representatives of painful patients; and
`(B) the nonvoting ex officio members shall include--
`(i) the Director of the National Cancer Institute;
`(ii) the Director of the National Institute of Dental and Craniofacial
Research;
`(iii) the Director of the National Institute of Child Health and Human
Development;
`(iv) the Director of the National Institute of Nursing Research;
`(v) the Director of the National Institute of Allergy and Infectious
Diseases;
`(vi) the Director of the National Institute of Arthritis and Musculoskeletal
and Skin Diseases;
`(vii) the Director of the National Institute of Mental Health;
`(viii) the Director of the National Institute of Neurological Disorders and
Stroke;
`(ix) the Director of the National Institute on Drug Abuse;
`(x) the Director of the National Institute on Disability and Rehabilitation
Research;
`(xi) the Director of the National Institute of Biomedical Imaging and
Bioengineering; and
`(xii) the Director of the National Bioethics Advisory Commission.
`(3) DUTIES- The Advisory Board shall advise, assist, consult with, and make
recommendations to the Director of the Center regarding the matters set forth in
subsection (d), including coordination, research, funding, and purposes.
`(f) ESTABLISHMENT OF REGIONAL PAIN RESEARCH CENTERS-
`(1) ESTABLISHMENT- To facilitate and enhance the research, research
training, and related activities to be carried out by the Center, the Director
of NIH, in consultation with the Director of the Center and the Advisory Board,
shall establish not less than 6 regional pain research centers, which shall
operate as part of the Center.
`(2) FOCUS AND DISTRIBUTION-
`(A) FOCUS- Not less than 4 of the regional centers established under
paragraph (1) shall have as their primary focus 1 of the categories of pain
described in subparagraphs (A), (B), and (C) of subsection (d)(3).
`(B) DISTRIBUTION- One regional pain research center shall be established in
each of the following regions of the United States (as such regions are
determined by the Director of the Center):
`(i) The Northeast region.
`(ii) The Southeast region.
`(iii) The Midwest region.
`(iv) The Southwest region.
`(v) The West region, including Hawaii.
`(vi) The Pacific Northwest region, including Alaska.
`(3) SELECTION- The regional centers shall be selected through a competitive
process from among institutions and centers of the type described in subsection
(d)(8).
`(g) ANNUAL CONSENSUS CONFERENCE ON PAIN AND PALLIATIVE CARE RESEARCH- To
assist the Center in the establishment and maintenance of a national agenda for
pain and palliative care research, and to ensure that the Center remains abreast
of research and clinical developments in both the public and private sectors,
the Director of the Center shall convene each year a consensus conference of
prominent researchers and clinicians in the field of pain and palliative care
research and treatment.
`(h) AUTHORIZATION OF APPROPRIATIONS-
`(1) IN GENERAL- For the purpose of carrying out this section, there are
authorized to be appropriated $40,000,000 for each of fiscal years 2004, 2005,
and 2006, and such sums as may be necessary thereafter.
`(2) REGIONAL CENTERS- Of the amount appropriated under paragraph (1) for
fiscal year 2005 and each subsequent fiscal year, not less than $1,500,000 shall
be made available to each of the regional centers established under subsection
(f).'.
SEC. 4. PAIN CARE EDUCATION AND TRAINING.
(a) PAIN AND PALLIATIVE CARE RESEARCH AND QUALITY- Part A of title IX of the
Public Health Service Act (42 U.S.C. 299 et seq.) is amended by adding at the
end the following:
`SEC. 904. PROGRAM FOR PAIN AND PALLIATIVE CARE RESEARCH AND QUALITY.
`(a) IN GENERAL- The Director shall carry out a program to--
`(1) develop and advance the quality, appropriateness, and effectiveness of
pain and palliative care; and
`(2) collect and disseminate protocols and evidence-based practices regarding
pain and palliative care, including pain care for terminally ill patients, and
make such information available to Federal, State, and local regulatory and
enforcement agencies, public and private health care programs, payors and
providers, health professions schools, hospices, and the general public.
`(b) DEFINITIONS- For purposes of this section:
`(1) The term `palliative care' means the comprehensive active, total care of
patients whose disease or medical condition is not responsive to curative
treatment or whose prognosis is limited due to progressive, far-advanced
disease. Palliative care includes treatment to reduce or alleviate pain and
other distressing signs and symptoms. The purpose of such care is to eliminate,
alleviate, or manage the patient's pain and suffering and thereby enhance the
quality of life.
`(2) The term `pain care' means the evaluation, diagnosis, treatment, and
management of primary and secondary pain, whether acute, chronic, persistent,
intractable, or associated with the end of life.'.
(b) EDUCATION AND TRAINING IN PAIN AND PALLIATIVE CARE- Part D of title VII
of the Public Health Service Act (42 U.S.C. 294 et seq.) is amended--
(1) by redesignating sections 754 through 757 as sections 755 through 758,
respectively; and
(2) by inserting after section 753 the following:
`SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN AND PALLIATIVE
CARE.
`(a) IN GENERAL- The Secretary, in consultation with the Director of the
Agency for Healthcare Research and Quality, may make awards of grants,
cooperative agreements, and contracts to health professions schools, hospices,
and other public and private entities for the development and implementation of
programs to provide education and training to health care professionals in pain
and palliative care.
`(b) PRIORITIES- In making awards under subsection (a), the Secretary shall
give priority to awards for the implementation of programs under such
subsection.
`(c) CERTAIN TOPICS- An award may be made under subsection (a) only if the
applicant for the award agrees that the program carried out with the award will
include information and education on--
`(1) professionally recognized means for diagnosing and treating pain and
related signs and symptoms, including the medically appropriate use of
controlled substances;
`(2) applicable laws on controlled substances, including the degree to which
misconceptions concerning such laws or the enforcement thereof may create
barriers to patient access to appropriate and effective pain care;
`(3) comprehensive interdisciplinary approaches to the delivery of pain and
palliative care, including delivery through specialized centers of pain care
treatment expertise; and
`(4) recent findings, developments, and improvements in the provision of pain
and palliative care.
`(d) PROGRAM SITES- Education and training under subsection (a) may be
provided at or through health professions schools, residency training programs,
and other graduate programs in the health professions, entities that provide
continuing medical and pharmacy education, hospices, and such other programs or
sites as the Secretary determines to be appropriate.
`(e) EVALUATION OF PROGRAMS- The Secretary shall (directly or through grants
or contracts) provide for the evaluation of programs implemented under
subsection
(a) in order to determine the effect of such programs on knowledge and
practice regarding pain and palliative care.
`(f) PEER REVIEW GROUPS- In carrying out section 799(f) with respect to this
section, the Secretary shall ensure that the membership of each peer review
group involved includes individuals with expertise and experience in pain and
palliative care.
`(g) DEFINITIONS- For purposes of this section:
`(1) The term `palliative care' means the comprehensive active, total care of
patients whose disease or medical condition is not responsive to curative
treatment or whose prognosis is limited due to progressive, far-advanced
disease. Palliative care includes treatment to reduce or alleviate pain and
other distressing signs and symptoms. The purpose of such care is to eliminate,
alleviate, or manage the patient's pain and suffering and thereby enhance the
quality of life.
`(2) The term `pain care' means the evaluation, diagnosis, treatment, and
management of primary and secondary pain, whether acute, chronic, persistent,
intractable, or associated with the end of life.'.
(c) AUTHORIZATION OF APPROPRIATIONS- Section 758 of the Public Health Service
Act (as redesignated by subsection (a)(1) of this section) is amended in
subsection (b)(1)(C)--
(1) by striking `sections 753, 754, and 755' and inserting `section 753, 754,
755, and 756'; and
(2) by striking `$22,631,000' and inserting `$37,631,000'.
(d) TECHNICAL AMENDMENT- Paragraph (2) of section 757(b) of the Public Health
Service Act (as redesignated by subsection (a)(1)) is amended by striking
`754(3)(A), and 755(b)' and inserting `755(3)(A), and 756(b)'.
SEC. 5. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGEMENT.
Part B of title II of the Public Health Service Act (42 U.S.C. 238 et seq.)
is amended by adding at the end the following:
`NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN MANAGEMENT
`SEC. 249. (a) ESTABLISHMENT- Not later than June 30, 2004, the Secretary
shall establish and implement a national education outreach and awareness
campaign described in subsection (b) to provide information to the public on
responsible pain management, related symptom management, and palliative
care.
`(b) REQUIREMENTS- The Secretary shall design the public awareness campaign
under this section to educate consumers, patients, their families, and other
caregivers with respect to--
`(1) the incidence and importance of pain as a national public health
problem;
`(2) the adverse physical, psychological, and financial consequences that can
result if pain is not appropriately diagnosed or treated;
`(3) the availability, benefits, and risks of all pain management and
palliative care treatment options;
`(4) the right of patients to have their pain promptly assessed,
appropriately treated, and regularly reassessed, and to have their treatment
adjusted if needed;
`(5) the availability in the public, non-profit, and private sectors of pain
management-related information, services and resources for consumers, patients,
their families, and other caregivers, including information on--
`(i) appropriate assessment, diagnosis and treatment options for all types of
pain and pain-related symptoms; and
`(ii) conditions for which no widely accepted treatment options are yet
available; and
`(6) other issues the Secretary deems appropriate.
`(c) COORDINATION-
`(1) LEAD OFFICIAL- The Secretary shall designate one official in the
Department of Health and Human Services to oversee the campaign established
under this section.
`(2) AGENCY COORDINATION- The Secretary shall ensure the involvement in the
public awareness campaign under this section of the Surgeon General of the
Public Health Service, the Director of the Centers for Disease Control and
Prevention, and such other representatives of offices and agencies of the
Department of Health and Human Services as the Secretary determines
appropriate.
`(d) UNDERSERVED POPULATIONS- In designing the public awareness campaign
under this section, the Secretary shall take into account the need to reach
underserved populations who are disproportionately under-treated for pain.
`(e) GRANTS AND CONTRACTS- The Secretary may make awards of grants,
cooperative agreements, and contracts to public agencies and private non-profit
organizations to assist with the development and implementation of the public
awareness campaign under this section.
`(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 following new section:
`Sec. 1111. Pain care
`The administering Secretaries shall develop and implement 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 services--
`(1) are assessed for pain at the time of admission 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 intractable 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 Security 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 appropriate
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 treatment of illnesses that frequently
accompany serious pain, including depression, other mental health disorders,
sleep disturbance, and substance abuse;
`(iii) provides medical and other health services through physicians and
other practitioners credentialed or experienced in pain medicine;
`(iv) provides for referral of patients with chronic pain as defined in
subparagraph (B)(i) to specialists, and, where appropriate, to a comprehensive
multidisciplinary pain management program as defined 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 activities of daily living, and has not
been significantly reduced or ameliorated despite reasonable treatment efforts
for a period of 6 months.
`(ii) COMPREHENSIVE MULTIDISCIPLINARY PAIN MANAGEMENT PROGRAM- 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 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 comprehensive pain management program by an
accrediting organization approved by the Secretary, including the Joint
Commission on the Accreditation of Health Care Organizations or the
Rehabilitation Accreditation Commission; and
`(V) is directed by 1 or more physicians credentialed in pain medicine, 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 providers, or under arrangement with out-of-network
providers, but in no event may an organization 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 following 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 appropriate care
for the treatment of patients in pain that--
`(A) is consistent with recognized guidelines and practice parameters for the
assessment 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
practitioners credentialed or experienced in pain medicine;
`(D) provides for referral of patients with chronic pain to specialists, and,
where appropriate, 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 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.
`(2) DEFINITIONS- For purposes of this subsection--
`(A) The term `chronic pain' means severe, persistent, or recurrent pain that
interferes with the activities of daily living, and has not been significantly
reduced or ameliorated despite reasonable treatment efforts for a period of 6
months.
`(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 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 comprehensive pain management program by an
accrediting organization approved by the Secretary, including the Joint
Commission on the Accreditation of Health Care Organizations or the
Rehabilitation Accreditation Commission; and
`(v) is directed by 1 or more physicians credentialed in pain medicine, 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.
`(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, premiums, or otherwise in the event appropriate pain
care in accordance with the standards set forth in this subsection 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 Congress a report on medicare expenditures for pain care during 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 specializing in pain medicine.
(2) An estimate of payments made under such part B to other providers and
suppliers for the provision 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 program 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:
`Sec. 1720F. Pain care
`The Secretary shall develop and implement a pain care initiative in all
health care facilities of the Department. 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 admission 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
secondary-pain, including acute, chronic, and intractable 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.
END
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