[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5465 Introduced in House (IH)]







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 Services

_______________________________________________________________________

                                 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 Representatives 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.
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 conditions among 
        active duty and retired military personnel.
            (2) Characteristics of modern warfare, including the use of 
        improvised explosive devices, produce substantial numbers of 
        battlefield casualties with significant damage to both the 
        central and peripheral 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 transition to community-based care, 
        contributes to the development 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.
            (6) The military health care systems have implemented 
        important pain care programs at some facilities 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 systems, and for society at large.
            (8) Research, diagnosis, treatment, and management 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:
``Sec. 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 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 services--
            ``(A) 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
            ``(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 specialty pain management services.
    ``(2) The initiative shall include the training and deployment of 
acute pain personnel and services at all Level III care facilities, 
and, to the extent feasible, on the battlefield.
    ``(c) Implementation.--The Secretary of Defense shall implement the 
pain care initiative--
            ``(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 sections 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 Secretaries (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 following new subsection:
    ``(f) Pain Care Standards.--(1) 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 means for assessment, 
        diagnosis, treatment, and management of acute and chronic pain;
            ``(B) includes evaluation and treatment of accompanying 
        illnesses, including depression, other mental health disorders, 
        sleep disturbance, and substance abuse;
            ``(C) provides medical and other health services through 
        physicians and other practitioners appropriately credentialed 
        or experienced in pain management;
            ``(D) provides for referral of patients with chronic pain 
        to specialists, and, in appropriate cases, 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 
        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:
            ``(A) The term `chronic pain' means severe, persistent, 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 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 one or more physicians 
                credentialed in pain management (or, in appropriate 
                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, 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 entered into on or after the date occurring one year 
after the date of the enactment 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 committees not later than six 
months after the date of the enactment of this Act a report on, the 
adequacy of pain care in the health care facilities, services, and 
programs of the Department of Defense.
    (b) Purposes.--The purposes of the study and report shall be to 
evaluate the consistency, across programs, facilities, relevant 
demographic groups, and geographic regions, with which--
            (1) patients are initially assessed and periodically 
        reassessed for pain;
            (2) both acute and chronic pain are promptly and 
        appropriately diagnosed, treated, and managed;
            (3) patients and their families or other caregivers 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 facilities are 
        adequately trained in pain management.
    (c) Authorization of Appropriations.--For purposes of carrying out 
this section, there is authorized to be appropriated such sums as may 
be necessary for fiscal years 2009 through 2011.
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