110 HR 5465 IH: Military Pain Care Act of U.S. House of Representatives 2008-02-14 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 110th CONGRESS 2d Session H. R. 5465 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.

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.

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.

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 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).

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.

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.