[Congressional Record Volume 147, Number 82 (Wednesday, June 13, 2001)]
[Senate]
[Pages S6213-S6217]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN (for himself, Mr. Smith of Oregon, Mr. Rockefeller, 
        and Mr. Breaux):
  S. 1024. 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; to the Committee on Health, Education, Labor, and Pensions.
  Mr. WYDEN. Mr. President, pain is our Nation's silent public health 
crisis. Pain is often left untreated or under-treated, especially among 
older patients, minorities and children. Forty to 50 percent of dying 
patients experience moderate to severe pain at least half of the time 
in the last days of their lives. A Brown University study published in 
last month's Journal of the American Medical Association found that 40 
percent of nursing home patients nationwide with acute or chronic pain 
are not getting treatment that brings them relief. Thousand of 
Americans die in pain every year, and thousands live in chronic pain.
  What is truly tragic for these patients is that the medical 
technology and know-now exist to make them more comfortable. What does 
not exist is a medical system that supports clinicians trying to 
address these issues or a system to support patients and families as 
they try to find help for pain.

[[Page S6214]]

  The primary goal of the Conquering Pain Act, a bipartisan bill that I 
am introducing today with Senators Smith, Rockefeller, and Breaux is to 
create a public health framework with on which effective pain 
management policies can be developed. Providing help to patients in 
pain, to their health care providers, and to others caring for those 
patients will ensure their access to pain management 24 hours a day, 
seven days a week, 365 days a year.
  The widespread crisis of failing to adequately address patients in 
pain is made crystal clear by the fact that only one State in the 
Nation has ever has sanctioned a physician for the under-treatment of 
pain. That State is my home State of Oregon, which is now also 
considering the creation of a commission on pain management with the 
State health department.
  The Conquering Pain Act does not seek to tell clinicians how to 
practice medicine. It does not override State regulation and oversight 
of medicine. it does provide information to physicians and families in 
an effort to support them. It also seeks to find answers to the complex 
problems created by the interplay between State and Federal regulation 
of pain medications.
  Most importantly, the bill would create six regional Family Support 
Networks linking patients, families and providers to information and 
services to assist patients in pain. These networks would also assist 
clinicians who need additional information, mentoring or support to 
deal with the medically complex cases that patients in pain often 
present.
  It would be cruel and callous for this Congress to continue to ignore 
the overwhelming number of scientific studies that show patient after 
patient failing to get relief from pain. This legislation, which enjoys 
broad support with the medical and patient community, would start us 
down the road toward addressing in a bipartisan, positive way one of 
our Nation's most serious and continued health problems.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1024

       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 2001''.
       (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) and 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

[[Page S6215]]

     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);
       (4) the Federal Employee Health Benefits Program under 
     title 5, United States Code;
       (5) the Civilian Health and Medical Program of the 
     Uniformed Services (CHAMPUS) as defined in section 1073(4) of 
     title 10, United States Code; and
       (6) 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. 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:
       ``(v) not later than 2 years after the date of enactment of 
     this clause, an evaluation (which may be made part of any 
     other relevant report of quality evaluation that the plan is 
     required to prepare) for the plan (updated annually) that 
     indicates the performance of the plan with respect to access 
     to, and quality of, pain and symptom management, including 
     such management as part of end of life care. Data shall be 
     posted in a comparable manner for consumer use on 
     www.medicare.gov.''.
       (b) Effective Date.--The amendments made by paragraph (1) 
     apply to information provided with respect to annual, 
     coordinated election periods (as defined in section 
     1851(e)(3)(B) of the Social Security Act (42 U.S.C. 1395-
     21(e)(3)(B)) beginning after the date of enactment of this 
     Act.

     SEC. 105. SURGEON GENERAL'S REPORT.

       Not later than October 1, 2002, the Surgeon General shall 
     prepare and submit to the appropriate committees of Congress 
     and the public, a report concerning the state of pain and 
     symptom management in the United States. The report shall 
     include--
       (1) a description of the legal and regulatory barriers that 
     may exist at the Federal and State levels to providing 
     adequate pain and symptom management;
       (2) an evaluation of provider competency in providing pain 
     and symptom management;
       (3) an identification of vulnerable populations, including 
     children, advanced elderly, non-English speakers, and 
     minorities, who may be likely to be underserved or may face 
     barriers to access to pain management and recommendations to 
     improve access to pain management for these populations;
       (4) an identification of barriers that may exist in 
     providing pain and symptom management in health care 
     settings, including assisted living facilities;
       (5) an identification of patient and family attitudes that 
     may exist which pose barriers in accessing pain and symptom 
     management or in the proper use of pain medications;
       (6) an evaluation of medical, nursing, and pharmacy school 
     training and residency training for pain and symptom 
     management;
       (7) a review of continuing medical education programs in 
     pain and symptom management; and
       (8) a description of the use of and access to mental health 
     services for patients in pain and patients at the end of 
     life.

                TITLE II--DEVELOPING COMMUNITY RESOURCES

     SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMPTOM 
                   MANAGEMENT.

       (a) Establishment.--The Secretary, acting through the 
     Public Health Service, shall award grants for the 
     establishment of 6 National Family Support Networks in Pain 
     and Symptom Management (in this section referred to as the 
     ``Networks'') to serve as national models for improving the 
     access and quality of pain and symptom management to chronic 
     pain patients (including chronically ill patients for whom 
     pain is a significant symptom) and those individuals in need 
     of pain and symptom management at the end of life and to 
     provide assistance to family members and caregivers.
       (b) Eligibility and Distribution.--
       (1) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       (A) be an academic facility or other entity that has 
     demonstrated an effective approach to training health care 
     providers including mental health professionals concerning 
     pain and symptom management and palliative care services; and
       (B) prepare and submit to the Secretary an application (to 
     be peer reviewed by a committee established by the 
     Secretary), at such time, in such manner, and containing such 
     information as the Secretary may require.
       (2) Distribution.--In providing for the establishment of 
     Networks under subsection (a), the Secretary shall ensure 
     that--
       (A) the geographic distribution of such Networks reflects a 
     balance between rural and urban needs; and
       (B) at least 3 Networks are established at academic 
     facilities.
       (c) Activities of Networks.--A Network that is established 
     under this section--
       (1) shall provide for an integrated interdisciplinary 
     approach, that includes psychological and counseling 
     services, to the delivery of pain and symptom management;
       (2) shall provide community leadership in establishing and 
     expanding public access to appropriate pain care, including 
     pain care at the end of life;
       (3) shall provide assistance, through caregiver supportive 
     services, that include counseling and education services;
       (4) shall develop a research agenda to promote effective 
     pain and symptom management for the broad spectrum of 
     patients in need of access to such care that can be 
     implemented by the Network;
       (5) shall provide for coordination and linkages between 
     clinical services in academic centers and surrounding 
     communities to assist in the widespread dissemination of 
     provider and patient information concerning how to access 
     options for pain management;
       (6) shall establish telemedicine links to provide education 
     and for the delivery of services in pain and symptom 
     management;
       (7) shall develop effective means of providing assistance 
     to providers and families for the management of a patient's 
     pain 24 hours a day, 7 days a week; and
       (8) may include complimentary medicine provided in 
     conjunction with traditional medical services.
       (d) Provider Pain and Symptom Management Communications 
     Projects.--
       (1) In general.--Each Network shall establish a process to 
     provide health care personnel with information 24 hours a 
     day, 7 days a week, concerning pain and symptom management. 
     Such process shall be designed to test the effectiveness of 
     specific forms of communications with health care personnel 
     so that such personnel may obtain information to ensure that 
     all appropriate patients

[[Page S6216]]

     are provided with pain and symptom management.
       (2) Termination.--The requirement of paragraph (1) shall 
     terminate with respect to a Network on the day that is 2 
     years after the date on which the Network has established the 
     communications method.
       (3) Evaluation.--Not later than 60 days after the 
     expiration of the 2-year period referred to in paragraph (2), 
     a Network shall conduct an evaluation and prepare and submit 
     to the Secretary a report concerning the costs of operation 
     and whether the form of communication can be shown to have 
     had a positive impact on the care of patients in chronic pain 
     or on patients with pain at the end of life.
       (4) Rule of construction.--Nothing in this subsection shall 
     be construed as limiting a Network from developing other ways 
     in which to provide support to families and providers, 24 
     hours a day, 7 days a week.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $18,000,000 for 
     fiscal years 2002 through 2004.

                   TITLE III--REIMBURSEMENT BARRIERS

     SEC. 301. REIMBURSEMENT BARRIERS REPORT.

       The Medicare Payment Advisory Commission (MedPac) 
     established under section 1805 of the Social Security Act (42 
     U.S.C. 1396b-6) shall conduct a study, and prepare and submit 
     to the appropriate committees of Congress a report, 
     concerning--
       (1) the manner in which medicare policies may pose barriers 
     in providing pain and symptom management and palliative care 
     services in different settings, including a focus on payment 
     for nursing home and home health services;
       (2) the identification of any financial barriers that may 
     exist within the medicare and medicaid programs under titles 
     XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et 
     seq., 1396 et seq.) that interfere with continuity of care 
     and interdisciplinary care or supportive care for the broad 
     range of chronic pain patients (including patients who are 
     chronically ill for whom pain is a significant symptom), and 
     for those who are terminally ill, and include the 
     recommendations of the Commission on ways to eliminate those 
     barriers that the Commission may identify;
       (3) the reimbursement barriers that exist, if any, in 
     providing pain and symptom management through hospice care, 
     particularly in rural areas, and if barriers exist, 
     recommendations concerning adjustments that would assist in 
     assuring patient access to pain and symptom management 
     through hospice care in rural areas;
       (4) whether the medicare reimbursement system provides 
     incentives to providers to delay informing terminally ill 
     patients of the availability of hospice and palliative care; 
     and
       (5) the impact of providing payments for medication therapy 
     management services in pain and symptom management and 
     palliative care services.

     SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM MANAGEMENT.

       (a) In General.--The General Accounting Office shall 
     conduct a survey of public and private health insurance 
     providers, including managed care entities, to determine 
     whether the reimbursement policies of such insurers inhibit 
     the access of chronic pain patients to pain and symptom 
     management and pain and symptom management for those in need 
     of end-of-life care (including patients who are chronically 
     ill for whom pain is a significant symptom). The survey shall 
     include a review of formularies for pain medication and the 
     effect of such formularies on pain and symptom management.
       (b) Report.--Not later than 1 year after the date of 
     enactment of this Act, the General Accounting Office shall 
     prepare and submit to the appropriate committees of Congress 
     a report concerning the survey conducted under subsection 
     (a).

   TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND 
                              INFORMATION

     SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM MANAGEMENT.

       (a) Establishment.--The Secretary shall establish an 
     advisory committee, to be known as the Advisory Committee on 
     Pain and Symptom Management, to make recommendations to the 
     Secretary concerning a coordinated Federal agenda on pain and 
     symptom management.
       (b) Membership.--The Advisory Committee established under 
     subsection (a) shall be comprised of 11 individuals to be 
     appointed by the Secretary, of which at least 1 member shall 
     be a representative of--
       (1) physicians (medical doctors or doctors of osteopathy) 
     who treat chronic pain patients or the terminally ill;
       (2) nurses who treat chronic pain patients or the 
     terminally ill;
       (3) pharmacists;
       (4) hospice;
       (5) pain researchers;
       (6) patient advocates;
       (7) caregivers; and
       (8) mental health providers.

     The members of the Committee shall designate 1 member to 
     serve as the chairperson of the Committee.
       (c) Meetings.--The Advisory Committee shall meet at the 
     call of the chairperson of the Committee.
       (d) Agenda.--The agenda of the Advisory Committee 
     established under subsection (a) shall include--
       (1) the development of recommendations to create a 
     coordinated Federal agenda on pain and symptom management;
       (2) the development of proposals to ensure that pain is 
     considered as the fifth vital sign for all patients;
       (3) the identification of research needs in pain and 
     symptom management, including gaps in pain and symptom 
     management guidelines;
       (4) the identification and dissemination of pain and 
     symptom management practice guidelines, research information, 
     and best practices;
       (5) proposals for patient education concerning how to 
     access pain and symptom management across health care 
     settings;
       (6) the manner in which to measure improvement in access to 
     pain and symptom management and improvement in the delivery 
     of care;
       (7) the development of ongoing strategies to assure the 
     aggressive use of pain medications, including opiods, 
     regardless of health care setting; and
       (8) the development of an ongoing mechanism to identify 
     barriers or potential barriers to pain and symptom management 
     created by Federal policies.
       (e) Recommendation.--Not later than 2 years after the date 
     of enactment of this Act, the Advisory Committee established 
     under subsection (a) shall prepare and submit to the 
     Secretary recommendations concerning a prioritization of the 
     need for a Federal agenda on pain and symptom management, and 
     ways in which to better coordinate the activities of entities 
     within the Department of Health and Human Services, and other 
     Federal entities charged with the responsibility for the 
     delivery of health care services or research on pain and 
     symptom management with respect to pain management.
       (f) Consultation.--In carrying out this section, the 
     Advisory Committee shall consult with all Federal agencies 
     that are responsible for providing health care services or 
     access to health services to determine the best means to 
     ensure that all Federal activities are coordinated with 
     respect to research and access to pain and symptom 
     management.
       (g) Administrative Support; Terms of Service; Other 
     Provisions.--The following shall apply with respect to the 
     Advisory Committee:
       (1) The Committee shall receive necessary and appropriate 
     administrative support, including appropriate funding, from 
     the Department of Health and Human Services.
       (2) The Committee shall hold open meetings and meet not 
     less than 4 times per year.
       (3) Members of the Committee shall not receive additional 
     compensation for their service. Such members may receive 
     reimbursement for appropriate and additional expenses that 
     are incurred through service on the Committee which would not 
     have incurred had they not been a member of the Committee.
       (4) The requirements of Appendix 2 of title 5, United 
     States Code.

     SEC. 402. INSTITUTES OF MEDICINE REPORT ON CONTROLLED 
                   SUBSTANCE REGULATION AND THE USE OF PAIN 
                   MEDICATIONS.

       (a) In General.--The Secretary, acting through a contract 
     entered into with the Institute of Medicine, shall review 
     findings that have been developed through research conducted 
     concerning--
       (1) the effects of controlled substance regulation on 
     patient access to effective care;
       (2) factors, if any, that may contribute to the underuse of 
     pain medications, including opiods;
       (3) the identification of State legal and regulatory 
     barriers, if any, that may impact patient access to 
     medications used for pain and symptom management; and
       (4) strategies to assure the aggressive use of pain 
     medications, including opiods, regardless of health care 
     setting.
       (b) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Secretary shall prepare and submit 
     to the appropriate committees of Congress a report concerning 
     the findings described in subsection (a).

     SEC. 403. CONFERENCE ON PAIN RESEARCH AND CARE.

       Not later than December 31, 2005, the Secretary, acting 
     through the National Institutes of Health, shall convene a 
     national conference to discuss the translation of pain 
     research into the delivery of health services including 
     mental health services to chronic pain patients and those 
     needing end-of-life care. The Secretary shall use unobligated 
     amounts appropriated for the Department of Health and Human 
     Services to carry out this section.

                    TITLE V--DEMONSTRATION PROJECTS

     SEC. 501. PROVIDER PERFORMANCE STANDARDS FOR IMPROVEMENT IN 
                   PAIN AND SYMPTOM MANAGEMENT.

       (a) In General.--The Secretary, acting through the Health 
     Resources Services Administration, shall award grants for the 
     establishment of not less than 5 demonstration projects to 
     determine effective methods to measure improvement in the 
     skills, knowledge, and attitudes and beliefs of health care 
     personnel in pain and symptom management as such skill, 
     knowledge, and attitudes and beliefs apply to providing 
     services to chronic pain patients and those patients 
     requiring pain and symptom management at the end of life.
       (b) Evaluation.--Projects established under subsection (a) 
     shall be evaluated to determine patient and caregiver 
     knowledge

[[Page S6217]]

     and attitudes toward pain and symptom management.
       (c) Application.--To be eligible to receive a grant under 
     subsection (a), an entity shall prepare and submit to the 
     Secretary an application at such time, in such manner and 
     containing such information as the Secretary may require.
       (d) Termination.--A project established under subsection 
     (a) shall terminate after the expiration of the 2-year period 
     beginning on the date on which such project was established.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.

     SEC. 502. END OF LIFE CARE DEMONSTRATION PROJECTS.

       The Secretary, acting through the Health Resources and 
     Services Administration, shall--
       (1) not later than January 1, 2004, carry out not less than 
     5 demonstration and evaluation projects that implement care 
     models for individuals at the end of life, at least one of 
     which shall be developed to assist those individuals who are 
     terminally ill and have no family or extended support, and 
     each of which may be carried out in collaboration with 
     domestic and international entities to gain and share 
     knowledge and experience on end of life care;
       (2) conduct 3 demonstration and evaluation activities 
     concerning the education and training of clinicians in end of 
     life care, and assist in the development and distribution of 
     accurate educational materials on both pain and symptom 
     management and end of life care;
       (3) in awarding grants for the training of health 
     professionals, give priority to awarding grant to entities 
     that will provide training for health professionals in pain 
     and symptom management and in end-of-life care at the 
     undergraduate level;
       (4) shall evaluate demonstration projects carried out under 
     this section within the 5-year period beginning on the 
     commencement of each such project; and
       (5) develop a strategy and make recommendations to Congress 
     to ensure that the United States health care system--
       (A) has a meaningful, comprehensive, and effective approach 
     to meet the needs of individuals and their caregivers as the 
     patient approaches death; and
       (B) integrates broader supportive services.

  Mr. SMITH of Oregon. Mr. President, I rise today to join my friend 
and colleague from Oregon in reintroducing the Conquering Pain Act. He 
and I have worked long and hard together to expand access to effective 
pain and symptom management for chronic pain and terminally ill 
patients, and I believe that this legislation is an important step 
toward accomplishing that goal. This is an issue of great importance to 
my home state of Oregon, and a matter of personal significance to me.
  Prior to my service in elected office, I served as a volunteer for my 
church. In this capacity, I found my professional work as a food 
processor in a constant, but blessed, state of interruption. On a 
weekly basis and at the oddest of hours, I found myself making 
continual rounds at St. Anthony's Hospital in Pendleton, Oregon. On 
many occasions I shared with parents the unspeakable joy of welcoming 
newborn babies into this world. On others, I suffered in heartbreaking 
sorrow as I tried to comfort the critically ill, or hold the hands of 
those who lay at the brink of eternity.
  On too many of these occasions, patients suffered intense pain and 
discomfort during their final hours; sometimes as a result of 
inadequate pain management techniques, and sometimes as a result of our 
medical focus on curing illness and prolonging life at any cost. I have 
seen many beloved friends suffer unnecessarily and I believe that all 
Americans have been touched at some point by a friend or family member 
struggling to cope with chronic or acute pain. We all deserve a health 
care system committed to adequately addressing the comfort of ailing 
patients.
  The legislation we reintroduce today, the Conquering Pain Act, is 
consistent with my belief that the practice of medicine must place 
greater emphasis on helping people who are experiencing chronic and 
acute pain.
  The Conquering Pain Act of 2001 will take a number of steps to ensure 
that patients have greater access to effective pain management. This 
legislation will commission studies by the Surgeon General's office, 
the General Accounting Office, the Institute of Medicine, and MedPac to 
examine the state of pain and symptom management in the United States, 
and to review regulatory obstacles that stifle effective pain 
management in our health care system. The Act will establish 
demonstration projects at the Department of Health and Human Services 
and other institutions to provide advanced pain management care and to 
research effective methods to measure improvement in the skills, 
knowledge, and attitudes of health care personnel in pain and symptom 
management. In addition, this bill will make important and timely 
information related to pain management available to patients and health 
care professionals over the Internet.
  The Conquering Pain Act of 2001 will do something that should have 
been done many years ago; it will finally establish a coordinated 
Federal agenda regarding pain and symptom management. For better or for 
worse, our health care system has focused intensely on curing disease 
but has never adequately addressed the need to provide effective pain 
management. Americans should expect their health care providers to 
attend to their comfort as well as their health, and I believe that 
this legislation will go a long way toward addressing this long-
standing deficiency.
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