[House Report 110-871]
[From the U.S. Government Publishing Office]





110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-871

======================================================================



 
                 NATIONAL PAIN CARE POLICY ACT OF 2008

                                _______
                                

 September 23, 2008.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2994]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2994) to amend the Public Health Service Act 
with respect to pain care, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     5
Background and Need for Legislation..............................     5
Hearings.........................................................     6
Committee Consideration..........................................     6
Committee Votes..................................................     6
Committee Oversight Findings.....................................     6
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Earmarks and Tax and Tariff Benefits.............................     7
Committee Cost Estimate..........................................     7
Congressional Budget Office Estimate.............................     7
Federal Mandates Statement.......................................     9
Advisory Committee Statement.....................................     9
Constitutional Authority Statement...............................     9
Applicability to Legislative Branch..............................     9
Section-by-Section Analysis of the Legislation...................     9
Changes in Existing Law Made by the Bill, as Reported............    11

                               Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``National Pain Care 
Policy Act of 2008''.
  (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Institute of Medicine Conference on Pain.
Sec. 3. Pain research at National Institutes of Health.
Sec. 4. Pain care education and training.
Sec. 5. Public awareness campaign on pain management.

SEC. 2. INSTITUTE OF MEDICINE CONFERENCE ON PAIN.

  (a) Convening.--Not later than June 30, 2009, the Secretary of Health 
and Human Services shall seek to enter into an agreement with the 
Institute of Medicine of the National Academies to convene a Conference 
on Pain (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) evaluate the adequacy of assessment, diagnosis, 
        treatment, and management of acute and chronic pain in the 
        general population, and in identified racial, ethnic, gender, 
        age, and other demographic groups that may be 
        disproportionately affected by inadequacies in the assessment, 
        diagnosis, treatment, and management of pain;
          (3) identify barriers to appropriate pain care, including--
                  (A) lack of understanding and education among 
                employers, patients, health care providers, regulators, 
                and third-party payors;
                  (B) barriers to access to care at the primary, 
                specialty, and tertiary care levels, including 
                barriers--
                          (i) specific to those populations that are 
                        disproportionately undertreated for pain;
                          (ii) related to physician concerns over 
                        regulatory and law enforcement policies 
                        applicable to some pain therapies; and
                          (iii) attributable to benefit, coverage, and 
                        payment policies in both the public and private 
                        sectors; and
                  (C) gaps in basic and clinical research on the 
                symptoms and causes of pain, and potential assessment 
                methods and new 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.
  (c) Other Appropriate Entity.--If the Institute of Medicine declines 
to enter into an agreement under subsection (a), the Secretary of 
Health and Human Services may enter into such agreement with another 
appropriate entity.
  (d) Report.--A report summarizing the Conference's findings and 
recommendations shall be submitted to the Congress not later than June 
30, 2010.
  (e) Authorization of Appropriations.--For the purpose of carrying out 
this section, there is authorized to be appropriated $500,000 for each 
of fiscal years 2009 and 2010.

SEC. 3. PAIN RESEARCH AT NATIONAL INSTITUTES OF HEALTH.

  Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et 
seq.) is amended by adding at the end the following:

``SEC. 409J. PAIN RESEARCH.

  ``(a) Research Initiatives.--
          ``(1) In general.--The Director of NIH is encouraged to 
        continue and expand, through the Pain Consortium, an aggressive 
        program of basic and clinical research on the causes of and 
        potential treatments for pain.
          ``(2) Annual recommendations.--Not less than annually, the 
        Pain Consortium, in consultation with the Division of Program 
        Coordination, Planning, and Strategic Initiatives, shall 
        develop and submit to the Director of NIH recommendations on 
        appropriate pain research initiatives that could be undertaken 
        with funds reserved under section 402A(c)(1) for the Common 
        Fund or otherwise available for such initiatives.
          ``(3) Definition.--In this subsection, the term `Pain 
        Consortium' means the Pain Consortium of the National 
        Institutes of Health or a similar trans-National Institutes of 
        Health coordinating entity designated by the Secretary for 
        purposes of this subsection.
  ``(b) Interagency Pain Research Coordinating Committee.--
          ``(1) Establishment.--The Secretary shall establish not later 
        than 1 year after the date of the enactment of this section and 
        as necessary maintain a committee, to be known as the 
        Interagency Pain Research Coordinating Committee (in this 
        section referred to as the `Committee'), to coordinate all 
        efforts within the Department of Health and Human Services and 
        other Federal agencies that relate to pain research.
          ``(2) Membership.--
                  ``(A) In general.--The Committee shall be composed of 
                the following voting members:
                          ``(i) Not more than 7 voting Federal 
                        representatives as follows:
                                  ``(I) The Director of the Centers for 
                                Disease Control and Prevention.
                                  ``(II) The Director of the National 
                                Institutes of Health and the directors 
                                of such national research institutes 
                                and national centers as the Secretary 
                                determines appropriate.
                                  ``(III) The heads of such other 
                                agencies of the Department of Health 
                                and Human Services as the Secretary 
                                determines appropriate.
                                  ``(IV) Representatives of other 
                                Federal agencies that conduct or 
                                support pain care research and 
                                treatment, including the Department of 
                                Defense and the Department of Veterans 
                                Affairs.
                          ``(ii) 12 additional voting members appointed 
                        under subparagraph (B).
                  ``(B) Additional members.--The Committee shall 
                include additional voting members appointed by the 
                Secretary as follows:
                          ``(i) 6 members shall be appointed from among 
                        scientists, physicians, and other health 
                        professionals, who--
                                  ``(I) are not officers or employees 
                                of the United States;
                                  ``(II) represent multiple 
                                disciplines, including clinical, basic, 
                                and public health sciences;
                                  ``(III) represent different 
                                geographical regions of the United 
                                States; and
                                  ``(IV) are from practice settings, 
                                academia, manufacturers or other 
                                research settings; and
                          ``(ii) 6 members shall be appointed from 
                        members of the general public, who are 
                        representatives of leading research, advocacy, 
                        and service organizations for individuals with 
                        pain-related conditions.
                  ``(C) Nonvoting members.--The Committee shall include 
                such nonvoting members as the Secretary determines to 
                be appropriate.
          ``(3) Chairperson.--The voting members of the Committee shall 
        select a chairperson from among such members. The selection of 
        a chairperson shall be subject to the approval of the Director 
        of NIH.
          ``(4) Meetings.--The Committee shall meet at the call of the 
        chairperson of the Committee or upon the request of the 
        Director of NIH, but in no case less often than once each year.
          ``(5) Duties.--The Committee shall--
                  ``(A) develop a summary of advances in pain care 
                research supported or conducted by the Federal agencies 
                relevant to the diagnosis, prevention, and treatment of 
                pain and diseases and disorders associated with pain;
                  ``(B) identify critical gaps in basic and clinical 
                research on the symptoms and causes of pain;
                  ``(C) make recommendations to ensure that the 
                activities of the National Institutes of Health and 
                other Federal agencies, including the Department of 
                Defense and the Department of Veteran Affairs, are free 
                of unnecessary duplication of effort;
                  ``(D) make recommendations on how best to disseminate 
                information on pain care; and
                  ``(E) make recommendations on how to expand 
                partnerships between public entities, including Federal 
                agencies, and private entities to expand collaborative, 
                cross-cutting research.
          ``(6) Review.--The Secretary shall review the necessity of 
        the Committee at least once every 2 years.''.

SEC. 4. PAIN CARE EDUCATION AND TRAINING.

  (a) Pain Care Education and Training.--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 758 as sections 755 
        through 759, respectively; and
          (2) by inserting after section 753 the following:

``SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE.

  ``(a) In General.--The Secretary 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 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) recognized means for assessing, diagnosing, treating, 
        and managing pain and related signs and symptoms, including the 
        medically appropriate use of controlled substances;
          ``(2) applicable laws, regulations, rules, and policies on 
        controlled substances, including the degree to which 
        misconceptions and concerns regarding such laws, regulations, 
        rules, and policies, or the enforcement thereof, may create 
        barriers to patient access to appropriate and effective pain 
        care;
          ``(3) interdisciplinary approaches to the delivery of pain 
        care, including delivery through specialized centers providing 
        comprehensive pain care treatment expertise;
          ``(4) cultural, linguistic, literacy, geographic, and other 
        barriers to care in underserved populations; and
          ``(5) recent findings, developments, and improvements in the 
        provision of pain 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 education in medicine, 
pain management, dentistry, psychology, social work, nursing, and 
pharmacy; 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 of pain 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 care.
  ``(g) Definitions.--For purposes of this section the term `pain care' 
means the assessment, diagnosis, treatment, or management of acute or 
chronic pain regardless of causation or body location.''.
  (b) Authorization of Appropriations.--Section 758(b)(1) of the Public 
Health Service Act (as redesignated by subsection (a)(1) of this 
section) is amended--
          (1) by striking ``and'' at the end of subparagraph (B);
          (2) by striking the period at the end of subparagraph (C) and 
        inserting ``; and''; and
          (3) by inserting after subparagraph (C) the following:
                  ``(D) not less than $5,000,000 for awards of grants, 
                cooperative agreements, and contracts under sections 
                754.''.
  (c) Technical Amendments.--Title VII of the Public Health Service Act 
(42 U.S.C. 292 et seq.) is amended--
          (1) in paragraph (2) of section 757(b) (as redesignated by 
        subsection (a)(1)), by striking ``754(3)(A), and 755(b)'' and 
        inserting ``755(3)(A), and 756(b)''; and
          (2) in subparagraph (C) of section 758(b)(1) (as redesignated 
        by subsection (a)(1)), by striking ``754, and 755'' and 
        inserting ``755, and 756''.

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:

``SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN 
                    MANAGEMENT.

  ``(a) Establishment.--Not later than June 30, 2009, the Secretary 
shall establish and implement a national pain care education outreach 
and awareness campaign described in subsection (b).
  ``(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, emotional, 
        societal, and financial consequences that can result if pain is 
        not appropriately assessed, diagnosed, treated, or managed;
          ``(3) the availability, benefits, and risks of all pain 
        treatment and management options;
          ``(4) having pain promptly assessed, appropriately diagnosed, 
        treated, and managed, and regularly reassessed with treatment 
        adjusted as needed;
          ``(5) the role of credentialed pain management specialists 
        and subspecialists, and of comprehensive interdisciplinary 
        centers of treatment expertise;
          ``(6) the availability in the public, nonprofit, and private 
        sectors of pain management-related information, services, and 
        resources for consumers, employers, third-party payors, 
        patients, their families, and caregivers, including information 
        on--
                  ``(A) appropriate assessment, diagnosis, treatment, 
                and management options for all types of pain and pain-
                related symptoms; and
                  ``(B) conditions for which no treatment options are 
                yet recognized; and
          ``(7) other issues the Secretary deems appropriate.
  ``(c) Consultation.--In designing and implementing the public 
awareness campaign required by this section, the Secretary shall 
consult with organizations representing patients in pain and other 
consumers, employers, physicians including physicians specializing in 
pain care, other pain management professionals, medical device 
manufacturers, and pharmaceutical companies.
  ``(d) 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.
  ``(e) Underserved Areas and Populations.--In designing the public 
awareness campaign under this section, the Secretary shall--
          ``(1) take into account the special needs of geographic areas 
        and racial, ethnic, gender, age, and other demographic groups 
        that are currently underserved; and
          ``(2) provide resources that will reduce disparities in 
        access to appropriate diagnosis, assessment, and treatment.
  ``(f) Grants and Contracts.--The Secretary may make awards of grants, 
cooperative agreements, and contracts to public agencies and private 
nonprofit organizations to assist with the development and 
implementation of the public awareness campaign under this section.
  ``(g) Evaluation and Report.--Not later than the end of fiscal year 
2011, the Secretary shall prepare and submit to the Congress a report 
evaluating the effectiveness of the public awareness campaign under 
this section in educating the general public with respect to the 
matters described in subsection (b).
  ``(h) Authorization of Appropriations.--For purposes of carrying out 
this section, there are authorized to be appropriated $2,000,000 for 
fiscal year 2009 and $4,000,000 for each of fiscal years 2010 and 
2011.''.

                          Purpose and Summary

    The purpose of H.R. 2994, the National Pain Care Policy Act 
of 2007, is to amend the Public Health Service Act with respect 
to pain care.

                  Background and Need for Legislation

    Pain is the most common reason Americans access the health 
care system and is a leading cause of disability and major 
contributor to health care costs. The National Center for 
Health Statistics estimates that 76.2 million, or one in every 
four Americans, have suffered from pain that lasts longer than 
24 hours and millions more suffer from acute pain. Most painful 
conditions can be relieved with proper treatment, and providing 
adequate pain management is a crucial component of improving 
and maintaining quality of life for patients, survivors, and 
their loved ones. People in pain, however, often face 
significant barriers that can prevent proper assessment, 
diagnosis, treatment, and management of their pain. Left 
untreated, pain can decrease the quality of life and affect 
every aspect of daily living, including work, sleep, and social 
relations.

                                Hearings

    No hearings were held in connection with H.R. 2994.

                        Committee Consideration

    On Wednesday, September 17, 2008, the full Committee met in 
open markup session and ordered H.R. 2994 favorably reported to 
the House, amended, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. No 
record votes were taken on amendments or in connection with 
ordering H.R. 2994 reported to the House. A motion by Mr. 
Dingell to order H.R. 2994 favorably reported to the House, 
amended, was agreed to by a voice vote.

                      Committee Oversight Findings

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the oversight findings of the 
Committee regarding H.R. 2994 are reflected in this report.

         Statement of General Performance Goals and Objectives

    The objective of H.R. 2994 is to amend the Public Health 
Service Act to (1) encourage the Secretary of Health and Human 
Services (HHS) to enter into an agreement with the Institute of 
Medicine (IOM) of the National Academies to convene a 
Conference on Pain; (2) encourage the Director of the National 
Institutes of Health (NIH) to continue to expand, through the 
Pain Consortium, an aggressive program of basic and clinical 
research on the causes of and potential treatments for pain; 
(3) establish an Interagency Pain Research Coordinating 
Committee within HHS; (4) allow the HHS Secretary to award 
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 care; and (5) require the HHS Secretary to establish and 
implement a national pain care education outreach and awareness 
campaign.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 2994 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    Regarding compliance with clause 9 of rule XXI of the Rules 
of the House of Representatives, H.R. 2994 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of Rule XXI.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
2994 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate on 
H.R. 2994 provided by the Congressional Budget Office pursuant 
to section 402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 22, 2008.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2994, the National 
Pain Care Policy Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Stephanie 
Cameron.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

H.R. 2994--National Pain Care Policy Act of 2008

    Summary: H.R. 2994 would amend the Public Health Service 
Act to coordinate research programs related to pain, and 
require the Secretary of Health and Human Services (HHS) to 
convene a conference on pain and conduct a public awareness 
campaign on pain management. CBO estimates that enacting H.R. 
2994 would cost $1 million in 2009 and $12 million over the 
2009-2013 period, assuming appropriation of the necessary 
amounts. Enacting H.R. 2994 would not affect direct spending or 
revenues.
    H.R. 2994 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on state, local, or tribal 
governments.
    Estimated Cost to the Federal Government: The estimated 
cost of H.R. 2994 is shown in the following table. The costs of 
this legislation fall within budget function 550 (health).

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year in millions of dollars--
                                                              --------------------------------------------------
                                                                2009    2010    2011    2012    2013   2009-2013
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level................................       4       6       5       1       1        17
Estimated Outlays............................................       1       4       5       1       1        12
----------------------------------------------------------------------------------------------------------------

    Basis of Estimate: H.R. 2994 would require the Secretary of 
HHS to convene a conference on pain, coordinate research 
programs related to pain, and conduct a public awareness 
campaign on pain management. For this estimate, CBO assumes 
that H.R. 2994 would be enacted near the beginning of fiscal 
year 2009, that the necessary amounts will be appropriated each 
year, and that outlays will follow historical spending patterns 
for similar activities. CBO estimates that implementing H.R. 
2994 would cost $12 million over the 2009-2013 period.

Institute of Medicine conference on pain

    H.R. 2994 would require the Secretary of HHS to collaborate 
with the Institute of Medicine of the National Academies (or 
other appropriate entity) to convene a conference on pain. This 
bill would require the Secretary to complete a report 
summarizing the conference findings and recommendations to be 
submitted to the Congress not later than June 30, 2010. H.R. 
2994 would authorize the appropriation of $0.5 million a year 
for fiscal years 2009 and 2010 for those purposes. Assuming the 
appropriation of the specified amounts, CBO estimates that 
provision would cost $1 million over the 2009-2013 period.

Pain research

    The bill would amend the Public Health Service Act to 
establish an interagency committee to coordinate pain research 
across federal agencies. Assuming the availability of 
appropriated funds, CBO estimates that provision would cost $4 
million over the 2009-2013 time period.

Public awareness campaign on pain management

    H.R. 2994 would direct the Secretary of HHS to conduct a 
nationwide campaign to increase public awareness of issues 
related to pain treatment and management. This bill would 
authorize the Secretary to award grants, cooperative 
agreements, and contracts to public agencies and private 
nonprofit organizations to assist with the development and 
implementation of the public awareness campaign.
    H.R. 2994 would authorize the appropriation of $2 million 
for fiscal years 2009 and $4 million a year for fiscal years 
2010 and 2011 for those activities. Assuming the appropriation 
of the authorized amounts, CBO estimates that implementing 
those provisions would cost $7 million over the 2009-2013 
period.
    Intergovernmental and private-sector impact: H.R. 2994 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Public institutions of higher education that 
provide education and training for health care professionals in 
pain care would benefit from grant funds authorized in the 
bill.
    Estimate prepared by: Federal Costs: Stephanie Cameron and 
Kirstin Nelson; Impact on State, Local, and Tribal Governments: 
Lisa Ramirez-Branum; Impact on the Private Sector: Keisuke 
Nakagawa.
    Estimate approved by: Keith J. Fontenot, Deputy Assistant 
Director for Health and Human Resources, Budget Analysis 
Division.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2994 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2994.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 2994 is provided in the 
provisions of Article I, section 8, clause 1, that relate to 
expending funds to provide for the general welfare of the 
United States.

                  Applicability to Legislative Branch

    The Committee finds that H.R. 2994 does not relate to the 
terms and conditions of employment or access to public services 
or accommodations within the meaning of section 102(b)(3) of 
the Congressional Accountability Act of 1995.

             Section-by-Section Analysis of the Legislation


Section 1. Short title; table of contents

    Section 1 establishes the short title of the bill as the 
National Pain Care Policy Act of 2008 and lists the table of 
contents.

Section 2. Institute of Medicine Conference on Pain

    Section 2 states that, no later than June 30, 2009, the HHS 
Secretary must seek to enter into an agreement with the IOM of 
the National Academies to convene a Conference on Pain. The 
purpose of the Conference shall be to increase the recognition 
of pain as a significant public health problem in the United 
States; evaluate the adequacy of assessment, diagnosis, 
treatment, and management of acute and chronic pain in the 
general population; identify racial, ethnic, gender, age, and 
other demographic groups that may be disproportionately 
affected by inadequacies in the system; identify barriers to 
appropriate pain care; and 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.
    If the Institute of Medicine declines to enter into this 
agreement, the HHS Secretary may enter into such agreement with 
another appropriate entity.
    Section 2 requires that a report summarizing the 
Conference's findings shall be submitted to Congress no later 
than June 30, 2010.
    For the purpose of carrying out section 2, this legislation 
authorizes to be appropriated $500,000 for each of fiscal years 
2009 and 2010.

Section 3. Pain research at National Institutes of Health

    Section 3 amends part B of title IV of the Public Health 
Service Act (42 U.S.C. 284 et seq.) by adding a new section 
which encourages the NIH Director to continue and expand, 
through the Pain Consortium, an aggressive program of basic and 
clinical research on the causes of and potential treatments for 
pain. At least once a year, the Pain Consortium, in 
consultation with the Division of Program Coordination, 
Planning, and Strategic Initiatives, shall develop and submit 
to the NIH Director recommendations on appropriate pain 
research initiatives that could be undertaken with funds 
reserved for the Common Fund or otherwise available for such 
initiatives.
    Section 3 defines the term ``Pain Consortium'' to mean the 
Pain Consortium of NIH or a similar trans-NIH coordinating 
entity designated by the Secretary.
    Section 3 directs the Secretary to establish an Interagency 
Pain Research Coordinating Committee, charged with coordinating 
all efforts within HHS and other Federal agencies that relate 
to pain research. Section 3 establishes the composition of the 
Coordinating Committee and requires that the Committee meet at 
the call of the chairperson, or upon the request of the NIH 
Director, but in no case less often than once per year.
    Section 3 establishes the duties of the Coordinating 
Committee and requires the Committee to develop a summary of 
advances in pain care research supported or conducted by the 
Federal agencies relevant to the diagnosis, treatment, and 
prevention of pain, and diseases and disorders associated with 
pain; identify critical gaps in basic and clinical research on 
the symptoms and causes of pain; and make recommendations. The 
Secretary shall review the necessity of the Committee at least 
once every two years.

Section 4. Pain care education and training

    Section 4 amends part D of title VII of the Public Health 
Service Act (42 U.S.C. 294 et seq.) by adding a new section 
which states that the Secretary may award 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 care.
    Section 4 states that an award may be made only if the 
applicant for the award agrees that the program carried out 
with the award will include information and education on 
recognized means for assessing, diagnosing, treating, and 
managing pain and related signs and symptoms, including the 
medically appropriate use of controlled substances. In 
addition, programs carried out must include information and 
education on applicable laws, regulations, rules, and policies 
on controlled substances; interdisciplinary approaches to the 
delivery of pain care; cultural, linguistic, literacy, 
geographic, and other barriers to care in underserved 
populations; and recent findings, developments, and 
improvements in the provision of pain care. The Secretary shall 
provide for the evaluation of these programs in order to 
determine the effect of such programs on the knowledge and 
practice of pain care.
    Section 4 defines the term ``pain care'' to mean the 
assessment, diagnosis, treatment, or management of acute or 
chronic pain regardless of causation or body location.
    Section 4 updates the existing authorization of 
appropriations to require that, of the amounts appropriated for 
a fiscal year, the Secretary shall make available not less than 
$5,000,000 for awards of grants, cooperative agreements, and 
contracts.

Section 5. Public awareness campaign on pain management

    Section 5 amends part B of title II of the Public Health 
Service Act (42 U.S.C. 238 et seq.) by adding a new section 
which requires that, no later than June 30, 2009, the Secretary 
shall establish and implement a national pain care education 
outreach and awareness campaign. Amongst other things, the 
public awareness campaign shall be designed to educate 
consumers, patients, their families, and other caregivers with 
respect to the incidence and importance of pain as a national 
public health problem. In designing and implementing the public 
awareness campaign, the Secretary shall consult with 
organizations representing patients in pain and other 
consumers, employers, physicians, other pain management 
professionals, medical device manufacturers, and pharmaceutical 
companies.
    The Secretary shall designate one official in HHS to 
oversee the public awareness campaign and the Secretary shall 
ensure the involvement of the Surgeon General of the Public 
Health Service, the Director of the Centers for Disease Control 
and Prevention, and other such representatives of offices and 
agencies of HHS as the Secretary determines appropriate.
    Section 5 requires that, in designing the public awareness 
campaign, the Secretary shall take into account the special 
needs of geographic areas and racial, ethnic, gender, age, and 
other demographic groups that are currently underserved and 
provide resources that will reduce disparities in access to 
appropriate diagnosis, assessment, and treatment.
    Under this section, the Secretary may make awards of 
grants, cooperative agreements, and contracts to public 
agencies and private nonprofit organizations to assist with the 
development and implementation of the public awareness 
campaign. In addition, the Secretary shall prepare and submit a 
report to Congress evaluating the effectiveness of the public 
awareness campaign in educating the general public.
    For purposes of carrying out this section, Section 5 
authorizes there to be appropriated $2,000,000 for fiscal year 
2009 and $4,000,000 for each of fiscal years 2010 and 2011.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




           *       *       *       *       *       *       *
TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS

           *       *       *       *       *       *       *



Part B--Miscellaneous Provisions

           *       *       *       *       *       *       *



SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN 
                    MANAGEMENT.

  (a) Establishment.--Not later than June 30, 2009, the 
Secretary shall establish and implement a national pain care 
education outreach and awareness campaign described in 
subsection (b).
  (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, emotional, 
        societal, and financial consequences that can result if 
        pain is not appropriately assessed, diagnosed, treated, 
        or managed;
          (3) the availability, benefits, and risks of all pain 
        treatment and management options;
          (4) having pain promptly assessed, appropriately 
        diagnosed, treated, and managed, and regularly 
        reassessed with treatment adjusted as needed;
          (5) the role of credentialed pain management 
        specialists and subspecialists, and of comprehensive 
        interdisciplinary centers of treatment expertise;
          (6) the availability in the public, nonprofit, and 
        private sectors of pain management-related information, 
        services, and resources for consumers, employers, 
        third-party payors, patients, their families, and 
        caregivers, including information on--
                  (A) appropriate assessment, diagnosis, 
                treatment, and management options for all types 
                of pain and pain-related symptoms; and
                  (B) conditions for which no treatment options 
                are yet recognized; and
          (7) other issues the Secretary deems appropriate.
  (c) Consultation.--In designing and implementing the public 
awareness campaign required by this section, the Secretary 
shall consult with organizations representing patients in pain 
and other consumers, employers, physicians including physicians 
specializing in pain care, other pain management professionals, 
medical device manufacturers, and pharmaceutical companies.
  (d) 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.
  (e) Underserved Areas and Populations.--In designing the 
public awareness campaign under this section, the Secretary 
shall--
          (1) take into account the special needs of geographic 
        areas and racial, ethnic, gender, age, and other 
        demographic groups that are currently underserved; and
          (2) provide resources that will reduce disparities in 
        access to appropriate diagnosis, assessment, and 
        treatment.
  (f) Grants and Contracts.--The Secretary may make awards of 
grants, cooperative agreements, and contracts to public 
agencies and private nonprofit organizations to assist with the 
development and implementation of the public awareness campaign 
under this section.
  (g) Evaluation and Report.--Not later than the end of fiscal 
year 2011, the Secretary shall prepare and submit to the 
Congress a report evaluating the effectiveness of the public 
awareness campaign under this section in educating the general 
public with respect to the matters described in subsection (b).
  (h) Authorization of Appropriations.--For purposes of 
carrying out this section, there are authorized to be 
appropriated $2,000,000 for fiscal year 2009 and $4,000,000 for 
each of fiscal years 2010 and 2011.

           *       *       *       *       *       *       *


TITLE IV--NATIONAL RESEARCH INSTITUTES

           *       *       *       *       *       *       *


Part B--General Provisions Respecting National Research Institutes

           *       *       *       *       *       *       *


SEC. 409J. PAIN RESEARCH.

  (a) Research Initiatives.--
          (1) In general.--The Director of NIH is encouraged to 
        continue and expand, through the Pain Consortium, an 
        aggressive program of basic and clinical research on 
        the causes of and potential treatments for pain.
          (2) Annual recommendations.--Not less than annually, 
        the Pain Consortium, in consultation with the Division 
        of Program Coordination, Planning, and Strategic 
        Initiatives, shall develop and submit to the Director 
        of NIH recommendations on appropriate pain research 
        initiatives that could be undertaken with funds 
        reserved under section 402A(c)(1) for the Common Fund 
        or otherwise available for such initiatives.
          (3) Definition.--In this subsection, the term ``Pain 
        Consortium'' means the Pain Consortium of the National 
        Institutes of Health or a similar trans-National 
        Institutes of Health coordinating entity designated by 
        the Secretary for purposes of this subsection.
  (b) Interagency Pain Research Coordinating Committee.--
          (1) Establishment.--The Secretary shall establish not 
        later than 1 year after the date of the enactment of 
        this section and as necessary maintain a committee, to 
        be known as the Interagency Pain Research Coordinating 
        Committee (in this section referred to as the 
        ``Committee''), to coordinate all efforts within the 
        Department of Health and Human Services and other 
        Federal agencies that relate to pain research.
          (2) Membership.--
                  (A) In general.--The Committee shall be 
                composed of the following voting members:
                          (i) Not more than 7 voting Federal 
                        representatives as follows:
                                  (I) The Director of the 
                                Centers for Disease Control and 
                                Prevention.
                                  (II) The Director of the 
                                National Institutes of Health 
                                and the directors of such 
                                national research institutes 
                                and national centers as the 
                                Secretary determines 
                                appropriate.
                                  (III) The heads of such other 
                                agencies of the Department of 
                                Health and Human Services as 
                                the Secretary determines 
                                appropriate.
                                  (IV) Representatives of other 
                                Federal agencies that conduct 
                                or support pain care research 
                                and treatment, including the 
                                Department of Defense and the 
                                Department of Veterans Affairs.
                          (ii) 12 additional voting members 
                        appointed under subparagraph (B).
                  (B) Additional members.--The Committee shall 
                include additional voting members appointed by 
                the Secretary as follows:
                          (i) 6 members shall be appointed from 
                        among scientists, physicians, and other 
                        health professionals, who--
                                  (I) are not officers or 
                                employees of the United States;
                                  (II) represent multiple 
                                disciplines, including 
                                clinical, basic, and public 
                                health sciences;
                                  (III) represent different 
                                geographical regions of the 
                                United States; and
                                  (IV) are from practice 
                                settings, academia, 
                                manufacturers or other research 
                                settings; and
                          (ii) 6 members shall be appointed 
                        from members of the general public, who 
                        are representatives of leading 
                        research, advocacy, and service 
                        organizations for individuals with 
                        pain-related conditions
                  (C) Nonvoting members.--The Committee shall 
                include such nonvoting members as the Secretary 
                determines to be appropriate.
          (3) Chairperson.--The voting members of the Committee 
        shall select a chairperson from among such members. The 
        selection of a chairperson shall be subject to the 
        approval of the Director of NIH.
          (4) Meetings.--The Committee shall meet at the call 
        of the chairperson of the Committee or upon the request 
        of the Director of NIH, but in no case less often than 
        once each year.
          (5) Duties.--The Committee shall--
                  (A) develop a summary of advances in pain 
                care research supported or conducted by the 
                Federal agencies relevant to the diagnosis, 
                prevention, and treatment of pain and diseases 
                and disorders associated with pain;
                  (B) identify critical gaps in basic and 
                clinical research on the symptoms and causes of 
                pain;
                  (C) make recommendations to ensure that the 
                activities of the National Institutes of Health 
                and other Federal agencies, including the 
                Department of Defense and the Department of 
                Veteran Affairs, are free of unnecessary 
                duplication of effort;
                  (D) make recommendations on how best to 
                disseminate information on pain care; and
                  (E) make recommendations on how to expand 
                partnerships between public entities, including 
                Federal agencies, and private entities to 
                expand collaborative, cross-cutting research.
          (6) Review.--The Secretary shall review the necessity 
        of the Committee at least once every 2 years.

           *       *       *       *       *       *       *


TITLE VII--HEALTH PROFESSIONS EDUCATION

           *       *       *       *       *       *       *


PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES

           *       *       *       *       *       *       *


SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE.

  (a) In General.--The Secretary 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 
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) recognized means for assessing, diagnosing, 
        treating, and managing pain and related signs and 
        symptoms, including the medically appropriate use of 
        controlled substances;
          (2) applicable laws, regulations, rules, and policies 
        on controlled substances, including the degree to which 
        misconceptions and concerns regarding such laws, 
        regulations, rules, and policies, or the enforcement 
        thereof, may create barriers to patient access to 
        appropriate and effective pain care;
          (3) interdisciplinary approaches to the delivery of 
        pain care, including delivery through specialized 
        centers providing comprehensive pain care treatment 
        expertise;
          (4) cultural, linguistic, literacy, geographic, and 
        other barriers to care in underserved populations; and
          (5) recent findings, developments, and improvements 
        in the provision of pain 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 education 
in medicine, pain management, dentistry, psychology, social 
work, nursing, and pharmacy; 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 of pain 
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 care.
  (g) Definitions.--For purposes of this section the term 
``pain care'' means the assessment, diagnosis, treatment, or 
management of acute or chronic pain regardless of causation or 
body location.

SEC. [754.] 755. QUENTIN N. BURDICK PROGRAM FOR RURAL INTERDISCIPLINARY 
                    TRAINING.

  (a) * * *

           *       *       *       *       *       *       *


SEC. [755.] 756. ALLIED HEALTH AND OTHER DISCIPLINES.

  (a) * * *

           *       *       *       *       *       *       *


SEC. [756.] 757. ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-
                    BASED LINKAGES.

  (a) * * *

           *       *       *       *       *       *       *

  (b) Composition.--
          (1) * * *

           *       *       *       *       *       *       *

          (2) Appointment.--Not later than 90 days after the 
        date of enactment of this Act, the Secretary shall 
        appoint the members of the Advisory Committee from 
        among individuals who are health professionals from 
        schools of the types described in sections 
        751(a)(1)(A), 751(a)(1)(B), 753(b), [754(3)(A), and 
        755(b)] 755(3)(A), and 756(b). In making such 
        appointments, the Secretary shall ensure a fair balance 
        between the health professions, that at least 75 
        percent of the members of the Advisory Committee are 
        health professionals, a broad geographic representation 
        of members and a balance between urban and rural 
        members. Members shall be appointed based on their 
        competence, interest, and knowledge of the mission of 
        the profession involved.

           *       *       *       *       *       *       *


SEC. [757.] 758. AUTHORIZATION OF APPROPRIATIONS.

  (a) * * *
  (b) Allocation.--
          (1) In general.--Of the amounts appropriated under 
        subsection (a) for a fiscal year, the Secretary shall 
        make available--
                  (A) * * *

           *       *       *       *       *       *       *

                  (B) not less than $3,765,000 for awards of 
                grants and contracts under section 752, of 
                which not less than 50 percent of such amount 
                shall be made available for centers described 
                in subsection (a)(1) of such section; [and]
                  (C) not less than $22,631,000 for awards of 
                grants and contracts under sections 753, [754, 
                and 755.] 755, and 756; and
                  (D) not less than $5,000,000 for awards of 
                grants, cooperative agreements, and contracts 
                under sections 754.

           *       *       *       *       *       *       *


SEC. [758.] 759. INTERDISCIPLINARY TRAINING AND EDUCATION ON DOMESTIC 
                    VIOLENCE AND OTHER TYPES OF VIOLENCE AND ABUSE.

  (a) * * *

           *       *       *       *       *       *       *


                                  
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