[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) * * *
* * * * * * *