[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4794 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 4794

To improve mammography services furnished by the Department of Veterans 
                    Affairs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 29, 2021

    Ms. Brownley (for herself and Mrs. Miller-Meeks) introduced the 
   following bill; which was referred to the Committee on Veterans' 
  Affairs, and in addition to the Committee on Armed Services, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To improve mammography services furnished by the Department of Veterans 
                    Affairs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Making Advances in 
Mammography and Medical Options for Veterans Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                 TITLE I--SCREENING AND EARLY DETECTION

Sec. 101. Strategic plan for breast imaging services for veterans.
Sec. 102. Telemammography pilot program of Department of Veterans 
                            Affairs.
Sec. 103. Upgrade of breast imaging at facilities of Department of 
                            Veterans Affairs to three-dimensional 
                            digital mammography.
Sec. 104. Study on availability of testing for breast cancer gene among 
                            veterans and expansion of availability of 
                            such testing.
Sec. 105. Mammography accessibility for paralyzed and disabled 
                            veterans.
Sec. 106. Report on access to and quality of mammography screenings 
                            furnished by Department of Veterans 
                            Affairs.
         TITLE II--PARTNERSHIPS FOR RESEARCH AND ACCESS TO CARE

Sec. 201. Partnerships with National Cancer Institute to expand access 
                            of veterans to cancer care.
Sec. 202. Report by Department of Veterans Affairs and Department of 
                            Defense on interagency collaboration on 
                            treating and researching breast cancer.

                 TITLE I--SCREENING AND EARLY DETECTION

SEC. 101. STRATEGIC PLAN FOR BREAST IMAGING SERVICES FOR VETERANS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the Committee on Veterans' Affairs of the Senate and the Committee 
on Veterans' Affairs of the House of Representatives a strategic plan 
for improving breast imaging services for veterans.
    (b) Elements.--The strategic plan required by subsection (a) 
shall--
            (1) cover the evolving needs of women veterans;
            (2) address geographic disparities of breast imaging 
        furnished at a facility of the Department of Veterans Affairs 
        and the use of breast imaging through non-Department providers 
        in the community;
            (3) address the use of digital breast tomosynthesis (DBT-3D 
        breast imaging);
            (4) address the needs of male veterans who require breast 
        cancer screening services; and
            (5) provide recommendations on--
                    (A) potential expansion of breast imaging services 
                furnished at facilities of the Department, including 
                infrastructure and staffing needs;
                    (B) the use of digital breast tomosynthesis;
                    (C) the use of mobile mammography; and
                    (D) other access and equity improvements for breast 
                imaging.

SEC. 102. TELEMAMMOGRAPHY PILOT PROGRAM OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Commencing not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
carry out a pilot program to provide telemammography services for 
veterans who live in--
            (1) States where the Department of Veterans Affairs does 
        not offer breast imaging services at a facility of the 
        Department; or
            (2) locations where access to breast imaging services at a 
        facility of the Department is difficult or not feasible, as 
        determined by the Secretary.
    (b) Duration.--The Secretary shall carry out the pilot program 
under subsection (a) for a three-year period beginning on the 
commencement of the pilot program.
    (c) Locations.--In carrying out the pilot program under subsection 
(a), the Secretary may use community-based outpatient clinics, mobile 
mammography, Federally qualified health centers (as defined in section 
1861(aa)(4) of the Social Security Act (42 U.S.C. 1395x(aa)(4)), rural 
health clinics, critical access hospitals, clinics of the Indian Health 
Service, and such other sites as the Secretary determines feasible to 
provide mammograms under the pilot program.
    (d) Sharing of Images and Results.--Under the pilot program under 
subsection (a)--
            (1) mammography images generated shall be sent to the 
        centralized telemammography center of the Department for 
        interpretation by expert radiologists; and
            (2) results shall be shared with the veteran and their 
        primary care provider.
    (e) Report.--
            (1) In general.--Not later than one year after the 
        conclusion of the pilot program under subsection (a), the 
        Secretary shall submit to the Committee on Veterans' Affairs of 
        the Senate and the Committee on Veterans' Affairs of the House 
        of Representatives a report evaluating the pilot program.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) An assessment of the quality of the mammography 
                provided under the pilot program under subsection (a).
                    (B) Feedback from veterans and providers 
                participating in the pilot program.
                    (C) A recommendation of the Secretary on the 
                continuation or discontinuation of the pilot program.

SEC. 103. UPGRADE OF BREAST IMAGING AT FACILITIES OF DEPARTMENT OF 
              VETERANS AFFAIRS TO THREE-DIMENSIONAL DIGITAL 
              MAMMOGRAPHY.

    Not later than two years after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall--
            (1) upgrade all mammography services at facilities of the 
        Department of Veterans Affairs that provide such services to 
        use digital breast tomosynthesis technology, also known as 
        three-dimensional breast imaging; and
            (2) submit to the Committee on Veterans' Affairs of the 
        Senate and the Committee on Veterans' Affairs of the House of 
        Representatives a report--
                    (A) indicating that the upgrade under paragraph (1) 
                has been completed; and
                    (B) listing the facilities or other locations of 
                the Department at which digital breast tomosynthesis 
                technology is used.

SEC. 104. STUDY ON AVAILABILITY OF TESTING FOR BREAST CANCER GENE AMONG 
              VETERANS AND EXPANSION OF AVAILABILITY OF SUCH TESTING.

    (a) Study.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        conduct a study on the availability of access to testing for 
        the breast cancer gene for veterans diagnosed with breast 
        cancer, as recommended by the guidelines set forth by the 
        National Comprehensive Cancer Network.
            (2) Elements.--In conducting the study under paragraph (1), 
        the Secretary shall examine--
                    (A) the feasibility of expanding the Joint Medicine 
                Service of the Department of Veterans Affairs to 
                provide genetic testing and counseling for veterans 
                with breast cancer across the country; and
                    (B) access to such testing and counseling for 
                veterans living in rural or highly rural areas, and any 
                gaps that may exist with respect to such access.
    (b) Expansion of Availability of Testing.--
            (1) In general.--The Secretary shall update guidelines or 
        institute new guidelines to increase the use of testing for the 
        breast cancer gene and genetic counseling for veterans 
        diagnosed with breast cancer.
            (2) Decision support tools.--In updating or instituting 
        guidelines under paragraph (1), the Secretary may develop 
        clinical decision support tools to facilitate delivery of 
        breast cancer care that is in line with national cancer 
        guidelines.
    (c) Report.--Not later than two years after the date of the 
enactment of this Act, the Secretary shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives a report on--
            (1) the results of the study under subsection (a);
            (2) any updates to guidelines or new guidelines instituted 
        under subsection (b); and
            (3) any progress of the Department in improving access to 
        and usage of testing for the breast cancer gene among veterans 
        diagnosed with breast cancer, including for veterans living in 
        rural or highly rural areas.
    (d) Definitions.--In this section, the terms ``rural'' and ``highly 
rural'' have the meanings given those terms in the Rural-Urban 
Commuting Areas coding system of the Department of Agriculture.

SEC. 105. MAMMOGRAPHY ACCESSIBILITY FOR PARALYZED AND DISABLED 
              VETERANS.

    (a) Study.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        conduct a study on the accessibility of breast imaging services 
        at facilities of the Department of Veterans Affairs for 
        veterans with paralysis, spinal cord injury or disorder (SCI/
        D), or another disability.
            (2) Accessibility.--The study required by paragraph (1) 
        shall include an assessment of the accessibility of the 
        physical infrastructure at breast imaging facilities of the 
        Department, including the imaging equipment, transfer 
        assistance, and the room in which services will be provided as 
        well as adherence to best practices for screening and treating 
        veterans with a spinal cord injury or disorder.
            (3) Screening rates.--
                    (A) Measurement.--The study required by paragraph 
                (1) shall include a measurement of breast cancer 
                screening rates for veterans with a spinal cord injury 
                or disorder during the two-year period preceding the 
                commencement of the study, including a breakout of the 
                screening rates for such veterans living in rural or 
                highly rural areas.
                    (B) Development of method.--If the Secretary is 
                unable to provide the measurement required under 
                subparagraph (A), the Secretary shall develop a method 
                to track breast cancer screening rates for veterans 
                with a spinal cord injury or disorder.
            (4) Report.--Not later than two years after the date of the 
        enactment of this Act, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on the findings of the study required by paragraph (1), 
        including--
                    (A) the rates of screening among veterans with a 
                spinal cord injury or disorder, including veterans 
                living in rural or highly rural areas, as required 
                under paragraph (3)(A); or
                    (B) if such rates are not available, a description 
                of the method developed to measure such rates as 
                required under paragraph (3)(B).
    (b) Care From Non-Department Providers.--The Secretary shall update 
the policies and directives of the Department to ensure that, in 
referring a veteran with a spinal cord injury or disorder for care from 
a non-Department provider, the Secretary shall--
            (1) confirm with the provider the accessibility of the 
        breast imaging site, including the imaging equipment, transfer 
        assistance, and the room in which services will be provided; 
        and
            (2) provide additional information to the provider on best 
        practices for screening and treating veterans with a spinal 
        cord injury or disorder.
    (c) Definitions.--In this section, the terms ``rural'' and ``highly 
rural'' have the meanings given those terms in the Rural-Urban 
Commuting Areas coding system of the Department of Agriculture.

SEC. 106. REPORT ON ACCESS TO AND QUALITY OF MAMMOGRAPHY SCREENINGS 
              FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Not later than two years after the date of the 
enactment of this Act, the Inspector General of the Department of 
Veterans Affairs shall submit to the Secretary of Veterans Affairs, the 
Committee on Veterans' Affairs of the Senate, and the Committee on 
Veterans' Affairs of the House of Representatives a report on 
mammography services furnished by the Department of Veterans Affairs.
    (b) Elements.--The report required by subsection (a) shall include 
an assessment of--
            (1) the access of veterans to mammography screenings, 
        whether at a facility of the Department or through a non-
        Department provider, including any staffing concerns of the 
        Department in providing such screenings;
            (2) the quality of such screenings and reading of the 
        images from such screenings, including whether such screenings 
        use three-dimensional mammography;
            (3) the communication of the results of such screenings, 
        including whether results are shared in a timely manner, 
        whether results are shared via the Joint Health Information 
        Exchange or another electronic mechanism, and whether results 
        are incorporated into the electronic health record of the 
        veteran;
            (4) the performance of the Women's Breast Oncology System 
        of Excellence of the Department; and
            (5) the access of veterans diagnosed with breast cancer to 
        a comprehensive breast cancer care team of the Department.
    (c) Follow-Up.--Not later than 180 days after the submittal of the 
report under subsection (a), the Secretary shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives a plan to address the 
deficiencies identified in the report under subsection (a), if any.

         TITLE II--PARTNERSHIPS FOR RESEARCH AND ACCESS TO CARE

SEC. 201. PARTNERSHIPS WITH NATIONAL CANCER INSTITUTE TO EXPAND ACCESS 
              OF VETERANS TO CANCER CARE.

    (a) Access to Care in Each VISN.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        enter into a partnership with not fewer than one cancer center 
        of the National Cancer Institute of the National Institutes of 
        Health in each Veterans Integrated Service Network of the 
        Department of Veterans Affairs to expand access to high-quality 
        cancer care for women veterans.
            (2) Treatment of rural veterans.--The Secretary, in 
        carrying out partnerships entered into under paragraph (1), 
        shall ensure that veterans with breast cancer who reside in 
        rural areas or States without a cancer center that has entered 
        into such a partnership with the Secretary are able to receive 
        care through such a partnership via telehealth.
    (b) Report on Partnership To Increase Access to Clinical Trials.--
Not later than 180 days after the date of the enactment of this Act, 
the Secretary shall submit to the Committee on Veterans' Affairs of the 
Senate and the Committee on Veterans' Affairs of the House of 
Representatives a report on--
            (1) how the Secretary will ensure that the advancements 
        made through the existing partnership between the Department of 
        Veterans Affairs and the National Cancer Institute to provide 
        veterans with access to clinical cancer research trials 
        (commonly referred to as ``NAVIGATE'') are permanently 
        implemented; and
            (2) the determination of the Secretary of whether expansion 
        of such partnership to more than the original 12 facilities of 
        the Department that were selected under such partnership is 
        feasible.
    (c) Periodic Reports.--Not later than three years after the date of 
the enactment of this Act, and every three years thereafter, the 
Secretary shall submit to the Committee on Veterans' Affairs of the 
Senate and the Committee on Veterans' Affairs of the House of 
Representatives a report--
            (1) assessing how the partnerships entered into under 
        subsection (a)(1) have impacted access by veterans to cancer 
        centers of the National Cancer Institute, including an 
        assessment of the telehealth options made available and used 
        pursuant to such partnerships; and
            (2) describing the advancements made with respect to access 
        by veterans to clinical cancer research trials through the 
        partnership described in subsection (b)(1), including how many 
        of those veterans were women veterans, minority veterans 
        (including racial and ethnic minorities), and rural veterans, 
        and identifying opportunities for further innovation.

SEC. 202. REPORT BY DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF 
              DEFENSE ON INTERAGENCY COLLABORATION ON TREATING AND 
              RESEARCHING BREAST CANCER.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
collaboration with the Secretary of Defense, shall submit to Congress a 
report on all current research and health care collaborations between 
the Department of Veterans Affairs and the Department of Defense on 
treating veterans and members of the Armed Forces with breast cancer.
    (b) Elements.--The report required by subsection (a)--
            (1) shall include a description of potential opportunities 
        for future interagency collaboration between the Department of 
        Veterans Affairs and the Department of Defense with respect to 
        treating and researching breast cancer; and
            (2) may include a focus on--
                    (A) with respect to women members of the Armed 
                Forces with a diagnosis of or who are undergoing 
                screening for breast cancer, transition of such members 
                from receiving care from the Department of Defense to 
                receiving care from the Department of Veterans Affairs;
                    (B) collaborative breast cancer research 
                opportunities between the Department of Veterans 
                Affairs and the Department of Defense;
                    (C) access to clinical trials; and
                    (D) such other matters as the Secretary of Veterans 
                Affairs and the Secretary of Defense consider 
                appropriate.
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