[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 2533 Enrolled Bill (ENR)]

        S.2533

                    One Hundred Seventeenth Congress

                                 of the

                        United States of America


                          AT THE SECOND SESSION

           Begun and held at the City of Washington on Monday,
          the third day of January, two thousand and twenty two


                                 An Act


 
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. Telescreening mammography 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. TELESCREENING MAMMOGRAPHY PILOT PROGRAM OF DEPARTMENT OF 
      VETERANS AFFAIRS.
    (a) In General.--Commencing not later than 18 months after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
carry out a pilot program to provide telescreening mammography 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 a 
    telescreening mammography center of the Department for 
    interpretation by qualified radiologists; and
        (2) results shall be shared with the veteran and their primary 
    care provider in accordance with policies established by the 
    Secretary.
    (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 molecular testing 
    and genetic counseling for veterans diagnosed with breast cancer, 
    including veterans living in rural or highly rural areas.
        (2) Decision support tools.--In updating or instituting 
    guidelines under paragraph (1), the Secretary may develop clinical 
    decision support tools, such as clinical pathways, 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);
        (3) breast cancer clinical pathways implemented by the 
    Department of Veterans Affairs and the utilization of those 
    pathways across the Department; and
        (4) any progress of the Department in improving access to and 
    usage of molecular and genetic testing 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.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.