117 S2533 RS: Making Advances in Mammography and Medical Options for Veterans Act
U.S. Senate
2022-03-10
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents(a)This Act may be cited as the Making Advances in Mammography and Medical Options for Veterans Act
.(b)The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.TITLE I—Screening and early detectionSec. 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 careSec. 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.<enum>I</enum><header>Screening and early detection</header><section id="idEBC47AC9C2B1454BB78D77E8DF8657E2" section-type="subsequent-section"><enum>101.</enum><header>Strategic plan for breast imaging services for veterans</header><subsection id="idd5868a12ffce4cb08cd89b97160fd756"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="idc0bf28e5d5b847d18a6f6a62eb24cddc"><enum>(b)</enum><header>Elements</header><text>The strategic plan required by subsection (a) shall—</text><paragraph id="id9B3A7BA7B66942BB98BA2E189E417494"><enum>(1)</enum><text>cover the evolving needs of women veterans;</text></paragraph><paragraph id="idC055CB06A2DA4CC39EE65B539D30C3EE"><enum>(2)</enum><text>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;</text></paragraph><paragraph id="id7F32E7A342AE476BA62695EDECAB60BB"><enum>(3)</enum><text>address the use of digital breast tomosynthesis (DBT–3D breast imaging);</text></paragraph><paragraph id="idBEBCBB5B16F6495E900726B52774D96D"><enum>(4)</enum><text>address the needs of male veterans who require breast cancer screening services; and</text></paragraph><paragraph id="id5fb8a184799b47dfad0c55040973ade5"><enum>(5)</enum><text>provide recommendations on—</text><subparagraph id="id31D2F39E5CA24779845B9FCA3329222A"><enum>(A)</enum><text>potential expansion of breast imaging services furnished at facilities of the Department, including infrastructure and staffing needs;</text></subparagraph><subparagraph id="id78A20D9F2C204ED3A7CCA53A28D33116"><enum>(B)</enum><text>the use of digital breast tomosynthesis;</text></subparagraph><subparagraph id="id8C34744408F344669BB702A5B0065399"><enum>(C)</enum><text>the use of mobile mammography; and</text></subparagraph><subparagraph id="id075529E7A22B4429A17899601778C3DB"><enum>(D)</enum><text>other access and equity improvements for breast imaging.</text></subparagraph></paragraph></subsection></section><section id="id68304f6b07b5479f8c2ac6299973aafd"><enum>102.</enum><header>Telemammography pilot program of Department of Veterans Affairs</header><subsection id="id18da0520525e40a5ad903b9641e63540"><enum>(a)</enum><header>In general</header><text>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—</text><paragraph id="idBA4E1802A5E04401A1281E00648B958C"><enum>(1)</enum><text>States where the Department of Veterans Affairs does not offer breast imaging services at a facility of the Department; or</text></paragraph><paragraph id="id04DE740A5D744F12B9721ED4318E6F1D"><enum>(2)</enum><text>locations where access to breast imaging services at a facility of the Department is difficult or not feasible, as determined by the Secretary.</text></paragraph></subsection><subsection id="id4A2CE5B3E00B40E09B20D2098EE4E6C3"><enum>(b)</enum><header>Duration</header><text>The Secretary shall carry out the pilot program under subsection (a) for a three-year period beginning on the commencement of the pilot program.</text></subsection><subsection id="id5ba82bafff214673977a5cd2d863e9ad"><enum>(c)</enum><header>Locations</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(aa)(4)</external-xref>)), 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.</text></subsection><subsection id="idCCA8167B0D3344258EECB4ACE37A7FAE"><enum>(d)</enum><header>Sharing of images and results</header><text>Under the pilot program under subsection (a)—</text><paragraph id="id76554629446F43348A22DA0822A9D7A2"><enum>(1)</enum><text>mammography images generated shall be sent to the centralized telemammography center of the Department for interpretation by expert radiologists; and</text></paragraph><paragraph id="id1c867762402f41bc9adef025be7711ac"><enum>(2)</enum><text>results shall be shared with the veteran and their primary care provider.</text></paragraph></subsection><subsection id="id5fb12b497aad45739aaa5ae4b6217023"><enum>(e)</enum><header>Report</header><paragraph id="id1E2765A6154041EDB50A174BD8523C2E"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id9d414319c437499b90ed2096cdfa9c92"><enum>(2)</enum><header>Elements</header><text>The report required by paragraph (1) shall include the following:</text><subparagraph id="idF46CE01DC4CF42FDA33FC457D3A28295"><enum>(A)</enum><text>An assessment of the quality of the mammography provided under the pilot program under subsection (a).</text></subparagraph><subparagraph id="idD9D4705FCBE8498BBDDCCA5D5AD07C7B"><enum>(B)</enum><text>Feedback from veterans and providers participating in the pilot program.</text></subparagraph><subparagraph id="id7BCCFF95C5984561A0E9558E16497DB8"><enum>(C)</enum><text>A recommendation of the Secretary on the continuation or discontinuation of the pilot program. </text></subparagraph></paragraph></subsection></section><section id="id7ae02222dbfc496f8a43bc8809580eae"><enum>103.</enum><header>Upgrade of breast imaging at facilities of Department of Veterans Affairs to three-dimensional digital mammography</header><text display-inline="no-display-inline">Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—</text><paragraph id="idCF62B49F7D3C487FB6777A2A37A9EB25"><enum>(1)</enum><text>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</text></paragraph><paragraph id="id348FF5799B774CB5943216B5236D4C04"><enum>(2)</enum><text>submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report—</text><subparagraph id="idD68E88C1EF664FD4B1BDCE695A6242FF"><enum>(A)</enum><text>indicating that the upgrade under paragraph (1) has been completed; and</text></subparagraph><subparagraph id="idD8935DB592764998B0BF2FE2CC05FFDD"><enum>(B)</enum><text>listing the facilities or other locations of the Department at which digital breast tomosynthesis technology is used.</text></subparagraph></paragraph></section><section id="id3f4d985d8b1f486ca4b0c4c16289c1e6"><enum>104.</enum><header>Study on availability of testing for breast cancer gene among veterans and expansion of availability of such testing</header><subsection id="id5ff43ddac1cc4bae82c5735907ca8856"><enum>(a)</enum><header>Study</header><paragraph id="idE3D40D91C6654ECF94751620992A8DFA"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id55a260b1307c4bf1b2be448bbca2b67f"><enum>(2)</enum><header>Elements</header><text>In conducting the study under paragraph (1), the Secretary shall examine—</text><subparagraph id="id4103158AABFA49548159F77EE1BEB526"><enum>(A)</enum><text>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</text></subparagraph><subparagraph id="id4df3715372dc4670b86dab3817d2e0d4"><enum>(B)</enum><text>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. </text></subparagraph></paragraph></subsection><subsection id="idd9b5894a3e5e46bcaf6484a6677af012"><enum>(b)</enum><header>Expansion of availability of testing</header><paragraph id="idA7B47BCAB73E4212BA6AB99977DF2EE2"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id38618DFAF8D0478DBE77AADEDD352222"><enum>(2)</enum><header>Decision support tools</header><text>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.</text></paragraph></subsection><subsection id="ide5a3263c1c4743aea29b0830a8cf6ffd"><enum>(c)</enum><header>Report</header><text>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—</text><paragraph id="id00AAC52525DA4602840C23B372ED8AB3"><enum>(1)</enum><text>the results of the study under subsection (a);</text></paragraph><paragraph id="id96D03935BC0C4CA996B22A91C97E2BA0"><enum>(2)</enum><text>any updates to guidelines or new guidelines instituted under subsection (b); and</text></paragraph><paragraph id="id44B4ABCEB8904A008D818E99C2082EEA"><enum>(3)</enum><text>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.</text></paragraph></subsection><subsection id="id3c1d978525614491b9677ebef1699f9c"><enum>(d)</enum><header>Definitions</header><text>In this section, the terms <term>rural</term> and <term>highly rural</term> have the meanings given those terms in the Rural-Urban Commuting Areas coding system of the Department of Agriculture. </text></subsection></section><section id="idd2f58dac77494a029fc4085f24888e7a"><enum>105.</enum><header>Mammography accessibility for paralyzed and disabled veterans</header><subsection id="idf50739bdc8d048c7a035464f231d2a50"><enum>(a)</enum><header>Study</header><paragraph id="id530F7DE03DD24D6799D785FD966BBB64"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id70116F9526624F46984301C1A96926B1"><enum>(2)</enum><header>Accessibility</header><text>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.</text></paragraph><paragraph id="id6485567d413a4756bef996bdfd2d2e13"><enum>(3)</enum><header>Screening rates</header><subparagraph id="idD7CC2685D2134A7BAC7E0FC2711A40A7"><enum>(A)</enum><header>Measurement</header><text>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.</text></subparagraph><subparagraph id="id1479A92575484C1BA4967AF3A0098A16"><enum>(B)</enum><header>Development of method</header><text>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.</text></subparagraph></paragraph><paragraph id="id122acf69b656439c84c5e9db314e3794"><enum>(4)</enum><header>Report</header><text>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—</text><subparagraph id="id895BF06F0CF1440091A48F34EDB60BD6"><enum>(A)</enum><text>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</text></subparagraph><subparagraph id="idF1CD0C1B8A9F41F9A1CDBF18D9972EA5"><enum>(B)</enum><text>if such rates are not available, a description of the method developed to measure such rates as required under paragraph (3)(B).</text></subparagraph></paragraph></subsection><subsection id="ida07a017a68374b2fa79d14595779bba7"><enum>(b)</enum><header>Care from non-Department providers</header><text>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—</text><paragraph id="id8C00C73C0DCB46E89F5CC3780C51AE5B"><enum>(1)</enum><text>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</text></paragraph><paragraph id="idddbb0ac0731c4dda8bda5fe0d7cd5bae"><enum>(2)</enum><text>provide additional information to the provider on best practices for screening and treating veterans with a spinal cord injury or disorder.</text></paragraph></subsection><subsection id="idFBFF4248F8264ECBAED2737C813599F9"><enum>(c)</enum><header>Definitions</header><text>In this section, the terms <term>rural</term> and <term>highly rural</term> have the meanings given those terms in the Rural-Urban Commuting Areas coding system of the Department of Agriculture. </text></subsection></section><section id="id67461bbad15d4d9a96cf48a8f41f1f46"><enum>106.</enum><header>Report on access to and quality of mammography screenings furnished by Department of Veterans Affairs</header><subsection id="id425D592DA67840EF959486D49A532471"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="id5C5CE868BB9C4FECB300BCBA6C32BB77"><enum>(b)</enum><header>Elements</header><text>The report required by subsection (a) shall include an assessment of—</text><paragraph id="id352139E5267E41ABA907DA54C923C3E4"><enum>(1)</enum><text>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;</text></paragraph><paragraph id="idA0EE658CA25E430DAFFF554ADEF09295"><enum>(2)</enum><text>the quality of such screenings and reading of the images from such screenings, including whether such screenings use three-dimensional mammography;</text></paragraph><paragraph id="id1A1ED8C1F06543268B17A26EB21D3A8F"><enum>(3)</enum><text>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;</text></paragraph><paragraph id="id48A32A84D902471E8FFA42FDFCFC67A6"><enum>(4)</enum><text>the performance of the Women’s Breast Oncology System of Excellence of the Department; and</text></paragraph><paragraph id="id0E6F96E839954A0695942646278035DA"><enum>(5)</enum><text>the access of veterans diagnosed with breast cancer to a comprehensive breast cancer care team of the Department.</text></paragraph></subsection><subsection id="idcf694dd504444002b2b2b0ca62dd8527"><enum>(c)</enum><header>Follow-Up</header><text>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. </text></subsection></section><enum>II</enum><header>Partnerships for research and access to care</header><section id="idF474473D93A649BF946074F5802370DD" section-type="subsequent-section"><enum>201.</enum><header>Partnerships with National Cancer Institute to expand access of veterans to cancer care</header><subsection id="id18893c16b55948e7b382041a8c2d4b83"><enum>(a)</enum><header>Access to care in each VISN</header><paragraph id="id0F67392317334BAE8BD62997CE7F79AF"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id12620a61c3104daf9adab12c815632fc"><enum>(2)</enum><header>Treatment of rural veterans</header><text>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.</text></paragraph></subsection><subsection id="idc673266ecbc74b9795a9f16498c1cd9e"><enum>(b)</enum><header>Report on partnership To increase access to clinical trials</header><text>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—</text><paragraph id="id61AA4241CE60491CB94E3236B68780F6"><enum>(1)</enum><text>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 <quote>NAVIGATE</quote>) are permanently implemented; and</text></paragraph><paragraph id="idE41C8BFB416C4DB583B1589CC84B09CD"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="idd457fab884624b63bf867d38b91ccd30"><enum>(c)</enum><header>Periodic reports</header><text>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—</text><paragraph id="ide4a23f8bd0c94ad5b3e09473749e5982"><enum>(1)</enum><text>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</text></paragraph><paragraph id="idCE8CBB1C86FC48E6B5F03F0DB9AB575A"><enum>(2)</enum><text>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.</text></paragraph></subsection></section><section id="idea95254474cc4099a68e2db144c1503c"><enum>202.</enum><header>Report by Department of Veterans Affairs and Department of Defense on interagency collaboration on treating and researching breast cancer</header><subsection id="id9ba6f1178d564f7d94c54e0c4442e039"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="idA9B00F1EBC974A0BBAAE4044D52F11EB"><enum>(b)</enum><header>Elements</header><text>The report required by subsection (a)—</text><paragraph id="id81FB5A562F674F95A890A6160012E820"><enum>(1)</enum><text>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</text></paragraph><paragraph id="id96ba64d83ed84f3aa094a3a06e4853e6"><enum>(2)</enum><text>may include a focus on—</text><subparagraph id="id633B880F3688407DA91468A426B81925"><enum>(A)</enum><text>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;</text></subparagraph><subparagraph id="id6B63815377F44E33AF5BC5EC8AD3E3F8"><enum>(B)</enum><text>collaborative breast cancer research opportunities between the Department of Veterans Affairs and the Department of Defense;</text></subparagraph><subparagraph id="idE66451DEA3624A418E0DAAE13BF1ACCA"><enum>(C)</enum><text>access to clinical trials; and</text></subparagraph><subparagraph id="id0D428494DC64411E8D48829B863DEAE3"><enum>(D)</enum><text>such other matters as the Secretary of Veterans Affairs and the Secretary of Defense consider appropriate.</text></subparagraph></paragraph></subsection></section>1.Short title; table of contents(a)This Act may be cited as the Making Advances in Mammography and Medical Options for Veterans Act
.(b)The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.TITLE I—Screening and early detectionSec. 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 careSec. 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.<enum>I</enum><header>Screening and early detection</header><section id="ideec50a95-dfba-4095-b4a5-4c60d1fd39fe" section-type="subsequent-section"><enum>101.</enum><header>Strategic plan for breast imaging services for veterans</header><subsection id="id8430b127-1307-496c-91b0-be343b58e26e"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="id16e60fb3-ba17-4586-97ec-7bbfa57b78d8"><enum>(b)</enum><header>Elements</header><text>The strategic plan required by subsection (a) shall—</text><paragraph id="id35b81852-c6a2-401b-994d-c05d41e9397f"><enum>(1)</enum><text>cover the evolving needs of women veterans;</text></paragraph><paragraph id="id1c84985f-9a25-4910-b4d7-7f6513abefc0"><enum>(2)</enum><text>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;</text></paragraph><paragraph id="id3b266aae-f8b7-4e57-95f1-fc25946d73eb"><enum>(3)</enum><text>address the use of digital breast tomosynthesis (DBT–3D breast imaging);</text></paragraph><paragraph id="id81dc0fca-9305-49ec-b2fc-09039d53ab34"><enum>(4)</enum><text>address the needs of male veterans who require breast cancer screening services; and</text></paragraph><paragraph id="id45479289-ff11-4584-9d5c-396a60b9e52e"><enum>(5)</enum><text>provide recommendations on—</text><subparagraph id="id6ae21686-1724-46e7-a959-2aa03036c370"><enum>(A)</enum><text>potential expansion of breast imaging services furnished at facilities of the Department, including infrastructure and staffing needs;</text></subparagraph><subparagraph id="id67987123-00ba-4a2f-b4a1-31e69e1d1a60"><enum>(B)</enum><text>the use of digital breast tomosynthesis;</text></subparagraph><subparagraph id="iddece0075-2c19-401d-acb6-fe9e6430918c"><enum>(C)</enum><text>the use of mobile mammography; and</text></subparagraph><subparagraph id="id94166b31-42fb-43fe-bcb9-55cdfcbf4c66"><enum>(D)</enum><text>other access and equity improvements for breast imaging.</text></subparagraph></paragraph></subsection></section><section id="id96072e77-19fc-4680-bc09-6084065f64e9"><enum>102.</enum><header>Telescreening mammography pilot program of Department of Veterans Affairs</header><subsection id="ida3198420-02fa-4398-ba30-a92c98b0d279"><enum>(a)</enum><header>In general</header><text>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—</text><paragraph id="id9e7d7974-2fd8-491d-937b-93c3e8728fb3"><enum>(1)</enum><text>States where the Department of Veterans Affairs does not offer breast imaging services at a facility of the Department; or</text></paragraph><paragraph id="id8fd65376-92ab-42de-bd1a-6b35f3814053"><enum>(2)</enum><text>locations where access to breast imaging services at a facility of the Department is difficult or not feasible, as determined by the Secretary.</text></paragraph></subsection><subsection id="id222aee48-d8ef-43d9-882d-8575f0c561d9"><enum>(b)</enum><header>Duration</header><text>The Secretary shall carry out the pilot program under subsection (a) for a three-year period beginning on the commencement of the pilot program.</text></subsection><subsection id="id829edaf9-7739-4ed7-96df-f13d9810c0b2"><enum>(c)</enum><header>Locations</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(aa)(4)</external-xref>)), 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.</text></subsection><subsection id="idb5ea9933-b648-4c9e-aaff-5aec6c4b53a6"><enum>(d)</enum><header>Sharing of images and results</header><text>Under the pilot program under subsection (a)—</text><paragraph id="idf265beb7-b890-4a59-9c93-b850180e4162"><enum>(1)</enum><text>mammography images generated shall be sent to a telescreening mammography center of the Department for interpretation by qualified radiologists; and</text></paragraph><paragraph id="id9ccaee7b-bb3a-4042-8a72-cd18c80e8985"><enum>(2)</enum><text>results shall be shared with the veteran and their primary care provider in accordance with policies established by the Secretary.</text></paragraph></subsection><subsection id="id3a93e12c-a14c-4f08-9e07-4e2ea168bed7"><enum>(e)</enum><header>Report</header><paragraph id="ideff6aefc-817c-4539-8067-4cac1ae4317a"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id9f60a223-61d6-4237-8a9b-1214a6ad464d"><enum>(2)</enum><header>Elements</header><text>The report required by paragraph (1) shall include the following:</text><subparagraph id="idc0dd40f7-a299-4819-aff2-4244d101fded"><enum>(A)</enum><text>An assessment of the quality of the mammography provided under the pilot program under subsection (a).</text></subparagraph><subparagraph id="id54078d97-3e60-4ab8-b2aa-46477c5c7e4e"><enum>(B)</enum><text>Feedback from veterans and providers participating in the pilot program.</text></subparagraph><subparagraph id="id0a24ee04-8e1a-4347-bf43-325861e0e6dc"><enum>(C)</enum><text>A recommendation of the Secretary on the continuation or discontinuation of the pilot program. </text></subparagraph></paragraph></subsection></section><section id="id60c4fe9c-af2b-49c6-899b-9274df147f03"><enum>103.</enum><header>Upgrade of breast imaging at facilities of Department of Veterans Affairs to three-dimensional digital mammography</header><text display-inline="no-display-inline">Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—</text><paragraph id="id580a15fe-c957-4993-a9c9-02e6e29fe4ef"><enum>(1)</enum><text>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</text></paragraph><paragraph id="idfe0a6c55-5709-4fe2-ac73-dd789ba15fcb"><enum>(2)</enum><text>submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report—</text><subparagraph id="id9904044a-b13f-4399-af1a-5bf73649a6a7"><enum>(A)</enum><text>indicating that the upgrade under paragraph (1) has been completed; and</text></subparagraph><subparagraph id="iddff7b148-9963-490e-bd43-380cc3ea0d79"><enum>(B)</enum><text>listing the facilities or other locations of the Department at which digital breast tomosynthesis technology is used.</text></subparagraph></paragraph></section><section id="ideb3c6c3b-3ce2-4f44-9eb8-3a134a66bfcf"><enum>104.</enum><header>Study on availability of testing for breast cancer gene among veterans and expansion of availability of such testing</header><subsection id="id7b3c38ff-2801-405f-a4ae-85be97ce3def"><enum>(a)</enum><header>Study</header><paragraph id="id832e737f-db32-4a3b-89e2-d276ee440d19"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="idba520472-850d-4fe5-84de-ec9f98583bb5"><enum>(2)</enum><header>Elements</header><text>In conducting the study under paragraph (1), the Secretary shall examine—</text><subparagraph id="id2a6c95e7-7702-4015-8bee-863deac83c54"><enum>(A)</enum><text>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</text></subparagraph><subparagraph id="iddbec59b0-5958-4644-93f1-7e96bc9d07f4"><enum>(B)</enum><text>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. </text></subparagraph></paragraph></subsection><subsection id="id5a286fd4-bbe7-411b-92bc-d91d4a9aa602"><enum>(b)</enum><header>Expansion of availability of testing</header><paragraph id="id6e1acb2f-422a-4427-99ed-cce2d8048e8f"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="ide45d3b94-f834-4ff3-bfbf-22f2d7ee2d66"><enum>(2)</enum><header>Decision support tools</header><text>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.</text></paragraph></subsection><subsection id="id929b92b3-f9d5-4983-9c60-115a558649b4"><enum>(c)</enum><header>Report</header><text>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—</text><paragraph id="id7fbeb3b2-0e29-4384-bc80-c83191a30b52"><enum>(1)</enum><text>the results of the study under subsection (a);</text></paragraph><paragraph id="id14241ef3-a7f5-471c-9ce2-33159e980da6"><enum>(2)</enum><text>any updates to guidelines or new guidelines instituted under subsection (b); </text></paragraph><paragraph id="id4840aae792ba48a0b636ca8e9e4da361"><enum>(3)</enum><text>breast cancer clinical pathways implemented by the Department of Veterans Affairs and the utilization of those pathways across the Department; and </text></paragraph><paragraph id="id004c39a4-64b4-4d82-b0ed-8be15b8d7093"><enum>(4)</enum><text>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.</text></paragraph></subsection><subsection id="idc12f58f1-7a41-41cd-9dd8-4536545b3fb0"><enum>(d)</enum><header>Definitions</header><text>In this section, the terms <term>rural</term> and <term>highly rural</term> have the meanings given those terms in the Rural-Urban Commuting Areas coding system of the Department of Agriculture. </text></subsection></section><section id="id2d808663-a07f-4498-ba6a-28077f142854"><enum>105.</enum><header>Mammography accessibility for paralyzed and disabled veterans</header><subsection id="id2c88a552-64bd-431d-bc42-85d2adfd8c45"><enum>(a)</enum><header>Study</header><paragraph id="id8a760272-5d75-4513-9f36-366f25008cca"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="ide17d65b4-f538-45c4-bca3-cd21e7172b69"><enum>(2)</enum><header>Accessibility</header><text>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.</text></paragraph><paragraph id="id8cd57727-2e4f-4c5f-b74e-62cec414e290"><enum>(3)</enum><header>Screening rates</header><subparagraph id="ida635cb13-c728-430d-9eb5-f536a851427a"><enum>(A)</enum><header>Measurement</header><text>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.</text></subparagraph><subparagraph id="id9047bbbf-b9d1-472d-9191-004d500c90b3"><enum>(B)</enum><header>Development of method</header><text>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.</text></subparagraph></paragraph><paragraph id="id7dce47d3-1f26-4455-a527-939965807d42"><enum>(4)</enum><header>Report</header><text>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—</text><subparagraph id="ide67a7be9-ceaf-4375-9cd1-2800dff0df47"><enum>(A)</enum><text>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</text></subparagraph><subparagraph id="idd3a1efca-071b-4a9c-9512-bb1dc7295e22"><enum>(B)</enum><text>if such rates are not available, a description of the method developed to measure such rates as required under paragraph (3)(B).</text></subparagraph></paragraph></subsection><subsection id="id4a7729b8-09e7-42bc-a1a3-f2bd9b326ed9"><enum>(b)</enum><header>Care from non-Department providers</header><text>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—</text><paragraph id="ide6a17289-af64-4ea9-a7d9-de0ccf0a0311"><enum>(1)</enum><text>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</text></paragraph><paragraph id="idad583dde-d4b0-4b03-a1f9-ca7fc38307aa"><enum>(2)</enum><text>provide additional information to the provider on best practices for screening and treating veterans with a spinal cord injury or disorder.</text></paragraph></subsection><subsection id="id1a545779-b76a-4068-ba61-0010fae963f9"><enum>(c)</enum><header>Definitions</header><text>In this section, the terms <term>rural</term> and <term>highly rural</term> have the meanings given those terms in the Rural-Urban Commuting Areas coding system of the Department of Agriculture. </text></subsection></section><section id="idae5c1db0-2005-40dd-9e58-13ed5c50e40e"><enum>106.</enum><header>Report on access to and quality of mammography screenings furnished by Department of Veterans Affairs</header><subsection id="id2a62e215-5205-48fd-b29f-e8f96b76c3ec"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="idc8396465-57b7-4687-9760-98fa29171f48"><enum>(b)</enum><header>Elements</header><text>The report required by subsection (a) shall include an assessment of—</text><paragraph id="idc96c9205-3085-4b3a-8474-2dab3454cb8b"><enum>(1)</enum><text>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;</text></paragraph><paragraph id="id66e561c7-e430-492d-b87a-192b00cb33da"><enum>(2)</enum><text>the quality of such screenings and reading of the images from such screenings, including whether such screenings use three-dimensional mammography;</text></paragraph><paragraph id="id64cbfd84-3448-4fea-a1db-47a90f7468d0"><enum>(3)</enum><text>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;</text></paragraph><paragraph id="ide9d15e52-2d78-4868-904b-2b00d41d3db3"><enum>(4)</enum><text>the performance of the Women’s Breast Oncology System of Excellence of the Department; and</text></paragraph><paragraph id="idee5aa8a9-2d20-46f6-8db5-3d9c775763b5"><enum>(5)</enum><text>the access of veterans diagnosed with breast cancer to a comprehensive breast cancer care team of the Department.</text></paragraph></subsection><subsection id="id7a798e28-0f90-438c-9125-6be8a17e6dbc"><enum>(c)</enum><header>Follow-Up</header><text>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. </text></subsection></section><enum>II</enum><header>Partnerships for research and access to care</header><section id="id73a25bf7-ce71-4a64-a2dc-e53ac18e0453" section-type="subsequent-section"><enum>201.</enum><header>Partnerships with National Cancer Institute to expand access of veterans to cancer care</header><subsection id="id0704e2c3-abec-4e59-9547-e61e6611a924"><enum>(a)</enum><header>Access to care in each VISN</header><paragraph id="id1651379a-0499-438f-a17b-23d303c64f84"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id9fafd974-ab20-4dd5-a813-e9751b1332c3"><enum>(2)</enum><header>Treatment of rural veterans</header><text>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.</text></paragraph></subsection><subsection id="id3f502542-0fc1-44a0-8836-d0c655f985e3"><enum>(b)</enum><header>Report on partnership To increase access to clinical trials</header><text>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—</text><paragraph id="id37a28993-9d51-40d7-b75a-9a67b0c1de23"><enum>(1)</enum><text>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 <quote>NAVIGATE</quote>) are permanently implemented; and</text></paragraph><paragraph id="id65390c1e-8536-4b98-adcb-9af40199be8d"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="idfb8d0569-261f-4f66-9d95-0cc5fc9845fc"><enum>(c)</enum><header>Periodic reports</header><text>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—</text><paragraph id="id17cce5fb-d95b-4189-a0a7-fcf18001d86d"><enum>(1)</enum><text>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</text></paragraph><paragraph id="idbcdf13c1-e400-4e80-bcd9-177020b6615f"><enum>(2)</enum><text>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.</text></paragraph></subsection></section><section id="id802bd866-e615-4dd1-ab7b-99c35f628805"><enum>202.</enum><header>Report by Department of Veterans Affairs and Department of Defense on interagency collaboration on treating and researching breast cancer</header><subsection id="id5a35e070-fabf-4341-90b0-2378188e5445"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="id8a469145-b5e3-49e1-99b0-695b23bd80a8"><enum>(b)</enum><header>Elements</header><text>The report required by subsection (a)—</text><paragraph id="idb9495a48-ec82-418c-8a10-1acf6088df2b"><enum>(1)</enum><text>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</text></paragraph><paragraph id="id3f006963-1455-4614-b8a6-6d57a62399df"><enum>(2)</enum><text>may include a focus on—</text><subparagraph id="id35b7438e-36e8-4a6b-81e8-5b38e4fe7e7e"><enum>(A)</enum><text>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;</text></subparagraph><subparagraph id="id2256f824-cb54-4742-b513-8e9ee31f23da"><enum>(B)</enum><text>collaborative breast cancer research opportunities between the Department of Veterans Affairs and the Department of Defense;</text></subparagraph><subparagraph id="ida271c734-dbbd-47b8-a9e2-4e1ea2c092de"><enum>(C)</enum><text>access to clinical trials; and</text></subparagraph><subparagraph id="ide26eb31e-f2ec-4436-81a1-3c0ff83ac5e0"><enum>(D)</enum><text>such other matters as the Secretary of Veterans Affairs and the Secretary of Defense consider appropriate.</text></subparagraph></paragraph></subsection></section>March 10 (legislative day, March 7), 2022Reported with an amendment