[Congressional Record Volume 168, Number 52 (Wednesday, March 23, 2022)]
[Senate]
[Pages S1754-S1756]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MAKING ADVANCES IN MAMMOGRAPHY AND MEDICAL OPTIONS FOR VETERANS ACT
Mr. SCHUMER. Mr. President, I ask unanimous consent that the Senate
proceed to the immediate consideration of Calendar No. 303, S. 2533.
The PRESIDING OFFICER. The clerk will report the bill by title.
The senior assistant legislative clerk read as follows:
A bill (S. 2533) to improve mammography services furnished
by the Department of Veterans Affairs, and for other
purposes.
There being no objection, the Senate proceeded to consider the bill,
which had been reported from the Committee on Veterans' Affairs, with
an amendment to strike all after the enacting clause and insert in lieu
thereof the following:
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.
[[Page S1755]]
(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.
Mr. SCHUMER. I ask unanimous consent that the committee-reported
substitute amendment be agreed to and that the bill be considered read
a third time.
The PRESIDING OFFICER. Without objection, it is so ordered.
The committee-reported amendment in the nature of a substitute was
agreed to.
The bill was ordered to be engrossed for a third reading and was read
the third time.
Mr. SCHUMER. I know of no further debate on the bill, as amended.
The PRESIDING OFFICER. If there is no further debate on the bill, the
bill having been read the third time, the question is, Shall the bill
pass?
The bill (S. 2533), as amended, was passed.
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Mr. SCHUMER. I further ask unanimous consent that the motion to
reconsider be considered made and laid upon the table.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SCHUMER. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. SCHUMER. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________