[Congressional Record Volume 168, Number 85 (Wednesday, May 18, 2022)]
[House]
[Pages H5112-H5115]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  MAKING ADVANCES IN MAMMOGRAPHY AND MEDICAL OPTIONS FOR VETERANS ACT

  Mr. TAKANO. Mr. Speaker, I move to suspend the rules and pass the 
bill (S. 2533) to improve mammography services furnished by the 
Department of Veterans Affairs, and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

[[Page H5113]]

  


                                S. 2533

       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

[[Page H5114]]

     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.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Takano) and the gentleman from Illinois (Mr. Bost) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. TAKANO. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
to insert extraneous material on S. 2533.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of S. 2533, Making Advances in 
Mammography and Medical Options for Veterans Act, or MAMMO Act, 
introduced by Senator Tester.
  This bill vastly improves the Department of Veterans Affairs' 
mammography services by updating policies and directives to ensure VA 
is not only following best practices, but also using the most advanced 
medical, diagnostic equipment and testing to aid in early detection and 
prevention of breast cancer.
  Mr. Speaker, timeliness matters. By ensuring VA is using the best 
practices and most up-to-date technologies, we will help decrease the 
risk that women veterans--a group that is nearly twice as likely to 
develop breast cancer than their civilian counterparts--are 
misdiagnosed, or undiagnosed, for breast cancer.
  Access to reliable mammograms at VA facilities is imperative in order 
to detect tumors years prior to physical touch detection. A veteran 
that receives an early diagnosis will have stronger treatment options 
and an increased likelihood of survival.
  It is important to note that women are not the only veterans 
susceptible to breast cancer, men are increasingly at risk, too. This 
bill addresses the needs of male veterans who may require prompt breast 
cancer screening services.
  In addition, this legislation calls on VA to collaborate with other 
Federal partners, such as the Department of Defense and the National 
Cancer Institute to enhance research and care for women veterans 
suffering from breast cancer.
  The MAMMO Act has broad bipartisan support, and I thank Chairwoman 
Brownley for her steadfast leadership on this issue and for introducing 
the House companion of this legislation with Dr. Miller-Meeks.
  Additionally, numerous veteran service organizations, such as Iraq 
and Afghanistan Veterans of America,

[[Page H5115]]

Wounded Warrior Project, and The American Legion have voiced robust 
support for this legislation.
  We cannot wait any longer to pass this critical piece of legislation. 
The MAMMO Act is essential for VA to provide high-quality, lifesaving 
care that veterans have not only earned but deserve.
  Mr. Speaker, I urge the passage of this important piece of 
legislation, and I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of S. 2533, the MAMMO for Veterans 
Act. This bill requires VA to develop a plan to improve breast imaging 
services. It also establishes a breast imaging telehealth pilot program 
to better serve women veterans in areas where VA does not have 
significant capacity, including rural areas.
  It also requires VA to upgrade breast imaging services at the VA 
facilities by using three-dimensional imaging and provide updated 
guidelines and genetic counseling for veterans diagnosed with breast 
cancer. Early detection is the key to fighting all forms of cancer, to 
include breast cancer.
  VA should make every effort to ensure veterans with breast cancer 
receive cutting-edge care, both in screening and treatment.
  I appreciate Senator Tester and my friend and fellow veteran, 
Congresswoman Miller-Meeks, for their work on this important bill. It 
has my full support.
  Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I am prepared to close, and I reserve the 
balance of my time.
  Mr. BOST. Mr. Speaker, I yield 3 minutes to the gentlewoman from Iowa 
(Mrs. Miller-Meeks), my good friend.

                              {time}  1330

  Mrs. MILLER-MEEKS. Mr. Speaker, I thank Ranking Member Bost for 
yielding me time to speak.
  I rise today to express my support for S. 2533, the Making Advances 
in Mammography and Medical Options for Veterans Act. I am proud to co-
lead the House companion of this important legislation with 
Congresswoman Brownley. I also thank Senators Tester and Boozman for 
their work in passing this bill.
  As a doctor and as a 24-year female veteran, I understand just how 
significant access to mammogram screenings can be. The VA has estimated 
that among the women enrolled in VA healthcare, about 700 female 
veterans are diagnosed with breast cancer each year, and the percentage 
of female veterans is only going to increase.
  This bill will ensure that female veterans have the best access to 
high-quality care, especially for female veterans that live in rural 
areas who are disabled and who are paralyzed. This bill will also 
create a 3-year pilot program to provide telemammography screenings to 
female veterans and will upgrade the VA mammography imaging to three-
dimensional breast imaging for VA hospitals. In addition, this bill 
will expand partnerships for care, research, and clinical trials with 
the NIH National Cancer Institute and the DOD.
  Today, as a doctor and a former director of public health, I am 
proudly voting in support of the bipartisan and bicameral MAMMO for 
Veterans Act. This bill will enhance mammography and telemammography 
screenings, and I urge all of my colleagues to vote in favor of S. 
2533, Making Advances in Mammography and Medical Options for Veterans 
Act. I look forward to a strong bipartisan vote today and sending this 
bill to the President to become law.
  Mr. TAKANO. Mr. Speaker, I have no further speakers, and I am 
prepared to close.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I encourage all of my colleagues to support 
this bill, and I yield back the balance of my time.
  Mr. TAKANO. Mr. Speaker, I ask all my colleagues to join me in 
passing S. 2533. In the last vote, the gentleman from Montana went out 
of my line of sight, and I thought we were going to pass this on 
suspension. I plead with him, let MAMMO go, let MAMMO pass on voice. By 
allowing us to pass it on voice, everybody says ``yes.''
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Takano) that the House suspend the rules 
and pass the bill, S. 2533.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. ROSENDALE. Mr. Speaker, on that I demand the yeas and nays.


                         Parliamentary Inquiry

  Mr. COHEN. Mr. Speaker, parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his parliamentary 
inquiry.
  Mr. COHEN. Mr. Speaker, what is the rule for having a vote not be 
done by voice vote but have to go to the floor for a recorded vote? Is 
it not a majority of the group necessary to have a hearing? The 
majority of a quorum, it is 20 percent of the quorum, I believe.
  The SPEAKER pro tempore. Once again, the gentleman will please state 
his parliamentary inquiry.
  Mr. COHEN. Mr. Speaker, my understanding is the rules require 20 
percent of a quorum to be present to request and have a vote be done by 
the yeas and nays. Is that not accurate?
  The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution 
8, the yeas and nays are considered as ordered upon any demand for the 
yeas and nays.
  Mr. COHEN. Mr. Speaker, on demand?
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion are postponed.

                          ____________________