[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,
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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.
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