[117th Congress Public Law 135]
[From the U.S. Government Publishing Office]



[[Page 1243]]

   MAKING ADVANCES IN MAMMOGRAPHY AND MEDICAL OPTIONS FOR VETERANS ACT

[[Page 136 STAT. 1244]]

Public Law 117-135
117th Congress

                                 An Act


 
To improve mammography services furnished by the Department of Veterans 
  Affairs, and for other purposes. <<NOTE: June 7, 2022 -  [S. 2533]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Making Advances 
in Mammography and Medical Options for Veterans Act. 38 USC 7322 
note.>> 
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. <<NOTE: Deadline.>> --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

[[Page 131 STAT. 1245]]

        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) <<NOTE: Recommenda- tions.>>  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) <<NOTE: Deadline.>>  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) <<NOTE: Assessment.>>  An assessment of the 
                quality of the mammography provided under the pilot 
                program under subsection (a).

[[Page 131 STAT. 1246]]

                    (B) Feedback from veterans and providers 
                participating in the pilot program.
                    (C) <<NOTE: Recommenda- tions.>>  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 <<NOTE: Deadline.>>  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) <<NOTE: Reports.>>  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) <<NOTE: List.>>  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. <<NOTE: Examination.>> --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) <<NOTE: Guidelines.>>  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);

[[Page 131 STAT. 1247]]

            (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. <<NOTE: Assessment.>> --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.-- <<NOTE: Time period.>> 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.-- <<NOTE: Updates.>> 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--

[[Page 131 STAT. 1248]]

            (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.-- <<NOTE: Assessment.>> 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.-- <<NOTE: Deadline. Plan.>> 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

[[Page 131 STAT. 1249]]

        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) <<NOTE: Determination.>>  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) <<NOTE: Assessment.>>  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--

[[Page 131 STAT. 1250]]

                    (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.

    Approved June 7, 2022.

LEGISLATIVE HISTORY--S. 2533:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD, Vol. 168 (2022):
            Mar. 23, considered and passed Senate.
            May 18, considered and passed House.
DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2022):
            June 7, Presidential remarks.

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