[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4794 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 4794
To improve mammography services furnished by the Department of Veterans
Affairs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 29, 2021
Ms. Brownley (for herself and Mrs. Miller-Meeks) introduced the
following bill; which was referred to the Committee on Veterans'
Affairs, and in addition to the Committee on Armed Services, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To improve mammography services furnished by the Department of Veterans
Affairs, and for other purposes.
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. 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 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. TELEMAMMOGRAPHY PILOT PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--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--
(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 the
centralized telemammography center of the Department for
interpretation by expert radiologists; and
(2) results shall be shared with the veteran and their
primary care provider.
(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 testing for the
breast cancer gene and genetic counseling for veterans
diagnosed with breast cancer.
(2) Decision support tools.--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.
(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); and
(3) 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.
(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.
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