[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:
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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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