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S. 2533: Making Advances in Mammography and Medical Options for Veterans Act


The text of the bill below is as of May 13, 2022 (Preprint (Suspension)).


117TH CONGRESS
   2D SESSION
                     S. 2533

                     AN ACT
     To improve mammography services furnished by the
    Department of Veterans Affairs, and for other purposes.

1         Be it enacted by the Senate and House of Representa-
2 tives of the United States of America in Congress assembled,

2 1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 2 (a) SHORT TITLE.—This Act may be cited as the 3 ‘‘Making Advances in Mammography and Medical Options 4 for Veterans Act’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 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 Vet- erans 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 fur- nished 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 vet- erans to cancer care. Sec. 202. Report by Department of Veterans Affairs and Department of De- fense on interagency collaboration on treating and researching breast cancer. 7 TITLE I—SCREENING AND 8 EARLY DETECTION 9 SEC. 101. STRATEGIC PLAN FOR BREAST IMAGING SERV- 10 ICES FOR VETERANS. 11 (a) IN GENERAL.—Not later than one year after the 12 date of the enactment of this Act, the Secretary of Vet- 13 erans Affairs shall submit to the Committee on Veterans’ 14 Affairs of the Senate and the Committee on Veterans’ Af- 15 fairs of the House of Representatives a strategic plan for 16 improving breast imaging services for veterans. † S 2533 ES
3 1 (b) ELEMENTS.—The strategic plan required by sub- 2 section (a) shall— 3 (1) cover the evolving needs of women veterans; 4 (2) address geographic disparities of breast im- 5 aging furnished at a facility of the Department of 6 Veterans Affairs and the use of breast imaging 7 through non-Department providers in the commu- 8 nity; 9 (3) address the use of digital breast 10 tomosynthesis (DBT–3D breast imaging); 11 (4) address the needs of male veterans who re- 12 quire breast cancer screening services; and 13 (5) provide recommendations on— 14 (A) potential expansion of breast imaging 15 services furnished at facilities of the Depart- 16 ment, including infrastructure and staffing 17 needs; 18 (B) the use of digital breast tomosynthesis; 19 (C) the use of mobile mammography; and 20 (D) other access and equity improvements 21 for breast imaging. † S 2533 ES
4 1 SEC. 102. TELESCREENING MAMMOGRAPHY PILOT PRO- 2 GRAM OF DEPARTMENT OF VETERANS AF- 3 FAIRS. 4 (a) IN GENERAL.—Commencing not later than 18 5 months after the date of the enactment of this Act, the 6 Secretary of Veterans Affairs shall carry out a pilot pro- 7 gram to provide telescreening mammography services for 8 veterans who live in— 9 (1) States where the Department of Veterans 10 Affairs does not offer breast imaging services at a 11 facility of the Department; or 12 (2) locations where access to breast imaging 13 services at a facility of the Department is difficult 14 or not feasible, as determined by the Secretary. 15 (b) DURATION.—The Secretary shall carry out the 16 pilot program under subsection (a) for a three-year period 17 beginning on the commencement of the pilot program. 18 (c) LOCATIONS.—In carrying out the pilot program 19 under subsection (a), the Secretary may use community- 20 based outpatient clinics, mobile mammography, Federally 21 qualified health centers (as defined in section 1861(aa)(4) 22 of the Social Security Act (42 U.S.C. 1395x(aa)(4))), 23 rural health clinics, critical access hospitals, clinics of the 24 Indian Health Service, and such other sites as the Sec- 25 retary determines feasible to provide mammograms under 26 the pilot program. † S 2533 ES
5 1 (d) SHARING OF IMAGES AND RESULTS.—Under the 2 pilot program under subsection (a)— 3 (1) mammography images generated shall be 4 sent to a telescreening mammography center of the 5 Department for interpretation by qualified radiolo- 6 gists; and 7 (2) results shall be shared with the veteran and 8 their primary care provider in accordance with poli- 9 cies established by the Secretary. 10 (e) REPORT.— 11 (1) IN GENERAL.—Not later than one year 12 after the conclusion of the pilot program under sub- 13 section (a), the Secretary shall submit to the Com- 14 mittee on Veterans’ Affairs of the Senate and the 15 Committee on Veterans’ Affairs of the House of 16 Representatives a report evaluating the pilot pro- 17 gram. 18 (2) ELEMENTS.—The report required by para- 19 graph (1) shall include the following: 20 (A) An assessment of the quality of the 21 mammography provided under the pilot pro- 22 gram under subsection (a). 23 (B) Feedback from veterans and providers 24 participating in the pilot program. † S 2533 ES
6 1 (C) A recommendation of the Secretary on 2 the continuation or discontinuation of the pilot 3 program. 4 SEC. 103. UPGRADE OF BREAST IMAGING AT FACILITIES OF 5 DEPARTMENT OF VETERANS AFFAIRS TO 6 THREE-DIMENSIONAL DIGITAL MAMMOG- 7 RAPHY. 8 Not later than two years after the date of the enact- 9 ment of this Act, the Secretary of Veterans Affairs shall— 10 (1) upgrade all mammography services at facili- 11 ties of the Department of Veterans Affairs that pro- 12 vide such services to use digital breast tomosynthesis 13 technology, also known as three-dimensional breast 14 imaging; and 15 (2) submit to the Committee on Veterans’ Af- 16 fairs of the Senate and the Committee on Veterans’ 17 Affairs of the House of Representatives a report— 18 (A) indicating that the upgrade under 19 paragraph (1) has been completed; and 20 (B) listing the facilities or other locations 21 of the Department at which digital breast 22 tomosynthesis technology is used. † S 2533 ES
7 1 SEC. 104. STUDY ON AVAILABILITY OF TESTING FOR 2 BREAST CANCER GENE AMONG VETERANS 3 AND EXPANSION OF AVAILABILITY OF SUCH 4 TESTING. 5 (a) STUDY.— 6 (1) IN GENERAL.—The Secretary of Veterans 7 Affairs shall conduct a study on the availability of 8 access to testing for the breast cancer gene for vet- 9 erans diagnosed with breast cancer, as recommended 10 by the guidelines set forth by the National Com- 11 prehensive Cancer Network. 12 (2) ELEMENTS.—In conducting the study under 13 paragraph (1), the Secretary shall examine— 14 (A) the feasibility of expanding the Joint 15 Medicine Service of the Department of Veterans 16 Affairs to provide genetic testing and coun- 17 seling for veterans with breast cancer across the 18 country; and 19 (B) access to such testing and counseling 20 for veterans living in rural or highly rural 21 areas, and any gaps that may exist with respect 22 to such access. 23 (b) EXPANSION OF AVAILABILITY OF TESTING.— 24 (1) IN GENERAL.—The Secretary shall update 25 guidelines or institute new guidelines to increase the 26 use of molecular testing and genetic counseling for † S 2533 ES
8 1 veterans diagnosed with breast cancer, including vet- 2 erans living in rural or highly rural areas. 3 (2) DECISION SUPPORT TOOLS.—In updating or 4 instituting guidelines under paragraph (1), the Sec- 5 retary may develop clinical decision support tools, 6 such as clinical pathways, to facilitate delivery of 7 breast cancer care that is in line with national can- 8 cer guidelines. 9 (c) REPORT.—Not later than two years after the date 10 of the enactment of this Act, the Secretary shall submit 11 to the Committee on Veterans’ Affairs of the Senate and 12 the Committee on Veterans’ Affairs of the House of Rep- 13 resentatives a report on— 14 (1) the results of the study under subsection 15 (a); 16 (2) any updates to guidelines or new guidelines 17 instituted under subsection (b); 18 (3) breast cancer clinical pathways implemented 19 by the Department of Veterans Affairs and the utili- 20 zation of those pathways across the Department; 21 and 22 (4) any progress of the Department in improv- 23 ing access to and usage of molecular and genetic 24 testing among veterans diagnosed with breast can- † S 2533 ES
9 1 cer, including for veterans living in rural or highly 2 rural areas. 3 (d) DEFINITIONS.—In this section, the terms ‘‘rural’’ 4 and ‘‘highly rural’’ have the meanings given those terms 5 in the Rural-Urban Commuting Areas coding system of 6 the Department of Agriculture. 7 SEC. 105. MAMMOGRAPHY ACCESSIBILITY FOR PARALYZED 8 AND DISABLED VETERANS. 9 (a) STUDY.— 10 (1) IN GENERAL.—The Secretary of Veterans 11 Affairs shall conduct a study on the accessibility of 12 breast imaging services at facilities of the Depart- 13 ment of Veterans Affairs for veterans with paralysis, 14 spinal cord injury or disorder (SCI/D), or another 15 disability. 16 (2) ACCESSIBILITY.—The study required by 17 paragraph (1) shall include an assessment of the ac- 18 cessibility of the physical infrastructure at breast 19 imaging facilities of the Department, including the 20 imaging equipment, transfer assistance, and the 21 room in which services will be provided as well as 22 adherence to best practices for screening and treat- 23 ing veterans with a spinal cord injury or disorder. 24 (3) SCREENING RATES.— † S 2533 ES
10 1 (A) MEASUREMENT.—The study required 2 by paragraph (1) shall include a measurement 3 of breast cancer screening rates for veterans 4 with a spinal cord injury or disorder during the 5 two-year period preceding the commencement of 6 the study, including a breakout of the screening 7 rates for such veterans living in rural or highly 8 rural areas. 9 (B) DEVELOPMENT OF METHOD.—If the 10 Secretary is unable to provide the measurement 11 required under subparagraph (A), the Secretary 12 shall develop a method to track breast cancer 13 screening rates for veterans with a spinal cord 14 injury or disorder. 15 (4) REPORT.—Not later than two years after 16 the date of the enactment of this Act, the Secretary 17 shall submit to the Committee on Veterans’ Affairs 18 of the Senate and the Committee on Veterans’ Af- 19 fairs of the House of Representatives a report on the 20 findings of the study required by paragraph (1), in- 21 cluding— 22 (A) the rates of screening among veterans 23 with a spinal cord injury or disorder, including 24 veterans living in rural or highly rural areas, as 25 required under paragraph (3)(A); or † S 2533 ES
11 1 (B) if such rates are not available, a de- 2 scription of the method developed to measure 3 such rates as required under paragraph (3)(B). 4 (b) CARE FROM NON-DEPARTMENT PROVIDERS.— 5 The Secretary shall update the policies and directives of 6 the Department to ensure that, in referring a veteran with 7 a spinal cord injury or disorder for care from a non-De- 8 partment provider, the Secretary shall— 9 (1) confirm with the provider the accessibility 10 of the breast imaging site, including the imaging 11 equipment, transfer assistance, and the room in 12 which services will be provided; and 13 (2) provide additional information to the pro- 14 vider on best practices for screening and treating 15 veterans with a spinal cord injury or disorder. 16 (c) DEFINITIONS.—In this section, the terms ‘‘rural’’ 17 and ‘‘highly rural’’ have the meanings given those terms 18 in the Rural-Urban Commuting Areas coding system of 19 the Department of Agriculture. 20 SEC. 106. REPORT ON ACCESS TO AND QUALITY OF MAM- 21 MOGRAPHY SCREENINGS FURNISHED BY DE- 22 PARTMENT OF VETERANS AFFAIRS. 23 (a) IN GENERAL.—Not later than two years after the 24 date of the enactment of this Act, the Inspector General 25 of the Department of Veterans Affairs shall submit to the † S 2533 ES
12 1 Secretary of Veterans Affairs, the Committee on Veterans’ 2 Affairs of the Senate, and the Committee on Veterans’ Af- 3 fairs of the House of Representatives a report on mam- 4 mography services furnished by the Department of Vet- 5 erans Affairs. 6 (b) ELEMENTS.—The report required by subsection 7 (a) shall include an assessment of— 8 (1) the access of veterans to mammography 9 screenings, whether at a facility of the Department 10 or through a non-Department provider, including 11 any staffing concerns of the Department in pro- 12 viding such screenings; 13 (2) the quality of such screenings and reading 14 of the images from such screenings, including wheth- 15 er such screenings use three-dimensional mammog- 16 raphy; 17 (3) the communication of the results of such 18 screenings, including whether results are shared in a 19 timely manner, whether results are shared via the 20 Joint Health Information Exchange or another elec- 21 tronic mechanism, and whether results are incor- 22 porated into the electronic health record of the vet- 23 eran; 24 (4) the performance of the Women’s Breast On- 25 cology System of Excellence of the Department; and † S 2533 ES
13 1 (5) the access of veterans diagnosed with breast 2 cancer to a comprehensive breast cancer care team 3 of the Department. 4 (c) FOLLOW-UP.—Not later than 180 days after the 5 submittal of the report under subsection (a), the Secretary 6 shall submit to the Committee on Veterans’ Affairs of the 7 Senate and the Committee on Veterans’ Affairs of the 8 House of Representatives a plan to address the defi- 9 ciencies identified in the report under subsection (a), if 10 any. 11 TITLE II—PARTNERSHIPS FOR 12 RESEARCH AND ACCESS TO 13 CARE 14 SEC. 201. PARTNERSHIPS WITH NATIONAL CANCER INSTI- 15 TUTE TO EXPAND ACCESS OF VETERANS TO 16 CANCER CARE. 17 (a) ACCESS TO CARE IN EACH VISN.— 18 (1) IN GENERAL.—The Secretary of Veterans 19 Affairs shall enter into a partnership with not fewer 20 than one cancer center of the National Cancer Insti- 21 tute of the National Institutes of Health in each 22 Veterans Integrated Service Network of the Depart- 23 ment of Veterans Affairs to expand access to high- 24 quality cancer care for women veterans. † S 2533 ES
14 1 (2) TREATMENT OF RURAL VETERANS.—The 2 Secretary, in carrying out partnerships entered into 3 under paragraph (1), shall ensure that veterans with 4 breast cancer who reside in rural areas or States 5 without a cancer center that has entered into such 6 a partnership with the Secretary are able to receive 7 care through such a partnership via telehealth. 8 (b) REPORT ON PARTNERSHIP TO INCREASE ACCESS 9 TO CLINICAL TRIALS.—Not later than 180 days after the 10 date of the enactment of this Act, the Secretary shall sub- 11 mit to the Committee on Veterans’ Affairs of the Senate 12 and the Committee on Veterans’ Affairs of the House of 13 Representatives a report on— 14 (1) how the Secretary will ensure that the ad- 15 vancements made through the existing partnership 16 between the Department of Veterans Affairs and the 17 National Cancer Institute to provide veterans with 18 access to clinical cancer research trials (commonly 19 referred to as ‘‘NAVIGATE’’) are permanently im- 20 plemented; and 21 (2) the determination of the Secretary of 22 whether expansion of such partnership to more than 23 the original 12 facilities of the Department that 24 were selected under such partnership is feasible. † S 2533 ES
15 1 (c) PERIODIC REPORTS.—Not later than three years 2 after the date of the enactment of this Act, and every 3 three years thereafter, the Secretary shall submit to the 4 Committee on Veterans’ Affairs of the Senate and the 5 Committee on Veterans’ Affairs of the House of Rep- 6 resentatives a report— 7 (1) assessing how the partnerships entered into 8 under subsection (a)(1) have impacted access by vet- 9 erans to cancer centers of the National Cancer Insti- 10 tute, including an assessment of the telehealth op- 11 tions made available and used pursuant to such 12 partnerships; and 13 (2) describing the advancements made with re- 14 spect to access by veterans to clinical cancer re- 15 search trials through the partnership described in 16 subsection (b)(1), including how many of those vet- 17 erans were women veterans, minority veterans (in- 18 cluding racial and ethnic minorities), and rural vet- 19 erans, and identifying opportunities for further inno- 20 vation. † S 2533 ES
16 1 SEC. 202. REPORT BY DEPARTMENT OF VETERANS AFFAIRS 2 AND DEPARTMENT OF DEFENSE ON INTER- 3 AGENCY COLLABORATION ON TREATING AND 4 RESEARCHING BREAST CANCER. 5 (a) IN GENERAL.—Not later than 180 days after the 6 date of the enactment of this Act, the Secretary of Vet- 7 erans Affairs, in collaboration with the Secretary of De- 8 fense, shall submit to Congress a report on all current re- 9 search and health care collaborations between the Depart- 10 ment of Veterans Affairs and the Department of Defense 11 on treating veterans and members of the Armed Forces 12 with breast cancer. 13 (b) ELEMENTS.—The report required by subsection 14 (a)— 15 (1) shall include a description of potential op- 16 portunities for future interagency collaboration be- 17 tween the Department of Veterans Affairs and the 18 Department of Defense with respect to treating and 19 researching breast cancer; and 20 (2) may include a focus on— 21 (A) with respect to women members of the 22 Armed Forces with a diagnosis of or who are 23 undergoing screening for breast cancer, transi- 24 tion of such members from receiving care from 25 the Department of Defense to receiving care 26 from the Department of Veterans Affairs; † S 2533 ES
17 1 (B) collaborative breast cancer research 2 opportunities between the Department of Vet- 3 erans Affairs and the Department of Defense; 4 (C) access to clinical trials; and 5 (D) such other matters as the Secretary of 6 Veterans Affairs and the Secretary of Defense 7 consider appropriate. Passed the Senate March 23, 2022. Attest: Secretary. † S 2533 ES
117TH CONGRESS 2D SESSION S. 2533 AN ACT To improve mammography services furnished by the Department of Veterans Affairs, and for other purposes.