Public Law 117-135 passed June 7, 2022

Making Advances in Mammography and Medical Options for Veterans Act

Title 1

Screening and Early Detection

Strategic Plan for Breast Imaging Services for Veterans

General

One year after the enactment of this Act, the Secretary of Veterans Affairs submit to the Committee on Veterans’ Affairs of the Senate and House of Representatives a strategic plan for improving breast imaging services for veterans.

Elements

Strategic plan requirements:

    • Cover the evolving needs of women veterans

    • Address geographic disparities of breast imaging at a facility of the Department of Veterans Affairs and the use of breast imaging at non-Department providers.

    • Address the use of digital breast tomosynthesis (DBT-3D imaging)

    • Address the need of male veterans who require breast cancer screening services.

    • Provide recommendations on potential expansion of breast imaging services furnished at facilities of the Department, including infrastructure and staffing, the use of digital breast tomosynthesis, the use of mobile mammography and other access and equity improvements.

Telescreening Mammography Pilot Program of Department of Veterans Affairs

General

18 months after the enactment of this Act, the Secretary of Veteran Affairs will carry out a pilot program to provide telescreening mammography services for veterans who live in States where the Department of Veterans Affairs do NOT offer breast imaging services at the Department or locations were services are difficult or NOT feasible.

Duration

The Secretary will carry out the pilot program for a 3 year period.

Locations

The Secretary may use community based outpatient clinics, mobile mammography, Federally qualified health centers (section 1861(aa)(4) Social Security Act (42 USC 1395x(aa)(4))), rural health clinics, critical access hospitals, Indian Health Service clinics, and other facilities the Secretary deems feasible.

Sharing of Images and Results

Images generated will be sent to tele screening mammography center of the Department for interpretation by qualified radiologists.

Results shared with veteran and their primary care provider.

Report

General

  • 1 year after the conclusion of the pilot program, the Secretary will submit a report to the Committee Veterans’ Affairs of the Senate and House of Representatives evaluating the pilot program.

Elements

  • Assessment of the quality of the mammography.

  • Feedback from veterans and providers participating.

  • Recommendation of the Secretary on the continuation or discontinuation of the pilot program.

Upgrade of Breast Imaging at Facilities of Department of Veterans Affairs to Three Dimensional Digital Mammography

2 years after the enactment of this Act, the Secretary will:

    • Upgrade ALL mammography services at facilities of the Department of Veterans Affairs to three-dimensional breast imaging.

    • Submit to the Committee on Veterans’ Affairs of the Senate and House of Representatives a report that in upgrade has been completed and listing the facilities and other locations which digital breast tomosynthesis technology is used.

Study on Availability of Testing for Breast Cancer Gene Among Veterans and Expansion of Availability of Such Testing

General

The Secretary of Veterans Affairs will conduct a study on the availability of access to testing for the breast cancer gene for those diagnosed with breast cancer recommended by the guidelines set forth by the National Comprehensive Cancer Network.

Elements

The Secretary will examine the feasibility of expanding the Joint Medicine Service of the Department of the VA to provide genetic testing and counseling with those diagnosed with breast cancer across the country.

Access to testing and counseling for veterans in rural areas and any gaps that may exist with respect to access for testing and counseling.

Expansion of Availability of Testing

General

  • The Secretary will update guidelines or create new guidelines to increase the use of molecular testing and genetic counseling for veterans diagnosed with breast cancer living in rural areas.

Decision Support Tools

  • The Secretary may develop clinical decision support tools, such as clinical pathways to facilitate delivery of breast cancer care, in line with national cancer guidelines.

Report

  • 2 years after the enactment of this Act, the Secretary will submit to the Committee on Veterans’ Affairs of the Senate and House of Representatives.

  • Results of the study

  • Updates to guidelines or new guidelines instituted

  • Breast cancer clinical pathways implemented by the Department of Veteran Affairs and utilization of those pathways across the Department.

  • Progress of the Department improving access and usage of molecular and genetic testing, including those living in rural areas.

Definitions

“Rural and highly rural areas”-

  • Meanings given in the Rural-Urban Commuting Areas coding system of the Department of Agriculture.

Mammography Accessibility for Paralyzed and Disabled Veterans

Study

General

  • The Secretary of Veterans Affairs will conduct a study on accessibility of breast imaging services for veterans with paralysis, spinal cord injury or disorders (SCI/D), or other disabilities.

Accessibility

  • An assessment of the accessibility of the physical infrastructure at said facilities of the Department, including imaging equipment, transfer assistance, the room in which service is provided and adherence to best practices for screening and treating veterans with SCI/D.

Screening Rates

Measurements

    • Measurement of breast cancer screening rates for veterans with a SCI/D during the 2 year period proceeding the commencement of the study, including a breakout of the screening rates for veterans living in rural areas.

Development of Method

    • The Secretary will develop a method to track breast cancer screening rates for veterans with SCI/D.

Report

    • 2 years after the enactment of this Act, the Secretary will submit to the Committee on Veterans’ Affairs of the Senate and House of Representatives findings include,

    • Rates of screening among veterans with SCI/D, including those in rural areas.

    • If rates are NOT available then a description of the method developed to measure the rate is required.

Care from Non-Department Providers

The Secretary will update the policies and directives of the Department to ensure that SCI/D veterans shall:

  • Confirm with the provider the accessibility of the site, including equipment, transfer assistance, room where services are provided and;

  • Provide additional information to the provider on best practices for screening and treating SCI/D veterans.

Report on Access to and Quality of Mammography Screening Furnished by Department of Veterans Affairs

General

2 years after the enactment of this Act, the Inspector General of the Department of Veterans Affairs  will submit to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate and House of Representatives a report on mammography services furnished by the Department of Veterans Affairs.

Elements

    • Access of veterans to mammography screenings either through the Department of non-Department provider, including staffing concerns in providing screenings.

    • Quality of screenings and reading the images, including the use of three-dimensional mammography.

    • Communication of the results, including results shared in a timely manner, results are shared via the Joint Health Information Exchange or another electronic mechanism, results are incorporated into the electronic health record of the veteran.

    • Performance of the Women’s Breast Oncology System of Excellence of the Department.

    • Access to a comprehensive breast cancer care team of the Department.

Follow-Up

180 days after the submittal of the report, the Secretary will submit to the Committee on Veterans’ Affairs of the Senate and House of Representative a plan to address the deficiencies identified.

Title 2

Partnerships for Research and Access to Care

Partnerships with National Cancer Institute to Expand Access of Veterans to Cancer Care

Access to Care in Each VISN

General

    • The Secretary of the Veterans Affairs will enter into a partnership with at least 1 cancer center of the National Cancer Institute of the National Institute of Health in each Veterans Integrated Service Network Department of Veterans Affairs to expand access to high quality cancer care for women veterans.

Treatment of Rural Veterans

    • The Secretary in partnership shall ensure veterans with breast cancer who live in rural areas os States without a cancer center are able to relieve care though such partnership via telehealth.

Report on Partnership to Increase Access to Clinical Trials

180 days after the enactment of this Act, the Secretary will submit to the Committee on Veterans’ Affairs of the Senate and House of Representative a report;

    • How the Secretary will ensure advancements made through existing partnerships to provide access to clinical cancer research trials (referred as “NAVIGATE”) are permanently implemented.

    • Determination of the Secretary whether expansion of partnerships to more than 12 facilities of the Department that were selected are feasible.

Periodic Reports

3 years after the enactment of this Act, and every 3 years afterward, the Secretary will submit to the Committee on Veterans’ Affairs of the Senate and House of Representative a report;

    • Assessing how the partnerships have impacted access by veterans to cancer centers of the National Cancer Institute, including assessment of Telehealth options made available and used.

    • Describing the advancements to access by veterans to clinical cancer research trials throughout he partnership, including how those veterans were women, minority and rural veterans and identifying opportunities for further innovation.

Report by Department of Veterans Affairs and Department of Defense on Interagency Collaboration on Treating and Researching Breast Cancer

General

180 days after the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense will submit a report to Congress on ALL current research and health care collaboration s between the Department of VA and Department of Defense on treating veterans and members with breast cancer.

Elements

Include a description of potential opportunities for future interagency collaboration between the Department of the Va and the Department of Defense to treating and researching breast cancer.

To women members of the Armed Forces with a diagnosis or who have undergone screening for breast cancer, transition of members from receiving care from the Department of Defense to receiving care from the Department of Veterans Affairs.

Collaboration great cancer research opportunities between Veterans Affairs and Defense Department.

Access to clinical trials.

Other matters as the Secretary of VA and the Secretary of Defense consider appropriate.