#aagth ,,congress  #b;d ,session  ,s4   
#becc  ,,an ,,act  ,to improve          
mammography services furnished by the   
,department of ,veterans ,affairs1 and  
for other purposes4  #a4 ,short title2  
table of contents  7a7 ,short title     
,this ,act may be cited as the ,making  
,advances in ,mammography and ,medical  
,options for ,veterans ,act4  7b7 ,table
 of contents ,the table of contents for 
this ,act is as follows3 ,sec4 #a4      
,short title2 table of contents4,,title 
,i--,screening and early detection,sec4 
#aja4 ,strategic plan for breast imaging
 services for veterans4,sec4 #ajb4      
,telescreening mammography pilot program
 of ,department of ,veterans            
,affairs4,sec4 #ajc4 ,upgrade of breast 
imaging at facilities of ,department of 
,veterans ,affairs to three-dimensional 
digital mammography4,sec4 #ajd4 ,study  
on availability of testing for breast   
cancer gene among veterans and expansion
 of availability of such testing4,sec4  
#aje4 ,mammography accessibility for    

paralyzed and disabled veterans4,sec4   
#ajf4 ,report on access to and quality  
of mammography screenings furnished by  
,department of ,veterans                
,affairs4,,title ,,ii--,partnerships for
 research and access to care,sec4 #bja4 
,partnerships with ,national ,cancer    
,institute to expand access of veterans 
to cancer care4,sec4 #bjb4 ,report by   
,department of ,veterans ,affairs and   
,department of ,defense on interagency  
collaboration on treating and           
researching breast cancer4  ,i          
,screening and early detection  #aja4   
,strategic plan for breast imaging      
services for veterans  7a7 ,in general  
,not later than one year after the date 
of the enactment of this ,act1 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 veterans4  7b7 ,elements   

,the strategic plan required by         
subsection 7a7 shall-- 7#a7 cover the   
evolving needs of women veterans2  7#b7 
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        
community2  7#c7 address the use of     
digital breast tomosynthesis            
7,,dbt-#c;,d breast imaging72  7#d7     
address the needs of male veterans who  
require breast cancer screening         
services2 and  7#e7 provide             
recommendations on-- 7,a7 potential     
expansion of breast imaging services    
furnished at facilities of the          
,department1 including infrastructure   
and staffing needs2  7,b7 the use of    
digital breast tomosynthesis2  7,c7 the 
use of mobile mammography2 and  7,d7    
other access and equity improvements for
 breast imaging4  #ajb4 ,telescreening  
mammography pilot program of ,department
 of ,veterans ,affairs  7a7 ,in general 

,commencing not later than #ah months   
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall carry out a pilot program
 to provide telescreening mammography   
services for veterans who live in-- 7#a7
 ,states where the ,department of       
,veterans ,affairs does not offer breast
 imaging services at a facility of the  
,department2 or  7#b7 locations where   
access to breast imaging services at a  
facility of the ,department is difficult
 or not feasible1 as determined by the  
,secretary4  7b7 ,duration ,the         
,secretary shall carry out the pilot    
program under subsection 7a7 for a      
three-year period beginning on the      
commencement of the pilot program4  7c7 
,locations ,in carrying out the pilot   
program under subsection 7a71 the       
,secretary may use community-based      
outpatient clinics1 mobile mammography1 
,federally qualified health centers 7as 
defined in section #ahfa7;aa77#d7 of the
 ,social ,security ,act 7#db ,u4,s4,c4  

#aciex7aa77#d7771 rural health clinics1 
critical access hospitals1 clinics of   
the ,indian ,health ,service1 and such  
other sites as the ,secretary determines
 feasible to provide mammograms under   
the pilot program4  7d7 ,sharing of     
images and results ,under the pilot     
program under subsection 7a7-- 7#a7     
mammography images generated shall be   
sent to a telescreening mammography     
center of the ,department for           
interpretation by qualified             
radiologists2 and  7#b7 results shall be
 shared with the veteran and their      
primary care provider in accordance with
 policies established by the ,secretary4
  7e7 ,report  7#a7 ,in general ,not    
later than one year after the conclusion
 of the pilot program under subsection  
7a71 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 program4  7#b7 ,elements ,the    

report required by paragraph 7#a7 shall 
include the following3 7,a7 ,an         
assessment of the quality of the        
mammography provided under the pilot    
program under subsection 7a74  7,b7     
,feedback from veterans and providers   
participating in the pilot program4     
7,c7 ,a recommendation of the ,secretary
 on the continuation or discontinuation 
of the pilot program4  #ajc4 ,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 ,act1 the     
,secretary of ,veterans ,affairs shall--
 7#a7 upgrade all mammography services  
at facilities of the ,department of     
,veterans ,affairs that provide such    
services to use digital breast          
tomosynthesis technology1 also known as 
three-dimensional breast imaging2 and   
7#b7 submit to the ,committee on        
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of

 the ,house of ,representatives a       
report-- 7,a7 indicating that the       
upgrade under paragraph 7#a7 has been   
completed2 and  7,b7 listing the        
facilities or other locations of the    
,department at which digital breast     
tomosynthesis technology is used4  #ajd4
 ,study on availability of testing for  
breast cancer gene among veterans and   
expansion of availability of such       
testing  7a7 ,study  7#a7 ,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 cancer1 as        
recommended by the guidelines set forth 
by the ,national ,comprehensive ,cancer 
,network4  7#b7 ,elements ,in conducting
 the study under paragraph 7#a71 the    
,secretary shall examine-- 7,a7 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 country2 and  
7,b7 access to such testing and         
counseling for veterans living in rural 
or highly rural areas1 and any gaps that
 may exist with respect to such access4 
7b7 ,expansion of availability of       
testing  7#a7 ,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 cancer1 including veterans living
 in rural or highly rural areas4  7#b7  
,decision support tools ,in updating or 
instituting guidelines under paragraph  
7#a71 the ,secretary may develop        
clinical decision support tools1 such as
 clinical pathways1 to facilitate       
delivery of breast cancer care that is  
in line with national cancer guidelines4
  7c7 ,report ,not later than two years 
after the date of the enactment of this 
,act1 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-- 7#a7 the 
results of the study under subsection   
7a72  7#b7 any updates to guidelines or 
new guidelines instituted under         
subsection 7b72  7#c7 breast cancer     
clinical pathways implemented by the    
,department of ,veterans ,affairs and   
the utilization of those pathways across
 the ,department2 and  7#d7 any progress
 of the ,department in improving access 
to and usage of molecular and genetic   
testing among veterans diagnosed with   
breast cancer1 including for veterans   
living in rural or highly rural areas4  
7d7 ,definitions ,in this section1 the  
terms rural and highly rural have the   
meanings given those terms in the       
,rural-,urban ,commuting ,areas coding  
system of the ,department of            
,agriculture4  #aje4 ,mammography       
accessibility for paralyzed and disabled
 veterans  7a7 ,study  7#a7 ,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    
paralysis1 spinal cord injury or        
disorder 7,,sci_/,d71 or another        
disability4  7#b7 ,accessibility ,the   
study required by paragraph 7#a7 shall  
include an assessment of the            
accessibility of the physical           
infrastructure at breast imaging        
facilities of the ,department1 including
 the imaging equipment1 transfer        
assistance1 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 disorder4  7#c7   
,screening rates  7,a7 ,measurement ,the
 study required by paragraph 7#a7 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 study1 including a  
breakout of the screening rates for such

 veterans living in rural or highly     
rural areas4  7,b7 ,development of      
method ,if the ,secretary is unable to  
provide the measurement required under  
subparagraph 7,a71 the ,secretary shall 
develop a method to track breast cancer 
screening rates for veterans with a     
spinal cord injury or disorder4  7#d7   
,report ,not later than two years after 
the date of the enactment of this ,act1 
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 7#a71 including-- 7,a7 the    
rates of screening among veterans with a
 spinal cord injury or disorder1        
including veterans living in rural or   
highly rural areas1 as required under   
paragraph 7#c77;,a72 or  7,b7 if such   
rates are not available1 a description  
of the method developed to measure such 
rates as required under paragraph       

7#c77;,b74  7b7 ,care from              
non-,department providers ,the          
,secretary shall update the policies and
 directives of the ,department to ensure
 that1 in referring a veteran with a    
spinal cord injury or disorder for care 
from a non-,department provider1 the    
,secretary shall-- 7#a7 confirm with the
 provider the accessibility of the      
breast imaging site1 including the      
imaging equipment1 transfer assistance1 
and the room in which services will be  
provided2 and  7#b7 provide additional  
information to the provider on best     
practices for screening and treating    
veterans with a spinal cord injury or   
disorder4  7c7 ,definitions ,in this    
section1 the terms rural and highly     
rural have the meanings given those     
terms in the ,rural-,urban ,commuting   
,areas coding system of the ,department 
of ,agriculture4  #ajf4 ,report on      
access to and quality of mammography    
screenings furnished by ,department of  
,veterans ,affairs  7a7 ,in general ,not

 later than two years after the date of 
the enactment of this ,act1 the         
,inspector ,general of the ,department  
of ,veterans ,affairs shall submit to   
the ,secretary of ,veterans ,affairs1   
the ,committee on ,veterans' ,affairs of
 the ,senate1 and the ,committee on     
,veterans' ,affairs of the ,house of    
,representatives a report on mammography
 services furnished by the ,department  
of ,veterans ,affairs4  7b7 ,elements   
,the report required by subsection 7a7  
shall include an assessment of-- 7#a7   
the access of veterans to mammography   
screenings1 whether at a facility of the
 ,department or through a               
non-,department provider1 including any 
staffing concerns of the ,department in 
providing such screenings2  7#b7 the    
quality of such screenings and reading  
of the images from such screenings1     
including whether such screenings use   
three-dimensional mammography2  7#c7 the
 communication of the results of such   
screenings1 including whether results   

are shared in a timely manner1 whether  
results are shared via the ,joint       
,health ,information ,exchange or       
another electronic mechanism1 and       
whether results are incorporated into   
the electronic health record of the     
veteran2  7#d7 the performance of the   
,women's ,breast ,oncology ,system of   
,excellence of the ,department2 and     
7#e7 the access of veterans diagnosed   
with breast cancer to a comprehensive   
breast cancer care team of the          
,department4  7c7 ,follow-,up ,not later
 than #ahj days after the submittal of  
the report under subsection 7a71 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 7a71 if any4  ,,ii     
,partnerships for research and access to
 care  #bja4 ,partnerships with         
,national ,cancer ,institute to expand  

access of veterans to cancer care  7a7  
,access to care in each ,,visn  7#a7 ,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      
veterans4  7#b7 ,treatment of rural     
veterans ,the ,secretary1 in carrying   
out partnerships entered into under     
paragraph 7#a71 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 telehealth4  7b7 ,report
 on partnership ,to increase access to  
clinical trials ,not later than #ahj    
days after the date of the enactment of 
this ,act1 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-- 7#a7 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 7commonly referred to as         
,,navigate7 are permanently implemented2
 and  7#b7 the determination of the     
,secretary of whether expansion of such 
partnership to more than the original   
#ab facilities of the ,department that  
were selected under such partnership is 
feasible4  7c7 ,periodic reports ,not   
later than three years after the date of
 the enactment of this ,act1 and every  
three years thereafter1 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-- 7#a7 assessing how the         
partnerships entered into under         
subsection 7a77#a7 have impacted access 
by veterans to cancer centers of the    
,national ,cancer ,institute1 including 
an assessment of the telehealth options 
made available and used pursuant to such
 partnerships2 and  7#b7 describing the 
advancements made with respect to access
 by veterans to clinical cancer research
 trials through the partnership         
described in subsection 7b77#a71        
including how many of those veterans    
were women veterans1 minority veterans  
7including racial and ethnic            
minorities71 and rural veterans1 and    
identifying opportunities for further   
innovation4  #bjb4 ,report by           
,department of ,veterans ,affairs and   
,department of ,defense on interagency  
collaboration on treating and           
researching breast cancer  7a7 ,in      
general ,not later than #ahj days after 
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs1 in

 collaboration with the ,secretary of   
,defense1 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 cancer4  7b7        
,elements ,the report required by       
subsection 7a7-- 7#a7 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 cancer2 and  7#b7 may
 include a focus on-- 7,a7 with respect 
to women members of the ,armed ,forces  
with a diagnosis of or who are          
undergoing screening for breast cancer1 
transition of such members from         
receiving care from the ,department of  
,defense to receiving care from the     
,department of ,veterans ,affairs2  7,b7
 collaborative breast cancer research   

opportunities between the ,department of
 ,veterans ,affairs and the ,department 
of ,defense2  7,c7 access to clinical   
trials2 and  7,d7 such other matters as 
the ,secretary of ,veterans ,affairs and
 the ,secretary of ,defense consider    
appropriate4  ,passed the ,senate ,march
 #bc1 #bjbb4,secretary