II 

116TH CONGRESS 

1ST SESSION S. 916 

To improve Federal efforts with respect to the prevention of maternal 

mortality, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 27, 2019 

Mr. DURBIN (for himself, Ms. DUCKWORTH, Mr. BLUMENTHAL, Mr. VAN

HOLLEN, Mr. MERKLEY, Mr. BROWN, Mr. SANDERS, Ms. SMITH, and 

Mr. KING) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To improve Federal efforts with respect to the prevention 

of maternal mortality, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Mothers and Offspring 

5 Mortality and Morbidity Awareness Act’’ or the 

6 ‘‘MOMMA’s Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

•S 916 IS

1 (1) Every year, across the United States, 

2 4,000,000 women give birth, about 700 women suf3 fer fatal complications during pregnancy, while giv4 ing birth or during the postpartum period, and 

5 70,000 women suffer near-fatal, partum-related 

6 complications. 

7 (2) The maternal mortality rate is often used as 

8 a proxy to measure the overall health of a popu9 lation. While the infant mortality rate in the United 

10 States has reached its lowest point, the risk of death 

11 for women in the United States during pregnancy, 

12 childbirth, or the postpartum period is higher than 

13 such risk in many other developed nations. The esti14 mated maternal mortality rate (per 100,000 live 

15 births) for the 48 contiguous States and Wash16 ington, DC increased from 18.8 percent in 2000 to 

17 23.8 percent in 2014 to 26.6 percent in 2018. This 

18 estimated rate is on par with such rate for under19 developed nations such as Iraq and Afghanistan. 

20 (3) International studies estimate the 2015 ma21 ternal mortality rate in the United States as 26.4 

22 per 100,000 live births, which is almost twice the 

23 2015 World Health Organization estimation of 14 

24 per 100,000 live births. 


pamtmann on DSKBFK8HB2PROD with BILLS
3 

•S 916 IS

1 (4) It is estimated that more than 60 percent 

2 of maternal deaths in the United States are prevent3 able. 

4 (5) According to the Centers for Disease Con5 trol and Prevention, the maternal mortality rate var6 ies drastically for women by race and ethnicity. 

7 There are 12.7 deaths per 100,000 live births for 

8 White women, 43.5 deaths per 100,000 live births 

9 for African-American women, and 14.4 deaths per 

10 100,000 live births for women of other ethnicities. 

11 While maternal mortality disparately impacts Afri12 can-American women, this urgent public health crisis 

13 traverses race, ethnicity, socioeconomic status, edu14 cational background, and geography. 

15 (6) African-American women are 3 to 4 times 

16 more likely to die from causes related to pregnancy 

17 and childbirth compared to non-Hispanic White 

18 women. 

19 (7) The findings described in paragraphs (1) 

20 through (6) are of major concern to researchers, 

21 academics, members of the business community, and 

22 providers across the obstetrical continuum rep23 resented by organizations such as March of Dimes; 

24 the Preeclampsia Foundation; the American College 

25 of Obstetricians and Gynecologists; the Society for 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•S 916 IS

1 Maternal-Fetal Medicine; the Association of Wom2 en’s Health, Obstetric, and Neonatal Nurses; the 

3 California Maternal Quality Care Collaborative; 

4 Black Women’s Health Imperative; the National 

5 Birth Equity Collaborative; Black Mamas Matter Al6 liance; EverThrive Illinois; the National Association 

7 of Certified Professional Midwives; PCOS Challenge: 

8 The National Polycystic Ovary Syndrome Associa9 tion; and the American College of Nurse Midwives. 

10 (8) Hemorrhage, cardiovascular and coronary 

11 conditions, cardiomyopathy, infection, embolism, 

12 mental health conditions, preeclampsia and eclamp13 sia, polycystic ovary syndrome, infection and sepsis, 

14 and anesthesia complications are the predominant 

15 medical causes of maternal-related deaths and com16 plications. Most of these conditions are largely pre17 ventable or manageable. 

18 (9) Oral health is an important part of 

19 perinatal health. Reducing bacteria in a woman’s 

20 mouth during pregnancy can significantly reduce her 

21 risk of developing oral diseases and spreading decay22 causing bacteria to her baby. Moreover, some evi23 dence suggests that women with periodontal disease 

24 during pregnancy could be at greater risk for poor 

25 birth outcomes, such as preeclampsia, pre-term 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

•S 916 IS

1 birth, and low-birth weight. Furthermore, a woman’s 

2 oral health during pregnancy is a good predictor of 

3 her newborn’s oral health, and since mothers can 

4 unintentionally spread oral bacteria to their babies, 

5 putting their children at higher risk for tooth decay, 

6 prevention efforts should happen even before chil7 dren are born, as a matter of pre-pregnancy health 

8 and prenatal care during pregnancy. 

9 (10) The United States has not been able to 

10 submit a formal maternal mortality rate to inter11 national data repositories since 2007. Thus, no offi12 cial maternal mortality rate exists for the United 

13 States. There can be no maternal mortality rate 

14 without streamlining maternal mortality-related data 

15 from the State level and extrapolating such data to 

16 the Federal level. 

17 (11) In the United States, death reporting and 

18 analysis is a State function rather than a Federal 

19 process. States report all deaths—including mater20 nal deaths—on a semi-voluntary basis, without 

21 standardization across States. While the Centers for 

22 Disease Control and Prevention has the capacity and 

23 system for collecting death-related data based on 

24 death certificates, these data are not sufficiently re25 ported by States in an organized and standard forVerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S916.IS S916

pamtmann on DSKBFK8HB2PROD with BILLS
6 

•S 916 IS

1 mat across States such that the Centers for Disease 

2 Control and Prevention is able to identify causes of 

3 maternal death and best practices for the prevention 

4 of such death. 

5 (12) Vital statistics systems often underesti6 mate maternal mortality and are insufficient data 

7 sources from which to derive a full scope of medical 

8 and social determinant factors contributing to ma9 ternal deaths. While the addition of pregnancy 

10 checkboxes on death certificates since 2003 have 

11 likely improved States’ abilities to identify preg12 nancy-related deaths, they are not generally com13 pleted by obstetrical providers or persons trained to 

14 recognize pregnancy-related mortality. Thus, these 

15 vital forms may be missing information or may cap16 ture inconsistent data. Due to varying maternal 

17 mortality-related analyses, lack of reliability, and 

18 granularity in data, current maternal mortality 

19 informatics do not fully encapsulate the myriad med20 ical and socially determinant factors that contribute 

21 to such high maternal mortality rates within the 

22 United States compared to other developed nations. 

23 Lack of standardization of data and data sharing 

24 across States and between Federal entities, health 


pamtmann on DSKBFK8HB2PROD with BILLS
7 

•S 916 IS

1 networks, and research institutions keep the Nation 

2 in the dark about ways to prevent maternal deaths. 

3 (13) Having reliable and valid State data ag4 gregated at the Federal level are critical to the Na5 tion’s ability to quell surges in maternal death and 

6 imperative for researchers to identify long-lasting 

7 interventions. 

8 (14) Leaders in maternal wellness highly rec9 ommend that maternal deaths be investigated at the 

10 State level first, and that standardized, streamlined, 

11 de-identified data regarding maternal deaths be sent 

12 annually to the Centers for Disease Control and Pre13 vention. Such data standardization and collection 

14 would be similar in operation and effect to the Na15 tional Program of Cancer Registries of the Centers 

16 for Disease Control and Prevention and akin to the 

17 Confidential Enquiry in Maternal Deaths Pro18 gramme in the United Kingdom. Such a maternal 

19 mortalities and morbidities registry and surveillance 

20 system would help providers, academicians, law21 makers, and the public to address questions con22 cerning the types of, causes of, and best practices to 

23 thwart, pregnancy-related or pregnancy-associated 

24 mortality and morbidity. 


pamtmann on DSKBFK8HB2PROD with BILLS
8 

•S 916 IS

1 (15) The United Nations’ Millennium Develop2 ment Goal 5a aimed to reduce by 75 percent, be3 tween 1990 and 2015, the maternal mortality rate, 

4 yet this metric has not been achieved. In fact, the 

5 maternal mortality rate in the United States has 

6 been estimated to have more than doubled between 

7 2000 and 2014. Yet, because national data are not 

8 fully available, the United States does not have an 

9 official maternal mortality rate. 

10 (16) Many States have struggled to establish or 

11 maintain Maternal Mortality Review Committees 

12 (referred to in this section as ‘‘MMRC’’). On the 

13 State level, MMRCs have lagged because States have 

14 not had the resources to mount local reviews. State15 level reviews are necessary as only the State depart16 ments of health have the authority to request med17 ical records, autopsy reports, and police reports crit18 ical to the function of the MMRC. 

19 (17) The United Kingdom regards maternal 

20 deaths as a health systems failure and a national 

21 committee of obstetrics experts review each maternal 

22 death or near-fatal childbirth complication. Such 

23 committee also establishes the predominant course of 

24 maternal-related deaths from conditions such as 

25 preeclampsia. Consequently, the United Kingdom 


pamtmann on DSKBFK8HB2PROD with BILLS
9 

•S 916 IS

1 has been able to reduce its incidence of preeclampsia 

2 to less than one in 10,000 women—its lowest rate 

3 since 1952. 

4 (18) The United States has no comparable, co5 ordinated Federal process by which to review cases 

6 of maternal mortality, systems failures, or best prac7 tices. Many States have active MMRCs and leverage 

8 their work to impact maternal wellness. For exam9 ple, the State of California has worked extensively 

10 with their State health departments, health and hos11 pital systems, and research collaborative organiza12 tions, including the California Maternal Quality Care 

13 Collaborative and the Alliance for Innovation on Ma14 ternal Health, to establish MMRCs, wherein such 

15 State has determined the most prevalent causes of 

16 maternal mortality and recorded and shared data 

17 with providers and researchers, who have developed 

18 and implemented safety bundles and care protocols 

19 related to preeclampsia, maternal hemorrhage, and 

20 the like. In this way, the State of California has 

21 been able to leverage its maternal mortality review 

22 board system, generate data, and apply those data 

23 to effect changes in maternal care-related protocol. 

24 To date, the State of California has reduced its maVerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S916.IS S916

pamtmann on DSKBFK8HB2PROD with BILLS
10 

•S 916 IS

1 ternal mortality rate, which is now comparable to 

2 the low rates of the United Kingdom. 

3 (19) Hospitals and health systems across the 

4 United States lack standardization of emergency ob5 stetrical protocols before, during, and after delivery. 

6 Consequently, many providers are delayed in recog7 nizing critical signs indicating maternal distress that 

8 quickly escalate into fatal or near-fatal incidences. 

9 Moreover, any attempt to address an obstetrical 

10 emergency that does not consider both clinical and 

11 public health approaches falls woefully under the 

12 mark of excellent care delivery. State-based maternal 

13 quality collaborative organizations, such as the Cali14 fornia Maternal Quality Care Collaborative or enti15 ties participating in the Alliance for Innovation on 

16 Maternal Health (AIM), have formed obstetrical pro17 tocols, tool kits, and other resources to improve sys18 tem care and response as they relate to maternal 

19 complications and warning signs for such conditions 

20 as maternal hemorrhage, hypertension, and 

21 preeclampsia. 

22 (20) The Centers for Disease Control and Pre23 vention reports that nearly half of all maternal 

24 deaths occur in the immediate postpartum period— 

25 the 42 days following a pregnancy—whereas more 


pamtmann on DSKBFK8HB2PROD with BILLS
11 

•S 916 IS

1 than one-third of pregnancy-related or pregnancy-as2 sociated deaths occur while a person is still preg3 nant. Yet, for women eligible for the Medicaid pro4 gram on the basis of pregnancy, such Medicaid cov5 erage lapses at the end of the month on which the 

6 60th postpartum day lands. 

7 (21) The experience of serious traumatic 

8 events, such as being exposed to domestic violence, 

9 substance use disorder, or pervasive racism, can 

10 over-activate the body’s stress-response system. 

11 Known as toxic stress, the repetition of high-doses 

12 of cortisol to the brain, can harm healthy neuro13 logical development, which can have cascading phys14 ical and mental health consequences, as documented 

15 in the Adverse Childhood Experiences study of the 

16 Centers for Disease Control and Prevention. 

17 (22) A growing body of evidence-based research 

18 has shown the correlation between the stress associ19 ated with one’s race—the stress of racism—and 

20 one’s birthing outcomes. The stress of sex and race 

21 discrimination and institutional racism has been 

22 demonstrated to contribute to a higher risk of ma23 ternal mortality, irrespective of one’s gestational 

24 age, maternal age, socioeconomic status, or indi25 vidual-level health risk factors, including poverty, 


pamtmann on DSKBFK8HB2PROD with BILLS
12 

•S 916 IS

1 limited access to prenatal care, and poor physical 

2 and mental health (although these are not nominal 

3 factors). African-American women remain the most 

4 at risk for pregnancy-associated or pregnancy-re5 lated causes of death. When it comes to 

6 preeclampsia, for example, which is related to obe7 sity, African-American women of normal weight re8 main the most at risk of dying during the perinatal 

9 period compared to non-African-American obese 

10 women. 

11 (23) The rising maternal mortality rate in the 

12 United States is driven predominantly by the dis13 proportionately high rates of African-American ma14 ternal mortality. 

15 (24) African-American women are 3 to 4 times 

16 more likely to die from pregnancy or maternal-re17 lated distress than are White women, yielding one of 

18 the greatest and most disconcerting racial disparities 

19 in public health. 

20 (25) Compared to women from other racial and 

21 ethnic demographics, African-American women 

22 across the socioeconomic spectrum experience pro23 longed, unrelenting stress related to racial and gen24 der discrimination, contributing to higher rates of 

25 maternal mortality, giving birth to low-weight baVerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S916.IS S916

pamtmann on DSKBFK8HB2PROD with BILLS
13 

•S 916 IS

1 bies, and experiencing pre-term birth. Racism is a 

2 risk-factor for these aforementioned experiences. 

3 This cumulative stress often extends across the life 

4 course and is situated in everyday spaces where Afri5 can-American women establish livelihood. Structural 

6 barriers, lack of access to care, and genetic pre7 dispositions to health vulnerabilities exacerbate Afri8 can-American women’s likelihood to experience poor 

9 or fatal birthing outcomes, but do not fully account 

10 for the great disparity. 

11 (26) African-American women are twice as like12 ly to experience postpartum depression, and dis13 proportionately higher rates of preeclampsia com14 pared to White women. 

15 (27) Racism is deeply ingrained in United 

16 States systems, including in health care delivery sys17 tems between patients and providers, often resulting 

18 in disparate treatment for pain, irreverence for cul19 tural norms with respect to health, and 

20 dismissiveness. Research has demonstrated that pa21 tients respond more warmly and adhere to medical 

22 treatment plans at a higher degree with providers of 

23 the same race or ethnicity or with providers with 

24 great ability to exercise empathy. However, the pro25 vider pool is not primed with many people of color, 


pamtmann on DSKBFK8HB2PROD with BILLS
14 

•S 916 IS

1 nor are providers (whether student-doctors in train2 ing or licensed practitioners) consistently required to 

3 undergo implicit bias, cultural competency, or empa4 thy training on a consistent, on-going basis. 

5 SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO 

6 PREVENTION OF MATERNAL MORTALITY. 

7 (a) TECHNICAL ASSISTANCE FOR STATES WITH RE8 SPECT TO REPORTING MATERNAL MORTALITY.—Not 

9 later than one year after the date of enactment of this 

10 Act, the Director of the Centers for Disease Control and 

11 Prevention (referred to in this section as the ‘‘Director’’), 

12 in consultation with the Administrator of the Health Re13 sources and Services Administration, shall provide tech14 nical assistance to States that elect to report comprehen15 sive data on maternal mortality, including oral, mental, 

16 and breastfeeding health information, for the purpose of 

17 encouraging uniformity in the reporting of such data and 

18 to encourage the sharing of such data among the respec19 tive States. 

20 (b) BEST PRACTICES RELATING TO PREVENTION OF

21 MATERNAL MORTALITY.— 

22 (1) IN GENERAL.—Not later than one year 

23 after the date of enactment of this Act— 

24 (A) the Director, in consultation with rel25 evant patient and provider groups, shall issue 


pamtmann on DSKBFK8HB2PROD with BILLS
15 

•S 916 IS

1 best practices to State maternal mortality re2 view committees on how best to identify and re3 view maternal mortality cases, taking into ac4 count any data made available by States relat5 ing to maternal mortality, including data on 

6 oral, mental, and breastfeeding health, and uti7 lization of any emergency services; and 

8 (B) the Director, working in collaboration 

9 with the Health Resources and Services Admin10 istration, shall issue best practices to hospitals, 

11 State professional society groups, and perinatal 

12 quality collaboratives on how best to prevent 

13 maternal mortality. 

14 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

15 purposes of carrying out this subsection, there is au16 thorized to be appropriated $5,000,000 for each of 

17 fiscal years 2019 through 2023. 

18 (c) ALLIANCE FOR INNOVATION ON MATERNAL

19 HEALTH GRANT PROGRAM.— 

20 (1) IN GENERAL.—Not later than one year 

21 after the date of enactment of this Act, the Sec22 retary of Health and Human Services (referred to in 

23 this subsection as the ‘‘Secretary’’), acting through 

24 the Associate Administrator of the Maternal and 

25 Child Health Bureau of the Health Resources and 


pamtmann on DSKBFK8HB2PROD with BILLS
16 

•S 916 IS

1 Services Administration, shall establish a grant pro2 gram to be known as the Alliance for Innovation on 

3 Maternal Health Grant Program (referred to in this 

4 subsection as ‘‘AIM’’) under which the Secretary 

5 shall award grants to eligible entities for the purpose 

6 of— 

7 (A) directing widespread adoption and im8 plementation of maternal safety bundles 

9 through collaborative State-based teams; and 

10 (B) collecting and analyzing process, struc11 ture, and outcome data to drive continuous im12 provement in the implementation of such safety 

13 bundles by such State-based teams with the ul14 timate goal of eliminating preventable maternal 

15 mortality and severe maternal morbidity in the 

16 United States. 

17 (2) ELIGIBLE ENTITIES.—In order to be eligi18 ble for a grant under paragraph (1), an entity 

19 shall— 

20 (A) submit to the Secretary an application 

21 at such time, in such manner, and containing 

22 such information as the Secretary may require; 

23 and 

24 (B) demonstrate in such application that 

25 the entity is an interdisciplinary, multi-stakeVerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S916.IS S916

pamtmann on DSKBFK8HB2PROD with BILLS
17 

•S 916 IS

1 holder, national organization with a national 

2 data-driven maternal safety and quality im3 provement initiative based on implementation 

4 approaches that have been proven to improve 

5 maternal safety and outcomes in the United 

6 States. 

7 (3) USE OF FUNDS.—An eligible entity that re8 ceives a grant under paragraph (1) shall use such 

9 grant funds— 

10 (A) to develop and implement, through a 

11 robust, multi-stakeholder process, maternal 

12 safety bundles to assist States and health care 

13 systems in aligning national, State, and hos14 pital-level quality improvement efforts to im15 prove maternal health outcomes, specifically the 

16 reduction of maternal mortality and severe ma17 ternal morbidity; 

18 (B) to ensure, in developing and imple19 menting maternal safety bundles under sub20 paragraph (A), that such maternal safety bun21 dles— 

22 (i) satisfy the quality improvement 

23 needs of a State or health care system by 

24 factoring in the results and findings of rel25 evant data reviews, such as reviews conVerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S916.IS S916

pamtmann on DSKBFK8HB2PROD with BILLS
18 

•S 916 IS

1 ducted by a State maternal mortality re2 view committee; and 

3 (ii) address topics such as— 

4 (I) obstetric hemorrhage; 

5 (II) maternal mental health; 

6 (III) the maternal venous system; 

7 (IV) obstetric care for women 

8 with substance use disorders, includ9 ing opioid use disorder; 

10 (V) postpartum care basics for 

11 maternal safety; 

12 (VI) reduction of peripartum ra13 cial and ethnic disparities; 

14 (VII) reduction of primary cae15 sarean birth; 

16 (VIII) severe hypertension in 

17 pregnancy; 

18 (IX) severe maternal morbidity 

19 reviews; 

20 (X) support after a severe mater21 nal morbidity event; 

22 (XI) thromboembolism; 

23 (XII) optimization of support for 

24 breastfeeding; and 

25 (XIII) maternal oral health; and 


pamtmann on DSKBFK8HB2PROD with BILLS
19 

•S 916 IS

1 (C) to provide ongoing technical assistance 

2 at the national and State levels to support im3 plementation of maternal safety bundles under 

4 subparagraph (A). 

5 (4) MATERNAL SAFETY BUNDLE DEFINED.— 

6 For purposes of this subsection, the term ‘‘maternal 

7 safety bundle’’ means standardized, evidence-in8 formed processes for maternal health care. 

9 (5) AUTHORIZATION OF APPROPRIATIONS.—For 

10 purposes of carrying out this subsection, there is au11 thorized to be appropriated $10,000,000 for each of 

12 fiscal years 2019 through 2023. 

13 (d) FUNDING FOR STATE-BASED PERINATAL QUAL14 ITY COLLABORATIVES DEVELOPMENT AND SUSTAIN15 ABILITY.— 

16 (1) IN GENERAL.—Not later than one year 

17 after the date of enactment of this Act, the Sec18 retary of Health and Human Services (referred to in 

19 this subsection as the ‘‘Secretary’’), acting through 

20 the Division of Reproductive Health of the Centers 

21 for Disease Control and Prevention, shall establish a 

22 grant program to be known as the State-Based 

23 Perinatal Quality Collaborative grant program under 

24 which the Secretary awards grants to eligible entities 

25 for the purpose of development and sustainability of 


pamtmann on DSKBFK8HB2PROD with BILLS
20 

•S 916 IS

1 perinatal quality collaboratives in every State, the 

2 District of Columbia, and eligible territories, in 

3 order to measurably improve perinatal care and 

4 perinatal health outcomes for pregnant and 

5 postpartum women and their infants. 

6 (2) GRANT AMOUNTS.—Grants awarded under 

7 this subsection shall be in amounts not to exceed 

8 $250,000 per year, for the duration of the grant pe9 riod. 

10 (3) STATE-BASED PERINATAL QUALITY COL11 LABORATIVE DEFINED.—For purposes of this sub12 section, the term ‘‘State-based perinatal quality col13 laborative’’ means a network of multidisciplinary 

14 teams that— 

15 (A) work to improve measurable outcomes 

16 for maternal and infant health by advancing 

17 evidence-informed clinical practices using qual18 ity improvement principles; 

19 (B) work with hospital-based or outpatient 

20 facility-based clinical teams, experts, and stake21 holders, including patients and families, to 

22 spread best practices and optimize resources to 

23 improve perinatal care and outcomes; 

24 (C) employ strategies that include the use 

25 of the collaborative learning model to provide 


pamtmann on DSKBFK8HB2PROD with BILLS
21 

•S 916 IS

1 opportunities for hospitals and clinical teams to 

2 collaborate on improvement strategies, rapid-re3 sponse data to provide timely feedback to hos4 pital and other clinical teams to track progress, 

5 and quality improvement science to provide sup6 port and coaching to hospital and clinical 

7 teams; and 

8 (D) have the goal of improving population9 level outcomes in maternal and infant health. 

10 (4) AUTHORIZATION OF APPROPRIATIONS.—For 

11 purposes of carrying out this subsection, there is au12 thorized to be appropriated $14,000,000 per year 

13 for each of fiscal years 2020 through 2024. 

14 (e) EXPANSION OF MEDICAID AND CHIP COVERAGE

15 FOR PREGNANT AND POSTPARTUM WOMEN.— 

16 (1) REQUIRING COVERAGE OF ORAL HEALTH

17 SERVICES FOR PREGNANT AND POSTPARTUM

18 WOMEN.— 

19 (A) MEDICAID.—Section 1905 of the So20 cial Security Act (42 U.S.C. 1396d) is amend21 ed— 

22 (i) in subsection (a)(4)— 

23 (I) by striking ‘‘; and (D)’’ and 

24 inserting ‘‘; (D)’’; and 


pamtmann on DSKBFK8HB2PROD with BILLS
22 

•S 916 IS

1 (II) by inserting ‘‘; and (E) oral 

2 health services for pregnant and 

3 postpartum women (as defined in sub4 section (ee))’’ after ‘‘subsection 

5 (bb))’’; and 

6 (ii) by adding at the end the following 

7 new subsection: 

8 ‘‘(ee) ORAL HEALTH SERVICES FOR PREGNANT AND

9 POSTPARTUM WOMEN.— 

10 ‘‘(1) IN GENERAL.—For purposes of this title, 

11 the term ‘oral health services for pregnant and 

12 postpartum women’ means dental services necessary 

13 to prevent disease and promote oral health, restore 

14 oral structures to health and function, and treat 

15 emergency conditions that are furnished to a woman 

16 during pregnancy (or during the 1-year period be17 ginning on the last day of the pregnancy). 

18 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 

19 the requirement to provide oral health services for 

20 pregnant and postpartum women, a State shall, at 

21 a minimum, provide coverage for preventive, diag22 nostic, periodontal, and restorative care consistent 

23 with recommendations for perinatal oral health care 

24 and dental care during pregnancy from the AmerVerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S916.IS S916

pamtmann on DSKBFK8HB2PROD with BILLS
23 

•S 916 IS

1 ican Academy of Pediatric Dentistry and the Amer2 ican College of Obstetricians and Gynecologists.’’. 

3 (B) CHIP.—Section 2103(c)(5)(A) of the 

4 Social Security Act (42 U.S.C. 

5 1397cc(c)(5)(A)) is amended by inserting ‘‘or a 

6 targeted low-income pregnant woman’’ after 

7 ‘‘targeted low-income child’’. 

8 (2) EXTENDING MEDICAID COVERAGE FOR

9 PREGNANT AND POSTPARTUM WOMEN.—Section 

10 1902 of the Social Security Act (42 U.S.C. 1396a) 

11 is amended— 

12 (A) in subsection (e)— 

13 (i) in paragraph (5)— 

14 (I) by inserting ‘‘(including oral 

15 health services for pregnant and 

16 postpartum women (as defined in sec17 tion 1905(ee))’’ after ‘‘postpartum 

18 medical assistance under the plan’’; 

19 and 

20 (II) by striking ‘‘60-day’’ and in21 serting ‘‘1-year’’; and 

22 (ii) in paragraph (6), by striking ‘‘60- 

23 day’’ and inserting ‘‘1-year’’; and 

24 (B) in subsection (l)(1)(A), by striking 

25 ‘‘60-day’’ and inserting ‘‘1-year’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
24 

•S 916 IS

1 (3) EXTENDING MEDICAID COVERAGE FOR

2 LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of the 

3 Social Security Act (42 U.S.C. 1396b(v)(4)(A)) is 

4 amended by striking ‘‘60-day’’ and inserting ‘‘1- 

5 year’’. 

6 (4) EXTENDING CHIP COVERAGE FOR PREG7 NANT AND POSTPARTUM WOMEN.—Section 

8 2112(d)(2)(A) of the Social Security Act (42 U.S.C. 

9 1397ll(d)(2)(A)) is amended by striking ‘‘60-day’’ 

10 and inserting ‘‘1-year’’. 

11 (5) MAINTENANCE OF EFFORT.— 

12 (A) MEDICAID.—Section 1902(l) of the So13 cial Security Act (42 U.S.C. 1396a(l)) is 

14 amended by adding at the end the following 

15 new paragraph: 

16 ‘‘(5) During the period that begins on the date of 

17 enactment of this paragraph and ends on the date that 

18 is five years after such date of enactment, as a condition 

19 for receiving any Federal payments under section 1903(a) 

20 for calendar quarters occurring during such period, a 

21 State shall not have in effect, with respect to women who 

22 are eligible for medical assistance under the State plan 

23 or under a waiver of such plan on the basis of being preg24 nant or having been pregnant, eligibility standards, meth25 odologies, or procedures under the State plan or waiver 


pamtmann on DSKBFK8HB2PROD with BILLS
25 

•S 916 IS

1 that are more restrictive than the eligibility standards, 

2 methodologies, or procedures, respectively, under such 

3 plan or waiver that are in effect on the date of enactment 

4 of this paragraph.’’. 

5 (B) CHIP.—Section 2105(d) of the Social 

6 Security Act (42 U.S.C. 1397ee(d)) is amended 

7 by adding at the end the following new para8 graph: 

9 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR10 GETED LOW-INCOME PREGNANT WOMEN.—During 

11 the period that begins on the date of enactment of 

12 this paragraph and ends on the date that is five 

13 years after such date of enactment, as a condition 

14 of receiving payments under subsection (a) and sec15 tion 1903(a), a State that elects to provide assist16 ance to women on the basis of being pregnant (in17 cluding pregnancy-related assistance provided to tar18 geted low-income pregnant women (as defined in 

19 section 2112(d)), pregnancy-related assistance pro20 vided to women who are eligible for such assistance 

21 through application of section 1902(v)(4)(A)(i) 

22 under section 2107(e)(1), or any other assistance 

23 under the State child health plan (or a waiver of 

24 such plan) which is provided to women on the basis 

25 of being pregnant) shall not have in effect, with reVerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S916.IS S916

pamtmann on DSKBFK8HB2PROD with BILLS
26 

•S 916 IS

1 spect to such women, eligibility standards, meth2 odologies, or procedures under such plan (or waiver) 

3 that are more restrictive than the eligibility stand4 ards, methodologies, or procedures, respectively, 

5 under such plan (or waiver) that are in effect on the 

6 date of enactment of this paragraph.’’. 

7 (6) INFORMATION ON BENEFITS.—The Sec8 retary of Health and Human Services shall make 

9 publicly available on the Internet website of the De10 partment of Health and Human Services, informa11 tion regarding benefits available to pregnant and 

12 postpartum women and under the Medicaid program 

13 and the Children’s Health Insurance Program, in14 cluding information on— 

15 (A) benefits that States are required to 

16 provide to pregnant and postpartum women 

17 under such programs; 

18 (B) optional benefits that States may pro19 vide to pregnant and postpartum women under 

20 such programs; and 

21 (C) the availability of different kinds of 

22 benefits for pregnant and postpartum women, 

23 including oral health and mental health bene24 fits, under such programs. 


pamtmann on DSKBFK8HB2PROD with BILLS
27 

•S 916 IS

1 (7) FEDERAL FUNDING FOR COST OF EX2 TENDED MEDICAID AND CHIP COVERAGE FOR

3 POSTPARTUM WOMEN.— 

4 (A) MEDICAID.—Section 1905 of the So5 cial Security Act (42 U.S.C. 1396d), as amend6 ed by paragraph (1), is further amended— 

7 (i) in subsection (b), by striking ‘‘and 

8 (aa)’’ and inserting ‘‘(aa), and (ff)’’; and 

9 (ii) by adding at the end the fol10 lowing: 

11 ‘‘(ff) INCREASED FMAP FOR EXTENDED MEDICAL

12 ASSISTANCE FOR POSTPARTUM WOMEN.—Notwith13 standing subsection (b), the Federal medical assistance 

14 percentage for a State, with respect to amounts expended 

15 by such State for medical assistance for a woman who is 

16 eligible for such assistance on the basis of being pregnant 

17 or having been pregnant that is provided during the 305- 

18 day period that begins on the 60th day after the last day 

19 of her pregnancy (including any such assistance provided 

20 during the month in which such period ends), shall be 

21 equal to— 

22 ‘‘(1) 100 percent for the first 20 calendar quar23 ters during which this subsection is in effect; and 

24 ‘‘(2) 90 percent for calendar quarters there25 after.’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
28 

•S 916 IS

1 (B) CHIP.—Section 2105(c) of the Social 

2 Security Act (42 U.S.C. 1397ee(c)) is amended 

3 by adding at the end the following new para4 graph: 

5 ‘‘(12) ENHANCED PAYMENT FOR EXTENDED

6 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 

7 Notwithstanding subsection (b), the enhanced 

8 FMAP, with respect to payments under subsection 

9 (a) for expenditures under the State child health 

10 plan (or a waiver of such plan) for assistance pro11 vided under the plan (or waiver) to a woman who is 

12 eligible for such assistance on the basis of being 

13 pregnant (including pregnancy-related assistance 

14 provided to a targeted low-income pregnant woman 

15 (as defined in section 2112(d)), pregnancy-related 

16 assistance provided to a woman who is eligible for 

17 such assistance through application of section 

18 1902(v)(4)(A)(i) under section 2107(e)(1), or any 

19 other assistance under the plan (or waiver) provided 

20 to a woman who is eligible for such assistance on the 

21 basis of being pregnant) during the 305-day period 

22 that begins on the 60th day after the last day of her 

23 pregnancy (including any such assistance provided 

24 during the month in which such period ends), shall 

25 be equal to— 


pamtmann on DSKBFK8HB2PROD with BILLS
29 

•S 916 IS

1 ‘‘(A) 100 percent for the first 20 calendar 

2 quarters during which this paragraph is in ef3 fect; and 

4 ‘‘(B) 90 percent for calendar quarters 

5 thereafter.’’. 

6 (8) EFFECTIVE DATE.— 

7 (A) IN GENERAL.—Subject to subpara8 graph (B), the amendments made by this sub9 section shall take effect on the first day of the 

10 first calendar quarter that begins on or after 

11 the date that is one year after the date of en12 actment of this Act. 

13 (B) EXCEPTION FOR STATE LEGISLA14 TION.—In the case of a State plan under title 

15 XIX of the Social Security Act or a State child 

16 health plan under title XXI of such Act that 

17 the Secretary of Health and Human Services 

18 determines requires State legislation in order 

19 for the respective plan to meet any requirement 

20 imposed by amendments made by this sub21 section, the respective plan shall not be re22 garded as failing to comply with the require23 ments of such title solely on the basis of its fail24 ure to meet such an additional requirement be25 fore the first day of the first calendar quarter 


pamtmann on DSKBFK8HB2PROD with BILLS
30 

•S 916 IS

1 beginning after the close of the first regular 

2 session of the State legislature that begins after 

3 the date of enactment of this Act. For purposes 

4 of the previous sentence, in the case of a State 

5 that has a 2-year legislative session, each year 

6 of the session shall be considered to be a sepa7 rate regular session of the State legislature. 

8 (f) REGIONAL CENTERS OF EXCELLENCE.—Part P 

9 of title III of the Public Health Service Act is amended 

10 by adding at the end the following new section: 

11 ‘‘SEC. 399V–7. REGIONAL CENTERS OF EXCELLENCE AD12 DRESSING IMPLICIT BIAS AND CULTURAL 

13 COMPETENCY IN PATIENT-PROVIDER INTER14 ACTIONS EDUCATION. 

15 ‘‘(a) IN GENERAL.—Not later than one year after the 

16 date of enactment of this section, the Secretary, in con17 sultation with such other agency heads as the Secretary 

18 determines appropriate, shall award cooperative agree19 ments for the establishment or support of regional centers 

20 of excellence addressing implicit bias and cultural com21 petency in patient-provider interactions education for the 

22 purpose of enhancing and improving how health care pro23 fessionals are educated in implicit bias and delivering cul24 turally competent health care. 


pamtmann on DSKBFK8HB2PROD with BILLS
31 

•S 916 IS

1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper2 ative agreement under subsection (a), an entity shall— 

3 ‘‘(1) be a public or other nonprofit entity speci4 fied by the Secretary that provides educational and 

5 training opportunities for students and health care 

6 professionals, which may be a health system, teach7 ing hospital, community health center, medical 

8 school, school of public health, dental school, social 

9 work school, school of professional psychology, or 

10 any other health professional school or program at 

11 an institution of higher education (as defined in sec12 tion 101 of the Higher Education Act of 1965) fo13 cused on the prevention, treatment, or recovery of 

14 health conditions that contribute to maternal mor15 tality and the prevention of maternal mortality and 

16 severe maternal morbidity; 

17 ‘‘(2) demonstrate community engagement and 

18 participation, such as through partnerships with 

19 home visiting and case management programs; and 

20 ‘‘(3) provide to the Secretary such information, 

21 at such time and in such manner, as the Secretary 

22 may require. 

23 ‘‘(c) DIVERSITY.—In awarding a cooperative agree24 ment under subsection (a), the Secretary shall take into 

25 account any regional differences among eligible entities 


pamtmann on DSKBFK8HB2PROD with BILLS
32 

•S 916 IS

1 and make an effort to ensure geographic diversity among 

2 award recipients. 

3 ‘‘(d) DISSEMINATION OF INFORMATION.— 

4 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 

5 shall make publicly available on the internet website 

6 of the Department of Health and Human Services 

7 information submitted to the Secretary under sub8 section (b)(3). 

9 ‘‘(2) EVALUATION.—The Secretary shall evalu10 ate each regional center of excellence established or 

11 supported pursuant to subsection (a) and dissemi12 nate the findings resulting from each such evalua13 tion to the appropriate public and private entities. 

14 ‘‘(3) DISTRIBUTION.—The Secretary shall share 

15 evaluations and overall findings with State depart16 ments of health and other relevant State level offices 

17 to inform State and local best practices. 

18 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec19 tion, the term ‘maternal mortality’ means death of a 

20 woman that occurs during pregnancy or within the one21 year period following the end of such pregnancy. 

22 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 

23 purposes of carrying out this section, there is authorized 

24 to be appropriated $5,000,000 for each of fiscal years 

25 2019 through 2023.’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
33 

•S 916 IS

1 (g) SPECIAL SUPPLEMENTAL NUTRITION PROGRAM

2 FOR WOMEN, INFANTS, AND CHILDREN.—Section 

3 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (42 

4 U.S.C. 1786(d)(3)(A)(ii)) is amended— 

5 (1) by striking the clause designation and head6 ing and all that follows through ‘‘A State’’ and in7 serting the following: 

8 ‘‘(ii) WOMEN.— 

9 ‘‘(I) BREASTFEEDING WOMEN.— 

10 A State’’; 

11 (2) in subclause (I) (as so designated), by strik12 ing ‘‘1 year’’ and all that follows through ‘‘earlier’’ 

13 and inserting ‘‘2 years postpartum’’; and 

14 (3) by adding at the end the following: 

15 ‘‘(II) POSTPARTUM WOMEN.—A 

16 State may elect to certify a 

17 postpartum woman for a period of 2 

18 years.’’. 

19 (h) DEFINITIONS.—In this section: 

20 (1) MATERNAL MORTALITY.—The term ‘‘mater21 nal mortality’’ means death of a woman that occurs 

22 during pregnancy or within the one-year period fol23 lowing the end of such pregnancy. 

24 (2) SEVERE MATERNAL MORBIDITY.—The term 

25 ‘‘severe maternal morbidity’’ includes unexpected 


pamtmann on DSKBFK8HB2PROD with BILLS
34 

•S 916 IS

1 outcomes of labor and delivery that result in signifi2 cant short-term or long-term consequences to a 

3 woman’s health. 

4 SEC. 4. INCREASING EXCISE TAXES ON CIGARETTES AND 

5 ESTABLISHING EXCISE TAX EQUITY AMONG 

6 ALL TOBACCO PRODUCT TAX RATES. 

7 (a) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO.— 

8 Section 5701(g) of the Internal Revenue Code of 1986 is 

9 amended by striking ‘‘$24.78’’ and inserting ‘‘$49.56’’. 

10 (b) TAX PARITY FOR PIPE TOBACCO.—Section 

11 5701(f) of the Internal Revenue Code of 1986 is amended 

12 by striking ‘‘$2.8311 cents’’ and inserting ‘‘$49.56’’. 

13 (c) TAX PARITY FOR SMOKELESS TOBACCO.— 

14 (1) Section 5701(e) of the Internal Revenue 

15 Code of 1986 is amended— 

16 (A) in paragraph (1), by striking ‘‘$1.51’’ 

17 and inserting ‘‘$26.84’’; 

18 (B) in paragraph (2), by striking ‘‘50.33 

19 cents’’ and inserting ‘‘$10.74’’; and 

20 (C) by adding at the end the following: 

21 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE

22 SINGLE-USE UNITS.—On discrete single-use units, 

23 $100.66 per thousand.’’. 

24 (2) Section 5702(m) of such Code is amend25 ed— 


pamtmann on DSKBFK8HB2PROD with BILLS
35 

•S 916 IS

1 (A) in paragraph (1), by striking ‘‘or chew2 ing tobacco’’ and inserting ‘‘, chewing tobacco, 

3 or discrete single-use unit’’; 

4 (B) in paragraphs (2) and (3), by inserting 

5 ‘‘that is not a discrete single-use unit’’ before 

6 the period in each such paragraph; and 

7 (C) by adding at the end the following: 

8 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 

9 ‘discrete single-use unit’ means any product con10 taining tobacco that— 

11 ‘‘(A) is not intended to be smoked; and 

12 ‘‘(B) is in the form of a lozenge, tablet, 

13 pill, pouch, dissolvable strip, or other discrete 

14 single-use or single-dose unit.’’. 

15 (d) TAX PARITY FOR SMALL CIGARS.—Paragraph 

16 (1) of section 5701(a) of the Internal Revenue Code of 

17 1986 is amended by striking ‘‘$50.33’’ and inserting 

18 ‘‘$100.66’’. 

19 (e) TAX PARITY FOR LARGE CIGARS.— 

20 (1) IN GENERAL.—Paragraph (2) of section 

21 5701(a) of the Internal Revenue Code of 1986 is 

22 amended by striking ‘‘52.75 percent’’ and all that 

23 follows through the period and inserting the fol24 lowing: ‘‘$49.56 per pound and a proportionate tax 


pamtmann on DSKBFK8HB2PROD with BILLS
36 

•S 916 IS

1 at the like rate on all fractional parts of a pound but 

2 not less than 10.066 cents per cigar.’’. 

3 (2) GUIDANCE.—The Secretary of the Treas4 ury, or the Secretary’s delegate, may issue guidance 

5 regarding the appropriate method for determining 

6 the weight of large cigars for purposes of calculating 

7 the applicable tax under section 5701(a)(2) of the 

8 Internal Revenue Code of 1986. 

9 (f) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO

10 AND CERTAIN PROCESSED TOBACCO.—Subsection (o) of 

11 section 5702 of the Internal Revenue Code of 1986 is 

12 amended by inserting ‘‘, and includes processed tobacco 

13 that is removed for delivery or delivered to a person other 

14 than a person with a permit provided under section 5713, 

15 but does not include removals of processed tobacco for ex16 portation’’ after ‘‘wrappers thereof’’. 

17 (g) CLARIFYING TAX RATE FOR OTHER TOBACCO

18 PRODUCTS.— 

19 (1) IN GENERAL.—Section 5701 of the Internal 

20 Revenue Code of 1986 is amended by adding at the 

21 end the following new subsection: 

22 ‘‘(i) OTHER TOBACCO PRODUCTS.—Any product not 

23 otherwise described under this section that has been deter24 mined to be a tobacco product by the Food and Drug Ad25 ministration through its authorities under the Family 


pamtmann on DSKBFK8HB2PROD with BILLS
37 

•S 916 IS

1 Smoking Prevention and Tobacco Control Act shall be 

2 taxed at a level of tax equivalent to the tax rate for ciga3 rettes on an estimated per use basis as determined by the 

4 Secretary.’’. 

5 (2) ESTABLISHING PER USE BASIS.—For pur6 poses of section 5701(i) of the Internal Revenue 

7 Code of 1986, not later than 12 months after the 

8 later of the date of the enactment of this Act or the 

9 date that a product has been determined to be a to10 bacco product by the Food and Drug Administra11 tion, the Secretary of the Treasury (or the Secretary 

12 of the Treasury’s delegate) shall issue final regula13 tions establishing the level of tax for such product 

14 that is equivalent to the tax rate for cigarettes on 

15 an estimated per use basis. 

16 (h) CLARIFYING DEFINITION OF TOBACCO PROD17 UCTS.— 

18 (1) IN GENERAL.—Subsection (c) of section 

19 5702 of the Internal Revenue Code of 1986 is 

20 amended to read as follows: 

21 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod22 ucts’ means— 

23 ‘‘(1) cigars, cigarettes, smokeless tobacco, pipe 

24 tobacco, and roll-your-own tobacco, and 


pamtmann on DSKBFK8HB2PROD with BILLS
38 

•S 916 IS

1 ‘‘(2) any other product subject to tax pursuant 

2 to section 5701(i).’’. 

3 (2) CONFORMING AMENDMENTS.—Subsection 

4 (d) of section 5702 of such Code is amended by 

5 striking ‘‘cigars, cigarettes, smokeless tobacco, pipe 

6 tobacco, or roll-your-own tobacco’’ each place it ap7 pears and inserting ‘‘tobacco products’’. 

8 (i) INCREASING TAX ON CIGARETTES.— 

9 (1) SMALL CIGARETTES.—Section 5701(b)(1) 

10 of such Code is amended by striking ‘‘$50.33’’ and 

11 inserting ‘‘$100.66’’. 

12 (2) LARGE CIGARETTES.—Section 5701(b)(2) 

13 of such Code is amended by striking ‘‘$105.69’’ and 

14 inserting ‘‘$211.38’’. 

15 (j) TAX RATES ADJUSTED FOR INFLATION.—Section 

16 5701 of such Code, as amended by subsection (g), is 

17 amended by adding at the end the following new sub18 section: 

19 ‘‘(j) INFLATION ADJUSTMENT.— 

20 ‘‘(1) IN GENERAL.—In the case of any calendar 

21 year beginning after 2018, the dollar amounts pro22 vided under this chapter shall each be increased by 

23 an amount equal to— 

24 ‘‘(A) such dollar amount, multiplied by 


pamtmann on DSKBFK8HB2PROD with BILLS
39 

•S 916 IS

1 ‘‘(B) the cost-of-living adjustment deter2 mined under section 1(f)(3) for the calendar 

3 year, determined by substituting ‘calendar year 

4 2017’ for ‘calendar year 2016’ in subparagraph 

5 (A)(ii) thereof. 

6 ‘‘(2) ROUNDING.—If any amount as adjusted 

7 under paragraph (1) is not a multiple of $0.01, such 

8 amount shall be rounded to the next highest multiple 

9 of $0.01.’’. 

10 (k) FLOOR STOCKS TAXES.— 

11 (1) IMPOSITION OF TAX.—On tobacco products 

12 manufactured in or imported into the United States 

13 which are removed before any tax increase date and 

14 held on such date for sale by any person, there is 

15 hereby imposed a tax in an amount equal to the ex16 cess of— 

17 (A) the tax which would be imposed under 

18 section 5701 of the Internal Revenue Code of 

19 1986 on the article if the article had been re20 moved on such date, over 

21 (B) the prior tax (if any) imposed under 

22 section 5701 of such Code on such article. 

23 (2) CREDIT AGAINST TAX.—Each person shall 

24 be allowed as a credit against the taxes imposed by 

25 paragraph (1) an amount equal to $500. Such credit 


pamtmann on DSKBFK8HB2PROD with BILLS
40 

•S 916 IS

1 shall not exceed the amount of taxes imposed by 

2 paragraph (1) on such date for which such person 

3 is liable. 

4 (3) LIABILITY FOR TAX AND METHOD OF PAY5 MENT.— 

6 (A) LIABILITY FOR TAX.—A person hold7 ing tobacco products on any tax increase date 

8 to which any tax imposed by paragraph (1) ap9 plies shall be liable for such tax. 

10 (B) METHOD OF PAYMENT.—The tax im11 posed by paragraph (1) shall be paid in such 

12 manner as the Secretary shall prescribe by reg13 ulations. 

14 (C) TIME FOR PAYMENT.—The tax im15 posed by paragraph (1) shall be paid on or be16 fore the date that is 120 days after the effective 

17 date of the tax rate increase. 

18 (4) ARTICLES IN FOREIGN TRADE ZONES.— 

19 Notwithstanding the Act of June 18, 1934 (com20 monly known as the Foreign Trade Zone Act, 48 

21 Stat. 998, 19 U.S.C. 81a et seq.), or any other pro22 vision of law, any article which is located in a for23 eign trade zone on any tax increase date shall be 

24 subject to the tax imposed by paragraph (1) if— 


pamtmann on DSKBFK8HB2PROD with BILLS
41 

•S 916 IS

1 (A) internal revenue taxes have been deter2 mined, or customs duties liquidated, with re3 spect to such article before such date pursuant 

4 to a request made under the 1st proviso of sec5 tion 3(a) of such Act; or 

6 (B) such article is held on such date under 

7 the supervision of an officer of the United 

8 States Customs and Border Protection of the 

9 Department of Homeland Security pursuant to 

10 the 2d proviso of such section 3(a). 

11 (5) DEFINITIONS.—For purposes of this sub12 section— 

13 (A) IN GENERAL.—Any term used in this 

14 subsection which is also used in section 5702 of 

15 such Code shall have the same meaning as such 

16 term has in such section. 

17 (B) TAX INCREASE DATE.—The term ‘‘tax 

18 increase date’’ means the effective date of any 

19 increase in any tobacco product excise tax rate 

20 pursuant to the amendments made by this sec21 tion (other than subsection (j) thereof). 

22 (C) SECRETARY.—The term ‘‘Secretary’’ 

23 means the Secretary of the Treasury or the 

24 Secretary’s delegate. 


pamtmann on DSKBFK8HB2PROD with BILLS
42 

•S 916 IS

1 (6) CONTROLLED GROUPS.—Rules similar to 

2 the rules of section 5061(e)(3) of such Code shall 

3 apply for purposes of this subsection. 

4 (7) OTHER LAWS APPLICABLE.—All provisions 

5 of law, including penalties, applicable with respect to 

6 the taxes imposed by section 5701 of such Code 

7 shall, insofar as applicable and not inconsistent with 

8 the provisions of this subsection, apply to the floor 

9 stocks taxes imposed by paragraph (1), to the same 

10 extent as if such taxes were imposed by such section 

11 5701. The Secretary may treat any person who bore 

12 the ultimate burden of the tax imposed by para13 graph (1) as the person to whom a credit or refund 

14 under such provisions may be allowed or made. 

15 (l) EFFECTIVE DATES.— 

16 (1) IN GENERAL.—Except as provided in para17 graphs (2) through (4), the amendments made by 

18 this section shall apply to articles removed (as de19 fined in section 5702(j) of the Internal Revenue 

20 Code of 1986) after the last day of the month which 

21 includes the date of the enactment of this Act. 

22 (2) DISCRETE SINGLE-USE UNITS AND PROC23 ESSED TOBACCO.—The amendments made by sub24 sections (c)(1)(C), (c)(2), and (f) shall apply to arti25 cles removed (as defined in section 5702(j) of the 


pamtmann on DSKBFK8HB2PROD with BILLS
43 

•S 916 IS

1 Internal Revenue Code of 1986) after the date that 

2 is 6 months after the date of the enactment of this 

3 Act. 

4 (3) LARGE CIGARS.—The amendments made by 

5 subsection (e) shall apply to articles removed after 

6 December 31, 2019. 

7 (4) OTHER TOBACCO PRODUCTS.—The amend8 ments made by subsection (g)(1) shall apply to prod9 ucts removed after the last day of the month which 

10 includes the date that the Secretary of the Treasury 

11 (or the Secretary of the Treasury’s delegate) issues 

12 final regulations establishing the level of tax for 

13 such product. 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS