II 

118TH CONGRESS 

1ST SESSION S. 2846 

To improve Federal efforts with respect to the prevention of maternal 

mortality, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 19, 2023 

Mr. DURBIN (for himself and Mr. VAN HOLLEN) 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 ‘‘Community Access, 

5 Resources, and Empowerment for Moms Act’’ or the 

6 ‘‘CARE for Moms Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 

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

10 4,000,000 women give birth, more than 1,000 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
2 

•S 2846 IS

1 women suffer fatal complications during pregnancy, 

2 while giving birth or during the postpartum period, 

3 and about 70,000 women suffer near-fatal, partum4 related complications. 

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

6 a proxy to measure the overall health of a popu7 lation. While the infant mortality rate in the United 

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

9 for women in the United States during pregnancy, 

10 childbirth, or the postpartum period is higher than 

11 such risk in many other high-income countries. The 

12 estimated maternal mortality rate (deaths per 

13 100,000 live births) for the 48 contiguous States 

14 and Washington, DC, increased from 14.5 percent in 

15 2000 to 32.0 in 2021. The United States is the only 

16 industrialized nation with a rising maternal mor17 tality rate. 

18 (3) The National Vital Statistics System of the 

19 Centers for Disease Control and Prevention has 

20 found that in 2021, there were 32.9 maternal deaths 

21 for every 100,000 live births in the United States. 

22 That ratio continues to exceed the rate in other 

23 high-income countries. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
3 

•S 2846 IS

1 (4) It is estimated that more than 80 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 about 26.6 deaths per 100,000 live births 

8 for White women, 69.9 deaths per 100,000 live 

9 births for non-Hispanic Black women, and 32.0 

10 deaths per 100,000 live births for American Indian/ 

11 Alaska Native women. While maternal mortality dis12 parately impacts Black women, this urgent public 

13 health crisis traverses race, ethnicity, socioeconomic 

14 status, educational background, and geography. 

15 (6) In the United States, non-Hispanic Black 

16 women are about 3 times more likely to die from 

17 causes related to pregnancy and childbirth compared 

18 to non-Hispanic White women, which is one of the 

19 most disconcerting racial disparities in public health. 

20 This disparity widens in certain cities and States 

21 across the country. 

22 (7) According to the National Center for Health 

23 Statistics of the Centers for Disease Control and 

24 Prevention, the maternal mortality rate heightens 

25 with age, as women 40 and older die at a rate of 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
4 

•S 2846 IS

1 138.5 per 100,000 births compared to 20.4 per 

2 100,000 for women under 25. This translates to 

3 women over 40 being 6.8 times more likely to die 

4 compared to their counterparts under 25 years of 

5 age. 

6 (8) The COVID–19 pandemic has exacerbated 

7 the maternal health crisis. A study of the Centers 

8 for Disease Control and Prevention suggested that 

9 pregnant women are at a significantly higher risk 

10 for severe outcomes, including death, from COVID– 

11 19 as compared to non-pregnant women. The 

12 COVID–19 pandemic also decreased access to pre13 natal and postpartum care. A study by the Govern14 ment Accountability Office found that COVID–19 

15 contributed to 25 percent of maternal deaths in 

16 2020 and 2021. 

17 (9) The findings described in paragraphs (1) 

18 through (8) are of major concern to researchers, 

19 academics, members of the business community, and 

20 providers across the obstetric continuum represented 

21 by organizations such as— 

22 (A) the American College of Nurse-Mid23 wives; 

24 (B) the American College of Obstetricians 

25 and Gynecologists; 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
5 

•S 2846 IS

1 (C) the American Medical Association; 

2 (D) the Association of Women’s Health, 

3 Obstetric and Neonatal Nurses; 

4 (E) the Black Mamas Matter Alliance; 

5 (F) the Black Women’s Health Imperative; 

6 (G) the California Maternal Quality Care 

7 Collaborative; 

8 (H) EverThrive Illinois; 

9 (I) the Illinois Perinatal Quality Collabo10 rative; 

11 (J) the March of Dimes; 

12 (K) the National Association of Certified 

13 Professional Midwives; 

14 (L) RH Impact: The Collaborative for Eq15 uity & Justice; 

16 (M) the National Partnership for Women 

17 & Families; 

18 (N) the National Polycystic Ovary Syn19 drome Association; 

20 (O) the Preeclampsia Foundation; 

21 (P) the Society for Maternal-Fetal Medi22 cine; 

23 (Q) the What To Expect Project; 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
6 

•S 2846 IS

1 (R) Tufts University School of Medicine 

2 Center for Black Maternal Health and Repro3 ductive Justice; 

4 (S) the Shades of Blue Project; 

5 (T) the Maternal Mental Health Leader6 ship Alliance; 

7 (U) Tulane University Mary Amelia Center 

8 for Women’s Health Equity Research; 

9 (V) In Our Own Voice: National Black 

10 Women’s Reproductive Justice Agenda; and 

11 (W) Physicians for Reproductive Health. 

12 (10) Hemorrhage, cardiovascular and coronary 

13 conditions, cardiomyopathy, infection or sepsis, em14 bolism, mental health conditions (including sub15 stance use disorder), hypertensive disorders, stroke 

16 and cerebrovascular accidents, and anesthesia com17 plications are the predominant medical causes of 

18 maternal-related deaths and complications. Most of 

19 these conditions are largely preventable or manage20 able. Even when these conditions are not prevent21 able, mortality and morbidity may be prevented 

22 when conditions are diagnosed and treated in a 

23 timely manner. 

24 (11) According to a study published by the 

25 Journal of Perinatal Education, doula-assisted 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
7 

•S 2846 IS

1 mothers are 4 times less likely to have a low-birth2 weight baby, 2 times less likely to experience a birth 

3 complication involving themselves or their baby, and 

4 significantly more likely to initiate breastfeeding and 

5 human lactation. Doula care has also been shown to 

6 produce cost savings resulting in part from reduced 

7 rates of cesarean and pre-term births. 

8 (12) Intimate partner violence is one of the 

9 leading causes of maternal death, and women are 

10 more likely to experience intimate partner violence 

11 during pregnancy than at any other time in their 

12 lives. It is also more dangerous than pregnancy. In13 timate partner violence during pregnancy and 

14 postpartum crosses every demographic and has been 

15 exacerbated by the COVID–19 pandemic. 

16 (13) Oral health is an important part of 

17 perinatal health. Reducing bacteria in a woman’s 

18 mouth during pregnancy can significantly reduce her 

19 risk of developing oral diseases and spreading decay20 causing bacteria to her baby. Moreover, some evi21 dence suggests that women with periodontal disease 

22 during pregnancy could be at greater risk for poor 

23 birth outcomes, such as preeclampsia, pre-term 

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

25 oral health during pregnancy is a good predictor of 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
8 

•S 2846 IS

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

2 unintentionally spread oral bacteria to their babies, 

3 putting their children at higher risk for tooth decay, 

4 prevention efforts should happen even before chil5 dren are born, as a matter of pre-pregnancy health 

6 and prenatal care during pregnancy. 

7 (14) In the United States, death reporting and 

8 analysis is a State function rather than a Federal 

9 process. States report all deaths—including mater10 nal deaths—on a semi-voluntary basis, without 

11 standardization across States. While the Centers for 

12 Disease Control and Prevention has the capacity and 

13 system for collecting death-related data based on 

14 death certificates, these data are not sufficiently re15 ported by States in an organized and standard for16 mat across States such that the Centers for Disease 

17 Control and Prevention is able to identify causes of 

18 maternal death and best practices for the prevention 

19 of such death. 

20 (15) Vital statistics systems often underesti21 mate maternal mortality and are insufficient data 

22 sources from which to derive a full scope of medical 

23 and social determinant factors contributing to ma24 ternal deaths, such as intimate partner violence. 

25 While the addition of pregnancy checkboxes on death 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
9 

•S 2846 IS

1 certificates since 2003 have likely improved States’ 

2 abilities to identify pregnancy-related deaths, they 

3 are not generally completed by obstetric providers or 

4 persons trained to recognize pregnancy-related mor5 tality. Thus, these vital forms may be missing infor6 mation or may capture inconsistent data. Due to 

7 varying maternal mortality-related analyses, lack of 

8 reliability, and granularity in data, current maternal 

9 mortality informatics do not fully encapsulate the 

10 myriad medical and socially determinant factors that 

11 contribute to such high maternal mortality rates 

12 within the United States compared to other devel13 oped nations. Lack of standardization of data and 

14 data sharing across States and between Federal en15 tities, health networks, and research institutions 

16 keep the Nation in the dark about ways to prevent 

17 maternal deaths. 

18 (16) Having reliable and valid State data ag19 gregated at the Federal level are critical to the Na20 tion’s ability to quell surges in maternal death and 

21 imperative for researchers to identify long-lasting 

22 interventions. 

23 (17) Leaders in maternal wellness highly rec24 ommend that maternal deaths and cases of maternal 

25 morbidity, including complications that result in 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
10 

•S 2846 IS

1 chronic illness and future increased risk of death, be 

2 investigated at the State level first, and that stand3 ardized, streamlined, de-identified data regarding 

4 maternal deaths be sent annually to the Centers for 

5 Disease Control and Prevention. Such data stand6 ardization and collection would be similar in oper7 ation and effect to the National Program of Cancer 

8 Registries of the Centers for Disease Control and 

9 Prevention and akin to the Confidential Enquiry in 

10 Maternal Deaths Programme in the United King11 dom. Such a maternal mortalities and morbidities 

12 registry and surveillance system would help pro13 viders, academicians, lawmakers, and the public to 

14 address questions concerning the types of, causes of, 

15 and best practices to thwart, maternal mortality and 

16 morbidity. 

17 (18) The United Nations’ Millennium Develop18 ment Goal 5a aimed to reduce by 75 percent, be19 tween 1990 and 2015, the maternal mortality rate, 

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

21 maternal mortality rate in the United States has 

22 been estimated to have more than doubled between 

23 2000 and 2014. 

24 (19) The United States has no comparable, co25 ordinated Federal process by which to review cases 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
11 

•S 2846 IS

1 of maternal mortality, systems failures, or best prac2 tices. The majority of States have active Maternal 

3 Mortality Review Committees (referred to in this 

4 section as ‘‘MMRC’’), which help leverage work to 

5 impact maternal wellness. For example, the State of 

6 California has worked extensively with their State 

7 health departments, health and hospital systems, 

8 and research collaborative organizations, including 

9 the California Maternal Quality Care Collaborative 

10 and the Alliance for Innovation on Maternal Health, 

11 to establish MMRCs, wherein such State has deter12 mined the most prevalent causes of maternal mor13 tality and recorded and shared data with providers 

14 and researchers, who have developed and imple15 mented safety bundles and care protocols related to 

16 preeclampsia, maternal hemorrhage, peripartum car17 diomyopathy, and the like. In this way, the State of 

18 California has been able to leverage its maternal 

19 mortality review board system, generate data, and 

20 apply those data to effect changes in maternal care21 related protocol. 

22 (20) Hospitals and health systems across the 

23 United States lack standardization of emergency ob24 stetric protocols before, during, and after delivery. 

25 Consequently, many providers are delayed in recogVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
12 

•S 2846 IS

1 nizing critical signs indicating maternal distress that 

2 quickly escalate into fatal or near-fatal incidences. 

3 Moreover, any attempt to address an obstetric emer4 gency that does not consider both clinical and public 

5 health approaches falls woefully under the mark of 

6 excellent care delivery. State-based perinatal quality 

7 collaboratives, or entities participating in the Alli8 ance for Innovation on Maternal Health (AIM), have 

9 formed obstetric protocols, tool kits, and other re10 sources to improve system care and response as they 

11 relate to maternal complications and warning signs 

12 for such conditions as maternal hemorrhage, hyper13 tension, and preeclampsia. These perinatal quality 

14 collaboratives serve an important role in providing 

15 infrastructure that supports quality improvement ef16 forts addressing obstetric care and outcomes. State17 based perinatal quality collaboratives partner with 

18 hospitals, physicians, nurses, midwives, patients, 

19 public health, and other stakeholders to provide op20 portunities for collaborative learning, rapid response 

21 data, and quality improvement science support to 

22 achieve systems-level change. 

23 (21) The Centers for Disease Control and Pre24 vention reports that 22 percent of deaths occurred 

25 during pregnancy, 25 percent occurred on the day of 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
13 

•S 2846 IS

1 delivery or within 7 days after the day of delivery, 

2 and 53 percent occurred between 7 days and 1 year 

3 after the day of delivery. Yet, for women eligible for 

4 the Medicaid program on the basis of pregnancy in 

5 States without Medicaid postpartum extension, such 

6 Medicaid coverage lapses at the end of the month on 

7 which the 60th postpartum day lands. 

8 (22) The experience of serious traumatic 

9 events, such as being exposed to domestic violence, 

10 substance use disorder, or pervasive and systematic 

11 racism, can over-activate the body’s stress-response 

12 system. Known as toxic stress, the repetition of 

13 high-doses of cortisol to the brain, can harm healthy 

14 neurological development and other body systems, 

15 which can have cascading physical and mental health 

16 consequences, as documented in the Adverse Child17 hood Experiences study of the Centers for Disease 

18 Control and Prevention. 

19 (23) A growing body of evidence-based research 

20 has shown the correlation between the stress associ21 ated with systematic racism and one’s birthing out22 comes. The undue stress of sex and race discrimina23 tion paired with institutional racism has been dem24 onstrated to contribute to a higher risk of maternal 

25 mortality, irrespective of one’s gestational age, maVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
14 

•S 2846 IS

1 ternal age, socioeconomic status, educational level, 

2 geographic region, or individual-level health risk fac3 tors, including poverty, limited access to prenatal 

4 care, and poor physical and mental health (although 

5 these are not nominal factors). Black women remain 

6 the most at risk for pregnancy-associated or preg7 nancy-related causes of death. When it comes to 

8 preeclampsia, for example, for which obesity is a risk 

9 factor, Black women of normal weight remain at a 

10 higher at risk of dying during the perinatal period 

11 compared to non-Black obese women. 

12 (24) The rising maternal mortality rate in the 

13 United States is driven predominantly by the dis14 proportionately high rates of Black maternal mor15 tality. 

16 (25) Compared to women from other racial and 

17 ethnic demographics, Black women across the socio18 economic spectrum experience prolonged, unrelenting 

19 stress related to systematic racial and gender dis20 crimination, contributing to higher rates of maternal 

21 mortality, giving birth to low-weight babies, and ex22 periencing pre-term birth. Racism is a risk-factor for 

23 these aforementioned experiences. This cumulative 

24 stress, called weathering, often extends across the 

25 life course and is situated in everyday spaces where 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
15 

•S 2846 IS

1 Black women establish livelihood. Systematic racism, 

2 structural barriers, lack of access to quality mater3 nal health care, lack of access to nutritious food, and 

4 social determinants of health exacerbate Black wom5 en’s likelihood to experience poor or fatal birthing 

6 outcomes, but do not fully account for the great dis7 parity. 

8 (26) Black women are twice as likely to experi9 ence postpartum depression, and disproportionately 

10 higher rates of preeclampsia compared to White 

11 women. 

12 (27) Racism is deeply ingrained in United 

13 States systems, including in health care delivery sys14 tems between patients and providers, often resulting 

15 in disparate treatment for pain, irreverence for cul16 tural norms with respect to health, and 

17 dismissiveness. However, the provider pool is not 

18 primed with many people of color, nor are providers 

19 (whether maternity care clinicians or maternity care 

20 support personnel) consistently required to undergo 

21 implicit bias, cultural competency, respectful care 

22 practices, or empathy training on a consistent, on23 going basis. 

24 (28) Women are not the only people who can 

25 become pregnant or give birth. Nonbinary, 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
16 

•S 2846 IS

1 transgender, and gender-expansive people can also 

2 become pregnant. The terms ‘‘birthing people’’ or 

3 ‘‘birthing persons’’ are also used to describe preg4 nant or postpartum people in a way that is inclusive 

5 of individuals who experience gender beyond the bi6 nary. 

7 (29) Substance misuse among pregnant women, 

8 including the use of substances that are illegal or 

9 criminalized, misuse of prescribed medications, and 

10 binge drinking, has increased year after year for the 

11 past decade. Pregnant people with substance use dis12 order, particularly those with opioids, amphetamines, 

13 and cocaine use disorders, are at greater risk of se14 vere maternal morbidity, including conditions such 

15 as eclampsia, heart attack or failure, and sepsis. 

16 SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO 

17 PREVENTION OF MATERNAL MORTALITY. 

18 (a) FUNDING FOR STATE-BASED PERINATAL QUAL19 ITY COLLABORATIVES DEVELOPMENT AND SUSTAIN20 ABILITY.— 

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

22 after the date of enactment of this Act, the Sec23 retary of Health and Human Services (referred to in 

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

25 the Division of Reproductive Health of the Centers 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
17 

•S 2846 IS

1 for Disease Control and Prevention, shall establish a 

2 grant program to be known as the State-Based 

3 Perinatal Quality Collaborative grant program under 

4 which the Secretary awards grants to eligible entities 

5 for the purpose of development and sustainability of 

6 perinatal quality collaboratives in every State, the 

7 District of Columbia, and eligible territories, in 

8 order to measurably improve perinatal care and 

9 perinatal health outcomes for pregnant and 

10 postpartum women and their infants. 

11 (2) GRANT AMOUNTS.—Grants awarded under 

12 this subsection shall be in amounts not to exceed 

13 $250,000 per year, for the duration of the grant pe14 riod. 

15 (3) STATE-BASED PERINATAL QUALITY COL16 LABORATIVE DEFINED.—For purposes of this sub17 section, the term ‘‘State-based perinatal quality col18 laborative’’ means a network of teams that— 

19 (A) is multidisciplinary in nature and in20 cludes the full range of perinatal and maternity 

21 care providers; 

22 (B) works to improve measurable outcomes 

23 for maternal and infant health by advancing 

24 evidence-informed clinical practices using qual25 ity improvement principles; 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
18 

•S 2846 IS

1 (C) works with hospital-based or out2 patient facility-based clinical teams, experts, 

3 and stakeholders, including patients and fami4 lies, to spread best practices and optimize re5 sources to improve perinatal care and outcomes; 

6 (D) employs strategies that include the use 

7 of the collaborative learning model to provide 

8 opportunities for hospitals and clinical teams to 

9 collaborate on improvement strategies, rapid-re10 sponse data to provide timely feedback to hos11 pital and other clinical teams to track progress, 

12 and quality improvement science to provide sup13 port and coaching to hospital and clinical 

14 teams; 

15 (E) has the goal of improving population16 level outcomes in maternal and infant health; 

17 and 

18 (F) has the goal of improving outcomes of 

19 all birthing people, through the coordination, 

20 integration, and collaboration across birth set21 tings. 

22 (4) AUTHORIZATION OF APPROPRIATIONS.—For 

23 purposes of carrying out this subsection, there is au24 thorized to be appropriated $35,000,000 for each of 

25 fiscal years 2024 through 2028. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
19 

•S 2846 IS

1 (b) EXPANSION OF MEDICAID AND CHIP COVERAGE

2 FOR PREGNANT AND POSTPARTUM WOMEN.— 

3 (1) REQUIRING COVERAGE OF ORAL HEALTH

4 SERVICES FOR PREGNANT AND POSTPARTUM

5 WOMEN.— 

6 (A) MEDICAID.—Section 1905 of the So7 cial Security Act (42 U.S.C. 1396d) is amend8 ed— 

9 (i) in subsection (a)(4)— 

10 (I) by striking ‘‘; and (D)’’ and 

11 inserting ‘‘; (D)’’; 

12 (II) by striking ‘‘; and (E)’’ and 

13 inserting ‘‘; (E)’’; 

14 (III) by striking ‘‘; and (F)’’ and 

15 inserting ‘‘; (F)’’; and 

16 (IV) by striking the semicolon at 

17 the end and inserting ‘‘; and (G) oral 

18 health services for pregnant and 

19 postpartum women (as defined in sub20 section (jj));’’; and 

21 (ii) by adding at the end the following 

22 new subsection: 

23 ‘‘(jj) ORAL HEALTH SERVICES FOR PREGNANT AND

24 POSTPARTUM WOMEN.— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
20 

•S 2846 IS

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

2 the term ‘oral health services for pregnant and 

3 postpartum women’ means dental services necessary 

4 to prevent disease and promote oral health, restore 

5 oral structures to health and function, and treat 

6 emergency conditions that are furnished to a woman 

7 during pregnancy (or during the 1-year period be8 ginning on the last day of the pregnancy). 

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

10 the requirement to provide oral health services for 

11 pregnant and postpartum women, a State shall, at 

12 a minimum, provide coverage for preventive, diag13 nostic, periodontal, and restorative care consistent 

14 with recommendations for perinatal oral health care 

15 and dental care during pregnancy from the Amer16 ican Academy of Pediatric Dentistry and the Amer17 ican College of Obstetricians and Gynecologists.’’. 

18 (B) CHIP.—Section 2103(c)(6) of the So19 cial Security Act (42 U.S.C. 1397cc(c)(6)) is 

20 amended— 

21 (i) in subparagraph (A)— 

22 (I) by inserting ‘‘or a targeted 

23 low-income pregnant woman’’ after 

24 ‘‘targeted low-income child’’; and 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
21 

•S 2846 IS

1 (II) by inserting ‘‘, and, in the 

2 case of a targeted low-income child 

3 who is pregnant or a targeted low-in4 come pregnant woman, satisfy the 

5 coverage requirements specified in 

6 section 1905(jj)’’ after ‘‘emergency 

7 conditions’’; and 

8 (ii) in subparagraph (B), by inserting 

9 ‘‘(but only if, in the case of a targeted low10 income child who is pregnant or a targeted 

11 low-income pregnant woman, the bench12 mark dental benefit package satisfies the 

13 coverage requirements specified in section 

14 1905(jj))’’ after ‘‘subparagraph (C)’’. 

15 (2) REQUIRING 12-MONTH CONTINUOUS COV16 ERAGE OF FULL BENEFITS FOR PREGNANT AND

17 POSTPARTUM INDIVIDUALS UNDER MEDICAID AND

18 CHIP.— 

19 (A) MEDICAID.—Section 1902 of the So20 cial Security Act (42 U.S.C. 1396a) is amend21 ed— 

22 (i) in subsection (a)— 

23 (ii) in paragraph (86), by striking 

24 ‘‘and’’ at the end; 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
22 

•S 2846 IS

1 (iii) in paragraph (87), by striking the 

2 period at the end and inserting ‘‘; and’’; 

3 and 

4 (iv) by inserting after paragraph (87) 

5 the following new paragraph: 

6 ‘‘(88) provide that the State plan is in compli7 ance with subsection (e)(16).’’; and 

8 (v) in subsection (e)(16)— 

9 (I) in subparagraph (A), by strik10 ing ‘‘At the option of the State, the 

11 State plan (or waiver of such State 

12 plan) may provide’’ and inserting ‘‘A 

13 State plan (or waiver of such State 

14 plan) shall provide’’; 

15 (II) in subparagraph (B), in the 

16 matter preceding clause (i), by strik17 ing ‘‘by a State making an election 

18 under this paragraph’’ and inserting 

19 ‘‘under a State plan (or a waiver of 

20 such State plan)’’; and 

21 (III) by striking subparagraph 

22 (C). 

23 (B) CHIP.— 

24 (i) IN GENERAL.—Section 

25 2107(e)(1)(J) of the Social Security Act 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
23 

•S 2846 IS

1 (42 U.S.C. 1397gg(e)(1)(J)), as inserted 

2 by section 9822 of the American Rescue 

3 Plan Act of 2021 (Public Law 117–2), is 

4 amended to read as follows: 

5 ‘‘(J) Paragraphs (5) and (16) of section 

6 1902(e) (relating to the requirement to provide 

7 medical assistance under the State plan or 

8 waiver consisting of full benefits during preg9 nancy and throughout the 12-month 

10 postpartum period under title XIX).’’. 

11 (ii) CONFORMING.—Section 

12 2112(d)(2)(A) of the Social Security Act 

13 (42 U.S.C. 1397ll(d)(2)(A)) is amended by 

14 striking ‘‘the month in which the 60-day 

15 period’’ and all that follows through ‘‘pur16 suant to section 2107(e)(1),’’. 

17 (3) MAINTENANCE OF EFFORT.— 

18 (A) MEDICAID.—Section 1902(l) of the So19 cial Security Act (42 U.S.C. 1396a(l)) is 

20 amended by adding at the end the following 

21 new paragraph: 

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

23 enactment of this paragraph and ends on the date that 

24 is 5 years after such date of enactment, as a condition 

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


kjohnson on DSK7ZCZBW3PROD with $$_JOB
24 

•S 2846 IS

1 for calendar quarters occurring during such period, a 

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

3 are eligible for medical assistance under the State plan 

4 or under a waiver of such plan on the basis of being preg5 nant or having been pregnant, eligibility standards, meth6 odologies, or procedures under the State plan or waiver 

7 that are more restrictive than the eligibility standards, 

8 methodologies, or procedures, respectively, under such 

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

10 of this paragraph.’’. 

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

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

13 by adding at the end the following new para14 graph: 

15 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR16 GETED LOW-INCOME PREGNANT WOMEN.—During 

17 the period that begins on the date of enactment of 

18 this paragraph and ends on the date that is 5 years 

19 after such date of enactment, as a condition of re20 ceiving payments under subsection (a) and section 

21 1903(a), a State that elects to provide assistance to 

22 women on the basis of being pregnant (including 

23 pregnancy-related assistance provided to targeted 

24 low-income pregnant women (as defined in section 

25 2112(d)), pregnancy-related assistance provided to 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
25 

•S 2846 IS

1 women who are eligible for such assistance through 

2 application of section 1902(v)(4)(A)(i) under section 

3 2107(e)(1), or any other assistance under the State 

4 child health plan (or a waiver of such plan) which 

5 is provided to women on the basis of being preg6 nant) shall not have in effect, with respect to such 

7 women, eligibility standards, methodologies, or pro8 cedures under such plan (or waiver) that are more 

9 restrictive than the eligibility standards, methodolo10 gies, or procedures, respectively, under such plan (or 

11 waiver) that are in effect on the date of enactment 

12 of this paragraph.’’. 

13 (4) INFORMATION ON BENEFITS.—The Sec14 retary of Health and Human Services shall make 

15 publicly available on the internet website of the De16 partment of Health and Human Services, informa17 tion regarding benefits available to pregnant and 

18 postpartum women and under the Medicaid program 

19 and the Children’s Health Insurance Program, in20 cluding information on— 

21 (A) benefits that States are required to 

22 provide to pregnant and postpartum women 

23 under such programs; 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
26 

•S 2846 IS

1 (B) optional benefits that States may pro2 vide to pregnant and postpartum women under 

3 such programs; and 

4 (C) the availability of different kinds of 

5 benefits for pregnant and postpartum women, 

6 including oral health and mental health benefits 

7 and breastfeeding services and supplies, under 

8 such programs. 

9 (5) FEDERAL FUNDING FOR COST OF EX10 TENDED MEDICAID AND CHIP COVERAGE FOR

11 POSTPARTUM WOMEN.— 

12 (A) MEDICAID.—Section 1905 of the So13 cial Security Act (42 U.S.C. 1396d), as amend14 ed by paragraph (1), is further amended by 

15 adding at the end the following: 

16 ‘‘(kk) INCREASED FMAP FOR EXTENDED MEDICAL

17 ASSISTANCE FOR POSTPARTUM INDIVIDUALS.— 

18 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

19 (b), the Federal medical assistance percentage for a 

20 State, with respect to amounts expended by such 

21 State for medical assistance for an individual who is 

22 eligible for such assistance on the basis of being 

23 pregnant or having been pregnant that is provided 

24 during the 305-day period that begins on the 60th 

25 day after the last day of the individual’s pregnancy 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
27 

•S 2846 IS

1 (including any such assistance provided during the 

2 month in which such period ends), shall be equal 

3 to— 

4 ‘‘(A) during the first 20-quarter period for 

5 which this subsection is in effect with respect to 

6 a State, 100 percent; and 

7 ‘‘(B) with respect to a State, during each 

8 quarter thereafter, 90 percent. 

9 ‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 

10 Any payment made to a territory for expenditures 

11 for medical assistance for an individual described in 

12 paragraph (1) that is subject to the Federal medical 

13 assistance percentage specified under paragraph (1) 

14 shall not be taken into account for purposes of ap15 plying payment limits under subsections (f) and (g) 

16 of section 1108.’’. 

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

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

19 by adding at the end the following new para20 graph: 

21 ‘‘(13) ENHANCED PAYMENT FOR EXTENDED

22 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 

23 Notwithstanding subsection (b), the enhanced 

24 FMAP, with respect to payments under subsection 

25 (a) for expenditures under the State child health 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
28 

•S 2846 IS

1 plan (or a waiver of such plan) for assistance pro2 vided under the plan (or waiver) to a woman who is 

3 eligible for such assistance on the basis of being 

4 pregnant (including pregnancy-related assistance 

5 provided to a targeted low-income pregnant woman 

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

7 assistance provided to a woman who is eligible for 

8 such assistance through application of section 

9 1902(v)(4)(A)(i) under section 2107(e)(1), or any 

10 other assistance under the plan (or waiver) provided 

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

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

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

14 pregnancy (including any such assistance provided 

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

16 be equal to— 

17 ‘‘(A) during the first 20-quarter period for 

18 which this subsection is in effect with respect to 

19 a State, 100 percent; and 

20 ‘‘(B) with respect to a State, during each 

21 quarter thereafter, 90 percent.’’. 

22 (6) GUIDANCE ON STATE OPTIONS FOR MED23 ICAID COVERAGE OF DOULA SERVICES.—Not later 

24 than 1 year after the date of the enactment of this 

25 Act, the Secretary of Health and Human Services 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
29 

•S 2846 IS

1 shall issue guidance for the States concerning op2 tions for Medicaid coverage and payment for support 

3 services provided by doulas. 

4 (7) ENHANCED FMAP FOR RURAL OBSTETRIC

5 AND GYNECOLOGICAL SERVICES.—Section 1905 of 

6 the Social Security Act (42 U.S.C. 1396d), as 

7 amended by paragraphs (1) and (5), is further 

8 amended— 

9 (A) in subsection (b), by striking ‘‘and 

10 (ii)’’ and inserting ‘‘(ii), (jj), (kk), and (ll)’’; 

11 and 

12 (B) by adding at the end the following new 

13 subsection: 

14 ‘‘(ll) INCREASED FMAP FOR MEDICAL ASSISTANCE

15 FOR OBSTETRIC AND GYNECOLOGICAL SERVICES FUR16 NISHED AT RURAL HOSPITALS.— 

17 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

18 (b), the Federal medical assistance percentage for a 

19 State, with respect to amounts expended by such 

20 State for medical assistance for obstetric or gyneco21 logical services that are furnished in a hospital that 

22 is located in a rural area (as defined for purposes 

23 of section 1886) shall be equal to 90 percent for 

24 each calendar quarter beginning with the first calVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
30 

•S 2846 IS

1 endar quarter during which this subsection is in ef2 fect. 

3 ‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 

4 Any payment made to a territory for expenditures 

5 for medical assistance described in paragraph (1) 

6 that is subject to the Federal medical assistance per7 centage specified under paragraph (1) shall not be 

8 taken into account for purposes of applying payment 

9 limits under subsections (f) and (g) of section 

10 1108.’’. 

11 (8) EFFECTIVE DATES.— 

12 (A) IN GENERAL.—Subject to subpara13 graphs (B) and (C)— 

14 (i) the amendments made by para15 graphs (1), (2), and (5) shall take effect 

16 on the first day of the first calendar quar17 ter that begins on or after the date that is 

18 1 year after the date of enactment of this 

19 Act; 

20 (ii) the amendments made by para21 graph (3) shall take effect on the date of 

22 enactment of this Act; and 

23 (iii) the amendments made by para24 graph (7) shall take effect on the first day 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
31 

•S 2846 IS

1 of the first calendar quarter that begins on 

2 or after the date of enactment of this Act. 

3 (B) EXCEPTION FOR STATE LEGISLA4 TION.—In the case of a State plan under title 

5 XIX of the Social Security Act or a State child 

6 health plan under title XXI of such Act that 

7 the Secretary of Health and Human Services 

8 determines requires State legislation in order 

9 for the respective plan to meet any requirement 

10 imposed by amendments made by this sub11 section, the respective plan shall not be re12 garded as failing to comply with the require13 ments of such title solely on the basis of its fail14 ure to meet such an additional requirement be15 fore the first day of the first calendar quarter 

16 beginning after the close of the first regular 

17 session of the State legislature that begins after 

18 the date of enactment of this Act. For purposes 

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

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

21 of the session shall be considered to be a sepa22 rate regular session of the State legislature. 

23 (C) STATE OPTION FOR EARLIER EFFEC24 TIVE DATE.—A State may elect to have sub25 section (e)(16) of section 1902 of the Social SeVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
32 

•S 2846 IS

1 curity Act (42 U.S.C. 1396a) and subparagraph 

2 (J) of section 2107(e)(1) of the Social Security 

3 Act (42 U.S.C. 1397gg(e)(1)), as amended by 

4 paragraph (2), and subsection (kk) of section 

5 1905 of the Social Security Act (42 U.S.C. 

6 1396d) and paragraph (13) of section 2105(c) 

7 of the Social Security Act (42 U.S.C. 

8 1397ee(c)), as added by paragraph (5), take ef9 fect with respect to the State on the first day 

10 of any fiscal quarter that begins before the date 

11 described in subparagraph (A) and apply to 

12 amounts payable to the State for expenditures 

13 for medical assistance, child health assistance, 

14 or pregnancy-related assistance to pregnant or 

15 postpartum individuals furnished on or after 

16 such day. 

17 (c) REGIONAL CENTERS OF EXCELLENCE.—Part P 

18 of title III of the Public Health Service Act (42 U.S.C. 

19 280g et seq.) is amended by adding at the end the fol20 lowing: 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
33 

•S 2846 IS

1 ‘‘SEC. 399V–8. REGIONAL CENTERS OF EXCELLENCE AD2 DRESSING IMPLICIT BIAS AND CULTURAL 

3 COMPETENCY IN PATIENT-PROVIDER INTER4 ACTIONS EDUCATION. 

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

6 date of enactment of this section, the Secretary, in con7 sultation with such other agency heads as the Secretary 

8 determines appropriate, shall award cooperative agree9 ments for the establishment or support of regional centers 

10 of excellence addressing implicit bias, cultural competency, 

11 and respectful care practices in patient-provider inter12 actions education for the purpose of enhancing and im13 proving how health care professionals are educated in im14 plicit bias and delivering culturally competent health care. 

15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper16 ative agreement under subsection (a), an entity shall— 

17 ‘‘(1) be a public or other nonprofit entity speci18 fied by the Secretary that provides educational and 

19 training opportunities for students and health care 

20 professionals, which may be a health system, teach21 ing hospital, community health center, medical 

22 school, school of public health, school of nursing, 

23 dental school, social work school, school of profes24 sional psychology, or any other health professional 

25 school or program at an institution of higher edu26 cation (as defined in section 101 of the Higher EduVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
34 

•S 2846 IS

1 cation Act of 1965) focused on the prevention, treat2 ment, or recovery of health conditions that con3 tribute to maternal mortality and the prevention of 

4 maternal mortality and severe maternal morbidity; 

5 ‘‘(2) demonstrate community engagement and 

6 participation, such as through partnerships with 

7 home visiting and case management programs and 

8 community-based organizations serving minority 

9 populations; 

10 ‘‘(3) demonstrate engagement with groups en11 gaged in the implementation of health care profes12 sional training in implicit bias and delivering cul13 turally competent care, such as departments of pub14 lic health, perinatal quality collaboratives, hospital 

15 systems, and health care professional groups, in 

16 order to obtain input on resources needed for effec17 tive implementation strategies; and 

18 ‘‘(4) provide to the Secretary such information, 

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

20 may require. 

21 ‘‘(c) DIVERSITY.—In awarding a cooperative agree22 ment under subsection (a), the Secretary shall take into 

23 account any regional differences among eligible entities 

24 and make an effort to ensure geographic diversity among 

25 award recipients. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
35 

•S 2846 IS

1 ‘‘(d) DISSEMINATION OF INFORMATION.— 

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

3 shall make publicly available on the internet website 

4 of the Department of Health and Human Services 

5 information submitted to the Secretary under sub6 section (b)(3). 

7 ‘‘(2) EVALUATION.—The Secretary shall evalu8 ate each regional center of excellence established or 

9 supported pursuant to subsection (a) and dissemi10 nate the findings resulting from each such evalua11 tion to the appropriate public and private entities. 

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

13 evaluations and overall findings with State depart14 ments of health and other relevant State level offices 

15 to inform State and local best practices. 

16 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec17 tion, the term ‘maternal mortality’ means death of a 

18 woman that occurs during pregnancy or within the one19 year period following the end of such pregnancy. 

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

21 purposes of carrying out this section, there is authorized 

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

23 2024 through 2028.’’. 

24 (d) SPECIAL SUPPLEMENTAL NUTRITION PROGRAM

25 FOR WOMEN, INFANTS, AND CHILDREN.—Section 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
36 

•S 2846 IS

1 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (42 

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

3 (1) by striking the clause designation and head4 ing and all that follows through ‘‘A State’’ and in5 serting the following: 

6 ‘‘(ii) WOMEN.— 

7 ‘‘(I) BREASTFEEDING WOMEN.— 

8 A State’’; 

9 (2) in subclause (I) (as so designated), by strik10 ing ‘‘1 year’’ and all that follows through ‘‘earlier’’ 

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

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

13 ‘‘(II) POSTPARTUM WOMEN.—A 

14 State may elect to certify a 

15 postpartum woman for a period of 2 

16 years.’’. 

17 (e) DEFINITION OF MATERNAL MORTALITY.—In this 

18 section, the term ‘‘maternal mortality’’ means death of a 

19 woman that occurs during pregnancy or within the one20 year period following the end of such pregnancy. 

21 SEC. 4. FULL SPECTRUM DOULA WORKFORCE. 

22 (a) IN GENERAL.—The Secretary of Health and 

23 Human Services shall establish and implement a program 

24 to award grants or contracts to health professions schools, 

25 schools of public health, academic health centers, State or 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
37 

•S 2846 IS

1 local governments, territories, Indian Tribes and Tribal 

2 organizations, Urban Indian organizations, Native Hawai3 ian organizations, or other appropriate public or private 

4 nonprofit entities or community-based organizations (or 

5 consortia of any such entities, including entities promoting 

6 multidisciplinary approaches), to establish or expand pro7 grams to grow and diversify the doula workforce, including 

8 through improving the capacity and supply of health care 

9 providers. 

10 (b) USE OF FUNDS.—Amounts made available by 

11 subsection (a) shall be used for the following activities: 

12 (1) Establishing programs that provide edu13 cation and training to individuals seeking appro14 priate training or certification as full spectrum 

15 doulas. 

16 (2) Expanding the capacity of existing pro17 grams described in paragraph (1), for the purpose of 

18 increasing the number of students enrolled in such 

19 programs, including by awarding scholarships for 

20 students who agree to work in underserved commu21 nities after receiving such education and training. 

22 (3) Developing and implementing strategies to 

23 recruit and retain students from underserved com24 munities, particularly from demographic groups ex25 periencing high rates of maternal mortality and seVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
38 

•S 2846 IS

1 vere maternal morbidity, including racial and ethnic 

2 minority groups, into programs described in para3 graphs (1) and (2). 

4 (c) FUNDING.—In addition to amounts otherwise 

5 available, there is appropriated to the Secretary of Health 

6 and Human Services for fiscal year 2024, out of any 

7 money in the Treasury not otherwise appropriated, 

8 $50,000,000, to remain available until expended, for car9 rying out this section. 

10 SEC. 5. GRANTS FOR RURAL OBSTETRIC MOBILE HEALTH 

11 UNITS. 

12 Part B of title III of the Public Health Service Act 

13 (42 U.S.C. 243 et seq.) is amended by adding at the end 

14 the following: 

15 ‘‘SEC. 320C. GRANTS FOR RURAL OBSTETRIC MOBILE 

16 HEALTH UNITS. 

17 ‘‘(a) IN GENERAL.—The Secretary, acting through 

18 the Administrator of the Health Resources and Services 

19 Administration (referred to in this section as the ‘Sec20 retary’), shall establish a pilot program under which the 

21 Secretary shall make grants to States— 

22 ‘‘(1) to purchase and equip rural mobile health 

23 units for the purpose of providing pre-conception, 

24 pregnancy, postpartum, and obstetric emergency 

25 services in rural and underserved communities; 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
39 

•S 2846 IS

1 ‘‘(2) to train providers including obstetrician2 gynecologists, certified nurse-midwives, nurse practi3 tioners, nurses, and midwives to operate and provide 

4 obstetric services, including training and planning 

5 for obstetric emergencies, in such mobile health 

6 units; and 

7 ‘‘(3) to address access issues, including social 

8 determinants of health and wrap-around clinical and 

9 community services including nutrition, housing, lac10 tation services, and transportation support and re11 ferrals. 

12 ‘‘(b) NO SHARING OF DATA WITH LAW ENFORCE13 MENT.—As a condition of receiving a grant under this sec14 tion, a State shall submit to the Secretary an assurance 

15 that the State will not make available to Federal or State 

16 law enforcement any personally identifiable information 

17 regarding any pregnant or postpartum individual collected 

18 pursuant to such grant. 

19 ‘‘(c) GRANT DURATION.—The period of a grant 

20 under this section shall not exceed 5 years. 

21 ‘‘(d) IMPLEMENTING AND REPORTING.— 

22 ‘‘(1) IN GENERAL.—States that receive pilot 

23 grants under this section shall— 

24 ‘‘(A) implement the program funded by the 

25 pilot grants; and 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
40 

•S 2846 IS

1 ‘‘(B) not later than 3 years after the date 

2 of enactment of this section, and not later than 

3 6 years after such date of enactment, submit to 

4 the Secretary a report that describes the results 

5 of such program, including— 

6 ‘‘(i) relevant information and relevant 

7 quantitative indicators of the programs’ 

8 success in improving the standard of care 

9 and maternal health outcomes for individ10 uals in rural and underserved communities 

11 seen for pre-conception, pregnancy, or 

12 postpartum visits in the rural mobile 

13 health units, stratified by the categories of 

14 data specified in paragraph (2); 

15 ‘‘(ii) relevant qualitative evaluations 

16 from individuals receiving pre-conception, 

17 pregnant, or postpartum care from rural 

18 mobile health units, including measures of 

19 patient-reported experience of care and 

20 measures of patient-reported issues with 

21 access to care without the rural mobile 

22 health unit pilot; and 

23 ‘‘(iii) strategies to sustain such pro24 grams beyond the duration of the grant 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
41 

•S 2846 IS

1 and expand such programs to other rural 

2 and underserved communities. 

3 ‘‘(2) CATEGORIES OF DATA.—The categories of 

4 data specified in this paragraph are the following: 

5 ‘‘(A) Race, ethnicity, sex, gender, gender 

6 identity, primary language, age, geography, in7 surance status, disability status. 

8 ‘‘(B) Number of visits provided for pre9 conception, prenatal, or postpartum care. 

10 ‘‘(C) Number of repeat visits provided for 

11 preconception, prenatal, or postpartum care. 

12 ‘‘(D) Number of screenings or tests pro13 vided for smoking, substance use, hypertension, 

14 sexually-transmitted diseases, diabetes, HIV, 

15 depression, intimate partner violence, pap 

16 smears, and pregnancy. 

17 ‘‘(3) DATA PRIVACY PROTECTION.—The reports 

18 referred to in paragraph (1)(B) shall not contain 

19 any personally identifiable information regarding 

20 any pregnant or postpartum individual. 

21 ‘‘(e) EVALUATION.—The Secretary shall conduct an 

22 evaluation of the pilot program under this section to deter23 mine the impact of the pilot program with respect to— 

24 ‘‘(1) the effectiveness of the grants awarded 

25 under this section to improve maternal health outVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
42 

•S 2846 IS

1 comes in rural and underserved communities, with 

2 data stratified by race, ethnicity, primary language, 

3 socioeconomic status, geography, insurance type, and 

4 other factors as the Secretary determines appro5 priate; 

6 ‘‘(2) spending on maternity care by States par7 ticipating in the pilot program; 

8 ‘‘(3) to the extent practicable, qualitative and 

9 quantitative measures of patient experience; and 

10 ‘‘(4) any other areas of assessment that the 

11 Secretary determines relevant. 

12 ‘‘(f) REPORT.—Not later than one year after the 

13 completion of the pilot program under this section, the 

14 Secretary shall submit to Congress, and make publicly 

15 available, a report that describes— 

16 ‘‘(1) the results of the evaluation conducted 

17 under subsection (e); and 

18 ‘‘(2) a recommendation regarding whether the 

19 pilot program should be continued after fiscal year 

20 2028 and expanded on a national basis. 

21 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to the Secretary to carry 

23 out this section $10,000,000 for each of fiscal years 2024 

24 through 2028.’’. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
43 

•S 2846 IS

1 SEC. 6. REQUIRING NOTIFICATION OF IMPENDING HOS2 PITAL OBSTETRIC UNIT CLOSURE. 

3 Section 1866(a)(1) of the Social Security Act (42 

4 U.S.C. 1395cc(a)(1)) is amended— 

5 (1) in subparagraph (X), by striking ‘‘and’’ at 

6 the end; 

7 (2) in subparagraph (Y)(ii)(V), by striking the 

8 period and inserting ‘‘, and’’; and 

9 (3) by inserting after subparagraph (Y) the fol10 lowing new subparagraph: 

11 ‘‘(Z) beginning 180 days after the date of the 

12 enactment of this subparagraph, in the case of a 

13 hospital, not less than 90 days prior to the closure 

14 of any obstetric unit of the hospital, to submit to the 

15 Secretary a notification which shall include— 

16 ‘‘(i) a report analyzing the impact the clo17 sure will have on the community; 

18 ‘‘(ii) steps the hospital will take to identify 

19 other health care providers that can alleviate 

20 any service gaps as a result of the closure; and 

21 ‘‘(iii) any additional information as may be 

22 required by the Secretary.’’. 

23 SEC. 7. EVALUATION AND REPORT ON MATERNAL HEALTH 

24 NEEDS. 

25 (a) IN GENERAL.—Not later than 2 years after the 

26 date of enactment of this Act, the Secretary of Health and 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
44 

•S 2846 IS

1 Human Services shall conduct, and submit to Congress 

2 a report that describes the results of, an evaluation of— 

3 (1) where the maternal health needs are great4 est in the United States; and 

5 (2) the Federal expenditures made to address 

6 such needs. 

7 (b) PERIOD COVERED.—The evaluation under sub8 section (a) shall cover the period of calendar years 2000 

9 through 2022. 

10 (c) ANALYSIS.—The evaluation under subsection (a) 

11 shall include analysis of the following: 

12 (1) How Federal funds provided to States for 

13 maternal health were distributed across regions, 

14 States, and localities or counties. 

15 (2) Barriers to applying for and receiving Fed16 eral funds for maternal health, including, with re17 spect to initial applications— 

18 (A) requirements for submission in part19 nership with other entities; and 

20 (B) stringent network requirements. 

21 (3) Why applicants did not receive funding, in22 cluding limited availability of funds, the strength of 

23 the respective applications, and failure to adhere to 

24 requirements. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
45 

•S 2846 IS

1 (d) DISAGGREGATION OF DATA.—The report under 

2 subsection (a) shall disaggregate data on mothers served 

3 by race, ethnicity, insurance status, and language spoken. 

4 SEC. 8. 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— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
46 

•S 2846 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, made from, or derived from tobacco or nico11 tine that— 

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

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

14 pill, pouch, dissolvable strip, or other discrete 

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

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

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

18 1986 is amended by striking ‘‘$50.33’’ and inserting 

19 ‘‘$100.66’’. 

20 (e) TAX PARITY FOR LARGE CIGARS.— 

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

22 5701(a) of the Internal Revenue Code of 1986 is 

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

24 follows through the period and inserting the fol25 lowing: ‘‘$49.56 per pound and a proportionate tax 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
47 

•S 2846 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 (3) CONFORMING AMENDMENT.—Section 5702 

10 of such Code is amended by striking subsection (l). 

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

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

13 section 5702 of the Internal Revenue Code of 1986 is 

14 amended by inserting ‘‘, and includes processed tobacco 

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

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

17 but does not include removals of processed tobacco for ex18 portation’’ after ‘‘wrappers thereof’’. 

19 (g) CLARIFYING TAX RATE FOR OTHER TOBACCO

20 PRODUCTS.— 

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

22 Revenue Code of 1986 is amended by adding at the 

23 end the following new subsection: 

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

25 otherwise described under this section that has been deterVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
48 

•S 2846 IS

1 mined to be a tobacco product by the Food and Drug Ad2 ministration through its authorities under the Family 

3 Smoking Prevention and Tobacco Control Act shall be 

4 taxed at a level of tax equivalent to the tax rate for ciga5 rettes on an estimated per use basis as determined by the 

6 Secretary.’’. 

7 (2) ESTABLISHING PER USE BASIS.—For pur8 poses of section 5701(i) of the Internal Revenue 

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

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

11 date that a product has been determined to be a to12 bacco product by the Food and Drug Administra13 tion, the Secretary of the Treasury (or the Secretary 

14 of the Treasury’s delegate) shall issue final regula15 tions establishing the level of tax for such product 

16 that is equivalent to the tax rate for cigarettes on 

17 an estimated per use basis. 

18 (h) CLARIFYING DEFINITION OF TOBACCO PROD19 UCTS.— 

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

21 5702 of the Internal Revenue Code of 1986 is 

22 amended to read as follows: 

23 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod24 ucts’ means— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
49 

•S 2846 IS

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

2 tobacco, and roll-your-own tobacco, and 

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

4 to section 5701(i).’’. 

5 (2) CONFORMING AMENDMENTS.—Subsection 

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

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

8 tobacco, or roll-your-own tobacco’’ each place it ap9 pears and inserting ‘‘tobacco products’’. 

10 (i) INCREASING TAX ON CIGARETTES.— 

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

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

13 inserting ‘‘$100.66’’. 

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

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

16 inserting ‘‘$211.38’’. 

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

18 5701 of such Code, as amended by subsection (g), is 

19 amended by adding at the end the following new sub20 section: 

21 ‘‘(j) INFLATION ADJUSTMENT.— 

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

23 year beginning after 2023, the dollar amounts pro24 vided under this chapter shall each be increased by 

25 an amount equal to— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
50 

•S 2846 IS

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

2 ‘‘(B) the cost-of-living adjustment deter3 mined under section 1(f)(3) for the calendar 

4 year, determined by substituting ‘calendar year 

5 2022’ for ‘calendar year 2016’ in subparagraph 

6 (A)(ii) thereof. 

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

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

9 amount shall be rounded to the next highest multiple 

10 of $0.01.’’. 

11 (k) FLOOR STOCKS TAXES.— 

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

13 manufactured in or imported into the United States 

14 which are removed before any tax increase date and 

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

16 hereby imposed a tax in an amount equal to the ex17 cess of— 

18 (A) the tax which would be imposed under 

19 section 5701 of the Internal Revenue Code of 

20 1986 on the article if the article had been re21 moved on such date, over 

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

23 section 5701 of such Code on such article. 

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

25 be allowed as a credit against the taxes imposed by 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
51 

•S 2846 IS

1 paragraph (1) an amount equal to the lesser of 

2 $1,000 or the amount of such taxes. For purposes 

3 of the preceding sentence, all persons treated as a 

4 single employer under subsection (b), (c), (m), or (o) 

5 of section 414 of the Internal Revenue Code of 1986 

6 shall be treated as 1 person for purposes of this 

7 paragraph. 

8 (3) LIABILITY FOR TAX AND METHOD OF PAY9 MENT.— 

10 (A) LIABILITY FOR TAX.—A person hold11 ing tobacco products on any tax increase date 

12 to which any tax imposed by paragraph (1) ap13 plies shall be liable for such tax. 

14 (B) METHOD OF PAYMENT.—The tax im15 posed by paragraph (1) shall be paid in such 

16 manner as the Secretary shall prescribe by reg17 ulations. 

18 (C) TIME FOR PAYMENT.—The tax im19 posed by paragraph (1) shall be paid on or be20 fore the date that is 120 days after the effective 

21 date of the tax rate increase. 

22 (4) ARTICLES IN FOREIGN TRADE ZONES.— 

23 Notwithstanding the Act of June 18, 1934 (com24 monly known as the Foreign Trade Zone Act, 48 

25 Stat. 998, 19 U.S.C. 81a et seq.), or any other proVerDate Sep 11 2014 04:28 Sep 21, 2023 Jkt 039200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S2846.IS S2846

kjohnson on DSK7ZCZBW3PROD with $$_JOB
52 

•S 2846 IS

1 vision of law, any article which is located in a for2 eign trade zone on any tax increase date shall be 

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

4 (A) internal revenue taxes have been deter5 mined, or customs duties liquidated, with re6 spect to such article before such date pursuant 

7 to a request made under the first proviso of 

8 section 3(a) of such Act, or 

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

10 the supervision of an officer of the United 

11 States Customs and Border Protection of the 

12 Department of Homeland Security pursuant to 

13 the second proviso of such section 3(a). 

14 (5) DEFINITIONS.—For purposes of this sub15 section— 

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

17 subsection which is also used in section 5702 of 

18 such Code shall have the same meaning as such 

19 term has in such section. 

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

21 increase date’’ means the effective date of any 

22 increase in any tobacco product excise tax rate 

23 pursuant to the amendments made by this sec24 tion (other than subsection (j) thereof). 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
53 

•S 2846 IS

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

2 means the Secretary of the Treasury or the 

3 Secretary’s delegate. 

4 (6) CONTROLLED GROUPS.—Rules similar to 

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

6 apply for purposes of this subsection. 

7 (7) OTHER LAWS APPLICABLE.—All provisions 

8 of law, including penalties, applicable with respect to 

9 the taxes imposed by section 5701 of such Code 

10 shall, insofar as applicable and not inconsistent with 

11 the provisions of this subsection, apply to the floor 

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

13 extent as if such taxes were imposed by such section 

14 5701. The Secretary may treat any person who bore 

15 the ultimate burden of the tax imposed by para16 graph (1) as the person to whom a credit or refund 

17 under such provisions may be allowed or made. 

18 (l) EFFECTIVE DATES.— 

19 (1) IN GENERAL.—Except as provided in para20 graphs (2) and (3), the amendments made by this 

21 section shall apply to articles removed (as defined in 

22 section 5702(j) of the Internal Revenue Code of 

23 1986) after the last day of the month which includes 

24 the date of the enactment of this Act. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
54 

•S 2846 IS

1 (2) DISCRETE SINGLE-USE UNITS, LARGE CI2 GARS, AND PROCESSED TOBACCO.—The amendments 

3 made by subsections (c)(1)(C), (c)(2), (e), and (f) 

4 shall apply to articles removed (as defined in section 

5 5702(j) of the Internal Revenue Code of 1986) after 

6 the date that is 6 months after the date of the en7 actment of this Act. 

8 (3) OTHER TOBACCO PRODUCTS.—The amend9 ments made by subsection (g)(1) shall apply to prod10 ucts removed after the last day of the month which 

11 includes the date that the Secretary of the Treasury 

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

13 final regulations establishing the level of tax for 

14 such product. 

Æ 


kjohnson on DSK7ZCZBW3PROD with $$_JOB