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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2846 Introduced in Senate (IS)]

<DOC>

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Community Access, Resources, and 
Empowerment for Moms Act'' or the ``CARE for Moms Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Every year, across the United States, nearly 4,000,000 
        women give birth, more than 1,000 women suffer fatal 
        complications during pregnancy, while giving birth or during 
        the postpartum period, and about 70,000 women suffer near-
        fatal, partum-related complications.
            (2) The maternal mortality rate is often used as a proxy to 
        measure the overall health of a population. While the infant 
        mortality rate in the United States has reached its lowest 
        point, the risk of death for women in the United States during 
        pregnancy, childbirth, or the postpartum period is higher than 
        such risk in many other high-income countries. The estimated 
        maternal mortality rate (deaths per 100,000 live births) for 
        the 48 contiguous States and Washington, DC, increased from 
        14.5 percent in 2000 to 32.0 in 2021. The United States is the 
        only industrialized nation with a rising maternal mortality 
        rate.
            (3) The National Vital Statistics System of the Centers for 
        Disease Control and Prevention has found that in 2021, there 
        were 32.9 maternal deaths for every 100,000 live births in the 
        United States. That ratio continues to exceed the rate in other 
        high-income countries.
            (4) It is estimated that more than 80 percent of maternal 
        deaths in the United States are preventable.
            (5) According to the Centers for Disease Control and 
        Prevention, the maternal mortality rate varies drastically for 
        women by race and ethnicity. There are about 26.6 deaths per 
        100,000 live births for White women, 69.9 deaths per 100,000 
        live births for non-Hispanic Black women, and 32.0 deaths per 
        100,000 live births for American Indian/Alaska Native women. 
        While maternal mortality disparately impacts Black women, this 
        urgent public health crisis traverses race, ethnicity, 
        socioeconomic status, educational background, and geography.
            (6) In the United States, non-Hispanic Black women are 
        about 3 times more likely to die from causes related to 
        pregnancy and childbirth compared to non-Hispanic White women, 
        which is one of the most disconcerting racial disparities in 
        public health. This disparity widens in certain cities and 
        States across the country.
            (7) According to the National Center for Health Statistics 
        of the Centers for Disease Control and Prevention, the maternal 
        mortality rate heightens with age, as women 40 and older die at 
        a rate of 138.5 per 100,000 births compared to 20.4 per 100,000 
        for women under 25. This translates to women over 40 being 6.8 
        times more likely to die compared to their counterparts under 
        25 years of age.
            (8) The COVID-19 pandemic has exacerbated the maternal 
        health crisis. A study of the Centers for Disease Control and 
        Prevention suggested that pregnant women are at a significantly 
        higher risk for severe outcomes, including death, from COVID-19 
        as compared to non-pregnant women. The COVID-19 pandemic also 
        decreased access to prenatal and postpartum care. A study by 
        the Government Accountability Office found that COVID-19 
        contributed to 25 percent of maternal deaths in 2020 and 2021.
            (9) The findings described in paragraphs (1) through (8) 
        are of major concern to researchers, academics, members of the 
        business community, and providers across the obstetric 
        continuum represented by organizations such as--
                    (A) the American College of Nurse-Midwives;
                    (B) the American College of Obstetricians and 
                Gynecologists;
                    (C) the American Medical Association;
                    (D) the Association of Women's Health, Obstetric 
                and Neonatal Nurses;
                    (E) the Black Mamas Matter Alliance;
                    (F) the Black Women's Health Imperative;
                    (G) the California Maternal Quality Care 
                Collaborative;
                    (H) EverThrive Illinois;
                    (I) the Illinois Perinatal Quality Collaborative;
                    (J) the March of Dimes;
                    (K) the National Association of Certified 
                Professional Midwives;
                    (L) RH Impact: The Collaborative for Equity & 
                Justice;
                    (M) the National Partnership for Women & Families;
                    (N) the National Polycystic Ovary Syndrome 
                Association;
                    (O) the Preeclampsia Foundation;
                    (P) the Society for Maternal-Fetal Medicine;
                    (Q) the What To Expect Project;
                    (R) Tufts University School of Medicine Center for 
                Black Maternal Health and Reproductive Justice;
                    (S) the Shades of Blue Project;
                    (T) the Maternal Mental Health Leadership Alliance;
                    (U) Tulane University Mary Amelia Center for 
                Women's Health Equity Research;
                    (V) In Our Own Voice: National Black Women's 
                Reproductive Justice Agenda; and
                    (W) Physicians for Reproductive Health.
            (10) Hemorrhage, cardiovascular and coronary conditions, 
        cardiomyopathy, infection or sepsis, embolism, mental health 
        conditions (including substance use disorder), hypertensive 
        disorders, stroke and cerebrovascular accidents, and anesthesia 
        complications are the predominant medical causes of maternal-
        related deaths and complications. Most of these conditions are 
        largely preventable or manageable. Even when these conditions 
        are not preventable, mortality and morbidity may be prevented 
        when conditions are diagnosed and treated in a timely manner.
            (11) According to a study published by the Journal of 
        Perinatal Education, doula-assisted mothers are 4 times less 
        likely to have a low-birthweight baby, 2 times less likely to 
        experience a birth complication involving themselves or their 
        baby, and significantly more likely to initiate breastfeeding 
        and human lactation. Doula care has also been shown to produce 
        cost savings resulting in part from reduced rates of cesarean 
        and pre-term births.
            (12) Intimate partner violence is one of the leading causes 
        of maternal death, and women are more likely to experience 
        intimate partner violence during pregnancy than at any other 
        time in their lives. It is also more dangerous than pregnancy. 
        Intimate partner violence during pregnancy and postpartum 
        crosses every demographic and has been exacerbated by the 
        COVID-19 pandemic.
            (13) Oral health is an important part of perinatal health. 
        Reducing bacteria in a woman's mouth during pregnancy can 
        significantly reduce her risk of developing oral diseases and 
        spreading decay-causing bacteria to her baby. Moreover, some 
        evidence suggests that women with periodontal disease during 
        pregnancy could be at greater risk for poor birth outcomes, 
        such as preeclampsia, pre-term birth, and low-birth weight. 
        Furthermore, a woman's oral health during pregnancy is a good 
        predictor of her newborn's oral health, and since mothers can 
        unintentionally spread oral bacteria to their babies, putting 
        their children at higher risk for tooth decay, prevention 
        efforts should happen even before children are born, as a 
        matter of pre-pregnancy health and prenatal care during 
        pregnancy.
            (14) In the United States, death reporting and analysis is 
        a State function rather than a Federal process. States report 
        all deaths--including maternal deaths--on a semi-voluntary 
        basis, without standardization across States. While the Centers 
        for Disease Control and Prevention has the capacity and system 
        for collecting death-related data based on death certificates, 
        these data are not sufficiently reported by States in an 
        organized and standard format across States such that the 
        Centers for Disease Control and Prevention is able to identify 
        causes of maternal death and best practices for the prevention 
        of such death.
            (15) Vital statistics systems often underestimate maternal 
        mortality and are insufficient data sources from which to 
        derive a full scope of medical and social determinant factors 
        contributing to maternal deaths, such as intimate partner 
        violence. While the addition of pregnancy checkboxes on death 
        certificates since 2003 have likely improved States' abilities 
        to identify pregnancy-related deaths, they are not generally 
        completed by obstetric providers or persons trained to 
        recognize pregnancy-related mortality. Thus, these vital forms 
        may be missing information or may capture inconsistent data. 
        Due to varying maternal mortality-related analyses, lack of 
        reliability, and granularity in data, current maternal 
        mortality informatics do not fully encapsulate the myriad 
        medical and socially determinant factors that contribute to 
        such high maternal mortality rates within the United States 
        compared to other developed nations. Lack of standardization of 
        data and data sharing across States and between Federal 
        entities, health networks, and research institutions keep the 
        Nation in the dark about ways to prevent maternal deaths.
            (16) Having reliable and valid State data aggregated at the 
        Federal level are critical to the Nation's ability to quell 
        surges in maternal death and imperative for researchers to 
        identify long-lasting interventions.
            (17) Leaders in maternal wellness highly recommend that 
        maternal deaths and cases of maternal morbidity, including 
        complications that result in chronic illness and future 
        increased risk of death, be investigated at the State level 
        first, and that standardized, streamlined, de-identified data 
        regarding maternal deaths be sent annually to the Centers for 
        Disease Control and Prevention. Such data standardization and 
        collection would be similar in operation and effect to the 
        National Program of Cancer Registries of the Centers for 
        Disease Control and Prevention and akin to the Confidential 
        Enquiry in Maternal Deaths Programme in the United Kingdom. 
        Such a maternal mortalities and morbidities registry and 
        surveillance system would help providers, academicians, 
        lawmakers, and the public to address questions concerning the 
        types of, causes of, and best practices to thwart, maternal 
        mortality and morbidity.
            (18) The United Nations' Millennium Development Goal 5a 
        aimed to reduce by 75 percent, between 1990 and 2015, the 
        maternal mortality rate, yet this metric has not been achieved. 
        In fact, the maternal mortality rate in the United States has 
        been estimated to have more than doubled between 2000 and 2014.
            (19) The United States has no comparable, coordinated 
        Federal process by which to review cases of maternal mortality, 
        systems failures, or best practices. The majority of States 
        have active Maternal Mortality Review Committees (referred to 
        in this section as ``MMRC''), which help leverage work to 
        impact maternal wellness. For example, the State of California 
        has worked extensively with their State health departments, 
        health and hospital systems, and research collaborative 
        organizations, including the California Maternal Quality Care 
        Collaborative and the Alliance for Innovation on Maternal 
        Health, to establish MMRCs, wherein such State has determined 
        the most prevalent causes of maternal mortality and recorded 
        and shared data with providers and researchers, who have 
        developed and implemented safety bundles and care protocols 
        related to preeclampsia, maternal hemorrhage, peripartum 
        cardiomyopathy, and the like. In this way, the State of 
        California has been able to leverage its maternal mortality 
        review board system, generate data, and apply those data to 
        effect changes in maternal care-related protocol.
            (20) Hospitals and health systems across the United States 
        lack standardization of emergency obstetric protocols before, 
        during, and after delivery. Consequently, many providers are 
        delayed in recognizing critical signs indicating maternal 
        distress that quickly escalate into fatal or near-fatal 
        incidences. Moreover, any attempt to address an obstetric 
        emergency that does not consider both clinical and public 
        health approaches falls woefully under the mark of excellent 
        care delivery. State-based perinatal quality collaboratives, or 
        entities participating in the Alliance for Innovation on 
        Maternal Health (AIM), have formed obstetric protocols, tool 
        kits, and other resources to improve system care and response 
        as they relate to maternal complications and warning signs for 
        such conditions as maternal hemorrhage, hypertension, and 
        preeclampsia. These perinatal quality collaboratives serve an 
        important role in providing infrastructure that supports 
        quality improvement efforts addressing obstetric care and 
        outcomes. State-based perinatal quality collaboratives partner 
        with hospitals, physicians, nurses, midwives, patients, public 
        health, and other stakeholders to provide opportunities for 
        collaborative learning, rapid response data, and quality 
        improvement science support to achieve systems-level change.
            (21) The Centers for Disease Control and Prevention reports 
        that 22 percent of deaths occurred during pregnancy, 25 percent 
        occurred on the day of delivery or within 7 days after the day 
        of delivery, and 53 percent occurred between 7 days and 1 year 
        after the day of delivery. Yet, for women eligible for the 
        Medicaid program on the basis of pregnancy in States without 
        Medicaid postpartum extension, such Medicaid coverage lapses at 
        the end of the month on which the 60th postpartum day lands.
            (22) The experience of serious traumatic events, such as 
        being exposed to domestic violence, substance use disorder, or 
        pervasive and systematic racism, can over-activate the body's 
        stress-response system. Known as toxic stress, the repetition 
        of high-doses of cortisol to the brain, can harm healthy 
        neurological development and other body systems, which can have 
        cascading physical and mental health consequences, as 
        documented in the Adverse Childhood Experiences study of the 
        Centers for Disease Control and Prevention.
            (23) A growing body of evidence-based research has shown 
        the correlation between the stress associated with systematic 
        racism and one's birthing outcomes. The undue stress of sex and 
        race discrimination paired with institutional racism has been 
        demonstrated to contribute to a higher risk of maternal 
        mortality, irrespective of one's gestational age, maternal age, 
        socioeconomic status, educational level, geographic region, or 
        individual-level health risk factors, including poverty, 
        limited access to prenatal care, and poor physical and mental 
        health (although these are not nominal factors). Black women 
        remain the most at risk for pregnancy-associated or pregnancy-
        related causes of death. When it comes to preeclampsia, for 
        example, for which obesity is a risk factor, Black women of 
        normal weight remain at a higher at risk of dying during the 
        perinatal period compared to non-Black obese women.
            (24) The rising maternal mortality rate in the United 
        States is driven predominantly by the disproportionately high 
        rates of Black maternal mortality.
            (25) Compared to women from other racial and ethnic 
        demographics, Black women across the socioeconomic spectrum 
        experience prolonged, unrelenting stress related to systematic 
        racial and gender discrimination, contributing to higher rates 
        of maternal mortality, giving birth to low-weight babies, and 
        experiencing pre-term birth. Racism is a risk-factor for these 
        aforementioned experiences. This cumulative stress, called 
        weathering, often extends across the life course and is 
        situated in everyday spaces where Black women establish 
        livelihood. Systematic racism, structural barriers, lack of 
        access to quality maternal health care, lack of access to 
        nutritious food, and social determinants of health exacerbate 
        Black women's likelihood to experience poor or fatal birthing 
        outcomes, but do not fully account for the great disparity.
            (26) Black women are twice as likely to experience 
        postpartum depression, and disproportionately higher rates of 
        preeclampsia compared to White women.
            (27) Racism is deeply ingrained in United States systems, 
        including in health care delivery systems between patients and 
        providers, often resulting in disparate treatment for pain, 
        irreverence for cultural norms with respect to health, and 
        dismissiveness. However, the provider pool is not primed with 
        many people of color, nor are providers (whether maternity care 
        clinicians or maternity care support personnel) consistently 
        required to undergo implicit bias, cultural competency, 
        respectful care practices, or empathy training on a consistent, 
        on-going basis.
            (28) Women are not the only people who can become pregnant 
        or give birth. Nonbinary, transgender, and gender-expansive 
        people can also become pregnant. The terms ``birthing people'' 
        or ``birthing persons'' are also used to describe pregnant or 
        postpartum people in a way that is inclusive of individuals who 
        experience gender beyond the binary.
            (29) Substance misuse among pregnant women, including the 
        use of substances that are illegal or criminalized, misuse of 
        prescribed medications, and binge drinking, has increased year 
        after year for the past decade. Pregnant people with substance 
        use disorder, particularly those with opioids, amphetamines, 
        and cocaine use disorders, are at greater risk of severe 
        maternal morbidity, including conditions such as eclampsia, 
        heart attack or failure, and sepsis.

SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO PREVENTION OF 
              MATERNAL MORTALITY.

    (a) Funding for State-Based Perinatal Quality Collaboratives 
Development and Sustainability.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this subsection as the ``Secretary''), 
        acting through the Division of Reproductive Health of the 
        Centers for Disease Control and Prevention, shall establish a 
        grant program to be known as the State-Based Perinatal Quality 
        Collaborative grant program under which the Secretary awards 
        grants to eligible entities for the purpose of development and 
        sustainability of perinatal quality collaboratives in every 
        State, the District of Columbia, and eligible territories, in 
        order to measurably improve perinatal care and perinatal health 
        outcomes for pregnant and postpartum women and their infants.
            (2) Grant amounts.--Grants awarded under this subsection 
        shall be in amounts not to exceed $250,000 per year, for the 
        duration of the grant period.
            (3) State-based perinatal quality collaborative defined.--
        For purposes of this subsection, the term ``State-based 
        perinatal quality collaborative'' means a network of teams 
        that--
                    (A) is multidisciplinary in nature and includes the 
                full range of perinatal and maternity care providers;
                    (B) works to improve measurable outcomes for 
                maternal and infant health by advancing evidence-
                informed clinical practices using quality improvement 
                principles;
                    (C) works with hospital-based or outpatient 
                facility-based clinical teams, experts, and 
                stakeholders, including patients and families, to 
                spread best practices and optimize resources to improve 
                perinatal care and outcomes;
                    (D) employs strategies that include the use of the 
                collaborative learning model to provide opportunities 
                for hospitals and clinical teams to collaborate on 
                improvement strategies, rapid-response data to provide 
                timely feedback to hospital and other clinical teams to 
                track progress, and quality improvement science to 
                provide support and coaching to hospital and clinical 
                teams;
                    (E) has the goal of improving population-level 
                outcomes in maternal and infant health; and
                    (F) has the goal of improving outcomes of all 
                birthing people, through the coordination, integration, 
                and collaboration across birth settings.
            (4) Authorization of appropriations.--For purposes of 
        carrying out this subsection, there is authorized to be 
        appropriated $35,000,000 for each of fiscal years 2024 through 
        2028.
    (b) Expansion of Medicaid and CHIP Coverage for Pregnant and 
Postpartum Women.--
            (1) Requiring coverage of oral health services for pregnant 
        and postpartum women.--
                    (A) Medicaid.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d) is amended--
                            (i) in subsection (a)(4)--
                                    (I) by striking ``; and (D)'' and 
                                inserting ``; (D)'';
                                    (II) by striking ``; and (E)'' and 
                                inserting ``; (E)'';
                                    (III) by striking ``; and (F)'' and 
                                inserting ``; (F)''; and
                                    (IV) by striking the semicolon at 
                                the end and inserting ``; and (G) oral 
                                health services for pregnant and 
                                postpartum women (as defined in 
                                subsection (jj));''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(jj) Oral Health Services for Pregnant and Postpartum Women.--
            ``(1) In general.--For purposes of this title, the term 
        `oral health services for pregnant and postpartum women' means 
        dental services necessary to prevent disease and promote oral 
        health, restore oral structures to health and function, and 
        treat emergency conditions that are furnished to a woman during 
        pregnancy (or during the 1-year period beginning on the last 
        day of the pregnancy).
            ``(2) Coverage requirements.--To satisfy the requirement to 
        provide oral health services for pregnant and postpartum women, 
        a State shall, at a minimum, provide coverage for preventive, 
        diagnostic, periodontal, and restorative care consistent with 
        recommendations for perinatal oral health care and dental care 
        during pregnancy from the American Academy of Pediatric 
        Dentistry and the American College of Obstetricians and 
        Gynecologists.''.
                    (B) CHIP.--Section 2103(c)(6) of the Social 
                Security Act (42 U.S.C. 1397cc(c)(6)) is amended--
                            (i) in subparagraph (A)--
                                    (I) by inserting ``or a targeted 
                                low-income pregnant woman'' after 
                                ``targeted low-income child''; and
                                    (II) by inserting ``, and, in the 
                                case of a targeted low-income child who 
                                is pregnant or a targeted low-income 
                                pregnant woman, satisfy the coverage 
                                requirements specified in section 
                                1905(jj)'' after ``emergency 
                                conditions''; and
                            (ii) in subparagraph (B), by inserting 
                        ``(but only if, in the case of a targeted low-
                        income child who is pregnant or a targeted low-
                        income pregnant woman, the benchmark dental 
                        benefit package satisfies the coverage 
                        requirements specified in section 1905(jj))'' 
                        after ``subparagraph (C)''.
            (2) Requiring 12-month continuous coverage of full benefits 
        for pregnant and postpartum individuals under medicaid and 
        chip.--
                    (A) Medicaid.--Section 1902 of the Social Security 
                Act (42 U.S.C. 1396a) is amended--
                            (i) in subsection (a)--
                            (ii) in paragraph (86), by striking ``and'' 
                        at the end;
                            (iii) in paragraph (87), by striking the 
                        period at the end and inserting ``; and''; and
                            (iv) by inserting after paragraph (87) the 
                        following new paragraph:
            ``(88) provide that the State plan is in compliance with 
        subsection (e)(16).''; and
                            (v) in subsection (e)(16)--
                                    (I) in subparagraph (A), by 
                                striking ``At the option of the State, 
                                the State plan (or waiver of such State 
                                plan) may provide'' and inserting ``A 
                                State plan (or waiver of such State 
                                plan) shall provide'';
                                    (II) in subparagraph (B), in the 
                                matter preceding clause (i), by 
                                striking ``by a State making an 
                                election under this paragraph'' and 
                                inserting ``under a State plan (or a 
                                waiver of such State plan)''; and
                                    (III) by striking subparagraph (C).
                    (B) CHIP.--
                            (i) In general.--Section 2107(e)(1)(J) of 
                        the Social Security Act (42 U.S.C. 
                        1397gg(e)(1)(J)), as inserted by section 9822 
                        of the American Rescue Plan Act of 2021 (Public 
                        Law 117-2), is amended to read as follows:
                    ``(J) Paragraphs (5) and (16) of section 1902(e) 
                (relating to the requirement to provide medical 
                assistance under the State plan or waiver consisting of 
                full benefits during pregnancy and throughout the 12-
                month postpartum period under title XIX).''.
                            (ii) Conforming.--Section 2112(d)(2)(A) of 
                        the Social Security Act (42 U.S.C. 
                        1397ll(d)(2)(A)) is amended by striking ``the 
                        month in which the 60-day period'' and all that 
                        follows through ``pursuant to section 
                        2107(e)(1),''.
            (3) Maintenance of effort.--
                    (A) Medicaid.--Section 1902(l) of the Social 
                Security Act (42 U.S.C. 1396a(l)) is amended by adding 
                at the end the following new paragraph:
    ``(5) During the period that begins on the date of enactment of 
this paragraph and ends on the date that is 5 years after such date of 
enactment, as a condition for receiving any Federal payments under 
section 1903(a) for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to women who are eligible 
for medical assistance under the State plan or under a waiver of such 
plan on the basis of being pregnant or having been pregnant, 
eligibility standards, methodologies, or procedures under the State 
plan or waiver that are more restrictive than the eligibility 
standards, methodologies, or procedures, respectively, under such plan 
or waiver that are in effect on the date of enactment of this 
paragraph.''.
                    (B) CHIP.--Section 2105(d) of the Social Security 
                Act (42 U.S.C. 1397ee(d)) is amended by adding at the 
                end the following new paragraph:
            ``(4) In eligibility standards for targeted low-income 
        pregnant women.--During the period that begins on the date of 
        enactment of this paragraph and ends on the date that is 5 
        years after such date of enactment, as a condition of receiving 
        payments under subsection (a) and section 1903(a), a State that 
        elects to provide assistance to women on the basis of being 
        pregnant (including pregnancy-related assistance provided to 
        targeted low-income pregnant women (as defined in section 
        2112(d)), pregnancy-related assistance provided to women who 
        are eligible for such assistance through application of section 
        1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
        assistance under the State child health plan (or a waiver of 
        such plan) which is provided to women on the basis of being 
        pregnant) shall not have in effect, with respect to such women, 
        eligibility standards, methodologies, or procedures under such 
        plan (or waiver) that are more restrictive than the eligibility 
        standards, methodologies, or procedures, respectively, under 
        such plan (or waiver) that are in effect on the date of 
        enactment of this paragraph.''.
            (4) Information on benefits.--The Secretary of Health and 
        Human Services shall make publicly available on the internet 
        website of the Department of Health and Human Services, 
        information regarding benefits available to pregnant and 
        postpartum women and under the Medicaid program and the 
        Children's Health Insurance Program, including information on--
                    (A) benefits that States are required to provide to 
                pregnant and postpartum women under such programs;
                    (B) optional benefits that States may provide to 
                pregnant and postpartum women under such programs; and
                    (C) the availability of different kinds of benefits 
                for pregnant and postpartum women, including oral 
                health and mental health benefits and breastfeeding 
                services and supplies, under such programs.
            (5) Federal funding for cost of extended medicaid and chip 
        coverage for postpartum women.--
                    (A) Medicaid.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d), as amended by paragraph (1), is 
                further amended by adding at the end the following:
    ``(kk) Increased FMAP for Extended Medical Assistance for 
Postpartum Individuals.--
            ``(1) In general.--Notwithstanding subsection (b), the 
        Federal medical assistance percentage for a State, with respect 
        to amounts expended by such State for medical assistance for an 
        individual who is eligible for such assistance on the basis of 
        being pregnant or having been pregnant that is provided during 
        the 305-day period that begins on the 60th day after the last 
        day of the individual's pregnancy (including any such 
        assistance provided during the month in which such period 
        ends), shall be equal to--
                    ``(A) during the first 20-quarter period for which 
                this subsection is in effect with respect to a State, 
                100 percent; and
                    ``(B) with respect to a State, during each quarter 
                thereafter, 90 percent.
            ``(2) Exclusion from territorial caps.-- Any payment made 
        to a territory for expenditures for medical assistance for an 
        individual described in paragraph (1) that is subject to the 
        Federal medical assistance percentage specified under paragraph 
        (1) shall not be taken into account for purposes of applying 
        payment limits under subsections (f) and (g) of section 
        1108.''.
                    (B) CHIP.--Section 2105(c) of the Social Security 
                Act (42 U.S.C. 1397ee(c)) is amended by adding at the 
                end the following new paragraph:
            ``(13) Enhanced payment for extended assistance provided to 
        pregnant women.-- Notwithstanding subsection (b), the enhanced 
        FMAP, with respect to payments under subsection (a) for 
        expenditures under the State child health plan (or a waiver of 
        such plan) for assistance provided under the plan (or waiver) 
        to a woman who is eligible for such assistance on the basis of 
        being pregnant (including pregnancy-related assistance provided 
        to a targeted low-income pregnant woman (as defined in section 
        2112(d)), pregnancy-related assistance provided to a woman who 
        is eligible for such assistance through application of section 
        1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
        assistance under the plan (or waiver) provided to a woman who 
        is eligible for such assistance on the basis of being pregnant) 
        during the 305-day period that begins on the 60th day after the 
        last day of her pregnancy (including any such assistance 
        provided during the month in which such period ends), shall be 
        equal to--
                    ``(A) during the first 20-quarter period for which 
                this subsection is in effect with respect to a State, 
                100 percent; and
                    ``(B) with respect to a State, during each quarter 
                thereafter, 90 percent.''.
            (6) Guidance on state options for medicaid coverage of 
        doula services.--Not later than 1 year after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services shall issue guidance for the States concerning options 
        for Medicaid coverage and payment for support services provided 
        by doulas.
            (7) Enhanced fmap for rural obstetric and gynecological 
        services.--Section 1905 of the Social Security Act (42 U.S.C. 
        1396d), as amended by paragraphs (1) and (5), is further 
        amended--
                    (A) in subsection (b), by striking ``and (ii)'' and 
                inserting ``(ii), (jj), (kk), and (ll)''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(ll) Increased FMAP for Medical Assistance for Obstetric and 
Gynecological Services Furnished at Rural Hospitals.--
            ``(1) In general.--Notwithstanding subsection (b), the 
        Federal medical assistance percentage for a State, with respect 
        to amounts expended by such State for medical assistance for 
        obstetric or gynecological services that are furnished in a 
        hospital that is located in a rural area (as defined for 
        purposes of section 1886) shall be equal to 90 percent for each 
        calendar quarter beginning with the first calendar quarter 
        during which this subsection is in effect.
            ``(2) Exclusion from territorial caps.--Any payment made to 
        a territory for expenditures for medical assistance described 
        in paragraph (1) that is subject to the Federal medical 
        assistance percentage specified under paragraph (1) shall not 
        be taken into account for purposes of applying payment limits 
        under subsections (f) and (g) of section 1108.''.
            (8) Effective dates.--
                    (A) In general.--Subject to subparagraphs (B) and 
                (C)--
                            (i) the amendments made by paragraphs (1), 
                        (2), and (5) shall take effect on the first day 
                        of the first calendar quarter that begins on or 
                        after the date that is 1 year after the date of 
                        enactment of this Act;
                            (ii) the amendments made by paragraph (3) 
                        shall take effect on the date of enactment of 
                        this Act; and
                            (iii) the amendments made by paragraph (7) 
                        shall take effect on the first day of the first 
                        calendar quarter that begins on or after the 
                        date of enactment of this Act.
                    (B) Exception for state legislation.--In the case 
                of a State plan under title XIX of the Social Security 
                Act or a State child health plan under title XXI of 
                such Act that the Secretary of Health and Human 
                Services determines requires State legislation in order 
                for the respective plan to meet any requirement imposed 
                by amendments made by this subsection, the respective 
                plan shall not be regarded as failing to comply with 
                the requirements of such title solely on the basis of 
                its failure to meet such an additional requirement 
                before the first day of the first calendar quarter 
                beginning after the close of the first regular session 
                of the State legislature that begins after the date of 
                enactment of this Act. For purposes of the previous 
                sentence, in the case of a State that has a 2-year 
                legislative session, each year of the session shall be 
                considered to be a separate regular session of the 
                State legislature.
                    (C) State option for earlier effective date.--A 
                State may elect to have subsection (e)(16) of section 
                1902 of the Social Security Act (42 U.S.C. 1396a) and 
                subparagraph (J) of section 2107(e)(1) of the Social 
                Security Act (42 U.S.C. 1397gg(e)(1)), as amended by 
                paragraph (2), and subsection (kk) of section 1905 of 
                the Social Security Act (42 U.S.C. 1396d) and paragraph 
                (13) of section 2105(c) of the Social Security Act (42 
                U.S.C. 1397ee(c)), as added by paragraph (5), take 
                effect with respect to the State on the first day of 
                any fiscal quarter that begins before the date 
                described in subparagraph (A) and apply to amounts 
                payable to the State for expenditures for medical 
                assistance, child health assistance, or pregnancy-
                related assistance to pregnant or postpartum 
                individuals furnished on or after such day.
    (c) Regional Centers of Excellence.--Part P of title III of the 
Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding 
at the end the following:

``SEC. 399V-8. REGIONAL CENTERS OF EXCELLENCE ADDRESSING IMPLICIT BIAS 
              AND CULTURAL COMPETENCY IN PATIENT-PROVIDER INTERACTIONS 
              EDUCATION.

    ``(a) In General.--Not later than one year after the date of 
enactment of this section, the Secretary, in consultation with such 
other agency heads as the Secretary determines appropriate, shall award 
cooperative agreements for the establishment or support of regional 
centers of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider interactions 
education for the purpose of enhancing and improving how health care 
professionals are educated in implicit bias and delivering culturally 
competent health care.
    ``(b) Eligibility.--To be eligible to receive a cooperative 
agreement under subsection (a), an entity shall--
            ``(1) be a public or other nonprofit entity specified by 
        the Secretary that provides educational and training 
        opportunities for students and health care professionals, which 
        may be a health system, teaching hospital, community health 
        center, medical school, school of public health, school of 
        nursing, dental school, social work school, school of 
        professional psychology, or any other health professional 
        school or program at an institution of higher education (as 
        defined in section 101 of the Higher Education Act of 1965) 
        focused on the prevention, treatment, or recovery of health 
        conditions that contribute to maternal mortality and the 
        prevention of maternal mortality and severe maternal morbidity;
            ``(2) demonstrate community engagement and participation, 
        such as through partnerships with home visiting and case 
        management programs and community-based organizations serving 
        minority populations;
            ``(3) demonstrate engagement with groups engaged in the 
        implementation of health care professional training in implicit 
        bias and delivering culturally competent care, such as 
        departments of public health, perinatal quality collaboratives, 
        hospital systems, and health care professional groups, in order 
        to obtain input on resources needed for effective 
        implementation strategies; and
            ``(4) provide to the Secretary such information, at such 
        time and in such manner, as the Secretary may require.
    ``(c) Diversity.--In awarding a cooperative agreement under 
subsection (a), the Secretary shall take into account any regional 
differences among eligible entities and make an effort to ensure 
geographic diversity among award recipients.
    ``(d) Dissemination of Information.--
            ``(1) Public availability.--The Secretary shall make 
        publicly available on the internet website of the Department of 
        Health and Human Services information submitted to the 
        Secretary under subsection (b)(3).
            ``(2) Evaluation.--The Secretary shall evaluate each 
        regional center of excellence established or supported pursuant 
        to subsection (a) and disseminate the findings resulting from 
        each such evaluation to the appropriate public and private 
        entities.
            ``(3) Distribution.--The Secretary shall share evaluations 
        and overall findings with State departments of health and other 
        relevant State level offices to inform State and local best 
        practices.
    ``(e) Maternal Mortality Defined.--In this section, the term 
`maternal mortality' means death of a woman that occurs during 
pregnancy or within the one-year period following the end of such 
pregnancy.
    ``(f) Authorization of Appropriations.--For purposes of carrying 
out this section, there is authorized to be appropriated $5,000,000 for 
each of fiscal years 2024 through 2028.''.
    (d) Special Supplemental Nutrition Program for Women, Infants, and 
Children.--Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 
(42 U.S.C. 1786(d)(3)(A)(ii)) is amended--
            (1) by striking the clause designation and heading and all 
        that follows through ``A State'' and inserting the following:
                            ``(ii) Women.--
                                    ``(I) Breastfeeding women.--A 
                                State'';
            (2) in subclause (I) (as so designated), by striking ``1 
        year'' and all that follows through ``earlier'' and inserting 
        ``2 years postpartum''; and
            (3) by adding at the end the following:
                                    ``(II) Postpartum women.--A State 
                                may elect to certify a postpartum woman 
                                for a period of 2 years.''.
    (e) Definition of Maternal Mortality.--In this section, the term 
``maternal mortality'' means death of a woman that occurs during 
pregnancy or within the one-year period following the end of such 
pregnancy.

SEC. 4. FULL SPECTRUM DOULA WORKFORCE.

    (a) In General.--The Secretary of Health and Human Services shall 
establish and implement a program to award grants or contracts to 
health professions schools, schools of public health, academic health 
centers, State or local governments, territories, Indian Tribes and 
Tribal organizations, Urban Indian organizations, Native Hawaiian 
organizations, or other appropriate public or private nonprofit 
entities or community-based organizations (or consortia of any such 
entities, including entities promoting multidisciplinary approaches), 
to establish or expand programs to grow and diversify the doula 
workforce, including through improving the capacity and supply of 
health care providers.
    (b) Use of Funds.--Amounts made available by subsection (a) shall 
be used for the following activities:
            (1) Establishing programs that provide education and 
        training to individuals seeking appropriate training or 
        certification as full spectrum doulas.
            (2) Expanding the capacity of existing programs described 
        in paragraph (1), for the purpose of increasing the number of 
        students enrolled in such programs, including by awarding 
        scholarships for students who agree to work in underserved 
        communities after receiving such education and training.
            (3) Developing and implementing strategies to recruit and 
        retain students from underserved communities, particularly from 
        demographic groups experiencing high rates of maternal 
        mortality and severe maternal morbidity, including racial and 
        ethnic minority groups, into programs described in paragraphs 
        (1) and (2).
    (c) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary of Health and Human Services for fiscal 
year 2024, out of any money in the Treasury not otherwise appropriated, 
$50,000,000, to remain available until expended, for carrying out this 
section.

SEC. 5. GRANTS FOR RURAL OBSTETRIC MOBILE HEALTH UNITS.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by adding at the end the following:

``SEC. 320C. GRANTS FOR RURAL OBSTETRIC MOBILE HEALTH UNITS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration (referred to in 
this section as the `Secretary'), shall establish a pilot program under 
which the Secretary shall make grants to States--
            ``(1) to purchase and equip rural mobile health units for 
        the purpose of providing pre-conception, pregnancy, postpartum, 
        and obstetric emergency services in rural and underserved 
        communities;
            ``(2) to train providers including obstetrician-
        gynecologists, certified nurse-midwives, nurse practitioners, 
        nurses, and midwives to operate and provide obstetric services, 
        including training and planning for obstetric emergencies, in 
        such mobile health units; and
            ``(3) to address access issues, including social 
        determinants of health and wrap-around clinical and community 
        services including nutrition, housing, lactation services, and 
        transportation support and referrals.
    ``(b) No Sharing of Data With Law Enforcement.--As a condition of 
receiving a grant under this section, a State shall submit to the 
Secretary an assurance that the State will not make available to 
Federal or State law enforcement any personally identifiable 
information regarding any pregnant or postpartum individual collected 
pursuant to such grant.
    ``(c) Grant Duration.--The period of a grant under this section 
shall not exceed 5 years.
    ``(d) Implementing and Reporting.--
            ``(1) In general.--States that receive pilot grants under 
        this section shall--
                    ``(A) implement the program funded by the pilot 
                grants; and
                    ``(B) not later than 3 years after the date of 
                enactment of this section, and not later than 6 years 
                after such date of enactment, submit to the Secretary a 
                report that describes the results of such program, 
                including--
                            ``(i) relevant information and relevant 
                        quantitative indicators of the programs' 
                        success in improving the standard of care and 
                        maternal health outcomes for individuals in 
                        rural and underserved communities seen for pre-
                        conception, pregnancy, or postpartum visits in 
                        the rural mobile health units, stratified by 
                        the categories of data specified in paragraph 
                        (2);
                            ``(ii) relevant qualitative evaluations 
                        from individuals receiving pre-conception, 
                        pregnant, or postpartum care from rural mobile 
                        health units, including measures of patient-
                        reported experience of care and measures of 
                        patient-reported issues with access to care 
                        without the rural mobile health unit pilot; and
                            ``(iii) strategies to sustain such programs 
                        beyond the duration of the grant and expand 
                        such programs to other rural and underserved 
                        communities.
            ``(2) Categories of data.--The categories of data specified 
        in this paragraph are the following:
                    ``(A) Race, ethnicity, sex, gender, gender 
                identity, primary language, age, geography, insurance 
                status, disability status.
                    ``(B) Number of visits provided for preconception, 
                prenatal, or postpartum care.
                    ``(C) Number of repeat visits provided for 
                preconception, prenatal, or postpartum care.
                    ``(D) Number of screenings or tests provided for 
                smoking, substance use, hypertension, sexually-
                transmitted diseases, diabetes, HIV, depression, 
                intimate partner violence, pap smears, and pregnancy.
            ``(3) Data privacy protection.--The reports referred to in 
        paragraph (1)(B) shall not contain any personally identifiable 
        information regarding any pregnant or postpartum individual.
    ``(e) Evaluation.--The Secretary shall conduct an evaluation of the 
pilot program under this section to determine the impact of the pilot 
program with respect to--
            ``(1) the effectiveness of the grants awarded under this 
        section to improve maternal health outcomes in rural and 
        underserved communities, with data stratified by race, 
        ethnicity, primary language, socioeconomic status, geography, 
        insurance type, and other factors as the Secretary determines 
        appropriate;
            ``(2) spending on maternity care by States participating in 
        the pilot program;
            ``(3) to the extent practicable, qualitative and 
        quantitative measures of patient experience; and
            ``(4) any other areas of assessment that the Secretary 
        determines relevant.
    ``(f) Report.--Not later than one year after the completion of the 
pilot program under this section, the Secretary shall submit to 
Congress, and make publicly available, a report that describes--
            ``(1) the results of the evaluation conducted under 
        subsection (e); and
            ``(2) a recommendation regarding whether the pilot program 
        should be continued after fiscal year 2028 and expanded on a 
        national basis.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary to carry out this section $10,000,000 for 
each of fiscal years 2024 through 2028.''.

SEC. 6. REQUIRING NOTIFICATION OF IMPENDING HOSPITAL OBSTETRIC UNIT 
              CLOSURE.

    Section 1866(a)(1) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)) is amended--
            (1) in subparagraph (X), by striking ``and'' at the end;
            (2) in subparagraph (Y)(ii)(V), by striking the period and 
        inserting ``, and''; and
            (3) by inserting after subparagraph (Y) the following new 
        subparagraph:
            ``(Z) beginning 180 days after the date of the enactment of 
        this subparagraph, in the case of a hospital, not less than 90 
        days prior to the closure of any obstetric unit of the 
        hospital, to submit to the Secretary a notification which shall 
        include--
                    ``(i) a report analyzing the impact the closure 
                will have on the community;
                    ``(ii) steps the hospital will take to identify 
                other health care providers that can alleviate any 
                service gaps as a result of the closure; and
                    ``(iii) any additional information as may be 
                required by the Secretary.''.

SEC. 7. EVALUATION AND REPORT ON MATERNAL HEALTH NEEDS.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Secretary of Health and Human Services shall conduct, 
and submit to Congress a report that describes the results of, an 
evaluation of--
            (1) where the maternal health needs are greatest in the 
        United States; and
            (2) the Federal expenditures made to address such needs.
    (b) Period Covered.--The evaluation under subsection (a) shall 
cover the period of calendar years 2000 through 2022.
    (c) Analysis.--The evaluation under subsection (a) shall include 
analysis of the following:
            (1) How Federal funds provided to States for maternal 
        health were distributed across regions, States, and localities 
        or counties.
            (2) Barriers to applying for and receiving Federal funds 
        for maternal health, including, with respect to initial 
        applications--
                    (A) requirements for submission in partnership with 
                other entities; and
                    (B) stringent network requirements.
            (3) Why applicants did not receive funding, including 
        limited availability of funds, the strength of the respective 
        applications, and failure to adhere to requirements.
    (d) Disaggregation of Data.--The report under subsection (a) shall 
disaggregate data on mothers served by race, ethnicity, insurance 
status, and language spoken.

SEC. 8. INCREASING EXCISE TAXES ON CIGARETTES AND ESTABLISHING EXCISE 
              TAX EQUITY AMONG ALL TOBACCO PRODUCT TAX RATES.

    (a) Tax Parity for Roll-Your-Own Tobacco.--Section 5701(g) of the 
Internal Revenue Code of 1986 is amended by striking ``$24.78'' and 
inserting ``$49.56''.
    (b) Tax Parity for Pipe Tobacco.--Section 5701(f) of the Internal 
Revenue Code of 1986 is amended by striking ``$2.8311 cents'' and 
inserting ``$49.56''.
    (c) Tax Parity for Smokeless Tobacco.--
            (1) Section 5701(e) of the Internal Revenue Code of 1986 is 
        amended--
                    (A) in paragraph (1), by striking ``$1.51'' and 
                inserting ``$26.84'';
                    (B) in paragraph (2), by striking ``50.33 cents'' 
                and inserting ``$10.74''; and
                    (C) by adding at the end the following:
            ``(3) Smokeless tobacco sold in discrete single-use 
        units.--On discrete single-use units, $100.66 per thousand.''.
            (2) Section 5702(m) of such Code is amended--
                    (A) in paragraph (1), by striking ``or chewing 
                tobacco'' and inserting ``, chewing tobacco, or 
                discrete single-use unit'';
                    (B) in paragraphs (2) and (3), by inserting ``that 
                is not a discrete single-use unit'' before the period 
                in each such paragraph; and
                    (C) by adding at the end the following:
            ``(4) Discrete single-use unit.--The term `discrete single-
        use unit' means any product containing, made from, or derived 
        from tobacco or nicotine that--
                    ``(A) is not intended to be smoked; and
                    ``(B) is in the form of a lozenge, tablet, pill, 
                pouch, dissolvable strip, or other discrete single-use 
                or single-dose unit.''.
    (d) Tax Parity for Small Cigars.--Paragraph (1) of section 5701(a) 
of the Internal Revenue Code of 1986 is amended by striking ``$50.33'' 
and inserting ``$100.66''.
    (e) Tax Parity for Large Cigars.--
            (1) In general.--Paragraph (2) of section 5701(a) of the 
        Internal Revenue Code of 1986 is amended by striking ``52.75 
        percent'' and all that follows through the period and inserting 
        the following: ``$49.56 per pound and a proportionate tax at 
        the like rate on all fractional parts of a pound but not less 
        than 10.066 cents per cigar.''.
            (2) Guidance.--The Secretary of the Treasury, or the 
        Secretary's delegate, may issue guidance regarding the 
        appropriate method for determining the weight of large cigars 
        for purposes of calculating the applicable tax under section 
        5701(a)(2) of the Internal Revenue Code of 1986.
            (3) Conforming amendment.--Section 5702 of such Code is 
        amended by striking subsection (l).
    (f) Tax Parity for Roll-Your-Own Tobacco and Certain Processed 
Tobacco.--Subsection (o) of section 5702 of the Internal Revenue Code 
of 1986 is amended by inserting ``, and includes processed tobacco that 
is removed for delivery or delivered to a person other than a person 
with a permit provided under section 5713, but does not include 
removals of processed tobacco for exportation'' after ``wrappers 
thereof''.
    (g) Clarifying Tax Rate for Other Tobacco Products.--
            (1) In general.--Section 5701 of the Internal Revenue Code 
        of 1986 is amended by adding at the end the following new 
        subsection:
    ``(i) Other Tobacco Products.--Any product not otherwise described 
under this section that has been determined to be a tobacco product by 
the Food and Drug Administration through its authorities under the 
Family Smoking Prevention and Tobacco Control Act shall be taxed at a 
level of tax equivalent to the tax rate for cigarettes on an estimated 
per use basis as determined by the Secretary.''.
            (2) Establishing per use basis.--For purposes of section 
        5701(i) of the Internal Revenue Code of 1986, not later than 12 
        months after the later of the date of the enactment of this Act 
        or the date that a product has been determined to be a tobacco 
        product by the Food and Drug Administration, the Secretary of 
        the Treasury (or the Secretary of the Treasury's delegate) 
        shall issue final regulations establishing the level of tax for 
        such product that is equivalent to the tax rate for cigarettes 
        on an estimated per use basis.
    (h) Clarifying Definition of Tobacco Products.--
            (1) In general.--Subsection (c) of section 5702 of the 
        Internal Revenue Code of 1986 is amended to read as follows:
    ``(c) Tobacco Products.--The term `tobacco products' means--
            ``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco, 
        and roll-your-own tobacco, and
            ``(2) any other product subject to tax pursuant to section 
        5701(i).''.
            (2) Conforming amendments.--Subsection (d) of section 5702 
        of such Code is amended by striking ``cigars, cigarettes, 
        smokeless tobacco, pipe tobacco, or roll-your-own tobacco'' 
        each place it appears and inserting ``tobacco products''.
    (i) Increasing Tax on Cigarettes.--
            (1) Small cigarettes.--Section 5701(b)(1) of such Code is 
        amended by striking ``$50.33'' and inserting ``$100.66''.
            (2) Large cigarettes.--Section 5701(b)(2) of such Code is 
        amended by striking ``$105.69'' and inserting ``$211.38''.
    (j) Tax Rates Adjusted for Inflation.--Section 5701 of such Code, 
as amended by subsection (g), is amended by adding at the end the 
following new subsection:
    ``(j) Inflation Adjustment.--
            ``(1) In general.--In the case of any calendar year 
        beginning after 2023, the dollar amounts provided under this 
        chapter shall each be increased by an amount equal to--
                    ``(A) such dollar amount, multiplied by
                    ``(B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year, determined 
                by substituting `calendar year 2022' for `calendar year 
                2016' in subparagraph (A)(ii) thereof.
            ``(2) Rounding.--If any amount as adjusted under paragraph 
        (1) is not a multiple of $0.01, such amount shall be rounded to 
        the next highest multiple of $0.01.''.
    (k) Floor Stocks Taxes.--
            (1) Imposition of tax.--On tobacco products manufactured in 
        or imported into the United States which are removed before any 
        tax increase date and held on such date for sale by any person, 
        there is hereby imposed a tax in an amount equal to the excess 
        of--
                    (A) the tax which would be imposed under section 
                5701 of the Internal Revenue Code of 1986 on the 
                article if the article had been removed on such date, 
                over
                    (B) the prior tax (if any) imposed under section 
                5701 of such Code on such article.
            (2) Credit against tax.--Each person shall be allowed as a 
        credit against the taxes imposed by paragraph (1) an amount 
        equal to the lesser of $1,000 or the amount of such taxes. For 
        purposes of the preceding sentence, all persons treated as a 
        single employer under subsection (b), (c), (m), or (o) of 
        section 414 of the Internal Revenue Code of 1986 shall be 
        treated as 1 person for purposes of this paragraph.
            (3) Liability for tax and method of payment.--
                    (A) Liability for tax.--A person holding tobacco 
                products on any tax increase date to which any tax 
                imposed by paragraph (1) applies shall be liable for 
                such tax.
                    (B) Method of payment.--The tax imposed by 
                paragraph (1) shall be paid in such manner as the 
                Secretary shall prescribe by regulations.
                    (C) Time for payment.--The tax imposed by paragraph 
                (1) shall be paid on or before the date that is 120 
                days after the effective date of the tax rate increase.
            (4) Articles in foreign trade zones.--Notwithstanding the 
        Act of June 18, 1934 (commonly known as the Foreign Trade Zone 
        Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other 
        provision of law, any article which is located in a foreign 
        trade zone on any tax increase date shall be subject to the tax 
        imposed by paragraph (1) if--
                    (A) internal revenue taxes have been determined, or 
                customs duties liquidated, with respect to such article 
                before such date pursuant to a request made under the 
                first proviso of section 3(a) of such Act, or
                    (B) such article is held on such date under the 
                supervision of an officer of the United States Customs 
                and Border Protection of the Department of Homeland 
                Security pursuant to the second proviso of such section 
                3(a).
            (5) Definitions.--For purposes of this subsection--
                    (A) In general.--Any term used in this subsection 
                which is also used in section 5702 of such Code shall 
                have the same meaning as such term has in such section.
                    (B) Tax increase date.--The term ``tax increase 
                date'' means the effective date of any increase in any 
                tobacco product excise tax rate pursuant to the 
                amendments made by this section (other than subsection 
                (j) thereof).
                    (C) Secretary.--The term ``Secretary'' means the 
                Secretary of the Treasury or the Secretary's delegate.
            (6) Controlled groups.--Rules similar to the rules of 
        section 5061(e)(3) of such Code shall apply for purposes of 
        this subsection.
            (7) Other laws applicable.--All provisions of law, 
        including penalties, applicable with respect to the taxes 
        imposed by section 5701 of such Code shall, insofar as 
        applicable and not inconsistent with the provisions of this 
        subsection, apply to the floor stocks taxes imposed by 
        paragraph (1), to the same extent as if such taxes were imposed 
        by such section 5701. The Secretary may treat any person who 
        bore the ultimate burden of the tax imposed by paragraph (1) as 
        the person to whom a credit or refund under such provisions may 
        be allowed or made.
    (l) Effective Dates.--
            (1) In general.--Except as provided in paragraphs (2) and 
        (3), the amendments made by this section shall apply to 
        articles removed (as defined in section 5702(j) of the Internal 
        Revenue Code of 1986) after the last day of the month which 
        includes the date of the enactment of this Act.
            (2) Discrete single-use units, large cigars, and processed 
        tobacco.--The amendments made by subsections (c)(1)(C), (c)(2), 
        (e), and (f) shall apply to articles removed (as defined in 
        section 5702(j) of the Internal Revenue Code of 1986) after the 
        date that is 6 months after the date of the enactment of this 
        Act.
            (3) Other tobacco products.--The amendments made by 
        subsection (g)(1) shall apply to products removed after the 
        last day of the month which includes the date that the 
        Secretary of the Treasury (or the Secretary of the Treasury's 
        delegate) issues final regulations establishing the level of 
        tax for such product.
                                 <all>
```