II 

109TH CONGRESS 

2D SESSION S. 3915 

To amend title XIX of the Social Security Act to encourage States to 

provide pregnant women enrolled in the Medicaid program with access 

to comprehensive tobacco cessation services. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 20, 2006 

Mr. HARKIN (for himself, Mr. DURBIN, Mr. DODD, Mr. LAUTENBERG, Mr. 

SCHUMER, and Mr. JOHNSON) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to encourage 

States to provide pregnant women enrolled in the Medicaid program with access to comprehensive tobacco cessation services. 

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 ‘‘Smoke Free Mothers 

5 and Babies Act of 2006’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) At least 1 out of every 10 pregnant women 

2 in the United States smokes, which accounts for 

3 over 500,000 births per year. 

4 (2) Tobacco use during pregnancy causes seri5 ous harm to the fetus. Fetal mortality rates are 35 

6 percent higher among pregnant women who smoke 

7 than among nonsmokers and the Surgeon General 

8 reports that a pregnant woman who smokes is 1.5 

9 to 3.5 times more likely than a non-smoker to have 

10 a low birth weight baby. 

11 (3) Studies have found that smoking and expo12 sure to secondhand smoke among pregnant women 

13 is a major cause of miscarriage, stillbirths, and sud14 den infant death syndrome (SIDS). 

15 (4) Preventing just 1 smoking-related low birth 

16 weight baby can save more than $40,000 in health 

17 care expenditures. 

18 (5) For every $1 spent on smoking cessation 

19 for pregnant women, an estimated $3 in neonatal in20 tensive care costs could be avoided. 

21 (6) Such expenditures have a disproportionate 

22 impact on Medicaid, with estimates indicating that 

23 pregnant women on Medicaid are 2.5 times more 

24 likely to smoke than pregnant women not on Med25 icaid. Smoking-attributable neonatal health care 


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1 costs are estimated to be $1,400,000,000 to 

2 $2,000,000,000 annually, and such costs for Med3 icaid total almost $228,000,000, that is, approxi4 mately, $738 per pregnant smoker. 

5 (7) States this year will collect 

6 $21,300,000,000 from the Master Settlement Agree7 ment of November 23, 1998, between participating 

8 tobacco manufacturers and Attorneys General of 46 

9 States, the District of Columbia, the Commonwealth 

10 of Puerto Rico, and 4 territories of the United 

11 States, other settlement agreements between compa12 nies within the tobacco industry and the States of 

13 Mississippi, Florida, Texas, and Minnesota, and to14 bacco taxes (an increase from $20,000,000,000 in 

15 fiscal year 2005). States are spending only 2.6 per16 cent of their tobacco revenue on tobacco prevention 

17 and cessation. 

18 (8) Evidence shows that the cuts States have 

19 made in tobacco prevention funding since 2002 have 

20 slowed or possibly stalled recent declines in youth 

21 smoking, putting further progress at risk. 


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1 SEC. 3. PROMOTING CESSATION OF TOBACCO USE BY 

2 PREGNANT WOMEN UNDER THE MEDICAID 

3 PROGRAM. 

4 (a) REQUIRING COVERAGE OF COUNSELING AND

5 PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE

6 BY PREGNANT WOMEN.—Section 1905 of the Social Secu7 rity Act (42 U.S.C. 1396d(a)(4)) is amended— 

8 (1) in subsection (a)(4)— 

9 (A) by striking ‘‘and’’ before ‘‘(C)’’; and 

10 (B) by inserting before the semicolon at 

11 the end the following new subparagraph: ‘‘; and 

12 (D) counseling and pharmacotherapy for ces13 sation of tobacco use by pregnant women (as 

14 defined in subsection (y))’’; and 

15 (2) by adding at the end the following: 

16 ‘‘(y)(1) For purposes of this title, the term ‘coun17 seling and pharmacotherapy for cessation of tobacco use 

18 by pregnant women’ means diagnostic, therapy, and coun19 seling services and pharmacotherapy (including the cov20 erage of prescription and nonprescription tobacco ces21 sation agents approved by the Food and Drug Administra22 tion) for cessation of tobacco use by pregnant women who 

23 use tobacco products or who are being treated for tobacco 

24 use that is furnished— 

25 ‘‘(A) by or under the supervision of a physician; 

26 or 


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1 ‘‘(B) by any other health care professional 

2 who— 

3 ‘‘(i) is legally authorized to furnish such 

4 services under State law (or the State regu5 latory mechanism provided by State law) of the 

6 State in which the services are furnished; and 

7 ‘‘(ii) is authorized to receive payment for 

8 other services under this title or is designated 

9 by the Secretary for this purpose. 

10 ‘‘(2) Subject to paragraph (3), such term is limited 

11 to— 

12 ‘‘(A) services recommended with respect to 

13 pregnant women in ‘Treating Tobacco Use and De14 pendence: A Clinical Practice Guideline’, published 

15 by the Public Health Service in June 2000, or any 

16 subsequent modification of such Guideline; and 

17 ‘‘(B) such other services that the Secretary rec18 ognizes to be effective for cessation of tobacco use 

19 by pregnant women. 

20 ‘‘(3) Such term shall not include coverage for drugs 

21 or biologicals that are not otherwise covered under this 

22 title.’’. 

23 (b) EXCEPTION FROM OPTIONAL RESTRICTION

24 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 


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1 Section 1927(d)(2) of the Social Security Act (42 U.S.C. 

2 1396r–8(d)(2)) is amended— 

3 (1) in subparagraph (E), by inserting before the 

4 period at the end the following: ‘‘, except in the case 

5 of pregnant women when recommended in accord6 ance with the Guideline referred to in section 

7 1905(y)(2)(A)’’; and 

8 (2) in subparagraph (G), by inserting before the 

9 period at the end the following: ‘‘, except, in the case 

10 of pregnant women when recommended in accord11 ance with the Guideline referred to in section 

12 1905(y)(2)(A), agents approved by the Food and 

13 Drug Administration for purposes of promoting, and 

14 when used to promote, tobacco cessation’’. 

15 (c) REMOVAL OF COST-SHARING FOR COUNSELING

16 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO

17 USE BY PREGNANT WOMEN.— 

18 (1) GENERAL COST SHARING LIMITATIONS.— 

19 Section 1916 of the Social Security Act (42 U.S.C. 

20 1396o) is amended in each of subsections (a)(2)(B) 

21 and (b)(2)(B) by inserting ‘‘, and counseling and 

22 pharmacotherapy for cessation of tobacco use by 

23 pregnant women (as defined in section 1905(y)) and 

24 covered outpatient drugs (as defined in subsection 

25 (k)(2) of section 1927 and including nonprescription 


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1 drugs described in subsection (d)(2) of such section) 

2 that are prescribed for purposes of promoting, and 

3 when used to promote, tobacco cessation by preg4 nant women in accordance with the Guideline re5 ferred to in section 1905(y)(2)(A)’’ after ‘‘com6 plicate the pregnancy’’. 

7 (2) APPLICATION TO ALTERNATIVE COST SHAR8 ING.—Section 1916A(b)(3)(B)(iii) of such Act (42 

9 U.S.C. 1396o–1(b)(3)(B)(iii)) is amended by insert10 ing ‘‘, and counseling and pharmacotherapy for ces11 sation of tobacco use by pregnant women (as defined 

12 in section 1905(y))’’ after ‘‘complicate the preg13 nancy’’. 

14 (d) INCREASED FMAP FOR TOBACCO CESSATION

15 COUNSELING SERVICES AND MEDICATIONS.—The first 

16 sentence of section 1905(b) of the Social Security Act (42 

17 U.S.C. 1396d(b)) is amended by inserting the following 

18 before the period: ‘‘, or medical assistance for counseling 

19 and pharmacotherapy for cessation of tobacco use by preg20 nant women (as defined in subsection (y)) and for covered 

21 outpatient drugs (as defined in subsection (k)(2) of section 

22 1927 and including nonprescription drugs described in 

23 subsection (d)(2) of such section) that are prescribed for 

24 purposes of promoting, and when used to promote, tobacco 


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1 cessation by pregnant women in accordance with the 

2 Guideline referred to in subsection (y)(2)(A)’’. 

3 (e) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to services furnished on or after 

5 the first fiscal year quarter that begins after the date of 

6 enactment of this Act. 

Æ 


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