I 

117TH CONGRESS 

1ST SESSION H. R. 3407 

To improve Federal efforts with respect to the prevention of maternal 

mortality, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 20, 2021 

Ms. KELLY of Illinois (for herself, Mrs. BEATTY, Ms. MOORE of Wisconsin, 

Ms. DEGETTE, Mr. BLUMENAUER, Mr. SCHNEIDER, Mrs. LAWRENCE, 

Ms. CASTOR of Florida, Ms. DELBENE, Ms. SEWELL, Mr. DEFAZIO, Ms. 

DEAN, Mr. SWALWELL, Mr. MEEKS, Mr. BUTTERFIELD, Mr. CARSON, 

Mr. PAYNE, Ms. KUSTER, Ms. CLARKE of New York, Mr. GRIJALVA, Ms. 

BARRAGA ́N, Ms. MENG, Mr. LOWENTHAL, Ms. LEE of California, Ms. 

WILSON of Florida, and Ms. BLUNT ROCHESTER) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

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, 


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1 SECTION 1. SHORT TITLE. 

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

3 Mortality and Morbidity Awareness Act’’ or the ‘‘MOM4 MA’s Act’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

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

8 4,000,000 women give birth, about 700 women suf9 fer fatal complications during pregnancy, while giv10 ing birth or during the postpartum period, and 

11 about 70,000 women suffer near-fatal, partum-re12 lated complications. 

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

14 a proxy to measure the overall health of a popu15 lation. While the infant mortality rate in the United 

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

17 for women in the United States during pregnancy, 

18 childbirth, or the postpartum period is higher than 

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

20 estimated maternal mortality rate (deaths per 

21 100,000 live births) for the 48 contiguous States 

22 and Washington, DC, increased from 14.5 percent in 

23 2000 to 17.3 in 2017. The United States is the only 

24 industrialized nation with a rising maternal mor25 tality rate. 


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1 (3) The National Vital Statistics System of the 

2 Centers for Disease Control and Prevention has 

3 found that in 2018, there were 17.4 maternal deaths 

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

5 This ratio is more than double that of most other 

6 high-income countries. 

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

8 of maternal deaths in the United States are prevent9 able. 

10 (5) According to the Centers for Disease Con11 trol and Prevention, the maternal mortality rate var12 ies drastically for women by race and ethnicity. 

13 There are about 13 deaths per 100,000 live births 

14 for White women, 40.8 deaths per 100,000 live 

15 births for non-Hispanic Black women, and 29.7 

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

17 Alaskan Native women. While maternal mortality 

18 disparately impacts Black women, this urgent public 

19 health crisis traverses race, ethnicity, socioeconomic 

20 status, educational background, and geography. 

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

22 women are about 3 times more likely to die from 

23 causes related to pregnancy and childbirth compared 

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

25 most disconcerting racial disparities in public health. 


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1 This disparity widens in certain cities and States 

2 across the country. 

3 (7) According to the National Center for Health 

4 Statistics of the Centers for Disease Control and 

5 Prevention, the maternal mortality rate heightens 

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

7 81.9 per 100,000 births compared to 10.6 per 

8 100,000 for women under 25. This translates to 

9 women over 40 being 7.7 times more likely to die 

10 compared to their counterparts under 25 years of 

11 age. 

12 (8) The COVID–19 pandemic risks exacer13 bating the maternal health crisis. A recent study of 

14 the Centers for Disease Control and Prevention sug15 gests that pregnant women are at a significantly 

16 higher risk for severe outcomes, including death, 

17 from COVID–19 as compared to non-pregnant 

18 women. The COVID–19 pandemic has also de19 creased access to prenatal and postpartum care. 

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

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

22 academics, members of the business community, and 

23 providers across the obstetric continuum represented 

24 by organizations such as— 


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1 (A) the American College of Nurse-Mid2 wives; 

3 (B) the American College of Obstetricians 

4 and Gynecologists; 

5 (C) the American Medical Association; 

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

7 Obstetric and Neonatal Nurses; 

8 (E) the Black Mamas Matter Alliance; 

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

10 (G) the California Maternal Quality Care 

11 Collaborative; 

12 (H) EverThrive Illinois; 

13 (I) the Illinois Perinatal Quality Collabo14 rative; 

15 (J) the March of Dimes; 

16 (K) the National Association of Certified 

17 Professional Midwives; 

18 (L) the National Birth Equity Collabo19 rative; 

20 (M) the National Partnership for Women 

21 & Families; 

22 (N) the National Polycystic Ovary Syn23 drome Association; 

24 (O) the Preeclampsia Foundation; 


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1 (P) the Society for Maternal-Fetal Medi2 cine; and 

3 (Q) the What To Expect Project. 

4 (10) Hemorrhage, cardiovascular and coronary 

5 conditions, cardiomyopathy, infection or sepsis, em6 bolism, mental health conditions (including sub7 stance use disorder), hypertensive disorders, stroke 

8 and cerebrovascular accidents, and anesthesia com9 plications are the predominant medical causes of 

10 maternal-related deaths and complications. Most of 

11 these conditions are largely preventable or manage12 able. Even when these conditions are not prevent13 able, mortality and morbidity may be prevented 

14 when conditions are diagnosed and treated in a 

15 timely manner. 

16 (11) According to a study published by the 

17 Journal of Perinatal Education, doula-assisted 

18 mothers are 4 times less likely to have a low-birth19 weight baby, 2 times less likely to experience a birth 

20 complication involving themselves or their baby, and 

21 significantly more likely to initiate breastfeeding. 

22 Doula care has also been shown to produce cost sav23 ings resulting in part from reduced rates of cesarean 

24 and pre-term births. 


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1 (12) Intimate partner violence is one of the 

2 leading causes of maternal death, and women are 

3 more likely to experience intimate partner violence 

4 during pregnancy than at any other time in their 

5 lives. It is also more dangerous than pregnancy. In6 timate partner violence during pregnancy and 

7 postpartum crosses every demographic and has been 

8 exacerbated by the COVID–19 pandemic. 

9 (13) Oral health is an important part of 

10 perinatal health. Reducing bacteria in a woman’s 

11 mouth during pregnancy can significantly reduce her 

12 risk of developing oral diseases and spreading decay13 causing bacteria to her baby. Moreover, some evi14 dence suggests that women with periodontal disease 

15 during pregnancy could be at greater risk for poor 

16 birth outcomes, such as preeclampsia, pre-term 

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

18 oral health during pregnancy is a good predictor of 

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

20 unintentionally spread oral bacteria to their babies, 

21 putting their children at higher risk for tooth decay, 

22 prevention efforts should happen even before chil23 dren are born, as a matter of pre-pregnancy health 

24 and prenatal care during pregnancy. 


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

2 analysis is a State function rather than a Federal 

3 process. States report all deaths—including mater4 nal deaths—on a semi-voluntary basis, without 

5 standardization across States. While the Centers for 

6 Disease Control and Prevention has the capacity and 

7 system for collecting death-related data based on 

8 death certificates, these data are not sufficiently re9 ported by States in an organized and standard for10 mat across States such that the Centers for Disease 

11 Control and Prevention is able to identify causes of 

12 maternal death and best practices for the prevention 

13 of such death. 

14 (15) Vital statistics systems often underesti15 mate maternal mortality and are insufficient data 

16 sources from which to derive a full scope of medical 

17 and social determinant factors contributing to ma18 ternal deaths, such as intimate partner violence. 

19 While the addition of pregnancy checkboxes on death 

20 certificates since 2003 have likely improved States’ 

21 abilities to identify pregnancy-related deaths, they 

22 are not generally completed by obstetric providers or 

23 persons trained to recognize pregnancy-related mor24 tality. Thus, these vital forms may be missing infor25 mation or may capture inconsistent data. Due to 


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1 varying maternal mortality-related analyses, lack of 

2 reliability, and granularity in data, current maternal 

3 mortality informatics do not fully encapsulate the 

4 myriad medical and socially determinant factors that 

5 contribute to such high maternal mortality rates 

6 within the United States compared to other devel7 oped nations. Lack of standardization of data and 

8 data sharing across States and between Federal en9 tities, health networks, and research institutions 

10 keep the Nation in the dark about ways to prevent 

11 maternal deaths. 

12 (16) Having reliable and valid State data ag13 gregated at the Federal level are critical to the Na14 tion’s ability to quell surges in maternal death and 

15 imperative for researchers to identify long-lasting 

16 interventions. 

17 (17) Leaders in maternal wellness highly rec18 ommend that maternal deaths and cases of maternal 

19 morbidity, including complications that result in 

20 chronic illness and future increased risk of death, be 

21 investigated at the State level first, and that stand22 ardized, streamlined, de-identified data regarding 

23 maternal deaths be sent annually to the Centers for 

24 Disease Control and Prevention. Such data stand25 ardization and collection would be similar in operVerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407

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1 ation and effect to the National Program of Cancer 

2 Registries of the Centers for Disease Control and 

3 Prevention and akin to the Confidential Enquiry in 

4 Maternal Deaths Programme in the United King5 dom. Such a maternal mortalities and morbidities 

6 registry and surveillance system would help pro7 viders, academicians, lawmakers, and the public to 

8 address questions concerning the types of, causes of, 

9 and best practices to thwart, maternal mortality and 

10 morbidity. 

11 (18) The United Nations’ Millennium Develop12 ment Goal 5a aimed to reduce by 75 percent, be13 tween 1990 and 2015, the maternal mortality rate, 

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

15 maternal mortality rate in the United States has 

16 been estimated to have more than doubled between 

17 2000 and 2014. 

18 (19) Many States have struggled to establish or 

19 maintain Maternal Mortality Review Committees 

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

21 State level, MMRCs have lagged because States have 

22 not had the resources to mount local reviews. State23 level reviews are necessary as only the State depart24 ments of health have the authority to request medVerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407

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1 ical records, autopsy reports, and police reports crit2 ical to the function of the MMRC. 

3 (20) The United States has no comparable, co4 ordinated Federal process by which to review cases 

5 of maternal mortality, systems failures, or best prac6 tices. Many States have active MMRCs and leverage 

7 their work to impact maternal wellness. For exam8 ple, the State of California has worked extensively 

9 with their State health departments, health and hos10 pital systems, and research collaborative organiza11 tions, including the California Maternal Quality Care 

12 Collaborative and the Alliance for Innovation on Ma13 ternal Health, to establish MMRCs, wherein such 

14 State has determined the most prevalent causes of 

15 maternal mortality and recorded and shared data 

16 with providers and researchers, who have developed 

17 and implemented safety bundles and care protocols 

18 related to preeclampsia, maternal hemorrhage, 

19 peripartum cardiomyopathy, and the like. In this 

20 way, the State of California has been able to lever21 age its maternal mortality review board system, gen22 erate data, and apply those data to effect changes 

23 in maternal care-related protocol. To date, the State 

24 of California has reduced its maternal mortality 


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1 rate, which is now comparable to the low rates of the 

2 United Kingdom. 

3 (21) Hospitals and health systems across the 

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

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

8 quickly escalate into fatal or near-fatal incidences. 

9 Moreover, any attempt to address an obstetric emer10 gency that does not consider both clinical and public 

11 health approaches falls woefully under the mark of 

12 excellent care delivery. State-based perinatal quality 

13 collaboratives, or entities participating in the Alli14 ance for Innovation on Maternal Health (AIM), have 

15 formed obstetric protocols, tool kits, and other re16 sources to improve system care and response as they 

17 relate to maternal complications and warning signs 

18 for such conditions as maternal hemorrhage, hyper19 tension, and preeclampsia. These perinatal quality 

20 collaboratives serve an important role in providing 

21 infrastructure that supports quality improvement ef22 forts addressing obstetric care and outcomes. State23 based perinatal quality collaboratives partner with 

24 hospitals, physicians, nurses, patients, public health, 

25 and other stakeholders to provide opportunities for 


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1 collaborative learning, rapid response data, and qual2 ity improvement science support to achieve systems3 level change. 

4 (22) The Centers for Disease Control and Pre5 vention reports that nearly half of all maternal 

6 deaths occur in the immediate postpartum period— 

7 the 42 days following a pregnancy—whereas more 

8 than one-third of maternal deaths occur while a per9 son is still pregnant. Further, 21 percent of mater10 nal deaths occur between 1 and 6 weeks postpartum, 

11 and 12 percent of maternal deaths occur during the 

12 remaining portion of the postpartum year. Yet, for 

13 women eligible for the Medicaid program on the 

14 basis of pregnancy, such Medicaid coverage lapses at 

15 the end of the month on which the 60th postpartum 

16 day lands. 

17 (23) The experience of serious traumatic 

18 events, such as being exposed to domestic violence, 

19 substance use disorder, or pervasive and systematic 

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

21 system. Known as toxic stress, the repetition of 

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

23 neurological development and other body systems, 

24 which can have cascading physical and mental health 

25 consequences, as documented in the Adverse ChildVerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407

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1 hood Experiences study of the Centers for Disease 

2 Control and Prevention. 

3 (24) A growing body of evidence-based research 

4 has shown the correlation between the stress associ5 ated with systematic racism and one’s birthing out6 comes. The undue stress of sex and race discrimina7 tion paired with institutional racism has been dem8 onstrated to contribute to a higher risk of maternal 

9 mortality, irrespective of one’s gestational age, ma10 ternal age, socioeconomic status, educational level, 

11 or individual-level health risk factors, including pov12 erty, limited access to prenatal care, and poor phys13 ical and mental health (although these are not nomi14 nal factors). Black women remain the most at risk 

15 for pregnancy-associated or pregnancy-related causes 

16 of death. When it comes to preeclampsia, for exam17 ple, for which obesity is a risk factor, Black women 

18 of normal weight remain at a higher at risk of dying 

19 during the perinatal period compared to non-Black 

20 obese women. 

21 (25) The rising maternal mortality rate in the 

22 United States is driven predominantly by the dis23 proportionately high rates of Black maternal mor24 tality. 


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1 (26) Compared to women from other racial and 

2 ethnic demographics, Black women across the socio3 economic spectrum experience prolonged, unrelenting 

4 stress related to systematic racial and gender dis5 crimination, contributing to higher rates of maternal 

6 mortality, giving birth to low-weight babies, and ex7 periencing pre-term birth. Racism is a risk-factor for 

8 these aforementioned experiences. This cumulative 

9 stress, called weathering, often extends across the 

10 life course and is situated in everyday spaces where 

11 Black women establish livelihood. Systematic racism, 

12 structural barriers, lack of access to care, lack of ac13 cess to nutritious food, and social determinants of 

14 health exacerbate Black women’s likelihood to expe15 rience poor or fatal birthing outcomes, but do not 

16 fully account for the great disparity. 

17 (27) Black women are twice as likely to experi18 ence postpartum depression, and disproportionately 

19 higher rates of preeclampsia compared to White 

20 women. 

21 (28) Racism is deeply ingrained in United 

22 States systems, including in health care delivery sys23 tems between patients and providers, often resulting 

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1 ness. However, the provider pool is not primed with 

2 many people of color, nor are providers (whether 

3 maternity care clinicians or maternity care support 

4 personnel) consistently required to undergo implicit 

5 bias, cultural competency, respectful care practices, 

6 or empathy training on a consistent, on-going basis. 

7 (29) Not all people who have been pregnant or 

8 given birth identify as being a ‘‘woman’’. The terms 

9 ‘‘birthing people’’ or ‘‘birthing persons’’ are also 

10 used to describe pregnant and postpartum people. 

11 SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO 

12 PREVENTION OF MATERNAL MORTALITY. 

13 (a) TECHNICAL ASSISTANCE FOR STATES WITH RE14 SPECT TO REPORTING MATERNAL MORTALITY.—Not 

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

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

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

18 in consultation with the Administrator of the Health Re19 sources and Services Administration, shall provide tech20 nical assistance to States that elect to report comprehen21 sive data on maternal mortality and factors relating to 

22 such mortality (including oral and mental health), inti23 mate partner violence, and breastfeeding health informa24 tion, for the purpose of encouraging uniformity in the reVerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407

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1 porting of such data and to encourage the sharing of such 

2 data among the respective States. 

3 (b) BEST PRACTICES RELATING TO PREVENTION OF

4 MATERNAL MORTALITY.— 

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

6 after the date of enactment of this Act— 

7 (A) the Director, in consultation with rel8 evant patient and provider groups, shall issue 

9 best practices to State maternal mortality re10 view committees on how best to identify and re11 view maternal mortality cases, taking into ac12 count any data made available by States relat13 ing to maternal mortality, including data on 

14 oral, mental, and breastfeeding health, and uti15 lization of any emergency services; and 

16 (B) the Director, working in collaboration 

17 with the Health Resources and Services Admin18 istration, shall issue best practices to hospitals, 

19 State professional society groups, and perinatal 

20 quality collaboratives on how best to prevent 

21 maternal mortality. 

22 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

23 purposes of carrying out this subsection, there is au24 thorized to be appropriated $5,000,000 for each of 

25 fiscal years 2021 through 2025. 


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1 (c) ALLIANCE FOR INNOVATION ON MATERNAL

2 HEALTH GRANT PROGRAM.— 

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

4 after the date of enactment of this Act, the Sec5 retary of Health and Human Services (referred to in 

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

7 the Associate Administrator of the Maternal and 

8 Child Health Bureau of the Health Resources and 

9 Services Administration, shall establish a grant pro10 gram to be known as the Alliance for Innovation on 

11 Maternal Health Grant Program (referred to in this 

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

13 shall award grants to eligible entities for the purpose 

14 of— 

15 (A) directing widespread adoption and im16 plementation of maternal safety bundles 

17 through collaborative State-based teams; and 

18 (B) collecting and analyzing process, struc19 ture, and outcome data to drive continuous im20 provement in the implementation of such safety 

21 bundles by such State-based teams with the ul22 timate goal of eliminating preventable maternal 

23 mortality and severe maternal morbidity in the 

24 United States. 


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1 (2) ELIGIBLE ENTITIES.—In order to be eligi2 ble for a grant under paragraph (1), an entity 

3 shall— 

4 (A) submit to the Secretary an application 

5 at such time, in such manner, and containing 

6 such information as the Secretary may require; 

7 and 

8 (B) demonstrate in such application that 

9 the entity is an interdisciplinary, multi-stake10 holder, national organization with a national 

11 data-driven maternal safety and quality im12 provement initiative based on implementation 

13 approaches that have been proven to improve 

14 maternal safety and outcomes in the United 

15 States. 

16 (3) USE OF FUNDS.—An eligible entity that re17 ceives a grant under paragraph (1) shall use such 

18 grant funds— 

19 (A) to develop and implement, through a 

20 robust, multi-stakeholder process, maternal 

21 safety bundles to assist States, perinatal quality 

22 collaboratives, and health care systems in align23 ing national, State, and hospital-level quality 

24 improvement efforts to improve maternal health 


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1 outcomes, specifically the reduction of maternal 

2 mortality and severe maternal morbidity; 

3 (B) to ensure, in developing and imple4 menting maternal safety bundles under sub5 paragraph (A), that such maternal safety bun6 dles— 

7 (i) satisfy the quality improvement 

8 needs of a State, perinatal quality collabo9 rative, or health care system by factoring 

10 in the results and findings of relevant data 

11 reviews, such as reviews conducted by a 

12 State maternal mortality review committee; 

13 and 

14 (ii) address topics which may in15 clude— 

16 (I) information on evidence-based 

17 practices to improve the quality and 

18 safety of maternal health care in hos19 pitals and other health care settings 

20 of a State or health care system, in21 cluding by addressing topics com22 monly associated with health com23 plications or risks related to prenatal 

24 care, labor care, birthing, and post25 partum care; 


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1 (II) best practices for improving 

2 maternal health care based on data 

3 findings and reviews conducted by a 

4 State maternal mortality review com5 mittee that address topics of relevance 

6 to common complications or health 

7 risks related to prenatal care, labor 

8 care, birthing, and postpartum care; 

9 (III) information on addressing 

10 determinants of health that impact 

11 maternal health outcomes for women 

12 before, during, and after pregnancy; 

13 (IV) obstetric hemorrhage; 

14 (V) obstetric and postpartum 

15 care for women with substance use 

16 disorders, including opioid use dis17 order; 

18 (VI) maternal cardiovascular sys19 tem; 

20 (VII) maternal mental health; 

21 (VIII) postpartum care basics for 

22 maternal safety; 

23 (IX) reduction of peripartum ra24 cial and ethnic disparities; 


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1 (X) reduction of primary cae2 sarean birth; 

3 (XI) severe hypertension in preg4 nancy; 

5 (XII) severe maternal morbidity 

6 reviews; 

7 (XIII) support after a severe ma8 ternal morbidity event; 

9 (XIV) thromboembolism; 

10 (XV) optimization of support for 

11 breastfeeding; 

12 (XVI) maternal oral health; and 

13 (XVII) intimate partner violence; 

14 and 

15 (C) to provide ongoing technical assistance 

16 at the national and State levels to support im17 plementation of maternal safety bundles under 

18 subparagraph (A). 

19 (4) MATERNAL SAFETY BUNDLE DEFINED.— 

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

21 safety bundle’’ means standardized, evidence-in22 formed processes for maternal health care. 

23 (5) AUTHORIZATION OF APPROPRIATIONS.—For 

24 purposes of carrying out this subsection, there is auVerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407

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1 thorized to be appropriated $10,000,000 for each of 

2 fiscal years 2021 through 2025. 

3 (d) FUNDING FOR STATE-BASED PERINATAL QUAL4 ITY COLLABORATIVES DEVELOPMENT AND SUSTAIN5 ABILITY.— 

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

7 after the date of enactment of this Act, the Sec8 retary of Health and Human Services (referred to in 

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

10 the Division of Reproductive Health of the Centers 

11 for Disease Control and Prevention, shall establish a 

12 grant program to be known as the State-Based 

13 Perinatal Quality Collaborative grant program under 

14 which the Secretary awards grants to eligible entities 

15 for the purpose of development and sustainability of 

16 perinatal quality collaboratives in every State, the 

17 District of Columbia, and eligible territories, in 

18 order to measurably improve perinatal care and 

19 perinatal health outcomes for pregnant and 

20 postpartum women and their infants. 

21 (2) GRANT AMOUNTS.—Grants awarded under 

22 this subsection shall be in amounts not to exceed 

23 $250,000 per year, for the duration of the grant pe24 riod. 


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1 (3) STATE-BASED PERINATAL QUALITY COL2 LABORATIVE DEFINED.—For purposes of this sub3 section, the term ‘‘State-based perinatal quality col4 laborative’’ means a network of teams that— 

5 (A) is multidisciplinary in nature and in6 cludes the full range of perinatal and maternity 

7 care providers; 

8 (B) works to improve measurable outcomes 

9 for maternal and infant health by advancing 

10 evidence-informed clinical practices using qual11 ity improvement principles; 

12 (C) works with hospital-based or out13 patient facility-based clinical teams, experts, 

14 and stakeholders, including patients and fami15 lies, to spread best practices and optimize re16 sources to improve perinatal care and outcomes; 

17 (D) employs strategies that include the use 

18 of the collaborative learning model to provide 

19 opportunities for hospitals and clinical teams to 

20 collaborate on improvement strategies, rapid-re21 sponse data to provide timely feedback to hos22 pital and other clinical teams to track progress, 

23 and quality improvement science to provide sup24 port and coaching to hospital and clinical 

25 teams; 


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1 (E) has the goal of improving population2 level outcomes in maternal and infant health; 

3 and 

4 (F) has the goal of improving outcomes of 

5 all birthing people, through the coordination, 

6 integration, and collaboration across birth set7 tings. 

8 (4) AUTHORIZATION OF APPROPRIATIONS.—For 

9 purposes of carrying out this subsection, there is au10 thorized to be appropriated $14,000,000 per year 

11 for each of fiscal years 2021 through 2025. 

12 (e) EXPANSION OF MEDICAID AND CHIP COVERAGE

13 FOR PREGNANT AND POSTPARTUM WOMEN.— 

14 (1) REQUIRING COVERAGE OF ORAL HEALTH

15 SERVICES FOR PREGNANT AND POSTPARTUM

16 WOMEN.— 

17 (A) MEDICAID.—Section 1905 of the So18 cial Security Act (42 U.S.C. 1396d) is amend19 ed— 

20 (i) in subsection (a)(4)— 

21 (I) by striking ‘‘; and (D)’’ and 

22 inserting ‘‘; (D)’’; and 

23 (II) by inserting ‘‘; and (E) oral 

24 health services for pregnant and 

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1 section (hh))’’ after ‘‘subsection 

2 (bb))’’; and 

3 (ii) by adding at the end the following 

4 new subsection: 

5 ‘‘(hh) ORAL HEALTH SERVICES FOR PREGNANT AND

6 POSTPARTUM WOMEN.— 

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

8 the term ‘oral health services for pregnant and 

9 postpartum women’ means dental services necessary 

10 to prevent disease and promote oral health, restore 

11 oral structures to health and function, and treat 

12 emergency conditions that are furnished to a woman 

13 during pregnancy (or during the 1-year period be14 ginning on the last day of the pregnancy). 

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

16 the requirement to provide oral health services for 

17 pregnant and postpartum women, a State shall, at 

18 a minimum, provide coverage for preventive, diag19 nostic, periodontal, and restorative care consistent 

20 with recommendations for perinatal oral health care 

21 and dental care during pregnancy from the Amer22 ican Academy of Pediatric Dentistry and the Amer23 ican College of Obstetricians and Gynecologists.’’. 

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

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


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1 1397cc(c)(5)(A)) is amended by inserting ‘‘or a 

2 targeted low-income pregnant woman’’ after 

3 ‘‘targeted low-income child’’. 

4 (2) EXTENDING MEDICAID COVERAGE FOR

5 PREGNANT AND POSTPARTUM WOMEN.—Section 

6 1902 of the Social Security Act (42 U.S.C. 1396a) 

7 is amended— 

8 (A) in subsection (e)— 

9 (i) in paragraph (5)— 

10 (I) by inserting ‘‘(including oral 

11 health services for pregnant and 

12 postpartum women (as defined in sec13 tion 1905(hh)))’’ after ‘‘postpartum 

14 medical assistance under the plan’’; 

15 and 

16 (II) by striking ‘‘60-day’’ and in17 serting ‘‘1-year’’; and 

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

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

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

21 ‘‘60-day’’ and inserting ‘‘1-year’’. 

22 (3) EXTENDING MEDICAID COVERAGE FOR

23 LAWFUL RESIDENTS.—Section 1903(v)(4)(A)(i) of 

24 the Social Security Act (42 U.S.C. 


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1 1396b(v)(4)(A)(i)) is amended by striking ‘‘60-day’’ 

2 and inserting ‘‘1-year’’. 

3 (4) EXTENDING CHIP COVERAGE FOR PREG4 NANT AND POSTPARTUM WOMEN.—Section 

5 2112(d)(2)(A) of the Social Security Act (42 U.S.C. 

6 1397ll(d)(2)(A)) is amended by striking ‘‘60-day’’ 

7 and inserting ‘‘1-year’’. 

8 (5) MAINTENANCE OF EFFORT.— 

9 (A) MEDICAID.—Section 1902(l) of the So10 cial Security Act (42 U.S.C. 1396a(l)) is 

11 amended by adding at the end the following 

12 new paragraph: 

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

14 enactment of this paragraph and ends on the date that 

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

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

17 for calendar quarters occurring during such period, a 

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

19 are eligible for medical assistance under the State plan 

20 or under a waiver of such plan on the basis of being preg21 nant or having been pregnant, eligibility standards, meth22 odologies, or procedures under the State plan or waiver 

23 that are more restrictive than the eligibility standards, 

24 methodologies, or procedures, respectively, under such 


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

2 of this paragraph.’’. 

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

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

5 by adding at the end the following new para6 graph: 

7 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR8 GETED LOW-INCOME PREGNANT WOMEN.—During 

9 the period that begins on the date of enactment of 

10 this paragraph and ends on the date that is five 

11 years after such date of enactment, as a condition 

12 of receiving payments under subsection (a) and sec13 tion 1903(a), a State that elects to provide assist14 ance to women on the basis of being pregnant (in15 cluding pregnancy-related assistance provided to tar16 geted low-income pregnant women (as defined in 

17 section 2112(d)), pregnancy-related assistance pro18 vided to women who are eligible for such assistance 

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

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

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

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

23 of being pregnant) shall not have in effect, with re24 spect to such women, eligibility standards, meth25 odologies, or procedures under such plan (or waiver) 


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1 that are more restrictive than the eligibility stand2 ards, methodologies, or procedures, respectively, 

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

4 date of enactment of this paragraph.’’. 

5 (6) INFORMATION ON BENEFITS.—The Sec6 retary of Health and Human Services shall make 

7 publicly available on the internet website of the De8 partment of Health and Human Services, informa9 tion regarding benefits available to pregnant and 

10 postpartum women and under the Medicaid program 

11 and the Children’s Health Insurance Program, in12 cluding information on— 

13 (A) benefits that States are required to 

14 provide to pregnant and postpartum women 

15 under such programs; 

16 (B) optional benefits that States may pro17 vide to pregnant and postpartum women under 

18 such programs; and 

19 (C) the availability of different kinds of 

20 benefits for pregnant and postpartum women, 

21 including oral health and mental health bene22 fits, under such programs. 

23 (7) FEDERAL FUNDING FOR COST OF EX24 TENDED MEDICAID AND CHIP COVERAGE FOR

25 POSTPARTUM WOMEN.— 


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1 (A) MEDICAID.—Section 1905 of the So2 cial Security Act (42 U.S.C. 1396d), as amend3 ed by paragraph (1), is further amended— 

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

5 (ff)’’ and inserting ‘‘(aa), and (ii)’’; and 

6 (ii) by adding at the end the fol7 lowing: 

8 ‘‘(b) INCREASED FMAP FOR EXTENDED MEDICAL

9 ASSISTANCE FOR POSTPARTUM WOMEN.—Notwith10 standing subsection (b), the Federal medical assistance 

11 percentage for a State, with respect to amounts expended 

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

13 eligible for such assistance on the basis of being pregnant 

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

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

16 of her pregnancy (including any such assistance provided 

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

18 equal to— 

19 ‘‘(1) 100 percent for the first 20 calendar quar20 ters during which this subsection is in effect; and 

21 ‘‘(2) 90 percent for calendar quarters there22 after.’’. 

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

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


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1 by adding at the end the following new para2 graph: 

3 ‘‘(12) ENHANCED PAYMENT FOR EXTENDED

4 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 

5 Notwithstanding subsection (b), the enhanced 

6 FMAP, with respect to payments under subsection 

7 (a) for expenditures under the State child health 

8 plan (or a waiver of such plan) for assistance pro9 vided under the plan (or waiver) to a woman who is 

10 eligible for such assistance on the basis of being 

11 pregnant (including pregnancy-related assistance 

12 provided to a targeted low-income pregnant woman 

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

14 assistance provided to a woman who is eligible for 

15 such assistance through application of section 

16 1902(v)(4)(A)(i) under section 2107(e)(1), or any 

17 other assistance under the plan (or waiver) provided 

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

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

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

21 pregnancy (including any such assistance provided 

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

23 be equal to— 


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

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

4 ‘‘(B) 90 percent for calendar quarters 

5 thereafter.’’. 

6 (8) GUIDANCE ON STATE OPTIONS FOR MED7 ICAID COVERAGE OF DOULA SERVICES.—Not later 

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

9 Act, the Secretary of Health and Human Services, 

10 acting through the Administrator of the Centers for 

11 Medicare & Medicaid Services, shall issue guidance 

12 for the States concerning options for Medicaid cov13 erage and payment for support services provided by 

14 doulas. 

15 (9) EFFECTIVE DATE.— 

16 (A) IN GENERAL.—Subject to subpara17 graph (B), the amendments made by this sub18 section shall take effect on the first day of the 

19 first calendar quarter that begins on or after 

20 the date that is one year after the date of en21 actment of this Act. 

22 (B) EXCEPTION FOR STATE LEGISLA23 TION.—In the case of a State plan under title 

24 XIX of the Social Security Act or a State child 

25 health plan under title XXI of such Act that 


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1 the Secretary of Health and Human Services 

2 determines requires State legislation in order 

3 for the respective plan to meet any requirement 

4 imposed by amendments made by this sub5 section, the respective plan shall not be re6 garded as failing to comply with the require7 ments of such title solely on the basis of its fail8 ure to meet such an additional requirement be9 fore the first day of the first calendar quarter 

10 beginning after the close of the first regular 

11 session of the State legislature that begins after 

12 the date of enactment of this Act. For purposes 

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

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

15 of the session shall be considered to be a sepa16 rate regular session of the State legislature. 

17 (f) 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 new section: 


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1 ‘‘SEC. 399V–7. 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 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407

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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; 

8 ‘‘(3) demonstrate engagement with groups en9 gaged in the implementation of health care profes10 sional training in implicit bias and delivering cul11 turally competent care, such as departments of pub12 lic health, perinatal quality collaboratives, hospital 

13 systems, and health care professional groups, in 

14 order to obtain input on resources needed for effec15 tive implementation strategies; and 

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

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

18 may require. 

19 ‘‘(c) DIVERSITY.—In awarding a cooperative agree20 ment under subsection (a), the Secretary shall take into 

21 account any regional differences among eligible entities 

22 and make an effort to ensure geographic diversity among 

23 award recipients. 

24 ‘‘(d) DISSEMINATION OF INFORMATION.— 


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

2 shall make publicly available on the internet website 

3 of the Department of Health and Human Services 

4 information submitted to the Secretary under sub5 section (b)(3). 

6 ‘‘(2) EVALUATION.—The Secretary shall evalu7 ate each regional center of excellence established or 

8 supported pursuant to subsection (a) and dissemi9 nate the findings resulting from each such evalua10 tion to the appropriate public and private entities. 

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

12 evaluations and overall findings with State depart13 ments of health and other relevant State level offices 

14 to inform State and local best practices. 

15 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec16 tion, the term ‘maternal mortality’ means death of a 

17 woman that occurs during pregnancy or within the one18 year period following the end of such pregnancy. 

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

20 purposes of carrying out this section, there is authorized 

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

22 2021 through 2025.’’. 

23 (g) SPECIAL SUPPLEMENTAL NUTRITION PROGRAM

24 FOR WOMEN, INFANTS, AND CHILDREN.—Section 


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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 postpar15 tum woman for a period of 2 years.’’. 

16 (h) DEFINITIONS.—In this section: 

17 (1) MATERNAL MORTALITY.—The term ‘‘mater18 nal mortality’’ means death of a woman that occurs 

19 during pregnancy or within the one-year period fol20 lowing the end of such pregnancy. 

21 (2) PREGNANCY RELATED DEATH.—The term 

22 ‘‘pregnancy related death’’ includes the death of a 

23 woman during pregnancy or within one year of the 

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1 vation of an unrelated condition by the physiologic 

2 effects of pregnancy. 

3 (3) SEVERE MATERNAL MORBIDITY.—The term 

4 ‘‘severe maternal morbidity’’ includes unexpected 

5 outcomes of labor and delivery that result in signifi6 cant short-term or long-term consequences to a 

7 woman’s health. 

8 SEC. 4. INCREASING EXCISE TAXES ON CIGARETTES AND 

9 ESTABLISHING EXCISE TAX EQUITY AMONG 

10 ALL TOBACCO PRODUCT TAX RATES. 

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

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

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

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

15 5701(f) of the Internal Revenue Code of 1986 is amended 

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

17 (c) TAX PARITY FOR SMOKELESS TOBACCO.— 

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

19 Code of 1986 is amended— 

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

21 and inserting ‘‘$26.84’’; 

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

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

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


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1 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE

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

3 $100.66 per thousand.’’. 

4 (2) Section 5702(m) of such Code is amend5 ed— 

6 (A) in paragraph (1), by striking ‘‘or chew7 ing tobacco’’ and inserting ‘‘, chewing tobacco, 

8 or discrete single-use unit’’; 

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

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

11 the period in each such paragraph; and 

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

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

14 ‘discrete single-use unit’ means any product con15 taining, made from, or derived from tobacco or nico16 tine that— 

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

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

19 pill, pouch, dissolvable strip, or other discrete 

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

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

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

23 1986 is amended by striking ‘‘$50.33’’ and inserting 

24 ‘‘$100.66’’. 

25 (e) TAX PARITY FOR LARGE CIGARS.— 


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

2 5701(a) of the Internal Revenue Code of 1986 is 

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

4 follows through the period and inserting the fol5 lowing: ‘‘$49.56 per pound and a proportionate tax 

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

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

8 (2) GUIDANCE.—The Secretary of the Treas9 ury, or the Secretary’s delegate, may issue guidance 

10 regarding the appropriate method for determining 

11 the weight of large cigars for purposes of calculating 

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

13 Internal Revenue Code of 1986. 

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

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

16 section 5702 of the Internal Revenue Code of 1986 is 

17 amended by inserting ‘‘, and includes processed tobacco 

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

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

20 but does not include removals of processed tobacco for ex21 portation’’ after ‘‘wrappers thereof’’. 

22 (g) CLARIFYING TAX RATE FOR OTHER TOBACCO

23 PRODUCTS.— 


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

2 Revenue Code of 1986 is amended by adding at the 

3 end the following new subsection: 

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

5 otherwise described under this section that has been deter6 mined to be a tobacco product by the Food and Drug Ad7 ministration through its authorities under the Family 

8 Smoking Prevention and Tobacco Control Act shall be 

9 taxed at a level of tax equivalent to the tax rate for ciga10 rettes on an estimated per use basis as determined by the 

11 Secretary.’’. 

12 (2) ESTABLISHING PER USE BASIS.—For pur13 poses of section 5701(i) of the Internal Revenue 

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

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

16 date that a product has been determined to be a to17 bacco product by the Food and Drug Administra18 tion, the Secretary of the Treasury (or the Secretary 

19 of the Treasury’s delegate) shall issue final regula20 tions establishing the level of tax for such product 

21 that is equivalent to the tax rate for cigarettes on 

22 an estimated per use basis. 

23 (h) CLARIFYING DEFINITION OF TOBACCO PROD24 UCTS.— 


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

2 5702 of the Internal Revenue Code of 1986 is 

3 amended to read as follows: 

4 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod5 ucts’ means— 

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

7 tobacco, and roll-your-own tobacco, and 

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

9 to section 5701(i).’’. 

10 (2) CONFORMING AMENDMENTS.—Subsection 

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

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

13 tobacco, or roll-your-own tobacco’’ each place it ap14 pears and inserting ‘‘tobacco products’’. 

15 (i) INCREASING TAX ON CIGARETTES.— 

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

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

18 inserting ‘‘$100.66’’. 

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

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

21 inserting ‘‘$211.38’’. 

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

23 5701 of such Code, as amended by subsection (g), is 

24 amended by adding at the end the following new sub25 section: 


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1 ‘‘(j) INFLATION ADJUSTMENT.— 

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

3 year beginning after 2021, the dollar amounts pro4 vided under this chapter shall each be increased by 

5 an amount equal to— 

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

7 ‘‘(B) the cost-of-living adjustment deter8 mined under section 1(f)(3) for the calendar 

9 year, determined by substituting ‘calendar year 

10 2020’ for ‘calendar year 2016’ in subparagraph 

11 (A)(ii) thereof. 

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

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

14 amount shall be rounded to the next highest multiple 

15 of $0.01.’’. 

16 (k) FLOOR STOCKS TAXES.— 

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

18 manufactured in or imported into the United States 

19 which are removed before any tax increase date and 

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

21 hereby imposed a tax in an amount equal to the ex22 cess of— 

23 (A) the tax which would be imposed under 

24 section 5701 of the Internal Revenue Code of 


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1 1986 on the article if the article had been re2 moved on such date, over 

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

4 section 5701 of such Code on such article. 

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

6 be allowed as a credit against the taxes imposed by 

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

8 shall not exceed the amount of taxes imposed by 

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

10 is liable. 

11 (3) LIABILITY FOR TAX AND METHOD OF PAY12 MENT.— 

13 (A) LIABILITY FOR TAX.—A person hold14 ing tobacco products on any tax increase date 

15 to which any tax imposed by paragraph (1) ap16 plies shall be liable for such tax. 

17 (B) METHOD OF PAYMENT.—The tax im18 posed by paragraph (1) shall be paid in such 

19 manner as the Secretary shall prescribe by reg20 ulations. 

21 (C) TIME FOR PAYMENT.—The tax im22 posed by paragraph (1) shall be paid on or be23 fore the date that is 120 days after the effective 

24 date of the tax rate increase. 


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1 (4) ARTICLES IN FOREIGN TRADE ZONES.— 

2 Notwithstanding the Act of June 18, 1934 (com3 monly known as the Foreign Trade Zone Act, 48 

4 Stat. 998, 19 U.S.C. 81a et seq.), or any other pro5 vision of law, any article which is located in a for6 eign trade zone on any tax increase date shall be 

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

8 (A) internal revenue taxes have been deter9 mined, or customs duties liquidated, with re10 spect to such article before such date pursuant 

11 to a request made under the first proviso of 

12 section 3(a) of such Act, or 

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

14 the supervision of an officer of the United 

15 States Customs and Border Protection of the 

16 Department of Homeland Security pursuant to 

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

18 (5) DEFINITIONS.—For purposes of this sub19 section— 

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

21 subsection which is also used in section 5702 of 

22 such Code shall have the same meaning as such 

23 term has in such section. 

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

25 increase date’’ means the effective date of any 


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1 increase in any tobacco product excise tax rate 

2 pursuant to the amendments made by this sec3 tion (other than subsection (j) thereof). 

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

5 means the Secretary of the Treasury or the 

6 Secretary’s delegate. 

7 (6) CONTROLLED GROUPS.—Rules similar to 

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

9 apply for purposes of this subsection. 

10 (7) OTHER LAWS APPLICABLE.—All provisions 

11 of law, including penalties, applicable with respect to 

12 the taxes imposed by section 5701 of such Code 

13 shall, insofar as applicable and not inconsistent with 

14 the provisions of this subsection, apply to the floor 

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

16 extent as if such taxes were imposed by such section 

17 5701. The Secretary may treat any person who bore 

18 the ultimate burden of the tax imposed by para19 graph (1) as the person to whom a credit or refund 

20 under such provisions may be allowed or made. 

21 (l) EFFECTIVE DATES.— 

22 (1) IN GENERAL.—Except as provided in para23 graphs (2) through (4), the amendments made by 

24 this section shall apply to articles removed (as de25 fined in section 5702(j) of the Internal Revenue 


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

2 includes the date of the enactment of this Act. 

3 (2) DISCRETE SINGLE-USE UNITS AND PROC4 ESSED TOBACCO.—The amendments made by sub5 sections (c)(1)(C), (c)(2), and (f) shall apply to arti6 cles removed (as defined in section 5702(j) of the 

7 Internal Revenue Code of 1986) after the date that 

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

9 Act. 

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

11 subsection (e) shall apply to articles removed after 

12 December 31, 2021. 

13 (4) OTHER TOBACCO PRODUCTS.—The amend14 ments made by subsection (g)(1) shall apply to prod15 ucts removed after the last day of the month which 

16 includes the date that the Secretary of the Treasury 

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

18 final regulations establishing the level of tax for 

19 such product. 

Æ 


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