Sec. 5201. Mothers and offspring mortality and morbidity awareness

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Not later than one year after the date of enactment of this Act, the Director of the Centers for Disease Control and Prevention (referred to in this section as the Director ), in consultation with the Administrator of the Health Resources and Services Administration, shall provide technical assistance to States that elect to report comprehensive data on maternal mortality and factors relating to such mortality (including oral and mental health), intimate partner violence, and breastfeeding health information, for the purpose of encouraging uniformity in the reporting of such data and to encourage the sharing of such data among the respective States.

Not later than one year after the date of enactment of this Act— the Director, in consultation with relevant patient and provider groups, shall issue best practices to State maternal mortality review committees on how best to identify and review maternal mortality cases, taking into account any data made available by States relating to maternal mortality, including data on oral, mental, and breastfeeding health, and utilization of any emergency services; and the Director, working in collaboration with the Health Resources and Services Administration, shall issue best practices to hospitals, State professional society groups, and perinatal quality collaboratives on how best to prevent maternal mortality.

For purposes of carrying out this paragraph, there is authorized to be appropriated $5,000,000 for each of fiscal years 2023 through 2027. Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Associate Administrator of the Maternal and Child Health Bureau of the Health Resources and Services Administration (referred to in this paragraph as the Secretary ), shall establish a grant program to be known as the Alliance for Innovation on Maternal Health Grant Program (referred to in this subsection as AIM ) under which the Secretary shall award grants to eligible entities for the purpose of— directing widespread adoption and implementation of maternal safety bundles through collaborative State-based teams; and collecting and analyzing process, structure, and outcome data to drive continuous improvement in the implementation of such safety bundles by such State-based teams with the ultimate goal of eliminating preventable maternal mortality and severe maternal morbidity in the United States.

In order to be eligible for a grant under subparagraph (A), an entity shall— submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and demonstrate in such application that the entity is an interdisciplinary, multi-stakeholder, national organization with a national data-driven maternal safety and quality improvement initiative based on implementation approaches that have been proven to improve maternal safety and outcomes in the United States.

An eligible entity that receives a grant under subparagraph

(A)shall use such grant funds— to develop and implement, through a robust, multi-stakeholder process, maternal safety bundles to assist States, perinatal quality collaboratives, and health care systems in aligning national, State, and hospital-level quality improvement efforts to improve maternal health outcomes, specifically the reduction of maternal mortality and severe maternal morbidity; to ensure, in developing and implementing maternal safety bundles under clause (i), that such maternal safety bundles— satisfy the quality improvement needs of a State, perinatal quality collaborative, or health care system by factoring in the results and findings of relevant data reviews, such as reviews conducted by a State maternal mortality review committee; and address topics which may include— information on evidence-based practices to improve the quality and safety of maternal health care in hospitals and other health care settings of a State or health care system, including by addressing topics commonly associated with health complications or risks related to prenatal care, labor care, birthing, and postpartum care; best practices for improving maternal health care based on data findings and reviews conducted by a State maternal mortality review committee that address topics of relevance to common complications or health risks related to prenatal care, labor care, birthing, and postpartum care; information on addressing determinants of health that impact maternal health outcomes for people before, during, and after pregnancy; obstetric hemorrhage; obstetric and postpartum care for people with substance use disorders, including opioid use disorder; maternal cardiovascular system; maternal mental health; postpartum care basics for maternal safety; reduction of peripartum racial and ethnic inequities; reduction of primary cesarean birth; severe hypertension in pregnancy; severe maternal morbidity reviews; support after a severe maternal morbidity event; thromboembolism; optimization of support for breastfeeding; maternal oral health; and intimate partner violence; and to provide ongoing technical assistance at the national and State levels to support implementation of maternal safety bundles under clause (i). For purposes of this paragraph, the term maternal safety bundle means standardized, evidence-informed processes for maternal health care. For purposes of carrying out this paragraph, there is authorized to be appropriated $10,000,000 for each of fiscal years 2023 through 2027. Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this paragraph 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 people and their infants. Grants awarded under this paragraph shall be in amounts not to exceed $250,000 per year, for the duration of the grant period. For purposes of this paragraph, the term State-based perinatal quality collaborative means a network of teams that— is multidisciplinary in nature and includes the full range of perinatal and maternity care providers; works to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement principles; 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; 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; has the goal of improving population-level outcomes in maternal and infant health; and has the goal of improving outcomes of all birthing people, through the coordination, integration, and collaboration across birth settings. For purposes of carrying out this paragraph, there is authorized to be appropriated $14,000,000 per year for each of fiscal years 2023 through 2027. Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as previously amended by this Act, is amended— in subsection (a)(4), by inserting ; and

(G)oral health services for pregnant and postpartum people (as defined in subsection (mm)) before the semicolon at the end; and by adding at the end the following new subsection: For purposes of this title, the term oral health services for pregnant and postpartum people 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 person during pregnancy (or during the 1-year period beginning on the last day of the pregnancy). To satisfy the requirement to provide oral health services for pregnant and postpartum people, a State shall 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. . Section 2103(c)(6)(A) of the Social Security Act ( 42 U.S.C. 1397cc(c)(6)(A) ) is amended by inserting or a targeted low-income pregnant person after targeted low-income child . Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— in subsection (e)— in paragraph (5)— by inserting (including oral health services for pregnant and postpartum people (as defined in section 1905(mm))) after postpartum medical assistance under the plan ; and by striking 60-day and inserting 1-year ; and in paragraph (6), by striking 60-day and inserting 1-year ; and in subsection (l)(1)(A), by striking 60-day and inserting 1-year . Section 2112(d)(2)(A) of the Social Security Act ( 42 U.S.C. 1397ll(d)(2)(A) ) is amended by striking 60-day and inserting 1-year . Section 1902(e)(16) of the Social Security Act ( 42 U.S.C. 1396a(e)(16) ) is amended— in subparagraph (A), by striking may provide and all that follows through the period and inserting the following: may provide that the State will provide the medical assistance described in subparagraph

(B)to an individual who, while pregnant, is eligible for and has received medical assistance under the State plan approved under this title (or a waiver of such plan), including during a period of retroactive eligibility under subsection (a)(34) and through the end of the month in which the 1-year period beginning on the last day of the individual's pregnancy ends. ; and in subparagraph (B), by striking 12-month each place it appears and inserting 1-year . Section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ) is amended, in the fifth sentence, by striking 60-day and inserting 1-year . 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: 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 people 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. . 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: During the period that begins on the date of enactment of this paragraph and ends on the date that is five 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 people on the basis of being pregnant (including pregnancy-related assistance provided to targeted low-income pregnant people (as defined in section 2112(d)), pregnancy-related assistance provided to people who are eligible for such assistance through application of section 1902(v)(4)(A) 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 people on the basis of being pregnant) shall not have in effect, with respect to such people, 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. . 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 people and under the Medicaid program and the Children's Health Insurance Program, including information on— benefits that States are required to provide to pregnant and postpartum people under such programs; optional benefits that States may provide to pregnant and postpartum people under such programs; and the availability of different kinds of benefits for pregnant and postpartum people, including oral health and mental health benefits, under such programs. Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as previously amended by this Act, is further amended— in subsection (b), by striking and

(ll)and inserting (ll), and

(nn); and by adding at the end the following: Notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to amounts expended by such State for medical assistance for a person 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 their pregnancy (including any such assistance provided during the month in which such period ends), shall be equal to— 100 percent for the first 20 calendar quarters during which this subsection is in effect; and 90 percent for calendar quarters thereafter. . 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: 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 person who is eligible for such assistance on the basis of being pregnant (including pregnancy-related assistance provided to a targeted low-income pregnant person (as defined in section 2112(d)), pregnancy-related assistance provided to a person who is eligible for such assistance through application of section 1902(v)(4)(A) under section 2107(e)(1), or any other assistance under the plan (or waiver) provided to a person 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— 100 percent for the first 20 calendar quarters during which this paragraph is in effect; and 90 percent for calendar quarters thereafter. . Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall issue guidance for the States concerning options for Medicaid coverage and payment for support services provided by doulas. Subject to clause (ii), the amendments made by this paragraph shall take effect on the first day of the first calendar quarter that begins on or after the date that is one year after the date of enactment of this Act. 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 paragraph, 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. Part P of title III of the Public Health Service Act ( 42 U.S.C. 280g et seq. ), as amended by section 5101, is further amended by adding at the end the following new section: 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. To be eligible to receive a cooperative agreement under subsection (a), an entity shall— 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; demonstrate community engagement and participation, such as through partnerships with home visiting and case management programs; 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 provide to the Secretary such information, at such time and in such manner, as the Secretary may require. 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. 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)(4). 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. 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. In this section, the term maternal mortality means death of a person that occurs during pregnancy or within the one-year period following the end of such pregnancy. For purposes of carrying out this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2023 through 2027. . Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 ( 42 U.S.C. 1786(d)(3)(A)(ii) ) is amended— by striking the clause designation and heading and all that follows through A State and inserting the following: A State ; in subclause

(I)(as so designated), by striking 1 year and all that follows through earlier and inserting 2 years postpartum ; and by adding at the end the following: A State may elect to certify a postpartum person for a period of 2 years. . In this subsection: The term maternal mortality means death of a person that occurs during pregnancy or within the one-year period following the end of such pregnancy. The term pregnancy related death includes the death of a person during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. The term severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant short-term or long-term consequences to a person’s health. Section 5701(b)(1) of the Internal Revenue Code of 1986 is amended by striking $50.33 and inserting $100.66 . Section 5701(b)(2) of such Code is amended by striking $105.69 and inserting $211.39 . Section 5701(a)(1) of such Code is amended by striking $50.33 and inserting $100.66 . Section 5701(a)(2) of such Code is amended by striking 52.75 percent and all that follows through the period and inserting $49.56 per pound and a proportionate tax at the like rate on all fractional parts of a pound but not less than 10.06 cents per cigar. . Section 5701(e) of such Code is amended— in paragraph (1), by striking $1.51 and inserting $26.84 , in paragraph (2), by striking 50.33 cents and inserting $10.70 , and by adding at the end the following new paragraph: On discrete single-use units, $100 per thousand. . Section 5702(m) of such Code is amended— in paragraph (1), by striking or chewing tobacco and inserting , chewing tobacco, or discrete single-use unit , in paragraphs

(2)and (3), by inserting and that is not a discrete single-use unit before the period at the end of each such paragraph, and by adding at the end the following new paragraph: The term discrete single-use unit means any product containing tobacco that— is not intended to be smoked, and is in the form of a lozenge, tablet, pill, pouch, dissolvable strip, or other discrete single-use or single-dose unit. . Section 5701(f) of such Code is amended by striking $2.8311 cents and inserting $49.56 . Section 5701(g) of such Code is amended by striking $24.78 and inserting $49.56 . Section 5702(o) of such Code 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 . Section 5701 of such Code is amended by redesignating subsection

(h)as subsection

(i)and by inserting after subsection

(g)the following new subsection: On taxable nicotine, manufactured in or imported into the United States, there shall be imposed a tax equal to the dollar amount specified in section 5701(b)(1) per 1,810 milligrams of nicotine (and a proportionate tax at the like rate on any fractional part thereof). . Section 5702 of such Code is amended by adding at the end the following new subsection: Except as otherwise provided in this subsection, the term taxable nicotine means any nicotine which has been extracted, concentrated, or synthesized. Such term shall not include any nicotine if the manufacturer or importer thereof demonstrates to the satisfaction of the Secretary of Health and Human Services that such nicotine will be used in— a drug— that is approved under section 505 of the Federal Food, Drug, and Cosmetic Act or licensed under section 351 of the Public Health Service Act, or for which an investigational use exemption has been authorized under section 505(i) of the Federal Food, Drug, and Cosmetic Act or under section 351(a) of the Public Health Service Act, or a combination product (as described in section 503(g) of the Federal Food, Drug, and Cosmetic Act), the constituent parts of which were approved or cleared under section 505, 510(k), or 515 of such Act. Tobacco products meeting the definition of cigars, cigarettes, smokeless tobacco, pipe tobacco, and roll-your-own tobacco in this section shall be classified and taxed as such despite any concentration of the nicotine inherent in those products or any addition of nicotine to those products during the manufacturing process. The Secretary shall prescribe such regulations or other guidance as is necessary or appropriate to carry out the purposes of this subsection, including regulations or other guidance for coordinating the taxation of tobacco products and taxable nicotine to protect revenue and prevent double taxation. . Section 5702(c) of such Code is amended by striking and roll-your-own tobacco and inserting roll-your-own tobacco, and taxable nicotine . Section 5702 of such Code, as amended by subparagraph (B), is amended by adding at the end the following new subsection: Any person who extracts, concentrates, or synthesizes nicotine shall be treated as a manufacturer of taxable nicotine (and as manufacturing such taxable nicotine). Any reference to a manufacturer of tobacco products, or to manufacturing tobacco products, shall be treated as including a reference to a manufacturer of taxable nicotine, or to manufacturing taxable nicotine, respectively. . Section 5702 of such Code is amended by striking subsection (l). On covered tobacco products, and cigarette papers and tubes, manufactured in or imported into the United States which are removed before the 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— 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 the prior tax (if any) imposed under section 5701 of such Code on such article. For purposes of this paragraph, the term covered tobacco products means any tobacco product other than— cigars described in section 5701(a)(2) of the Internal Revenue Code of 1986, discrete single-use units (as defined in section 5702(m)(4) of such Code, as amended by this subsection), and taxable nicotine (as defined in section 5702(q) of such Code, as amended by this subsection). Each person shall be allowed as a credit against the taxes imposed by subparagraph

(A)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 subparagraph. The person referred to in subparagraph

(A)shall be liable for the tax imposed by such subparagraph. The tax imposed by subparagraph

(A)shall be paid in such manner as the Secretary may provide. 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 covered tobacco products, or cigarette papers and tubes, which are located in a foreign trade zone on the tax increase date, shall be subject to the tax imposed by subparagraph

(A)if— 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 1st proviso of section 3(a) of such Act, or 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 2d proviso of such section 3(a). For purposes of this paragraph, the term tax increase date means the first day of the first calendar quarter described in paragraph (11)(A). Terms used in this paragraph which are also used in section 5702 of the Internal Revenue Code of 1986 shall have the same meaning as when used in such section. Except as otherwise provided in this paragraph, the amendments made by this subsection shall apply to articles removed in calendar quarters beginning after the date of the enactment of this Act. The amendments made by paragraphs (3), (4)(A)(iii), (4)(B), and

(8)shall apply to articles removed in calendar quarters beginning after the date which is 180 days after the date of the enactment of this Act. A person which is lawfully engaged in business as a manufacturer or importer of taxable nicotine (within the meaning of subchapter A of chapter 52 of the Internal Revenue Code of 1986, as amended by this subsection) on the date of the enactment of this Act, first becomes subject to the requirements of subchapter B of chapter 52 of such Code by reason of the amendments made by this subsection, and submits an application under such subchapter B to engage in such business not later than 90 days after the date of the enactment of this Act, shall not be denied the right to carry on such business by reason of such requirements before final action on such application.

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