H.R. 6303

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6303 Introduced in House (IH)]

<DOC>

119th CONGRESS
1st Session
H. R. 6303

To improve Federal efforts with respect to the prevention of maternal 
mortality, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

November 25, 2025

Ms. Kelly of Illinois introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the 
Committees on Education and Workforce, and Ways and Means, 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.

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

SECTION 1. SHORT TITLE.

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

SEC. 2. FINDINGS.

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

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

(a) Funding for State-Based Perinatal Quality Collaboratives 
Development and Sustainability.--
(1) In general.--Not later than one year after the date of 
enactment of this Act, the Secretary of Health and Human 
Services (referred to in this subsection as the ``Secretary''), 
acting through the Division of Reproductive Health of the 
Centers for Disease Control and Prevention, shall establish a 
grant program to be known as the State-Based Perinatal Quality 
Collaborative grant program under which the Secretary awards 
grants to eligible entities for the purpose of development and 
sustainability of perinatal quality collaboratives in every 
State, the District of Columbia, and eligible territories, in 
order to measurably improve perinatal care and perinatal health 
outcomes for pregnant and postpartum women and their infants.
(2) Grant amounts.--Grants awarded under this subsection 
shall be in amounts not to exceed $250,000 per year, for the 
duration of the grant period.
(3) State-based perinatal quality collaborative defined.--
For purposes of this subsection, the term ``State-based 
perinatal quality collaborative'' means a network of teams 
that--
(A) is multidisciplinary in nature and includes the 
full range of perinatal and maternity care providers;
(B) works to improve measurable outcomes for 
maternal and infant health by advancing evidence-
informed clinical practices using quality improvement 
principles;
(C) works with hospital-based or outpatient 
facility-based clinical teams, experts, and 
stakeholders, including patients and families, to 
spread best practices and optimize resources to improve 
perinatal care and outcomes;
(D) employs strategies that include the use of the 
collaborative learning model to provide opportunities 
for hospitals and clinical teams to collaborate on 
improvement strategies, rapid-response data to provide 
timely feedback to hospital and other clinical teams to 
track progress, and quality improvement science to 
provide support and coaching to hospital and clinical 
teams;
(E) has the goal of improving population-level 
outcomes in maternal and infant health; and
(F) has the goal of improving outcomes of all 
birthing people, through the coordination, integration, 
and collaboration across birth settings.
(4) Authorization of appropriations.--For purposes of 
carrying out this subsection, there is authorized to be 
appropriated $35,000,000 per year for each of fiscal years 2026 
through 2030.
(b) Expansion of Medicaid and CHIP Coverage for Pregnant and 
Postpartum Women.--
(1) Requiring coverage of oral health services for pregnant 
and postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security 
Act (42 U.S.C. 1396d) is amended--
(i) in subsection (a)(4)--
(I) by striking ``; and (D)'' and 
inserting ``; (D)'';
(II) by striking ``; and (E)'' and 
inserting ``; (E)'';
(III) by striking ``; and (F)'' and 
inserting ``; (F)''; and
(IV) by striking the semicolon at 
the end and inserting ``; and (G) oral 
health services for pregnant and 
postpartum women (as defined in 
subsection (jj));''; and
(ii) by adding at the end the following new 
subsection:
``(jj) Oral Health Services for Pregnant and Postpartum Women.--
``(1) In general.--For purposes of this title, the term 
`oral health services for pregnant and postpartum women' means 
dental services necessary to prevent disease and promote oral 
health, restore oral structures to health and function, and 
treat emergency conditions that are furnished to a woman during 
pregnancy (or during the 1-year period beginning on the last 
day of the pregnancy).
``(2) Coverage requirements.--To satisfy the requirement to 
provide oral health services for pregnant and postpartum women, 
a State shall, at a minimum, provide coverage for preventive, 
diagnostic, periodontal, and restorative care consistent with 
recommendations for perinatal oral health care and dental care 
during pregnancy from the American Academy of Pediatric 
Dentistry and the American College of Obstetricians and 
Gynecologists.''.
(B) CHIP.--Section 2103(c)(6) of the Social 
Security Act (42 U.S.C. 1397cc(c)(6)) is amended--
(i) in subparagraph (A)--
(I) by inserting ``or a targeted 
low-income pregnant woman'' after 
``targeted low-income child''; and
(II) by inserting ``, and, in the 
case of a targeted low-income child who 
is pregnant or a targeted low-income 
pregnant woman, satisfy the coverage 
requirements specified in section 
1905(jj)'' after ``emergency 
conditions''; and
(ii) in subparagraph (B), by inserting 
``(but only if, in the case of a targeted low-
income child who is pregnant or a targeted low-
income pregnant woman, the benchmark dental 
benefit package satisfies the coverage 
requirements specified in section 1905(jj))'' 
after ``subparagraph (C)''.
(2) Requiring 12-month continuous coverage of full benefits 
for pregnant and postpartum individuals under medicaid and 
chip.--
(A) Medicaid.--Section 1902 of the Social Security 
Act (42 U.S.C. 1396a) is amended--
(i) in subsection (a)--
(ii) in paragraph (86), by striking ``and'' 
at the end;
(iii) in paragraph (87), by striking the 
period at the end and inserting ``; and''; and
(iv) by inserting after paragraph (87) the 
following new paragraph:
``(88) provide that the State plan is in compliance with 
subsection (e)(16).''; and
(v) in subsection (e)(16)--
(I) in subparagraph (A), by 
striking ``At the option of the State, 
the State plan (or waiver of such State 
plan) may provide'' and inserting ``A 
State plan (or waiver of such State 
plan) shall provide'';
(II) in subparagraph (B), in the 
matter preceding clause (i), by 
striking ``by a State making an 
election under this paragraph'' and 
inserting ``under a State plan (or a 
waiver of such State plan)''; and
(III) by striking subparagraph (C).
(B) CHIP.--
(i) In general.--Section 2107(e)(1)(J) of 
the Social Security Act (42 U.S.C. 
1397gg(e)(1)(J)), as inserted by section 9822 
of the American Rescue Plan Act of 2021 (Public 
Law 117-2), is amended to read as follows:
``(J) Paragraphs (5) and (16) of section 1902(e) 
(relating to the requirement to provide medical 
assistance under the State plan or waiver consisting of 
full benefits during pregnancy and throughout the 12-
month postpartum period under title XIX).''.
(ii) Conforming amendment.--Section 
2112(d)(2)(A) of the Social Security Act (42 
U.S.C. 1397ll(d)(2)(A)) is amended by striking 
``the month in which the 60-day period'' and 
all that follows through ``pursuant to section 
2107(e)(1),''.
(3) Maintenance of effort.--
(A) Medicaid.--Section 1902(l) of the Social 
Security Act (42 U.S.C. 1396a(l)) is amended by adding 
at the end the following new paragraph:
``(5) During the period that begins on the date of enactment of 
this paragraph and ends on the date that is 5 years after such date of 
enactment, as a condition for receiving any Federal payments under 
section 1903(a) for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to women who are eligible 
for medical assistance under the State plan or under a waiver of such 
plan on the basis of being pregnant or having been pregnant, 
eligibility standards, methodologies, or procedures under the State 
plan or waiver that are more restrictive than the eligibility 
standards, methodologies, or procedures, respectively, under such plan 
or waiver that are in effect on the date of enactment of this 
paragraph.''.
(B) CHIP.--Section 2105(d) of the Social Security 
Act (42 U.S.C. 1397ee(d)) is amended by adding at the 
end the following new paragraph:
``(4) In eligibility standards for targeted low-income 
pregnant women.--During the period that begins on the date of 
enactment of this paragraph and ends on the date that is 5 
years after such date of enactment, as a condition of receiving 
payments under subsection (a) and section 1903(a), a State that 
elects to provide assistance to women on the basis of being 
pregnant (including pregnancy-related assistance provided to 
targeted low-income pregnant women (as defined in section 
2112(d)), pregnancy-related assistance provided to women who 
are eligible for such assistance through application of section 
1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
assistance under the State child health plan (or a waiver of 
such plan) which is provided to women on the basis of being 
pregnant) shall not have in effect, with respect to such women, 
eligibility standards, methodologies, or procedures under such 
plan (or waiver) that are more restrictive than the eligibility 
standards, methodologies, or procedures, respectively, under 
such plan (or waiver) that are in effect on the date of 
enactment of this paragraph.''.
(4) Information on benefits.--The Secretary of Health and 
Human Services shall make publicly available on the internet 
website of the Department of Health and Human Services, 
information regarding benefits available to pregnant and 
postpartum women and under the Medicaid program and the 
Children's Health Insurance Program, including information on--
(A) benefits that States are required to provide to 
pregnant and postpartum women under such programs;
(B) optional benefits that States may provide to 
pregnant and postpartum women under such programs; and
(C) the availability of different kinds of benefits 
for pregnant and postpartum women, including oral 
health and mental health benefits and breastfeeding 
services and supplies, under such programs.
(5) Federal funding for cost of extended medicaid and chip 
coverage for postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security 
Act (42 U.S.C. 1396d), as amended by paragraph (1), is 
further amended by adding at the end the following:
``(kk) Increased FMAP for Extended Medical Assistance for 
Postpartum Individuals.--
``(1) In general.--Notwithstanding subsection (b), the 
Federal medical assistance percentage for a State, with respect 
to amounts expended by such State for medical assistance for an 
individual who is eligible for such assistance on the basis of 
being pregnant or having been pregnant that is provided during 
the 305-day period that begins on the 60th day after the last 
day of the individual's pregnancy (including any such 
assistance provided during the month in which such period 
ends), shall be equal to--
``(A) during the first 20-quarter period for which 
this subsection is in effect with respect to a State, 
100 percent; and
``(B) with respect to a State, during each quarter 
thereafter, 90 percent.
``(2) Exclusion from territorial caps.--Any payment made to 
a territory for expenditures for medical assistance for an 
individual described in paragraph (1) that is subject to the 
Federal medical assistance percentage specified under paragraph 
(1) shall not be taken into account for purposes of applying 
payment limits under subsections (f) and (g) of section 
1108.''.
(B) CHIP.--Section 2105(c) of the Social Security 
Act (42 U.S.C. 1397ee(c)) is amended by adding at the 
end the following new paragraph:
``(13) Enhanced payment for extended assistance provided to 
pregnant women.--Notwithstanding subsection (b), the enhanced 
FMAP, with respect to payments under subsection (a) for 
expenditures under the State child health plan (or a waiver of 
such plan) for assistance provided under the plan (or waiver) 
to a woman who is eligible for such assistance on the basis of 
being pregnant (including pregnancy-related assistance provided 
to a targeted low-income pregnant woman (as defined in section 
2112(d)), pregnancy-related assistance provided to a woman who 
is eligible for such assistance through application of section 
1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
assistance under the plan (or waiver) provided to a woman who 
is eligible for such assistance on the basis of being pregnant) 
during the 305-day period that begins on the 60th day after the 
last day of her pregnancy (including any such assistance 
provided during the month in which such period ends), shall be 
equal to--
``(A) during the first 20-quarter period for which 
this subsection is in effect with respect to a State, 
100 percent; and
``(B) with respect to a State, during each quarter 
thereafter, 90 percent.''.
(6) Guidance on state options for medicaid coverage of 
doula services.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human 
Services shall issue guidance for the States concerning options 
for Medicaid coverage and payment for support services provided 
by doulas.
(7) Enhanced fmap for rural obstetric and gynecological 
services.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d), as amended by paragraphs (1) and (5), is further 
amended--
(A) in subsection (b), by striking ``and (ii)'' and 
inserting ``(ii), (jj), (kk), and (ll)''; and
(B) by adding at the end the following new 
subsection:
``(ll) Increased FMAP for Medical Assistance for Obstetric and 
Gynecological Services Furnished at Rural Hospitals.--
``(1) In general.--Notwithstanding subsection (b), the 
Federal medical assistance percentage for a State, with respect 
to amounts expended by such State for medical assistance for 
obstetric or gynecological services that are furnished in a 
hospital that is located in a rural area (as defined for 
purposes of section 1886) shall be equal to 90 percent for each 
calendar quarter beginning with the first calendar quarter 
during which this subsection is in effect.
``(2) Exclusion from territorial caps.--Any payment made to 
a territory for expenditures for medical assistance described 
in paragraph (1) that is subject to the Federal medical 
assistance percentage specified under paragraph (1) shall not 
be taken into account for purposes of applying payment limits 
under subsections (f) and (g) of section 1108.''.
(8) Effective dates.--
(A) In general.--Subject to subparagraphs (B) and 
(C)--
(i) the amendments made by paragraphs (1), 
(2), and (5) shall take effect on the first day 
of the first calendar quarter that begins on or 
after the date that is 1 year after the date of 
enactment of this Act;
(ii) the amendments made by paragraph (3) 
shall take effect on the date of enactment of 
this Act; and
(iii) the amendments made by paragraph (7) 
shall take effect on the first day of the first 
calendar quarter that begins on or after the 
date of enactment of this Act.
(B) Exception for state legislation.--In the case 
of a State plan under title XIX of the Social Security 
Act or a State child health plan under title XXI of 
such Act that the Secretary of Health and Human 
Services determines requires State legislation in order 
for the respective plan to meet any requirement imposed 
by amendments made by this subsection, the respective 
plan shall not be regarded as failing to comply with 
the requirements of such title solely on the basis of 
its failure to meet such an additional requirement 
before the first day of the first calendar quarter 
beginning after the close of the first regular session 
of the State legislature that begins after the date of 
enactment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of the session shall be 
considered to be a separate regular session of the 
State legislature.
(C) State option for earlier effective date.--A 
State may elect to have subsection (e)(16) of section 
1902 of the Social Security Act (42 U.S.C. 1396a) and 
subparagraph (J) of section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)), as amended by 
paragraph (2), and subsection (kk) of section 1905 of 
the Social Security Act (42 U.S.C. 1396d) and paragraph 
(13) of section 2105(c) of the Social Security Act (42 
U.S.C. 1397ee(c)), as added by paragraph (5), take 
effect with respect to the State on the first day of 
any fiscal quarter that begins before the date 
described in subparagraph (A) and apply to amounts 
payable to the State for expenditures for medical 
assistance, child health assistance, or pregnancy-
related assistance to pregnant or postpartum 
individuals furnished on or after such day.
(c) Regional Centers of Excellence.--Part P of title III of the 
Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding 
at the end the following:

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

``(a) In General.--Not later than one year after the date of 
enactment of this section, the Secretary, in consultation with such 
other agency heads as the Secretary determines appropriate, shall award 
cooperative agreements for the establishment or support of regional 
centers of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider interactions 
education for the purpose of enhancing and improving how health care 
professionals are educated in implicit bias and delivering culturally 
competent health care.
``(b) Eligibility.--To be eligible to receive a cooperative 
agreement under subsection (a), an entity shall--
``(1) be a public or other nonprofit entity specified by 
the Secretary that provides educational and training 
opportunities for students and health care professionals, which 
may be a health system, teaching hospital, community health 
center, medical school, school of public health, school of 
nursing, dental school, social work school, school of 
professional psychology, or any other health professional 
school or program at an institution of higher education (as 
defined in section 101 of the Higher Education Act of 1965) 
focused on the prevention, treatment, or recovery of health 
conditions that contribute to maternal mortality and the 
prevention of maternal mortality and severe maternal morbidity;
``(2) demonstrate community engagement and participation, 
such as through partnerships with home visiting and case 
management programs or community-based organizations serving 
minority populations;
``(3) demonstrate engagement with groups engaged in the 
implementation of health care professional training in implicit 
bias and delivering culturally competent care, such as 
departments of public health, perinatal quality collaboratives, 
hospital systems, and health care professional groups, in order 
to obtain input on resources needed for effective 
implementation strategies; and
``(4) provide to the Secretary such information, at such 
time and in such manner, as the Secretary may require.
``(c) Diversity.--In awarding a cooperative agreement under 
subsection (a), the Secretary shall take into account any regional 
differences among eligible entities and make an effort to ensure 
geographic diversity among award recipients.
``(d) Dissemination of Information.--
``(1) Public availability.--The Secretary shall make 
publicly available on the internet website of the Department of 
Health and Human Services information submitted to the 
Secretary under subsection (b)(3).
``(2) Evaluation.--The Secretary shall evaluate each 
regional center of excellence established or supported pursuant 
to subsection (a) and disseminate the findings resulting from 
each such evaluation to the appropriate public and private 
entities.
``(3) Distribution.--The Secretary shall share evaluations 
and overall findings with State departments of health and other 
relevant State level offices to inform State and local best 
practices.
``(e) Maternal Mortality Defined.--In this section, the term 
`maternal mortality' means death of a woman that occurs during 
pregnancy or within the one-year period following the end of such 
pregnancy.
``(f) Authorization of Appropriations.--For purposes of carrying 
out this section, there is authorized to be appropriated $5,000,000 for 
each of fiscal years 2026 through 2030.''.
(d) Special Supplemental Nutrition Program for Women, Infants, and 
Children.--Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 
(42 U.S.C. 1786(d)(3)(A)(ii)) is amended--
(1) by striking the clause designation and heading and all 
that follows through ``A State'' and inserting the following:
``(ii) Women.--
``(I) Breastfeeding women.--A 
State'';
(2) in subclause (I) (as so designated), by striking ``1 
year'' and all that follows through ``earlier'' and inserting 
``2 years postpartum''; and
(3) by adding at the end the following:
``(II) Postpartum women.--A State 
may elect to certify a postpartum woman 
for a period of 2 years.''.
(e) Definition of Maternal Mortality.--In this section, the term 
``maternal mortality'' means death of a woman that occurs during 
pregnancy or within the one-year period following the end of such 
pregnancy.

SEC. 4. FULL SPECTRUM DOULA WORKFORCE.

(a) In General.--The Secretary of Health and Human Services shall 
establish and implement a program to award grants or contracts to 
health professions schools, schools of public health, academic health 
centers, State or local governments, territories, Indian Tribes and 
Tribal organizations, Urban Indian organizations, Native Hawaiian 
organizations, community-based organizations, or other appropriate 
public or private nonprofit entities (or consortia of any such 
entities, including entities promoting multidisciplinary approaches), 
to establish or expand programs to grow and diversify the doula 
workforce, including through improving the capacity and supply of 
health care providers.
(b) Use of Funds.--Amounts made available by subsection (a) shall 
be used for the following activities:
(1) Establishing programs that provide education and 
training to individuals seeking appropriate training or 
certification as full spectrum doulas.
(2) Expanding the capacity of existing programs described 
in paragraph (1), for the purpose of increasing the number of 
students enrolled in such programs, including by awarding 
scholarships for students who agree to work in underserved 
communities after receiving such education and training.
(3) Developing and implementing strategies to recruit and 
retain students from underserved communities, particularly from 
demographic groups experiencing high rates of maternal 
mortality and severe maternal morbidity, including racial and 
ethnic minority groups, into programs described in paragraphs 
(1) and (2).
(c) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary for fiscal year 2026, out of any money in 
the Treasury not otherwise appropriated, $50,000,000, to remain 
available until expended, for carrying out this section.

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

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

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

``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration (referred to in 
this section as the `Secretary'), shall establish a pilot program under 
which the Secretary shall make grants to States--
``(1) to purchase and equip rural mobile health units for 
the purpose of providing pre-conception, pregnancy, postpartum, 
and obstetric emergency services in rural and underserved 
communities;
``(2) to train providers including obstetrician-
gynecologists, certified nurse-midwives, nurse practitioners, 
nurses, and midwives to operate and provide obstetric services, 
including training and planning for obstetric emergencies, in 
such mobile health units; and
``(3) to address access issues, including social 
determinants of health and wrap-around clinical and community 
services including nutrition, housing, lactation services, and 
transportation support and referrals.
``(b) No Sharing of Data With Law Enforcement.--As a condition of 
receiving a grant under this section, a State shall submit to the 
Secretary an assurance that the State will not make available to 
Federal or State law enforcement any personally identifiable 
information regarding any pregnant or postpartum individual collected 
pursuant to such grant.
``(c) Grant Duration.--The period of a grant under this section 
shall not exceed 5 years.
``(d) Implementing and Reporting.--
``(1) In general.--States that receive pilot grants under 
this section shall be responsible for--
``(A) implementing the program funded by the pilot 
grants; and
``(B) not later than 3 years after the date of 
enactment of this Act, and 6 years after the date of 
enactment of this Act, submitting a report containing 
the results of such program to the Secretary, 
including--
``(i) relevant information and relevant 
quantitative indicators of the programs' 
success in improving the standard of care and 
maternal health outcomes for individuals in 
rural and underserved communities seen for pre-
conception, pregnancy, or postpartum visits in 
the rural mobile health units, stratified by 
the categories of data specified in paragraph 
(2);
``(ii) relevant qualitative evaluations 
from individuals receiving pre-conception, 
pregnant, or postpartum care from rural mobile 
health units, including measures of patient-
reported experience of care and measures of 
patient-reported issues with access to care 
without the rural mobile health unit pilot; and
``(iii) strategies to sustain such programs 
beyond the duration of the grant and expand 
such programs to other rural and underserved 
communities.
``(2) Categories of data.--The categories of data specified 
in this paragraph are the following:
``(A) Race, ethnicity, sex, gender, gender 
identity, primary language, age, geography, disability 
status, and insurance status.
``(B) Number of visits provided for preconception, 
prenatal, or postpartum care.
``(C) Number of repeat visits provided for 
preconception, prenatal, or postpartum care.
``(D) Number of screenings or tests provided for 
smoking, substance use, hypertension, sexually 
transmitted diseases, diabetes, HIV, depression, 
intimate partner violence, Pap smears, and pregnancy.
``(3) Data privacy protection.--The reports referred to in 
paragraph (1)(B) shall not contain any personally identifiable 
information regarding any pregnant or postpartum individual.
``(e) Evaluation.--The Secretary shall conduct an evaluation of the 
pilot program under this section to determine the impact of the pilot 
program with respect to--
``(1) the effectiveness of the grants awarded under this 
section to improve maternal health outcomes in rural and 
underserved communities, with data stratified by race, 
ethnicity, primary language, socioeconomic status, geography, 
insurance type, and other factors as the Secretary determines 
appropriate;
``(2) spending on maternity care by States participating in 
the pilot program;
``(3) to the extent practicable, qualitative, and 
quantitative measures of patient experience; and
``(4) any other areas of assessment that the Secretary 
determines relevant.
``(f) Report.--Not later than one year after the completion of the 
pilot program under this section, the Secretary shall submit to the 
Congress, and make publicly available, a report containing--
``(1) the results of any evaluation conducted under 
subsection (e); and
``(2) a recommendation regarding whether the pilot program 
should be continued after fiscal year 2030 and expanded on a 
national basis.
``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary to carry out this section $10,000,000 for 
each of fiscal years 2026 through 2030.''.

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

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

SEC. 7. REPORT ON MATERNAL HEALTH NEEDS.

(a) In General.--Not later than 24 months after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
prepare, and submit to the Congress, a report on--
(1) where the maternal health needs are greatest in the 
United States; and
(2) the Federal expenditures made to address such needs.
(b) Period Covered.--The report under subsection (a) shall cover 
the period of 2000 through 2024.
(c) Contents.--The report under subsection (a) shall include 
analysis of the following:
(1) How Federal funds provided to States for maternal 
health were distributed across regions, States, and localities 
or counties.
(2) Barriers to applying for and receiving Federal funds 
for maternal health, including with respect to initial 
applications--
(A) requirements for submission in partnership with 
other entities; and
(B) stringent network requirements.
(3) Why applicants did not receive funding, including 
limited availability of funds, the strength of the respective 
applications, and failure to adhere to requirements.
(d) Disaggregation of Data.--The report under subsection (a) shall 
disaggregate data on mothers served by race, ethnicity, insurance 
status, and language spoken.

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

(a) Tax Parity for Roll-Your-Own Tobacco.--Section 5701(g) of the 
Internal Revenue Code of 1986 is amended by striking ``$24.78'' and 
inserting ``$49.56''.
(b) Tax Parity for Pipe Tobacco.--Section 5701(f) of the Internal 
Revenue Code of 1986 is amended by striking ``$2.8311 cents'' and 
inserting ``$49.56''.
(c) Tax Parity for Smokeless Tobacco.--
(1) Section 5701(e) of the Internal Revenue Code of 1986 is 
amended--
(A) in paragraph (1), by striking ``$1.51'' and 
inserting ``$26.84'';
(B) in paragraph (2), by striking ``50.33 cents'' 
and inserting ``$10.74''; and
(C) by adding at the end the following:
``(3) Smokeless tobacco sold in discrete single-use 
units.--On discrete single-use units, $100.66 per thousand.''.
(2) Section 5702(m) of such Code is amended--
(A) in paragraph (1), by striking ``or chewing 
tobacco'' and inserting ``, chewing tobacco, or 
discrete single-use unit'';
(B) in paragraphs (2) and (3), by inserting ``that 
is not a discrete single-use unit'' before the period 
in each such paragraph; and
(C) by adding at the end the following:
``(4) Discrete single-use unit.--The term `discrete single-
use unit' means any product containing, made from, or derived 
from tobacco or nicotine that--
``(A) is not intended to be smoked; and
``(B) is in the form of a lozenge, tablet, pill, 
pouch, dissolvable strip, or other discrete single-use 
or single-dose unit.''.
(d) Tax Parity for Small Cigars.--Paragraph (1) of section 5701(a) 
of the Internal Revenue Code of 1986 is amended by striking ``$50.33'' 
and inserting ``$100.66''.
(e) Tax Parity for Large Cigars.--
(1) In general.--Paragraph (2) of section 5701(a) of the 
Internal Revenue Code of 1986 is amended by striking ``52.75 
percent'' and all that follows through the period and inserting 
the following: ``$49.56 per pound and a proportionate tax at 
the like rate on all fractional parts of a pound but not less 
than 10.066 cents per cigar.''.
(2) Guidance.--The Secretary of the Treasury, or the 
Secretary's delegate, may issue guidance regarding the 
appropriate method for determining the weight of large cigars 
for purposes of calculating the applicable tax under section 
5701(a)(2) of the Internal Revenue Code of 1986.
(3) Conforming amendment.--Section 5702 of such Code is 
amended by striking subsection (l).
(f) Tax Parity for Roll-Your-Own Tobacco and Certain Processed 
Tobacco.--Subsection (o) of section 5702 of the Internal Revenue Code 
of 1986 is amended by inserting ``, and includes processed tobacco that 
is removed for delivery or delivered to a person other than a person 
with a permit provided under section 5713, but does not include 
removals of processed tobacco for exportation'' after ``wrappers 
thereof''.
(g) Clarifying Tax Rate for Other Tobacco Products.--
(1) In general.--Section 5701 of the Internal Revenue Code 
of 1986 is amended by adding at the end the following new 
subsection:
``(i) Other Tobacco Products.--Any product not otherwise described 
under this section that has been determined to be a tobacco product by 
the Food and Drug Administration through its authorities under the 
Family Smoking Prevention and Tobacco Control Act shall be taxed at a 
level of tax equivalent to the tax rate for cigarettes on an estimated 
per use basis as determined by the Secretary.''.
(2) Establishing per use basis.--For purposes of section 
5701(i) of the Internal Revenue Code of 1986, not later than 12 
months after the later of the date of the enactment of this Act 
or the date that a product has been determined to be a tobacco 
product by the Food and Drug Administration, the Secretary of 
the Treasury (or the Secretary of the Treasury's delegate) 
shall issue final regulations establishing the level of tax for 
such product that is equivalent to the tax rate for cigarettes 
on an estimated per use basis.
(h) Clarifying Definition of Tobacco Products.--
(1) In general.--Subsection (c) of section 5702 of the 
Internal Revenue Code of 1986 is amended to read as follows:
``(c) Tobacco Products.--The term `tobacco products' means--
``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco, 
and roll-your-own tobacco, and
``(2) any other product subject to tax pursuant to section 
5701(i).''.
(2) Conforming amendments.--Subsection (d) of section 5702 
of such Code is amended by striking ``cigars, cigarettes, 
smokeless tobacco, pipe tobacco, or roll-your-own tobacco'' 
each place it appears and inserting ``tobacco products''.
(i) Increasing Tax on Cigarettes.--
(1) Small cigarettes.--Section 5701(b)(1) of such Code is 
amended by striking ``$50.33'' and inserting ``$100.66''.
(2) Large cigarettes.--Section 5701(b)(2) of such Code is 
amended by striking ``$105.69'' and inserting ``$211.38''.
(j) Tax Rates Adjusted for Inflation.--Section 5701 of such Code, 
as amended by subsection (g), is amended by adding at the end the 
following new subsection:
``(j) Inflation Adjustment.--
``(1) In general.--In the case of any calendar year 
beginning after 2025, the dollar amounts provided under this 
chapter shall each be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined 
under section 1(f)(3) for the calendar year, determined 
by substituting `calendar year 2024' for `calendar year 
2016' in subparagraph (A)(ii) thereof.
``(2) Rounding.--If any amount as adjusted under paragraph 
(1) is not a multiple of $0.01, such amount shall be rounded to 
the next highest multiple of $0.01.''.
(k) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products manufactured in 
or imported into the United States which are removed before any 
tax increase date and held on such date for sale by any person, 
there is hereby imposed a tax in an amount equal to the excess 
of--
(A) the tax which would be imposed under section 
5701 of the Internal Revenue Code of 1986 on the 
article if the article had been removed on such date, 
over
(B) the prior tax (if any) imposed under section 
5701 of such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a 
credit against the taxes imposed by paragraph (1) an amount 
equal to the lesser of $1,000 or the amount of such taxes. For 
purposes of the preceding sentence, all persons treated as a 
single employer under subsection (b), (c), (m), or (o) of 
section 414 of the Internal Revenue Code of 1986 shall be 
treated as 1 person for purposes of this paragraph.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco 
products on any tax increase date to which any tax 
imposed by paragraph (1) applies shall be liable for 
such tax.
(B) Method of payment.--The tax imposed by 
paragraph (1) shall be paid in such manner as the 
Secretary shall prescribe by regulations.
(C) Time for payment.--The tax imposed by paragraph 
(1) shall be paid on or before the date that is 120 
days after the effective date of the tax rate increase.
(4) Articles in foreign trade zones.--Notwithstanding the 
Act of June 18, 1934 (commonly known as the Foreign Trade Zone 
Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other 
provision of law, any article which is located in a foreign 
trade zone on any tax increase date shall be subject to the tax 
imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or 
customs duties liquidated, with respect to such article 
before such date pursuant to a request made under the 
first proviso of section 3(a) of such Act, or
(B) such article is held on such date under the 
supervision of an officer of the United States Customs 
and Border Protection of the Department of Homeland 
Security pursuant to the second proviso of such section 
3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection 
which is also used in section 5702 of such Code shall 
have the same meaning as such term has in such section.
(B) Tax increase date.--The term ``tax increase 
date'' means the effective date of any increase in any 
tobacco product excise tax rate pursuant to the 
amendments made by this section (other than subsection 
(j) thereof).
(C) Secretary.--The term ``Secretary'' means the 
Secretary of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of 
section 5061(e)(3) of such Code shall apply for purposes of 
this subsection.
(7) Other laws applicable.--All provisions of law, 
including penalties, applicable with respect to the taxes 
imposed by section 5701 of such Code shall, insofar as 
applicable and not inconsistent with the provisions of this 
subsection, apply to the floor stocks taxes imposed by 
paragraph (1), to the same extent as if such taxes were imposed 
by such section 5701. The Secretary may treat any person who 
bore the ultimate burden of the tax imposed by paragraph (1) as 
the person to whom a credit or refund under such provisions may 
be allowed or made.
(l) Effective Dates.--
(1) In general.--Except as provided in paragraphs (2) and 
(3), the amendments made by this section shall apply to 
articles removed (as defined in section 5702(j) of the Internal 
Revenue Code of 1986) after the last day of the month which 
includes the date of the enactment of this Act.
(2) Discrete single-use units, large cigars, and processed 
tobacco.--The amendments made by subsections (c)(1)(C), (c)(2), 
(e), and (f) shall apply to articles removed (as defined in 
section 5702(j) of the Internal Revenue Code of 1986) after the 
date that is 6 months after the date of the enactment of this 
Act.
(3) Other tobacco products.--The amendments made by 
subsection (g)(1) shall apply to products removed after the 
last day of the month which includes the date that the 
Secretary of the Treasury (or the Secretary of the Treasury's 
delegate) issues final regulations establishing the level of 
tax for such product.
<all>