,,ii #aaf? ,,congress #a/ ,session ,s4 #iaf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #bg1 #bjai,mr4 ,durb9 7= himself1 ,ms4 ,duckwor?1 ,mr4 ,blum5?al1 ,mr4 ,van ,holl51 ,mr4 ,m]kley1 ,mr4 ,br[n1 ,mr4 ,s&]s1 ,ms4 ,smi?1 & ,mr4 ,k+7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to improve ,f$]al ef=ts ) respect to ! prev5tion ( mat]nal mortality1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,mo!rs & ,(fspr+ ,mortality & ,morbidity ,aw>5ess ,act or ! ,,momma's ,act4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,e ye>1 across ! ,unit$ ,/ates1 #d1jjj1jjj wom5 give bir?1 ab\t #gjj wom5 suff] fatal complications dur+ pregnancy1 :ile giv+ bir? or dur+ ! po/p>tum p]iod1 & #gj1jjj wom5 suff] ne>-fatal1 p>tum-relat$ complications4 7#b7 ,! mat]nal mortality rate is (t5 us$ z a proxy to measure ! ov]all heal? ( a population4 ,:ile ! infant mortality rate 9 ! ,unit$ ,/ates has rea*$ its l[e/ po9t1 ! risk ( dea? = wom5 9 ! ,unit$ ,/ates dur+ pregnancy1 *ildbir?1 or ! po/p>tum p]iod is high] ?an su* risk 9 _m o!r develop$ nations4 ,! e/imat$ mat]nal mortality rate 7p] #ajj1jjj live bir?s7 = ! #dh contigu\s ,/ates & ,wa%+ton1 ,,dc increas$ f #ah4h p]c5t 9 #bjjj to #bc4h p]c5t 9 #bjad to #bf4f p]c5t 9 #bjah4 ,?is e/imat$ rate is on p> ) su* rate = und]develop$ nations su* z ,iraq & ,afghani/an4 7#c7 ,int]national /udies e/imate ! #bjae mat]nal mortality rate 9 ! ,unit$ ,/ates z #bf4d p] #ajj1jjj live bir?s1 :i* is almo/ twice ! #bjae ,_w ,heal? ,organization e/imation ( #ad p] #ajj1jjj live bir?s4 7#d7 ,x is e/imat$ t m ?an #fj p]c5t ( mat]nal dea?s 9 ! ,unit$ ,/ates are prev5table4 7#e7 ,accord+ to ! ,c5t]s = ,disease ,control & ,prev5tion1 ! mat]nal mortality rate v>ies dra/ically = wom5 by race & e?nicity4 ,!re are #ab4g dea?s p] #ajj1jjj live bir?s = ,:ite wom51 #dc4e dea?s p] #ajj1jjj live bir?s = ,african-,am]ican wom51 & #ad4d dea?s p] #ajj1jjj live bir?s = wom5 ( o!r e?nicities4 ,:ile mat]nal mortality disp>ately impacts ,african-,am]ican wom51 ?is urg5t public heal? crisis trav]ses race1 e?nicity1 socioeconomic /atus1 educational backgr\nd1 & geography4 7#f7 ,african-,am]ican wom5 are #c to #d times m likely to die f causes relat$ to pregnancy & *ildbir? comp>$ to non-,hispanic ,:ite wom54 7#g7 ,! f9d+s describ$ 9 p>agraphs 7#a7 ?r\gh 7#f7 are ( major conc]n to rese>*]s1 academics1 memb]s ( ! bus9ess community1 & provid]s across ! ob/etrical cont9uum repres5t$ by organizations su* z ,m>* ( ,dimes2 ! ,preeclampsia ,f\ndation2 ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s2 ! ,society = ,mat]nal-,fetal ,m$ic9e2 ! ,association ( ,wom5's ,heal?1 ,ob/etric1 & ,neonatal ,nurses2 ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative2 ,black ,wom5's ,heal? ,imp]ative2 ! ,national ,bir? ,equity ,collaborative2 ,black ,mamas ,matt] ,alliance2 ,ever,thrive ,ill9ois2 ! ,national ,association ( ,c]tifi$ ,pr(essional ,midwives2 ,,pcos ,*all5ge3 ,! ,national ,polycy/ic ,ov>y ,syndrome ,association2 & ! ,am]ican ,college ( ,nurse ,midwives4 7#h7 ,hemorrhage1 c>diovascul> & coron>y conditions1 c>diomyopa?y1 infection1 embolism1 m5tal heal? conditions1 preeclampsia & eclampsia1 polycy/ic ov>y syndrome1 infection & sepsis1 & ane/hesia complications are ! pr$om9ant m$ical causes ( mat]nal-relat$ dea?s & complications4 ,mo/ ( ^! conditions are l>gely prev5table or manageable4 7#i7 ,oral heal? is an important "p ( p]9atal heal?4 ,r$uc+ bact]ia 9 a woman's m\? dur+ pregnancy c significantly r$uce h] risk ( develop+ oral diseases & spread+ decay-caus+ bact]ia to h] baby4 ,moreov]1 "s evid5ce sugge/s t wom5 ) p]iodontal disease dur+ pregnancy c\ld be at great] risk = poor bir? outcomes1 su* z preeclampsia1 pre-t]m bir?1 & l[-bir? weight4 ,fur!rmore1 a woman's oral heal? dur+ pregnancy is a good pr$ictor ( h] newborn's oral heal?1 & s9ce mo!rs c un9t5tionally spread oral bact]ia to _! babies1 putt+ _! *ildr5 at high] risk = too? decay1 prev5tion ef=ts %\ld happ5 ev5 be=e *ildr5 are born1 z a matt] ( pre-pregnancy heal? & pr5atal c>e dur+ pregnancy4 7#aj7 ,! ,unit$ ,/ates has n be5 able to submit a =mal mat]nal mortality rate to int]national data repositories s9ce #bjjg4 ,?us1 no (ficial mat]nal mortality rate exi/s = ! ,unit$ ,/ates4 ,!re c be no mat]nal mortality rate )\t /reaml9+ mat]nal mortality-relat$ data f ! ,/ate level & extrapolat+ su* data to ! ,f$]al level4 7#aa7 ,9 ! ,unit$ ,/ates1 dea? report+ & analysis is a ,/ate function r ?an a ,f$]al process4 ,/ates report all dea?s--includ+ mat]nal dea?s--on a semi-volunt>y basis1 )\t /&>dization across ,/ates4 ,:ile ! ,c5t]s = ,disease ,control & ,prev5tion has ! capacity & sy/em = collect+ dea?-relat$ data bas$ on dea? c]tificates1 ^! data are n suffici5tly report$ by ,/ates 9 an organiz$ & /&>d =mat across ,/ates su* t ! ,c5t]s = ,disease ,control & ,prev5tion is able to id5tify causes ( mat]nal dea? & be/ practices = ! prev5tion ( su* dea?4 7#ab7 ,vital /ati/ics sy/ems (t5 und]e/imate mat]nal mortality & are insuffici5t data s\rces f :i* to d]ive a full scope ( m$ical & social det]m9ant factors contribut+ to mat]nal dea?s4 ,:ile ! addition ( pregnancy *eckboxes on dea? c]tificates s9ce #bjjc h likely improv$ ,/ates' abilities to id5tify pregnancy-relat$ dea?s1 !y are n g5]ally complet$ by ob/etrical provid]s or p]sons tra9$ to recognize pregnancy-relat$ mortality4 ,?us1 ^! vital =ms may be miss+ in=mation or may capture inconsi/5t data4 ,due to v>y+ mat]nal mortality-relat$ analyses1 lack ( reliability1 & granul>ity 9 data1 curr5t mat]nal mortality in=matics d n fully encapsulate ! myriad m$ical & socially det]m9ant factors t contribute to su* high mat]nal mortality rates )9 ! ,unit$ ,/ates comp>$ to o!r develop$ nations4 ,lack ( /&>dization ( data & data %>+ across ,/ates & betwe5 ,f$]al entities1 heal? networks1 & rese>* in/itutions keep ! ,nation 9 ! d>k ab\t ways to prev5t mat]nal dea?s4 7#ac7 ,hav+ reliable & valid ,/ate data aggregat$ at ! ,f$]al level are critical to ! ,nation's ability to quell surges 9 mat]nal dea? & imp]ative = rese>*]s to id5tify long-la/+ int]v5tions4 7#ad7 ,lead]s 9 mat]nal wellness highly recomm5d t mat]nal dea?s be inve/igat$ at ! ,/ate level fir/1 & t /&>diz$1 /reaml9$1 de-id5tifi$ data reg>d+ mat]nal dea?s be s5t annually to ! ,c5t]s = ,disease ,control & ,prev5tion4 ,su* data /&>dization & collection w\ld be simil> 9 op]ation & effect to ! ,national ,program ( ,canc] ,regi/ries ( ! ,c5t]s = ,disease ,control & ,prev5tion & ak9 to ! ,confid5tial ,enquiry 9 ,mat]nal ,dea?s ,programme 9 ! ,unit$ ,k+dom4 ,su* a mat]nal mortalities & morbidities regi/ry & surveillance sy/em w\ld help provid]s1 academicians1 lawmak]s1 & ! public to address que/ions conc]n+ ! types (1 causes (1 & be/ practices to ?w>t1 pregnancy-relat$ or pregnancy-associat$ mortality & morbidity4 7#ae7 ,! ,unit$ ,nations' ,mill5nium ,developm5t ,goal #e;a aim$ to r$uce by #ge p]c5t1 betwe5 #aiij & #bjae1 ! mat]nal mortality rate1 yet ?is metric has n be5 a*iev$4 ,9 fact1 ! mat]nal mortality rate 9 ! ,unit$ ,/ates has be5 e/imat$ to h m ?an d\bl$ betwe5 #bjjj & #bjad4 ,yet1 because national data are n fully available1 ! ,unit$ ,/ates does n h an (ficial mat]nal mortality rate4 7#af7 ,_m ,/ates h /ruggl$ to e/abli% or ma9ta9 ,mat]nal ,mortality ,review ,committees 7ref]r$ to 9 ?is section z ,,mmrc74 ,on ! ,/ate level1 ,m,m,r,cs h lagg$ because ,/ates h n _h ! res\rces to m\nt local reviews4 ,/ate-level reviews are necess>y z only ! ,/ate dep>tm5ts ( heal? h ! au?ority to reque/ m$ical records1 autopsy reports1 & police reports critical to ! function ( ! ,,mmrc4 7#ag7 ,! ,unit$ ,k+dom reg>ds mat]nal dea?s z a heal? sy/ems failure & a national committee ( ob/etrics exp]ts review ea* mat]nal dea? or ne>-fatal *ildbir? complication4 ,su* committee also e/abli%es ! pr$om9ant c\rse ( mat]nal-relat$ dea?s f conditions su* z preeclampsia4 ,consequ5tly1 ! ,unit$ ,k+dom has be5 able to r$uce its incid5ce ( preeclampsia to less ?an "o 9 #aj1jjj wom5--its l[e/ rate s9ce #aieb4 7#ah7 ,! ,unit$ ,/ates has no comp>able1 coord9at$ ,f$]al process by :i* to review cases ( mat]nal mortality1 sy/ems failures1 or be/ practices4 ,_m ,/ates h active ,m,m,r,cs & lev]age _! "w to impact mat]nal wellness4 ,= example1 ! ,/ate ( ,cali=nia has work$ ext5sively ) _! ,/ate heal? dep>tm5ts1 heal? & hospital sy/ems1 & rese>* collaborative organizations1 includ+ ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative & ! ,alliance = ,innovation on ,mat]nal ,heal?1 to e/abli% ,m,m,r,cs1 :]e9 su* ,/ate has det]m9$ ! mo/ preval5t causes ( mat]nal mortality & record$ & %>$ data ) provid]s & rese>*]s1 :o h develop$ & implem5t$ safety bundles & c>e protocols relat$ to preeclampsia1 mat]nal hemorrhage1 & ! l4 ,9 ?is way1 ! ,/ate ( ,cali=nia has be5 able to lev]age its mat]nal mortality review bo>d sy/em1 g5]ate data1 & apply ^? data to effect *anges 9 mat]nal c>e-relat$ protocol4 ,to date1 ! ,/ate ( ,cali=nia has r$uc$ its mat]nal mortality rate1 :i* is n[ comp>able to ! l[ rates ( ! ,unit$ ,k+dom4 7#ai7 ,hospitals & heal? sy/ems across ! ,unit$ ,/ates lack /&>dization ( em]g5cy ob/etrical protocols be=e1 dur+1 & aft] deliv]y4 ,consequ5tly1 _m provid]s are delay$ 9 recogniz+ critical signs indicat+ mat]nal di/ress t quickly escalate into fatal or ne>-fatal incid5ces4 ,moreov]1 any attempt to address an ob/etrical em]g5cy t does n consid] bo? cl9ical & public heal? approa*es falls woefully "u ! m>k ( excell5t c>e deliv]y4 ,/ate-bas$ mat]nal quality collaborative organizations1 su* z ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative or entities p>ticipat+ 9 ! ,alliance = ,innovation on ,mat]nal ,heal? 7,,aim71 h =m$ ob/etrical protocols1 tool kits1 & o!r res\rces to improve sy/em c>e & response z !y relate to mat]nal complications & w>n+ signs = su* conditions z mat]nal hemorrhage1 hyp]t5sion1 & preeclampsia4 7#bj7 ,! ,c5t]s = ,disease ,control & ,prev5tion reports t ne>ly half ( all mat]nal dea?s occur 9 ! imm$iate po/p>tum p]iod--! #db days foll[+ a pregnancy--:]eas m ?an "o-?ird ( pregnancy-relat$ or pregnancy-associat$ dea?s occur :ile a p]son is /ill pregnant4 ,yet1 = wom5 eligible = ! ,m$icaid program on ! basis ( pregnancy1 su* ,m$icaid cov]age lapses at ! end ( ! mon? on :i* ! #fj? po/p>tum day l&s4 7#ba7 ,! exp]i5ce ( s]i\s traumatic ev5ts1 su* z be+ expos$ to dome/ic viol5ce1 sub/ance use disord]1 or p]vasive racism1 c ov]-activate ! body's /ress-response sy/em4 ,kn[n z toxic /ress1 ! repetition ( high-doses ( cortisol to ! bra91 c h>m heal?y neurological developm5t1 :i* c h cascad+ physical & m5tal heal? consequ5ces1 z docum5t$ 9 ! ,adv]se ,*ildhood ,exp]i5ces /udy ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7#bb7 ,a gr[+ body ( evid5ce-bas$ rese>* has %[n ! correlation betwe5 ! /ress associat$ ) "o's race--! /ress ( racism--& "o's bir?+ outcomes4 ,! /ress ( sex & race discrim9ation & in/itutional racism has be5 demon/rat$ to contribute to a high] risk ( mat]nal mortality1 irrespective ( "o's ge/ational age1 mat]nal age1 socioeconomic /atus1 or individual-level heal? risk factors1 includ+ pov]ty1 limit$ access to pr5atal c>e1 & poor physical & m5tal heal? 7al?\gh ^! are n nom9al factors74 ,african-,am]ican wom5 rema9 ! mo/ at risk = pregnancy-associat$ or pregnancy-relat$ causes ( dea?4 ,:5 x comes to preeclampsia1 = example1 :i* is relat$ to obesity1 ,african-,am]ican wom5 ( normal weight rema9 ! mo/ at risk ( dy+ dur+ ! p]9atal p]iod comp>$ to non-,african-,am]ican obese wom54 7#bc7 ,! ris+ mat]nal mortality rate 9 ! ,unit$ ,/ates is driv5 pr$om9antly by ! disproportionately high rates ( ,african-,am]ican mat]nal mortality4 7#bd7 ,african-,am]ican wom5 are #c to #d times m likely to die f pregnancy or mat]nal-relat$ di/ress ?an are ,:ite wom51 yield+ "o ( ! greate/ & mo/ disconc]t+ racial disp>ities 9 public heal?4 7#be7 ,comp>$ to wom5 f o!r racial & e?nic demographics1 ,african-,am]ican wom5 across ! socioeconomic spectrum exp]i5ce prolong$1 unrel5t+ /ress relat$ to racial & g5d] discrim9ation1 contribut+ to high] rates ( mat]nal mortality1 giv+ bir? to l[-weight babies1 & exp]i5c+ pre-t]m bir?4 ,racism is a risk-factor = ^! a=em5tion$ exp]i5ces4 ,?is cumulative /ress (t5 ext5ds across ! life c\rse & is situat$ 9 ev]yday spaces :]e ,african-,am]ican wom5 e/abli% livelihood4 ,/ructural b>ri]s1 lack ( access to c>e1 & g5etic pr$ispositions to heal? vuln]abilities exac]bate ,african-,am]ican wom5's likelihood to exp]i5ce poor or fatal bir?+ outcomes1 b d n fully acc\nt = ! great disp>ity4 7#bf7 ,african-,am]ican wom5 are twice z likely to exp]i5ce po/p>tum depression1 & disproportionately high] rates ( preeclampsia comp>$ to ,:ite wom54 7#bg7 ,racism is deeply +ra9$ 9 ,unit$ ,/ates sy/ems1 includ+ 9 heal? c>e deliv]y sy/ems betwe5 pati5ts & provid]s1 (t5 result+ 9 disp>ate treatm5t = pa91 irrev]5ce = cultural norms ) respect to heal?1 & dismissiv5ess4 ,rese>* has demon/rat$ t pati5ts respond m w>mly & adh]e to m$ical treatm5t plans at a high] degree ) provid]s ( ! same race or e?nicity or ) provid]s ) great ability to ex]cise empa?y4 ,h[ev]1 ! provid] pool is n prim$ ) _m p ( color1 nor are provid]s 7:e!r /ud5t-doctors 9 tra9+ or lic5s$ practition]s7 consi/5tly requir$ to und]go implicit bias1 cultural compet5cy1 or empa?y tra9+ on a consi/5t1 on-go+ basis4 #c4 ,improv+ ,f$]al ef=ts ) respect to prev5tion ( mat]nal mortality 7a7 ,te*nical assi/ance = ,/ates ) respect to report+ mat]nal mortality ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is section z ! ,director71 9 consultation ) ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all provide te*nical assi/ance to ,/ates t elect to report compreh5sive data on mat]nal mortality1 includ+ oral1 m5tal1 & brea/fe$+ heal? in=mation1 = ! purpose ( enc\rag+ uni=mity 9 ! report+ ( su* data & to enc\rage ! %>+ ( su* data among ! respective ,/ates4 7b7 ,be/ practices relat+ to prev5tion ( mat]nal mortality 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act-- 7,a7 ! ,director1 9 consultation ) relevant pati5t & provid] gr\ps1 %all issue be/ practices to ,/ate mat]nal mortality review committees on h[ be/ to id5tify & review mat]nal mortality cases1 tak+ into acc\nt any data made available by ,/ates relat+ to mat]nal mortality1 includ+ data on oral1 m5tal1 & brea/fe$+ heal?1 & utilization ( any em]g5cy s]vices2 & 7,b7 ! ,director1 work+ 9 collaboration ) ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all issue be/ practices to hospitals1 ,/ate pr(essional society gr\ps1 & p]9atal quality collaboratives on h[ be/ to prev5t mat]nal mortality4 7#b7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is subsection1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ea* ( fiscal ye>s #bjai ?r\gh #bjbc4 7c7 ,alliance = ,innovation on ,mat]nal ,heal? ,grant ,program 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,secret>y71 act+ ?r\gh ! ,associate ,adm9i/rator ( ! ,mat]nal & ,*ild ,heal? ,bureau ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all e/abli% a grant program to be kn[n z ! ,alliance = ,innovation on ,mat]nal ,heal? ,grant ,program 7ref]r$ to 9 ?is subsection z ,,aim7 "u :i* ! ,secret>y %all aw>d grants to eligible entities = ! purpose (-- 7,a7 direct+ widespread adoption & implem5tation ( mat]nal safety bundles ?r\gh collaborative ,/ate-bas$ teams2 & 7,b7 collect+ & analyz+ process1 /ructure1 & outcome data to drive cont9u\s improvem5t 9 ! implem5tation ( su* safety bundles by su* ,/ate-bas$ teams ) ! ultimate goal ( elim9at+ prev5table mat]nal mortality & sev]e mat]nal morbidity 9 ! ,unit$ ,/ates4 7#b7 ,eligible entities ,9 ord] to be eligible = a grant "u p>agraph 7#a71 an entity %all-- 7,a7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require2 & 7,b7 demon/rate 9 su* application t ! entity is an int]discipl9>y1 multi-/akehold]1 national organization ) a national data-driv5 mat]nal safety & quality improvem5t initiative bas$ on implem5tation approa*es t h be5 prov5 to improve mat]nal safety & outcomes 9 ! ,unit$ ,/ates4 7#c7 ,use ( funds ,an eligible entity t receives a grant "u p>agraph 7#a7 %all use su* grant funds-- 7,a7 to develop & implem5t1 ?r\gh a robu/1 multi-/akehold] process1 mat]nal safety bundles to assi/ ,/ates & heal? c>e sy/ems 9 align+ national1 ,/ate1 & hospital-level quality improvem5t ef=ts to improve mat]nal heal? outcomes1 specifically ! r$uction ( mat]nal mortality & sev]e mat]nal morbidity2 7,b7 to ensure1 9 develop+ & implem5t+ mat]nal safety bundles "u subp>agraph 7,a71 t su* mat]nal safety bundles-- 7i7 satisfy ! quality improvem5t ne$s ( a ,/ate or heal? c>e sy/em by factor+ 9 ! results & f9d+s ( relevant data reviews1 su* z reviews conduct$ by a ,/ate mat]nal mortality review committee2 & 7ii7 address topics su* z-- 7,i7 ob/etric hemorrhage2 7,,ii7 mat]nal m5tal heal?2 7,,iii7 ! mat]nal v5\s sy/em2 7,,iv7 ob/etric c>e = wom5 ) sub/ance use disord]s1 includ+ opioid use disord]2 7,v7 po/p>tum c>e basics = mat]nal safety2 7,,vi7 r$uction ( p]ip>tum racial & e?nic disp>ities2 7,,vii7 r$uction ( prim>y caes>ean bir?2 7,,viii7 sev]e hyp]t5sion 9 pregnancy2 7,,ix7 sev]e mat]nal morbidity reviews2 7,x7 support aft] a sev]e mat]nal morbidity ev5t2 7,,xi7 ?romboembolism2 7,,xii7 optimization ( support = brea/fe$+2 & 7,,xiii7 mat]nal oral heal?2 & 7,c7 to provide ongo+ te*nical assi/ance at ! national & ,/ate levels to support implem5tation ( mat]nal safety bundles "u subp>agraph 7,a74 7#d7 ,mat]nal safety bundle def9$ ,= purposes ( ?is subsection1 ! t]m mat]nal safety bundle means /&>diz$1 evid5ce-in=m$ processes = mat]nal heal? c>e4 7#e7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is subsection1 !re is au?oriz$ to be appropriat$ #aj1jjj1jjj = ea* ( fiscal ye>s #bjai ?r\gh #bjbc4 7d7 ,fund+ = ,/ate-,bas$ p]9atal quality collaboratives developm5t & su/a9ability 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,secret>y71 act+ ?r\gh ! ,division ( ,reproductive ,heal? ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all e/abli% a grant program to be kn[n z ! ,/ate-,bas$ ,p]9atal ,quality ,collaborative grant program "u :i* ! ,secret>y aw>ds grants to eligible entities = ! purpose ( developm5t & su/a9ability ( p]9atal quality collaboratives 9 e ,/ate1 ! ,di/rict ( ,columbia1 & eligible t]ritories1 9 ord] to measurably improve p]9atal c>e & p]9atal heal? outcomes = pregnant & po/p>tum wom5 & _! infants4 7#b7 ,grant am\nts ,grants aw>d$ "u ?is subsection %all be 9 am\nts n to exce$ #bej1jjj p] ye>1 = ! duration ( ! grant p]iod4 7#c7 ,/ate-bas$ p]9atal quality collaborative def9$ ,= purposes ( ?is subsection1 ! t]m ,/ate-bas$ p]9atal quality collaborative means a network ( multidiscipl9>y teams t-- 7,a7 "w to improve measurable outcomes = mat]nal & infant heal? by advanc+ evid5ce-in=m$ cl9ical practices us+ quality improvem5t pr9ciples2 7,b7 "w ) hospital-bas$ or outpati5t facility-bas$ cl9ical teams1 exp]ts1 & /akehold]s1 includ+ pati5ts & families1 to spread be/ practices & optimize res\rces to improve p]9atal c>e & outcomes2 7,c7 employ /rategies t include ! use ( ! collaborative le>n+ model to provide opportunities = hospitals & cl9ical teams to collaborate on improvem5t /rategies1 rapid-response data to provide timely fe$back to hospital & o!r cl9ical teams to track progress1 & quality improvem5t sci5ce to provide support & coa*+ to hospital & cl9ical teams2 & 7,d7 h ! goal ( improv+ population-level outcomes 9 mat]nal & infant heal?4 7#d7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is subsection1 !re is au?oriz$ to be appropriat$ #ad1jjj1jjj p] ye> = ea* ( fiscal ye>s #bjbj ?r\gh #bjbd4 7e7 ,expansion ( ,m$icaid & ,,*ip cov]age = pregnant & po/p>tum wom5 7#a7 ,requir+ cov]age ( oral heal? s]vices = pregnant & po/p>tum wom5 7,a7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7i7 9 subsection 7a77#d7-- 7,i7 by /rik+ 2 & 7,d7 & ins]t+ 2 7,d72 & 7,,ii7 by ins]t+ 2 & 7,e7 oral heal? s]vices = pregnant & po/p>tum wom5 7z def9$ 9 subsection 7ee77 aft] subsection 7bb772 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7ee7 ,oral heal? s]vices = pregnant & po/p>tum wom5 7#a7 ,9 g5]al ,= purposes ( ?is title1 ! t]m oral heal? s]vices = pregnant & po/p>tum wom5 means d5tal s]vices necess>y to prev5t disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 & treat em]g5cy conditions t are furni%$ to a woman dur+ pregnancy 7or dur+ ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy74 7#b7 ,cov]age requirem5ts ,to satisfy ! requirem5t to provide oral heal? s]vices = pregnant & po/p>tum wom51 a ,/ate %all1 at a m9imum1 provide cov]age = prev5tive1 diagno/ic1 p]iodontal1 & re/orative c>e consi/5t ) recomm5dations = p]9atal oral heal? c>e & d5tal c>e dur+ pregnancy f ! ,am]ican ,academy ( ,p$iatric ,d5ti/ry & ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s4 4 7,b7 ,,*ip ,section #bajc7;c77#e77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#e77;,a77 is am5d$ by ins]t+ or a t>get$ l[-income pregnant woman aft] t>get$ l[-income *ild4 7#b7 ,ext5d+ ,m$icaid cov]age = pregnant & po/p>tum wom5 ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7,a7 9 subsection 7e7-- 7i7 9 p>agraph 7#e7-- 7,i7 by ins]t+ 7includ+ oral heal? s]vices = pregnant & po/p>tum wom5 7z def9$ 9 section #aije7;ee77 aft] po/p>tum m$ical assi/ance "u ! plan2 & 7,,ii7 by /rik+ #fj-;day & ins]t+ #a-ye>2 & 7ii7 9 p>agraph 7#f71 by /rik+ #fj-;day & ins]t+ #a-ye>2 & 7,b7 9 subsection 7l77#a77;,a71 by /rik+ #fj-;day & ins]t+ #a-ye>4 7#c7 ,ext5d+ ,m$icaid cov]age = lawful resid5ts ,section #aijc7v77#d77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#d77;,a77 is am5d$ by /rik+ #fj-;day & ins]t+ #a-ye>4 7#d7 ,ext5d+ ,,*ip cov]age = pregnant & po/p>tum wom5 ,section #baab7;d77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is am5d$ by /rik+ #fj-;day & ins]t+ #a-ye>4 7#e7 ,ma9t5ance ( ef=t 7,a7 ,m$icaid ,section #aijb7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is five ye>s aft] su* date ( enactm5t1 z a condition = receiv+ any ,f$]al paym5ts "u section #aijc7;a7 = cal5d> qu>t]s occurr+ dur+ su* p]iod1 a ,/ate %all n h 9 effect1 ) respect to wom5 :o are eligible = m$ical assi/ance "u ! ,/ate plan or "u a waiv] ( su* plan on ! basis ( be+ pregnant or hav+ be5 pregnant1 eligibility /&>ds1 me?odologies1 or proc$ures "u ! ,/ate plan or waiv] t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan or waiv] t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 4 7,b7 ,,*ip ,section #baje7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,9 eligibility /&>ds = t>get$ l[-income pregnant wom5 ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is five ye>s aft] su* date ( enactm5t1 z a condition ( receiv+ paym5ts "u subsection 7a7 & section #aijc7;a71 a ,/ate t elects to provide assi/ance to wom5 on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to t>get$ l[-income pregnant wom5 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to wom5 :o are eligible = su* assi/ance ?r\gh application ( section #aijb7v77#d77;,a77i7 "u section #bajg7;e77#a71 or any o!r assi/ance "u ! ,/ate *ild heal? plan 7or a waiv] ( su* plan7 :i* is provid$ to wom5 on ! basis ( be+ pregnant7 %all n h 9 effect1 ) respect to su* wom51 eligibility /&>ds1 me?odologies1 or proc$ures "u su* plan 7or waiv]7 t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan 7or waiv]7 t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 4 7#f7 ,in=mation on b5efits ,! ,secret>y ( ,heal? & ,human ,s]vices %all make publicly available on ! ,int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 in=mation reg>d+ b5efits available to pregnant & po/p>tum wom5 & "u ! ,m$icaid program & ! ,*ildr5's ,heal? ,insurance ,program1 includ+ in=mation on-- 7,a7 b5efits t ,/ates are requir$ to provide to pregnant & po/p>tum wom5 "u su* programs2 7,b7 optional b5efits t ,/ates may provide to pregnant & po/p>tum wom5 "u su* programs2 & 7,c7 ! availability ( diff]5t k9ds ( b5efits = pregnant & po/p>tum wom51 includ+ oral heal? & m5tal heal? b5efits1 "u su* programs4 7#g7 ,f$]al fund+ = co/ ( ext5d$ ,m$icaid & ,,*ip cov]age = po/p>tum wom5 7,a7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by p>agraph 7#a71 is fur!r am5d$-- 7i7 9 subsection 7b71 by /rik+ & 7aa7 & ins]t+ 7aa71 & 7ff72 & 7ii7 by add+ at ! end ! foll[+3 7ff7 ,increas$ ,,fmap = ext5d$ m$ical assi/ance = po/p>tum wom5 ,not)/&+ subsection 7b71 ! ,f$]al m$ical assi/ance p]c5tage = a ,/ate1 ) respect to am\nts exp5d$ by su* ,/ate = m$ical assi/ance = a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant or hav+ be5 pregnant t is provid$ dur+ ! #cje-;day p]iod t beg9s on ! #fj? day aft] ! la/ day ( h] pregnancy 7includ+ any su* assi/ance provid$ dur+ ! mon? 9 :i* su* p]iod ends71 %all be equal to-- 7#a7 #ajj p]c5t = ! fir/ #bj cal5d> qu>t]s dur+ :i* ?is subsection is 9 effect2 & 7#b7 #ij p]c5t = cal5d> qu>t]s !reaft]4 4 7,b7 ,,*ip ,section #baje7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ab7 ,enhanc$ paym5t = ext5d$ assi/ance provid$ to pregnant wom5 ,not)/&+ subsection 7b71 ! enhanc$ ,,fmap1 ) respect to paym5ts "u subsection 7a7 = exp5ditures "u ! ,/ate *ild heal? plan 7or a waiv] ( su* plan7 = assi/ance provid$ "u ! plan 7or waiv]7 to a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to a t>get$ l[-income pregnant woman 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to a woman :o is eligible = su* assi/ance ?r\gh application ( section #aijb7v77#d77;,a77i7 "u section #bajg7;e77#a71 or any o!r assi/ance "u ! plan 7or waiv]7 provid$ to a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant7 dur+ ! #cje-;day p]iod t beg9s on ! #fj? day aft] ! la/ day ( h] pregnancy 7includ+ any su* assi/ance provid$ dur+ ! mon? 9 :i* su* p]iod ends71 %all be equal to-- 7,a7 #ajj p]c5t = ! fir/ #bj cal5d> qu>t]s dur+ :i* ?is p>agraph is 9 effect2 & 7,b7 #ij p]c5t = cal5d> qu>t]s !reaft]4 4 7#h7 ,effective date 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! am5dm5ts made by ?is subsection %all take effect on ! fir/ day ( ! fir/ cal5d> qu>t] t beg9s on or aft] ! date t is "o ye> aft] ! date ( enactm5t ( ?is ,act4 7,b7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act or a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 9 ord] = ! respective plan to meet any requirem5t impos$ by am5dm5ts made by ?is subsection1 ! respective plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet su* an additional requirem5t be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session %all be consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 7f7 ,regional c5t]s ( excell5ce ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act is am5d$ by add+ at ! end ! foll[+ new section3 #cii,v-#g4 ,regional c5t]s ( excell5ce address+ implicit bias & cultural compet5cy 9 pati5t-provid] int]actions education 7a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) su* o!r ag5cy heads z ! ,secret>y det]m9es appropriate1 %all aw>d coop]ative agreem5ts = ! e/abli%m5t or support ( regional c5t]s ( excell5ce address+ implicit bias & cultural compet5cy 9 pati5t-provid] int]actions education = ! purpose ( enhanc+ & improv+ h[ heal? c>e pr(essionals are educat$ 9 implicit bias & deliv]+ culturally compet5t heal? c>e4 7b7 ,eligibility ,to be eligible to receive a coop]ative agreem5t "u subsection 7a71 an entity %all-- 7#a7 be a public or o!r nonpr(it entity specifi$ by ! ,secret>y t provides educational & tra9+ opportunities = /ud5ts & heal? c>e pr(essionals1 :i* may be a heal? sy/em1 tea*+ hospital1 community heal? c5t]1 m$ical s*ool1 s*ool ( public heal?1 d5tal s*ool1 social "w s*ool1 s*ool ( pr(essional psy*ology1 or any o!r heal? pr(essional s*ool or program at an in/itution ( high] education 7z def9$ 9 section #aja ( ! ,high] ,education ,act ( #aife7 focus$ on ! prev5tion1 treatm5t1 or recov]y ( heal? conditions t contribute to mat]nal mortality & ! prev5tion ( mat]nal mortality & sev]e mat]nal morbidity2 7#b7 demon/rate community engagem5t & p>ticipation1 su* z ?r\gh p>tn]%ips ) home visit+ & case managem5t programs2 & 7#c7 provide to ! ,secret>y su* in=mation1 at su* "t & 9 su* mann]1 z ! ,secret>y may require4 7c7 ,div]sity ,9 aw>d+ a coop]ative agreem5t "u subsection 7a71 ! ,secret>y %all take into acc\nt any regional diff]5ces among eligible entities & make an ef=t to ensure geographic div]sity among aw>d recipi5ts4 7d7 ,dissem9ation ( in=mation 7#a7 ,public availability ,! ,secret>y %all make publicly available on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices in=mation submitt$ to ! ,secret>y "u subsection 7b77#c74 7#b7 ,evaluation ,! ,secret>y %all evaluate ea* regional c5t] ( excell5ce e/abli%$ or support$ pursuant to subsection 7a7 & dissem9ate ! f9d+s result+ f ea* su* evaluation to ! appropriate public & private entities4 7#c7 ,di/ribution ,! ,secret>y %all %>e evaluations & ov]all f9d+s ) ,/ate dep>tm5ts ( heal? & o!r relevant ,/ate level (fices to in=m ,/ate & local be/ practices4 7e7 ,mat]nal mortality def9$ ,9 ?is section1 ! t]m mat]nal mortality means dea? ( a woman t occurs dur+ pregnancy or )9 ! "o-ye> p]iod foll[+ ! end ( su* pregnancy4 7f7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is section1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ea* ( fiscal ye>s #bjai ?r\gh #bjbc4 4 7g7 ,special supplem5tal nutrition program = wom51 infants1 & *ildr5 ,section #ag7;d77#c77;,a77ii7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is am5d$-- 7#a7 by /rik+ ! clause designation & head+ & all t foll[s ?r\gh ,a ,/ate & ins]t+ ! foll[+3 7ii7 ,wom5 7,i7 ,brea/fe$+ wom5 ,a ,/ate 2 7#b7 9 subclause 7,i7 7z s designat$71 by /rik+ #a ye> & all t foll[s ?r\gh e>li] & ins]t+ #b ye>s po/p>tum2 & 7#c7 by add+ at ! end ! foll[+3 7,,ii7 ,po/p>tum wom5 ,a ,/ate may elect to c]tify a po/p>tum woman = a p]iod ( #b ye>s4 4 7h7 ,def9itions ,9 ?is section3 7#a7 ,mat]nal mortality ,! t]m mat]nal mortality means dea? ( a woman t occurs dur+ pregnancy or )9 ! "o-ye> p]iod foll[+ ! end ( su* pregnancy4 7#b7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity includes unexpect$ outcomes ( labor & deliv]y t result 9 significant %ort-t]m or long-t]m consequ5ces to a woman's heal?4 #d4 ,increas+ excise taxes on cig>ettes & e/abli%+ excise tax equity among all tobacco product tax rates 7a7 ,tax p>ity = roll-,y\r-,own tobacco ,section #egja7;g7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #bd4gh & ins]t+ #di4ef4 7b7 ,tax p>ity = pipe tobacco ,section #egja7;f7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #b4hcaa c5ts & ins]t+ #di4ef4 7c7 ,tax p>ity = smokeless tobacco 7#a7 ,section #egja7;e7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 9 p>agraph 7#a71 by /rik+ #a4ea & ins]t+ #bf4hd2 7,b7 9 p>agraph 7#b71 by /rik+ #ej4cc c5ts & ins]t+ #aj4gd2 & 7,c7 by add+ at ! end ! foll[+3 7#c7 ,smokeless tobacco sold 9 discrete s+le-use units ,on discrete s+le-use units1 #ajj4ff p] ?\s&4 4 7#b7 ,section #egjb7m7 ( su* ,code is am5d$-- 7,a7 9 p>agraph 7#a71 by /rik+ or *ew+ tobacco & ins]t+ 1 *ew+ tobacco1 or discrete s+le-use unit2 7,b7 9 p>agraphs 7#b7 & 7#c71 by ins]t+ t is n a discrete s+le-use unit be=e ! p]iod 9 ea* su* p>agraph2 & 7,c7 by add+ at ! end ! foll[+3 7#d7 ,discrete s+le-use unit ,! t]m discrete s+le-use unit means any product conta9+ tobacco t-- 7,a7 is n int5d$ to be smok$2 & 7,b7 is 9 ! =m ( a loz5ge1 tablet1 pill1 p\*1 dissolvable /rip1 or o!r discrete s+le-use or s+le-dose unit4 4 7d7 ,tax p>ity = small cig>s ,p>agraph 7#a7 ( section #egja7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #ej4cc & ins]t+ #ajj4ff4 7e7 ,tax p>ity = l>ge cig>s 7#a7 ,9 g5]al ,p>agraph 7#b7 ( section #egja7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #eb4ge p]c5t & all t foll[s ?r\gh ! p]iod & ins]t+ ! foll[+3 #di4ef p] p\nd & a proportionate tax at ! l rate on all fractional p>ts ( a p\nd b n less ?an #aj4jff c5ts p] cig>44 7#b7 ,guidance ,! ,secret>y ( ! ,treasury1 or ! ,secret>y's delegate1 may issue guidance reg>d+ ! appropriate me?od = det]m9+ ! weight ( l>ge cig>s = purposes ( calculat+ ! applicable tax "u section #egja7;a77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf4 7f7 ,tax p>ity = roll-,y\r-,own tobacco & c]ta9 process$ tobacco ,subsection 7o7 ( section #egjb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ 1 & includes process$ tobacco t is remov$ = deliv]y or deliv]$ to a p]son o!r ?an a p]son ) a p]mit provid$ "u section #egac1 b does n include removals ( process$ tobacco = exportation aft] wrapp]s !re(4 7g7 ,cl>ify+ tax rate = o!r tobacco products 7#a7 ,9 g5]al ,section #egja ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,o!r tobacco products ,any product n o!rwise describ$ "u ?is section t has be5 det]m9$ to be a tobacco product by ! ,food & ,drug ,adm9i/ration ?r\gh its au?orities "u ! ,family ,smok+ ,prev5tion & ,tobacco ,control ,act %all be tax$ at a level ( tax equival5t to ! tax rate = cig>ettes on an e/imat$ p] use basis z det]m9$ by ! ,secret>y4 4 7#b7 ,e/abli%+ p] use basis ,= purposes ( section #egja7;i7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 n lat] ?an #ab mon?s aft] ! lat] ( ! date ( ! enactm5t ( ?is ,act or ! date t a product has be5 det]m9$ to be a tobacco product by ! ,food & ,drug ,adm9i/ration1 ! ,secret>y ( ! ,treasury 7or ! ,secret>y ( ! ,treasury's delegate7 %all issue f9al regulations e/abli%+ ! level ( tax = su* product t is equival5t to ! tax rate = cig>ettes on an e/imat$ p] use basis4 7h7 ,cl>ify+ def9ition ( tobacco products 7#a7 ,9 g5]al ,subsection 7c7 ( section #egjb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7c7 ,tobacco products ,! t]m tobacco products means-- 7#a7 cig>s1 cig>ettes1 smokeless tobacco1 pipe tobacco1 & roll-y\r-own tobacco1 & 7#b7 any o!r product subject to tax pursuant to section #egja7;i74 4 7#b7 ,con=m+ am5dm5ts ,subsection 7d7 ( section #egjb ( su* ,code is am5d$ by /rik+ cig>s1 cig>ettes1 smokeless tobacco1 pipe tobacco1 or roll-y\r-own tobacco ea* place x appe>s & ins]t+ tobacco products4 7i7 ,increas+ tax on cig>ettes 7#a7 ,small cig>ettes ,section #egja7;b77#a7 ( su* ,code is am5d$ by /rik+ #ej4cc & ins]t+ #ajj4ff4 7#b7 ,l>ge cig>ettes ,section #egja7;b77#b7 ( su* ,code is am5d$ by /rik+ #aje4fi & ins]t+ #baa4ch4 7j7 ,tax rates adju/$ = inflation ,section #egja ( su* ,code1 z am5d$ by subsection 7g71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,inflation adju/m5t 7#a7 ,9 g5]al ,9 ! case ( any cal5d> ye> beg9n+ aft] #bjah1 ! doll> am\nts provid$ "u ?is *apt] %all ea* be increas$ by an am\nt equal to-- 7,a7 su* doll> am\nt1 multipli$ by 7,b7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye>1 det]m9$ by sub/itut+ #8cal5d> ye> #bjag' = #8cal5d> ye> #bjaf' 9 subp>agraph 7,a77ii7 !re(4 7#b7 ,r\nd+ ,if any am\nt z adju/$ "u p>agraph 7#a7 is n a multiple ( #j4ja1 su* am\nt %all be r\nd$ to ! next highe/ multiple ( #j4ja4 4 7k7 ,floor ,/ocks ,taxes 7#a7 ,imposition ( tax ,on tobacco products manufactur$ 9 or import$ into ! ,unit$ ,/ates :i* are remov$ be=e any tax increase date & held on su* date = sale by any p]son1 !re is h]eby impos$ a tax 9 an am\nt equal to ! excess (-- 7,a7 ! tax :i* w\ld be impos$ "u section #egja ( ! ,int]nal ,rev5ue ,code ( #aihf on ! article if ! article _h be5 remov$ on su* date1 ov] 7,b7 ! prior tax 7if any7 impos$ "u section #egja ( su* ,code on su* article4 7#b7 ,cr$it aga9/ tax ,ea* p]son %all be all[$ z a cr$it aga9/ ! taxes impos$ by p>agraph 7#a7 an am\nt equal to #ejj4 ,su* cr$it %all n exce$ ! am\nt ( taxes impos$ by p>agraph 7#a7 on su* date = :i* su* p]son is liable4 7#c7 ,liability = tax & me?od ( paym5t 7,a7 ,liability = tax ,a p]son hold+ tobacco products on any tax increase date to :i* any tax impos$ by p>agraph 7#a7 applies %all be liable = su* tax4 7,b7 ,me?od ( paym5t ,! tax impos$ by p>agraph 7#a7 %all be paid 9 su* mann] z ! ,secret>y %all prescribe by regulations4 7,c7 ,"t = paym5t ,! tax impos$ by p>agraph 7#a7 %all be paid on or be=e ! date t is #abj days aft] ! effective date ( ! tax rate increase4 7#d7 ,articles 9 =eign trade zones ,not)/&+ ! ,act ( ,june #ah1 #aicd 7commonly kn[n z ! ,=eign ,trade ,zone ,act1 #dh ,/at4 #iih1 #ai ,u4,s4,c4 #ha;a et seq471 or any o!r provision ( law1 any article :i* is locat$ 9 a =eign trade zone on any tax increase date %all be subject to ! tax impos$ by p>agraph 7#a7 if-- 7,a7 int]nal rev5ue taxes h be5 det]m9$1 or cu/oms duties liquidat$1 ) respect to su* article be=e su* date pursuant to a reque/ made "u ! #a/ proviso ( section #c7;a7 ( su* ,act2 or 7,b7 su* article is held on su* date "u ! sup]vision ( an (fic] ( ! ,unit$ ,/ates ,cu/oms & ,bord] ,protection ( ! ,dep>tm5t ( ,homel& ,security pursuant to ! #b;d proviso ( su* section #c7;a74 7#e7 ,def9itions ,= purposes ( ?is subsection-- 7,a7 ,9 g5]al ,any t]m us$ 9 ?is subsection :i* is also us$ 9 section #egjb ( su* ,code %all h ! same mean+ z su* t]m has 9 su* section4 7,b7 ,tax increase date ,! t]m tax increase date means ! effective date ( any increase 9 any tobacco product excise tax rate pursuant to ! am5dm5ts made by ?is section 7o!r ?an subsection 7j7 !re(74 7,c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ! ,treasury or ! ,secret>y's delegate4 7#f7 ,controll$ gr\ps ,rules simil> to ! rules ( section #ejfa7;e77#c7 ( su* ,code %all apply = purposes ( ?is subsection4 7#g7 ,o!r laws applicable ,all provisions ( law1 includ+ p5alties1 applicable ) respect to ! taxes impos$ by section #egja ( su* ,code %all1 ins(> z applicable & n inconsi/5t ) ! provisions ( ?is subsection1 apply to ! floor /ocks taxes impos$ by p>agraph 7#a71 to ! same ext5t z if su* taxes 7 impos$ by su* section #egja4 ,! ,secret>y may treat any p]son :o bore ! ultimate burd5 ( ! tax impos$ by p>agraph 7#a7 z ! p]son to :om a cr$it or refund "u su* provisions may be all[$ or made4 7l7 ,effective dates 7#a7 ,9 g5]al ,except z provid$ 9 p>agraphs 7#b7 ?r\gh 7#d71 ! am5dm5ts made by ?is section %all apply to articles remov$ 7z def9$ 9 section #egjb7;j7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 aft] ! la/ day ( ! mon? :i* includes ! date ( ! enactm5t ( ?is ,act4 7#b7 ,discrete s+le-use units & process$ tobacco ,! am5dm5ts made by subsections 7c77#a77;,c71 7c77#b71 & 7f7 %all apply to articles remov$ 7z def9$ 9 section #egjb7;j7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 aft] ! date t is #f mon?s aft] ! date ( ! enactm5t ( ?is ,act4 7#c7 ,l>ge cig>s ,! am5dm5ts made by subsection 7e7 %all apply to articles remov$ aft] ,decemb] #ca1 #bjai4 7#d7 ,o!r tobacco products ,! am5dm5ts made by subsection 7g77#a7 %all apply to products remov$ aft] ! la/ day ( ! mon? :i* includes ! date t ! ,secret>y ( ! ,treasury 7or ! ,secret>y ( ! ,treasury's delegate7 issues f9al regulations e/abli%+ ! level ( tax = su* product4