STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS; Congressional Record Vol. 165, No. 53
(Senate - March 27, 2019)

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[Pages S2045-S2054]
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          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. WYDEN (for himself and Mr. Cotton):
  S. 890. A bill to authorize the Sergeant at Arms to protect the 
personal technology devices and accounts of Senators and covered 
employees from cyber attacks and hostile information collection 
activities, and for other purposes; to the Committee on Rules and 
Administration.
  Mr. WYDEN. Mr. President, today I, along with my colleague Senator 
Cotton from Arkansas, am introducing the Senate Cybersecurity 
Protection Act to defend the integrity of American democracy by 
providing cybersecurity protection for the personal accounts and 
electronic devices of Senators and and key members of their staff.
  In 2016, hackers working for the Russian government broke into a 
range of targets, including the network of the Democratic National 
Committee and the email account of Senator Hillary Clinton's 
presidential campaign manager, John Podesta. These widely publicized 
breaches are only the tip of the iceberg. These hacks are widely known 
today because the emails stolen from these accounts were subsequently 
weaponized and used as part of a campaign to influence the outcome of 
several elections--most publicly, the presidential race between Donald 
Trump and Hillary Clinton, but also U.S. House of Representatives races 
in Illinois, New Hampshire, New Mexico, North Carolina, Ohio, and 
Pennsylvania. Senator Lindsey Graham also reported that his campaign's 
email was successfully compromised.
  While the Russian hacks in 2016 were a watershed moment, these are 
merely the most visible and disruptive examples of foreign intelligence 
services

[[Page S2046]]

using offensive cyber capabilities to target those involved in our 
political process. Senior officials from the 2008 Obama and McCain 
presidential campaigns have publicly confirmed that both organizations 
were compromised by hackers. In 2017, the media reported that then-
White House Chief of Staff John Kelly's personal cell phone had been 
compromised, possibly for as long as ten months before the malware was 
discovered. And in 2018, media reports revealed that the personal email 
accounts of senior congressional staffers had been targeted by the 
notorious Russian hacking group ``Fancy-Bear.'' These and other events 
clearly demonstrate the unique threats faced by Senators and their 
staff. Unfortunately, as I revealed in a letter to Senate leadership 
last year, the Sergeant At Arms (SAA), which is responsible for the 
Senate's cybersecurity, informed me that it currently lacks the 
authority to use official Senate resources to protect the personal 
devices and accounts of Senators and key Senate staff, even when those 
staff are being targeted by foreign governments.
  Senators Cotton and I are not alone in recognizing the seriousness of 
this national security threat.
  Last year, then-Director of the National Security Agency Admiral 
Michael Rogers acknowledged in a letter to me that personal devices and 
accounts of senior U.S. government officials ``remain prime targets for 
exploitation.'' Likewise, in written responses to post-hearing 
questions from the Senate Intelligence Committee last year, Director of 
National Intelligence Dan Coats wrote that ``[t]he personal accounts 
and devices of government officials can contain information that is 
useful for our adversaries to target, either directly or indirectly, 
these officials and the organizations with which they are affiliated.'' 
The Appropriations Committee also noted last year in its report 
accompanying the 2019 Legislative Branch Appropriations bill that it 
``continues to be concerned that Senators are being targeted for 
hacking and cyber attacks, especially via their personal devices and 
accounts.''
  Currently, Senators and staffers are expected to protect their own 
devices and accounts from foreign government hackers. This is absurd. 
Senators and the vast majority of their staff are not cybersecurity 
experts, and certainly do not have the training our resources to defend 
themselves from sophisticated foreign intelligence agencies. Eric 
Rosenbach, who was formerly Chief of Staff to Secretary of Defense Ash 
Carter, has endorsed the bill we are introducing today, observing that 
``Senators and their staff should not be expected to go toe to toe with 
some of the most sophisticated adversaries in cyberspace; authorizing 
protection of personal accounts is a critical component of our cyber 
defense efforts.'' Likewise, Bruce Schreier, a noted cybersecurity 
expert has also endorsed the bill, stating that ``[i]t is ludicrous to 
expect individual senators and their staff to to defend themselves from 
spies and hackers. Hostile foreign intelligence services do not respect 
the arbitrary line between work and personal technology. As such, the 
U.S. government must extend its defensive cyber perimeter to include 
legislators' personal devices and accounts.''
  Our bill would permit the SAA to provide voluntary, opt-in 
cybersecurity assistance to Senators and key Senate staff to secure 
their personal devices and accounts. Any Senate staffer would be 
eligible to receive assistance, provided that the Senator employing 
them determines that they are highly vulnerable to cyber attacks and 
information collection because of their position in the Senate.
  There is precedent for extending cybersecurity protection to the 
personal devices of government officials. Section 1645 of the 2017 
National Defense Authorization Act permits the Secretary of Defense to 
provide personal device cybersecurity assistance to officials whom the 
secretary ``determines to be highly vulnerable to cyber attacks and 
hostile information collection activities because of the positions 
occupied by such personnel in the Department.'' The Senate 
Cybersecurity Protection Act is also similar to provisions included in 
the intelligence authorization bill approved by the Senate Select 
Committee on Intelligence in 2018, which would permit the Director of 
National Intelligence to protect the personal devices and accounts of 
high-risk staff in the intelligence community.
  Passage of this common sense, bipartisan legislation would provide 
Senators and their staff with much-needed protection for their personal 
accounts and devices, and with them, the integrity of American 
democracy. I thank my colleague Senator Cotton for his efforts on this 
bill, and hope the Senate will promptly pass this vital legislation.
                                 ______
                                 
      By Mr. DURBIN (for himself, Mr. Blumenthal, Mr. Booker, Mr. 
        Cardin, Mr. Coons, Ms. Duckworth, Ms. Harris, Mr. Kaine, Ms. 
        Klobuchar, Mr. Markey, Mr. Whitehouse, Mr. Sanders, Mr. Schatz, 
        and Mr. Reed):
  S. 894. A bill to authorize dedicated domestic terrorism offices 
within the Department of Homeland Security, the Department of Justice, 
and the Federal Bureau of Investigation to analyze and monitor domestic 
terrorist activity and require the Federal Government to take steps to 
prevent domestic terrorism; to the Committee on the Judiciary.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 894

       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 ``Domestic Terrorism 
     Prevention Act of 2019''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) White supremacists and other far-right-wing extremists 
     are the most significant domestic terrorism threat facing the 
     United States.
       (2) On February 22, 2019, a Trump Administration United 
     States Department of Justice official wrote in a New York 
     Times op-ed that ``white supremacy and far-right extremism 
     are among the greatest domestic-security threats facing the 
     United States. Regrettably, over the past 25 years, law 
     enforcement, at both the Federal and State levels, has been 
     slow to respond. . . .Killings committed by individuals and 
     groups associated with far-right extremist groups have risen 
     significantly.''.
       (3) An April 2017 Government Accountability Office report 
     on the significant, lethal threat posed by domestic violent 
     extremists explained that ``[s]ince September 12, 2001, the 
     number of fatalities caused by domestic violent extremists 
     has ranged from 1 to 49 in a given year.'' The report noted: 
     ``[F]atalities resulting from attacks by far right wing 
     violent extremists have exceeded those caused by radical 
     Islamist violent extremists in 10 of the 15 years, and were 
     the same in 3 of the years since September 12, 2001. Of the 
     85 violent extremist incidents that resulted in death since 
     September 12, 2001, far right wing violent extremist groups 
     were responsible for 62 (73 percent) while radical Islamist 
     violent extremists were responsible for 23 (27 percent).''.
       (4) An unclassified May 2017 joint intelligence bulletin 
     from the Federal Bureau of Investigation and the Department 
     of Homeland Security found that ``white supremacist extremism 
     poses [a] persistent threat of lethal violence,'' and that 
     White supremacists ``were responsible for 49 homicides in 26 
     attacks from 2000 to 2016 . . . more than any other domestic 
     extremist movement''.
       (5) Fatal terrorist attacks by far-right-wing extremists 
     include--
       (A) the August 5, 2012, mass shooting at a Sikh gurdwara in 
     Oak Creek, Wisconsin, in which a White supremacist shot and 
     killed 6 members of the gurdwara;
       (B) the April 13, 2014, mass shooting at a Jewish community 
     center and a Jewish assisted living facility in Overland 
     Park, Kansas, in which a neo-Nazi shot and killed 3 
     civilians, including a 14-year-old teenager;
       (C) the June 8, 2014, ambush in Las Vegas, Nevada, in which 
     2 supporters of the far-right-wing ``patriot'' movement shot 
     and killed 2 police officers and a civilian;
       (D) the June 17, 2015, mass shooting at the Emanuel AME 
     Church in Charleston, South Carolina, in which a White 
     supremacist shot and killed 9 members of the church;
       (E) the November 27, 2015, mass shooting at a Planned 
     Parenthood clinic in Colorado Springs, Colorado, in which an 
     anti-abortion extremist shot and killed a police officer and 
     2 civilians;
       (F) the March 20, 2017, murder of an African-American man 
     in New York City, allegedly committed by a White supremacist 
     who reportedly traveled to New York ``for the purpose of 
     killing black men'';
       (G) the May 26, 2017, attack in Portland, Oregon, in which 
     a White supremacist allegedly murdered 2 men and injured a 
     third after the men defended 2 young women whom the 
     individual had targeted with anti-Muslim hate speech;

[[Page S2047]]

       (H) the August 12, 2017, attack in Charlottesville, 
     Virginia, in which a White supremacist killed one and injured 
     nineteen after driving his car through a crowd of individuals 
     protesting a neo-Nazi rally, and of which former Attorney 
     General Jeff Sessions said, ``It does meet the definition of 
     domestic terrorism in our statute.'';
       (I) the July 2018 murder of an African-American woman from 
     Kansas City, Missouri, allegedly committed by a White 
     supremacist who reportedly bragged about being a member of 
     the Ku Klux Klan;
       (J) the October 24, 2018, shooting in Jeffersontown, 
     Kentucky, in which a White man allegedly murdered 2 African 
     Americans at a grocery store after first attempting to enter 
     a church with a predominantly African-American congregation 
     during a service; and
       (K) the October 27, 2018, mass shooting at the Tree of Life 
     Synagogue in Pittsburgh, Pennsylvania, in which a White 
     nationalist allegedly shot and killed 11 members of the 
     congregation.
       (6) In November 2018, the Federal Bureau of Investigation 
     released its annual hate crime incident report, which found 
     that in 2017, hate crimes increased by approximately 17 
     percent, including a 23-percent increase in religion-based 
     hate crimes, an 18-percent increase in race-based crimes, and 
     a 5-percent increase in crimes directed against LGBT 
     individuals. The total number of reported hate crimes rose 
     for the third consecutive year. The previous year's report 
     found that in 2016, hate crimes increased by almost 5 
     percent, including a 19-percent rise in hate crimes against 
     American Muslims; additionally, of the hate crimes motivated 
     by religious bias in 2016, 53 percent were anti-Semitic. 
     Similarly, the report analyzing 2015 data found that hate 
     crimes increased by 6 percent that year. Much of the 2015 
     increase came from a 66-percent rise in attacks on American 
     Muslims and a 9-percent rise in attacks on American Jews. In 
     all three reports, race-based crimes were most numerous, and 
     those crimes most often targeted African Americans.
       (7) On March 15, 2019, a White nationalist was arrested and 
     charged with murder after allegedly killing 50 Muslim 
     worshippers and injuring more than 40 in a massacre at the Al 
     Noor Mosque and Linwood Mosque in Christchurch, New Zealand. 
     The alleged shooter posted a hate-filled, xenophobic 
     manifesto that detailed his White nationalist ideology before 
     the massacre. Prime Minister Jacinda Ardern labeled the 
     massacre a terrorist attack.
       (8) In January 2017, a right-wing extremist who had 
     expressed anti-Muslim views was charged with murder for 
     allegedly killing 6 people and injuring 19 in a shooting 
     rampage at a mosque in Quebec City, Canada. It was the first-
     ever mass shooting at a mosque in North America, and Prime 
     Minister Trudeau labeled it a terrorist attack.
       (9) On February 15, 2019, Federal authorities arrested U.S. 
     Coast Guard Lieutenant Christopher Paul Hasson, who was 
     allegedly planning to kill a number of prominent journalists, 
     professors, judges, and ``leftists in general''. In court 
     filings, prosecutors described Lieutenant Hasson as a 
     ``domestic terrorist'' who in an email ``identified himself 
     as a White Nationalist for over 30 years and advocated for 
     `focused violence' in order to establish a white homeland.''.

     SEC. 3. DEFINITIONS.

       In this Act--
       (1) the term ``Director'' means the Director of the Federal 
     Bureau of Investigation;
       (2) the term ``domestic terrorism'' has the meaning given 
     the term in section 2331 of title 18, United States Code, 
     except that it does not include acts perpetrated by 
     individuals associated with or inspired by--
       (A) a foreign person or organization designated as a 
     foreign terrorist organization under section 219 of the 
     Immigration and Nationality Act (8 U.S.C. 1189);
       (B) an individual or organization designated under 
     Executive Order 13224 (50 U.S.C. 1701 note); or
       (C) a state sponsor of terrorism as determined by the 
     Secretary of State under section 6(j) of the Export 
     Administration Act of 1979 (50 U.S.C. 4605), section 40 of 
     the Arms Export Control Act (22 U.S.C. 2780), or section 620A 
     of the Foreign Assistance Act of 1961 (22 U.S.C. 2371);
       (3) the term ``Domestic Terrorism Executive Committee'' 
     means the committee within the Department of Justice tasked 
     with assessing and sharing information about ongoing domestic 
     terrorism threats;
       (4) the term ``hate crime incident'' means an act described 
     in section 245, 247, or 249 of title 18, United States Code, 
     or in section 901 of the Civil Rights Act of 1968 (42 U.S.C. 
     3631);
       (5) the term ``Secretary'' means the Secretary of Homeland 
     Security; and
       (6) the term ``uniformed services'' has the meaning given 
     the term in section 101(a) of title 10, United States Code.

     SEC. 4. OFFICES TO COMBAT DOMESTIC TERRORISM.

       (a) Authorization of Offices To Monitor, Analyze, 
     Investigate, and Prosecute Domestic Terrorism.--
       (1) Domestic terrorism unit.--There is authorized a 
     Domestic Terrorism Unit in the Office of Intelligence and 
     Analysis of the Department of Homeland Security, which shall 
     be responsible for monitoring and analyzing domestic 
     terrorism activity.
       (2) Domestic terrorism office.--There is authorized a 
     Domestic Terrorism Office in the Counterterrorism Section of 
     the National Security Division of the Department of Justice--
       (A) which shall be responsible for investigating and 
     prosecuting incidents of domestic terrorism; and
       (B) which shall be headed by the Domestic Terrorism 
     Counsel.
       (3) Domestic terrorism section of the fbi.--There is 
     authorized a Domestic Terrorism Section within the 
     Counterterrorism Division of the Federal Bureau of 
     Investigation, which shall be responsible for investigating 
     domestic terrorism activity.
       (4) Staffing.--The Secretary, the Attorney General, and the 
     Director shall each ensure that the offices authorized under 
     this section in their respective agencies shall have adequate 
     staff to perform the required duties.
       (b) Joint Report on Domestic Terrorism.--
       (1) Annual report required.--Not later than 180 days after 
     the date of enactment of this Act, and each year thereafter, 
     the Secretary of Homeland Security, the Attorney General, and 
     the Director of the Federal Bureau of Investigation shall 
     submit a joint report authored by the domestic terrorism 
     offices authorized under paragraphs (1), (2), and (3) of 
     subsection (a) to--
       (A) the Committee on the Judiciary, the Committee on 
     Homeland Security and Governmental Affairs, and the Select 
     Committee on Intelligence of the Senate; and
       (B) the Committee on the Judiciary, the Committee on 
     Homeland Security, and the Permanent Select Committee on 
     Intelligence of the House of Representatives.
       (2) Contents.--Each report submitted under paragraph (1) 
     shall include--
       (A) an assessment of the domestic terrorism threat posed by 
     White supremacists and neo-Nazis, including White supremacist 
     and neo-Nazi infiltration of Federal, State, and local law 
     enforcement agencies and the uniformed services; and
       (B)(i) in the first report, an analysis of incidents or 
     attempted incidents of domestic terrorism that have occurred 
     in the United States since April 19, 1995; and
       (ii) in each subsequent report, an analysis of incidents or 
     attempted incidents of domestic terrorism that occurred in 
     the United States during the preceding year; and
       (C) a quantitative analysis of domestic terrorism for the 
     preceding year, including the number of--
       (i) domestic terrorism related assessments initiated by the 
     Federal Bureau of Investigation, including the number of 
     assessments from each classification and subcategory;
       (ii) domestic terrorism-related preliminary investigations 
     initiated by the Federal Bureau of Investigation, including 
     the number of preliminary investigations from each 
     classification and subcategory, and how many preliminary 
     investigations resulted from assessments;
       (iii) domestic terrorism-related full investigations 
     initiated by the Federal Bureau of Investigation, including 
     the number of full investigations from each classification 
     and subcategory, and how many full investigations resulted 
     from preliminary investigations and assessments;
       (iv) domestic terrorism-related incidents, including the 
     number of incidents from each classification and subcategory, 
     the number of deaths and injuries resulting from each 
     incident, and a detailed explanation of each incident;
       (v) Federal domestic terrorism-related arrests, including 
     the number of arrests from each classification and 
     subcategory, and a detailed explanation of each arrest;
       (vi) Federal domestic terrorism-related indictments, 
     including the number of indictments from each classification 
     and subcategory, and a detailed explanation of each 
     indictment;
       (vii) Federal domestic terrorism-related prosecutions, 
     including the number of incidents from each classification 
     and subcategory, and a detailed explanation of each 
     prosecution;
       (viii) Federal domestic terrorism-related convictions, 
     including the number of convictions from each classification 
     and subcategory, and a detailed explanation of each 
     conviction; and
       (ix) Federal domestic terrorism-related weapons recoveries, 
     including the number of each type of weapon and the number of 
     weapons from each classification and subcategory.
       (3) Hate crimes.--In compiling a joint report under this 
     subsection, the domestic terrorism offices authorized under 
     paragraphs (1), (2), and (3) of subsection (a) shall, in 
     consultation with the Civil Rights Division of the Department 
     of Justice and the Civil Rights Unit of the Federal Bureau of 
     Investigation, review each hate crime incident reported 
     during the preceding year to determine whether the incident 
     also constitutes a domestic terrorism-related incident.
       (4) Classification and public release.--Each report 
     submitted under paragraph (1) shall be--
       (A) unclassified, to the greatest extent possible, with a 
     classified annex only if necessary; and
       (B) in the case of the unclassified portion of the report, 
     posted on the public websites of the Department of Homeland 
     Security, the Department of Justice, and the Federal Bureau 
     of Investigation.
       (c) Domestic Terrorism Executive Committee.--There is 
     authorized a Domestic Terrorism Executive Committee, which 
     shall--

[[Page S2048]]

       (1) meet on a regular basis, and not less regularly than 4 
     times each year, to coordinate with United States Attorneys 
     and other key public safety officials across the country to 
     promote information sharing and ensure an effective, 
     responsive, and organized joint effort to combat domestic 
     terrorism; and
       (2) be co-chaired by--
       (A) the Domestic Terrorism Counsel authorized under 
     subsection (a)(2)(B);
       (B) a United States Attorney or Assistant United States 
     Attorney;
       (C) a member of the National Security Division of the 
     Department of Justice; and
       (D) a member of the Federal Bureau of Investigation.
       (d) Focus on Greatest Threats.--The domestic terrorism 
     offices authorized under paragraphs (1), (2), and (3) of 
     subsection (a) shall focus their limited resources on the 
     most significant domestic terrorism threats, as determined by 
     the number of domestic terrorism-related incidents from each 
     category and subclassification in the joint report for the 
     preceding year required under subsection (b).

     SEC. 5. TRAINING TO COMBAT DOMESTIC TERRORISM.

       (a) Required Training and Resources.--The Secretary, the 
     Attorney General, and the Director shall review the anti-
     terrorism training and resource programs of their respective 
     agencies that are provided to Federal, State, local, and 
     Tribal law enforcement agencies, including the State and 
     Local Anti-Terrorism Program that is funded by the Bureau of 
     Justice Assistance of the Department of Justice, and ensure 
     that such programs include training and resources to assist 
     State, local, and Tribal law enforcement agencies in 
     understanding, detecting, deterring, and investigating acts 
     of domestic terrorism and White supremacist and neo-Nazi 
     infiltration of law enforcement agencies. The domestic-
     terrorism training shall focus on the most significant 
     domestic terrorism threats, as determined by the quantitative 
     analysis in the joint report required under section 4(b).
       (b) Requirement.--Any individual who provides domestic 
     terrorism training required under this section shall have--
       (1) expertise in domestic terrorism; and
       (2) relevant academic, law enforcement, or other experience 
     in matters related to domestic terrorism.
       (c) Report.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act and once each year thereafter, the 
     Secretary, the Attorney General, and the Director shall each 
     submit an annual report to the committees of Congress 
     described in section 4(b)(1) on the domestic terrorism 
     training implemented by their respective agencies under this 
     section, which shall include copies of all training materials 
     used and the names and qualifications of the individuals who 
     provide the training.
       (2) Classification and public release.--Each report 
     submitted under paragraph (1) shall be--
       (A) unclassified, to the greatest extent possible, with a 
     classified annex only if necessary; and
       (B) in the case of the unclassified portion of each report, 
     posted on the public website of the Department of Homeland 
     Security, the Department of Justice, and the Federal Bureau 
     of Investigation.

     SEC. 6. COMBATTING DOMESTIC TERRORISM THROUGH JOINT TERRORISM 
                   TASK FORCES AND FUSION CENTERS.

       (a) In General.--The joint terrorism task forces of the 
     Federal Bureau of Investigation and State, local, and 
     regional fusion centers, as established under section 210A of 
     the Homeland Security Act of 2002 (6 U.S.C. 124h), shall 
     each, in coordination with the Domestic Terrorism Executive 
     Committee and the domestic terrorism offices authorized under 
     paragraphs (1), (2), and (3) of section 4(a) of this Act--
       (1) share intelligence to address domestic terrorism 
     activities;
       (2) conduct an annual, intelligence-based assessment of 
     domestic terrorism activities in their jurisdictions; and
       (3) formulate and execute a plan to address and combat 
     domestic terrorism activities in their jurisdictions.
       (b) Requirement.--The activities required under subsection 
     (a) shall focus on the most significant domestic terrorism 
     threats, as determined by the number of domestic terrorism-
     related incidents from each category and subclassification in 
     the joint report for the preceding year required under 
     section 4(b).

     SEC. 7. INTERAGENCY TASK FORCE.

       Not later than 180 days after the date of enactment of this 
     Act, the Attorney General, the Director, the Secretary, and 
     the Secretary of Defense shall establish an interagency task 
     force to combat White supremacist and neo-Nazi infiltration 
     of the uniformed services.

     SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

       There are authorized to be appropriated to the Department 
     of Justice, the Federal Bureau of Investigation, the 
     Department of Homeland Security, and the Department of 
     Defense such sums as may be necessary to carry out this Act.
                                 ______
                                 
      By Mr. THUNE (for himself and Ms. Stabenow):
  S. 895. A bill to provide for a permanent extension of the 
enforcement instruction on supervision requirements for outpatient 
therapeutic services in critical access and small rural hospitals; to 
the Committee on Finance.
  Mr. THUNE. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 895

       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 ``Rural Hospital Regulatory 
     Relief Act of 2019''.

     SEC. 2. PERMANENT EXTENSION OF ENFORCEMENT INSTRUCTION ON 
                   SUPERVISION REQUIREMENTS FOR OUTPATIENT 
                   THERAPEUTIC SERVICES IN CRITICAL ACCESS AND 
                   SMALL RURAL HOSPITALS.

       Section 1834 of the Social Security Act (42 U.S.C. 1395m) 
     is amended by adding at the end the following new subsection:
       ``(x) Permanent Extension of Enforcement Instruction on 
     Supervision Requirements for Outpatient Therapeutic Services 
     in Critical Access and Small Rural Hospitals.--On and after 
     the date of the enactment of this subsection, the Secretary 
     shall continue to apply the enforcement instruction described 
     in the notice of the Centers for Medicare & Medicaid Services 
     entitled `Enforcement Instruction on Supervision Requirements 
     for Outpatient Therapeutic Services in Critical Access and 
     Small Rural Hospitals for CY 2013', dated November 1, 2012 
     (providing for an exception to the restatement and 
     clarification under the final rulemaking changes to the 
     Medicare hospital outpatient prospective payment system and 
     calendar year 2009 payment rates (published in the Federal 
     Register on November 18, 2008, 73 Fed. Reg. 68702 through 
     68704) with respect to requirements for direct supervision by 
     physicians for therapeutic hospital outpatient services) and 
     extended by section 1 of Public Law 113-198, section 1 of 
     Public Law 114-112, section 16004(a) of the 21st Century 
     Cures Act (Public Law 114-255), and section 51007 of the 
     Bipartisan Budget Act (Public Law 115-123), and reinstated 
     for calendar years 2018 and 2019 under the final rule 
     entitled `Medicare Program: Hospital Outpatient Prospective 
     Payment and Ambulatory Surgical Center Payment Systems and 
     Quality Reporting Programs' published on December 14, 2017 
     (82 Fed. Reg. 59216).''.
                                 ______
                                 
      By Mr. KAINE (for himself and Mr. Carper):
  S. 899. A bill to limit the authority of the President to modify duty 
rates for national security reasons and to limit the authority of the 
United States Trade Representative to impose certain duties or import 
restrictions, and for other purposes; to the Committee on Finance.
  Mr. KAINE. Mr. President, today Senator Carper and I introduced the 
Reclaiming Congressional Trade Authority Act of 2019. Enacting this 
bill would restore the role on Congress in overseeing international 
trade matters.
  I have been outspoken against the abuse of executive authorities that 
have been delegated to the President. Congress has a Constitutional 
power to oversee international trade. We have recently seen an abuse of 
this power, as with other executive authorities. This bill would 
mandate expanded Congressional involvement in international trade 
decisions by requiring the Trump Administration--and future 
Administrations--to further analyze, communicate, and justify tariff 
actions to Congress. Congress would then review new tariffs and if the 
Administration used national security to justify the tariffs' need, 
Congress would be required to approve them.
  I am advocating for my colleagues to consider supporting this bill, 
especially as the damaging effects of the ongoing trade war continue. 
It's time for Congress to step in and act on our Constitutional duty.
                                 ______
                                 
      By Mr. DAINES (for himself and Mr. Tester):
  S. 900. A bill to designate the community-based outpatient clinic of 
the Department of Veterans Affairs in Bozeman, Montana, as the ``Travis 
W. Atkins Department of Veterans Affairs Clinic''; to the Committee on 
Veterans' Affairs.
  Mr. DAINES. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 900

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

     SECTION 1. DESIGNATION OF TRAVIS W. ATKINS DEPARTMENT OF 
                   VETERANS AFFAIRS CLINIC IN BOZEMAN, MONTANA.

       (a) Designation.--The community-based outpatient clinic of 
     the Department of Veterans Affairs located at 300 North 
     Willson

[[Page S2049]]

     Avenue, Bozeman, Montana, shall after the date of the 
     enactment of this Act be known and designated as the ``Travis 
     W. Atkins Department of Veterans Affairs Clinic'' or the 
     ``Travis W. Atkins VA Clinic''.
       (b) Reference.--Any reference in any law, regulation, map, 
     document, paper, or other record of the United States to the 
     community-based outpatient clinic referred to in subsection 
     (a) shall be considered to be a reference to the Travis W. 
     Atkins Department of Veterans Affairs Clinic.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself and Mrs. Capito):
  S. 906. A bill to improve the management of driftnet fishing; to the 
Committee on Commerce, Science, and Transportation.
  Mrs. FEINSTEIN. Mr. President, I am pleased to re-introduce the 
``Driftnet Modernization and Bycatch Reduction Act.'' This legislation 
would update the Magnuson-Stevens Fishery Conservation and Management 
Act to phase out the use of harmful drift gillnets and replace them 
with more sustainable fishing gear. I would like to thank my colleague, 
Senator Capito, for once again co-leading this important bill.
  Drift gillnets, which are approximately one to one and a half miles 
long, are intended to catch swordfish and thresher shark off the coast 
of California. Tragically, nearly 60 other species are frequently 
caught and killed in the nets, including dolphins, porpoises, whales, 
sea lions, and sea turtles. These are known as bycatch.
  While some of these species can be sold, most are wastefully thrown 
back into the ocean either dead or seriously injured.
  According to the National Marine Fisheries Service, these harmful 
nets account for 90% of whale and porpoise species killed in West Coast 
Fisheries. In the 1980s, Congress enacted legislation to end the 
domestic use of driftnets approximately 1.5 miles or longer. Under 
President George H.W. Bush, the United States entered binding 
international agreements banning such nets worldwide.
  Driftnets are prohibited or are not utilized off the United States' 
Atlantic and Gulf coasts as well as in Washington State, Oregon, 
Alaska, and Hawaii. Mexico permanently banned the use of these nets in 
the Gulf of California in 2017.
  However, neither domestic nor international law currently includes 
the drift gillnets used in Federal waters off the coast of California 
to catch swordfish and thresher shark, despite their significant impact 
on protected marine life. This California-based fishery is the last 
place in the United States where these deadly driftnets are allowed.
  Last year, the California legislature passed a bill, subsequently 
signed into law by Governor Jerry Brown, to phase out these large-mesh 
drift gillnets in State waters and establish a buyout program over a 
four-year period.
  The State law requires the California Department of Fish and Wildlife 
to establish a voluntary ``permit transition program'' by March 2020 
that will compensate fishermen during this transition process. 
California has already dedicated $1 million for the program and another 
$1 million is being sought through a public-private partnership.
  Now that these nets are banned in State waters, our legislation to 
ban the nets in Federal waters is more timely than ever. The ``Driftnet 
Modernization and Bycatch Reduction Act'' would phase out the use of 
drift gillnets over the five years after enactment. The bill also 
authorizes the Department of Commerce to assist fishermen in 
transitioning from driftnets to more sustainable gear types, which 
studies have shown actually increase profitability.
  Updated fishing gear that could replace driftnets is available and 
has been successfully deployed in the Atlantic Ocean and in trials in 
the Pacific Ocean. Deep-set buoy gear, for example, allows fishermen to 
more accurately target swordfish and other marketable species in deep, 
cold water. The gear alerts fishermen immediately when they have fish 
on the line, so the fish can be retrieved and delivered to market 
quickly, thereby garnering a higher price.
  In a 2016 poll, California voters overwhelmingly supported efforts to 
end the use of drift gillnets to catch swordfish, with 87 percent of 
those surveyed in a poll commissioned by The Pew Charitable Trusts 
agreeing that fishermen should use less harmful gear.
  Our bill enjoys support from a wide range of commercial fishing 
companies, sportfishing groups, and environmental organizations, 
including: the American Sportfishing Association, the International 
Game Fish Association, Coastal Conservation Association of California, 
Yamaha USA, Okaiwa Corporation, the Pew Charitable Trusts, Oceana, Sea 
Legacy, and Mission Blue.
  Our ``Driftnet Modernization and Bycatch Reduction Act'' will protect 
valuable marine life unique to the West Coast, including several 
endangered species. This bill will also help fishermen to provide 
fresher, more profitable, and more sustainable seafood to American 
consumers.
  I look forward to working with my colleagues to pass the ``Driftnet 
Modernization and Bycatch Reduction Act.'' Thank you, Mr. President. I 
yield the Floor.
                                 ______
                                 
      By Mr. SCHUMER (for himself and Mrs. Gillibrand):
  S. 908. A bill to provide for an equitable management of summer 
flounder based on geographic, scientific, and economic data and for 
other purposes; to the Committee on Commerce, Science, and 
Transportation.
  Mr. SCHUMER. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 908

       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 ``Fluke Fairness Act of 
     2019''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) Summer flounder is an important economic fish stock for 
     commercial and recreational fishermen across the Northeast 
     and Mid-Atlantic United States.
       (2) The Magnuson-Stevens Fishery Conservation and 
     Management Act (16 U.S.C. 1801 et seq.) was reauthorized in 
     2006 and instituted annual catch limits and accountability 
     measures for important fish stocks.
       (3) That reauthorization prompted fishery managers to look 
     at alternate management schemes to rebuild depleted stocks 
     like summer flounder.
       (4) Summer flounder occur in both State and Federal waters 
     and are managed through a joint fishery management plan 
     between the Council and the Commission.
       (5) The Council and the Commission decided that each 
     State's recreational and commercial harvest limits for summer 
     flounder would be based upon landings in previous years.
       (6) These historical landings were based on flawed data 
     sets that no longer provide fairness or flexibility for 
     fisheries managers to allocate resources based on the best 
     science.
       (7) This allocation mechanism resulted in an uneven split 
     among the States along the East Coast which is problematic.
       (8) The fishery management plan for summer flounder does 
     not account for regional changes in the location of the fluke 
     stock even though the stock has moved further to the north 
     and changes in effort by anglers along the East Coast.
       (9) The States have been locked in a management system 
     based on data collected from 1981 to 1989, thus, the summer 
     flounder stock is not being managed using the best available 
     science and modern fishery management techniques.
       (10) It is in the interest of the Federal Government to 
     establish a new fishery management plan for summer flounder 
     that is based on current geographic, scientific, and economic 
     realities.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Commission.--The term ``Commission'' means the Atlantic 
     States Marine Fisheries Commission.
       (2) Council.--The term ``Council'' means the Mid-Atlantic 
     Fishery Management Council established under section 302(a) 
     of the Magnuson-Stevens Fishery Conservation and Management 
     Act (16 U.S.C. 1852(a)).
       (3) National standards.--The term ``National Standards'' 
     means the national standards for fishery conservation and 
     management set out in section 301(a) of the Magnuson-Stevens 
     Fishery Conservation and Management Act (16 U.S.C. 1851(a)).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Commerce.
       (5) Summer flounder.--The term ``summer flounder'' means 
     the species Paralichthys dentatus.

     SEC. 4. SUMMER FLOUNDER MANAGEMENT REFORM.

       (a) Fishery Management Plan Modification.--Not later than 1 
     year after the date of enactment of this Act, the Council 
     shall submit to the Secretary, and the Secretary may approve, 
     a modified fishery management plan for the commercial 
     management of summer flounder under title III of the 
     Magnuson-Stevens Fishery Conservation and Management Act (16 
     U.S.C. 1851 et seq.) or an amendment to such plan that--

[[Page S2050]]

       (1) shall be based on the best scientific information 
     available;
       (2) establishes commercial quotas in direct proportion to 
     the distribution, abundance, and location of summer flounder 
     as reflected by fishery independent surveys conducted by the 
     National Marine Fisheries Service and State agencies;
       (3) considers regional, coastwide, or other management 
     measures for summer flounder that comply with the National 
     Standards; and
       (4) prohibits the establishment of commercial catch quotas 
     for summer flounder on a State-by-State basis using 
     historical landings data that does not reflect the status of 
     the summer flounder stock, based on the most recent 
     scientific information.
       (b) Consultation With the Commission.--In preparing the 
     modified fishery management plan or an amendment to such a 
     plan as described in subsection (a), the Council shall 
     consult with the Commission to ensure consistent management 
     throughout the range of the summer flounder.
       (c) Failure to Submit Plan.--If the Council fails to submit 
     a modified fishery management plan or an amendment to such a 
     plan as described in subsection (a) that may be approved by 
     the Secretary, the Secretary shall prepare and consider such 
     a modified plan or amendment.

     SEC. 5. REPORT.

       Not later than 1 year after the date of the approval under 
     section 4 of a modified fishery management plan for the 
     commercial management of summer flounder or an amendment to 
     such plan, the Comptroller General of the United States shall 
     submit to Congress a report on the implementation of such 
     modified plan or amendment that includes an assessment of 
     whether such implementation complies with the National 
     Standards.
                                 ______
                                 
      By Mr. DURBIN (for himself, Ms. Duckworth, Mr. Blumenthal, Mr. 
        Van Hollen, Mr. Merkley, Mr. Brown, Mr. Sanders, Ms. Smith, and 
        Mr. King):
  S. 916. A bill to improve Federal efforts with respect to the 
prevention of maternal mortality, and for other purposes; to the 
Committee on Finance.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 916

       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 ``Mothers and Offspring 
     Mortality and Morbidity Awareness Act'' or the ``MOMMA's 
     Act''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) Every year, across the United States, 4,000,000 women 
     give birth, about 700 women suffer fatal complications during 
     pregnancy, while giving birth or during the postpartum 
     period, and 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 developed nations. The 
     estimated maternal mortality rate (per 100,000 live births) 
     for the 48 contiguous States and Washington, DC increased 
     from 18.8 percent in 2000 to 23.8 percent in 2014 to 26.6 
     percent in 2018. This estimated rate is on par with such rate 
     for underdeveloped nations such as Iraq and Afghanistan.
       (3) International studies estimate the 2015 maternal 
     mortality rate in the United States as 26.4 per 100,000 live 
     births, which is almost twice the 2015 World Health 
     Organization estimation of 14 per 100,000 live births.
       (4) It is estimated that more than 60 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 12.7 deaths per 
     100,000 live births for White women, 43.5 deaths per 100,000 
     live births for African-American women, and 14.4 deaths per 
     100,000 live births for women of other ethnicities. While 
     maternal mortality disparately impacts African-American 
     women, this urgent public health crisis traverses race, 
     ethnicity, socioeconomic status, educational background, and 
     geography.
       (6) African-American women are 3 to 4 times more likely to 
     die from causes related to pregnancy and childbirth compared 
     to non-Hispanic White women.
       (7) The findings described in paragraphs (1) through (6) 
     are of major concern to researchers, academics, members of 
     the business community, and providers across the obstetrical 
     continuum represented by organizations such as March of 
     Dimes; the Preeclampsia Foundation; the American College of 
     Obstetricians and Gynecologists; the Society for Maternal-
     Fetal Medicine; the Association of Women's Health, Obstetric, 
     and Neonatal Nurses; the California Maternal Quality Care 
     Collaborative; Black Women's Health Imperative; the National 
     Birth Equity Collaborative; Black Mamas Matter Alliance; 
     EverThrive Illinois; the National Association of Certified 
     Professional Midwives; PCOS Challenge: The National 
     Polycystic Ovary Sundrome Association; and the American 
     College of Nurse Midwives.
       (8) Hemorrhage, cardiovascular and coronary conditions, 
     cardiomyopathy, infection, embolism, mental health 
     conditions, preeclampsia and eclampsia, polycystic ovary 
     syndrome, infection and sepsis, and anesthesia complications 
     are the predominant medical causes of maternal-related deaths 
     and complications. Most of these conditions are largely 
     preventable or manageable.
       (9) 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 pre-eclampsia, 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.
       (10) The United States has not been able to submit a formal 
     maternal mortality rate to international data repositories 
     since 2007. Thus, no official maternal mortality rate exists 
     for the United States. There can be no maternal mortality 
     rate without streamlining maternal mortality-related data 
     from the State level and extrapolating such data to the 
     Federal level.
       (11) 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.
       (12) 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. 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 
     obstetrical 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.
       (13) 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.
       (14) Leaders in maternal wellness highly recommend that 
     maternal deaths 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, pregnancy-
     related or pregnancy-associated mortality and morbidity.
       (15) 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. Yet, because national data are not fully 
     available, the United States does not have an official 
     maternal mortality rate.
       (16) Many States have struggled to establish or maintain 
     Maternal Mortality Review Committees (referred to in this 
     section as ``MMRC''). On the State level, MMRCs have lagged 
     because States have not had the resources to mount local 
     reviews. State-level reviews are necessary as only the State 
     departments of health have the authority to request medical 
     records, autopsy reports,

[[Page S2051]]

     and police reports critical to the function of the MMRC.
       (17) The United Kingdom regards maternal deaths as a health 
     systems failure and a national committee of obstetrics 
     experts review each maternal death or near-fatal childbirth 
     complication. Such committee also establishes the predominant 
     course of maternal-related deaths from conditions such as 
     preeclampsia. Consequently, the United Kingdom has been able 
     to reduce its incidence of preeclampsia to less than one in 
     10,000 women--its lowest rate since 1952.
       (18) The United States has no comparable, coordinated 
     Federal process by which to review cases of maternal 
     mortality, systems failures, or best practices. Many States 
     have active MMRCs and leverage their 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, 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. To date, the State of California has 
     reduced its maternal mortality rate, which is now comparable 
     to the low rates of the United Kingdom.
       (19) Hospitals and health systems across the United States 
     lack standardization of emergency obstetrical 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 
     obstetrical emergency that does not consider both clinical 
     and public health approaches falls woefully under the mark of 
     excellent care delivery. State-based maternal quality 
     collaborative organizations, such as the California Maternal 
     Quality Care Collaborative or entities participating in the 
     Alliance for Innovation on Maternal Health (AIM), have formed 
     obstetrical 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.
       (20) The Centers for Disease Control and Prevention reports 
     that nearly half of all maternal deaths occur in the 
     immediate postpartum period--the 42 days following a 
     pregnancy--whereas more than one-third of pregnancy-related 
     or pregnancy-associated deaths occur while a person is still 
     pregnant. Yet, for women eligible for the Medicaid program on 
     the basis of pregnancy, such Medicaid coverage lapses at the 
     end of the month on which the 60th postpartum day lands.
       (21) The experience of serious traumatic events, such as 
     being exposed to domestic violence, substance use disorder, 
     or pervasive 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, 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.
       (22) A growing body of evidence-based research has shown 
     the correlation between the stress associated with one's 
     race--the stress of racism--and one's birthing outcomes. The 
     stress of sex and race discrimination and institutional 
     racism has been demonstrated to contribute to a higher risk 
     of maternal mortality, irrespective of one's gestational age, 
     maternal age, socioeconomic status, 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). African-American women remain 
     the most at risk for pregnancy-associated or pregnancy-
     related causes of death. When it comes to preeclampsia, for 
     example, which is related to obesity, African-American women 
     of normal weight remain the most at risk of dying during the 
     perinatal period compared to non-African-American obese 
     women.
       (23) The rising maternal mortality rate in the United 
     States is driven predominantly by the disproportionately high 
     rates of African-American maternal mortality.
       (24) African-American women are 3 to 4 times more likely to 
     die from pregnancy or maternal-related distress than are 
     White women, yielding one of the greatest and most 
     disconcerting racial disparities in public health.
       (25) Compared to women from other racial and ethnic 
     demographics, African-American women across the socioeconomic 
     spectrum experience prolonged, unrelenting stress related to 
     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 often extends across the life course and is situated 
     in everyday spaces where African-American women establish 
     livelihood. Structural barriers, lack of access to care, and 
     genetic predispositions to health vulnerabilities exacerbate 
     African-American women's likelihood to experience poor or 
     fatal birthing outcomes, but do not fully account for the 
     great disparity.
       (26) African-American 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. Research has demonstrated that patients 
     respond more warmly and adhere to medical treatment plans at 
     a higher degree with providers of the same race or ethnicity 
     or with providers with great ability to exercise empathy. 
     However, the provider pool is not primed with many people of 
     color, nor are providers (whether student-doctors in training 
     or licensed practitioners) consistently required to undergo 
     implicit bias, cultural competency, or empathy training on a 
     consistent, on-going basis.

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

       (a) Technical Assistance for States With Respect to 
     Reporting Maternal Mortality.--Not later than one year after 
     the date of enactment of this Act, the Director of the 
     Centers for Disease Control and Prevention (referred to in 
     this section as the ``Director''), in consultation with the 
     Administrator of the Health Resources and Services 
     Administration, shall provide technical assistance to States 
     that elect to report comprehensive data on maternal 
     mortality, including oral, mental, and breastfeeding health 
     information, for the purpose of encouraging uniformity in the 
     reporting of such data and to encourage the sharing of such 
     data among the respective States.
       (b) Best Practices Relating to Prevention of Maternal 
     Mortality.--
       (1) In general.--Not later than one year after the date of 
     enactment of this Act--
       (A) the Director, in consultation with relevant patient and 
     provider groups, shall issue best practices to State maternal 
     mortality review committees on how best to identify and 
     review maternal mortality cases, taking into account any data 
     made available by States relating to maternal mortality, 
     including data on oral, mental, and breastfeeding health, and 
     utilization of any emergency services; and
       (B) the Director, working in collaboration with the Health 
     Resources and Services Administration, shall issue best 
     practices to hospitals, State professional society groups, 
     and perinatal quality collaboratives on how best to prevent 
     maternal mortality.
       (2) Authorization of appropriations.--For purposes of 
     carrying out this subsection, there is authorized to be 
     appropriated $5,000,000 for each of fiscal years 2019 through 
     2023.
       (c) Alliance for Innovation on Maternal Health Grant 
     Program.--
       (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 Associate Administrator of 
     the Maternal and Child Health Bureau of the Health Resources 
     and Services Administration, shall establish a grant program 
     to be known as the Alliance for Innovation on Maternal Health 
     Grant Program (referred to in this subsection as ``AIM'') 
     under which the Secretary shall award grants to eligible 
     entities for the purpose of--
       (A) directing widespread adoption and implementation of 
     maternal safety bundles through collaborative State-based 
     teams; and
       (B) collecting and analyzing process, structure, and 
     outcome data to drive continuous improvement in the 
     implementation of such safety bundles by such State-based 
     teams with the ultimate goal of eliminating preventable 
     maternal mortality and severe maternal morbidity in the 
     United States.
       (2) Eligible entities.--In order to be eligible for a grant 
     under paragraph (1), an entity shall--
       (A) submit to the Secretary an application at such time, in 
     such manner, and containing such information as the Secretary 
     may require; and
       (B) demonstrate in such application that the entity is an 
     interdisciplinary, multi-stakeholder, national organization 
     with a national data-driven maternal safety and quality 
     improvement initiative based on implementation approaches 
     that have been proven to improve maternal safety and outcomes 
     in the United States.
       (3) Use of funds.--An eligible entity that receives a grant 
     under paragraph (1) shall use such grant funds--
       (A) to develop and implement, through a robust, multi-
     stakeholder process, maternal safety bundles to assist States 
     and health care systems in aligning national, State, and 
     hospital-level quality improvement efforts to improve 
     maternal health outcomes, specifically the reduction of 
     maternal mortality and severe maternal morbidity;
       (B) to ensure, in developing and implementing maternal 
     safety bundles under subparagraph (A), that such maternal 
     safety bundles--
       (i) satisfy the quality improvement needs of a State or 
     health care system by factoring in the results and findings 
     of relevant data reviews, such as reviews conducted by a

[[Page S2052]]

     State maternal mortality review committee; and
       (ii) address topics such as--

       (I) obstetric hemorrhage;
       (II) maternal mental health;
       (III) the maternal venous system;
       (IV) obstetric care for women with substance use disorders, 
     including opioid use disorder;
       (V) postpartum care basics for maternal safety;
       (VI) reduction of peripartum racial and ethnic disparities;
       (VII) reduction of primary caesarean birth;
       (VIII) severe hypertension in pregnancy;
       (IX) severe maternal morbidity reviews;
       (X) support after a severe maternal morbidity event;
       (XI) thromboembolism;
       (XII) optimization of support for breastfeeding; and
       (XIII) maternal oral health; and

       (C) to provide ongoing technical assistance at the national 
     and State levels to support implementation of maternal safety 
     bundles under subparagraph (A).
       (4) Maternal safety bundle defined.--For purposes of this 
     subsection, the term ``maternal safety bundle'' means 
     standardized, evidence-informed processes for maternal health 
     care.
       (5) Authorization of appropriations.--For purposes of 
     carrying out this subsection, there is authorized to be 
     appropriated $10,000,000 for each of fiscal years 2019 
     through 2023.
       (d) 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 
     multidisciplinary teams that--
       (A) work to improve measurable outcomes for maternal and 
     infant health by advancing evidence-informed clinical 
     practices using quality improvement principles;
       (B) work 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;
       (C) employ 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; and
       (D) have the goal of improving population-level outcomes in 
     maternal and infant health.
       (4) Authorization of appropriations.--For purposes of 
     carrying out this subsection, there is authorized to be 
     appropriated $14,000,000 per year for each of fiscal years 
     2020 through 2024.
       (e) 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)''; and
       (II) by inserting ``; and (E) oral health services for 
     pregnant and postpartum women (as defined in subsection 
     (ee))'' after ``subsection (bb))''; and

       (ii) by adding at the end the following new subsection:
       ``(ee) 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)(5)(A) of the Social Security Act 
     (42 U.S.C. 1397cc(c)(5)(A)) is amended by inserting ``or a 
     targeted low-income pregnant woman'' after ``targeted low-
     income child''.
       (2) Extending medicaid coverage for pregnant and postpartum 
     women.--Section 1902 of the Social Security Act (42 U.S.C. 
     1396a) is amended--
       (A) in subsection (e)--
       (i) in paragraph (5)--

       (I) by inserting ``(including oral health services for 
     pregnant and postpartum women (as defined in section 
     1905(ee))'' after ``postpartum medical assistance under the 
     plan''; and
       (II) by striking ``60-day'' and inserting ``1-year''; and

       (ii) in paragraph (6), by striking ``60-day'' and inserting 
     ``1-year''; and
       (B) in subsection (l)(1)(A), by striking ``60-day'' and 
     inserting ``1-year''.
       (3) Extending medicaid coverage for lawful residents.--
     Section 1903(v)(4)(A) of the Social Security Act (42 U.S.C. 
     1396b(v)(4)(A)) is amended by striking ``60-day'' and 
     inserting ``1-year''.
       (4) Extending chip coverage for pregnant and postpartum 
     women.--Section 2112(d)(2)(A) of the Social Security Act (42 
     U.S.C. 1397ll(d)(2)(A)) is amended by striking ``60-day'' and 
     inserting ``1-year''.
       (5) 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 five 
     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 five 
     years after such date of enactment, as a condition of 
     receiving payments under subsection (a) and section 1903(a), 
     a State that elects to provide assistance to 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.''.
       (6) 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, under such programs.
       (7) 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--
       (i) in subsection (b), by striking ``and (aa)'' and 
     inserting ``(aa), and (ff)''; and
       (ii) by adding at the end the following:
       ``(ff) Increased FMAP for Extended Medical Assistance for 
     Postpartum Women.--Notwithstanding subsection (b), the 
     Federal medical assistance percentage for a State, with 
     respect to amounts expended by such State for medical 
     assistance for a woman 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 60/th/ 
     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--
       ``(1) 100 percent for the first 20 calendar quarters during 
     which this subsection is in effect; and

[[Page S2053]]

       ``(2) 90 percent for calendar quarters thereafter.''.
       (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:
       ``(12) 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) 100 percent for the first 20 calendar quarters during 
     which this paragraph is in effect; and
       ``(B) 90 percent for calendar quarters thereafter.''.
       (8) Effective date.--
       (A) In general.--Subject to subparagraph (B), the 
     amendments made by this subsection shall take effect on the 
     first day of the first calendar quarter that begins on or 
     after the date that is one year after the date of enactment 
     of this Act.
       (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.
       (f) Regional Centers of Excellence.--Part P of title III of 
     the Public Health Service Act is amended by adding at the end 
     the following new section:

     ``SEC. 399V-7. 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 and cultural competency 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, 
     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; and
       ``(3) 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 2019 through 
     2023.''.
       (g) 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.''.

       (h) Definitions.--In this section:
       (1) Maternal mortality.--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.
       (2) Severe maternal morbidity.--The term ``severe maternal 
     morbidity'' includes unexpected outcomes of labor and 
     delivery that result in significant short-term or long-term 
     consequences to a woman's health.

     SEC. 4. 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 tobacco 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.
       (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

[[Page S2054]]

     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 2018, 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 2017' 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 $500. Such credit shall not exceed the amount of 
     taxes imposed by paragraph (1) on such date for which such 
     person is liable.
       (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 1st 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 2d 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) 
     through (4), 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 and processed tobacco.--The 
     amendments made by subsections (c)(1)(C), (c)(2), 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) Large cigars.--The amendments made by subsection (e) 
     shall apply to articles removed after December 31, 2019.
       (4) 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.

                          ____________________