[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 670 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 670

 To amend title XIX of the Social Security Act to encourage States to 
provide pregnant women enrolled in the Medicaid program with access to 
               comprehensive tobacco cessation services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 23, 2009

  Mr. Harkin (for himself, Mr. Lautenberg, Mr. Leahy, and Mr. Durbin) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to encourage States to 
provide pregnant women enrolled in the Medicaid program with access to 
               comprehensive tobacco cessation services.

    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 ``Smoke Free Mothers and Babies Act of 
2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) At least 1 out of every 10 pregnant women in the United 
        States smokes, which accounts for over 400,000 births per year.
            (2) Tobacco use during pregnancy causes serious harm to the 
        fetus. Fetal mortality rates are 35 percent higher among 
        pregnant women who smoke than among nonsmokers and the Surgeon 
        General reports that a pregnant woman who smokes is 1.5 to 3.5 
        times more likely than a nonsmoker to have a low birth weight 
        baby.
            (3) Studies have found that smoking and exposure to 
        secondhand smoke among pregnant women is a major cause of 
        miscarriage, stillbirths, and sudden infant death syndrome 
        (SIDS).
            (4) A single percentage point decline in smoking prevalence 
        among pregnant women would prevent 1,300 cases of low birth 
        weight among babies annually and save at least $21,000,000 in 
        direct medical costs.
            (5) For every $1 spent on smoking cessation for pregnant 
        women, an estimated $3 in neonatal intensive care costs could 
        be avoided.
            (6) Such costs have a disproportionate impact on Medicaid, 
        with estimates indicating that pregnant women on Medicaid are 
        more likely to smoke than pregnant women not on Medicaid. 
        Smoking-attributable neonatal health care costs for Medicaid 
        total almost $228,000,000, more than $700 per pregnant smoker.
            (7) In fiscal year 2008, States collected a record 
        $24,400,000,000 from settlement agreements with the tobacco 
        industry and tobacco taxes (an increase from $22,300,000,000 in 
        fiscal year 2007). In fiscal year 2008, States spent just 2.9 
        percent of their tobacco-related revenue on tobacco prevention 
        and cessation.
            (8) Evidence shows that the cuts States have made in 
        tobacco prevention funding since 2002 have slowed or possibly 
        stalled recent declines in youth smoking, putting further 
        progress at risk.

SEC. 3. PROMOTING CESSATION OF TOBACCO USE BY PREGNANT WOMEN UNDER THE 
              MEDICAID PROGRAM.

    (a) Requiring Coverage of Counseling and Pharmacotherapy for 
Cessation of Tobacco Use by Pregnant Women.--Section 1905 of the Social 
Security Act (42 U.S.C. 1396d(a)(4)) is amended--
            (1) in subsection (a)(4)--
                    (A) by striking ``and'' before ``(C)''; and
                    (B) by inserting before the semicolon at the end 
                the following new subparagraph: ``; and (D) counseling 
                and pharmacotherapy for cessation of tobacco use by 
                pregnant women (as defined in subsection (y))''; and
            (2) by adding at the end the following:
    ``(y)(1) For purposes of this title, the term `counseling and 
pharmacotherapy for cessation of tobacco use by pregnant women' means 
diagnostic, therapy, and counseling services and pharmacotherapy 
(including the coverage of prescription and nonprescription tobacco 
cessation agents approved by the Food and Drug Administration) for 
cessation of tobacco use by pregnant women who use tobacco products or 
who are being treated for tobacco use that is furnished--
            ``(A) by or under the supervision of a physician; or
            ``(B) by any other health care professional who--
                    ``(i) is legally authorized to furnish such 
                services under State law (or the State regulatory 
                mechanism provided by State law) of the State in which 
                the services are furnished; and
                    ``(ii) is authorized to receive payment for other 
                services under this title or is designated by the 
                Secretary for this purpose.
    ``(2) Subject to paragraph (3), such term is limited to--
            ``(A) services recommended with respect to pregnant women 
        in `Treating Tobacco Use and Dependence: A Clinical Practice 
        Guideline', published by the Public Health Service in June 
        2000, or any subsequent modification of such Guideline; and
            ``(B) such other services that the Secretary recognizes to 
        be effective for cessation of tobacco use by pregnant women.
    ``(3) Such term shall not include coverage for drugs or biologicals 
that are not otherwise covered under this title.''.
    (b) Exception From Optional Restriction Under Medicaid Prescription 
Drug Coverage.--Section 1927(d)(2) of the Social Security Act (42 
U.S.C. 1396r-8(d)(2)) is amended--
            (1) in subparagraph (E), by inserting before the period at 
        the end the following: ``, except in the case of pregnant women 
        when recommended in accordance with the Guideline referred to 
        in section 1905(y)(2)(A)''; and
            (2) in subparagraph (G), by inserting before the period at 
        the end the following: ``, except, in the case of pregnant 
        women when recommended in accordance with the Guideline 
        referred to in section 1905(y)(2)(A), agents approved by the 
        Food and Drug Administration for purposes of promoting, and 
        when used to promote, tobacco cessation''.
    (c) Removal of Cost-Sharing for Counseling and Pharmacotherapy for 
Cessation of Tobacco Use by Pregnant Women.--
            (1) General cost-sharing limitations.--Section 1916 of the 
        Social Security Act (42 U.S.C. 1396o) is amended in each of 
        subsections (a)(2)(B) and (b)(2)(B) by inserting ``, and 
        counseling and pharmacotherapy for cessation of tobacco use by 
        pregnant women (as defined in section 1905(y)) and covered 
        outpatient drugs (as defined in subsection (k)(2) of section 
        1927 and including nonprescription drugs described in 
        subsection (d)(2) of such section) that are prescribed for 
        purposes of promoting, and when used to promote, tobacco 
        cessation by pregnant women in accordance with the Guideline 
        referred to in section 1905(y)(2)(A)'' after ``complicate the 
        pregnancy''.
            (2) Application to alternative cost-sharing.--Section 
        1916A(b)(3)(B)(iii) of such Act (42 U.S.C. 1396o-
        1(b)(3)(B)(iii)) is amended by inserting ``, and counseling and 
        pharmacotherapy for cessation of tobacco use by pregnant women 
        (as defined in section 1905(y))'' after ``complicate the 
        pregnancy''.
    (d) Increased FMAP for Tobacco Cessation Counseling Services and 
Medications.--The first sentence of section 1905(b) of the Social 
Security Act (42 U.S.C. 1396d(b)) is amended by inserting the following 
before the period: ``, and medical assistance provided for counseling 
and pharmacotherapy for cessation of tobacco use by pregnant women (as 
defined in subsection (y)) and for covered outpatient drugs (as defined 
in subsection (k)(2) of section 1927 and including nonprescription 
drugs described in subsection (d)(2) of such section) that are 
prescribed for purposes of promoting, and when used to promote, tobacco 
cessation by pregnant women in accordance with the Guideline referred 
to in subsection (y)(2)(A)''.
    (e) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to services 
        furnished on or after the first fiscal year quarter that begins 
        after the date of enactment of this Act.
            (2) Extension of effective date for state law amendment.--
        In the case of a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
        Health and Human Services determines requires State legislation 
        in order for the plan to meet the additional requirement 
        imposed by the amendment made by subsection (a), the State plan 
        shall not be regarded as failing to comply with the 
        requirements of such title solely on the basis of its failure 
        to meet these additional requirements 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 is considered to 
        be a separate regular session of the State legislature.
                                 <all>