[Congressional Record Volume 167, Number 35 (Wednesday, February 24, 2021)]
[Senate]
[Pages S858-S865]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTION

      By Mr. THUNE (for himself, Ms. Stabenow, Mrs. Fischer, and Mr. 
        Warner):
  S. 402. A bill to amend the Bipartisan Congressional Trade Priorities 
and Accountability Act of 2015 to include a trade negotiating objecting 
relating to addressing the security of the global communications 
infrastructure; 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. 402

       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 ``Network Security Trade Act 
     of 2021''.

     SEC. 2. TRADE NEGOTIATING OBJECTIVE RELATING TO SECURITY OF 
                   COMMUNICATIONS NETWORKS.

       Section 102(a) of the Bipartisan Congressional Trade 
     Priorities and Accountability Act of 2015 (19 U.S.C. 4201(a)) 
     is amended--
       (1) in paragraph (14), by striking ``; and'' and inserting 
     a semicolon;
       (2) in paragraph (15), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(16) to ensure that the equipment and technology that 
     create the global communications infrastructure are not 
     compromised by addressing--
       ``(A) barriers to the security of communications networks 
     and supply chains; and
       ``(B) unfair trade practices of suppliers of communications 
     equipment that are owned, controlled, or supported by a 
     foreign government.''.

[[Page S859]]

  

                                 ______
                                 
      By Mr. DURBIN (for himself, Ms. Duckworth, Mrs. Shaheen, Mr. 
        Brown, Ms. Stabenow, Mr. Blumenthal, Ms. Klobuchar, Ms. Smith, 
        Mr. Van Hollen, and Mr. Sanders):
  S. 411. A bill to improve Federal efforts with respect to the 
prevention of maternal mortality, and for other purposes; 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. 411

       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, nearly 4,000,000 
     women give birth, about 700 women suffer fatal complications 
     during pregnancy, while giving birth or during the postpartum 
     period, and about 70,000 women suffer near-fatal, partum-
     related complications.
       (2) The maternal mortality rate is often used as a proxy to 
     measure the overall health of a population. While the infant 
     mortality rate in the United States has reached its lowest 
     point, the risk of death for women in the United States 
     during pregnancy, childbirth, or the postpartum period is 
     higher than such risk in many other high-income countries. 
     The estimated maternal mortality rate (deaths per 100,000 
     live births) for the 48 contiguous States and Washington, 
     D.C. increased from 14.5 percent in 2000 to 17.3 in 2017. The 
     United States is the only industrialized nation with a rising 
     maternal mortality rate.
       (3) The National Vital Statistics System of the Centers for 
     Disease Control and Prevention has found that in 2018, there 
     were 17.4 maternal deaths for every 100,000 live births in 
     the United States. This ratio is more than double that of 
     most other high-income countries.
       (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 about 13 deaths 
     per 100,000 live births for White women, 40.8 deaths per 
     100,000 live births for non-Hispanic Black women, and 29.7 
     deaths per 100,000 live births for American Indian/Alaskan 
     Native women. While maternal mortality disparately impacts 
     Black women, this urgent public health crisis traverses race, 
     ethnicity, socioeconomic status, educational background, and 
     geography.
       (6) In the United States, non-Hispanic Black women are 
     about 3 times more likely to die from causes related to 
     pregnancy and childbirth compared to non-Hispanic White 
     women, which is one of the most disconcerting racial 
     disparities in public health. This disparity widens in 
     certain cities and States across the country.
       (7) According to the National Center for Health Statistics 
     of the Centers for Disease Control and Prevention, the 
     maternal mortality rate heightens with age, as women 40 and 
     older die at a rate of 81.9 per 100,000 births compared to 
     10.6 per 100,000 for women under 25. This translates to women 
     over 40 being 7.7 times more likely to die compared to their 
     counterparts under 25 years of age.
       (8) The COVID-19 pandemic risks exacerbating the maternal 
     health crisis. A recent study of the Centers for Disease 
     Control and Prevention suggests that pregnant women are at a 
     significantly higher risk for severe outcomes, including 
     death, from COVID-19 as compared to non-pregnant women. The 
     COVID-19 pandemic has also decreased access to prenatal and 
     postpartum care.
       (9) The findings described in paragraphs (1) through (8) 
     are of major concern to researchers, academics, members of 
     the business community, and providers across the obstetric 
     continuum represented by organizations such as--
       (A) the American College of Nurse-Midwives;
       (B) the American College of Obstetricians and 
     Gynecologists;
       (C) the American Medical Association;
       (D) the Association of Women's Health, Obstetric and 
     Neonatal Nurses;
       (E) the Black Mamas Matter Alliance;
       (F) the Black Women's Health Imperative;
       (G) the California Maternal Quality Care Collaborative;
       (H) EverThrive Illinois;
       (I) the Illinois Perinatal Quality Collaborative;
       (J) the March of Dimes;
       (K) the National Association of Certified Professional 
     Midwives;
       (L) the National Birth Equity Collaborative;
       (M) the National Partnership for Women & Families;
       (N) the National Polycystic Ovary Syndrome Association;
       (O) the Preeclampsia Foundation;
       (P) the Society for Maternal-Fetal Medicine; and
       (Q) the What To Expect Project.
       (10) Hemorrhage, cardiovascular and coronary conditions, 
     cardiomyopathy, infection or sepsis, embolism, mental health 
     conditions (including substance use disorder), hypertensive 
     disorders, stroke and cerebrovascular accidents, and 
     anesthesia complications are the predominant medical causes 
     of maternal-related deaths and complications. Most of these 
     conditions are largely preventable or manageable. Even when 
     these conditions are not preventable, mortality and morbidity 
     may be prevented when conditions are diagnosed and treated in 
     a timely manner.
       (11) According to a study published by the Journal of 
     Perinatal Education, doula-assisted mothers are 4 times less 
     likely to have a low-birthweight baby, 2 times less likely to 
     experience a birth complication involving themselves or their 
     baby, and significantly more likely to initiate 
     breastfeeding. Doula care has also been shown to produce cost 
     savings resulting in part from reduced rates of cesarean and 
     pre-term births.
       (12) Intimate partner violence is one of the leading causes 
     of maternal death, and women are more likely to experience 
     intimate partner violence during pregnancy than at any other 
     time in their lives. It is also more dangerous than 
     pregnancy. Intimate partner violence during pregnancy and 
     postpartum crosses every demographic and has been exacerbated 
     by the COVID-19 pandemic.
       (13) Oral health is an important part of perinatal health. 
     Reducing bacteria in a woman's mouth during pregnancy can 
     significantly reduce her risk of developing oral diseases and 
     spreading decay-causing bacteria to her baby. Moreover, some 
     evidence suggests that women with periodontal disease during 
     pregnancy could be at greater risk for poor birth outcomes, 
     such as preeclampsia, pre-term birth, and low-birth weight. 
     Furthermore, a woman's oral health during pregnancy is a good 
     predictor of her newborn's oral health, and since mothers can 
     unintentionally spread oral bacteria to their babies, putting 
     their children at higher risk for tooth decay, prevention 
     efforts should happen even before children are born, as a 
     matter of pre-pregnancy health and prenatal care during 
     pregnancy.
       (14) In the United States, death reporting and analysis is 
     a State function rather than a Federal process. States report 
     all deaths--including maternal deaths--on a semi-voluntary 
     basis, without standardization across States. While the 
     Centers for Disease Control and Prevention has the capacity 
     and system for collecting death-related data based on death 
     certificates, these data are not sufficiently reported by 
     States in an organized and standard format across States such 
     that the Centers for Disease Control and Prevention is able 
     to identify causes of maternal death and best practices for 
     the prevention of such death.
       (15) Vital statistics systems often underestimate maternal 
     mortality and are insufficient data sources from which to 
     derive a full scope of medical and social determinant factors 
     contributing to maternal deaths, such as intimate partner 
     violence. While the addition of pregnancy checkboxes on death 
     certificates since 2003 have likely improved States' 
     abilities to identify pregnancy-related deaths, they are not 
     generally completed by obstetric providers or persons trained 
     to recognize pregnancy-related mortality. Thus, these vital 
     forms may be missing information or may capture inconsistent 
     data. Due to varying maternal mortality-related analyses, 
     lack of reliability, and granularity in data, current 
     maternal mortality informatics do not fully encapsulate the 
     myriad medical and socially determinant factors that 
     contribute to such high maternal mortality rates within the 
     United States compared to other developed nations. Lack of 
     standardization of data and data sharing across States and 
     between Federal entities, health networks, and research 
     institutions keep the Nation in the dark about ways to 
     prevent maternal deaths.
       (16) Having reliable and valid State data aggregated at the 
     Federal level are critical to the Nation's ability to quell 
     surges in maternal death and imperative for researchers to 
     identify long-lasting interventions.
       (17) Leaders in maternal wellness highly recommend that 
     maternal deaths and cases of maternal morbidity, including 
     complications that result in chronic illness and future 
     increased risk of death, be investigated at the State level 
     first, and that standardized, streamlined, de-identified data 
     regarding maternal deaths be sent annually to the Centers for 
     Disease Control and Prevention. Such data standardization and 
     collection would be similar in operation and effect to the 
     National Program of Cancer Registries of the Centers for 
     Disease Control and Prevention and akin to the Confidential 
     Enquiry in Maternal Deaths Programme in the United Kingdom. 
     Such a maternal mortalities and morbidities registry and 
     surveillance system would help providers, academicians, 
     lawmakers, and the public to address questions concerning the 
     types of, causes of, and best practices to thwart, maternal 
     mortality and morbidity.
       (18) The United Nations' Millennium Development Goal 5a 
     aimed to reduce by 75 percent, between 1990 and 2015, the 
     maternal mortality rate, yet this metric has not been 
     achieved. In fact, the maternal mortality rate in the United 
     States has been estimated to have more than doubled between 
     2000 and 2014.
       (19) Many States have struggled to establish or maintain 
     Maternal Mortality Review

[[Page S860]]

     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, and 
     police reports critical to the function of the MMRC.
       (20) 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, peripartum 
     cardiomyopathy, and the like. In this way, the State of 
     California has been able to leverage its maternal mortality 
     review board system, generate data, and apply those data to 
     effect changes in maternal care-related protocol. To date, 
     the State of California has reduced its maternal mortality 
     rate, which is now comparable to the low rates of the United 
     Kingdom.
       (21) Hospitals and health systems across the United States 
     lack standardization of emergency obstetric protocols before, 
     during, and after delivery. Consequently, many providers are 
     delayed in recognizing critical signs indicating maternal 
     distress that quickly escalate into fatal or near-fatal 
     incidences. Moreover, any attempt to address an obstetric 
     emergency that does not consider both clinical and public 
     health approaches falls woefully under the mark of excellent 
     care delivery. State-based perinatal quality collaboratives, 
     or entities participating in the Alliance for Innovation on 
     Maternal Health (AIM), have formed obstetric protocols, tool 
     kits, and other resources to improve system care and response 
     as they relate to maternal complications and warning signs 
     for such conditions as maternal hemorrhage, hypertension, and 
     preeclampsia. These perinatal quality collaboratives serve an 
     important role in providing infrastructure that supports 
     quality improvement efforts addressing obstetric care and 
     outcomes. State-based perinatal quality collaboratives 
     partner with hospitals, physicians, nurses, patients, public 
     health, and other stakeholders to provide opportunities for 
     collaborative learning, rapid response data, and quality 
     improvement science support to achieve systems-level change.
       (22) 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 maternal deaths 
     occur while a person is still pregnant. Further, 21 percent 
     of maternal deaths occur between 1 and 6 weeks postpartum, 
     and 12 percent of maternal deaths occur during the remaining 
     portion of the postpartum year. 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.
       (23) The experience of serious traumatic events, such as 
     being exposed to domestic violence, substance use disorder, 
     or pervasive and systematic racism, can over-activate the 
     body's stress-response system. Known as toxic stress, the 
     repetition of high-doses of cortisol to the brain, can harm 
     healthy neurological development and other body systems, 
     which can have cascading physical and mental health 
     consequences, as documented in the Adverse Childhood 
     Experiences study of the Centers for Disease Control and 
     Prevention.
       (24) A growing body of evidence-based research has shown 
     the correlation between the stress associated with systematic 
     racism and one's birthing outcomes. The undue stress of sex 
     and race discrimination paired with institutional racism has 
     been demonstrated to contribute to a higher risk of maternal 
     mortality, irrespective of one's gestational age, maternal 
     age, socioeconomic status, educational level, or individual-
     level health risk factors, including poverty, limited access 
     to prenatal care, and poor physical and mental health 
     (although these are not nominal factors). Black women remain 
     the most at risk for pregnancy-associated or pregnancy-
     related causes of death. When it comes to preeclampsia, for 
     example, for which obesity is a risk factor, Black women of 
     normal weight remain at a higher at risk of dying during the 
     perinatal period compared to non-Black obese women.
       (25) The rising maternal mortality rate in the United 
     States is driven predominantly by the disproportionately high 
     rates of Black maternal mortality.
       (26) Compared to women from other racial and ethnic 
     demographics, Black women across the socioeconomic spectrum 
     experience prolonged, unrelenting stress related to 
     systematic racial and gender discrimination, contributing to 
     higher rates of maternal mortality, giving birth to low-
     weight babies, and experiencing pre-term birth. Racism is a 
     risk-factor for these aforementioned experiences. This 
     cumulative stress, called weathering, often extends across 
     the life course and is situated in everyday spaces where 
     Black women establish livelihood. Systematic racism, 
     structural barriers, lack of access to care, lack of access 
     to nutritious food, and social determinants of health 
     exacerbate Black women's likelihood to experience poor or 
     fatal birthing outcomes, but do not fully account for the 
     great disparity.
       (27) Black women are twice as likely to experience 
     postpartum depression, and disproportionately higher rates of 
     preeclampsia compared to White women.
       (28) Racism is deeply ingrained in United States systems, 
     including in health care delivery systems between patients 
     and providers, often resulting in disparate treatment for 
     pain, irreverence for cultural norms with respect to health, 
     and dismissiveness. However, the provider pool is not primed 
     with many people of color, nor are providers (whether 
     maternity care clinicians or maternity care support 
     personnel) consistently required to undergo implicit bias, 
     cultural competency, respectful care practices, or empathy 
     training on a consistent, on-going basis.
       (29) Not all people who have been pregnant or given birth 
     identify as being a ``woman''. The terms ``birthing people'' 
     or ``birthing persons'' are also used to describe pregnant 
     and postpartum people.

     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 
     and factors relating to such mortality (including oral and 
     mental health), intimate partner violence, and breastfeeding 
     health information, for the purpose of encouraging uniformity 
     in the reporting of such data and to encourage the sharing of 
     such data among the respective States.
       (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 2021 through 
     2025.
       (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, perinatal quality collaboratives, and health care 
     systems in aligning national, State, and hospital-level 
     quality improvement efforts to improve maternal health 
     outcomes, specifically the reduction of maternal mortality 
     and severe maternal morbidity;

[[Page S861]]

       (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, 
     perinatal quality collaborative, or health care system by 
     factoring in the results and findings of relevant data 
     reviews, such as reviews conducted by a State maternal 
     mortality review committee; and
       (ii) address topics which may include--

       (I) information on evidence-based practices to improve the 
     quality and safety of maternal health care in hospitals and 
     other health care settings of a State or health care system, 
     including by addressing topics commonly associated with 
     health complications or risks related to prenatal care, labor 
     care, birthing, and postpartum care;
       (II) best practices for improving maternal health care 
     based on data findings and reviews conducted by a State 
     maternal mortality review committee that address topics of 
     relevance to common complications or health risks related to 
     prenatal care, labor care, birthing, and postpartum care;
       (III) information on addressing determinants of health that 
     impact maternal health outcomes for women before, during, and 
     after pregnancy;
       (IV) obstetric hemorrhage;
       (V) obstetric and postpartum care for women with substance 
     use disorders, including opioid use disorder;
       (VI) maternal cardiovascular system;
       (VII) maternal mental health;
       (VIII) postpartum care basics for maternal safety;
       (IX) reduction of peripartum racial and ethnic disparities;
       (X) reduction of primary caesarean birth;
       (XI) severe hypertension in pregnancy;
       (XII) severe maternal morbidity reviews;
       (XIII) support after a severe maternal morbidity event;
       (XIV) thromboembolism;
       (XV) optimization of support for breastfeeding;
       (XVI) maternal oral health; and
       (XVII) Intimate partner violence; 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 2021 
     through 2025.
       (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 teams 
     that--
       (A) is multidisciplinary in nature and includes the full 
     range of perinatal and maternity care providers;
       (B) works to improve measurable outcomes for maternal and 
     infant health by advancing evidence-informed clinical 
     practices using quality improvement principles;
       (C) works with hospital-based or outpatient facility-based 
     clinical teams, experts, and stakeholders, including patients 
     and families, to spread best practices and optimize resources 
     to improve perinatal care and outcomes;
       (D) employs strategies that include the use of the 
     collaborative learning model to provide opportunities for 
     hospitals and clinical teams to collaborate on improvement 
     strategies, rapid-response data to provide timely feedback to 
     hospital and other clinical teams to track progress, and 
     quality improvement science to provide support and coaching 
     to hospital and clinical teams;
       (E) has the goal of improving population-level outcomes in 
     maternal and infant health; and
       (F) has the goal of improving outcomes of all birthing 
     people, through the coordination, integration, and 
     collaboration across birth settings.
       (4) Authorization of appropriations.--For purposes of 
     carrying out this subsection, there is authorized to be 
     appropriated $14,000,000 per year for each of fiscal years 
     2021 through 2025.
       (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 
     (hh))'' after ``subsection (bb))''; and

       (ii) by adding at the end the following new subsection:
       ``(hh) 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(hh)))'' 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)(i) of the Social Security Act (42 
     U.S.C. 1396b(v)(4)(A)(i)) 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--

[[Page S862]]

       (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 (ff)'' and 
     inserting ``(aa), and (ii)''; and
       (ii) by adding at the end the following:
       ``(b) 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 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--
       ``(1) 100 percent for the first 20 calendar quarters during 
     which this subsection is in effect; and
       ``(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) Guidance on state options for medicaid coverage of 
     doula services.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services, acting through the Administrator of the Centers for 
     Medicare & Medicaid Services, shall issue guidance for the 
     States concerning options for Medicaid coverage and payment 
     for support services provided by doulas.
       (9) 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 (42 U.S.C. 280g et seq.) 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, cultural competency, and respectful 
     care practices in patient-provider interactions education for 
     the purpose of enhancing and improving how health care 
     professionals are educated in implicit bias and delivering 
     culturally competent health care.
       ``(b) Eligibility.--To be eligible to receive a cooperative 
     agreement under subsection (a), an entity shall--
       ``(1) be a public or other nonprofit entity specified by 
     the Secretary that provides educational and training 
     opportunities for students and health care professionals, 
     which may be a health system, teaching hospital, community 
     health center, medical school, school of public health, 
     school of nursing, dental school, social work school, school 
     of professional psychology, or any other health professional 
     school or program at an institution of higher education (as 
     defined in section 101 of the Higher Education Act of 1965) 
     focused on the prevention, treatment, or recovery of health 
     conditions that contribute to maternal mortality and the 
     prevention of maternal mortality and severe maternal 
     morbidity;
       ``(2) demonstrate community engagement and participation, 
     such as through partnerships with home visiting and case 
     management programs;
       ``(3) demonstrate engagement with groups engaged in the 
     implementation of health care professional training in 
     implicit bias and delivering culturally competent care, such 
     as departments of public health, perinatal quality 
     collaboratives, hospital systems, and health care 
     professional groups, in order to obtain input on resources 
     needed for effective implementation strategies; and
       ``(4) provide to the Secretary such information, at such 
     time and in such manner, as the Secretary may require.
       ``(c) Diversity.--In awarding a cooperative agreement under 
     subsection (a), the Secretary shall take into account any 
     regional differences among eligible entities and make an 
     effort to ensure geographic diversity among award recipients.
       ``(d) Dissemination of Information.--
       ``(1) Public availability.--The Secretary shall make 
     publicly available on the internet website of the Department 
     of Health and Human Services information submitted to the 
     Secretary under subsection (b)(3).
       ``(2) Evaluation.--The Secretary shall evaluate each 
     regional center of excellence established or supported 
     pursuant to subsection (a) and disseminate the findings 
     resulting from each such evaluation to the appropriate public 
     and private entities.
       ``(3) Distribution.--The Secretary shall share evaluations 
     and overall findings with State departments of health and 
     other relevant State level offices to inform State and local 
     best practices.
       ``(e) Maternal Mortality Defined.--In this section, the 
     term `maternal mortality' means death of a woman that occurs 
     during pregnancy or within the one-year period following the 
     end of such pregnancy.
       ``(f) Authorization of Appropriations.--For purposes of 
     carrying out this section, there is authorized to be 
     appropriated $5,000,000 for each of fiscal years 2021 through 
     2025.''.
       (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) Pregnancy related death.--The term ``pregnancy related 
     death'' includes the death of a woman during pregnancy or 
     within one year of the end of pregnancy from a pregnancy 
     complication, a chain of events initiated by pregnancy, or 
     the aggravation of an unrelated condition by the physiologic 
     effects of pregnancy.
       (3) 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'';

[[Page S863]]

       (B) in paragraphs (2) and (3), by inserting ``that is not a 
     discrete single-use unit'' before the period in each such 
     paragraph; and
       (C) by adding at the end the following:
       ``(4) Discrete single-use unit.--The term `discrete single-
     use unit' means any product containing, made from, or derived 
     from tobacco or nicotine that--
       ``(A) is not intended to be smoked; and
       ``(B) is in the form of a lozenge, tablet, pill, pouch, 
     dissolvable strip, or other discrete single-use or single-
     dose unit.''.
       (d) Tax Parity for Small Cigars.--Paragraph (1) of section 
     5701(a) of the Internal Revenue Code of 1986 is amended by 
     striking ``$50.33'' and inserting ``$100.66''.
       (e) Tax Parity for Large Cigars.--
       (1) In general.--Paragraph (2) of section 5701(a) of the 
     Internal Revenue Code of 1986 is amended by striking ``52.75 
     percent'' and all that follows through the period and 
     inserting the following: ``$49.56 per pound and a 
     proportionate tax at the like rate on all fractional parts of 
     a pound but not less than 10.066 cents per cigar.''.
       (2) Guidance.--The Secretary of the Treasury, or the 
     Secretary's delegate, may issue guidance regarding the 
     appropriate method for determining the weight of large cigars 
     for purposes of calculating the applicable tax under section 
     5701(a)(2) of the Internal Revenue Code of 1986.
       (f) Tax Parity for Roll-Your-Own Tobacco and Certain 
     Processed Tobacco.--Subsection (o) of section 5702 of the 
     Internal Revenue Code of 1986 is amended by inserting ``, and 
     includes processed tobacco that is removed for delivery or 
     delivered to a person other than a person with a permit 
     provided under section 5713, but does not include removals of 
     processed tobacco for exportation'' after ``wrappers 
     thereof''.
       (g) Clarifying Tax Rate for Other Tobacco Products.--
       (1) In general.--Section 5701 of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(i) Other Tobacco Products.--Any product not otherwise 
     described under this section that has been determined to be a 
     tobacco product by the Food and Drug Administration through 
     its authorities under the Family Smoking Prevention and 
     Tobacco Control Act shall be taxed at a level of tax 
     equivalent to the tax rate for cigarettes on an estimated per 
     use basis as determined by the Secretary.''.
       (2) Establishing per use basis.--For purposes of section 
     5701(i) of the Internal Revenue Code of 1986, not later than 
     12 months after the later of the date of the enactment of 
     this Act or the date that a product has been determined to be 
     a tobacco product by the Food and Drug Administration, the 
     Secretary of the Treasury (or the Secretary of the Treasury's 
     delegate) shall issue final regulations establishing the 
     level of tax for such product that is equivalent to the tax 
     rate for cigarettes on an estimated per use basis.
       (h) Clarifying Definition of Tobacco Products.--
       (1) In general.--Subsection (c) of section 5702 of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(c) Tobacco Products.--The term `tobacco products' 
     means--
       ``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco, 
     and roll-your-own tobacco, and
       ``(2) any other product subject to tax pursuant to section 
     5701(i).''.
       (2) Conforming amendments.--Subsection (d) of section 5702 
     of such Code is amended by striking ``cigars, cigarettes, 
     smokeless tobacco, pipe tobacco, or roll-your-own tobacco'' 
     each place it appears and inserting ``tobacco products''.
       (i) Increasing Tax on Cigarettes.--
       (1) Small cigarettes.--Section 5701(b)(1) of such Code is 
     amended by striking ``$50.33'' and inserting ``$100.66''.
       (2) Large cigarettes.--Section 5701(b)(2) of such Code is 
     amended by striking ``$105.69'' and inserting ``$211.38''.
       (j) Tax Rates Adjusted for Inflation.--Section 5701 of such 
     Code, as amended by subsection (g), is amended by adding at 
     the end the following new subsection:
       ``(j) Inflation Adjustment.--
       ``(1) In general.--In the case of any calendar year 
     beginning after 2021, 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 2020' 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, 2021.
       (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.
                                 ______
                                 
      By Ms. KLOBUCHAR:
  S. 422. A bill to allow Senators, Senators-elect, committees of the 
Senate, leadership offices, and other offices of the Senate to share 
employees, and for other purposes; considered and passed.

                                 S. 422

       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 ``Senate Shared Employee 
     Act''.

     SEC. 2. ALLOWING SENATORS, COMMITTEES, LEADERSHIP OFFICES, 
                   AND OTHER OFFICES OF THE SENATE TO SHARE 
                   EMPLOYEES.

       (a) In General.--Section 114 of the Legislative Branch 
     Appropriation Act, 1978 (2 U.S.C. 4576) is amended--
       (1) by inserting ``(a)'' before ``Notwithstanding'';
       (2) by striking ``position, each of'' and all that follows 
     through the period at the end and inserting the following: 
     ``qualifying position if the aggregate gross pay from those 
     positions does not exceed--
       ``(1) the maximum rate specified in section 105(d)(2) of 
     the Legislative Branch Appropriation Act, 1968 (2 U.S.C. 
     4575(d)(2)), as amended and modified; or
       ``(2) in a case where 1 or more of the individual's 
     qualifying positions are positions described in subsection 
     (d)(2)(B), the maximum rate specified in section 105(e)(3) of 
     the Legislative Branch Appropriation Act, 1968 (2 U.S.C. 
     4575(e)(3)), as amended and modified.''; and
       (3) by adding at the end the following:
       ``(b)(1) For an individual serving in more than 1 
     qualifying position under subsection

[[Page S864]]

     (a), the cost of any travel for official business shall be 
     paid by the office authorizing the travel.
       ``(2) Messages for each electronic mail account used in 
     connection with carrying out the official duties of an 
     individual serving in more than 1 qualifying position under 
     subsection (a) may be delivered to and sent from a single 
     handheld communications device provided to the individual for 
     purposes of official business.
       ``(3)(A) For purposes of the Ethics in Government Act of 
     1978 (5 U.S.C. App.), the rate of basic pay for an individual 
     serving in more than 1 qualifying position under subsection 
     (a) shall be the total basic pay received by the individual 
     from all such positions.
       ``(B) For an individual serving in more than one qualifying 
     position under subsection (a), for purposes of the rights and 
     obligations described in, or described in the provisions 
     applied under, title II of the Congressional Accountability 
     Act of 1995 (2 U.S.C. 1311 et seq.) related to practices used 
     at a time when the individual is serving in such a qualifying 
     position with an employing office, the rate of pay for the 
     individual shall be the individual rate of pay received from 
     the employing office.
       ``(c)(1) If the duties of a qualifying position under 
     subsection (a) include information technology services and 
     support, an individual may only serve in the qualifying 
     position and 1 or more additional qualifying positions under 
     such subsection if the individual is in compliance with each 
     information technology standard and policy established for 
     Senate offices by the Office of the Sergeant at Arms and 
     Doorkeeper of the Senate.
       ``(2) Notwithstanding subsection (a), an employee serving 
     in a qualifying position in the Office of the Secretary of 
     the Senate or the Office of the Sergeant at Arms and 
     Doorkeeper of the Senate may serve in an additional 
     qualifying position only if--
       ``(A) the other qualifying position is with the other 
     Office; or
       ``(B) the Committee on Rules and Administration of the 
     Senate has approved the arrangement.
       ``(d) In this section, the term `qualifying position' means 
     a position that--
       ``(1) is designated as a shared position for purposes of 
     this section by the Senator or other head of the office in 
     which the position is located; and
       ``(2) is one of the following:
       ``(A) A position--
       ``(i) that is in the office of a Senator; and
       ``(ii) the pay of which is disbursed by the Secretary of 
     the Senate.
       ``(B) A position--
       ``(i) that is in any committee of the Senate (including a 
     select or special committee) or a joint committee of 
     Congress; and
       ``(ii) the pay of which is disbursed by the Secretary of 
     the Senate out of an appropriation under the heading 
     `inquiries and investigations' or `Joint Economic Committee', 
     or a heading relating to a Joint Congressional Committee on 
     Inaugural Ceremonies.
       ``(C) A position--
       ``(i) that is in another office (excluding the Office of 
     the Vice President and the Office of the Chaplain of the 
     Senate); and
       ``(ii) the pay of which is disbursed by the Secretary of 
     the Senate out of an appropriation under the heading 
     `Salaries, Officers and Employees'.
       ``(D) A position--
       ``(i) that is filled pursuant to section 105 of the Second 
     Supplemental Appropriations Act, 1978 (2 U.S.C. 6311); and
       ``(ii) the pay of which is disbursed by the Secretary of 
     the Senate out of an appropriation under the heading 
     `miscellaneous items'.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect beginning on the day that is 6 months after 
     the date of enactment of this Act.
                                 ______
                                 
      By Mr. DURBIN (for himself, Mr. Lee, Mr. Leahy, Mr. Grassley, 
        Mrs. Feinstein, Mr. Rubio, Ms. Klobuchar, Mr. Cruz, Mr. Coons, 
        Mrs. Blackburn, Mr. Blumenthal, and Ms. Hirono):
  S. 426. A bill to amend the Inspector General Act of 1978 relative to 
the powers of the Department of Justice Inspector General; 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. 426

       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 ``Inspector General Access Act 
     of 2021''.

     SEC. 2. INVESTIGATIONS OF DEPARTMENT OF JUSTICE PERSONNEL.

       Section 8E of the Inspector General Act of 1978 (5 U.S.C. 
     App.) is amended--
       (1) in subsection (b)--
       (A) in paragraph (2), by striking ``and paragraph (3)'';
       (B) by striking paragraph (3);
       (C) by redesignating paragraphs (4) and (5) as paragraphs 
     (3) and (4), respectively; and
       (D) in paragraph (4), as redesignated, by striking 
     ``paragraph (4)'' and inserting ``paragraph (3)''; and
       (2) in subsection (d), by striking ``, except with respect 
     to allegations described in subsection (b)(3),''.
                                 ______
                                 
      By Ms. COLLINS (for herself and Ms. Rosen):
  S. 436. A bill to provide Federal matching funding for State-level 
broadband programs; to the Committee on Commerce, Science, and 
Transportation.
  Ms. COLLINS. Mr. President, I rise today to introduce the American 
Broadband Buildout Act. This legislation would help ensure that rural 
Americans have access to broadband services at the speeds they need to 
participate fully in the benefits of our modern society and economy. I 
want to thank my colleague Senator Rosen for joining me in introducing 
this bill today.
  Twenty-five years ago, Americans typically accessed the internet 
using their home phone lines via modems, capable of downloading data at 
just 56 kilobits per second, too slow even to support MP3-quality 
streaming music. Today, the Federal Communications Commission defines 
broadband service as having a threshold download speed nearly 500 times 
faster.
  Many areas of our country, particularly our rural communities, simply 
do not have the infrastructure to achieve these speeds and fully tap 
into the opportunities that digital connectivity can deliver. According 
to a 2019 Pew Research Center survey, nearly 37 percent of rural 
Americans lack a broadband connection compared to 25 percent of urban 
Americans.
  Similar disparities occur in terms of broadband adoption. That is the 
rate at which Americans subscribe to broadband service once they have 
access to it.
  The survey also found that 15 percent of rural Americans don't use 
the internet at home compared to just 9 percent of urban Americans.
  The current pandemic has brought these connectivity challenges into 
stark focus as many families have had to move their education, their 
workplaces, and their healthcare services online.
  Andrea Powers, the town manager of Fort Fairfield in northern Maine, 
recently described a number of challenges in her community: students 
who have to sit on the town's library steps in order to finish research 
projects and submit their papers; a business owner who was forced to 
relocate his company to another community in order to have a chance to 
succeed; a senior citizen who requires the care of distant doctors but 
does not have the capacity to travel nor access the telehealth options.
  Andrea told me the story of one family whose jobs rely heavily on 
access to high-speed broadband. They were told that it would cost them 
$15,000 to bring that connection to their doorstep. Andrea summed up 
the reality facing so many rural communities that lack access in this 
way. She said: ``We will continue to see a loss of business retention 
and expansion along with job creation. We simply cannot afford to allow 
this to happen. Online schooling, business growth and development, 
telehealth care, and economic agriculture success are all dependent on 
. . . affordable fiber optic broadband.''
  Telehealth services are an essential piece of the national broadband 
conversation. Often, rural communities struggle to attract and retain 
healthcare providers that they need to ensure access to quality care. 
Broadband is vital to bridging that gap to enable innovative healthcare 
delivery.
  Let me give you an example. Hospice workers at Northern Light 
Homecare were able to use the internet and video technology to help 
support a patient living on an island off the coast of Maine--not far 
as the seagull flies, but hours away in travel time. Although the 
connection was poor, the video enabled nurses to monitor the patient's 
condition and symptoms and, equally important, to provide emotional 
support to her and to her family. As one hospice worker put it, ``our 
hospice team could be doing so much more with video and telemonitoring 
technologies if only Maine had better connectivity.''
  The American Broadband Buildout Act would help close this ``digital 
divide'' between urban and rural America by providing up to $15 billion 
in matching grants to assist States and State-

[[Page S865]]

approved entities in building that ``last-mile'' infrastructure to 
bring high-speed broadband directly to homes and businesses in areas 
that lack it.
  Projects would have to be located in unserved areas--that is, areas 
where broadband is unavailable at speeds that meet the FCC standards. 
Focusing on those areas will direct support where it is most needed and 
will protect against overbuilding where infrastructure is already in 
place.
  The Federal funding authorized in our bill would be matched through 
public-private partnerships between the broadband service provider and 
the State where they provide service. This means that States and their 
private sector partners will have ``skin in the game'' so that the 
projects will be well thought out and sustainable. This model will also 
incentivize existing service providers to extend their networks to 
rural areas and swiftly connect new households.
  Third, the bill would require that projects be designed to be 
``future proof,'' meaning that the infrastructure installed must be 
capable of delivering higher speeds as broadband accelerates in the 
future. We want these investments to serve rural Americans now and in 
the future without having to rebuild every time technology advances.
  Our bill would also prioritize projects in States that have 
traditionally lagged behind the national average in terms of broadband 
subscribers and those that are at risk of falling further behind as 
broadband speeds increase.
  Finally, the bill would provide grants for digital literacy and 
public awareness campaigns to encourage wider broadband adoption once 
access is available. Increasing broadband adoption will help drive down 
the cost of the service and make it more affordable for everyone.
  Rural Americans need access to high-speed internet just as urban 
Americans do. In fact, one could argue they need it even more, 
especially during these times that can require remote work, education, 
and healthcare. The bill that Senator Rosen and I are introducing today 
would help bridge this digital divide by funding ``future proof'' 
broadband where it is needed most and give a boost to job creation in 
rural America.
  As the Presiding Officer well knows, businesses will not locate in 
areas that do not have this essential service, in many cases. I urge 
all of our colleagues to join in supporting this bill.
  Thank you

                          ____________________