[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 259 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 259
To amend the Public Health Service Act to address the increased burden
that maintaining the health and hygiene of infants and toddlers places
on families in need, the resultant adverse health effects on children
and families, and the limited child care options available for infants
and toddlers who lack sufficient diapers, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 11, 2021
Ms. Lee of California (for herself, Mrs. Carolyn B. Maloney of New
York, Mrs. Watson Coleman, Mr. Pocan, Ms. Meng, Mr. Rush, Ms.
Schakowsky, Mr. Grijalva, Mr. Cohen, Mr. Peters, Mrs. Hayes, Mr. Sires,
Ms. Norton, and Ms. Chu) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to address the increased burden
that maintaining the health and hygiene of infants and toddlers places
on families in need, the resultant adverse health effects on children
and families, and the limited child care options available for infants
and toddlers who lack sufficient diapers, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``End Diaper Need Act of 2021''.
SEC. 2. DIAPER DISTRIBUTION DEMONSTRATION PROJECT.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-7. DIAPER DISTRIBUTION DEMONSTRATION PROGRAM.
``(a) Establishment.--The Secretary shall make grants to assist
eligible entities to conduct demonstration projects that implement and
evaluate strategies to help low-income families to address the diaper
needs of infants and toddlers.
``(b) Design of Program.--In carrying out the grant program under
subsection (a), the Secretary shall--
``(1) consult with relevant stakeholders, including
agencies, professional associations, and nonprofit
organizations, on the design of the program; and
``(2) design the program in such a way that the program--
``(A) decreases diaper need in low-income families
and meets the unmet diaper needs of infants and
toddlers in such families through--
``(i) the distribution of free diapers and
diapering supplies;
``(ii) community outreach to assist in
participation in existing diaper distribution
programs; or
``(iii) improving access to diapers and
diapering supplies as part of a comprehensive
service; and
``(B) increases the abilities of communities and
low-income families in those communities to provide for
the diaper needs of infants and toddlers in those
communities.
``(c) Eligible Entities.--To be eligible for a grant under this
section, an entity shall--
``(1) be a State or local governmental entity, an Indian
Tribe or tribal organization (as defined in section 4 of the
Indian Self-Determination and Education Assistance Act), or a
nonprofit organization described in section 501(c)(3) of the
Internal Revenue Code of 1986 and exempt from taxation under
section 501(a) of such Code;
``(2) have experience in the area of--
``(A) community distributions of basic need
services, including experience collecting, warehousing,
and distributing basic necessities such as diapers,
food, or menstrual products;
``(B) child care;
``(C) child development activities in low-income
communities; or
``(D) motherhood, fatherhood, or parent-education
efforts serving low-income parents of young children;
``(3) demonstrate competency to implement a project,
provide fiscal accountability, collect data, and prepare
reports and other necessary documentation;
``(4) demonstrate a willingness to share information with
researchers, practitioners, and other interested parties; and
``(5) submit to the Secretary a description of the design
of the evaluation to be carried out under subsection (d)(2) and
receive the Secretary's approval of such design based on a
determination that such design is rigorous and is likely to
yield information that is credible and will be useful to other
States.
``(d) Use of Funds.--Amounts provided through a grant under this
section shall be used to conduct a demonstration project to implement
and evaluate strategies to help low-income families to address the
diaper needs of infants and toddlers, which use may include any of the
following:
``(1) To pay for the purchase of diapers and diapering
supplies and fund diaper distribution demonstration projects
that serve low-income families with one or more children 3
years of age or younger.
``(2) Using not more than 25 percent of the funds received
by the grantee under this section, to evaluate the effect of
activities under paragraph (1) on mitigating the health and
developmental risks of unmet diaper need among infants,
toddlers, and other family members in low-income families,
including the risks of diaper dermatitis, urinary tract
infections, and parental and child depression and anxiety.
``(3) To integrate activities under paragraph (1) with
other basic needs assistance programs serving eligible children
and their families, including the following:
``(A) Programs funded by the Temporary Assistance
for Needy Families program, including its State
maintenance of effort provisions.
``(B) Programs designed to support the health of
eligible children, such as the Children's Health
Insurance Program under title XXI of the Social
Security Act, the Medicaid program under title XIX of
such Act, or State-funded health care programs.
``(C) Programs funded through the Special
Supplemental Nutrition Program for Women, Infants, and
Children.
``(D) Programs that offer early home visiting
services, including the Nurse-Family Partnership and
the Maternal, Infant, and Early Childhood Home Visiting
(MIECHV) Program (including the Tribal Home Visiting
Program).
``(E) Programs to provide improved and affordable
access to child care, including programs funded through
the Child Care and Development Fund, the Temporary
Assistance for Needy Families program, or a State-
funded program.
``(e) No Effect on Other Programs.--Any assistance or benefits
received by a family as a result of a project established pursuant to
this section shall be disregarded for purposes of determining the
family's eligibility for, or amount of, benefits under any other
Federal needs-based programs.
``(f) Reports.--As a condition of receiving a grant under this
section for a fiscal year, the grantee shall submit to the Secretary,
not later than 6 months after the end of the fiscal year, a report that
specifies, by month and fiscal year, the following:
``(1) The number of infants and toddlers and the age of the
infant and toddlers who received assistance from the grantee's
diaper distribution project.
``(2) The number of families that have received assistance
from the grantee's diaper distribution project.
``(3) The number of diapers, and the number of each type of
diapering supply, distributed under the grantee's diaper
distribution project.
``(4) The ZIP Code or ZIP Codes where the grantee
distributed diapers and diaper supplies.
``(5) The method or methods the grantee uses to distribute
diapers and diapering supplies.
``(6) Such other information as the Secretary may specify.
``(g) Evaluation.--The Secretary, in consultation with each grantee
under this section, shall--
``(1) not later than 2 years after the date of enactment of
the End Diaper Need Act of 2021--
``(A) complete an evaluation of the effectiveness
of the program carried out pursuant to this section;
``(B) submit to the relevant congressional
committees a report on the results of such evaluation;
and
``(C) publish the results of the evaluation on the
internet website of the Department of Health and Human
Services; and
``(2)(A) not later than 3 years after the date of enactment
of the End Diaper Need Act of 2021, update the evaluation
required by paragraph (1)(A); and
``(B) not later than 90 days after completion of the
updated evaluation under subparagraph (A)--
``(i) submit to the relevant congressional
committees a report describing the results of such
updated evaluation; and
``(ii) publish the results of such evaluation on
the internet website of the Department of Health and
Human Services.
``(h) Definitions.--In this section:
``(1) Diaper.--The term `diaper' means an absorbent garment
that--
``(A) is washable or disposable that may be worn by
an infant or toddler who is not toilet-trained; and
``(B) if disposable--
``(i) does not use any latex or common
allergens; and
``(ii) meets or exceeds the quality
standards for diapers commercially available
through retail sale in the following
categories:
``(I) Absorbency (with acceptable
rates for first and second wetting).
``(II) Waterproof outer cover.
``(III) Flexible leg openings.
``(IV) Refastening closures.
``(2) Diapering supplies.--The term `diapering supplies'
means items, including diaper wipes and diaper cream, necessary
to ensure that a child using a diaper is properly cleaned and
protected from diaper rash.
``(3) Eligible child.--The term `eligible child' means a
child who--
``(A) has not attained 4 years of age; and
``(B) is a member of a family whose self-certified
income is not more than 200 percent of the Federal
poverty line.
``(4) Federal poverty line.--The term `Federal poverty
line' means the Federal poverty line as defined by the Office
of Management and Budget and revised annually in accordance
with section 673(2) of the Omnibus Budget Reconciliation Act of
1981 applicable to a family of the size involved.
``(5) Low-income.--The term `low-income', with respect to a
family, means a family whose self-certified income is not more
than 200 percent of the Federal poverty line.
``(i) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated $100,000,000 for each of fiscal
years 2022 through 2025.
``(2) Availability of funds.--Funds provided to a grantee
under this section for a fiscal year may be expended by the
grantee only in such fiscal year or the succeeding fiscal
year.''.
SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY COMPLEX CHILDREN.
Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is
amended by adding at the end the following new paragraph:
``(11)(A) In the case of any waiver under this subsection that
provides medical assistance to a medically complex child who has been
diagnosed with bowel or bladder incontinence, a bowel or bladder
condition that causes excess urine or stool (such as short gut syndrome
or diabetes insipidus), or a severe skin condition that causes skin
erosions (such as epidermolysis bullosa), such medical assistance shall
include, for the duration of the waiver, the provision of 200 medically
necessary diapers per month and diapering supplies. Such medical
assistance may include the provision of medically necessary diapers in
amounts greater than 200 if a licensed health care provider (such as a
physician, nurse practitioner, or physician assistant) specifies that
such greater amounts are necessary for such medically complex child.
``(B) For purposes of this paragraph--
``(i) the term `medically complex child' means an
individual who is at least three years of age and for whom a
licensed health care provider has provided a diagnosis of one
or more significant chronic conditions;
``(ii) the term `medically necessary diaper' means an
absorbent garment that is--
``(I) washable or disposable; and
``(II) worn by a medically complex child who has
been diagnosed with a condition described in
subparagraph (A) and needs such garment to correct or
ameliorate such condition; and
``(iii) the term `diapering supplies' means items,
including diaper wipes and diaper creams, necessary to ensure
that a medically complex child who has been diagnosed with a
condition described in subparagraph (A) and uses a medically
necessary diaper is properly cleaned and protected from diaper
rash.''.
SEC. 4. INCLUSION OF DIAPERS AND DIAPERING SUPPLIES AS QUALIFIED
MEDICAL EXPENSES.
(a) Health Savings Accounts.--Section 223(d)(2) of the Internal
Revenue Code of 1986 is amended--
(1) by adding at the end of subparagraph (A) the following:
``For purposes of this subparagraph, amounts paid for medically
necessary diapers and diapering supplies shall be treated as
paid for medical care.''; and
(2) by adding at the end the following new subparagraph:
``(E) Medically necessary diapers and diapering
supplies.--For purposes of this paragraph--
``(i) Medically necessary diapers.--The
term `medically necessary diaper' means an
absorbent garment that is washable or
disposable worn by an individual needs diapers
because they are medically necessary, serve a
preventative medical purpose, or are needed to
correct or ameliorate defects or physical or
mental illnesses or conditions which are
diagnosed by a licenced health care provider.
``(ii) Diapering supplies.--The term
`diapering supplies' means items, including
diaper wipes and diaper creams necessary to
ensure that a child using a medically necessary
diaper is properly cleaned and protected from
diaper rash.''.
(b) Archer MSAs.--Section 220(d)(2)(A) of such Code is amended by
adding at the end the following: ``For purposes of this subparagraph,
amounts paid for medically necessary diapers and diapering supplies (as
defined in section 223(d)(2)(D)) shall be treated as paid for medical
care.''.
(c) Health Flexible Spending Arrangements and Health Reimbursement
Arrangements.--Section 106 of such Code is amended by adding at the end
the following new subsection:
``(h) Reimbursements for Medically Necessary Diapers and Diapering
Supplies.--For purposes of this section and section 105, expenses
incurred for medically necessary diapers and diapering supplies (as
defined in section 223(d)(2)(D)) shall be treated as incurred for
medical care.''.
(d) Effective Dates.--
(1) Distributions from health savings accounts.--The
amendments made by subsections (a) and (b) shall apply to
amounts paid after December 31, 2021.
(2) Reimbursements.--The amendment made by subsection (c)
shall apply to expenses incurred after December 31, 2021.
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