End Diaper Need Act of 2021

I 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. SCHA- KOWSKY, 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 provi- sions 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 hy- giene of infants and toddlers places on families in need, the resultant adverse health effects on children and fami- lies, and the limited child care options available for in- fants and toddlers who lack sufficient diapers, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 259 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘End Diaper Need Act 2 of 2021’’. 3 SEC. 2. DIAPER DISTRIBUTION DEMONSTRATION PROJECT. 4 Part P of title III of the Public Health Service Act 5 (42 U.S.C. 280g et seq.) is amended by adding at the end 6 the following: 7 ‘‘SEC. 399V–7. DIAPER DISTRIBUTION DEMONSTRATION 8 PROGRAM. 9 ‘‘(a) ESTABLISHMENT.—The Secretary shall make 10 grants to assist eligible entities to conduct demonstration 11 projects that implement and evaluate strategies to help 12 low-income families to address the diaper needs of infants 13 and toddlers. 14 ‘‘(b) DESIGN OF PROGRAM.—In carrying out the 15 grant program under subsection (a), the Secretary shall— 16 ‘‘(1) consult with relevant stakeholders, includ- 17 ing agencies, professional associations, and nonprofit 18 organizations, on the design of the program; and 19 ‘‘(2) design the program in such a way that the 20 program— 21 ‘‘(A) decreases diaper need in low-income 22 families and meets the unmet diaper needs of 23 infants and toddlers in such families through— 24 ‘‘(i) the distribution of free diapers 25 and diapering supplies; 26 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 259 IH ‘‘(ii) community outreach to assist in 1 participation in existing diaper distribution 2 programs; or 3 ‘‘(iii) improving access to diapers and 4 diapering supplies as part of a comprehen- 5 sive service; and 6 ‘‘(B) increases the abilities of communities 7 and low-income families in those communities 8 to provide for the diaper needs of infants and 9 toddlers in those communities. 10 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible for a grant 11 under this section, an entity shall— 12 ‘‘(1) be a State or local governmental entity, an 13 Indian Tribe or tribal organization (as defined in 14 section 4 of the Indian Self-Determination and Edu- 15 cation Assistance Act), or a nonprofit organization 16 described in section 501(c)(3) of the Internal Rev- 17 enue Code of 1986 and exempt from taxation under 18 section 501(a) of such Code; 19 ‘‘(2) have experience in the area of— 20 ‘‘(A) community distributions of basic need 21 services, including experience collecting, 22 warehousing, and distributing basic necessities 23 such as diapers, food, or menstrual products; 24 ‘‘(B) child care; 25 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 259 IH ‘‘(C) child development activities in low-in- 1 come communities; or 2 ‘‘(D) motherhood, fatherhood, or parent- 3 education efforts serving low-income parents of 4 young children; 5 ‘‘(3) demonstrate competency to implement a 6 project, provide fiscal accountability, collect data, 7 and prepare reports and other necessary documenta- 8 tion; 9 ‘‘(4) demonstrate a willingness to share infor- 10 mation with researchers, practitioners, and other in- 11 terested parties; and 12 ‘‘(5) submit to the Secretary a description of 13 the design of the evaluation to be carried out under 14 subsection (d)(2) and receive the Secretary’s ap- 15 proval of such design based on a determination that 16 such design is rigorous and is likely to yield informa- 17 tion that is credible and will be useful to other 18 States. 19 ‘‘(d) USE OF FUNDS.—Amounts provided through a 20 grant under this section shall be used to conduct a dem- 21 onstration project to implement and evaluate strategies to 22 help low-income families to address the diaper needs of 23 infants and toddlers, which use may include any of the 24 following: 25 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 259 IH ‘‘(1) To pay for the purchase of diapers and 1 diapering supplies and fund diaper distribution dem- 2 onstration projects that serve low-income families 3 with one or more children 3 years of age or younger. 4 ‘‘(2) Using not more than 25 percent of the 5 funds received by the grantee under this section, to 6 evaluate the effect of activities under paragraph (1) 7 on mitigating the health and developmental risks of 8 unmet diaper need among infants, toddlers, and 9 other family members in low-income families, includ- 10 ing the risks of diaper dermatitis, urinary tract in- 11 fections, and parental and child depression and anx- 12 iety. 13 ‘‘(3) To integrate activities under paragraph (1) 14 with other basic needs assistance programs serving 15 eligible children and their families, including the fol- 16 lowing: 17 ‘‘(A) Programs funded by the Temporary 18 Assistance for Needy Families program, includ- 19 ing its State maintenance of effort provisions. 20 ‘‘(B) Programs designed to support the 21 health of eligible children, such as the Chil- 22 dren’s Health Insurance Program under title 23 XXI of the Social Security Act, the Medicaid 24 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 259 IH program under title XIX of such Act, or State- 1 funded health care programs. 2 ‘‘(C) Programs funded through the Special 3 Supplemental Nutrition Program for Women, 4 Infants, and Children. 5 ‘‘(D) Programs that offer early home vis- 6 iting services, including the Nurse-Family Part- 7 nership and the Maternal, Infant, and Early 8 Childhood Home Visiting (MIECHV) Program 9 (including the Tribal Home Visiting Program). 10 ‘‘(E) Programs to provide improved and 11 affordable access to child care, including pro- 12 grams funded through the Child Care and De- 13 velopment Fund, the Temporary Assistance for 14 Needy Families program, or a State-funded 15 program. 16 ‘‘(e) NO EFFECT ON OTHER PROGRAMS.—Any as- 17 sistance or benefits received by a family as a result of a 18 project established pursuant to this section shall be dis- 19 regarded for purposes of determining the family’s eligi- 20 bility for, or amount of, benefits under any other Federal 21 needs-based programs. 22 ‘‘(f) REPORTS.—As a condition of receiving a grant 23 under this section for a fiscal year, the grantee shall sub- 24 mit to the Secretary, not later than 6 months after the 25 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 259 IH end of the fiscal year, a report that specifies, by month 1 and fiscal year, the following: 2 ‘‘(1) The number of infants and toddlers and 3 the age of the infant and toddlers who received as- 4 sistance from the grantee’s diaper distribution 5 project. 6 ‘‘(2) The number of families that have received 7 assistance from the grantee’s diaper distribution 8 project. 9 ‘‘(3) The number of diapers, and the number of 10 each type of diapering supply, distributed under the 11 grantee’s diaper distribution project. 12 ‘‘(4) The ZIP Code or ZIP Codes where the 13 grantee distributed diapers and diaper supplies. 14 ‘‘(5) The method or methods the grantee uses 15 to distribute diapers and diapering supplies. 16 ‘‘(6) Such other information as the Secretary 17 may specify. 18 ‘‘(g) EVALUATION.—The Secretary, in consultation 19 with each grantee under this section, shall— 20 ‘‘(1) not later than 2 years after the date of en- 21 actment of the End Diaper Need Act of 2021— 22 ‘‘(A) complete an evaluation of the effec- 23 tiveness of the program carried out pursuant to 24 this section; 25 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 259 IH ‘‘(B) submit to the relevant congressional 1 committees a report on the results of such eval- 2 uation; and 3 ‘‘(C) publish the results of the evaluation 4 on the internet website of the Department of 5 Health and Human Services; and 6 ‘‘(2)(A) not later than 3 years after the date of 7 enactment of the End Diaper Need Act of 2021, up- 8 date the evaluation required by paragraph (1)(A); 9 and 10 ‘‘(B) not later than 90 days after completion of 11 the updated evaluation under subparagraph (A)— 12 ‘‘(i) submit to the relevant congressional 13 committees a report describing the results of 14 such updated evaluation; and 15 ‘‘(ii) publish the results of such evaluation 16 on the internet website of the Department of 17 Health and Human Services. 18 ‘‘(h) DEFINITIONS.—In this section: 19 ‘‘(1) DIAPER.—The term ‘diaper’ means an ab- 20 sorbent garment that— 21 ‘‘(A) is washable or disposable that may be 22 worn by an infant or toddler who is not toilet- 23 trained; and 24 ‘‘(B) if disposable— 25 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 259 IH ‘‘(i) does not use any latex or common 1 allergens; and 2 ‘‘(ii) meets or exceeds the quality 3 standards for diapers commercially avail- 4 able through retail sale in the following 5 categories: 6 ‘‘(I) Absorbency (with acceptable 7 rates for first and second wetting). 8 ‘‘(II) Waterproof outer cover. 9 ‘‘(III) Flexible leg openings. 10 ‘‘(IV) Refastening closures. 11 ‘‘(2) DIAPERING SUPPLIES.—The term ‘dia- 12 pering supplies’ means items, including diaper wipes 13 and diaper cream, necessary to ensure that a child 14 using a diaper is properly cleaned and protected 15 from diaper rash. 16 ‘‘(3) ELIGIBLE CHILD.—The term ‘eligible 17 child’ means a child who— 18 ‘‘(A) has not attained 4 years of age; and 19 ‘‘(B) is a member of a family whose self- 20 certified income is not more than 200 percent 21 of the Federal poverty line. 22 ‘‘(4) FEDERAL POVERTY LINE.—The term 23 ‘Federal poverty line’ means the Federal poverty line 24 as defined by the Office of Management and Budget 25 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 259 IH and revised annually in accordance with section 1 673(2) of the Omnibus Budget Reconciliation Act of 2 1981 applicable to a family of the size involved. 3 ‘‘(5) LOW-INCOME.—The term ‘low-income’, 4 with respect to a family, means a family whose self- 5 certified income is not more than 200 percent of the 6 Federal poverty line. 7 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.— 8 ‘‘(1) IN GENERAL.—To carry out this section, 9 there is authorized to be appropriated $100,000,000 10 for each of fiscal years 2022 through 2025. 11 ‘‘(2) AVAILABILITY OF FUNDS.—Funds pro- 12 vided to a grantee under this section for a fiscal 13 year may be expended by the grantee only in such 14 fiscal year or the succeeding fiscal year.’’. 15 SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 16 COMPLEX CHILDREN. 17 Section 1915(c) of the Social Security Act (42 U.S.C. 18 1396n(c)) is amended by adding at the end the following 19 new paragraph: 20 ‘‘(11)(A) In the case of any waiver under this sub- 21 section that provides medical assistance to a medically 22 complex child who has been diagnosed with bowel or blad- 23 der incontinence, a bowel or bladder condition that causes 24 excess urine or stool (such as short gut syndrome or diabe- 25 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 259 IH tes insipidus), or a severe skin condition that causes skin 1 erosions (such as epidermolysis bullosa), such medical as- 2 sistance shall include, for the duration of the waiver, the 3 provision of 200 medically necessary diapers per month 4 and diapering supplies. Such medical assistance may in- 5 clude the provision of medically necessary diapers in 6 amounts greater than 200 if a licensed health care pro- 7 vider (such as a physician, nurse practitioner, or physician 8 assistant) specifies that such greater amounts are nec- 9 essary for such medically complex child. 10 ‘‘(B) For purposes of this paragraph— 11 ‘‘(i) the term ‘medically complex child’ means 12 an individual who is at least three years of age and 13 for whom a licensed health care provider has pro- 14 vided a diagnosis of one or more significant chronic 15 conditions; 16 ‘‘(ii) the term ‘medically necessary diaper’ 17 means an absorbent garment that is— 18 ‘‘(I) washable or disposable; and 19 ‘‘(II) worn by a medically complex child 20 who has been diagnosed with a condition de- 21 scribed in subparagraph (A) and needs such 22 garment to correct or ameliorate such condition; 23 and 24 VerDate Sep 11 2014 05:42 Feb 05, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 259 IH ‘‘(iii) the term ‘diapering supplies’ means items, 1 including diaper wipes and diaper creams, necessary 2 to ensure that a medically complex child who has 3 been diagnosed with a condition described in sub- 4 paragraph (A) and uses a medically necessary diaper 5 is properly cleaned and protected from diaper rash.’’. 6 SEC. 4. INCLUSION OF DIAPERS AND D [Text truncated for display. Full text available on Congress.gov.]