End Diaper Need Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1404 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 SENATE OF THE UNITED STATES MAY 9, 2019 Ms. DUCKWORTH (for herself and Mr. CASEY) introduced the following bill; which was read twice and referred to the Committee on Finance 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘End Diaper Need Act 4 of 2019’’. 5 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 2 •S 1404 IS SEC. 2. DIAPER DISTRIBUTION DEMONSTRATION PROJECT. 1 Part P of title III of the Public Health Service Act 2 (42 U.S.C. 280g et seq.) is amended by adding at the end 3 the following: 4 ‘‘SEC. 399V–7. DIAPER DISTRIBUTION DEMONSTRATION 5 PROGRAM. 6 ‘‘(a) ESTABLISHMENT.—The Secretary shall make 7 grants to assist eligible entities in conducting demonstra- 8 tion projects that implement and evaluate strategies to 9 help low-income families address the diaper needs of in- 10 fants and toddlers. 11 ‘‘(b) DESIGN OF PROGRAM.—In carrying out the 12 grant program under subsection (a), the Secretary shall— 13 ‘‘(1) consult with relevant stakeholders, includ- 14 ing agencies, professional associations, and nonprofit 15 organizations, on the design of the program; and 16 ‘‘(2) design the program in such a way that the 17 program— 18 ‘‘(A) decreases diaper need in low-income 19 families and meets the unmet diaper needs of 20 infants and toddlers in such families through— 21 ‘‘(i) the distribution of free diapers 22 and diapering supplies; 23 ‘‘(ii) community outreach to assist in 24 participation in existing diaper distribution 25 programs; or 26 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 3 •S 1404 IS ‘‘(iii) improving access to diapers and 1 diapering supplies as part of a comprehen- 2 sive service; and 3 ‘‘(B) increases the ability of communities 4 and low-income families in such communities to 5 provide for the diaper needs of infants and tod- 6 dlers. 7 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible for a grant 8 under this section, an entity shall— 9 ‘‘(1) be a State or local governmental entity, an 10 Indian tribe or tribal organization (as defined in sec- 11 tion 4 of the Indian Self-Determination and Edu- 12 cation Assistance Act), or a nonprofit organization 13 described in section 501(c)(3) of the Internal Rev- 14 enue Code of 1986 and exempt from taxation under 15 section 501(a) of such Code; 16 ‘‘(2) have experience in the area of— 17 ‘‘(A) community distributions of basic need 18 services, including experience collecting, 19 warehousing, and distributing basic necessities 20 such as diapers, food, or menstrual products; 21 ‘‘(B) child care; 22 ‘‘(C) child development activities in low-in- 23 come communities; or 24 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 4 •S 1404 IS ‘‘(D) motherhood, fatherhood, or parent- 1 education efforts serving low-income parents of 2 young children; 3 ‘‘(3) demonstrate competency to implement a 4 project, provide fiscal accountability, collect data, 5 and prepare reports and other necessary documenta- 6 tion; 7 ‘‘(4) demonstrate a willingness to share infor- 8 mation with researchers, practitioners, and other in- 9 terested parties; and 10 ‘‘(5) submit to the Secretary a description of 11 the design of the evaluation to be carried out under 12 subsection (d)(2) and receive the Secretary’s ap- 13 proval of such design based on a determination that 14 such design is rigorous and is likely to yield informa- 15 tion that is credible and useful to other States. 16 ‘‘(d) USE OF FUNDS.—Amounts provided through a 17 grant under this section shall be used to conduct a dem- 18 onstration project to implement and evaluate strategies to 19 help low-income families to address the diaper needs of 20 infants and toddlers, which may include any of the fol- 21 lowing: 22 ‘‘(1) Paying for the purchase of diapers and 23 diapering supplies and funding diaper distribution 24 demonstration projects that serve low-income fami- 25 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 5 •S 1404 IS lies with one or more children 3 years of age or 1 younger. 2 ‘‘(2) Using not more than 25 percent of the 3 funds received by the grantee under this section, 4 evaluating the effect of activities under paragraph 5 (1) on mitigating the health and developmental risks 6 of unmet diaper need among infants, toddlers, and 7 other family members in low-income families, includ- 8 ing the risks of diaper dermatitis, urinary tract in- 9 fections, and parental and child depression and anx- 10 iety. 11 ‘‘(3) Integrating activities under paragraph (1) 12 with other basic needs assistance programs serving 13 eligible children and their families, including the fol- 14 lowing: 15 ‘‘(A) Programs funded by the temporary 16 assistance for needy families program under 17 part A of title IV of the Social Security Act, in- 18 cluding the State maintenance of effort provi- 19 sions of such program. 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 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 6 •S 1404 IS 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, in- 4 fants, and children under section 17 of the 5 Child Nutrition Act of 1966. 6 ‘‘(D) Programs that offer early home vis- 7 iting services, including the nurse-family part- 8 nership programs and the Maternal, infant, and 9 early childhood home visiting program (includ- 10 ing the Tribal home visiting program) under 11 section 511 of the Social Security Act. 12 ‘‘(E) Programs to provide improved and 13 affordable access to child care, including pro- 14 grams funded through the Child Care and De- 15 velopment Fund, the temporary assistance for 16 needy families program under part A of title IV 17 of the Social Security Act, or a State-funded 18 program. 19 ‘‘(e) NO EFFECT ON OTHER PROGRAMS.—Any as- 20 sistance or benefits received by a family as a result of a 21 project established pursuant to this section shall be dis- 22 regarded for purposes of determining the family’s eligi- 23 bility for, or amount of, benefits under any other Federal 24 needs-based programs. 25 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 7 •S 1404 IS ‘‘(f) REPORTS.—As a condition of receiving a grant 1 under this section for a fiscal year, the grantee shall sub- 2 mit to the Secretary, not later than 6 months after the 3 end of the fiscal year, a report that specifies, by month 4 and fiscal year, the following: 5 ‘‘(1) The number of infants and toddlers and 6 the age of the infants and toddlers who received as- 7 sistance from the grantee’s diaper distribution 8 project. 9 ‘‘(2) The number of families that have received 10 assistance from the grantee’s diaper distribution 11 project. 12 ‘‘(3) The number of diapers, and the number of 13 each type of diapering supply, distributed under the 14 grantee’s diaper distribution project. 15 ‘‘(4) The ZIP Code or ZIP Codes where the 16 grantee distributed diapers and diaper supplies. 17 ‘‘(5) The method or methods the grantee uses 18 to distribute diapers and diapering supplies. 19 ‘‘(6) Such other information as the Secretary 20 may specify. 21 ‘‘(g) EVALUATION.—The Secretary, in consultation 22 with each grantee under this section, shall— 23 ‘‘(1) not later than 2 years after the date of en- 24 actment of the End Diaper Need Act of 2019— 25 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 8 •S 1404 IS ‘‘(A) complete an evaluation of the effec- 1 tiveness of the program carried out pursuant to 2 this section; 3 ‘‘(B) submit to the relevant congressional 4 committees a report on the results of such eval- 5 uation; and 6 ‘‘(C) publish the results of the evaluation 7 on the internet website of the Department of 8 Health and Human Services; and 9 ‘‘(2)(A) not later than 3 years after the date of 10 enactment of the End Diaper Need Act of 2019, up- 11 date the evaluation required by paragraph (1)(A); 12 and 13 ‘‘(B) not later than 90 days after completion of 14 the updated evaluation under subparagraph (A)— 15 ‘‘(i) submit to the relevant congressional 16 committees a report describing the results of 17 such updated evaluation; and 18 ‘‘(ii) publish the results of such evaluation 19 on the internet website of the Department of 20 Health and Human Services. 21 ‘‘(h) DEFINITIONS.—In this section: 22 ‘‘(1) DIAPER.—The term ‘diaper’ means an ab- 23 sorbent garment that— 24 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 9 •S 1404 IS ‘‘(A) is washable or disposable that may be 1 worn by an infant or toddler who is not toilet- 2 trained; and 3 ‘‘(B) if disposable— 4 ‘‘(i) does not use any latex or common 5 allergens; and 6 ‘‘(ii) meets or exceeds the quality 7 standards for diapers commercially avail- 8 able through retail sale in the following 9 categories: 10 ‘‘(I) Absorbency (with acceptable 11 rates for first and second wetting). 12 ‘‘(II) Waterproof outer cover. 13 ‘‘(III) Flexible leg openings. 14 ‘‘(IV) Refastening closures. 15 ‘‘(2) DIAPERING SUPPLIES.—The term ‘dia- 16 pering supplies’ means items, including diaper wipes 17 and diaper cream, necessary to ensure that a child 18 using a diaper is properly cleaned and protected 19 from diaper rash. 20 ‘‘(3) ELIGIBLE CHILD.—The term ‘eligible 21 child’ means a child who— 22 ‘‘(A) has not attained 4 years of age; and 23 ‘‘(B) is a member of a low-income family. 24 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 10 •S 1404 IS ‘‘(4) FEDERAL POVERTY LINE.—The term 1 ‘Federal poverty line’ means the Federal poverty line 2 as defined by the Office of Management and Budget 3 and revised annually in accordance with section 4 673(2) of the Omnibus Budget Reconciliation Act of 5 1981 applicable to a family of the size involved. 6 ‘‘(5) LOW-INCOME.—The term ‘low-income’, 7 with respect to a family, means a family whose self- 8 certified income is not more than 200 percent of the 9 Federal poverty line. 10 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.— 11 ‘‘(1) IN GENERAL.—To carry out this section, 12 there is authorized to be appropriated $100,000,000 13 for each of fiscal years 2020 through 2023. 14 ‘‘(2) AVAILABILITY OF FUNDS.—Funds pro- 15 vided to a grantee under this section for a fiscal 16 year may be expended by the grantee only in such 17 fiscal year or the succeeding fiscal year.’’. 18 SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 19 COMPLEX CHILDREN. 20 Section 1915(c) of the Social Security Act (42 U.S.C. 21 1396n(c)) is amended by adding at the end the following 22 new paragraph: 23 ‘‘(11)(A) In the case of any waiver under this sub- 24 section that provides medical assistance to a medically 25 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 11 •S 1404 IS complex child who has been diagnosed with bowel or blad- 1 der incontinence, a bowel or bladder condition that causes 2 excess urine or stool (such as short gut syndrome or diabe- 3 tes insipidus), or a severe skin condition that causes skin 4 erosions (such as epidermolysis bullosa), such medical as- 5 sistance shall include, for the duration of the waiver, the 6 provision of 200 medically necessary diapers per month 7 and diapering supplies. Such medical assistance may in- 8 clude the provision of medically necessary diapers in 9 amounts greater than 200 if a licensed health care pro- 10 vider (such as a physician, nurse practitioner, or physician 11 assistant) specifies that such greater amounts are nec- 12 essary for such medically complex child. 13 ‘‘(B) For purposes of this paragraph— 14 ‘‘(i) the term ‘medically complex child’ means 15 an individual who is at least three years of age and 16 for whom a licensed health care provider has pro- 17 vided a diagnosis of one or more significant chronic 18 conditions; 19 ‘‘(ii) the term ‘medically necessary diaper’ 20 means an absorbent garment that is— 21 ‘‘(I) washable or disposable; and 22 ‘‘(II) worn by a medically complex child 23 who has been diagnosed with a condition de- 24 scribed in subparagraph (A) and needs such 25 VerDate Sep 11 2014 22:58 May 21, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1404.IS S1404 tkelley on DSKBCP9HB2PROD with BILLS 12 •S 1404 IS garment to correct or ameliorate such condition; 1 and 2 ‘‘(iii) the term ‘diapering supplies’ means items, 3 including diaper wipes and diaper creams, necessary 4 to ensure that a medically complex child who has 5 been diagnosed with a condition described in sub- 6 paragraph (A) and uses a medically necessary diaper 7 is properly cleaned and protected from diaper rash.’’. 8 SEC. 4. INCLUSION OF DIAPERS AND DIAPERING SUPPLIES 9 AS QUALIFIED MEDICAL EXPENSES. 10 (a) HEALTH SAVINGS ACCOUNTS.—Section 11 223(d)(2) of the Internal Revenue Code of 1986 is amend- 12 ed— 13 (1) by adding at the end of subparagraph (A) 14 the following: ‘‘For purposes of this subparagraph, 15 amounts [Text truncated for display. Full text available on Congress.gov.]