No official summary available for this bill.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5644 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 5644
To address the increased burden that maintaining the health and hygiene
of infants and toddlers, medically complex children, and low-income
adults or adults with disabilities who rely on adult incontinence
materials and supplies place 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 diapering supplies, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 21, 2023
Ms. Lee of California 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 address the increased burden that maintaining the health and hygiene
of infants and toddlers, medically complex children, and low-income
adults or adults with disabilities who rely on adult incontinence
materials and supplies place 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 diapering supplies, 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 2023''.
SEC. 2. GRANTS FOR DIAPER ASSISTANCE, INCLUDING DIAPERING SUPPLIES AND
ADULT INCONTINENCE MATERIALS AND SUPPLIES.
(a) Grants.--The Secretary shall make grants to assist eligible
entities to help low-income families to address the diaper needs of
infants and toddlers.
(b) Reservation of Funds.--
(1) Technical assistance and training.--The Secretary shall
reserve not more than 2 percent of the amount made available
pursuant to subsection (a) for each of fiscal years 2024
through 2027 for purposes of entering into an agreement with a
national entity described in subsection (c) to assist in
providing technical assistance and training, to support
effective policy, practice, research, and cross-system
collaboration among grantees and subgrantees, and to assist in
the administration of the program described in this section;
and
(2) Evaluation.--The Secretary shall reserve not more than
$3,000,000 of the amount made available pursuant to subsection
(a) for fiscal year 2024 for purposes of conducting an
evaluation under subsection (f).
(c) National Entity Described.--A national entity described in this
subsection is 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, that--
(1) has experience in more than 1 State 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;
(2) demonstrates competency to implement a project, provide
fiscal accountability, collect data, and prepare reports and
other necessary documentation; and
(3) demonstrates a willingness to share information with
researchers, practitioners, and other interested parties.
(d) Use of Funds.--
(1) In general.--An eligible entity to which a grant is
made under this section shall use the grant in accordance with
this subsection.
(2) Rules governing use of funds.--
(A) In general.--Funds are used in accordance with
this subsection if--
(i) the State, in consultation with
relevant stakeholders, including agencies,
professional associations, and nonprofit
organizations, distributes the funds to
eligible entities to--
(I) decrease the need for diapers
and diapering supplies and adult
incontinence materials and supplies in
low-income families and meet such unmet
needs of infants and toddlers,
medically complex children, and low-
income adults and adults with
disabilities in such families through--
(aa) the distribution of
free diapers and diapering
supplies, medically necessary
diapers, and adult incontinence
materials and supplies; and
(bb) improving access to
diapers and diapering supplies,
medically necessary diapers,
and adult incontinence
materials and supplies;
(II) carry out community outreach
to assist in participation in diaper
distribution programs or programs that
distribute medically necessary diapers
or adult incontinence materials and
supplies; and
(III) increase the ability of
communities and low-income families in
such communities to provide for the
need for diapers and diapering
supplies, medically necessary diapers,
and adult continence materials and
supplies, of infants and toddlers,
medically complex children, and low-
income adults and adults with
disabilities;
(ii) the funds are used subject to the
limitations in section 2005 of the Social
Security Act (42 U.S.C. 1397d); and
(iii) the funds are used to supplement, not
supplant, State general revenue funds provided
for the purposes described in clause (i).
(B) Administrative costs.--A State receiving funds
made available under subsection (a) may use not more
than 5 percent of the funds for State administrative
costs, which may include costs of contracting,
monitoring, and reporting.
(C) Allowable uses by eligible entities.--An
eligible entity receiving funds made available under
subsection (a) shall use the funds for any of the
following:
(i) To pay for the purchase and
distribution of diapers and diapering supplies,
medically necessary diapers, and funding diaper
(including medically necessary diapers)
distribution that serves low-income families
with--
(I) 1 or more children 3 years of
age or younger; or
(II) 1 or more medically complex
children.
(ii) To pay for the purchase and
distribution of adult incontinence materials
and supplies and funding distribution of the
materials and supplies for low-income families
with 1 or more low-income adults, adults with
disabilities, or children with a disability who
have attained 3 years of age and have not
attained 19 years of age, who rely on adult
incontinence materials and supplies.
(iii) To integrate activities carried out
under clause (i) with other basic needs
assistance programs serving eligible children
and their families, including the following:
(I) Programs funded by the
temporary assistance for needy families
program under part A of title IV of the
Social Security Act (42 U.S.C. 601 et
seq.), including the State maintenance
of effort provisions of such program.
(II) 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.
(III) Programs funded through the
special supplemental nutrition program
for women, infants, and children under
section 17 of the Child Nutrition Act
of 1966.
(IV) Programs that offer early home
visiting services, including the
maternal, infant, and early childhood
home visiting program (including the
Tribal home visiting program) under
section 511 of the Social Security Act
(42 U.S.C. 711).
(V) 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 under part A of title IV of the
Social Security Act (42 U.S.C. 601 et
seq.), or a State-funded program.
(VI) Programs funded under part C
of the Individuals with Disabilities
Education Act (20 U.S.C. 1431 et seq.).
(D) Availability of funds.--
(i) Funds distributed to eligible
entities.--Funds made available under
subsection (a) that are distributed to an
eligible entity by a State for a fiscal year
may be expended by the eligible entity only in
such fiscal year or the succeeding fiscal year.
(ii) Evaluation.--Funds reserved under
subsection (b)(2) to carry out the evaluation
under subsection (f) shall be available for
expenditure during the 3-year period that
begins on the date of enactment of this Act.
(E) No effect on other programs.--Any assistance or
benefits received by a family through funds made
available under subsection (a) shall be disregarded for
purposes of determining the family's eligibility for,
or amount of, benefits under any other Federal needs-
based programs.
(e) Annual Reports.--A State shall include in the annual report
required under section 2006 of the Social Security Act (42 U.S.C.
1397e) covering each of fiscal years 2022 through 2025, information
detailing how eligible entities, including subgrantees, used funds made
available under subsection (a) to distribute diapers and diapering
supplies and adult incontinence materials and supplies to families in
need. Each such report shall include the following:
(1) The number and age of infants, toddlers, medically
complex children, and low-income adults and adults with
disabilities who received assistance or benefits through such
funds.
(2) The number of families that have received assistance or
benefits through such funds.
(3) The number of diapers, medically necessary diapers, or
adult incontinence materials and supplies (such as adult
diapers, briefs, protective underwear, pull-ons, pull-ups,
liners, shields, guards, pads, undergarments), and the number
of each type of diapering or adult incontinence supply,
distributed through the use of such funds.
(4) The ZIP Code or ZIP Codes where the eligible entity (or
subgrantee) distributed diapers and diapering supplies and
adult incontinence materials and supplies.
(5) The method or methods the eligible entity (or
subgrantee) uses to distribute diapers and diapering supplies
and, adult incontinence materials and supplies.
(6) Such other information as the Secretary may specify.
(f) Evaluation.--The Secretary, in consultation with States, the
national entity described in subsection (c), and eligible entities
receiving funds made available under this section, shall--
(1) not later than 2 years after the date of enactment of
this Act--
(A) complete an evaluation of the effectiveness of
the assistance program carried out pursuant to this
section, such as the effect of activities carried out
under this Act on mitigating the health and
developmental risks of unmet diaper need among infants,
toddlers, medically complex children, and other family
members in low-income families, including the risks of
diaper dermatitis, urinary tract infections, and
parental and child depression and anxiety;
(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;
(2) not later than 3 years after the date of enactment of
this Act, update the evaluation required by paragraph (1)(A);
and
(3) not later than 120 days after completion of the updated
evaluation under paragraph (2)--
(A) submit to the relevant congressional committees
a report describing the results of such updated
evaluation; and
(B) publish the results of such evaluation on the
internet website of the Department of Health and Human
Services.
(g) Guidance.--Not later than 180 days after enactment of this Act,
the Secretary shall issue guidance regarding how the provisions of this
section should be carried out, including information regarding eligible
entities, allowable use of funds, and reporting requirements.
(h) Definitions.--In this section:
(1) Adult incontinence materials and supplies.--The term
``adult incontinence materials and supplies'' means those
supplies that are used to assist adults or adults with
disabilities and includes adult diapers, briefs, protective
underwear, pull-ons, pull-ups, liners, shields, guards, pads,
undergarments, disposable wipes, over-the-counter adult diaper
rash cream products, intermittent catheterization, indwelling
catheters, condom catheters, urinary drainage bags, external
collection devices, wearable urinals, and penile clamps.
(2) Adults with disabilities.--The term ``adults with
disabilities'' means individuals who--
(A) have attained 18 years of age; and
(B) have a disability (as such term is defined,
with respect to an individual, in section 3 of the
Americans with Disabilities Act of 1990 (42 U.S.C.
12102)).
(3) 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.
(4) Diapering supplies.--The term ``diapering supplies''
means items, including diaper wipes and diaper cream, necessary
to ensure that--
(A) an eligible child using a diaper is properly
cleaned and protected from diaper rash; or
(B) a medically complex child who uses a medically
necessary diaper is properly cleaned and protected from
diaper rash.
(5) 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 low-income family.
(6) Eligible entities.--The term ``eligible entity'' means
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 that--
(A) has experience in the area of--
(i) community distributions of basic need
services, including experience collecting,
warehousing, and distributing basic necessities
such as diapers, food, or menstrual products;
(ii) child care;
(iii) child development activities in low-
income communities; or
(iv) motherhood, fatherhood, or parent
education efforts serving low-income parents of
young children;
(B) demonstrates competency to implement a project,
provide fiscal accountability, collect data, and
prepare reports and other necessary documentation; and
(C) demonstrates a willingness to share information
with researchers, practitioners, and other interested
parties.
(7) 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 (42 U.S.C. 9902(2)) applicable to a family of the size
involved.
(8) 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.
(9) Medically complex child.--The term ``medically complex
child'' means an individual who has attained 3 years of age and
for whom a licensed health care provider has provided a
diagnosis of 1 or more significant chronic conditions.
(10) Medically necessary diaper.--The term ``medically
necessary diaper'' means an absorbent garment that is--
(A) washable or disposable;
(B) worn by 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) and needs such garment to
correct or ameliorate such condition; and
(C) 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.
(11) State.--The term ``State'' means the 50 States, the
District of Columbia, the Commonwealth of Puerto Rico the
United States Virgin Islands, Guam, the Commonwealth of the
Northern Mariana Islands, American Samoa, the Republic of the
Marshall Islands, the Federated States of Micronesia, and the
Republic of Palau.
(i) Limitations on Authorization of Appropriations.--To carry out
this section, there is authorized to be appropriated $200,000,000 for
each of fiscal years 2024 through 2027.
(j) Exemption of Program From Sequestration.--
(1) In general.--Section 255(h) of the Balanced Budget and
Emergency Deficit Control Act of 1985 (2 U.S.C. 905(h)) is
amended by inserting after ``Supplemental Security Income
Program (28-0406-0-1-609).'' the following:
``Targeted funding for States for diaper assistance,
including diapering supplies and adult incontinence materials
and supplies.''.
(2) Applicability.--The amendment made by this subsection
shall apply to any sequestration order issued under the
Balanced Budget and Emergency Deficit Control Act of 1985 (2
U.S.C. 900 et seq.) on or after the date of enactment of this
Act.
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 has attained age 3 and for whom a licensed
health care provider has provided a diagnosis of 1 or more
significant chronic conditions.
``(ii) The term `medically necessary diaper' means an
absorbent garment that is--
``(I) washable or disposable;
``(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) if disposable--
``(aa) does not use any latex or common
allergens; and
``(bb) meets or exceeds the quality
standards for diapers commercially available
through retail sale in the following
categories:
``(AA) Absorbency (with acceptable
rates for first and second wetting).
``(BB) Waterproof outer cover.
``(CC) Flexible leg openings.
``(DD) Refastening closures.
``(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 inserting ``, medically necessary diapers, and
diapering supplies'' after ``menstrual care products'' in the
last sentence of subparagraph (A); 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 which is washable or
disposable and which is worn by an individual
who has attained 3 years of age because of
medical necessity, such as someone 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) and needs such garment
to correct or ameliorate such condition, to
serve a preventative medical purpose, or to
correct or ameliorate defects or physical or
mental illnesses or conditions diagnosed by a
licensed health care provider, and, 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:
``(aa) Absorbency (with
acceptable rates for first and
second wetting).
``(bb) Waterproof outer
cover.
``(cc) Flexible leg
openings.
``(dd) Refastening
closures.
``(ii) Diapering supplies.--The term
`diapering supplies' means items, including
diaper wipes and diaper creams, necessary to
ensure that an individual wearing medically
necessary diapers is properly cleaned and
protected from diaper rash.''.
(b) Archer MSAs.--The last sentence of section 220(d)(2)(A) of such
Code is amended by inserting ``, medically necessary diapers (as
defined in section 223(d)(2)(E)), and diapering supplies (as defined in
section 223(d)(2)(E))'' after ``menstrual care products (as defined in
section 223(d)(2)(D))''.
(c) Health Flexible Spending Arrangements and Health Reimbursement
Arrangements.--Section 106(f) of such Code is amended--
(1) by inserting ``, medically necessary diapers (as
defined in section 223(d)(2)(E)), and diapering supplies (as
defined in section 223(d)(2)(E))'' after ``menstrual care
products (as defined in section 223(d)(2)(D))''; and
(2) in the heading, by inserting ``, Medically Necessary
Diapers, and Diapering Supplies'' after ``Menstrual Care
Products''.
(d) Effective Dates.--
(1) Distributions from certain accounts.--The amendments
made by subsections (a) and (b) shall apply to amounts paid
after December 31, 2024.
(2) Reimbursements.--The amendment made by subsection (c)
shall apply to expenses incurred after December 31, 2024.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Work and Welfare.
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