[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1404 Introduced in Senate (IS)]

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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 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 2019''.

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 in conducting demonstration projects that implement 
and evaluate strategies to help low-income families 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 ability of communities and low-
                income families in such communities to provide for the 
                diaper needs of infants and toddlers.
    ``(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 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 may include any of the 
following:
            ``(1) Paying for the purchase of diapers and diapering 
        supplies and funding 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, evaluating 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) Integrating 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 under part A of title IV of 
                the Social Security Act, including the State 
                maintenance of effort provisions of such program.
                    ``(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 under section 17 of the Child Nutrition Act of 
                1966.
                    ``(D) Programs that offer early home visiting 
                services, including the nurse-family partnership 
                programs and the Maternal, infant, and early childhood 
                home visiting program (including the Tribal home 
                visiting program) under section 511 of the Social 
                Security Act.
                    ``(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 under part A of 
                title IV of the Social Security Act, 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 
        infants 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 2019--
                    ``(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 2019, 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 low-income family.
            ``(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 2020 through 2023.
            ``(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:
                    ``(D) 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, 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.
                            ``(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.--Section 220(d)(2)(A) of the Internal Revenue Code 
of 1986 is amended by adding at the end the following: ``For purposes 
of this subparagraph, amounts paid for medically necessary diapers and 
diapering supplies (as such terms are 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 the Internal Revenue Code of 1986 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 
such terms are defined in section 223(d)(2)(D)) shall be treated as 
incurred for medical care.''.
    (d) Effective Dates.--
            (1) Distributions from certain accounts.--The amendments 
        made by subsections (a) and (b) shall apply to amounts paid 
        after December 31, 2020.
            (2) Reimbursements.--The amendment made by subsection (c) 
        shall apply to expenses incurred after December 31, 2020.
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