,i #aafth ,,congress #ast ,session ,h4 ,r4 #ahdf ,,in ,,the ,,house ,,of ,,representatives ,march #ba1 #bjai,ms4 ,lee of ,california 7for herself1 ,ms4 ,moore1 ,mr4 ,khanna1 ,ms4 ,omar1 ,mr4 ,hastings1 ,ms4 ,norton1 ,ms4 ,jackson ,lee1 ,mr4 ,mc,nerney1 ,mr4 ,nadler1 ,mr4 ,rush1 ,mr4 ,cohen1 ,mrs4 ,carolyn ,b4 ,maloney of ,new ,york1 ,ms4 ,pressley1 ,mrs4 ,kirkpatrick1 ,mr4 ,grijalva1 ,mr4 ,takano1 ,ms4 ,wild1 ,mr4 ,pocan1 ,ms4 ,ocasio-,cortez1 ,ms4 ,jayapal1 ,ms4 ,mc,collum1 ,ms4 ,schakowsky1 ,mr4 ,peters1 ,ms4 ,sewell of ,alabama1 and ,ms4 ,de,lauro7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 need1 the resultant adverse health effects on children and families1 and the limited child care options available for infants and toddlers who lack sufficient diapers1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,end ,diaper ,need ,act of #bjai4 #b4 ,diaper distribution demonstration project ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#g4 ,diaper distribution demonstration program 7a7 ,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 toddlers4 7b7 ,design of program ,in carrying out the grant program under subsection 7a71 the ,secretary shall-- 7#a7 consult with relevant stakeholders1 including agencies1 professional associations1 and nonprofit organizations1 on the design of the program2 and 7#b7 design the program in such a way that the program-- 7,a7 decreases diaper need in low-income families and meets the unmet diaper needs of infants and toddlers in such families through-- 7i7 the distribution of free diapers and diapering supplies2 7ii7 community outreach to assist in participation in existing diaper distribution programs2 or 7iii7 improving access to diapers and diapering supplies as part of a comprehensive service2 and 7,b7 increases the abilities of communities and low-income families in those communities to provide for the diaper needs of infants and toddlers in those communities4 7c7 ,eligible entities ,to be eligible for a grant under this section1 an entity shall-- 7#a7 be a ,state or local governmental entity1 an ,indian ,tribe or tribal organization 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act71 or a nonprofit organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from taxation under section #eja7;a7 of such ,code2 7#b7 have experience in the area of-- 7,a7 community distributions of basic need services1 including experience collecting1 warehousing1 and distributing basic necessities such as diapers1 food1 or menstrual products2 7,b7 child care2 7,c7 child development activities in low-income communities2 or 7,d7 motherhood1 fatherhood1 or parent-education efforts serving low-income parents of young children2 7#c7 demonstrate competency to implement a project1 provide fiscal accountability1 collect data1 and prepare reports and other necessary documentation2 7#d7 demonstrate a willingness to share information with researchers1 practitioners1 and other interested parties2 and 7#e7 submit to the ,secretary a description of the design of the evaluation to be carried out under subsection 7d77#b7 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 ,states4 7d7 ,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 toddlers1 which use may include any of the following3 7#a7 ,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 #c years of age or younger4 7#b7 ,using not more than #be percent of the funds received by the grantee under this section1 to evaluate the effect of activities under paragraph 7#a7 on mitigating the health and developmental risks of unmet diaper need among infants1 toddlers1 and other family members in low-income families1 including the risks of diaper dermatitis1 urinary tract infections1 and parental and child depression and anxiety4 7#c7 ,to integrate activities under paragraph 7#a7 with other basic needs assistance programs serving eligible children and their families1 including the following3 7,a7 ,programs funded by the ,temporary ,assistance for ,needy ,families program1 including its ,state maintenance of effort provisions4 7,b7 ,programs designed to support the health of eligible children1 such as the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 or ,state-funded health care programs4 7,c7 ,programs funded through the ,special ,supplemental ,nutrition ,program for ,women1 ,infants1 and ,children4 7,d7 ,programs that offer early home visiting services1 including the ,nurse-,family ,partnership and the ,maternal1 ,infant1 and ,early ,childhood ,home ,visiting 7,,miechv7 ,program 7including the ,tribal ,home ,visiting ,program74 7,e7 ,programs to provide improved and affordable access to child care1 including programs funded through the ,child ,care and ,development ,fund1 the ,temporary ,assistance for ,needy ,families program1 or a ,state-funded program4 7e7 ,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 for1 or amount of1 benefits under any other ,federal needs-based programs4 7f7 ,reports ,as a condition of receiving a grant under this section for a fiscal year1 the grantee shall submit to the ,secretary1 not later than #f months after the end of the fiscal year1 a report that specifies1 by month and fiscal year1 the following3 7#a7 ,the number of infants and toddlers and the age of the infant and toddlers who received assistance from the grantee's diaper distribution project4 7#b7 ,the number of families that have received assistance from the grantee's diaper distribution project4 7#c7 ,the number of diapers1 and the number of each type of diapering supply1 distributed under the grantee's diaper distribution project4 7#d7 ,the ,,zip ,code or ,,zip ,codes where the grantee distributed diapers and diaper supplies4 7#e7 ,the method or methods the grantee uses to distribute diapers and diapering supplies4 7#f7 ,such other information as the ,secretary may specify4 7g7 ,evaluation ,the ,secretary1 in consultation with each grantee under this section1 shall-- 7#a7 not later than #b years after the date of enactment of the ,end ,diaper ,need ,act of #bjai-- 7,a7 complete an evaluation of the effectiveness of the program carried out pursuant to this section2 7,b7 submit to the relevant congressional committees a report on the results of such evaluation2 and 7,c7 publish the results of the evaluation on the internet website of the ,department of ,health and ,human ,services2 and 7#b7 7,a7 not later than #c years after the date of enactment of the ,end ,diaper ,need ,act of #bjai1 update the evaluation required by paragraph 7#a77;,a72 and 7,b7 not later than #ij days after completion of the updated evaluation under subparagraph 7,a7-- 7i7 submit to the relevant congressional committees a report describing the results of such updated evaluation2 and 7ii7 publish the results of such evaluation on the internet website of the ,department of ,health and ,human ,services4 7h7 ,definitions ,in this section3 7#a7 ,diaper ,the term diaper means an absorbent garment that-- 7,a7 is washable or disposable that may be worn by an infant or toddler who is not toilet-trained2 and 7,b7 if disposable-- 7i7 does not use any latex or common allergens2 and 7ii7 meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories3 7,i7 ,absorbency 7with acceptable rates for first and second wetting74 7,,ii7 ,waterproof outer cover4 7,,iii7 ,flexible leg openings4 7,,iv7 ,refastening closures4 7#b7 ,diapering supplies ,the term diapering supplies means items1 including diaper wipes and diaper cream1 necessary to ensure that a child using a diaper is properly cleaned and protected from diaper rash4 7#c7 ,eligible child ,the term eligible child means a child who-- 7,a7 has not attained #d years of age2 and 7,b7 is a member of a family whose self-certified income is not more than #bjj percent of the ,federal poverty line4 7#d7 ,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 #fgc7b7 of the ,omnibus ,budget ,reconciliation ,act of #aiha applicable to a family of the size involved4 7#e7 ,low-income ,the term low-income1 with respect to a family1 means a family whose self-certified income is not more than #bjj percent of the ,federal poverty line4 7i7 ,authorization of appropriations 7#a7 ,in general ,to carry out this section1 there is authorized to be appropriated #ajj1jjj1jjj for each of fiscal years #bjbj through #bjbc4 7#b7 ,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 year4 4 #c4 ,improving access to diapers for medically complex children ,section #aiae7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7c77 is amended by adding at the end the following new paragraph3 7#aa7 7,a7 ,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 incontinence1 a bowel or bladder condition that causes excess urine or stool 7such as short gut syndrome or diabetes insipidus71 or a severe skin condition that causes skin erosions 7such as epidermolysis bullosa71 such medical assistance shall include1 for the duration of the waiver1 the provision of #bjj medically necessary diapers per month and diapering supplies4 ,such medical assistance may include the provision of medically necessary diapers in amounts greater than #bjj if a licensed health care provider 7such as a physician1 nurse practitioner1 or physician assistant7 specifies that such greater amounts are necessary for such medically complex child4 7,b7 ,for purposes of this paragraph-- 7i7 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 conditions2 7ii7 the term medically necessary diaper means an absorbent garment that is-- 7,i7 washable or disposable2 and 7,,ii7 worn by a medically complex child who has been diagnosed with a condition described in subparagraph 7,a7 and needs such garment to correct or ameliorate such condition2 and 7iii7 the term diapering supplies means items1 including diaper wipes and diaper creams1 necessary to ensure that a medically complex child who has been diagnosed with a condition described in subparagraph 7,a7 and uses a medically necessary diaper is properly cleaned and protected from diaper rash4 4 #d4 ,inclusion of diapers and diapering supplies as qualified medical expenses 7a7 ,health savings accounts ,section #bbc7;d77#b7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 by adding at the end of subparagraph 7,a7 the following3 ,for purposes of this subparagraph1 amounts paid for medically necessary diapers and diapering supplies shall be treated as paid for medical care42 and 7#b7 by adding at the end the following new subparagraph3 7,d7 ,medically necessary diapers and diapering supplies ,for purposes of this paragraph-- 7i7 ,medically necessary diapers ,the term medically necessary diaper means an absorbent garment that is washable or disposable worn by an individual who has attained #c years of age and needs diapers because they are medically necessary1 serve a preventative medical purpose1 or are needed to correct or ameliorate defects or physical or mental illnesses or conditions which are diagnosed by a licenced health care provider4 7ii7 ,diapering supplies ,the term diapering supplies means items1 including diaper wipes and diaper creams necessary to ensure that a child using a medically necessary diaper is properly cleaned and protected from diaper rash4 4 7b7 ,archer ,m,s,as ,section #bbj7;d77#b77;,a7 of such ,code is amended by adding at the end the following3 ,for purposes of this subparagraph1 amounts paid for medically necessary diapers and diapering supplies 7as defined in section #bbc7;d77#b77;,d77 shall be treated as paid for medical care44 7c7 ,health flexible spending arrangements and health reimbursement arrangements ,section #ajf of such ,code is amended by adding at the end the following new subsection3 7f7 ,reimbursements for medically necessary diapers and diapering supplies ,for purposes of this section and section #aje1 expenses incurred for medically necessary diapers and diapering supplies 7as defined in section #bbc7;d77#b77;,d77 shall be treated as incurred for medical care4 4 7d7 ,effective dates 7#a7 ,distributions from health savings accounts ,the amendments made by subsections 7a7 and 7b7 shall apply to amounts paid after ,december #ca1 #bjbj4 7#b7 ,reimbursements ,the amendment made by subsection 7c7 shall apply to expenses incurred after ,december #ca1 #bjbj4