,,ii #aaith ,,congress #ast ,session ,s4 #ahae ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bj1 #bjbe ,ms4 ,duckworth 7for herself1 ,mr4 ,cramer1 and ,mr4 ,kelly7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to provide targeted funding for ,states and other eligible entities through the ,social ,services ,block ,grant program to address the increased burden that maintaining the health and hygiene of infants and toddlers1 medically complex children1 and low-income adults or adults with disabilities who rely on adult incontinence materials and supplies place 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 diapers and diapering supplies1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,end ,diaper ,need ,act of #bjbe4 #b4 ,targeted funding for diaper assistance 7including diapering supplies and adult incontinence materials and supplies7 through the ,social ,services ,block ,grant ,program 7a7 ,increase in funding for ,social ,services ,block ,grant ,program 7#a7 ,in general ,the amount specified in subsection 7c7 of section #bjjc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;b7 for purposes of subsections 7a7 and 7b7 of such section is deemed to be #a1ijj1jjj1jjj for each of fiscal years #bjbf through #bjbi4 ,each ,state shall use the increase in funding the ,state receives as a result of this section in accordance with subsection 7b7 of this section4 7#b7 ,appropriation 7,a7 ,in general ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there is appropriated #bjj1jjj1jjj for each of fiscal years #bjbf through #bjbi1 to carry out this section4 7,b7 ,reservations 7i7 ,purposes ,the ,secretary shall reserve1 from the amount appropriated under subparagraph 7,a7 to carry out this section-- 7,i7 for each of fiscal years #bjbf through #bjbi1 not more than #b percent of the amount appropriated for the fiscal year for purposes of entering into an agreement with a national entity described in subparagraph 7,c7 to assist in providing technical assistance and training1 to support effective policy1 practice1 research1 and cross-system collaboration among grantees and subgrantees1 and to assist in the administration of the program described in this section2 and 7,,ii7 for fiscal year #bjbf1 an amount1 not to exceed #c1jjj1jjj1 for purposes of conducting an evaluation under subsection 7d74 7ii7 ,no ,state entitlement to reserved funds ,the ,state entitlement under section #bjjb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;a7a77 shall not apply to the amounts reserved under clause 7i74 7,c7 ,national entity described ,a national entity described in this subparagraph is 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 ,code1 that-- 7i7 has experience in more than #a ,state in the area of-- 7,i7 community distributions of basic need services1 including experience collecting1 warehousing1 and distributing basic necessities such as diapers1 food1 or menstrual products2 7,,ii7 child care2 7,,iii7 child development activities in low-income communities2 or 7,,iv7 motherhood1 fatherhood1 or parent education efforts serving low-income parents of young children2 7ii7 demonstrates competency to implement a project1 provide fiscal accountability1 collect data1 and prepare reports and other necessary documentation2 and 7iii7 demonstrates a willingness to share information with researchers1 practitioners1 and other interested parties4 7b7 ,rules governing use of additional funds 7#a7 ,in general ,funds are used in accordance with this subsection if-- 7,a7 the ,state1 in consultation with relevant stakeholders1 including agencies1 professional associations1 and nonprofit organizations1 distributes the funds to eligible entities to-- 7i7 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 toddlers1 medically complex children1 and low-income adults and adults with disabilities in such families through-- 7,i7 the distribution of free diapers and diapering supplies1 medically necessary diapers1 and adult incontinence materials and supplies2 and 7,,ii7 improving access to diapers and diapering supplies1 medically necessary diapers1 and adult incontinence materials and supplies2 7ii7 carry out community outreach to assist in participation in diaper distribution programs or programs that distribute medically necessary diapers or adult incontinence materials and supplies2 and 7iii7 increase the ability of communities and low-income families in such communities to provide for the need for diapers and diapering supplies1 medically necessary diapers1 and adult continence materials and supplies1 of infants and toddlers1 medically complex children1 and low-income adults and adults with disabilities2 7,b7 the funds are used subject to the limitations in section #bjje of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;d72 and 7,c7 the funds are used to supplement1 not supplant1 ,state general revenue funds provided for the purposes described in subparagraph 7,a74 7#b7 ,administrative costs ,a ,state receiving funds made available under subsection 7a7 may use not more than #e percent of the funds for ,state administrative costs1 which may include costs of contracting1 monitoring1 and reporting4 7#c7 ,allowable uses by eligible entities ,an eligible entity receiving funds made available under subsection 7a7 shall use the funds for any of the following3 7,a7 ,to pay for the purchase and distribution of diapers and diapering supplies1 medically necessary diapers1 and funding diaper 7including medically necessary diapers7 distribution that serves low-income families with-- 7i7 #a or more children #c years of age or younger2 or 7ii7 #a or more medically complex children4 7,b7 ,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 #a or more low-income adults1 adults with disabilities1 or children with a disability who have attained #c years of age and have not attained #ai years of age1 who rely on adult incontinence materials and supplies4 7,c7 ,to integrate activities carried out under subparagraph 7,a7 with other basic needs assistance programs serving eligible children and their families1 including the following3 7i7 ,programs funded by the temporary assistance for needy families program under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 including the ,state maintenance of effort provisions of such program4 7ii7 ,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 7iii7 ,programs funded through the special supplemental nutrition program for women1 infants1 and children under section #ag of the ,child ,nutrition ,act of #aiff4 7iv7 ,programs that offer early home visiting services1 including the maternal1 infant1 and early childhood home visiting program 7including the ,tribal home visiting program7 under section #eaa of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa74 7v7 ,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 program under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 or a ,state-funded program4 7vi7 ,programs funded under part ,c of the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adca et seq474 7#d7 ,availability of funds 7,a7 ,funds distributed to eligible entities ,funds made available under subsection 7a7 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 year4 7,b7 ,evaluation ,funds reserved under subsection 7a77#b77;,b77i77,,ii7 to carry out the evaluation under subsection 7d7 shall be available for expenditure during the #c-year period that begins on the date of enactment of this ,act4 7#e7 ,no effect on other programs ,any assistance or benefits received by a family through funds made available under subsection 7a7 shall be disregarded for purposes of determining the family's eligibility for1 or amount of1 benefits under any other ,federal needs-based programs4 7c7 ,annual reports ,a ,state shall include in the annual report required under section #bjjf of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;e7 covering each of fiscal years #bjbf through #bjbi1 information detailing how eligible entities1 including subgrantees1 used funds made available under subsection 7a7 to distribute diapers and diapering supplies and adult incontinence materials and supplies to families in need4 ,each such report shall include the following3 7#a7 ,the number and age of infants1 toddlers1 medically complex children1 and low-income adults and adults with disabilities who received assistance or benefits through such funds4 7#b7 ,the number of families that have received assistance or benefits through such funds4 7#c7 ,the number of diapers1 medically necessary diapers1 or adult incontinence materials and supplies 7such as adult diapers1 briefs1 protective underwear1 pull-ons1 pull-ups1 liners1 shields1 guards1 pads1 undergarments71 and the number of each type of diapering or adult incontinence supply1 distributed through the use of such funds4 7#d7 ,the ,,zip ,code or ,,zip ,codes where the eligible entity 7or subgrantee7 distributed diapers and diapering supplies and adult incontinence materials and supplies4 7#e7 ,the method or methods the eligible entity 7or subgrantee7 uses to distribute diapers and diapering supplies and1 adult incontinence materials and supplies4 7#f7 ,such other information as the ,secretary may specify4 7d7 ,evaluation ,the ,secretary1 in consultation with ,states1 the national entity described in subsection 7a77#b77;,c71 and eligible entities receiving funds made available under this section1 shall-- 7#a7 not later than #b years after the date of enactment of this ,act-- 7,a7 complete an evaluation of the effectiveness of the assistance program carried out pursuant to this section1 such as the effect of activities carried out under this ,act on mitigating the health and developmental risks of unmet diaper need among infants1 toddlers1 medically complex children1 and other family members in low-income families1 including the risks of diaper dermatitis1 urinary tract infections1 and parental and child depression and anxiety2 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 7#b7 not later than #c years after the date of enactment of this ,act1 update the evaluation required by paragraph 7#a77;,a72 and 7#c7 not later than #abj days after completion of the updated evaluation under paragraph 7#b7-- 7,a7 submit to the relevant congressional committees a report describing the results of such updated evaluation2 and 7,b7 publish the results of such evaluation on the internet website of the ,department of ,health and ,human ,services4 7e7 ,guidance ,not later than #ahj days after enactment of this ,act1 the ,secretary shall issue guidance regarding how the provisions of this section should be carried out1 including information regarding eligible entities1 allowable use of funds1 and reporting requirements4 7f7 ,definitions ,in this section3 7#a7 ,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 diapers1 briefs1 protective underwear1 pull-ons1 pull-ups1 liners1 shields1 guards1 pads1 undergarments1 disposable wipes1 over-the-counter adult diaper rash cream products1 intermittent catheterization1 indwelling catheters1 condom catheters1 urinary drainage bags1 external collection devices1 wearable urinals1 and penile clamps4 7#b7 ,adults with disabilities ,the term adults with disabilities means individuals who-- 7,a7 have attained #ah years of age2 and 7,b7 have a disability 7as such term is defined1 with respect to an individual1 in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb774 7#c7 ,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#d7 ,diaper bank - ,the term diaper bank means a nonprofit organization that-- 7,a7 is 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 is established and operating primarily for the purpose of collecting or purchasing diapers and diapering supplies2 and 7,c7 distributes diapers and diapering supplies either directly or through partnerships for eventual distribution to individuals free of charge4 7#e7 ,diapering supplies ,the term diapering supplies means items1 including diaper wipes and diaper cream1 necessary to ensure that-- 7,a7 an eligible child using a diaper is properly cleaned and protected from diaper rash2 or 7,b7 a medically complex child who uses a medically necessary diaper is properly cleaned and protected from diaper rash4 7#f7 ,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 low-income family4 7#g7 ,eligible entities ,the term eligible entity means 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 diaper bank or other 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 ,code that-- 7,a7 has at least #a year of demonstrated experience in the area of-- 7i7 community distributions of diapers and diapering supplies and other basic need services1 such as food or menstrual products2 7ii7 child care2 7iii7 child development activities in low-income communities2 or 7iv7 motherhood1 fatherhood1 or parent education efforts serving low-income parents of young children2 7,b7 demonstrates competency to implement a project1 provide fiscal accountability1 collect data1 and prepare reports and other necessary documentation2 and 7,c7 demonstrates a willingness to share information with researchers1 practitioners1 and other interested parties4 7#h7 ,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 7#db ,u4,s4,c4 #iijb7b77 applicable to a family of the size involved4 7#i7 ,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 7#aj7 ,medically complex child ,the term medically complex child means an individual who has attained #c years of age and for whom a licensed health care provider has provided a diagnosis of #a or more significant chronic conditions4 7#aa7 ,medically necessary diaper ,the term medically necessary diaper means an absorbent garment that is-- 7,a7 washable or disposable2 7,b7 worn by 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 bullosa7 and needs such garment to correct or ameliorate such condition2 and 7,c7 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#ab7 ,state ,the term ,state means the #ej ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 ,american ,samoa1 the ,republic of the ,marshall ,islands1 the ,federated ,states of ,micronesia1 and the ,republic of ,palau4 7g7 ,exemption of program from sequestration 7#a7 ,in general ,section #bee7;h7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe 7#b ,u4,s4,c4 #ije7;h77 is amended by inserting after ,supplemental ,security ,income ,program 7#bh-jdjf-j-a-fji74 the following3 ,targeted funding for ,states for diaper assistance 7including diapering supplies and adult incontinence materials and supplies7 through the ,social ,services ,block ,grant ,program4 4 7#b7 ,applicability ,the amendment made by this subsection shall apply to any sequestration order issued under the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe 7#b ,u4,s4,c4 #ijj et seq47 on or after the date of enactment of this ,act4 #c4 ,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 inserting 1 medically necessary diapers1 and diapering supplies after menstrual care products in the last sentence of subparagraph 7,a72 and 7#b7 by adding at the end the following new subparagraph3 7,e7 ,medically necessary diapers and diapering supplies ,for purposes of this paragraph-- 7i7 ,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 #c years of age because of medical necessity1 such as someone 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 bullosa7 and needs such garment to correct or ameliorate such condition1 to serve a preventative medical purpose1 or to correct or ameliorate defects or physical or mental illnesses or conditions diagnosed by a licensed health care provider1 and1 if disposable-- 7,i7 does not use any latex or common allergens2 and 7,,ii7 meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories3 7aa7 ,absorbency 7with acceptable rates for first and second wetting74 7bb7 ,waterproof outer cover4 7cc7 ,flexible leg openings4 7dd7 ,refastening closures4 7ii7 ,diapering supplies ,the term diapering supplies means items1 including diaper wipes and diaper creams1 necessary to ensure that an individual wearing medically necessary diapers is properly cleaned and protected from diaper rash4 4 7b7 ,archer ,m,s,as ,the last sentence of section #bbj7;d77#b77;,a7 of such ,code is amended by inserting 1 medically necessary diapers 7as defined in section #bbc7;d77#b77;,e771 and diapering supplies 7as defined in section #bbc7;d77#b77;,e77 after menstrual care products 7as defined in section #bbc7;d77#b77;,d774 7c7 ,health flexible spending arrangements and health reimbursement arrangements ,section #ajf7;f7 of such ,code is amended-- 7#a7 by inserting 1 medically necessary diapers 7as defined in section #bbc7;d77#b77;,e771 and diapering supplies 7as defined in section #bbc7;d77#b77;,e77 after menstrual care products 7as defined in section #bbc7;d77#b77;,d772 and 7#b7 in the heading1 by inserting 1 medically necessary diapers1 and diapering supplies after menstrual care products4 7d7 ,effective dates 7#a7 ,distributions from certain accounts ,the amendments made by subsections 7a7 and 7b7 shall apply to amounts paid after ,december #ca1 #bjbe4 7#b7 ,reimbursements ,the amendment made by subsection 7c7 shall apply to expenses incurred after ,december #ca1 #bjbe4