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[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.
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