Health Enterprise Zones Act of 2021
This bill provides for the designation of Health Enterprise Zones in certain geographic areas with documented and measurable health disparities. This designation, which expires 10 fiscal years after the bill's enactment, confers eligibility for certain grants, student loan repayment programs, and tax credits for those working to reduce health disparities and improve health outcomes in these zones.
Specifically, community-based nonprofits or local government agencies, in coalition with health care providers, social service organizations, and others, may apply to the Department of Health and Human Services (HHS) for the designation. The application must include a plan to reduce health disparities and achieve other outcomes.
In implementing the program, HHS must consult with, among others, the Department of Housing and Urban Development. When approving applications, HHS shall consider factors including geographic diversity and the commitment of supporting funds from the private sector. HHS (1) may award grants to organizations or agencies that applied for the designation to support activities aligned with their plans, and (2) must carry out a student loan repayment program for health care providers who agree to provide services in a Health Enterprise Zone.
In addition, the bill establishes tax credits for employers that hire, and individuals who work as, Health Enterprise Zone workers.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4510 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 4510
To provide for the designation of areas as Health Enterprise Zones to
reduce health disparities and improve health outcomes in such areas,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 19, 2021
Mr. Brown (for himself, Mr. Hoyer, Ms. Blunt Rochester, Mr. Cardenas,
Ms. Kelly of Illinois, Ms. Kuster, and Ms. Sewell) 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 provide for the designation of areas as Health Enterprise Zones to
reduce health disparities and improve health outcomes in such areas,
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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health Enterprise
Zones Act of 2021''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Designation of Health Enterprise Zones.
Sec. 3. Consultation.
Sec. 4. Tax incentives.
Sec. 5. Grants.
Sec. 6. Student loan repayment program.
Sec. 7. 10-percent increase of payment for items and services payable
under Medicare Part B furnished in Health
Enterprise Zones.
Sec. 8. Reporting.
Sec. 9. Definitions.
Sec. 10. Authorization of appropriations.
SEC. 2. DESIGNATION OF HEALTH ENTERPRISE ZONES.
(a) Designation.--
(1) In general.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall, pursuant to
applications submitted under subsection (c), designate areas as
Health Enterprise Zones to reduce health disparities and
improve health outcomes in such areas.
(2) Eligibility of area.--To be designated as a Health
Enterprise Zone under this section, an area must--
(A) be a contiguous geographic area in one census
tract or ZIP Code;
(B) have measurable and documented racial, ethnic,
or geographic health disparities and poor health
outcomes, demonstrated by--
(i) average income below 150 percent of the
Federal poverty line;
(ii) a rate of participation in the special
supplemental nutrition program under section 17
of the Child Nutrition Act of 1966 (42 U.S.C.
1786) that is higher than the national average
rate of participation in such program; and
(iii) lower life expectancy than the
national average;
(iv) a higher percentage of instances of
low birth weight than the national average; or
(v) designation under section 332 of the
Public Health Service Act (42 U.S.C. 254e) as a
health professional shortage area; and
(C) are part of a Metropolitan Statistical Area or
Micropolitan Statistical Area identified by the Office
of Management and Budget.
(b) Solicitation of Applications.--The Secretary shall--
(1) not later than 12 months after the date of enactment of
this Act, solicit applications under subsection (c); and
(2) publish on the website of the Department of Health and
Human Services--
(A) the names of all applicants, together with the
names of each applicant's coalition partners; and
(B) a description of all areas proposed to be
designated as Health Enterprise Zones.
(c) Submission of Applications.--To seek the designation of an area
as a Health Enterprise Zone, a community-based nonprofit organization
or local governmental agency, in coalition with an array of health care
providers, hospitals, nonprofit community health clinics, health
centers, social service organizations, and other related organizations
shall submit an application to the Secretary.
(d) Contents.--An application under subsection (c) shall--
(1) include an effective and sustainable plan with respect
to the area proposed for designation--
(A) to reduce health disparities;
(B) to reduce the costs of, or to produce savings
to, the health care system;
(C) to improve health outcomes; and
(D) to utilize one or more of the incentives
established pursuant to sections 4, 5, 6, and 7 to
address health care provider capacity, improve health
services delivery, effectuate community improvements,
or conduct outreach and education efforts; and
(2) identify specific diseases or indicators of health for
improvement of health outcomes in such area, including at least
one of the following: cardiovascular disease, asthma, diabetes,
dental health, behavioral health, maternal and birth health,
sexually transmitted infections, and obesity.
(e) Considerations.--The Secretary--
(1) shall consider geographic diversity, among other
factors, in selecting areas for designation as Health
Enterprise Zones; and
(2) may conduct outreach efforts to encourage a
geographically diverse pool of applicants, including for
designating Health Enterprise Zones in rural areas.
(f) Priority.--In selecting areas for designation as Health
Enterprise Zones, the Secretary shall give higher priority to
applications based on the extent to which they demonstrate the
following:
(1) Support from, and participation of, key stakeholders in
the public and private sectors in the area proposed for
designation, including residents and local governments of such
area.
(2) A plan for long-term funding and sustainability.
(3) Supporting funds from the private sector.
(4) Integration with any applicable State health
improvement process or plan.
(5) A plan for evaluation of the impact of designation of
such area as a Health Enterprise Zone.
(6) A plan to utilize existing State tax credits, grants,
or other incentives to reduce health disparities and improve
health outcomes in the proposed Health Enterprise Zone.
(7) Such other factors as the Secretary determines are
appropriate to demonstrate a commitment to reduce health
disparities and improve health outcomes in such area.
(g) Period of Designation.--The designation under this section of
any area as a Health Enterprise Zone shall expire at the end of the
period of 10 fiscal years following the enactment of this Act.
SEC. 3. CONSULTATION.
The Secretary shall carry out this Act in consultation with--
(1) the Secretary of Housing and Urban Development; and
(2) the Deputy Assistant Secretary for Minority Health.
SEC. 4. TAX INCENTIVES.
(a) Work Opportunity Credit for Hiring Health Enterprise Zone
Workers.--
(1) In general.--Section 51(d)(1) of the Internal Revenue
Code of 1986 is amended by striking ``or'' at the end of
subparagraph (I), by striking the period at the end of
subparagraph (J) and inserting ``, or'', and by adding at the
end the following new subparagraph:
``(K) a qualified Health Enterprise Zone worker, to
the extent that the qualified first-year wages with
respect to such worker are paid for qualified Health
Enterprise Zone work.''.
(2) Qualified health enterprise zone worker.--Section 51(d)
of such Code is amended by adding at the end the following new
paragraphs:
``(16) Qualified health enterprise zone worker.--The term
`qualified Health Enterprise Zone worker' means any individual
who is certified by the designated local agency as having (as
of the hiring date) a principal place of employment within a
Health Enterprise Zone (as such term is defined in section 9 of
the Health Enterprise Zones Act of 2021).
``(17) Qualified health enterprise zone work.--The term
`qualified Health Enterprise Zone work' means employment by a
Health Enterprise Zone practitioner (as such term is defined in
section 9 of the Health Enterprise Zones Act of 2021), the
primary official duties of which promote access to healthcare
in a Health Enterprise Zone (as such term is defined in section
9 of the Health Enterprise Zones Act of 2021).''.
(3) Effective date.--The amendments made by this section
shall apply to amounts paid or incurred after the date of the
enactment of this Act to individuals who begin work for the
employer after such date.
(b) Credit for Health Enterprise Zone Workers.--
(1) In general.--Subpart A of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 is amended by
inserting after section 25D the following new section:
``SEC. 25E. CREDIT FOR QUALIFIED HEALTH ENTERPRISE ZONE WORKERS.
``(a) Allowance of Credit.--In the case of a qualified Health
Enterprise Zone worker, there shall be allowed as a credit against the
tax imposed by this chapter for a taxable year an amount equal to 40%
of wages received for qualified Health Enterprise Zone work.
``(b) Definitions.--For purposes of this section--
``(1) The term `qualified Health Enterprise Zone worker'
means, with respect to wages, an individual whose principal
place of employment while earning such wages is within a Health
Enterprise Zone (as such term is defined in section 9 of the
Health Enterprise Zones Act of 2021).
``(2) The term `qualified Health Enterprise Zone work' has
the meaning given such term in section 51.''.
(2) Clerical amendment.--The table of sections for subpart
A of part IV of subchapter A of chapter 1 of such Code is
amended by inserting after the item relating to section 25D the
following new item:
``Sec. 25E. Credit for qualified Health Enterprise Zone workers.''.
(3) Effective date.--The amendments made by this section
shall apply to amounts paid or incurred after the date of the
enactment of this Act.
SEC. 5. GRANTS.
(a) Authorization.--For each area designated under section 2 as a
Health Enterprise Zone, the Secretary may award a grant to the
community-based nonprofit organization or local governmental agency
that applied for such designation to support such applicant and its
coalition partners in reducing health disparities and improving health
outcomes in such area.
(b) Use of Funds.--Programs and activities funded through a grant
under this section shall be consistent with the grantee's plan
submitted pursuant to section 2(d)(1) and may include the following:
(1) Subgrants to health care practitioners.--
(A) In general.--For the purpose of improving or
expanding the delivery of health care in the respective
Health Enterprise Zone, the grantee may award subgrants
to Health Enterprise Zone practitioners to defray costs
related to innovative strategies listed in paragraph
(2).
(B) Eligibility.--To be eligible to receive a
subgrant pursuant to subparagraph (A), a Health
Enterprise Zone practitioner shall--
(i) own or lease a health care facility in
the Health Enterprise Zone; or
(ii) provide health care in such a
facility.
(C) Amount.--The amount of a subgrant under
subparagraph (A) may not exceed the lesser of--
(i) $5,000,000; or
(ii) 50 percent of the costs of the
equipment, or capital or leasehold
improvements, to be defrayed using the subgrant
to implement innovative strategies listed in
paragraph (2).
(2) Innovative strategies.--A grantee (or subgrantee) may
use a grant received under this section (or a subgrant received
under paragraph (1)) to implement innovative public health
strategies in the respective Health Enterprise Zone, which
strategies may include--
(A) internships and volunteer opportunities for
students who reside in the Health Enterprise Zone;
(B) funding resources to improve health care
provider capacity to serve non-English speakers;
(C) operation of medical, mental and behavioral
health, and dental mobile clinics;
(D) provision of transportation to and from medical
appointments for patients;
(E) funding resources to improve access to healthy
food, recreation, and high-quality housing;
(F) capital or leasehold improvements to a health
care facility in the respective Health Enterprise Zone;
and
(G) medical or dental equipment to be used in such
a facility.
SEC. 6. STUDENT LOAN REPAYMENT PROGRAM.
(a) In General.--The Secretary shall carry out a loan repayment
program under which the Secretary enters into agreements with eligible
Health Enterprise Zone practitioners to make payments on the principal
and interest of the eligible educational loans of such practitioners
for each year such practitioners agree to provide health care services
in a Health Enterprise Zone.
(b) Limitations.--In entering into loan repayment agreements under
this section, the Secretary may not agree to--
(1) make payments for more than 10 years with respect to a
practitioner; or
(2) pay more than $10,000 per year, or more than a total of
$100,000, with respect to a practitioner.
(c) Ineligibility for Double Benefits.--No borrower may, for the
same service, receive a reduction of loan obligations or a loan
repayment under both--
(1) this section; and
(2) any federally supported loan forgiveness program,
including under section 338B, 338I, or 846 of this Act, or
section 428J, 428L, 455(m), or 460 of the Higher Education Act
of 1965.
(d) Definitions.--In this section:
(1) The term ``eligible educational loan'' means any
federally funded or guaranteed student loan as determined
appropriate by the Secretary in coordination with the Secretary
of Education.
(2) The term ``eligible Health Enterprise Zone
practitioner'' means a Health Enterprise Zone practitioner who
agrees--
(A) to provide health care services in a Health
Enterprise Zone for a specified period that is not less
than one year; and
(B) has one or more eligible educational loans.
SEC. 7. 10-PERCENT INCREASE OF PAYMENT FOR ITEMS AND SERVICES PAYABLE
UNDER MEDICARE PART B FURNISHED IN HEALTH ENTERPRISE
ZONES.
Section 1833(a) of the Social Security Act (42 U.S.C.1395l(a)) is
amended by inserting before the period at the end the following: ``.
With respect to items and services payable under this part that are
furnished in a Health Enterprise Zone (as defined in section 9 of the
Health Enterprise Zones Act of 2021) during the period beginning on the
first day an area is designated a Health Enterprise Zone under section
2(a)(1) of such Act and ending on the last day of the fiscal year that
is 10 fiscal years following the enactment of this Act, the payment
rates otherwise established for such items and services shall be
increased by 10 percent. The cost-sharing requirements (if any)
applicable to an item or service described in the preceding sentence
furnished to an individual shall be calculated as if such preceding
sentence did not apply''.
SEC. 8. REPORTING.
(a) In General.--Not later than the end of each fiscal year in the
period of 10 fiscal years following the date of enactment of this Act,
the Secretary shall submit to the Congress a report on the
implementation of this Act and the results thereof.
(b) Contents.--Each report under subsection (a) shall--
(1) specify the number and types of incentives provided
pursuant to this Act in each Health Enterprise Zone designated
under section 2;
(2) include evidence of the extent to which the incentives
utilized by each Health Enterprise Zone have succeeded--
(A) in attracting health care practitioners to
practice in Health Enterprise Zones;
(B) in reducing health disparities and improving
health outcomes in Health Enterprise Zones; and
(C) in reducing health costs and hospital
admissions and readmissions in Health Enterprise Zones.
SEC. 9. DEFINITIONS.
In this Act:
(1) The term ``Health Enterprise Zone'' means an area
designated under section 2 as a Health Enterprise Zone.
(2) The term ``Health Enterprise Zone practitioner'' means
a health care practitioner who--
(A) is licensed or certified in accordance with
applicable State law to treat patients in the
respective Health Enterprise Zone;
(B) provides--
(i) primary care, which may include
obstetrics, gynecological services, pediatric
services, or geriatric services;
(ii) behavioral health services, which may
include mental health or substance use disorder
services; or
(iii) dental services; and
(C) is a participating provider of services or
supplier under the Medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.) or
a participating provider under a State plan under title
XIX of such Act (42 U.S.C. 1396 et seq.).
(3) The term ``Secretary'' means the Secretary of Health
and Human Services.
SEC. 10. AUTHORIZATION OF APPROPRIATIONS.
To carry out this Act, there is authorized to be appropriated such
sums as may be necessary for the period of 10 fiscal years following
the date of enactment of this Act.
<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.
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