,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #gaeh  ,,in ,,the ,,house ,,of  
,,representatives  ,june #aa1 #bjbj,mr4 
,brown of ,maryland 7for himself1 ,mr4  
,hoyer1 ,ms4 ,sewell of ,alabama1 ,ms4  
,kuster of ,new ,hampshire1 and ,ms4    
,blunt ,rochester7 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 provide for the          
designation of areas as ,health         
,enterprise ,zones to reduce health     
disparities and improve health outcomes 
in such areas1 and for other purposes4  
#a4 ,short title2 table of contents  7a7
 ,short title ,this ,act may be cited as
 the ,health ,enterprise ,zones ,act of 
#bjbj4  7b7 ,table of contents ,this    
table of contents of this ,act is as    

follows3 ,sec4 #a4 ,short title2 table  
of contents4,sec4 #b4 ,designation of   
,health ,enterprise ,zones4,sec4 #c4    
,consultation4,sec4 #d4 ,tax            
incentives4,sec4 #e4 ,grants4,sec4 #f4  
,student loan repayment program4,sec4   
#g4 ,ten percent increase of payment for
 items and services payable under       
,medicare ,part ,b furnished in ,health 
,enterprise ,zones4,sec4 #h4            
,reporting4,sec4 #i4 ,definitions4,sec4 
#aj4 ,authorization of appropriations4  
#b4 ,designation of ,health ,enterprise 
,zones  7a7 ,designation  7#a7 ,in      
general ,not later than #ah months after
 the date of enactment of this ,act1 the
 ,secretary shall1 pursuant to          
applications submitted under subsection 
7c71 designate areas as ,health         
,enterprise ,zones to reduce health     
disparities and improve health outcomes 
in such areas4  7#b7 ,eligibility of    
area ,to be designated as a ,health     
,enterprise ,zone under this section1 an
 area must-- 7,a7 be a contiguous       

geographic area in one census tract or  
,,zip code2  7,b7 have measurable and   
documented racial1 ethnic1 or geographic
 health disparities and poor health     
outcomes1 demonstrated by-- 7i7 average 
income below #aej percent of the        
,federal poverty line2  7ii7 a rate of  
eligibility in the special supplemental 
nutrition program under section #ag of  
the ,child ,nutrition ,act of #aiff 7#db
 ,u4,s4,c4 #aghf7 that is higher than   
the national average rate of eligibility
 in such program2  7iii7 lower life     
expectancy than the national average2 or
  7iv7 a higher percentage of instances 
of low birth weight than the national   
average2 and  7,c7 are part of a        
,metropolitan ,statistical ,area or     
,micropolitan ,statistical ,area        
identified by the ,office of ,management
 and ,budget4  7b7 ,solicitation of     
applications ,the ,secretary shall--    
7#a7 not later than #ab months after the
 date of enactment of this ,act1 solicit
 applications under subsection 7c72 and 

7#b7 publish on the website of the      
,department of ,health and ,human       
,services-- 7,a7 the names of all       
applicants1 together with the names of  
each applicant's coalition partners2 and
  7,b7 a description of all areas       
proposed to be designated as ,health    
,enterprise ,zones4  7c7 ,submission of 
applications ,to seek the designation of
 an area as a ,health ,enterprise ,zone1
 a community-based nonprofit            
organization or local governmental      
agency1 in coalition with an array of   
health care providers1 hospitals1       
nonprofit community health clinics1     
health centers1 social service          
organizations1 and other related        
organizations shall submit an           
application to the ,secretary4  7d7     
,contents ,an application under         
subsection 7c7 shall-- 7#a7 include an  
effective and sustainable plan with     
respect to the area proposed for        
designation-- 7,a7 to reduce health     
disparities2  7,b7 to reduce the costs  

of1 or to produce savings to1 the health
 care system2  7,c7 to improve health   
outcomes2 and  7,d7 to utilize one or   
more of the incentives established      
pursuant to sections #d1 #e1 #f1 and #g 
to address health care provider         
capacity1 improve health services       
delivery1 effectuate community          
improvements1 or conduct outreach and   
education efforts2 and  7#b7 identify   
specific diseases or indicators of      
health for improvement of health        
outcomes in such area1 including at     
least one of the following3             
cardiovascular disease1 asthma1         
diabetes1 dental health1 behavioral     
health1 maternal and birth health1      
sexually transmitted infections1 and    
obesity4  7e7 ,considerations ,the      
,secretary-- 7#a7 shall consider        
geographic diversity1 among other       
factors1 in selecting areas for         
designation as ,health ,enterprise      
,zones2 and  7#b7 may conduct outreach  
efforts to encourage a geographically   

diverse pool of applicants1 including   
for designating ,health ,enterprise     
,zones in rural areas4  7f7 ,priority   
,in selecting areas for designation as  
,health ,enterprise ,zones1 the         
,secretary shall give higher priority to
 applications based on the extent to    
which they demonstrate the following3   
7#a7 ,support from1 and participation   
of1 key stakeholders in the public and  
private sectors in the area proposed for
 designation1 including residents and   
local governments of such area4  7#b7 ,a
 plan for long-term funding and         
sustainability4  7#c7 ,supporting funds 
from the private sector4  7#d7          
,integration with any applicable ,state 
health improvement process or plan4     
7#e7 ,a plan for evaluation of the      
impact of designation of such area as a 
,health ,enterprise ,zone4  7#f7 ,a plan
 to utilize existing ,state tax credits1
 grants1 or other incentives to reduce  
health disparities and improve health   
outcomes in the proposed ,health        

,enterprise ,zone4  7#g7 ,such other    
factors as the ,secretary determines are
 appropriate to demonstrate a commitment
 to reduce health disparities and       
improve health outcomes in such area4   
7g7 ,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
 #aj fiscal years following the         
enactment of this ,act4  #c4            
,consultation ,the ,secretary shall     
carry out this ,act in consultation     
with-- 7#a7 the ,secretary of ,housing  
and ,urban ,development2 and  7#b7 the  
,deputy ,assistant ,secretary for       
,minority ,health4  #d4 ,tax incentives 
7a7 ,work opportunity credit for hiring 
,health ,enterprise ,zone workers  7#a7 
,in general ,section #ea7;d77#a7 of the 
,internal ,revenue ,code of #aihf is    
amended by striking or at the end of    
subparagraph 7,i71 by striking the      
period at the end of subparagraph 7,j7  
and inserting 1 or1 and by adding at the

 end the following new subparagraph3    
7,k7 a qualified ,health ,enterprise    
,zone worker1 to the extent that the    
qualified first-year wages with respect 
to such worker are paid for qualified   
,health ,enterprise ,zone work4  4  7#b7
 ,qualified ,health ,enterprise ,zone   
worker ,section #ea7;d7 of such ,code is
 amended by adding at the end the       
following new paragraphs3  7#af7        
,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 7as of
 the hiring date7 a principal place of  
employment within a ,health ,enterprise 
,zone 7as such term is defined in       
section #i of the ,health ,enterprise   
,zones ,act of #bjbj74  7#ag7 ,qualified
 ,health ,enterprise ,zone work ,the    
term qualified ,health ,enterprise ,zone
 work means employment by a ,health     
,enterprise ,zone practitioner 7as such 
term is defined in section #i of the    

,health ,enterprise ,zones ,act of      
#bjbj71 the primary official duties of  
which promote access to healthcare in a 
,health ,enterprise ,zone 7as such term 
is defined in section #i of the ,health 
,enterprise ,zones ,act of #bjbj74  4   
7#c7 ,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 date4  7b7 ,credit  
for ,health ,enterprise ,zone workers   
7#a7 ,in general ,subpart ,a of part    
,,iv of subchapter ,a of chapter #a of  
the ,internal ,revenue ,code of #aihf is
 amended by inserting after section     
#be;,d the following new section3       
#be;,e4 ,credit for qualified ,health   
,enterprise ,zone workers  7a7          
,allowance of credit ,in the case of a  
qualified ,health ,enterprise ,zone     
worker1 there shall be allowed as a     
credit against the tax imposed by this  
chapter for a taxable year an amount    

equal to #dj percent of wages received  
for qualified ,health ,enterprise ,zone 
work4  7b7 ,definitions ,for purposes of
 this section-- 7#a7 ,the term qualified
 ,health ,enterprise ,zone worker means1
 with respect to wages1 an individual   
whose principal place of employment     
while earning such wages is within a    
,health ,enterprise ,zone 7as such term 
is defined in section #i of the ,health 
,enterprise ,zones ,act of #bjbj74  7#b7
 ,the term qualified ,health ,enterprise
 ,zone work has the meaning given such  
term in section #ea4  4  7#b7 ,clerical 
amendment ,the table of sections for    
subpart ,a of part ,,iv of subchapter ,a
 of chapter #a of such ,code is amended 
by inserting after the item relating to 
section #be;,d the following new item3  
,sec4 #be;,e4 ,credit for qualified     
,health ,enterprise ,zone workers4  4   
7#c7 ,effective date ,the amendments    
made by this section shall apply to     
amounts paid or incurred after the date 
of the enactment of this ,act4  #e4     

,grants  7a7 ,authorization ,for each   
area designated under section #b as a   
,health ,enterprise ,zone1 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   
area4  7b7 ,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 #b7;d77#a7 and may include the 
following3 7#a7 ,subgrants to health    
care practitioners  7,a7 ,in general    
,for the purpose of improving or        
expanding the delivery of health care in
 the respective ,health ,enterprise     
,zone1 the grantee may award subgrants  
to ,health ,enterprise ,zone            
practitioners to defray costs related to
 innovative strategies listed in        
paragraph 7#b74  7,b7 ,eligibility ,to  

be eligible to receive a subgrant       
pursuant to subparagraph 7,a71 a ,health
 ,enterprise ,zone practitioner shall-- 
7i7 own or lease a health care facility 
in the ,health ,enterprise ,zone2 or    
7ii7 provide health care in such a      
facility4  7,c7 ,amount ,the amount of a
 subgrant under subparagraph 7,a7 may   
not exceed the lesser of-- 7i7          
#e1jjj1jjj2 or  7ii7 #ej percent of the 
costs of the equipment1 or capital or   
leasehold improvements1 to be defrayed  
using the subgrant to implement         
innovative strategies listed in         
paragraph 7#b74  7#b7 ,innovative       
strategies ,a grantee 7or subgrantee7   
may use a grant received under this     
section 7or a subgrant received under   
paragraph 7#a77 to implement innovative 
public health strategies in the         
respective ,health ,enterprise ,zone1   
which strategies may include-- 7,a7     
internships and volunteer opportunities 
for students who reside in the ,health  
,enterprise ,zone2  7,b7 funding        

resources to improve health care        
provider capacity to serve non-,english 
speakers2  7,c7 operation of medical1   
mental and behavioral health1 and dental
 mobile clinics2  7,d7 provision of     
transportation to and from medical      
appointments for patients2  7,e7 funding
 resources to improve access to healthy 
food1 recreation1 and high-quality      
housing2  7,f7 capital or leasehold     
improvements to a health care facility  
in the respective ,health ,enterprise   
,zone2 and  7,g7 medical or dental      
equipment to be used in such a facility4
  #f4 ,student loan repayment program   
7a7 ,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  

,zone4  7b7 ,limitations ,in entering   
into loan repayment agreements under    
this section1 the ,secretary may not    
agree to-- 7#a7 make payments for more  
than #aj years with respect to a        
practitioner2 or  7#b7 pay more than    
#aj1jjj per year1 or more than a total  
of #ajj1jjj1 with respect to a          
practitioner4  7c7 ,definitions ,in this
 section3 7#a7 ,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 
,education4  7#b7 ,the term eligible    
,health ,enterprise ,zone practitioner  
means a ,health ,enterprise ,zone       
practitioner who agrees-- 7,a7 to       
provide health care services in a       
,health ,enterprise ,zone for a         
specified period that is not less than  
one year2 and  7,b7 has one or more     
eligible educational loans4  #g4 ,ten   
percent increase of payment for items   
and services payable under ,medicare    

,part ,b furnished in ,health           
,enterprise ,zones ,section #ahcc7;a7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #aciel7a77 is amended by      
inserting before the period at the end  
the following3 4 ,with respect to items 
and services payable under this part    
that are furnished in a ,health         
,enterprise ,zone 7as defined in section
 #i of the ,health ,enterprise ,zones   
,act of #bjbj7 during the period        
beginning on the first day an area is   
designated a ,health ,enterprise ,zone  
under section #b7;a77#a7 of such ,act   
and ending on the last day of the fiscal
 year that is #aj fiscal years following
 the enactment of this ,act1 the payment
 rates otherwise established for such   
items and services shall be increased by
 #aj percent4  #h4 ,reporting  7a7 ,in  
general ,not later than the end of each 
fiscal year in the period of #aj fiscal 
years following the date of enactment of
 this ,act1 the ,secretary shall submit 
to the ,congress a report on the        

implementation of this ,act and the     
results thereof4  7b7 ,contents ,each   
report under subsection 7a7 shall-- 7#a7
 specify the number and types of        
incentives provided pursuant to this    
,act in each ,health ,enterprise ,zone  
designated under section #b2  7#b7      
include evidence of the extent to which 
the incentives utilized by each ,health 
,enterprise ,zone have succeeded-- 7,a7 
in attracting health care practitioners 
to practice in ,health ,enterprise      
,zones2  7,b7 in reducing health        
disparities and improving health        
outcomes in ,health ,enterprise ,zones2 
and  7,c7 in reducing health costs and  
hospital admissions and readmissions in 
,health ,enterprise ,zones4  #i4        
,definitions ,in this ,act3 7#a7 ,the   
term ,health ,enterprise ,zone means an 
area designated under section #b as a   
,health ,enterprise ,zone4  7#b7 ,the   
term ,health ,enterprise ,zone          
practitioner means a health care        
practitioner who-- 7,a7 is licensed or  

certified in accordance with applicable 
,state law to treat patients in the     
respective ,health ,enterprise ,zone2   
7,b7 provides-- 7i7 primary care1 which 
may include obstetrics1 gynecological   
services1 pediatric services1 or        
geriatric services2  7ii7 behavioral    
health services1 which may include      
mental health or substance use disorder 
services2 or  7iii7 dental services2 and
  7,c7 is a participating provider of   
services or supplier under the ,medicare
 program under title ,,xviii of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 or a participating       
provider under a ,state plan under title
 ,,xix of such ,act 7#db ,u4,s4,c4 #acif
 et seq474  7#c7 ,the term ,secretary   
means the ,secretary of ,health and     
,human ,services4  #aj4 ,authorization  
of appropriations ,to carry out this    
,act1 there is authorized to be         
appropriated such sums as may be        
necessary for the period of #aj fiscal  
years following the date of enactment of

 this ,act4