,,ii #aagth ,,congress #b;d ,session ,s4 #ebic ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ai1 #bjbb,mr4 ,padilla introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 #bjbb4 7b7 ,table of contents ,the 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 ,incentive payments for ,medicare part ,b items and services 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 shall-- 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 participation 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 participation in such program2 7iii7 lower life expectancy than the national average2 7iv7 a higher percentage of instances of low birth weight than the national average2 or 7v7 designation under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7 as a health professional shortage area2 and 7,c7 be part of a metropolitan statistical area or micropolitan statistical area identified by the ,director of the ,office of ,management and ,budget4 7b7 ,solicitation of applications ,the ,secretary shall-- 7#a7 not later than #a year 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 applicants under subsection 7c71 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 organizations1 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 section #d1 #e1 or #f of this ,act1 or section #ahcc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a771 as amended by section #g of this ,act1 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 7,a7 ,cardiovascular disease4 7,b7 ,asthma4 7,c7 ,diabetes4 7,d7 ,dental health4 7,e7 ,behavioral health4 7,f7 ,maternal and birth health4 7,g7 ,sexually transmitted infections4 7,h7 ,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 an area demonstrates 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 an area as a ,health ,enterprise ,zone shall be in effect until the date that is #aj years after the date on which the first such area is so designated4 #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 paragraph3 7#af7 ,health ,enterprise ,zones 7,a7 ,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 ,zone4 7,b7 ,qualified ,health ,enterprise ,zone work ,the term qualified ,health ,enterprise ,zone work means employment by a ,health ,enterprise ,zone practitioner1 the primary official duties of which promote access to healthcare in a ,health ,enterprise ,zone4 7,c7 ,related terms ,for purposes of this paragraph1 the terms ,health ,enterprise ,zone and ,health ,enterprise ,zone practitioner have the same meaning given such terms under section #i of the ,health ,enterprise ,zones ,act of #bjbb4 4 7#c7 ,effective date ,the amendments made by this subsection 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 #aihf1 as amended by section #acdjb of ,public ,law #aag-afi1 is amended by inserting after section #be;,e the following new section3 #be;,f4 ,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 work during such taxable year4 7b7 ,definitions ,for purposes of this section-- 7#a7 ,qualified ,health ,enterprise ,zone worker ,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 #bjbb74 7#b7 ,qualified ,health ,enterprise ,zone work ,the term qualified ,health ,enterprise ,zone work has the same meaning given such term in section #ea7;d77#af77;,b74 4 7#b7 ,clerical amendment ,the table of sections for subpart ,a of part ,,iv of subchapter ,a of chapter #a of such ,code1 as amended by section #acdjb7;d7 of ,public ,law #aag-afi1 is amended by inserting after the item relating to section #be;,e the following new item3 ,sec4 #be;,f4 ,credit for qualified ,health ,enterprise ,zone workers4 4 7#c7 ,effective date ,the amendments made by this subsection shall apply to wages received 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 improvements4 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 ,ineligibility for double benefits ,no borrower may1 for the same service1 receive a reduction of loan obligations or a loan repayment under both-- 7#a7 this section2 and 7#b7 any federally supported loan forgiveness program1 including under section #cch;,b1 #cch;,i1 or #hdf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl-#a1 #bedq-#a1 #bign71 or section #dbh;,j1 #dbh,l1 #dee7m71 or #dfj of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajgh-aj1 #ajgh-ab1 #ajhg;e7m71 #ajhg;j74 7d7 ,definitions ,in this section3 7#a7 ,the term eligible educational loan means any federally funded or guaranteed student loan1 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-- 7,a7 agrees 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 ,incentive payments for ,medicare part ,b items and services furnished in ,health ,enterprise ,zones ,section #ahcc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is amended by adding at the end the following new subsection3 7ee7 ,incentive payments for items and services furnished in ,health ,enterprise ,zones 7#a7 ,in general ,in the case of items and services furnished under this part in an area that is designated as a ,health ,enterprise ,zone section #b7;a77#a7 of the ,health ,enterprise ,zones ,act of #bjbb1 in addition to the amount of payment that would otherwise be made for such items and services under this part1 there also shall be paid 7on a monthly or quarterly basis7 an amount equal to #aj percent of the payment amount for the item or service under this part4 7#b7 ,coordination with other payments ,the amount of the additional payment for an item or a service under this subsection and subsection 7m7 shall be determined without regard to any additional payment for the item or service under subsection 7m7 and this subsection1 respectively4 ,the amount of the additional payment for an item or a service under this subsection and subsection 7z7 shall be determined without regard to any additional payment for the item or service under subsection 7z7 and this subsection1 respectively4 4 #h4 ,reporting 7a7 ,in general ,not later than the day that is #aj years after the first ,health ,enterprise ,zone is designated under section #b7;a77#a71 the ,secretary shall submit to ,congress a report on the implementation of this ,act 7and the amendments made by this ,act7 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 and 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 beginning on the date of enactment of this ,act and ending on the last day of the #aj-year period that begins on the date on which the first ,health ,enterprise ,zone is designated under section #b7;a77#a74