,,ii #aai? ,,congress #b;d ,session ,s4 #chdj ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,febru>y #aa1 #bjbf,mr4 ,padilla introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to provide = ! designation ( areas z ,heal? ,inve/m5t ,zones to r$uce heal? disp>ities & improve heal? outcomes 9 su* areas1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,heal? ,inve/m5t ,zones ,act ( #bjbf4 #b4 ,designation ( ,heal? ,inve/m5t ,zones 7a7 ,designation 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all1 pursuant to applications submitt$ "u subsection 7c71 designate areas z ,heal? ,inve/m5t ,zones to r$uce heal? disp>ities & improve heal? outcomes 9 su* areas4 7#b7 ,eligibility ( area ,to be designat$ z a ,heal? ,inve/m5t ,zone "u ?is section1 an area %all-- 7,a7 be a contigu\s geographic area2 & 7,b7 h measurable & docum5t$ geographic heal? disp>ities & poor heal? outcomes1 demon/rat$ by-- 7i7 av]age income bel[ #aej p]c5t ( ! ,f$]al pov]ty l9e 7z def9$ by ! ,(fice ( ,managem5t & ,budget bas$ on ! mo/ rec5t data available f ! ,bureau ( ! ,c5sus72 7ii7 a rate ( p>ticipation 9 ! special supplem5tal nutrition program "u section #ag ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7 t is high] ?an ! national av]age rate ( p>ticipation 9 su* program2 7iii7 l[] life expectancy ?an ! national av]age2 7iv7 a high] p]c5tage ( in/ances ( l[ bir? weight ?an ! national av]age2 or 7v7 designation "u section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e7 z a heal? pr(essional %ortage area4 7#c7 ,publication ( designee in=mation ,n lat] ?an #a ye> aft] ! date on :i* all areas are designat$ z ,heal? ,inve/m5t ,zones "u p>agraph 7#a71 ! ,secret>y %all publi% on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices-- 7,a7 ! "n ( ea* su* ,heal? ,inve/m5t ,zone1 toge!r ) ! names ( ea* coalition p>tn]2 & 7,b7 a description ( all areas s designat$4 7b7 ,solicitation ( applications ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all solicit applications "u subsection 7c74 7c7 ,submission ( applications 7#a7 ,9 g5]al ,to seek ! designation ( an area z a ,heal? ,inve/m5t ,zone1 a community-bas$ nonpr(it organization or local gov]nm5tal ag5cy1 9 coalition ) heal? c>e provid]s1 hospitals1 nonpr(it community heal? cl9ics1 heal? c5t]s1 social s]vice organizations1 & o!r relat$ organizations1 %all submit an application to ! ,secret>y4 7#b7 ,applications = grants ,z "p ( an application "u ?is subsection1 a community-bas$ nonpr(it organization or local gov]nm5tal ag5cy may include an application = a grant "u section #d7;a74 ,su* community-bas$ nonpr(it organization or local gov]nm5tal ag5cy %all describe h[ ! use ( grant funds w\ld be consi/5t ) ! plan submitt$ pursuant to subsection 7d77#a7 & :e!r su* community-bas$ nonpr(it organization or local gov]nm5tal ag5cy int5ds to aw>d subgrants or implem5t innovative public heal? /rategies "u section #d7;b74 7d7 ,cont5ts ,an application "u subsection 7c7 %all-- 7#a7 include an effective & su/a9able plan ) respect to ! area propos$ = designation-- 7,a7 to r$uce heal? disp>ities2 7,b7 to r$uce ! co/s (1 or to produce sav+s to1 ! heal? c>e sy/em2 7,c7 to improve heal? outcomes2 & 7,d7 to utilize "o or m ( ! inc5tives e/abli%$ pursuant to section #e1 section #ea ( ! ,int]nal ,rev5ue ,code ( #aihf 7z am5d$ by section #c7;a771 = wages paid to qualifi$ ,heal? ,inve/m5t ,zone work]s 7z def9$ 9 section #ea7;d77#af7 ( su* ,code71 section #be;,g ( ! ,int]nal ,rev5ue ,code ( #aihf 7z add$ by section #c7;b771 or subsection 7ee7 ( section #ahcc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 7z am5d$ by section #f7 to address heal? c>e provid] capacity1 improve heal? s]vices deliv]y1 effectuate community improvem5ts1 or conduct outrea* & education ef=ts2 & 7#b7 id5tify specific diseases or indicators ( heal? = improvem5t ( heal? outcomes 9 su* area1 includ+ at lea/ #a ( ! foll[+3 7,a7 ,c>diovascul> disease4 7,b7 ,a/hma4 7,c7 ,diabetes4 7,d7 ,behavioral heal?4 7,e7 ,mat]nal & bir? heal?4 7,f7 ,obesity4 7e7 ,consid]ations ,! ,secret>y-- 7#a7 %all consid] geographic div]sity1 among o!r factors1 9 select+ areas = designation z ,heal? ,inve/m5t ,zones2 & 7#b7 may conduct outrea* ef=ts to enc\rage a geographically div]se pool ( applicants1 includ+ = designat+ ,heal? ,inve/m5t ,zones 9 rural areas4 7f7 ,priority ,9 select+ areas = designation z ,heal? ,inve/m5t ,zones1 ! ,secret>y %all give high] priority to applications bas$ on ! ext5t to :i* an area demon/rates ! foll[+3 7#a7 ,support f1 & p>ticipation (1 key /akehold]s 9 ! area propos$ = designation1 includ+ resid5ts & local gov]nm5ts ( su* area4 7#b7 ,a plan = long-t]m fund+ & su/a9ability4 7#c7 ,integration ) any applicable ,/ate heal? improvem5t process or plan4 7#d7 ,a plan = evaluation ( ! impact ( designation ( su* area z a ,heal? ,inve/m5t ,zone4 7#e7 ,a plan to utilize exi/+ ,/ate tax cr$its1 grants1 or o!r inc5tives to r$uce heal? disp>ities & improve heal? outcomes 9 ! propos$ ,heal? ,inve/m5t ,zone4 7#f7 ,su* o!r factors z ! ,secret>y det]m9es are appropriate to demon/rate a commitm5t to r$uce heal? disp>ities & improve heal? outcomes 9 su* area4 7g7 ,p]iod ( designation ,! designation "u ?is section ( an area z a ,heal? ,inve/m5t ,zone %all be 9 effect until ! date t is #aj ye>s aft] ! date on :i* ! fir/ su* area is s designat$4 #c4 ,tax inc5tives 7a7 ,"w opportunity cr$it = hir+ ,heal? ,inve/m5t ,zone work]s 7#a7 ,9 g5]al ,section #ea7;d77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ or at ! end ( subp>agraph 7,i71 by /rik+ ! p]iod at ! end ( subp>agraph 7,j7 & ins]t+ 1 or1 & by add+ at ! end ! foll[+ new subp>agraph3 7,k7 a qualifi$ ,heal? ,inve/m5t ,zone work]1 to ! ext5t t ! qualifi$ fir/-ye> wages ) respect to su* work] are paid = qualifi$ ,heal? ,inve/m5t ,zone "w4 4 7#b7 ,qualifi$ ,heal? ,inve/m5t ,zone work] ,section #ea7;d7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#af7 ,heal? ,inve/m5t ,zones 7,a7 ,qualifi$ ,heal? ,inve/m5t ,zone work] ,! t]m qualifi$ ,heal? ,inve/m5t ,zone work] means any individual :o is c]tifi$ by ! designat$ local ag5cy z hav+ 7z ( ! hir+ date7 a pr9cipal place ( employm5t )9 a ,heal? ,inve/m5t ,zone4 7,b7 ,qualifi$ ,heal? ,inve/m5t ,zone "w ,! t]m qualifi$ ,heal? ,inve/m5t ,zone "w means employm5t by a ,heal? ,inve/m5t ,zone practition]1 ! prim>y (ficial duties ( su* employm5t be+ to promote access to heal?c>e 9 a ,heal? ,inve/m5t ,zone4 7,c7 ,relat$ t]ms ,= purposes ( ?is p>agraph1 ! t]ms ,heal? ,inve/m5t ,zone & ,heal? ,inve/m5t ,zone practition] h ! same mean+ giv5 su* t]ms "u section #h ( ! ,heal? ,inve/m5t ,zones ,act ( #bjbf4 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to am\nts paid or incurr$ aft] ! date ( ! enactm5t ( ?is ,act to individuals :o beg9 "w = ! employ] aft] su* date4 7b7 ,cr$it = ,heal? ,inve/m5t ,zone work]s 7#a7 ,9 g5]al ,subp>t ,a ( "p ,,iv ( sub*apt] ,a ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf1 z am5d$ by section #gjdaa ( ,public ,law #aai-ba1 is am5d$ by ins]t+ aft] section #be;,f ! foll[+ new section3 #be;,g4 ,cr$it = qualifi$ ,heal? ,inve/m5t ,zone work]s 7a7 ,all[ance ( cr$it ,9 ! case ( a qualifi$ ,heal? ,inve/m5t ,zone work]1 !re %all be all[$ z a cr$it aga9/ ! tax impos$ by ?is *apt] = a taxable ye> an am\nt equal to #cj p]c5t ( wages receiv$ = qualifi$ ,heal? ,inve/m5t ,zone "w dur+ su* taxable ye>4 7b7 ,def9itions ,= purposes ( ?is section-- 7#a7 ,qualifi$ ,heal? ,inve/m5t ,zone work] ,! t]m qualifi$ ,heal? ,inve/m5t ,zone work] means1 ) respect to wages1 an individual ^: pr9cipal place ( employm5t :ile e>n+ su* wages is )9 a ,heal? ,inve/m5t ,zone 7z su* t]m is def9$ 9 section #h ( ! ,heal? ,inve/m5t ,zones ,act ( #bjbf74 7#b7 ,qualifi$ ,heal? ,inve/m5t ,zone "w ,! t]m qualifi$ ,heal? ,inve/m5t ,zone "w has ! same mean+ giv5 su* t]m 9 section #ea7;d77#af77;,b74 4 7#b7 ,cl]ical am5dm5t ,! table ( sections = subp>t ,a ( "p ,,iv ( sub*apt] ,a ( *apt] #a ( su* ,code1 z am5d$ by section #gjdaa ( ,public ,law #aai-ba1 is am5d$ by ins]t+ aft] ! item relat+ to section #be;,f ! foll[+ new item3 ,sec4 #be;,g4 ,cr$it = qualifi$ ,heal? ,inve/m5t ,zone work]s4 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to wages receiv$ aft] ! date ( ! enactm5t ( ?is ,act4 #d4 ,grants 7a7 ,au?orization ,= ea* area designat$ z a ,heal? ,inve/m5t ,zone1 ! ,secret>y may aw>d a grant to ! community-bas$ nonpr(it organization or local gov]nm5tal ag5cy t appli$ = su* designation to support su* applicant & its coalition p>tn]s 9 r$uc+ heal? disp>ities & improv+ heal? outcomes 9 su* area4 7b7 ,use ( funds ,programs & activities fund$ ?r\gh a grant "u ?is section %all be consi/5t ) ! grantee's plan submitt$ pursuant to section #b7;d77#a7 & may include ! foll[+3 7#a7 ,subgrants to heal? c>e practition]s 7,a7 ,9 g5]al ,= ! purpose ( improv+ or exp&+ ! deliv]y ( heal? c>e 9 ! respective ,heal? ,inve/m5t ,zone1 ! grantee may aw>d subgrants to ,heal? ,inve/m5t ,zone practition]s to defray co/s relat$ to innovative /rategies li/$ 9 p>agraph 7#b74 7,b7 ,eligibility ,to be eligible to receive a subgrant pursuant to subp>agraph 7,a71 a ,heal? ,inve/m5t ,zone practition] %all-- 7i7 own or lease a heal? c>e facility 9 ! ,heal? ,inve/m5t ,zone2 or 7ii7 provide heal? c>e 9 su* a facility4 7,c7 ,am\nt ,! am\nt ( a subgrant "u subp>agraph 7,a7 may n exce$ ! less] (-- 7i7 #e1jjj1jjj2 or 7ii7 #ej p]c5t ( ! co/s ( ! equipm5t1 or capital or leasehold improvem5ts4 7#b7 ,innovative /rategies ,a grantee 7or subgrantee7 may use a grant receiv$ "u ?is section 7or a subgrant receiv$ "u p>agraph 7#a77 to implem5t innovative public heal? /rategies 9 ! respective ,heal? ,inve/m5t ,zone1 :i* /rategies may include-- 7,a7 int]n%ips & volunte] opportunities = /ud5ts :o reside 9 ! ,heal? ,inve/m5t ,zone2 7,b7 fund+ res\rces to improve heal? c>e provid] capacity to s]ve non-,engli% speak]s2 7,c7 op]ation ( m$ical1 m5tal & behavioral heal?1 & d5tal mobile cl9ics2 7,d7 provision ( transportation to & f m$ical appo9tm5ts = pati5ts2 7,e7 fund+ res\rces to improve access to heal?y food1 recreation1 & high-quality h\s+2 7,f7 capital or leasehold improvem5ts to a heal? c>e facility 9 ! respective ,heal? ,inve/m5t ,zone2 & 7,g7 m$ical or d5tal equipm5t to be us$ 9 su* a facility4 #e4 ,/ud5t loan repaym5t program 7a7 ,9 g5]al ,! ,secret>y %all c>ry out a loan repaym5t program "u :i* ! ,secret>y ent]s into agreem5ts ) eligible ,heal? ,inve/m5t ,zone practition]s to make paym5ts on ! pr9cipal & int]e/ ( ! eligible educational loans ( su* practition]s = ea* ye> su* practition]s agree to provide heal? c>e s]vices 9 a ,heal? ,inve/m5t ,zone4 7b7 ,limitations ,9 ent]+ into loan repaym5t agreem5ts "u ?is section1 ! ,secret>y may n agree to-- 7#a7 make paym5ts = m ?an #aj ye>s ) respect to a practition]2 or 7#b7 pay m ?an #aj1jjj p] ye>1 or m ?an a total ( #ajj1jjj1 ) respect to a practition]4 7c7 ,relation%ip to o!r b5efits 7#a7 ,c\nt+ ( paym5ts ,a paym5t made to1 or on behalf (1 an eligible ,heal? ,inve/m5t ,zone practition] "u ?is section %all be consid]$ a qualify+ paym5t c\nt$ t[>d any total numb] ( requir$ paym5ts = =giv5ess or cancellation on an o!rwise applicable /ud5t loan plan or program "u ! ,high] ,education ,act ( #aife or ! ,public ,heal? ,s]vice ,act1 su* z "u subsection 7m7 or 7q7 ( section #dee or section #dic;,c ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajhg;e2 #ajih;e74 7#b7 ,no d\ble paym5ts ,no borr[] may1 = ! same s]vice1 receive a paym5t = an eligible educational loan "u-- 7,a7 ?is section2 & 7,b7 ano!r f$]ally support$ loan program t provides a paym5t to1 or on behalf (1 t borr[]4 7#c7 ,no reimbursem5t ,an eligible ,heal? ,inve/m5t ,zone practition] %all n receive a paym5t or reimbursem5t "u ?is section = an eligible educational loan t has be5 =giv51 cancell$1 or repaid4 7d7 ,def9itions ,9 ?is section3 7#a7 ,eligible educational loan ,! t]m eligible educational loan means any f$]ally fund$ or gu>ante$ /ud5t loan1 z det]m9$ appropriate by ! ,secret>y1 9 consultation ) ! ,secret>y ( ,education4 7#b7 ,eligible ,heal? ,inve/m5t ,zone practition] ,! t]m eligible ,heal? ,inve/m5t ,zone practition] means a ,heal? ,inve/m5t ,zone practition] :o-- 7,a7 agrees to provide full-"t heal? c>e s]vices 9 a ,heal? ,inve/m5t ,zone = a specifi$ p]iod t is n less ?an #a ye>2 & 7,b7 has #a or m eligible educational loans4 #f4 ,inc5tive paym5ts = ,m$ic>e "p ,b items & s]vices furni%$ 9 ,heal? ,inve/m5t ,zones ,section #ahcc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7ee7 ,inc5tive paym5ts = items & s]vices furni%$ 9 ,heal? ,inve/m5t ,zones 7#a7 ,9 g5]al ,9 ! case ( items & s]vices furni%$ "u ?is "p 9 an area t is designat$ z a ,heal? ,inve/m5t ,zone "u section #b7;a77#a7 ( ! ,heal? ,inve/m5t ,zones ,act ( #bjbf1 9 addition to ! am\nt ( paym5t t w\ld o!rwise be made = su* items & s]vices "u ?is "p1 !re also %all be paid 7on a mon?ly or qu>t]ly basis7-- 7,a7 an am\nt equal to #aj p]c5t ( ! paym5t am\nt = ! item or s]vice "u ?is "p2 7,b7 = su* an item or s]vice furni%$ at a free/&+ physician (fice or cl9ic 7z def9$ 9 p>agraph 7#b77 or a ,f$]ally qualifi$ heal? c5t] 7z def9$ 9 section #ahfa7;aa77#c771 9 addition to any applicable additional paym5t am\nt "u ?is p>agraph1 an am\nt equal to #e p]c5t ( ! paym5t am\nt = ! item or s]vice "u ?is "p2 & 7,c7 = an annual wellness visit 7,,hcpcs codes ,g#jdch-;,g#jdci71 diabetes self-managem5t tra9+ 7,,cpt codes #ihifj-ihifb71 *ronic c>e managem5t 7,,cpt codes #iidhg-iidia71 & a prev5tative scre5+ su* z a mammography or colorectal canc] scre5+1 9 addition to any applicable additional paym5t am\nt "u ?is p>agraph1 an am\nt equal to #aj p]c5t ( ! paym5t am\nt = su* item or s]vice "u ?is "p4 7#b7 ,def9ition ( free/&+ physician (fice or cl9ic ,9 ?is subsection1 ! t]m free/&+ physician (fice or cl9ic means a cl9ic t-- 7,a7 bills by place ( s]vice code #aa 7(fice7 or #bb 7indep5d5t cl9ic7 9 ! physician fee s*$ule "u section #ahdh2 & 7,b7 is n directly or indirectly own$ or controll$ by a hospital sy/em enroll$ 9 ! ,m$ic>e ,provid] ,enrollm5t1 ,*a91 & ,own]%ip ,sy/em 7commonly ref]r$ to z ,,pecos74 7#c7 ,coord9ation ) o!r paym5ts ,! am\nt ( ! additional paym5t = an item or a s]vice "u ?is subsection & subsection 7m7 %all be det]m9$ )\t reg>d to any additional paym5t = ! item or s]vice "u subsection 7m7 & ?is subsection1 respectively4 ,! am\nt ( ! additional paym5t = an item or a s]vice "u ?is subsection & subsection 7z7 %all be det]m9$ )\t reg>d to any additional paym5t = ! item or s]vice "u subsection 7z7 & ?is subsection1 respectively4 4 #g4 ,report+ 7a7 ,9 g5]al ,n lat] ?an ! day t is #aj ye>s aft] ! fir/ ,heal? ,inve/m5t ,zone is designat$1 ! ,secret>y %all submit to ,congress a report on ! implem5tation ( ?is ,act 7& ! am5dm5ts made by ?is ,act7 & ! results !re(4 7b7 ,cont5ts ,ea* report "u subsection 7a7 %all-- 7#a7 specify ! numb] & types ( inc5tives provid$ pursuant to ?is ,act 9 ea* ,heal? ,inve/m5t ,zone2 & 7#b7 include evid5ce ( ! ext5t to :i* ! inc5tives utiliz$ by ea* ,heal? ,inve/m5t ,zone h-- 7,a7 succe$$-- 7i7 9 attract+ heal? c>e practition]s to practice 9 ,heal? ,inve/m5t ,zones2 7ii7 9 r$uc+ heal? disp>ities & improv+ heal? outcomes 9 ,heal? ,inve/m5t ,zones2 & 7iii7 9 r$uc+ heal? co/s & hospital admissions & readmissions 9 ,heal? ,inve/m5t ,zones2 & 7,b7 impact$ access to prim>y c>e s]vices & utilization ( em]g5cy room s]vices4 #h4 ,def9itions ,9 ?is ,act3 7#a7 ,! t]m ,heal? ,inve/m5t ,zone means an area designat$ "u section #b z a ,heal? ,inve/m5t ,zone4 7#b7 ,! t]m ,heal? ,inve/m5t ,zone practition] means a heal? c>e practition] :o-- 7,a7 is lic5s$ or c]tifi$ 9 accordance ) applicable ,/ate law to treat pati5ts 9 ! applicable ,heal? ,inve/m5t ,zone2 7,b7 provides-- 7i7 prim>y c>e1 :i* may include ob/etrics1 gynecological s]vices1 p$iatric s]vices1 or g]iatric s]vices2 7ii7 behavioral heal? s]vices1 :i* may include m5tal heal? or sub/ance use disord] s]vices2 or 7iii7 d5tal s]vices2 & 7,c7 is a p>ticipat+ provid] ( s]vices or suppli] "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or a p>ticipat+ provid] "u a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 #i4 ,au?orization ( appropriations ,to c>ry out ?is ,act1 !re is au?oriz$ to be appropriat$ su* sums z may be necess>y = ! p]iod beg9n+ on ! date ( enactm5t ( ?is ,act & end+ on ! la/ day ( ! #aj-ye> p]iod t beg9s on ! date on :i* ! fir/ ,heal? ,inve/m5t ,zone is designat$4