[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5293 Introduced in Senate (IS)]
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117th CONGRESS
2d Session
S. 5293
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 SENATE OF THE UNITED STATES
December 19, 2022
Mr. Padilla introduced the following bill; 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 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 2022''.
(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. Incentive payments for Medicare part B items and services
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 shall--
(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;
(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) be part of a metropolitan statistical area or
micropolitan statistical area identified by the
Director of the Office of Management and Budget.
(b) Solicitation of Applications.--The Secretary shall--
(1) not later than 1 year 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 under subsection
(c), 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 section 4, 5, or 6 of this Act,
or section 1833(a) of the Social Security Act (42
U.S.C. 1395l(a)), as amended by section 7 of this Act,
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:
(A) Cardiovascular disease.
(B) Asthma.
(C) Diabetes.
(D) Dental health.
(E) Behavioral health.
(F) Maternal and birth health.
(G) Sexually transmitted infections.
(H) 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 an area demonstrates 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
an area as a Health Enterprise Zone shall be in effect until the date
that is 10 years after the date on which the first such area is so
designated.
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
paragraph:
``(16) Health enterprise zones.--
``(A) 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.
``(B) Qualified health enterprise zone work.--The
term `qualified Health Enterprise Zone work' means
employment by a Health Enterprise Zone practitioner,
the primary official duties of which promote access to
healthcare in a Health Enterprise Zone.
``(C) Related terms.--For purposes of this
paragraph, the terms `Health Enterprise Zone' and
`Health Enterprise Zone practitioner' have the same
meaning given such terms under section 9 of the Health
Enterprise Zones Act of 2022.''.
(3) 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 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, as amended by
section 13402 of Public Law 117-169, is amended by inserting
after section 25E the following new section:
``SEC. 25F. 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
percent of wages received for qualified Health Enterprise Zone work
during such taxable year.
``(b) Definitions.--For purposes of this section--
``(1) Qualified health enterprise zone worker.--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 2022).
``(2) Qualified health enterprise zone work.--The term
`qualified Health Enterprise Zone work' has the same meaning
given such term in section 51(d)(16)(B).''.
(2) Clerical amendment.--The table of sections for subpart
A of part IV of subchapter A of chapter 1 of such Code, as
amended by section 13402(d) of Public Law 117-169, is amended
by inserting after the item relating to section 25E the
following new item:
``Sec. 25F. Credit for qualified Health Enterprise Zone workers.''.
(3) Effective date.--The amendments made by this subsection
shall apply to wages received 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.
(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 the Public Health
Service Act (42 U.S.C. 254l-1, 254q-1, 297n), or section 428J,
428L, 455(m), or 460 of the Higher Education Act of 1965 (20
U.S.C. 1078-10, 1078-12, 1087e(m), 1087j).
(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--
(A) agrees 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. INCENTIVE PAYMENTS FOR MEDICARE PART B ITEMS AND SERVICES
FURNISHED IN HEALTH ENTERPRISE ZONES.
Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) is
amended by adding at the end the following new subsection:
``(ee) Incentive Payments for Items and Services Furnished in
Health Enterprise Zones.--
``(1) 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 2(a)(1) of the Health Enterprise
Zones Act of 2022, in addition to the amount of payment that
would otherwise be made for such items and services under this
part, there also shall be paid (on a monthly or quarterly
basis) an amount equal to 10 percent of the payment amount for
the item or service under this part.
``(2) Coordination with other payments.--The amount of the
additional payment for an item or a service under this
subsection and subsection (m) shall be determined without
regard to any additional payment for the item or service under
subsection (m) and this subsection, respectively. The amount of
the additional payment for an item or a service under this
subsection and subsection (z) shall be determined without
regard to any additional payment for the item or service under
subsection (z) and this subsection, respectively.''.
SEC. 8. REPORTING.
(a) In General.--Not later than the day that is 10 years after the
first Health Enterprise Zone is designated under section 2(a)(1), the
Secretary shall submit to Congress a report on the implementation of
this Act (and the amendments made by 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; and
(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 beginning on the date of
enactment of this Act and ending on the last day of the 10-year period
that begins on the date on which the first Health Enterprise Zone is
designated under section 2(a)(1).
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