II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Health Enterprise Zones Act of 2022’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 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. 


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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. 

1 SEC. 2. DESIGNATION OF HEALTH ENTERPRISE ZONES. 

2 (a) DESIGNATION.— 

3 (1) IN GENERAL.—Not later than 18 months 

4 after the date of enactment of this Act, the Sec5 retary shall, pursuant to applications submitted 

6 under subsection (c), designate areas as Health En7 terprise Zones to reduce health disparities and im8 prove health outcomes in such areas. 

9 (2) ELIGIBILITY OF AREA.—To be designated 

10 as a Health Enterprise Zone under this section, an 

11 area shall— 

12 (A) be a contiguous geographic area in one 

13 census tract or ZIP Code; 

14 (B) have measurable and documented ra15 cial, ethnic, or geographic health disparities and 

16 poor health outcomes, demonstrated by— 

17 (i) average income below 150 percent 

18 of the Federal poverty line; 

19 (ii) a rate of participation in the spe20 cial supplemental nutrition program under 

21 section 17 of the Child Nutrition Act of 

22 1966 (42 U.S.C. 1786) that is higher than 


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1 the national average rate of participation 

2 in such program; 

3 (iii) lower life expectancy than the na4 tional average; 

5 (iv) a higher percentage of instances 

6 of low birth weight than the national aver7 age; or 

8 (v) designation under section 332 of 

9 the Public Health Service Act (42 U.S.C. 

10 254e) as a health professional shortage 

11 area; and 

12 (C) be part of a metropolitan statistical 

13 area or micropolitan statistical area identified 

14 by the Director of the Office of Management 

15 and Budget. 

16 (b) SOLICITATION OF APPLICATIONS.—The Sec17 retary shall— 

18 (1) not later than 1 year after the date of en19 actment of this Act, solicit applications under sub20 section (c); and 

21 (2) publish on the website of the Department of 

22 Health and Human Services— 

23 (A) the names of all applicants under sub24 section (c), together with the names of each ap25 plicant’s coalition partners; and 


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1 (B) a description of all areas proposed to 

2 be designated as Health Enterprise Zones. 

3 (c) SUBMISSION OF APPLICATIONS.—To seek the 

4 designation of an area as a Health Enterprise Zone, a 

5 community-based nonprofit organization or local govern6 mental agency, in coalition with an array of health care 

7 providers, hospitals, nonprofit community health clinics, 

8 health centers, social service organizations, and other re9 lated organizations, shall submit an application to the Sec10 retary. 

11 (d) CONTENTS.—An application under subsection (c) 

12 shall— 

13 (1) include an effective and sustainable plan 

14 with respect to the area proposed for designation— 

15 (A) to reduce health disparities; 

16 (B) to reduce the costs of, or to produce 

17 savings to, the health care system; 

18 (C) to improve health outcomes; and 

19 (D) to utilize one or more of the incentives 

20 established pursuant to section 4, 5, or 6 of this 

21 Act, or section 1833(a) of the Social Security 

22 Act (42 U.S.C. 1395l(a)), as amended by sec23 tion 7 of this Act, to address health care pro24 vider capacity, improve health services delivery, 


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1 effectuate community improvements, or conduct 

2 outreach and education efforts; and 

3 (2) identify specific diseases or indicators of 

4 health for improvement of health outcomes in such 

5 area, including at least one of the following: 

6 (A) Cardiovascular disease. 

7 (B) Asthma. 

8 (C) Diabetes. 

9 (D) Dental health. 

10 (E) Behavioral health. 

11 (F) Maternal and birth health. 

12 (G) Sexually transmitted infections. 

13 (H) Obesity. 

14 (e) CONSIDERATIONS.—The Secretary— 

15 (1) shall consider geographic diversity, among 

16 other factors, in selecting areas for designation as 

17 Health Enterprise Zones; and 

18 (2) may conduct outreach efforts to encourage 

19 a geographically diverse pool of applicants, including 

20 for designating Health Enterprise Zones in rural 

21 areas. 

22 (f) PRIORITY.—In selecting areas for designation as 

23 Health Enterprise Zones, the Secretary shall give higher 

24 priority to applications based on the extent to which an 

25 area demonstrates the following: 


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1 (1) Support from, and participation of, key 

2 stakeholders in the public and private sectors in the 

3 area proposed for designation, including residents 

4 and local governments of such area. 

5 (2) A plan for long-term funding and sustain6 ability. 

7 (3) Supporting funds from the private sector. 

8 (4) Integration with any applicable State health 

9 improvement process or plan. 

10 (5) A plan for evaluation of the impact of des11 ignation of such area as a Health Enterprise Zone. 

12 (6) A plan to utilize existing State tax credits, 

13 grants, or other incentives to reduce health dispari14 ties and improve health outcomes in the proposed 

15 Health Enterprise Zone. 

16 (7) Such other factors as the Secretary deter17 mines are appropriate to demonstrate a commitment 

18 to reduce health disparities and improve health out19 comes in such area. 

20 (g) PERIOD OF DESIGNATION.—The designation 

21 under this section of an area as a Health Enterprise Zone 

22 shall be in effect until the date that is 10 years after the 

23 date on which the first such area is so designated. 


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1 SEC. 3. CONSULTATION. 

2 The Secretary shall carry out this Act in consultation 

3 with— 

4 (1) the Secretary of Housing and Urban Devel5 opment; and 

6 (2) the Deputy Assistant Secretary for Minority 

7 Health. 

8 SEC. 4. TAX INCENTIVES. 

9 (a) WORK OPPORTUNITY CREDIT FOR HIRING

10 HEALTH ENTERPRISE ZONE WORKERS.— 

11 (1) IN GENERAL.—Section 51(d)(1) of the In12 ternal Revenue Code of 1986 is amended by striking 

13 ‘‘or’’ at the end of subparagraph (I), by striking the 

14 period at the end of subparagraph (J) and inserting 

15 ‘‘, or’’, and by adding at the end the following new 

16 subparagraph: 

17 ‘‘(K) a qualified Health Enterprise Zone 

18 worker, to the extent that the qualified first19 year wages with respect to such worker are paid 

20 for qualified Health Enterprise Zone work.’’. 

21 (2) QUALIFIED HEALTH ENTERPRISE ZONE

22 WORKER.—Section 51(d) of such Code is amended 

23 by adding at the end the following new paragraph: 

24 ‘‘(16) HEALTH ENTERPRISE ZONES.— 

25 ‘‘(A) QUALIFIED HEALTH ENTERPRISE

26 ZONE WORKER.—The term ‘qualified Health 


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1 Enterprise Zone worker’ means any individual 

2 who is certified by the designated local agency 

3 as having (as of the hiring date) a principal 

4 place of employment within a Health Enterprise 

5 Zone. 

6 ‘‘(B) QUALIFIED HEALTH ENTERPRISE

7 ZONE WORK.—The term ‘qualified Health En8 terprise Zone work’ means employment by a 

9 Health Enterprise Zone practitioner, the pri10 mary official duties of which promote access to 

11 healthcare in a Health Enterprise Zone. 

12 ‘‘(C) RELATED TERMS.—For purposes of 

13 this paragraph, the terms ‘Health Enterprise 

14 Zone’ and ‘Health Enterprise Zone practitioner’ 

15 have the same meaning given such terms under 

16 section 9 of the Health Enterprise Zones Act of 

17 2022.’’. 

18 (3) EFFECTIVE DATE.—The amendments made 

19 by this subsection shall apply to amounts paid or in20 curred after the date of the enactment of this Act 

21 to individuals who begin work for the employer after 

22 such date. 

23 (b) CREDIT FOR HEALTH ENTERPRISE ZONE WORK24 ERS.— 


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1 (1) IN GENERAL.—Subpart A of part IV of sub2 chapter A of chapter 1 of the Internal Revenue Code 

3 of 1986, as amended by section 13402 of Public 

4 Law 117–169, is amended by inserting after section 

5 25E the following new section: 

6 ‘‘SEC. 25F. CREDIT FOR QUALIFIED HEALTH ENTERPRISE 

7 ZONE WORKERS. 

8 ‘‘(a) ALLOWANCE OF CREDIT.—In the case of a 

9 qualified Health Enterprise Zone worker, there shall be 

10 allowed as a credit against the tax imposed by this chapter 

11 for a taxable year an amount equal to 40 percent of wages 

12 received for qualified Health Enterprise Zone work during 

13 such taxable year. 

14 ‘‘(b) DEFINITIONS.—For purposes of this section— 

15 ‘‘(1) QUALIFIED HEALTH ENTERPRISE ZONE

16 WORKER.—The term ‘qualified Health Enterprise 

17 Zone worker’ means, with respect to wages, an indi18 vidual whose principal place of employment while 

19 earning such wages is within a Health Enterprise 

20 Zone (as such term is defined in section 9 of the 

21 Health Enterprise Zones Act of 2022). 

22 ‘‘(2) QUALIFIED HEALTH ENTERPRISE ZONE

23 WORK.—The term ‘qualified Health Enterprise Zone 

24 work’ has the same meaning given such term in sec25 tion 51(d)(16)(B).’’. 


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1 (2) CLERICAL AMENDMENT.—The table of sec2 tions for subpart A of part IV of subchapter A of 

3 chapter 1 of such Code, as amended by section 

4 13402(d) of Public Law 117–169, is amended by in5 serting after the item relating to section 25E the fol6 lowing new item: 

‘‘Sec. 25F. Credit for qualified Health Enterprise Zone workers.’’. 

7 (3) EFFECTIVE DATE.—The amendments made 

8 by this subsection shall apply to wages received after 

9 the date of the enactment of this Act. 

10 SEC. 5. GRANTS. 

11 (a) AUTHORIZATION.—For each area designated 

12 under section 2 as a Health Enterprise Zone, the Sec13 retary may award a grant to the community-based non14 profit organization or local governmental agency that ap15 plied for such designation to support such applicant and 

16 its coalition partners in reducing health disparities and 

17 improving health outcomes in such area. 

18 (b) USE OF FUNDS.—Programs and activities funded 

19 through a grant under this section shall be consistent with 

20 the grantee’s plan submitted pursuant to section 2(d)(1) 

21 and may include the following: 

22 (1) SUBGRANTS TO HEALTH CARE PRACTI23 TIONERS.— 

24 (A) IN GENERAL.—For the purpose of im25 proving or expanding the delivery of health care 


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1 in the respective Health Enterprise Zone, the 

2 grantee may award subgrants to Health Enter3 prise Zone practitioners to defray costs related 

4 to innovative strategies listed in paragraph (2). 

5 (B) ELIGIBILITY.—To be eligible to receive 

6 a subgrant pursuant to subparagraph (A), a 

7 Health Enterprise Zone practitioner shall— 

8 (i) own or lease a health care facility 

9 in the Health Enterprise Zone; or 

10 (ii) provide health care in such a facil11 ity. 

12 (C) AMOUNT.—The amount of a subgrant 

13 under subparagraph (A) may not exceed the 

14 lesser of— 

15 (i) $5,000,000; or 

16 (ii) 50 percent of the costs of the 

17 equipment, or capital or leasehold improve18 ments. 

19 (2) INNOVATIVE STRATEGIES.—A grantee (or 

20 subgrantee) may use a grant received under this sec21 tion (or a subgrant received under paragraph (1)) to 

22 implement innovative public health strategies in the 

23 respective Health Enterprise Zone, which strategies 

24 may include— 


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1 (A) internships and volunteer opportunities 

2 for students who reside in the Health Enter3 prise Zone; 

4 (B) funding resources to improve health 

5 care provider capacity to serve non-English 

6 speakers; 

7 (C) operation of medical, mental and be8 havioral health, and dental mobile clinics; 

9 (D) provision of transportation to and 

10 from medical appointments for patients; 

11 (E) funding resources to improve access to 

12 healthy food, recreation, and high-quality hous13 ing; 

14 (F) capital or leasehold improvements to a 

15 health care facility in the respective Health En16 terprise Zone; and 

17 (G) medical or dental equipment to be 

18 used in such a facility. 

19 SEC. 6. STUDENT LOAN REPAYMENT PROGRAM. 

20 (a) IN GENERAL.—The Secretary shall carry out a 

21 loan repayment program under which the Secretary enters 

22 into agreements with eligible Health Enterprise Zone 

23 practitioners to make payments on the principal and inter24 est of the eligible educational loans of such practitioners 


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1 for each year such practitioners agree to provide health 

2 care services in a Health Enterprise Zone. 

3 (b) LIMITATIONS.—In entering into loan repayment 

4 agreements under this section, the Secretary may not 

5 agree to— 

6 (1) make payments for more than 10 years with 

7 respect to a practitioner; or 

8 (2) pay more than $10,000 per year, or more 

9 than a total of $100,000, with respect to a practi10 tioner. 

11 (c) INELIGIBILITY FOR DOUBLE BENEFITS.—No 

12 borrower may, for the same service, receive a reduction 

13 of loan obligations or a loan repayment under both— 

14 (1) this section; and 

15 (2) any federally supported loan forgiveness 

16 program, including under section 338B, 338I, or 

17 846 of the Public Health Service Act (42 U.S.C. 

18 254l–1, 254q–1, 297n), or section 428J, 428L, 

19 455(m), or 460 of the Higher Education Act of 

20 1965 (20 U.S.C. 1078–10, 1078–12, 1087e(m), 

21 1087j). 

22 (d) DEFINITIONS.—In this section: 

23 (1) The term ‘‘eligible educational loan’’ means 

24 any federally funded or guaranteed student loan, as 


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1 determined appropriate by the Secretary in coordina2 tion with the Secretary of Education. 

3 (2) The term ‘‘eligible Health Enterprise Zone 

4 practitioner’’ means a Health Enterprise Zone prac5 titioner who— 

6 (A) agrees to provide health care services 

7 in a Health Enterprise Zone for a specified pe8 riod that is not less than one year; and 

9 (B) has one or more eligible educational 

10 loans. 

11 SEC. 7. INCENTIVE PAYMENTS FOR MEDICARE PART B 

12 ITEMS AND SERVICES FURNISHED IN 

13 HEALTH ENTERPRISE ZONES. 

14 Section 1833(a) of the Social Security Act (42 U.S.C. 

15 1395l(a)) is amended by adding at the end the following 

16 new subsection: 

17 ‘‘(ee) INCENTIVE PAYMENTS FOR ITEMS AND SERV18 ICES FURNISHED IN HEALTH ENTERPRISE ZONES.— 

19 ‘‘(1) IN GENERAL.—In the case of items and 

20 services furnished under this part in an area that is 

21 designated as a Health Enterprise Zone section 

22 2(a)(1) of the Health Enterprise Zones Act of 2022, 

23 in addition to the amount of payment that would 

24 otherwise be made for such items and services under 

25 this part, there also shall be paid (on a monthly or 


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1 quarterly basis) an amount equal to 10 percent of 

2 the payment amount for the item or service under 

3 this part. 

4 ‘‘(2) COORDINATION WITH OTHER PAY5 MENTS.—The amount of the additional payment for 

6 an item or a service under this subsection and sub7 section (m) shall be determined without regard to 

8 any additional payment for the item or service under 

9 subsection (m) and this subsection, respectively. The 

10 amount of the additional payment for an item or a 

11 service under this subsection and subsection (z) shall 

12 be determined without regard to any additional pay13 ment for the item or service under subsection (z) 

14 and this subsection, respectively.’’. 

15 SEC. 8. REPORTING. 

16 (a) IN GENERAL.—Not later than the day that is 10 

17 years after the first Health Enterprise Zone is designated 

18 under section 2(a)(1), the Secretary shall submit to Con19 gress a report on the implementation of this Act (and the 

20 amendments made by this Act) and the results thereof. 

21 (b) CONTENTS.—Each report under subsection (a) 

22 shall— 

23 (1) specify the number and types of incentives 

24 provided pursuant to this Act in each Health Enter25 prise Zone designated under section 2; and 


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1 (2) include evidence of the extent to which the 

2 incentives utilized by each Health Enterprise Zone 

3 have succeeded— 

4 (A) in attracting health care practitioners 

5 to practice in Health Enterprise Zones; 

6 (B) in reducing health disparities and im7 proving health outcomes in Health Enterprise 

8 Zones; and 

9 (C) in reducing health costs and hospital 

10 admissions and readmissions in Health Enter11 prise Zones. 

12 SEC. 9. DEFINITIONS. 

13 In this Act: 

14 (1) The term ‘‘Health Enterprise Zone’’ means 

15 an area designated under section 2 as a Health En16 terprise Zone. 

17 (2) The term ‘‘Health Enterprise Zone practi18 tioner’’ means a health care practitioner who— 

19 (A) is licensed or certified in accordance 

20 with applicable State law to treat patients in 

21 the respective Health Enterprise Zone; 

22 (B) provides— 

23 (i) primary care, which may include 

24 obstetrics, gynecological services, pediatric 

25 services, or geriatric services; 


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1 (ii) behavioral health services, which 

2 may include mental health or substance 

3 use disorder services; or 

4 (iii) dental services; and 

5 (C) is a participating provider of services 

6 or supplier under the Medicare program under 

7 title XVIII of the Social Security Act (42 

8 U.S.C. 1395 et seq.) or a participating provider 

9 under a State plan under title XIX of such Act 

10 (42 U.S.C. 1396 et seq.). 

11 (3) The term ‘‘Secretary’’ means the Secretary 

12 of Health and Human Services. 

13 SEC. 10. AUTHORIZATION OF APPROPRIATIONS. 

14 To carry out this Act, there is authorized to be appro15 priated such sums as may be necessary for the period be16 ginning on the date of enactment of this Act and ending 

17 on the last day of the 10-year period that begins on the 

18 date on which the first Health Enterprise Zone is des19 ignated under section 2(a)(1). 

Æ 


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