I 

116TH CONGRESS 

2D SESSION H. R. 7158 

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 HOUSE OF REPRESENTATIVES 

JUNE 11, 2020 

Mr. BROWN of Maryland (for himself, Mr. HOYER, Ms. SEWELL of Alabama, 

Ms. KUSTER of New Hampshire, and Ms. BLUNT ROCHESTER) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committee on Ways and Means, 

for a period to be subsequently determined by the Speaker, 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 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 2020’’. 

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

7 this Act is as follows: 


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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. Ten percent increase of payment for items and services payable under 

Medicare Part B 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 must— 

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 eligibility in the special 

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1 tion 17 of the Child Nutrition Act of 1966 

2 (42 U.S.C. 1786) that is higher than the 

3 national average rate of eligibility in such 

4 program; 

5 (iii) lower life expectancy than the na6 tional average; or 

7 (iv) a higher percentage of instances 

8 of low birth weight than the national aver9 age; and 

10 (C) are part of a Metropolitan Statistical 

11 Area or Micropolitan Statistical Area identified 

12 by the Office of Management and Budget. 

13 (b) SOLICITATION OF APPLICATIONS.—The Sec14 retary shall— 

15 (1) not later than 12 months after the date of 

16 enactment of this Act, solicit applications under sub17 section (c); and 

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

19 Health and Human Services— 

20 (A) the names of all applicants, together 

21 with the names of each applicant’s coalition 

22 partners; and 

23 (B) a description of all areas proposed to 

24 be designated as Health Enterprise Zones. 


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

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

3 community-based nonprofit organization or local govern4 mental agency, in coalition with an array of health care 

5 providers, hospitals, nonprofit community health clinics, 

6 health centers, social service organizations, and other re7 lated organizations shall submit an application to the Sec8 retary. 

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

10 shall— 

11 (1) include an effective and sustainable plan 

12 with respect to the area proposed for designation— 

13 (A) to reduce health disparities; 

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

15 savings to, the health care system; 

16 (C) to improve health outcomes; and 

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

18 established pursuant to sections 4, 5, 6, and 7 

19 to address health care provider capacity, im20 prove health services delivery, effectuate com21 munity improvements, or conduct outreach and 

22 education efforts; and 

23 (2) identify specific diseases or indicators of 

24 health for improvement of health outcomes in such 

25 area, including at least one of the following: cardioVerDate Sep 11 2014 20:56 Jun 30, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H7158.IH H7158

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1 vascular disease, asthma, diabetes, dental health, be2 havioral health, maternal and birth health, sexually 

3 transmitted infections, and obesity. 

4 (e) CONSIDERATIONS.—The Secretary— 

5 (1) shall consider geographic diversity, among 

6 other factors, in selecting areas for designation as 

7 Health Enterprise Zones; and 

8 (2) may conduct outreach efforts to encourage 

9 a geographically diverse pool of applicants, including 

10 for designating Health Enterprise Zones in rural 

11 areas. 

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

13 Health Enterprise Zones, the Secretary shall give higher 

14 priority to applications based on the extent to which they 

15 demonstrate the following: 

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

17 stakeholders in the public and private sectors in the 

18 area proposed for designation, including residents 

19 and local governments of such area. 

20 (2) A plan for long-term funding and sustain21 ability. 

22 (3) Supporting funds from the private sector. 

23 (4) Integration with any applicable State health 

24 improvement process or plan. 


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1 (5) A plan for evaluation of the impact of des2 ignation of such area as a Health Enterprise Zone. 

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

4 grants, or other incentives to reduce health dispari5 ties and improve health outcomes in the proposed 

6 Health Enterprise Zone. 

7 (7) Such other factors as the Secretary deter8 mines are appropriate to demonstrate a commitment 

9 to reduce health disparities and improve health out10 comes in such area. 

11 (g) PERIOD OF DESIGNATION.—The designation 

12 under this section of any area as a Health Enterprise Zone 

13 shall expire at the end of the period of 10 fiscal years 

14 following the enactment of this Act. 

15 SEC. 3. CONSULTATION. 

16 The Secretary shall carry out this Act in consultation 

17 with— 

18 (1) the Secretary of Housing and Urban Devel19 opment; and 

20 (2) the Deputy Assistant Secretary for Minority 

21 Health. 

22 SEC. 4. TAX INCENTIVES. 

23 (a) WORK OPPORTUNITY CREDIT FOR HIRING

24 HEALTH ENTERPRISE ZONE WORKERS.— 


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1 (1) IN GENERAL.—Section 51(d)(1) of the In2 ternal Revenue Code of 1986 is amended by striking 

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

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

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

6 subparagraph: 

7 ‘‘(K) a qualified Health Enterprise Zone 

8 worker, to the extent that the qualified first9 year wages with respect to such worker are paid 

10 for qualified Health Enterprise Zone work.’’. 

11 (2) QUALIFIED HEALTH ENTERPRISE ZONE

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

13 by adding at the end the following new paragraphs: 

14 ‘‘(16) QUALIFIED HEALTH ENTERPRISE ZONE

15 WORKER.—The term ‘qualified Health Enterprise 

16 Zone worker’ means any individual who is certified 

17 by the designated local agency as having (as of the 

18 hiring date) a principal place of employment within 

19 a Health Enterprise Zone (as such term is defined 

20 in section 9 of the Health Enterprise Zones Act of 

21 2020). 

22 ‘‘(17) QUALIFIED HEALTH ENTERPRISE ZONE

23 WORK.—The term ‘qualified Health Enterprise Zone 

24 work’ means employment by a Health Enterprise 

25 Zone practitioner (as such term is defined in section 


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1 9 of the Health Enterprise Zones Act of 2020), the 

2 primary official duties of which promote access to 

3 healthcare in a Health Enterprise Zone (as such 

4 term is defined in section 9 of the Health Enterprise 

5 Zones Act of 2020).’’. 

6 (3) EFFECTIVE DATE.—The amendments made 

7 by this section shall apply to amounts paid or in8 curred after the date of the enactment of this Act 

9 to individuals who begin work for the employer after 

10 such date. 

11 (b) CREDIT FOR HEALTH ENTERPRISE ZONE WORK12 ERS.— 

13 (1) IN GENERAL.—Subpart A of part IV of sub14 chapter A of chapter 1 of the Internal Revenue Code 

15 of 1986 is amended by inserting after section 25D 

16 the following new section: 

17 ‘‘SEC. 25E. CREDIT FOR QUALIFIED HEALTH ENTERPRISE 

18 ZONE WORKERS. 

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

20 qualified Health Enterprise Zone worker, there shall be 

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

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

23 received for qualified Health Enterprise Zone work. 

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


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1 ‘‘(1) The term ‘qualified Health Enterprise 

2 Zone worker’ means, with respect to wages, an indi3 vidual whose principal place of employment while 

4 earning such wages is within a Health Enterprise 

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

6 Health Enterprise Zones Act of 2020). 

7 ‘‘(2) The term ‘qualified Health Enterprise 

8 Zone work’ has the meaning given such term in sec9 tion 51.’’. 

10 (2) CLERICAL AMENDMENT.—The table of sec11 tions for subpart A of part IV of subchapter A of 

12 chapter 1 of such Code is amended by inserting 

13 after the item relating to section 25D the following 

14 new item: 

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

15 (3) EFFECTIVE DATE.—The amendments made 

16 by this section shall apply to amounts paid or in17 curred after the date of the enactment of this Act. 

18 SEC. 5. GRANTS. 

19 (a) AUTHORIZATION.—For each area designated 

20 under section 2 as a Health Enterprise Zone, the Sec21 retary may award a grant to the community-based non22 profit organization or local governmental agency that ap23 plied for such designation to support such applicant and 

24 its coalition partners in reducing health disparities and 

25 improving health outcomes in such area. 


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

2 through a grant under this section shall be consistent with 

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

4 and may include the following: 

5 (1) SUBGRANTS TO HEALTH CARE PRACTI6 TIONERS.— 

7 (A) IN GENERAL.—For the purpose of im8 proving or expanding the delivery of health care 

9 in the respective Health Enterprise Zone, the 

10 grantee may award subgrants to Health Enter11 prise Zone practitioners to defray costs related 

12 to innovative strategies listed in paragraph (2). 

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

14 a subgrant pursuant to subparagraph (A), a 

15 Health Enterprise Zone practitioner shall— 

16 (i) own or lease a health care facility 

17 in the Health Enterprise Zone; or 

18 (ii) provide health care in such a facil19 ity. 

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

21 under subparagraph (A) may not exceed the 

22 lesser of— 

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

24 (ii) 50 percent of the costs of the 

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1 ments, to be defrayed using the subgrant 

2 to implement innovative strategies listed in 

3 paragraph (2). 

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

5 subgrantee) may use a grant received under this sec6 tion (or a subgrant received under paragraph (1)) to 

7 implement innovative public health strategies in the 

8 respective Health Enterprise Zone, which strategies 

9 may include— 

10 (A) internships and volunteer opportunities 

11 for students who reside in the Health Enter12 prise Zone; 

13 (B) funding resources to improve health 

14 care provider capacity to serve non-English 

15 speakers; 

16 (C) operation of medical, mental and be17 havioral health, and dental mobile clinics; 

18 (D) provision of transportation to and 

19 from medical appointments for patients; 

20 (E) funding resources to improve access to 

21 healthy food, recreation, and high-quality hous22 ing; 

23 (F) capital or leasehold improvements to a 

24 health care facility in the respective Health En25 terprise Zone; and 


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1 (G) medical or dental equipment to be 

2 used in such a facility. 

3 SEC. 6. STUDENT LOAN REPAYMENT PROGRAM. 

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

5 loan repayment program under which the Secretary enters 

6 into agreements with eligible Health Enterprise Zone 

7 practitioners to make payments on the principal and inter8 est of the eligible educational loans of such practitioners 

9 for each year such practitioners agree to provide health 

10 care services in a Health Enterprise Zone. 

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

12 agreements under this section, the Secretary may not 

13 agree to— 

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

15 respect to a practitioner; or 

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

17 than a total of $100,000, with respect to a practi18 tioner. 

19 (c) DEFINITIONS.—In this section: 

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

21 any federally funded or guaranteed student loan as 

22 determined appropriate by the Secretary in coordina23 tion with the Secretary of Education. 


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

2 practitioner’’ means a Health Enterprise Zone prac3 titioner who agrees— 

4 (A) to provide health care services in a 

5 Health Enterprise Zone for a specified period 

6 that is not less than one year; and 

7 (B) has one or more eligible educational 

8 loans. 

9 SEC. 7. TEN PERCENT INCREASE OF PAYMENT FOR ITEMS 

10 AND SERVICES PAYABLE UNDER MEDICARE 

11 PART B FURNISHED IN HEALTH ENTERPRISE 

12 ZONES. 

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

14 1395l(a)) is amended by inserting before the period at the 

15 end the following: ‘‘. With respect to items and services 

16 payable under this part that are furnished in a Health 

17 Enterprise Zone (as defined in section 9 of the Health 

18 Enterprise Zones Act of 2020) during the period begin19 ning on the first day an area is designated a Health En20 terprise Zone under section 2(a)(1) of such Act and end21 ing on the last day of the fiscal year that is 10 fiscal years 

22 following the enactment of this Act, the payment rates 

23 otherwise established for such items and services shall be 

24 increased by 10 percent’’. 


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1 SEC. 8. REPORTING. 

2 (a) IN GENERAL.—Not later than the end of each 

3 fiscal year in the period of 10 fiscal years following the 

4 date of enactment of this Act, the Secretary shall submit 

5 to the Congress a report on the implementation of this 

6 Act and the results thereof. 

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

8 shall— 

9 (1) specify the number and types of incentives 

10 provided pursuant to this Act in each Health Enter11 prise Zone designated under section 2; 

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

13 incentives utilized by each Health Enterprise Zone 

14 have succeeded— 

15 (A) in attracting health care practitioners 

16 to practice in Health Enterprise Zones; 

17 (B) in reducing health disparities and im18 proving health outcomes in Health Enterprise 

19 Zones; and 

20 (C) in reducing health costs and hospital 

21 admissions and readmissions in Health Enter22 prise Zones. 

23 SEC. 9. DEFINITIONS. 

24 In this Act: 


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

2 an area designated under section 2 as a Health En3 terprise Zone. 

4 (2) The term ‘‘Health Enterprise Zone practi5 tioner’’ means a health care practitioner who— 

6 (A) is licensed or certified in accordance 

7 with applicable State law to treat patients in 

8 the respective Health Enterprise Zone; 

9 (B) provides— 

10 (i) primary care, which may include 

11 obstetrics, gynecological services, pediatric 

12 services, or geriatric services; 

13 (ii) behavioral health services, which 

14 may include mental health or substance 

15 use disorder services; or 

16 (iii) dental services; and 

17 (C) is a participating provider of services 

18 or supplier under the Medicare program under 

19 title XVIII of the Social Security Act (42 

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

21 under a State plan under title XIX of such Act 

22 (42 U.S.C. 1396 et seq.). 

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

24 of Health and Human Services. 


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1 SEC. 10. AUTHORIZATION OF APPROPRIATIONS. 

2 To carry out this Act, there is authorized to be appro3 priated such sums as may be necessary for the period of 

4 10 fiscal years following the date of enactment of this Act. 

Æ 


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