I 

118TH CONGRESS 

1ST SESSION H. R. 6475 

To provide for the designation of areas as Health Disparity Zones to reduce 

health disparities and improve health outcomes in such areas, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 21, 2023 

Mr. THANEDAR 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 Disparity 

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 Disparity Zones Act of 2023’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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Sec. 2. Designation of Health Disparity Zones. 

Sec. 3. Consultation. 

Sec. 4. Tax incentives. 

Sec. 5. Grants. 

Sec. 6. Student loan repayment program. 

Sec. 7. 10-percent increase of payment for items and services payable under 

Medicare Part B furnished in Health Disparity Zones. 

Sec. 8. Reporting. 

Sec. 9. Definitions. 

Sec. 10. Authorization of appropriations. 

1 SEC. 2. DESIGNATION OF HEALTH DISPARITY 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 Dis7 parity 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 Disparity 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 participation in the spe20 cial supplemental nutrition program under 


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1 section 17 of the Child Nutrition Act of 

2 1966 (42 U.S.C. 1786) that is higher than 

3 the national average rate of participation 

4 in such program; 

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

7 (iv) a higher percentage of instances 

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

10 (v) designation under section 332 of 

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

12 254e) as a health professional shortage 

13 area; and 

14 (C) are part of a Metropolitan Statistical 

15 Area or Micropolitan Statistical Area identified 

16 by the Office of Management and Budget. 

17 (b) SOLICITATION OF APPLICATIONS.—The Sec18 retary shall— 

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

20 enactment of this Act, solicit applications under sub21 section (c); and 

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

23 Health and Human Services— 


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1 (A) the names of all applicants, together 

2 with the names of each applicant’s coalition 

3 partners; and 

4 (B) a description of all areas proposed to 

5 be designated as Health Disparity Zones. 

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

7 designation of an area as a Health Disparity Zone, a com8 munity-based nonprofit organization or local governmental 

9 agency, in coalition with an array of health care providers, 

10 hospitals, nonprofit community health clinics, health cen11 ters, social service organizations, and other related organi12 zations shall submit an application to the Secretary. 

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

14 shall— 

15 (1) include an effective and sustainable plan 

16 with respect to the area proposed for designation— 

17 (A) to reduce health disparities; 

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

19 savings to, the health care system; 

20 (C) to improve health outcomes; and 

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

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

23 to address health care provider capacity, im24 prove health services delivery, effectuate comVerDate Sep 11 2014 23:12 Dec 01, 2023 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6475.IH H6475

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1 munity improvements, or conduct outreach and 

2 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: cardio6 vascular disease, asthma, diabetes, dental health, be7 havioral health, maternal and birth health, sexually 

8 transmitted infections, and obesity. 

9 (e) CONSIDERATIONS.—The Secretary— 

10 (1) shall consider geographic diversity, among 

11 other factors, in selecting areas for designation as 

12 Health Disparity Zones; and 

13 (2) may conduct outreach efforts to encourage 

14 a geographically diverse pool of applicants, including 

15 for designating Health Disparity Zones in rural 

16 areas. 

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

18 Health Disparity Zones, the Secretary shall give higher 

19 priority to applications based on the extent to which they 

20 demonstrate the following: 

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

22 stakeholders in the public and private sectors in the 

23 area proposed for designation, including residents 

24 and local governments of such area. 


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1 (2) A plan for long-term funding and sustain2 ability. 

3 (3) Supporting funds from the private sector. 

4 (4) Integration with any applicable State health 

5 improvement process or plan. 

6 (5) A plan for evaluation of the impact of des7 ignation of such area as a Health Disparity Zone. 

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

9 grants, or other incentives to reduce health dispari10 ties and improve health outcomes in the proposed 

11 Health Disparity Zone. 

12 (7) Such other factors as the Secretary deter13 mines are appropriate to demonstrate a commitment 

14 to reduce health disparities and improve health out15 comes in such area. 

16 (g) PERIOD OF DESIGNATION.—The designation 

17 under this section of any area as a Health Disparity Zone 

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

19 following the enactment of this Act. 

20 SEC. 3. CONSULTATION. 

21 The Secretary shall carry out this Act in consultation 

22 with— 

23 (1) the Secretary of Housing and Urban Devel24 opment; and 


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1 (2) the Deputy Assistant Secretary for Minority 

2 Health. 

3 SEC. 4. TAX INCENTIVES. 

4 (a) WORK OPPORTUNITY CREDIT FOR HIRING

5 HEALTH DISPARITY ZONE WORKERS.— 

6 (1) IN GENERAL.—Section 51(d)(1) of the In7 ternal Revenue Code of 1986 is amended— 

8 (A) in subparagraph (I), by striking ‘‘or’’ 

9 at the end; 

10 (B) in subparagraph (J), by striking the 

11 period at the end and inserting ‘‘, or’’; and 

12 (C) by adding at the end the following: 

13 ‘‘(K) a qualified Health Disparity Zone 

14 worker, to the extent that the qualified first15 year wages with respect to such worker are paid 

16 for qualified Health Disparity Zone work.’’. 

17 (2) QUALIFIED HEALTH DISPARITY ZONE

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

19 by adding at the end the following new paragraphs: 

20 ‘‘(16) QUALIFIED HEALTH DISPARITY ZONE

21 WORKER.—The term ‘qualified Health Disparity 

22 Zone worker’ means any individual who is certified 

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

24 hiring date) a principal place of employment within 

25 a Health Disparity Zone (as such term is defined in 


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1 section 9 of the Health Disparity Zones Act of 

2 2023). 

3 ‘‘(17) QUALIFIED HEALTH DISPARITY ZONE

4 WORK.—The term ‘qualified Health Disparity Zone 

5 work’ means employment by a Health Disparity 

6 Zone practitioner (as such term is defined in section 

7 9 of the Health Disparity Zones Act of 2023), the 

8 primary official duties of which promote access to 

9 healthcare in a Health Disparity Zone (as such term 

10 is defined in section 9 of the Health Disparity Zones 

11 Act of 2023).’’. 

12 (3) EFFECTIVE DATE.—The amendments made 

13 by this section shall apply to amounts paid or in14 curred after the date of the enactment of this Act 

15 to individuals who begin work for the employer after 

16 such date. 

17 (b) CREDIT FOR HEALTH DISPARITY ZONE WORK18 ERS.— 

19 (1) IN GENERAL.—Subpart A of part IV of sub20 chapter A of chapter 1 of the Internal Revenue Code 

21 of 1986 is amended by inserting after section 25E 

22 the following new section: 


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1 ‘‘SEC. 25F. CREDIT FOR QUALIFIED HEALTH DISPARITY 

2 ZONE WORKERS. 

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

4 qualified Health Disparity Zone worker, there shall be al5 lowed as a credit against the tax imposed by this chapter 

6 for a taxable year an amount equal to 40% of wages re7 ceived for qualified Health Disparity Zone work. 

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

9 ‘‘(1) The term ‘qualified Health Disparity Zone 

10 worker’ means, with respect to wages, an individual 

11 whose principal place of employment while earning 

12 such wages is within a Health Disparity Zone (as 

13 such term is defined in section 9 of the Health Dis14 parity Zones Act of 2023). 

15 ‘‘(2) The term ‘qualified Health Disparity Zone 

16 work’ has the meaning given such term in section 

17 51.’’. 

18 (2) CLERICAL AMENDMENT.—The table of sec19 tions for subpart A of part IV of subchapter A of 

20 chapter 1 of such Code is amended by inserting 

21 after the item relating to section 25D the following 

22 new item: 

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

23 (3) EFFECTIVE DATE.—The amendments made 

24 by this section shall apply to amounts paid or in25 curred after the date of the enactment of this Act. 


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1 SEC. 5. GRANTS. 

2 (a) AUTHORIZATION.—For each area designated 

3 under section 2 as a Health Disparity Zone, the Secretary 

4 may award a grant to the community-based nonprofit or5 ganization or local governmental agency that applied for 

6 such designation to support such applicant and its coali7 tion partners in reducing health disparities and improving 

8 health outcomes in such area. 

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

10 through a grant under this section shall be consistent with 

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

12 and may include the following: 

13 (1) SUBGRANTS TO HEALTH CARE PRACTI14 TIONERS.— 

15 (A) IN GENERAL.—For the purpose of im16 proving or expanding the delivery of health care 

17 in the respective Health Disparity Zone, the 

18 grantee may award subgrants to Health Dis19 parity Zone practitioners to defray costs related 

20 to innovative strategies listed in paragraph (2). 

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

22 a subgrant pursuant to subparagraph (A), a 

23 Health Disparity Zone practitioner shall— 

24 (i) own or lease a health care facility 

25 in the Health Disparity Zone; or 


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1 (ii) provide health care in such a facil2 ity. 

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

4 under subparagraph (A) may not exceed the 

5 lesser of— 

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

7 (ii) 50 percent of the costs of the 

8 equipment, or capital or leasehold improve9 ments, to be defrayed using the subgrant 

10 to implement innovative strategies listed in 

11 paragraph (2). 

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

13 subgrantee) may use a grant received under this sec14 tion (or a subgrant received under paragraph (1)) to 

15 implement innovative public health strategies in the 

16 respective Health Disparity Zone, which strategies 

17 may include— 

18 (A) internships and volunteer opportunities 

19 for students who reside in the Health Disparity 

20 Zone; 

21 (B) funding resources to improve health 

22 care provider capacity to serve non-English 

23 speakers; 

24 (C) operation of medical, mental and be25 havioral health, and dental mobile clinics; 


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1 (D) provision of transportation to and 

2 from medical appointments for patients; 

3 (E) funding resources to improve access to 

4 healthy food, recreation, and high-quality hous5 ing; 

6 (F) capital or leasehold improvements to a 

7 health care facility in the respective Health Dis8 parity Zone; and 

9 (G) medical or dental equipment to be 

10 used in such a facility. 

11 SEC. 6. STUDENT LOAN REPAYMENT PROGRAM. 

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

13 loan repayment program under which the Secretary enters 

14 into agreements with eligible Health Disparity Zone prac15 titioners to make payments on the principal and interest 

16 of the eligible educational loans of such practitioners for 

17 each year such practitioners agree to provide health care 

18 services in a Health Disparity Zone. 

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

20 agreements under this section, the Secretary may not 

21 agree to— 

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

23 respect to a practitioner; or 


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

2 than a total of $100,000, with respect to a practi3 tioner. 

4 (c) INELIGIBILITY FOR DOUBLE BENEFITS.—No 

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

6 of loan obligations or a loan repayment under both— 

7 (1) this section; and 

8 (2) any federally supported loan forgiveness 

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

10 846 of this Act, or section 428J, 428L, 455(m), or 

11 460 of the Higher Education Act of 1965. 

12 (d) DEFINITIONS.—In this section: 

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

14 any federally funded or guaranteed student loan as 

15 determined appropriate by the Secretary in coordina16 tion with the Secretary of Education. 

17 (2) The term ‘‘eligible Health Disparity Zone 

18 practitioner’’ means a Health Disparity Zone practi19 tioner who agrees— 

20 (A) to provide health care services in a 

21 Health Disparity Zone for a specified period 

22 that is not less than one year; and 

23 (B) has one or more eligible educational 

24 loans. 


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1 SEC. 7. 10-PERCENT INCREASE OF PAYMENT FOR ITEMS 

2 AND SERVICES PAYABLE UNDER MEDICARE 

3 PART B FURNISHED IN HEALTH DISPARITY 

4 ZONES. 

5 Section 1833(a) of the Social Security Act (42 

6 U.S.C.1395l(a)) is amended by inserting before the period 

7 at the end the following: ‘‘. With respect to items and serv8 ices payable under this part that are furnished in a Health 

9 Disparity Zone (as defined in section 9 of the Health Dis10 parity Zones Act of 2023) during the period beginning on 

11 the first day an area is designated a Health Disparity 

12 Zone under section 2(a)(1) of such Act and ending on the 

13 last day of the fiscal year that is 10 fiscal years following 

14 the enactment of this Act, the payment rates otherwise 

15 established for such items and services shall be increased 

16 by 10 percent. The cost-sharing requirements (if any) ap17 plicable to an item or service described in the preceding 

18 sentence furnished to an individual shall be calculated as 

19 if such preceding sentence did not apply’’. 

20 SEC. 8. REPORTING. 

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

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

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

24 to the Congress a report on the implementation of this 

25 Act and the results thereof. 


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

2 shall— 

3 (1) specify the number and types of incentives 

4 provided pursuant to this Act in each Health Dis5 parity Zone designated under section 2; 

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

7 incentives utilized by each Health Disparity Zone 

8 have succeeded— 

9 (A) in attracting health care practitioners 

10 to practice in Health Disparity Zones; 

11 (B) in reducing health disparities and im12 proving health outcomes in Health Disparity 

13 Zones; and 

14 (C) in reducing health costs and hospital 

15 admissions and readmissions in Health Dis16 parity Zones. 

17 SEC. 9. DEFINITIONS. 

18 In this Act: 

19 (1) The term ‘‘Health Disparity Zone’’ means 

20 an area designated under section 2 as a Health Dis21 parity Zone. 

22 (2) The term ‘‘Health Disparity Zone practi23 tioner’’ means a health care practitioner who— 


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1 (A) is licensed or certified in accordance 

2 with applicable State law to treat patients in 

3 the respective Health Disparity Zone; 

4 (B) provides— 

5 (i) primary care, which may include 

6 obstetrics, gynecological services, pediatric 

7 services, or geriatric services; 

8 (ii) behavioral health services, which 

9 may include mental health or substance 

10 use disorder services; or 

11 (iii) dental services; and 

12 (C) is a participating provider of services 

13 or supplier under the Medicare program under 

14 title XVIII of the Social Security Act (42 

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

16 under a State plan under title XIX of such Act 

17 (42 U.S.C. 1396 et seq.). 

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

19 of Health and Human Services. 

20 SEC. 10. AUTHORIZATION OF APPROPRIATIONS. 

21 To carry out this Act, there is authorized to be appro22 priated such sums as may be necessary for the period of 

23 10 fiscal years following the date of enactment of this Act. 

Æ 


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