I 
117TH CONGRESS 
1ST SESSION H. R. 4510 
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 
JULY 19, 2021 
Mr. BROWN
(for himself, Mr. HOYER, Ms. BLUNT
ROCHESTER, Mr. 
CA´RDENAS, Ms. KELLY of Illinois, Ms. KUSTER, and Ms. SEWELL) intro-
duced 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. 
Be it enacted by the Senate and House of Representa-
tives 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 2021’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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. 10-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. 
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 Sec-
retary shall, pursuant to applications submitted 
under subsection (c), designate areas as Health En-
terprise Zones to reduce health disparities and im-
prove health outcomes in such areas. 
(2) ELIGIBILITY OF AREA.—To be designated 
as a Health Enterprise Zone under this section, an 
area must— 
(A) be a contiguous geographic area in one 
census tract or ZIP Code; 
(B) have measurable and documented ra-
cial, 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 spe-
cial supplemental nutrition program under 
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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; and 
(iii) lower life expectancy than the na-
tional average; 
(iv) a higher percentage of instances 
of low birth weight than the national aver-
age; 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) are part of a Metropolitan Statistical 
Area or Micropolitan Statistical Area identified 
by the Office of Management and Budget. 
(b) SOLICITATION
OF
APPLICATIONS.—The Sec-
retary shall— 
(1) not later than 12 months after the date of 
enactment of this Act, solicit applications under sub-
section (c); and 
(2) publish on the website of the Department of 
Health and Human Services— 
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(A) the names of all applicants, 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 govern-
mental agency, in coalition with an array of health care 
providers, hospitals, nonprofit community health clinics, 
health centers, social service organizations, and other re-
lated organizations shall submit an application to the Sec-
retary. 
(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 sections 4, 5, 6, and 7 
to address health care provider capacity, im-
prove health services delivery, effectuate com-
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munity 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: cardio-
vascular disease, asthma, diabetes, dental health, be-
havioral health, maternal and birth health, sexually 
transmitted infections, and 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 they 
demonstrate 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. 
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(2) A plan for long-term funding and sustain-
ability. 
(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 des-
ignation of such area as a Health Enterprise Zone. 
(6) A plan to utilize existing State tax credits, 
grants, or other incentives to reduce health dispari-
ties and improve health outcomes in the proposed 
Health Enterprise Zone. 
(7) Such other factors as the Secretary deter-
mines are appropriate to demonstrate a commitment 
to reduce health disparities and improve health out-
comes in such area. 
(g) PERIOD
OF
DESIGNATION.—The designation 
under this section of any area as a Health Enterprise Zone 
shall expire at the end of the period of 10 fiscal years 
following the enactment of this Act. 
SEC. 3. CONSULTATION. 
The Secretary shall carry out this Act in consultation 
with— 
(1) the Secretary of Housing and Urban Devel-
opment; and 
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(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 In-
ternal 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 paragraphs: 
‘‘(16) 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 (as such term is defined 
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in section 9 of the Health Enterprise Zones Act of 
2021). 
‘‘(17) QUALIFIED HEALTH ENTERPRISE ZONE 
WORK.—The term ‘qualified Health Enterprise Zone 
work’ means employment by a Health Enterprise 
Zone practitioner (as such term is defined in section 
9 of the Health Enterprise Zones Act of 2021), the 
primary official duties of which promote access to 
healthcare in a Health Enterprise Zone (as such 
term is defined in section 9 of the Health Enterprise 
Zones Act of 2021).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this section shall apply to amounts paid or in-
curred 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 WORK-
ERS.— 
(1) IN GENERAL.—Subpart A of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code 
of 1986 is amended by inserting after section 25D 
the following new section: 
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‘‘SEC. 25E. 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% of wages re-
ceived for qualified Health Enterprise Zone work. 
‘‘(b) DEFINITIONS.—For purposes of this section— 
‘‘(1) The term ‘qualified Health Enterprise 
Zone worker’ means, with respect to wages, an indi-
vidual 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 2021). 
‘‘(2) The term ‘qualified Health Enterprise 
Zone work’ has the meaning given such term in sec-
tion 51.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subpart A of part IV of subchapter A of 
chapter 1 of such Code is amended by inserting 
after the item relating to section 25D the following 
new item: 
‘‘Sec. 25E. Credit for qualified Health Enterprise Zone workers.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this section shall apply to amounts paid or in-
curred after the date of the enactment of this Act. 
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SEC. 5. GRANTS. 
(a) AUTHORIZATION.—For each area designated 
under section 2 as a Health Enterprise Zone, the Sec-
retary may award a grant to the community-based non-
profit organization or local governmental agency that ap-
plied 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
PRACTI-
TIONERS.— 
(A) IN GENERAL.—For the purpose of im-
proving or expanding the delivery of health care 
in the respective Health Enterprise Zone, the 
grantee may award subgrants to Health Enter-
prise 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 
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(ii) provide health care in such a facil-
ity. 
(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 improve-
ments, to be defrayed using the subgrant 
to implement innovative strategies listed in 
paragraph (2). 
(2) INNOVATIVE STRATEGIES.—A grantee (or 
subgrantee) may use a grant received under this sec-
tion (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 Enter-
prise Zone; 
(B) funding resources to improve health 
care provider capacity to serve non-English 
speakers; 
(C) operation of medical, mental and be-
havioral health, and dental mobile clinics; 
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(D) provision of transportation to and 
from medical appointments for patients; 
(E) funding resources to improve access to 
healthy food, recreation, and high-quality hous-
ing; 
(F) capital or leasehold improvements to a 
health care facility in the respective Health En-
terprise 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 inter-
est 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 
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(2) pay more than $10,000 per year, or more 
than a total of $100,000, with respect to a practi-
tioner. 
(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 this Act, or section 428J, 428L, 455(m), or 
460 of the Higher Education Act of 1965. 
(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 coordina-
tion with the Secretary of Education. 
(2) The term ‘‘eligible Health Enterprise Zone 
practitioner’’ means a Health Enterprise Zone prac-
titioner who agrees— 
(A) 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. 
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SEC. 7. 10-PERCENT INCREASE OF PAYMENT FOR ITEMS 
AND SERVICES PAYABLE UNDER MEDICARE 
PART B FURNISHED IN HEALTH ENTERPRISE 
ZONES. 
Section 1833(a) of the Social Security Act (42 
U.S.C.1395l(a)) is amended by inserting before the period 
at the end the following: ‘‘. With respect to items and serv-
ices payable under this part that are furnished in a Health 
Enterprise Zone (as defined in section 9 of the Health 
Enterprise Zones Act of 2021) during the period begin-
ning on the first day an area is designated a Health En-
terprise Zone under section 2(a)(1) of such Act and end-
ing on the last day of the fiscal year that is 10 fiscal years 
following the enactment of this Act, the payment rates 
otherwise established for such items and services shall be 
increased by 10 percent. The cost-sharing requirements (if 
any) applicable to an item or service described in the pre-
ceding sentence furnished to an individual shall be cal-
culated as if such preceding sentence did not apply’’. 
SEC. 8. REPORTING. 
(a) IN GENERAL.—Not later than the end of each 
fiscal year in the period of 10 fiscal years following the 
date of enactment of this Act, the Secretary shall submit 
to the Congress a report on the implementation of this 
Act and the results thereof. 
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(b) CONTENTS.—Each report under subsection (a) 
shall— 
(1) specify the number and types of incentives 
provided pursuant to this Act in each Health Enter-
prise Zone designated under section 2; 
(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 im-
proving health outcomes in Health Enterprise 
Zones; and 
(C) in reducing health costs and hospital 
admissions and readmissions in Health Enter-
prise Zones. 
SEC. 9. DEFINITIONS. 
In this Act: 
(1) The term ‘‘Health Enterprise Zone’’ means 
an area designated under section 2 as a Health En-
terprise Zone. 
(2) The term ‘‘Health Enterprise Zone practi-
tioner’’ means a health care practitioner who— 
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(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 appro-
priated such sums as may be necessary for the period of 
10 fiscal years following the date of enactment of this Act. 
Æ 
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