Health Enterprise Zones Act of 2021
Bill: H.R.4510 | Sponsor: Rep. Brown, Anthony G. (D-MD)
Policy area: Health

Summary:
Health Enterprise Zones Act of 2021
This bill provides for the designation of Health Enterprise Zones in certain geographic areas with documented and measurable health disparities. This designation, which expires 10 fiscal years after the bill's enactment, confers eligibility for certain grants, student loan repayment programs, and tax credits for those working to reduce health disparities and improve health outcomes in these zones.
Specifically, community-based nonprofits or local government agencies, in coalition with health care providers, social service organizations, and others, may apply to the Department of Health and Human Services (HHS) for the designation. The application must include a plan to reduce health disparities and achieve other outcomes.
In implementing the program, HHS must consult with, among others, the Department of Housing and Urban Development. When approving applications, HHS shall consider factors including geographic diversity and the commitment of supporting funds from the private sector. HHS (1) may award grants to organizations or agencies that applied for the designation to support activities aligned with their plans, and (2) must carry out a student loan repayment program for health care providers who agree to provide services in a Health Enterprise Zone.
In addition, the bill establishes tax credits for employers that hire, and individuals who work as, Health Enterprise Zone workers.

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 2021''.
    (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. 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 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 must--
                    (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; and
                            (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) are part of a Metropolitan Statistical Area or 
                Micropolitan Statistical Area identified by the Office 
                of Management and Budget.
    (b) Solicitation of Applications.--The Secretary shall--
            (1) not later than 12 months 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, 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 sections 4, 5, 6, and 7 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: cardiovascular disease, asthma, diabetes, 
        dental health, behavioral 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.
            (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 
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 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 
        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 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 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 is amended by 
        inserting after section 25D the following new section:

``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 received 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 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 2021).
            ``(2) The term `qualified Health Enterprise Zone work' has 
        the meaning given such term in section 51.''.
            (2) Clerical amendment.--The table of sections 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 incurred 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, 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 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 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 coordination with the Secretary 
        of Education.
            (2) The term ``eligible Health Enterprise Zone 
        practitioner'' means a Health Enterprise Zone practitioner 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.

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 services 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 beginning on the 
first day an area is designated a Health Enterprise Zone under section 
2(a)(1) of such Act and ending 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 preceding sentence 
furnished to an individual shall be calculated 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.
    (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;
            (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 of 10 fiscal years following 
the date of enactment of this Act.
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