The HEART Act aims to create an income tax incentive for donations to rural hospital organizations in Arkansas by establishing a new subchapter in the Arkansas Code. This subchapter defines essential terms such as "critical access hospital" and "rural hospital organization," and sets criteria for these organizations to qualify for contributions, including the provision of healthcare services to indigent patients. The Department of Health will compile a list of eligible organizations and develop an operations manual to rank them based on financial need. The bill also introduces an income tax credit for individual and corporate taxpayers who contribute to these organizations, with specific limits on the total amount of credits allowed in a taxable year and caps on individual contributions.

Additionally, the bill amends the existing tax credit program by requiring taxpayers to obtain preapproval from the secretary for their contributions, which will not count against credit limits if regulations are not followed. It ensures that preapproved taxpayers retain their status even if credit percentages change and allows them to benefit from the credit even if the organization fails to meet reporting requirements. The Department of Finance and Administration is prohibited from taking adverse actions against donors if their contributions were preapproved before an organization was removed from the eligibility list. The bill also mandates documentation for claiming credits, transparency in reporting, and an annual audit for accountability, with these changes effective for tax years beginning on or after January 1, 2024.