[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 665 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 665
To provide incentives to physicians to practice in rural and medically
underserved communities, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 6, 2023
Ms. Klobuchar (for herself, Ms. Collins, Ms. Rosen, Mr. Tillis, Mr.
King, Mr. Thune, Mr. Merkley, Mrs. Capito, Mr. Coons, Mr. Paul, Mr.
Durbin, Mr. Moran, Mrs. Shaheen, Mr. Wicker, Ms. Smith, Mr. Marshall,
Mr. Blumenthal, Mr. Cramer, and Mr. Boozman) introduced the following
bill; which was read twice and referred to the Committee on the
Judiciary
_______________________________________________________________________
A BILL
To provide incentives to physicians to practice in rural and medically
underserved communities, 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.
This Act may be cited as the ``Conrad State 30 and Physician Access
Reauthorization Act''.
SEC. 2. CONRAD STATE 30 PROGRAM.
(a) Extension.--Section 220(c) of the Immigration and Nationality
Technical Corrections Act of 1994 (Public Law 103-416; 8 U.S.C. 1182
note) is amended by striking ``September 30, 2015'' and inserting ``on
the date that is 3 years after the date of the enactment of the Conrad
State 30 and Physician Access Reauthorization Act''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if enacted on September 30, 2018.
SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN MEDICALLY
UNDERSERVED COMMUNITIES.
Section 201(b)(1) of the Immigration and Nationality Act (8 U.S.C.
1151(b)(1)) is amended by adding at the end the following:
``(F)(i) Alien physicians who have completed service
requirements of a waiver requested under section
203(b)(2)(B)(ii), including--
``(I) alien physicians who completed such service
before the date of the enactment of the Conrad State 30
and Physician Access Act; and
``(II) the spouse or children of an alien physician
described in subclause (I).
``(ii) Nothing in this subparagraph may be construed--
``(I) to prevent the filing of a petition with the
Secretary of Homeland Security for classification under
section 204(a) or the filing of an application for
adjustment of status under section 245 by an alien
physician described in this subparagraph before the
date by which such alien physician has completed the
service described in section 214(l) or worked full-time
as a physician for an aggregate of 5 years at the
location identified in the section 214(l) waiver or in
an area or areas designated by the Secretary of Health
and Human Services as having a shortage of health care
professionals; or
``(II) to permit the Secretary of Homeland Security
to grant a petition or application described in
subclause (I) until the alien has satisfied all of the
requirements of the waiver received under section
214(l).''.
SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS.
(a) Exceptions to 2-Year Foreign Residency Requirement.--Section
214(l)(1) of the Immigration and Nationality Act (8 U.S.C. 1184(l)(1))
is amended--
(1) in the matter preceding subparagraph (A), by striking
``Attorney General'' and inserting ``Secretary of Homeland
Security'';
(2) in subparagraph (A), by striking ``Director of the
United States Information Agency'' and inserting ``Secretary of
State'';
(3) in subparagraph (B), by inserting ``, except as
provided in paragraphs (7) and (8)'' before the semicolon at
the end;
(4) in subparagraph (C), by striking clauses (i) and (ii)
and inserting the following:
``(i) the alien demonstrates a bona fide offer of
full-time employment at a health facility or health
care organization, which employment has been determined
by the Secretary of Homeland Security to be in the
public interest; and
``(ii) the alien--
``(I) has accepted employment with the
health facility or health care organization in
a geographic area or areas which are designated
by the Secretary of Health and Human Services
as having a shortage of health care
professionals;
``(II) begins employment by the later of
the date that is--
``(aa) 120 days after receiving
such waiver;
``(bb) 120 days after completing
graduate medical education or training
under a program approved pursuant to
section 212(j)(1); or
``(cc) 120 days after receiving
nonimmigrant status or employment
authorization, if the alien or the
alien's employer petitions for such
nonimmigrant status or employment
authorization not later than 120 days
after the date on which the alien
completes his or her graduate medical
education or training under a program
approved pursuant to section 212(j)(1);
and
``(III) agrees to continue to work for a
total of not less than 3 years in the status
authorized for such employment under this
subsection, except as provided in paragraph
(8).''; and
(5) in subparagraph (D), in the matter preceding clause
(i), by inserting ``(except as provided in paragraph (8))''.
(b) Allowable Visa Status for Physicians Fulfilling Waiver
Requirements in Medically Underserved Areas.--Section 214(l)(2)(A) of
such Act (8 U.S.C. 1184(l)(2)(A)) is amended to read as follows:
``(A) Upon the request of an interested Federal agency or
an interested State agency for recommendation of a waiver under
this section by a physician who is maintaining valid
nonimmigrant status under section 101(a)(15)(J) and a favorable
recommendation by the Secretary of State, the Secretary of
Homeland Security may change the status of such physician to
any status authorized for employment under this Act. The
numerical limitations contained in subsection (g)(1)(A) shall
not apply to any alien whose status is changed under this
subparagraph.''.
(c) Violation of Agreements.--Section 214(l)(3)(A) of such Act (8
U.S.C. 1184(l)(3)(A)) is amended by inserting ``substantial requirement
of an'' before ``agreement entered into''.
(d) Physician Employment in Underserved Areas.--Section 214(l) of
such Act, as amended by this section, is further amended by adding at
the end the following:
``(4)(A) If an interested State agency denies an application for a
waiver under paragraph (1)(B) from a physician pursuing graduate
medical education or training pursuant to section 101(a)(15)(J) because
the State has requested the maximum number of waivers permitted for
that fiscal year, the physician's nonimmigrant status shall be extended
for up to 6 months if the physician agrees to seek a waiver under this
subsection (except for paragraph (1)(D)(ii)) to work for an employer
described in paragraph (1)(C) in a State that has not yet requested the
maximum number of waivers.
``(B) Such physician shall be authorized to work only for the
employer referred to in subparagraph (A) during the period beginning on
the date on which a new waiver application is filed with such State and
ending on the earlier of--
``(i) the date on which the Secretary of Homeland Security
denies such waiver; or
``(ii) the date on which the Secretary approves an
application for change of status under paragraph (2)(A)
pursuant to the approval of such waiver.''.
(e) Contract Requirements.--Section 214(l) of such Act, as amended
by this section, is further amended by adding at the end the following:
``(5) An alien granted a waiver under paragraph (1)(C) shall enter
into an employment agreement with the contracting health facility or
health care organization that--
``(A) specifies the maximum number of on-call hours per
week (which may be a monthly average) that the alien will be
expected to be available and the compensation the alien will
receive for on-call time;
``(B) specifies--
``(i) whether the contracting facility or
organization--
``(I) has secured medical malpractice
liability protection for the alien under
section 224(g) of the Public Health Service Act
(42 U.S.C. 233(g)); or
``(II) will pay the alien's malpractice
insurance premiums;
``(ii) whether the employer will provide
malpractice insurance for the alien; and
``(iii) the amount of such liability protection
that will be provided;
``(C) describes all of the work locations that the alien
will work and includes a statement that the contracting
facility or organization will not add additional work locations
without the approval of the Federal agency or State agency that
requested the waiver; and
``(D) does not include a non-compete provision.
``(6) An alien granted a waiver under this subsection whose
employment relationship with a health facility or health care
organization terminates under paragraph (1)(C)(ii) during the 3-year
service period required under paragraph (1) shall be considered to be
maintaining lawful status in an authorized period of stay during the
120-day period referred to in items (aa) and (bb) of subclause (III) of
paragraph (1)(C)(ii) or the 45-day period referred to in subclause
(III)(cc) of such paragraph.''.
(f) Recapturing Waiver Slots Lost to Other States.--Section 214(l)
of such Act, as amended by this section, is further amended by adding
at the end the following:
``(7) If a recipient of a waiver under this subsection terminates
the recipient's employment with a health facility or health care
organization pursuant to paragraph (1)(C)(ii), including termination of
employment because of circumstances described in paragraph
(1)(C)(ii)(III), and accepts new employment with such a facility or
organization in a different State, the State from which the alien is
departing may be accorded an additional waiver by the Secretary of
State for use in the fiscal year in which the alien's employment was
terminated.''.
(g) Exception to 3-Year Work Requirement.--Section 214(l) of such
Act, as amended by this section, is further amended by adding at the
end the following:
``(8) The 3-year work requirement set forth in subparagraphs (C)
and (D) of paragraph (1) shall not apply if--
``(A)(i) the Secretary of Homeland Security determines that
extenuating circumstances, including violations by the employer
of the employment agreement with the alien or of labor and
employment laws, exist that justify a lesser period of
employment at such facility or organization; and
``(ii) the alien demonstrates, not later than 120 days
after the employment termination date (unless the Secretary
determines that extenuating circumstances would justify an
extension), another bona fide offer of employment at a health
facility or health care organization in a geographic area or
areas which are designated by the Secretary of Health and Human
Services as having a shortage of health care professionals, for
the remainder of such 3-year period;
``(B)(i) the interested State agency that requested the
waiver attests that extenuating circumstances, including
violations by the employer of the employment agreement with the
alien or of labor and employment laws, exist that justify a
lesser period of employment at such facility or organization;
and
``(ii) the alien demonstrates, not later than 120 days
after the employment termination date (unless the Secretary
determines that extenuating circumstances would justify an
extension), another bona fide offer of employment at a health
facility or health care organization in a geographic area or
areas which are designated by the Secretary of Health and Human
Services as having a shortage of health care professionals, for
the remainder of such 3-year period; or
``(C) the alien--
``(i) elects not to pursue a determination of
extenuating circumstances pursuant to subclause (A) or
(B);
``(ii) terminates the alien's employment
relationship with the health facility or health care
organization at which the alien was employed;
``(iii) demonstrates, not later than 45 days after
the employment termination date, another bona fide
offer of employment at a health facility or health care
organization in a geographic area or areas, in the
State that requested the alien's waiver, which are
designated by the Secretary of Health and Human
Services as having a shortage of health care
professionals; and
``(iv) agrees to be employed for the remainder of
such 3-year period, and 1 additional year for each
termination under clause (ii).''.
SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS.
(a) In General.--Section 214(l) of the Immigration and Nationality
Act (8 U.S.C. 1184(l)), as amended by section 4, is further amended by
adding at the end the following:
``(9)(A)(i) All States shall be allotted a total of 35 waivers
under paragraph (1)(B) for a fiscal year if 90 percent of the waivers
available to the States receiving at least 5 waivers were used in the
previous fiscal year.
``(ii) When an allotment occurs under clause (i), all States shall
be allotted an additional 5 waivers under paragraph (1)(B) for each
subsequent fiscal year if 90 percent of the waivers available to the
States receiving at least 5 waivers were used in the previous fiscal
year. If the States are allotted 45 or more waivers for a fiscal year,
the States will only receive an additional increase of 5 waivers the
following fiscal year if 95 percent of the waivers available to the
States receiving at least 1 waiver were used in the previous fiscal
year.
``(B) Any increase in allotments under subparagraph (A) shall be
maintained indefinitely, unless in a fiscal year, the total number of
such waivers granted is 5 percent lower than in the last year in which
there was an increase in the number of waivers allotted pursuant to
this paragraph, in which case--
``(i) the number of waivers allotted shall be decreased by
5 for all States beginning in the next fiscal year; and
``(ii) each additional 5 percent decrease in such waivers
granted from the last year in which there was an increase in
the allotment, shall result in an additional decrease of 5
waivers allotted for all States, provided that the number of
waivers allotted for all States shall not drop below 30.''.
(b) Academic Medical Centers.--Section 214(l)(1)(D) of such Act (8
U.S.C. 1184(l)(1)(D)) is amended--
(1) in clause (ii), by striking ``and'' at the end;
(2) in clause (iii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(iv) in the case of a request by an interested
State agency--
``(I) the head of such agency determines
that the alien is to practice medicine in, or
be on the faculty of a residency program at, an
academic medical center (as that term is
defined in section 411.355(e)(2) of title 42,
Code of Federal Regulations, or similar
successor regulation), without regard to
whether such facility is located within an area
designated by the Secretary of Health and Human
Services as having a shortage of health care
professionals; and
``(II) the head of such agency determines
that--
``(aa) the alien physician's work
is in the public interest; and
``(bb) the grant of such waiver
would not cause the number of the
waivers granted on behalf of aliens for
such State for a fiscal year (within
the limitation in subparagraph (B) and
subject to paragraph (6)) in accordance
with the conditions of this clause to
exceed 3.''.
SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, AND OTHER PROVISIONS
RELATED TO PHYSICIAN IMMIGRATION.
(a) Dual Intent for Physicians Seeking Graduate Medical Training.--
Section 214(b) of the Immigration and Nationality Act (8 U.S.C.
1184(b)) is amended by striking ``(other than a nonimmigrant described
in subparagraph (L) or (V) of section 101(a)(15), and other than a
nonimmigrant described in any provision of section 101(a)(15)(H)(i)
except subclause (b1) of such section)'' and inserting ``(other than a
nonimmigrant described in subparagraph (L) or (V) of section
101(a)(15), a nonimmigrant described in any provision of section
101(a)(15)(H)(i) (except subclause (b1) of such section), and an alien
coming to the United States to receive graduate medical education or
training as described in section 212(j) or to take examinations
required to receive graduate medical education or training as described
in section 212(j))''.
(b) Physician National Interest Waiver Clarifications.--
(1) Practice and geographic area.--Section
203(b)(2)(B)(ii)(I) of the Immigration and Nationality Act (8
U.S.C. 1153(b)(2)(B)(ii)(I)) is amended by striking items (aa)
and (bb) and inserting the following:
``(aa) the alien physician agrees to work
on a full-time basis practicing primary care,
specialty medicine, or a combination thereof,
in an area or areas designated by the Secretary
of Health and Human Services as having a
shortage of health care professionals, or at a
health care facility under the jurisdiction of
the Secretary of Veterans Affairs; or
``(bb) the alien physician is pursuing such
waiver based upon service at a facility or
facilities that serve patients who reside in a
geographic area or areas designated by the
Secretary of Health and Human Services as
having a shortage of health care professionals
(without regard to whether such facility or
facilities are located within such an area) and
a Federal agency, or a local, county, regional,
or State department of public health determines
the alien physician's work was or will be in
the public interest.''.
(2) Five-year service requirement.--Section
203(b)(2)(B)(ii) of the Immigration and Nationality Act (8
U.S.C. 1153(B)(ii)) is amended--
(A) by moving subclauses (II), (III), and (IV) 4
ems to the left; and
(B) in subclause (II)--
(i) by inserting ``(aa)'' after ``(II)'';
and
(ii) by adding at the end the following:
``(bb) The 5-year service requirement under
item (aa) shall begin on the date on which the
alien physician begins work in the shortage
area in any legal status and not on the date on
which an immigrant visa petition is filed or
approved. Such service shall be aggregated
without regard to when such service began and
without regard to whether such service began
during or in conjunction with a course of
graduate medical education.
``(cc) An alien physician shall not be
required to submit an employment contract with
a term exceeding the balance of the 5-year
commitment yet to be served or an employment
contract dated within a minimum time period
before filing a visa petition under this
subsection.
``(dd) An alien physician shall not be
required to file additional immigrant visa
petitions upon a change of work location from
the location approved in the original national
interest immigrant petition.''.
(c) Technical Clarification Regarding Advanced Degree for
Physicians.--Section 203(b)(2)(A) of the Immigration and Nationality
Act (8 U.S.C. 1153(b)(2)(A)) is amended by adding at the end the
following: ``An alien physician holding a foreign medical degree that
has been deemed sufficient for acceptance by an accredited United
States medical residency or fellowship program is a member of the
professions holding an advanced degree or its equivalent.''.
(d) Short-Term Work Authorization for Physicians Completing Their
Residencies.--
(1) In general.--A physician completing graduate medical
education or training described in section 212(j) of the
Immigration and Nationality Act (8 U.S.C. 1182(j)) as a
nonimmigrant described in section 101(a)(15)(H)(i) of such Act
(8 U.S.C. 1101(a)(15)(H)(i))--
(A) shall have such nonimmigrant status
automatically extended until October 1 of the fiscal
year for which a petition for a continuation of such
nonimmigrant status has been submitted in a timely
manner and the employment start date for the
beneficiary of such petition is October 1 of that
fiscal year; and
(B) shall be authorized to be employed incident to
status during the period between the filing of such
petition and October 1 of such fiscal year.
(2) Termination.--The physician's status and employment
authorization shall terminate on the date that is 30 days after
the date on which a petition described in paragraph (1)(A) is
rejected, denied or revoked.
(3) Automatic extension.--A physician's status and
employment authorization will automatically extend to October 1
of the next fiscal year if all of the visas described in
section 101(a)(15)(H)(i) of such Act that were authorized to be
issued for the fiscal year have been issued.
(e) Applicability of Section 212(e) to Spouses and Children of J-1
Exchange Visitors.--A spouse or child of an exchange visitor described
in section 101(a)(15)(J) of the Immigration and Nationality Act (8
U.S.C. 1101(a)(15)(J)) shall not be subject to the requirements under
section 212(e) of such Act (8 U.S.C. 1182(e)).
SEC. 7. ANNUAL CONRAD STATE 30 J-1 VISA WAIVER PROGRAM STATISTICAL
REPORT.
The Director of U.S. Citizenship and Immigration Services shall
submit an annual report to Congress and to the Department of Health and
Human Services that identifies the number of aliens admitted during the
most recently concluded fiscal year as a result of the Conrad State 30
J-1 Visa Waiver Program established under sections 212(e) and 214(l) of
the Immigration and Nationality Act (8 U.S.C. 1182(e) and 1184(l)),
broken down by State.
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