[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1189 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1189

To provide incentives to physicians to practice in rural and medically 
            underserved communities and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 5, 2015

 Ms. Klobuchar (for herself, Ms. Heitkamp, Mr. Moran, and Ms. Collins) 
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 
Act''.

SEC. 2. CONRAD STATE 30 PROGRAM.

    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 ``and before September 30, 2015''.

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 alien physicians who completed such 
        service before the date of the enactment of the Conrad State 30 
        and Physician Access Act and any spouses or children of such 
        alien physicians.
            ``(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 prior to 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 such a petition or application until the alien 
                has satisfied all the requirements of the waiver 
                received under section 214(l).''.

SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS.

    (a) In General.--Section 214(l)(1)(C) of the Immigration and 
Nationality Act (8 U.S.C. 1184(l)(1)(C)) is amended 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 care organization, 
                which employment has been determined by the Secretary 
                of Homeland Security to be in the public interest; and
                    ``(ii) the alien agrees to begin 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 by the later of 
                the date that is 90 days after receiving such waiver, 
                90 days after completing graduate medical education or 
                training under a program approved pursuant to section 
                212(j)(1), or 90 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 90 days 
                after the date the alien completes his or her graduate 
                medical education or training and agrees to continue to 
                work for a total of not less than 3 years in any status 
                authorized for such employment under this subsection 
                unless--
                            ``(I) the Secretary determines that 
                        extenuating circumstances exist that justify a 
                        lesser period of employment at such facility or 
                        organization, in which case the alien shall 
                        demonstrate another bona fide offer of 
                        employment at a health facility or health care 
                        organization, for the remainder of such 3-year 
                        period;
                            ``(II) the interested State agency that 
                        requested the waiver attests that extenuating 
                        circumstances exist that justify a lesser 
                        period of employment at such facility or 
                        organization in which case the alien shall 
                        demonstrate another bona fide offer of 
                        employment at a health facility or health care 
                        organization so designated by the Secretary of 
                        Health and Human Services, for the remainder of 
                        such 3-year period; or
                            ``(III) if the alien elects not to pursue a 
                        determination of extenuating circumstances 
                        pursuant to subclause (I) or (II), the alien 
                        terminates the alien's employment relationship 
                        with such facility or organization, in which 
                        case the alien shall be employed for the 
                        remainder of such 3-year period, and 1 
                        additional year for each termination, at 
                        another 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; and''.
    (b) Physician Employment in Underserved Areas.--Section 214(l) of 
the Immigration and Nationality Act (8 U.S.C. 1184(l)) is amended by 
adding at the end the following:
    ``(4) If a physician pursuing graduate medical education or 
training pursuant to section 101(a)(15)(J) applies for a waiver under 
paragraph (1)(B) with an interested State agency and the application is 
denied because the State has requested the maximum number of waivers 
permitted for that fiscal year, the physician's nonimmigrant status 
shall be extended for a period of 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 interested State agency whose State has not 
yet requested the maximum number of waivers. The physician shall be 
authorized to work only for such interested State agency from the date 
on which a new waiver application is filed with the State until the 
date on which the Secretary of Homeland Security denies such waiver or 
issues work authorization for such employment pursuant to the approval 
of such waiver.''.
    (c) Contract Requirements.--Section 214(l) of the Immigration and 
Nationality Act (8 U.S.C. 1184(l)), as amended by subsection (b), 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 whether the contracting facility or 
        organization will pay for the alien's malpractice insurance 
        premiums, including whether the employer will provide 
        malpractice insurance and, if so, the amount of such insurance 
        that will be provided;
            ``(C) describes all of the work locations that the alien 
        will work and 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 paragraph (1)(C) whose 
employment relationship with a health facility or health care 
organization terminates during the 3-year service period required by 
such paragraph--
            ``(A) shall have a period of 120 days beginning on the date 
        of such termination of employment to submit to the Secretary of 
        Homeland Security applications or petitions to commence 
        employment with another contracting 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; and
            ``(B) shall be considered to be maintaining lawful status 
        in an authorized stay during the 120-day period referred to in 
        subsection (A).''.

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 subsections (b) and (c) of 
section 4, is further amended by adding at the end the following:
    ``(7)(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 allocation has occurred 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 the 
Immigration and Nationality 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) Allowable Visa Status for Physicians Fulfilling Waiver 
Requirements in Medically Underserved Areas.--Section 214(l)(2)(A) of 
the Immigration and Nationality Act (8 U.S.C. 1184(l)(2)(A)) is amended 
by striking ``an alien described in section 101(a)(15)(H)(i)(b).'' and 
inserting ``any status authorized for employment under this Act.''.
    (c) 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)(II) of the Immigration and Nationality Act (8 
        U.S.C. 1153(B)(ii)(II)) is amended--
                    (A) by inserting ``(aa)'' after ``(II)''; and
                    (B) by adding at the end the following:
                                    ``(bb) The 5-year service 
                                requirement of item (aa) shall be 
                                counted from the date the alien 
                                physician begins work in the shortage 
                                area in any legal status and not the 
                                date 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, nor an employment contract 
                                dated within a minimum time period 
                                prior to filing of a visa petition 
                                pursuant to 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.''.
    (d) 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 ``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.''.
    (e) Short-Term Work Authorization for Physicians Completing Their 
Residencies.--A physician completing graduate medical education or 
training as 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)) 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 where the 
employment start date for the beneficiary of such petition is October 1 
of that fiscal year. Such physician 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. However, the physician's 
status and employment authorization shall terminate 30 days from the 
date such petition is rejected, denied or revoked. A physician's status 
and employment authorization will automatically extend to October 1 of 
the next fiscal year if all visas as described in such section 
101(a)(15)(H)(i) authorized to be issued for the fiscal year have been 
issued.
    (f) 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 of 
section 212(e) of the Immigration and Nationality Act (8 U.S.C. 
1182(e)).
                                 <all>