[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 898 Introduced in Senate (IS)]

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115th CONGRESS
  1st Session
                                 S. 898

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 7, 2017

 Ms. Klobuchar (for herself, Ms. Collins, and Ms. Heitkamp) 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 
``September 30, 2021''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if enacted on April 28, 2017.

SEC. 3. EMPLOYMENT PROTECTIONS FOR PHYSICIANS.

    (a) In General.--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 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; and
            (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) 90 days after receiving such 
                                waiver;
                                    ``(bb) 90 days after completing 
                                graduate medical education or training 
                                under a program approved pursuant to 
                                section 212(j)(1); or
                                    ``(cc) 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 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 unless--
                                    ``(aa) 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, in which case 
                                the alien shall demonstrate, not later 
                                than 90 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;
                                    ``(bb) 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 in which case the alien 
                                shall demonstrate, not later than 90 
                                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
                                    ``(cc) if the alien elects not to 
                                pursue a determination of extenuating 
                                circumstances pursuant to item (aa) or 
                                (bb), the alien terminates the alien's 
                                employment relationship with such 
                                facility or organization, in which case 
                                the alien shall demonstrate, 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 agree to be employed 
                                for the remainder of such 3-year 
                                period, and 1 additional year for each 
                                termination under this subclause; 
                                and''.
    (b) Allowable Visa Status for Physicians Fulfilling Waiver 
Requirements in Medically Underserved Areas.--Section 214(l)(2) of such 
Act (8 U.S.C. 1184(l)(2)) is amended by amending subparagraph (A) 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 
        that of an alien described in section 101(a)(15)(H)(i)(B). 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 (8 U.S.C. 1184(l)) is amended by adding at the end the 
following:
    ``(4)(A) If an interested State agency denies the 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) from the date on which a new 
waiver application is filed with such State until 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 subsection (d), 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 will pay the alien's malpractice insurance 
                premiums;
                    ``(ii) whether the employer will provide 
                malpractice insurance; and
                    ``(iii) the amount of such insurance 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 
90-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 subsections (d) and (e), 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.''.

SEC. 4. 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 3, is further amended by 
adding at the end the following:
    ``(8)(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 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. 5. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, AND OTHER PROVISIONS 
              RELATED TO PHYSICIAN IMMIGRATION.

    (a) Visa Eligibility.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of State shall amend guidance in 
the Foreign Affairs Manual to clarify that the expression of a future 
intention to seek a waiver under section 214(l) of the Immigration and 
Nationality Act (8 U.S.C. 1184(l)) by an alien coming to the United 
States to receive graduate medical education or training, as described 
in section 212(j) of such Act (8 U.S.C. 1182(j)), or to take 
examinations required to receive such graduate medical education or 
training, shall not, by itself, constitute evidence of an intention to 
abandon a foreign residence for purposes of obtaining a visa as a 
nonimmigrant or otherwise obtaining or maintaining the status of a 
nonimmigrant.
    (b) Applicability of Section 212(e) to Spouses and Children of J-1 
Exchange Visitors.--Section 212(e) of the Immigration and Nationality 
Act (8 U.S.C. 1182(e)) is amended--
            (1) by inserting ``(1)'' after ``(e)''; and
            (2) by adding at the end the following
    ``(2) A spouse or child of an exchange visitor described in section 
101(a)(15)(J) shall not be subject to the requirements under this 
subsection solely on account of such spouse or child's derivative 
nonimmigrant status to an exchange visitor who is subject to the 
requirements under this subsection.''.
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