[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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