[Congressional Record Volume 144, Number 107 (Monday, August 3, 1998)]
[House]
[Pages H6931-H6935]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      HEALTH PROFESSIONAL SHORTAGE AREA NURSING RELIEF ACT OF 1998

  Mr. SMITH of Texas. Mr. Speaker, I move to suspend the rules and pass 
the bill (H.R. 2759) to amend the Immigration and Nationality Act with 
respect to the requirements for the admission of nonimmigrant nurses 
who will practice in health professional shortage areas, as amended.
  The Clerk read as follows:

                               H.R. 2759

       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 ``Health Professional Shortage 
     Area Nursing Relief Act of 1998''.

     SEC. 2. REQUIREMENTS FOR ADMISSION OF NONIMMIGRANT NURSES IN 
                   HEALTH PROFESSIONAL SHORTAGE AREAS DURING 4-
                   YEAR PERIOD.

       (a) Establishment of a New Nonimmigrant Classification for 
     Nonimmigrant Nurses in Health Professional Shortage Areas.--
     Section 101(a)(15)(H)(i) of the Immigration and Nationality 
     Act (8 U.S.C. 1101(a)(15)(H)(i)) is amended by striking ``; 
     or'' at the end and inserting the following: ``, or (c) who 
     is coming temporarily to the United States to perform 
     services as a registered nurse, who meets the qualifications 
     described in section 212(m)(1), and with respect to whom the 
     Secretary of Labor determines and certifies to the Attorney 
     General that an unexpired attestation is on file and in 
     effect under section 212(m)(2) for the facility (as defined 
     in section 212(m)(6)) for which the alien will perform the 
     services; or''.
       (b) Requirements.--Section 212(m) of the Immigration and 
     Nationality Act (8 U.S.C. 1182(m)) is amended to read as 
     follows:
       ``(m)(1) The qualifications referred to in section 
     101(a)(15)(H)(i)(c), with respect to an alien who is coming 
     to the United States to perform nursing services for a 
     facility, are that the alien--
       ``(A) has obtained a full and unrestricted license to 
     practice professional nursing in the country where the alien 
     obtained nursing education or has received nursing education 
     in the United States;
       ``(B) has passed an appropriate examination (recognized in 
     regulations promulgated in consultation with the Secretary of 
     Health and Human Services) or has a full and unrestricted 
     license under State law to practice professional nursing in 
     the State of intended employment; and
       ``(C) is fully qualified and eligible under the laws 
     (including such temporary or interim licensing requirements 
     which authorize the nurse to be employed) governing the place 
     of intended employment to engage in the practice of 
     professional nursing as a registered nurse immediately upon 
     admission to the United States and is authorized under such 
     laws to be employed by the facility.
       ``(2)(A) The attestation referred to in section 
     101(a)(15)(H)(i)(c), with respect to a facility for which an 
     alien will perform services, is an attestation as to the 
     following:
       ``(i) The facility meets all the requirements of paragraph 
     (6).
       ``(ii) The employment of the alien will not adversely 
     affect the wages and working conditions of registered nurses 
     similarly employed.
       ``(iii) The alien employed by the facility will be paid the 
     wage rate for registered nurses similarly employed by the 
     facility.
       ``(iv) The facility has taken and is taking timely and 
     significant steps designed to recruit and retain sufficient 
     registered nurses who are United States citizens or 
     immigrants who are authorized to perform nursing services, in 
     order to remove as quickly as reasonably possible the 
     dependence of the facility on nonimmigrant registered nurses.
       ``(v) There is not a strike or lockout in the course of a 
     labor dispute, the facility has not laid off registered 
     nurses within the previous year other than terminations for 
     cause, and the employment of such an alien is not intended or 
     designed to influence an election for a bargaining 
     representative for registered nurses of the facility.
       ``(vi) At the time of the filing of the petition for 
     registered nurses under section 101(a)(15)(H)(i)(c), notice 
     of the filing has been provided by the facility to the 
     bargaining representative of the registered nurses at the 
     facility or, where there is no such bargaining 
     representative, notice of the filing has been provided to 
     registered nurses employed at the facility through posting in 
     conspicuous locations.
       ``(vii) The facility will not, at any time, employ a number 
     of aliens issued visas or otherwise provided nonimmigrant 
     status under section 101(a)(15)(H)(i)(c) that exceeds 33 
     percent of the total number of registered nurses employed by 
     the facility.
       ``(viii) The facility will not, with respect to any alien 
     issued a visa or otherwise provided nonimmigrant status under 
     section 101(a)(15)(H)(i)(c)--
       ``(I) authorize the alien to perform nursing services at 
     any worksite other than a worksite controlled by the 
     facility; or
       ``(II) transfer the place of employment of the alien from 
     one worksite to another.

     Nothing in clause (iv) shall be construed as requiring a 
     facility to have taken significant steps described in such 
     clause before the date of the enactment of the Health 
     Professional Shortage Area Nursing Relief Act of 1998. A copy 
     of the attestation shall be provided, within 30 days of the 
     date of filing, to registered nurses employed at the facility 
     on the date of filing.
       ``(B) For purposes of subparagraph (A)(iv), each of the 
     following shall be considered a significant step reasonably 
     designed to recruit and retain registered nurses:
       ``(i) Operating a training program for registered nurses at 
     the facility or financing (or providing participation in) a 
     training program for registered nurses elsewhere.
       ``(ii) Providing career development programs and other 
     methods of facilitating health care workers to become 
     registered nurses.
       ``(iii) Paying registered nurses wages at a rate higher 
     than currently being paid to registered nurses similarly 
     employed in the geographic area.
       ``(iv) Providing adequate support services to free 
     registered nurses from administrative and other non-nursing 
     duties.
       ``(v) Providing reasonable opportunities for meaningful 
     salary advancement by registered nurses.

     The steps described in this subparagraph shall not be 
     considered to be an exclusive list of the significant steps 
     that may be taken to meet the conditions of subparagraph 
     (A)(iv). Nothing in this subparagraph shall require a 
     facility to take more than one step if the facility can 
     demonstrate, and the Attorney General determines, that taking 
     a second step is not reasonable.
       ``(C) Subject to subparagraph (E), an attestation under 
     subparagraph (A)--
       ``(i) shall expire on the date that is the later of--
       ``(I) the end of the one-year period beginning on the date 
     of its filing with the Secretary of Labor; or
       ``(II) the end of the period of admission under section 
     101(a)(15)(H)(i)(c) of the last alien with respect to whose 
     admission it was applied (in accordance with clause (ii)); 
     and
       ``(ii) shall apply to petitions filed during the one-year 
     period beginning on the date of its filing with the Secretary 
     of Labor if the facility states in each such petition that it 
     continues to comply with the conditions in the attestation.
       ``(D) A facility may meet the requirements under this 
     paragraph with respect to more than one registered nurse in a 
     single petition.
       ``(E)(i) The Secretary of Labor shall compile and make 
     available for public examination in a timely manner in 
     Washington, D.C., a list identifying facilities which have 
     filed petitions for nonimmigrants under section 
     101(a)(15)(H)(i)(c) and, for each such facility, a copy of 
     the facility's attestation under subparagraph (A) (and 
     accompanying documentation) and each such petition filed by 
     the facility.
       ``(ii) The Secretary of Labor shall establish a process, 
     including reasonable time limits, for the receipt, 
     investigation, and disposition of complaints respecting a 
     facility's failure to meet conditions attested to or a 
     facility's misrepresentation of a material fact in an 
     attestation. Complaints may be filed by any aggrieved person 
     or organization (including bargaining representatives, 
     associations deemed appropriate by the Secretary, and other 
     aggrieved parties as determined under regulations of the 
     Secretary). The Secretary shall conduct an investigation 
     under this clause if there is reasonable cause to believe 
     that a facility fails to meet conditions attested to. Subject 
     to the time limits established under this clause, this 
     subparagraph shall apply regardless of whether an attestation 
     is expired or unexpired at the time a complaint is filed.
       ``(iii) Under such process, the Secretary shall provide, 
     within 180 days after the date such a complaint is filed, for 
     a determination as to whether or not a basis exists to make a 
     finding described in clause (iv). If the Secretary determines 
     that such a basis exists, the Secretary shall provide for 
     notice of such determination to the interested parties and an 
     opportunity for a hearing on the complaint within 60 days of 
     the date of the determination.
       ``(iv) If the Secretary of Labor finds, after notice and 
     opportunity for a hearing, that a facility (for which an 
     attestation is made) has failed to meet a condition attested 
     to or that there was a misrepresentation of material fact in 
     the attestation, the Secretary shall notify the Attorney 
     General of such finding and may, in addition, impose such 
     other administrative remedies (including civil monetary 
     penalties in an amount not to exceed $1,000 per nurse per 
     violation, with the total penalty not to exceed $10,000 per 
     violation) as the Secretary determines to be appropriate. 
     Upon receipt of such notice, the Attorney General shall not 
     approve petitions filed with respect to a facility during a 
     period of at least one year for nurses to be employed by the 
     facility.
       ``(v) In addition to the sanctions provided for under 
     clause (iv), if the Secretary of Labor finds, after notice 
     and an opportunity for a hearing, that a facility has 
     violated the condition attested to under subparagraph

[[Page H6932]]

     (A)(iii) (relating to payment of registered nurses at the 
     prevailing wage rate), the Secretary shall order the facility 
     to provide for payment of such amounts of back pay as may be 
     required to comply with such condition.
       ``(F)(i) The Secretary of Labor shall impose on a facility 
     filing an attestation under subparagraph (A) a filing fee, in 
     an amount prescribed by the Secretary based on the costs of 
     carrying out the Secretary's duties under this subsection, 
     but not exceeding $250.
       ``(ii) Fees collected under this subparagraph shall be 
     deposited in a fund established for this purpose in the 
     Treasury of the United States.
       ``(iii) The collected fees in the fund shall be available 
     to the Secretary of Labor, to the extent and in such amounts 
     as may be provided in appropriations Acts, to cover the costs 
     described in clause (i), in addition to any other funds that 
     are available to the Secretary to cover such costs.
       ``(3) The period of admission of an alien under section 
     101(a)(15)(H)(i)(c) shall be 3 years.
       ``(4) The total number of nonimmigrant visas issued 
     pursuant to petitions granted under section 
     101(a)(15)(H)(i)(c) in each fiscal year shall not exceed 500. 
     The number of petitions granted under section 
     101(a)(15)(H)(i)(c) for each State in each fiscal year shall 
     not exceed the following:
       ``(A) For States with populations of less than 10,000,000, 
     based upon the 1990 decennial census of population, 25 
     petitions.
       ``(B) For States with populations of 10,000,000 or more, 
     based upon the the 1990 decennial census of population, 50 
     petitions.
       ``(5) A facility that has filed a petition under section 
     101(a)(15)(H)(i)(c) to employ a nonimmigrant to perform 
     nursing services for the facility--
       ``(A) shall provide the nonimmigrant a wage rate and 
     working conditions commensurate with those of nurses 
     similarly employed by the facility;
       ``(B) shall require the nonimmigrant to work hours 
     commensurate with those of nurses similarly employed by the 
     facility; and
       ``(C) shall not interfere with the right of the 
     nonimmigrant to join or organize a union.
       ``(6) For purposes of this subsection and section 
     101(a)(15)(H)(i)(c), the term `facility' means a subsection 
     (d) hospital (as defined in section 1886(d)(1)(B) of the 
     Social Security Act (42 U.S.C. 1395ww(d)(1)(B))) that meets 
     the following requirements:
       ``(A) As of March 31, 1997, the hospital was located in a 
     health professional shortage area (as defined in section 332 
     of the Public Health Service Act (42 U.S.C. 254e)).
       ``(B) Based on its settled cost report filed under title 
     XVIII of the Social Security Act for its cost reporting 
     period beginning during fiscal year 1994--
       ``(i) the hospital has not less than 190 licensed acute 
     care beds;
       ``(ii) the number of the hospital's inpatient days for such 
     period which were made up of patients who (for such days) 
     were entitled to benefits under part A of such title is not 
     less than 35 percent of the total number of such hospital's 
     acute care inpatient days for such period; and
       ``(iii) the number of the hospital's inpatient days for 
     such period which were made up of patients who (for such 
     days) were eligible for medical assistance under a State plan 
     approved under title XIX of the Social Security Act, is not 
     less than 28 percent of the total number of such hospital's 
     acute care inpatient days for such period.''.
       (c) Repealer.--Clause (i) of section 101(a)(15)(H) of the 
     Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(H)(i)) 
     is amended by striking subclause (a).
       (d) Implementation.-- Not later than 90 days after the date 
     of enactment of this Act, the Secretary of Labor (in 
     consultation, to the extent required, with the Secretary of 
     Health and Human Services) and the Attorney General shall 
     promulgate final or interim final regulations to carry out 
     section 212(m) of the Immigration and Nationality Act (as 
     amended by subsection (b)).
       (e) Limiting Application of Nonimmigrant Changes to 4-Year 
     Period.--The amendments made by this section shall apply to 
     classification petitions filed for nonimmigrant status only 
     during the 4-year period beginning on the date that interim 
     or final regulation are first promulgated under subsection 
     (d).

     SEC. 3. RECOMMENDATIONS FOR ALTERNATIVE REMEDY FOR NURSING 
                   SHORTAGE.

       Not later than the last day of the 4-year period described 
     in section 2(e), the Secretary of Health and Human Services 
     and the Secretary of Labor shall jointly submit to the 
     Congress recommendations (including legislative 
     specifications) with respect to the following:
       (1) A program to eliminate the dependence of facilities 
     described in section 212(m)(6) of the Immigration and 
     Nationality Act (as amended by section 2(b)) on nonimmigrant 
     registered nurses by providing for a permanent solution to 
     the shortage of registered nurses who are United States 
     citizens or aliens lawfully admitted for permanent residence.
       (2) A method of enforcing the requirements imposed on 
     facilities under sections 101(a)(15)(H)(i)(c) and 212(m) of 
     the Immigration and Nationality Act (as amended by section 2) 
     that would be more effective than the process described in 
     section 212(m)(2)(E) of such Act (as so amended).

     SEC. 4. CERTIFICATION FOR CERTAIN ALIEN NURSES.

       (a) In General.--
       (1) Section 212 of the Immigration and Nationality Act (8 
     U.S.C. 1182) is amended by adding after subsection (o) the 
     following new subsection:
       ``(p) Subsection (a)(5)(C) shall not apply to an alien who 
     seeks to enter the United States for the purpose of 
     performing labor as a nurse who presents to the consular 
     officer (or in the case of an adjustment of status, the 
     Attorney General) a certified statement from the Commission 
     on Graduates of Foreign Nursing Schools (or an equivalent 
     independent credentialing organization approved for the 
     certification of nurses under subsection (a)(5)(C) by the 
     Attorney General in consultation with the Secretary of Health 
     and Human Services) that--
       ``(1) the alien has a valid and unrestricted license as a 
     nurse in a State where the alien intends to be employed and 
     such State verifies that the foreign licenses of alien nurses 
     are authentic and unencumbered;
       ``(2) the alien has passed the National Council Licensure 
     Examination (NCLEX);
       ``(3) the alien is a graduate of a nursing program--
       ``(A) in which the language of instruction was English;
       ``(B) located in a country--
       ``(i) designated by such commission not later than 30 days 
     after the date of the enactment of the Health Professional 
     Shortage Area Nursing Relief Act of 1998, based on such 
     commission's assessment that the quality of nursing education 
     in that country, and the English language proficiency of 
     those who complete such programs in that country, justify the 
     country's designation; or
       ``(ii) designated on the basis of such an assessment by 
     unanimous agreement of such commission and any equivalent 
     credentialing organizations which have been approved under 
     subsection (a)(5)(C) for the certification of nurses under 
     this subsection; and
       ``(C)(i) which was in operation on or before the date of 
     the enactment of the Health Professional Shortage Area 
     Nursing Relief Act of 1998; or
       ``(ii) has been approved by unanimous agreement of such 
     commission and any equivalent credentialing organizations 
     which have been approved under subsection (a)(5)(C) for the 
     certification of nurses under this subsection.''.
       (2) Section 212(a)(5)(C) of the Immigration and Nationality 
     Act (8 U.S.C. 1182(a)(5)(C)) is amended by striking ``Any 
     alien who seeks'' and inserting ``Subject to subsection (p), 
     any alien who seeks''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on the date of the enactment of this Act, 
     without regard to whether or not final regulations to carry 
     out such amendment have been promulgated by such date.
       (c) Issuance of Certified Statements.--The Commission on 
     Graduates of Foreign Nursing Schools, or any approved 
     equivalent independent credentialing organization, shall 
     issue certified statements pursuant to the amendment under 
     subsection (a) not more than 35 days after the receipt of a 
     complete application for such a statement.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Smith) and the gentlewoman from California (Ms. Lofgren) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Texas (Mr. Smith).


                             General Leave

  Mr. SMITH of Texas. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. SMITH of Texas. Mr. Speaker, I yield such time as he may consume 
to the gentleman from Illinois (Mr. Hyde), the chairman of the 
Committee on the Judiciary.
  (Mr. HYDE asked and was given permission to revise and extend his 
remarks.)
  Mr. HYDE. Mr. Speaker, I am very pleased to support H.R. 2759, 
legislation that is responsive to a crisis facing some large hospitals 
with high percentages of Medicare and Medicaid patients in health 
professional shortage areas. The viability of essential health care for 
large numbers of people is threatened when certain acute care 
facilities in medically underserved, impoverished communities cannot 
recruit sufficient numbers of registered nurses to meet their 
requirements.
  H.R. 2759 provides such hospitals relief in compelling circumstances 
by facilitating the temporary administration of registered nurses in an 
H-1C nonimmigrant visa category, subject to a nationwide ceiling of 500 
visas issued annually and limits of 50 or 25, depending on a State's 
population, on the numbers of nurses who can be approved

[[Page H6933]]

each year for hospitals in any one State.
  This narrowly focused program, which will sunset after a 4-year 
period, is designed to address urgent needs that cannot be met in any 
other way. St. Bernard's Hospital, located in the Englewood community 
in Chicago, brought its precarious situation to my attention. Because I 
knew the continued functioning of St. Bernard's Hospital would be so 
essential to the residents of the Englewood community, I decided to 
endorse an appropriately limited legislative remedy.
  The bill that our colleague, the distinguished gentleman from 
Illinois (Mr. Rush) introduced, clearly merited bipartisan 
Congressional support. It provided relief to particularly vulnerable 
hospitals and incorporated many safeguards designed to protect American 
jobs.
  I commend the gentleman from Texas (Mr. Smith), chairman of the 
Subcommittee on Immigration and Claims, and the gentleman from Michigan 
(Mr. Conyers), ranking minority member of our full committee, for their 
important contributions to this carefully-crafted legislation. Of 
course I commend my colleague, the gentleman from Chicago, Illinois 
(Mr. Rush), for his initiative. It is most helpful.
  I certainly urge my colleagues to support this measure.
  Ms. LOFGREN. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Illinois (Mr. Rush).
  Mr. RUSH. Mr. Speaker, I thank the gentlewoman for yielding me time.
  Mr. Speaker, I rise today to encourage my colleagues to vote in favor 
of my bill, H.R. 2759, the Health Professional Shortage Area Nursing 
Relief Act. My reason for encouraging passage of this legislation is 
simple: to assist the underserved communities of this Nation by 
providing adequate health care for their residents.
  Today there are some areas across this country which experience a 
scarcity of health professionals, even though numbers indicate that no 
nursing shortage currently exists nationally. Such an area exists in my 
district, the First District of Illinois.
  The Englewood community, as was mentioned earlier, is a poor urban 
community with a high incidence of crime, and it is served primarily by 
St. Bernard's Hospital. This small community hospital's emergency room 
business averages approximately 31,000 per year. Fifty percent of their 
patients are Medicare recipients and 35 percent receive Medicaid. Also 
their charity care continues to grow and to soar.
  The Immigration Nursing Act of 1989 created the H-1A visa program in 
order to allow foreign-educated nurses to work in the United States. 
The rationale for the H-1A program, as acknowledged by the AFL-CIO, the 
American Nurses Association and others, was to address spot shortage 
areas in health care.
  St. Bernard's Hospital utilized the H-1A program to maintain an 
adequate staffing of nurses. The H-1A program was vital to St. 
Bernard's continued existence. Prior to this program, St. Bernard's 
hired temporary nurses. As a result, the hospital's nursing 
expenditures increased by approximately $2 million in an effort to 
provide health care to its patients in 1992. This additional cost 
brought St. Bernard's very, very close to closing its doors.
  The H-1A visa program expired on September 30, 1997. Currently, Mr. 
Speaker, as you know, no program exists that would assist hospitals 
such as St. Bernard's in their effort to retain qualified nurses. My 
legislation merely seeks to close the gap created by the expiration of 
the H-1A program.
  H.R. 2759 prescribes that any hospitals which seek to hire foreign 
nurses under these provisions must meet the following criteria: One, 
shall be located in a health professional shortage area; two, have at 
least 190 acute care beds; three, have a Medicare population of 35 
percent; and, four, have a Medicaid population of at least 28 percent.
  As one who has always fought for the American worker, I can assure 
you and all those who express concern that this proposal does not have 
a detrimental effect on American nurses. My legislation sets a cap on 
new visas that may be issued each year. The legislation also provides 
processing requirements that require employers to attest that the 
hiring of foreign nurses would not adversely affect the wages and 
working conditions of registered nurses. The Secretary of Labor will 
oversee this process and provide penalties for noncompliance.
  Mr. Speaker, health care is indeed a basic human right. The hallmarks 
of civilized nations are health care, education and democracy. The 
state of health care is of grave concern in my district. Hospitals have 
closed, city health clinics are closing, and payments for Medicare and 
Medicaid have been cut back. This legislation, the legislation that we 
must pass today, is aimed at helping hospitals like St. Bernard's keep 
their doors open to the communities that they serve.
  Mr. Speaker, I also want to commend the chairman of the Committee on 
the Judiciary, the gentleman from Illinois (Mr. Hyde), the ranking 
member, the gentleman from Michigan (Mr. Conyers), the subcommittee 
chairman, the gentleman from Texas (Mr. Smith), and the ranking member, 
the gentleman from North Carolina (Mr. Watt). Their patience, their 
indulgence, their concern, their commitment is outstanding, and I 
certainly appreciate it, and the residents and citizens of the First 
Congressional District thank you for all your consideration and all 
your input.
  Mr. SMITH of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. SMITH of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. SMITH of Texas. Mr. Speaker, I rise in support of this bill, and 
I concur with the comments made by the gentleman from Illinois 
(Chairman Hyde) and the gentlewoman from California (Ms. Lofgren).
  Mr. Speaker. Because of a shortage of nurses in the late 1980's, 
Congress passed the Immigration Nursing Relief Act of 1989. That Act 
created for five years the H-1A temporary visa program for registered 
nurses. When the program sunseted, the House of Representatives decided 
against extending it.
  There does not appear to be a national nursing shortage today--so, 
there is no need to revise the H-1A program. However, a number of 
hospitals with unique circumstances are still experiencing great 
difficulty in attracting American nurses. Hospitals serving mostly poor 
patients in inner city neighborhoods have special difficulties. So do 
certain hospitals in rural areas.
  H.R. 2759, the ``Health Professional Shortage Area Nursing Relief Act 
of 1998'', introduced by our colleague Bobby Rush, has been drafted 
very narrowly to help precisely these kinds of hospitals. It would 
create a new temporary registered nurse visa program designated ``H-
1C'' that would provide up to 500 visas a year and that would sunset in 
four years.
  To be able to petition for an alien, an employer would have to meet 
four conditions. First, the employer would have to be located in a 
health professional shortage area as designated by the Department of 
Health and Human Services. Second, the employer would have to have at 
least 190 acute care beds. Third, a certain percentage of the 
employer's patients would have to be Medicare patients. Fourth, a 
certain percentage of patients would have to be Medicaid patients.
  The H-1C program created by this bill would adopt those protections 
for American nurses contained in the expired H-1A program. For 
instance, for a hospital to be eligible for H-1C nurses, it would have 
to agree to take timely and significant steps to recruit American 
nurses. In addition, H-1C nurses would have to be paid the prevailing 
wage. Additional protections have also been added. For instance, an 
amendment by John Conyers was adopted at the Judiciary Committee 
providing that H-1C nurses can not comprise more than 33% of a 
hospital's workforce of registered nurses and that a hospital can not 
contract out H-1C nurses to work at another facility.
  Our goal should be that set out by the Immigration Nursing Relief 
Advisory Committee, created by the Immigration Nursing Relief Act of 
1989. We need to ``balance both the continuing need for foreign nurses 
in certain specialties and localities for which their are not adequate 
domestic registered nurses and the need to continue to lessen 
employers' dependence on foreign registered nurses and protect the 
wages and working conditions of U.S. registered nurses.''
  I believe this bill successfully balances both these needs. Because 
it is so narrowly drafted, it is not opposed by the American Nurses 
Association.
  The bill contains one modification from the version reported by the 
Judiciary Committee. The bill now provides a limited exemption from 
section 212(a)(5)(C) of the Immigration and Nationality Act. That 
section provides for a

[[Page H6934]]

certification process for aliens seeking to enter the United States to 
work as non-physician health care workers. The section is designed to 
ensure that the credentials of alien health care workers are authentic 
and that they have sufficient training and English language ability to 
adequately perform their jobs.
  The bill provides that section 212(a)(5)(C) shall not apply to an 
alien seeking to work as a nurse where the Commission on Graduates of 
Foreign Nursing Schools or another credentialing organization certifies 
that the alien (1) has a valid and unrestricted license in the state of 
intended employment and such state verifies the alien's license as 
authentic and unencumbered, (2) the alien has passed the National 
Council Licensure Examination, and (3) the alien is the graduate of a 
nursing program in which the language of instruction was English and it 
is determined that the quality of nursing education in that country, 
and the English language proficiency of those who complete the program, 
is of sufficient quality.
  Nurses who meet all these requirements clearly are of the standard 
that section 212(a)(5)(C) is trying to ensure. Therefore, it is not 
necessary that the section apply to such nurses.
  I urge my colleagues to support this bill.
  Ms. LOFGREN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, when the Subcommittee on Immigration addressed this 
issue, reservations were expressed by some. But I think the bill that 
is before us today reflects hard work, certainly by the chairman of our 
committee, and by the author of the bill, the gentleman from Illinois 
(Mr. Rush) to narrow this measure to a point where it could be here 
today to be considered on the Suspension Calendar.
  We know that there is actually not a shortage of nurses in America 
today. However, there have been spot shortages in hospitals such as the 
gentleman from Illinois (Mr. Rush) and the chairman described. I am 
mindful that these hospitals could make use of the H-1B program to 
fulfill this need. However, that is not available at this pressing 
moment. I am mindful as well that the measure has been tailored and 
limited in such a way that it will meet the need addressed by the 
gentleman from Illinois (Chairman Hyde) and the author, the gentleman 
from Illinois (Mr. Rush), but will not impact the Nation to the point 
where the American Nurses Association has communicated to the committee 
that they do not oppose the bill and remain neutral on the bill, which 
I think speaks volumes about the great effort undertaken by the 
gentleman from Illinois (Chairman Hyde) and the gentleman from Illinois 
(Mr. Rush), as well as the committee.
  So I certainly intend to vote for the bill, with some reservations, I 
guess, because I would have hoped we could have already resolved the 
broader issue, but we have not. I do understand the pressing health 
care needs, and, therefore, I will support this measure and urge my 
colleagues to do so.
  Mr. CONYERS. Mr. Speaker, the Nursing Relief Act addresses the 
pressing need for nurses at low-income, inner-city hospitals and moves 
firmly in the direction of developing a new, more permanent solution to 
this problem that will utilize nurses from the American workforce 
instead of continuing to rely on foreign labor.
  The Nursing Relief Act would allow up to 500 fully qualified foreign 
nurses to enter the United States each fiscal year to work for three-
year periods. This, however, would not be an ongoing program. The act 
would sunset in four years.
  H.R. 2759 also provides that the Attorney General determine whether 
hospitals are taking reasonable steps to recruit and retain nurses from 
within the American worforce. In addition, the Department of Labor and 
the Department of Health and Human Services would be required to 
conduct a study to establish ways for these hospitals to fulfill their 
staffing needs from within the American workforce. More specific 
information about the bill may be found in a summary attached to this 
statement.
  The bill also includes a provision that would create an abbreviated 
certification process for nurses who meet specific qualifications 
standards. Without certification, nurses are denied admission to the 
United States as uncertified foreign health-care workers under section 
212(a)(5)(C) of the Immigration and Nationality Act.
  I urge the Members to join me in voting for this balanced, common 
sense bill.

  Health Professional Shortage Area Nursing Relief Act of 1998, H.R. 
                                 2759.


                              bill summary

       1. Purpose. To create a new nonimmigrant visa for qualified 
     foreign nurses who are coming to the United States to work at 
     a hospital in a health professional shortage area.
       2. Eligibility requirements.
       a. Must be coming temporarily to perform services as a 
     registered nurse.
       b. Must have either a U.S. nursing education or a license 
     to practice professional nursing in the foreign country where 
     the nurse obtained his or her nursing education.
       c. Must have passed an appropriate examination or have a 
     license to practice in the State of intended employment.
       d. Must be qualified to practice nursing in the State of 
     intended employment immediately upon admission to the U.S..
       3. Hospitals seeking to employ such nurses must file an 
     attestation which includes the following assurances:
       a. 1. As of March 31, 1997, it was located in a health 
     professional shortage area.
       2. It has at least 190 acute care beds.
       3. The number of inpatient days for its Social Security Act 
     report period beginning during fiscal year 1994 was made up 
     of patients not less than 35% of whom were entitled to SSA 
     benefits under part A of the Act.
       4. The number of inpatient days for such period was made up 
     of patients not less than 28% of whom were eligible for 
     medical assistance under a State plan approved by SSA.
       b. The employment of the alien will not adversely affect 
     the wages or working conditions of registered nurses 
     similarly employed by the hospital.
       c. The alien will be paid the wage rate for registered 
     nurses similarly employed by the hospital.
       d. The hospital has taken and is taking timely and 
     significant steps to recruit and retain sufficient nurses 
     from the American work force.
       e. There is not a strike or lockout in the course of a 
     labor dispute, nurses have not been laid off within the 
     previous year, and the employment of aliens is not intended 
     or designed to influence an election for a bargaining 
     representative for the American nurses at the hospital.
       f. The hospital will not use foreign nurses for more than 
     33% of its nursing staff.
       4. The following are considered significant steps 
     reasonably designed to recruit and retain registered nurses:
       a. Operating a training program for nurses at the hospital 
     or financing or participating in a training program for 
     nurses elsewhere.
       b. Providing career development programs to make it easier 
     for health care workers to become nurses.
       c. Paying nurses wages at a rate higher than currently 
     being paid for nurses similarly employed in the geographic 
     area.
       d. Providing adequate support services to free nurses from 
     non-nursing duties.
       e. Providing reasonable opportunities for salary 
     advancement by nurses.
       The hospital only has to take one of these steps if it can 
     establish that taking a second step is not reasonable.
       5. Failure to meet the conditions of an attestation or 
     misrepresentation of a material fact in an attestation.
       a. If the Secretary of Labor determines that it is 
     warranted, a hearing will be scheduled.
       b. Fines of up to $1,000 per nurse per violation may be 
     imposed, but the total penalty cannot exceed $10,000 per 
     violation. Also, the Attorney General will not approve nurse 
     petitions filed by the hospital for at least one year.
       c. When wage rate violations occur, a hospital may be 
     ordered to provide back pay.
       6. An attestation filing fee of up to $250 may be imposed. 
     These fees may be made available by an appropriations bill to 
     cover the costs of this program.
       7. The admission period for these nurses shall be 3 years.
       8. Limited number of visas.
       a. The total number of visas issued under this Act shall 
     not exceed 500 in any fiscal year.
       b. States with populations of less than 10,000,000, are 
     limited to 25 petitions.
       c. States with populations of 10,000,000 or more, are 
     limited to 50 petitions.
       9. Additional requirements for the hospitals.
       a. Must provide foreign nurses with a wage rate and working 
     conditions commensurate with those of nurses similarly 
     employed by the hospital.
       b. Must require the foreign nurses to work hours 
     commensurate with those of nurses similarly employed by the 
     hospital.
       c. Must not interfere with the right of the foreign nurses 
     to join or organize a union.
       10. Implementing regulations must be promulgated not later 
     than 90 days after the date of enactment of this Act.
       11. Act sunsets in 4 years.
       12. Alternative remedy for nursing shortage.
       Secretary of Health and Human Services and Secretary of 
     Labor shall jointly recommend to Congress (1) a program to 
     eliminate the dependence of hospitals on foreign nurses by 
     providing for a permanent solution to the shortage of nurses 
     from the American work force, and (2) a more effective method 
     of enforcing the requirements imposed on hospitals 
     participating in these programs.
       13. Certification for certain alien nurses.
       a. The existing INA exclusion ground for uncertified health 
     care workers will not apply to foreign nurses who are 
     certified under this new provision.
       b. The Commission on Graduates of Foreign Nursing Schools 
     (``CGFNS'') has certified that a nurse admitted to the United 
     States under this program has met the following requirements:

[[Page H6935]]

       1. Nurse has a valid and unrestricted license in the State 
     of intended employment and such State verified that he or she 
     has a foreign license which is authentic and unencumbered.
       2. Nurse has passed the National Council Licensure 
     Examination (NCLEX).
       3. Nurse is a graduate of a nursing program in which (i) 
     the language of instruction was English; and (ii) the program 
     was located in a country designated unanimously by CGFNS and 
     any other authorized credentialing organizations based on a 
     determination that the quality of nursing education in that 
     country, and the English language proficiency of those who 
     complete such programs in that country, justify the country's 
     designation.
       4. CGFNS will make the initial designations during the 30-
     day period following passage of the Act.
       c. These provisions will take effect on the date of the 
     enactment of the Act without regard to whether or not final 
     regulations have been promulgated to carry them out.
  Mr. DAVIS of Illinois. Mr. Speaker, I am pleased to express support 
for H.R. 2759, the Health Professional Shortage Area Nursing Relief 
Act, introduced by my colleague the Honorable Bobby Rush. H.R. 2759 
provides opportunities for institutions in medical manpower shortage 
areas to hire foreign trained nurses who have been granted special 
waivers to enter the country and work.
  Initially, I had some concerns about this bill due to reservations 
expressed by some nursing groups, especially the Chicago Chapter of the 
Black Nurses Association. However, after reading the bill and having 
discussions with Congressman Rush, I am convinced that there is little 
room for negative impact on opportunities for U.S. trained nurses who 
are available and ready to work in these special situations. This bill 
is well crafted, it has built in protections and should go a long way 
towards meeting concrete needs. Therefore, I commend the gentleman from 
Illinois, Mr. Rush, for entertaining a specific problem and finding a 
solution which will benefit one of our great community hospitals, St. 
Bernards in Chicago and other institutions experiencing similar 
problems throughout the Nation. I am pleased to support this well 
crafted legislation and congratulate Congressman Rush on his creativity 
and ingenuity.
  Ms. LOFGREN. Mr. Speaker, I yield back the balance of my time.
  Mr. SMITH of Texas. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Texas (Mr. Smith) that the House suspend the rules and 
pass the bill, H.R. 2759, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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