[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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