[Congressional Record Volume 145, Number 152 (Tuesday, November 2, 1999)]
[House]
[Pages H11321-H11324]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           NURSING RELIEF FOR DISADVANTAGED AREAS ACT OF 1999

  Mr. SMITH of Texas. Mr. Speaker, I move to suspend the rules and 
concur in the Senate amendment to the bill (H.R. 441) 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.
  The Clerk read as follows:
       Senate Amendment:
       Page 18, after line 5, insert:

     SEC. 5. NATIONAL INTEREST WAIVERS OF JOB OFFER REQUIREMENTS 
                   FOR ALIENS WHO ARE MEMBERS OF THE PROFESSIONS 
                   HOLDING ADVANCED DEGREES OR ALIENS OF 
                   EXCEPTIONAL ABILITY.

       Section 203(b)(2)(B) of the Immigration and Nationality Act 
     (8 U.S.C. 1153(b)(2)(B)) is amended to read as follows:
       ``(B) Waiver of job offer.--
       ``(i) National interest waiver.--Subject to clause (ii), 
     the Attorney General may, when the Attorney General deems it 
     to be in the national interest, waive the requirements of 
     subparagraph (A) that an alien's services in the sciences, 
     arts, professions, or business be sought by an employer in 
     the United States.
       ``(ii) Physicians working in shortage areas or veterans 
     facilities.--

       ``(I) In general.--The Attorney General shall grant a 
     national interest waiver pursuant to clause (i) on behalf of 
     any alien physician with respect to whom a petition for 
     preference classification has been filed under subparagraph 
     (A) if--

       ``(aa) the alien physician agrees to work full time as a 
     physician 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; and
       ``(bb) a Federal agency or a department of public health in 
     any State has previously determined that the alien 
     physician's work in such an area or at such facility was in 
     the public interest.

       ``(II) Prohibition.--No permanent resident visa may be 
     issued to an alien physician described in subclause (I) by 
     the Secretary of State under section 204(b), and the Attorney 
     General may not adjust the status of such an alien physician 
     from that of a nonimmigrant alien to that of a permanent 
     resident alien under section 245, until such time as the 
     alien has worked full time as a physician for an aggregate of 
     five years (not including the time served in the status of an 
     alien described in section 101(a)(15)(J)), 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.
       ``(III) Statutory construction.--Nothing in this 
     subparagraph may be construed to prevent the filing of a 
     petition with the Attorney General 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 subclause (I) prior to the date by which such 
     alien physician has completed the service described in 
     subclause (II).
       ``(IV) Effective date.--The requirements of this subsection 
     do not affect waivers on behalf of alien physicians approved 
     under section 203(b)(2)(B) before the enactment date of this 
     subsection. In the case of a physician for whom an 
     application for a waiver was filed under section 203(b)(2)(B) 
     prior to November 1, 1998, the Attorney General shall grant a 
     national interest waiver pursuant to section 203(b)(2)(B) 
     except that the alien is required to have worked full time as 
     a physician for an aggregate of three years (not including 
     time served in the status of an alien described in section 
     101(a)(15)(J)) before a visa can be issued to the alien under 
     section 204(b) or the status of the alien is adjusted to 
     permanent resident under section 245.''.

     SEC. 6. FURTHER CLARIFICATION OF TREATMENT OF CERTAIN 
                   INTERNATIONAL ACCOUNTING FIRMS.

       Section 206(a) of the Immigration Act of 1990 (8 U.S.C. 
     1101 note) is amended to read as follows:
       ``(a) Clarification of Treatment of Certain International 
     Accounting and Management Consulting Firms.--In applying 
     sections 101(a)(15)(L) and 203(b)(1)(C) of the Immigration 
     and Nationality Act, and for no other purpose, in the case of 
     a partnership that is organized in the United States to 
     provide accounting or management consulting services and that 
     markets its accounting or management consulting services 
     under an internationally recognized name under an agreement 
     with a worldwide coordinating organization that is 
     collectively owned and controlled by the member accounting 
     and management consulting firms or by the elected members

[[Page H11322]]

     (partners, shareholders, members, employees) thereof, an 
     entity that is organized outside the United States to provide 
     accounting or management consulting services shall be 
     considered to be an affiliate of the United States accounting 
     or management consulting partnership if it markets its 
     accounting or management consulting services under the same 
     internationally recognized name directly or indirectly under 
     an agreement with the same worldwide coordinating 
     organization of which the United States partnership is also a 
     member. Those partnerships organized within the United States 
     and entities organized outside the United States which are 
     considered affiliates under this subsection shall continue to 
     be considered affiliates to the extent such firms enter into 
     a plan of association with a successor worldwide coordinating 
     organization, which need not be collectively owned and 
     controlled.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Smith) and the gentlewoman from Texas (Ms. Jackson-Lee) 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 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 myself such time as I may 
consume.
  Mr. Speaker, a number of hospitals with unique circumstances continue 
to experience great difficulty in attracting American nurses. This is 
especially true of hospitals serving mostly poor patients in inner city 
neighborhoods and some hospitals in rural areas. H.R. 441, the Nursing 
Relief for Disadvantaged Areas Act of 1999, was introduced by the 
gentleman from Illinois (Mr. Rush) and 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 4 years. 
Because it is so narrowly drafted, it is not opposed by the American 
Nurses Association.
  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 provide 
at least 190 acute care beds. Third, a certain percentage of the 
employer's patients would have to be Medicare patients. And, fourth, a 
certain percentage of patients would have to be Medicaid patients.
  The House passed H.R. 441 on May 24, 1999. Two weeks ago, the Senate 
added two amendments to H.R. 441 and then passed the bill. The first 
amendment allows certain areas with a shortage of health care 
professions to have easier access to foreign physicians. The provision 
directs the Attorney General to waive, in the national interest, the 
labor certification requirement for certain alien physicians applying 
for visas in the employment-based third preference immigrant visa 
category. These national interest waivers will be available to those 
alien physicians who agree to work full time as a physician 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. 
By allowing alien physicians and the medical facilities that employ 
them to avoid the labor certification process, this provision ensures 
that residents of areas with a shortage of health care professionals 
will have access to quality health care. Language is included requiring 
the alien physicians who benefit from a national interest waiver work 
as physicians for 5 years in areas with a shortage of health care 
professionals, an increase of 2 years from the requirement of current 
law.
  The second amendment is a technical clarification to the L visa which 
is a temporary, nonimmigrant visa. The L visa permits an American 
company which is part of an international business to make intracompany 
transfers to this country from abroad of foreign executives, managers 
and employees with specialized knowledge.
  In 1990, Congress in section 206(a) of the Immigration Act of 1990 
made a technical clarification to the L visa program to assure that 
international accounting firms and their related management consulting 
practices would qualify for use of the L visa. Congress believed that 
this clarification was needed because, for legal and historical 
reasons, these firms are not structured in the same way that most 
international corporations are structured. The laws of different 
foreign countries pertaining to the accounting profession have caused 
international accounting and associated management consulting 
businesses to be generally organized as partnerships held together by 
contracts with a worldwide coordinating organization. Congress made 
sure in 1990 that these international positions were not disadvantaged 
under the L visa program just because they were not structured like 
traditional corporations.
  The second amendment makes sure that our immigration laws keep up 
with changes in the global economy. It simply assures that any 
international management consulting firm that separates from an 
international accounting firm but continues to keep the qualifying 
worldwide organizational structure may continue to use the L visa as it 
has in the past. Accordingly, no new category of visa is created and no 
new influx of L visa holders will occur. Attached to my remarks is an 
Interpretation of Technical Amendment which further explains this 
provision.

                 Interpretation of Technical Amendment

       ``Collective'' and ``collectively'' refer to a relationship 
     between the accounting and management consulting firms or the 
     elected members (partners, shareholders, members, employees) 
     of the various accounting and management consulting firms 
     inclusive of both accounting service firms and management 
     consulting service firms or the elected members (partners, 
     shareholders, members, employees) thereof.
       An entity shall be considered to be ``marketing its 
     services under the same internationally recognized name 
     directly or indirectly under an agreement'' if it engages in 
     a trade or business and markets its trade or business under 
     the same internationally recognized name and one of the 
     following direct or indirect relationships apply to the 
     entity:
       (a) It has an agreement with the worldwide coordinating 
     organization, or
       (b) It is a parent, branch, subsidiary or affiliate 
     relationship to an entity which has an agreement with a 
     qualifying worldwide coordinating organization, or
       (c) It is majority owned by members of such entity with an 
     agreement and/or the members of its parent, subsidiary or 
     affiliate entities, or
       (d) It is indirectly party to one or more agreements 
     connecting it to the worldwide coordinating organization, as 
     shown by facts and circumstances.
       This provision is intended to provide the basis of 
     continued L visa program eligibility for those worldwide 
     coordinating organizations which may in the future divide or 
     spin-off parallel business units which may independently plan 
     to associate with a non-collective worldwide coordinating 
     organization.

  Mr. Speaker, I reserve the balance of my time.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I rise in support of the Nursing Relief for 
Disadvantaged Areas Act of 1999. I thank the gentleman from Illinois 
(Mr. Hyde) and the gentleman from Michigan (Mr. Conyers) for 
shepherding this legislation through our full committee, I thank the 
chairman of the Subcommittee on Immigration and Claims, a committee on 
which I serve as the ranking member, and I particularly thank the 
distinguished gentleman from Illinois (Mr. Rush) who had the insight 
and the leadership to bring this legislation forward.
  It is important as we reflect upon and respect the nursing profession 
of this Nation that we also take into consideration any legislation of 
this type that would not in any way diminish their ability to serve 
those who are in need. We are here on the floor today to vote on two 
amendments passed by the United States Senate 2 weeks ago. This bill 
passed the full House on May 24, 1999.
  The first amendment amends the Immigration and Nationality Act that 
would loosen residency requirements for foreign physicians who serve in 
underserved areas in the United States. For those physicians, it would 
provide waivers of the requirement that an employer sponsor individuals 
seeking to live and work in the United States. This is a good 
amendment, Mr. Speaker, as it will encourage physicians from other 
countries to aid the United States in areas and locales where there is 
a real health care shortage.

[[Page H11323]]

  The other amendment, Mr. Speaker, deals with the L visa. The L visa 
is temporary, a temporary nonimmigrant visa allowing a U.S. company 
which is part of an international business to make intracompany 
transfers from overseas of foreign executives, managers and employees 
with specialized knowledge of America. In 1990, Congress clarified that 
international accounting firms and their related management consulting 
practices would be able to use the L visas. The effect of this 
amendment would be to make sure that any international management 
consulting firm that separates from an international accounting firm 
yet continues to maintain the qualifying worldwide organizational 
structure may continue to use the L visa even if it is no longer 
connected to an accounting firm.
  The registered nurse temporary visa program was created by the 
Immigration Nursing Relief Act of 1989 and expired in September 1997. 
The Immigration Nursing Relief Act was enacted in response to a 
nationwide shortage of nurses sufficient to disrupt the delivery of 
services to patients in some of the health care institutions and to 
potentially place patients in jeopardy.
  I support H.R. 441, because it creates a new registered nurse 
temporary visa program that would sunset after 5 years. It would limit 
the number of visas that can be issued to 500 a year and hospitals 
would be able to petition for an alien nurse to those in need. H.R. 441 
would serve to decrease the nursing shortage in the United States and 
set up an H-1C visa program.
  I would also like to note that the American Nursing Association does 
not oppose this bill and supports the time limits placed on this bill. 
Additionally, we will be working with them to ensure that the elements 
of this bill will ultimately serve its purpose to help those in need of 
nursing care.
  Again, the bill's sponsor's leadership on this issue has been 
tenacious. He has worked on this issue for well over a year to limit 
the shortage of health care professionals not only in the First 
Congressional District of Illinois but in the inner cities and rural 
communities across this Nation. I support this amendment as it is 
employer and employee friendly, Mr. Speaker.
  I urge my colleagues to support H.R. 441 as amended by the Senate.
  Mr. Speaker, I would like to thank the gentleman from Texas, 
Congressman Lamar Smith, the Chairman of our Immigration and Claims 
Subcommittee on which I serve as Ranking Member, and Congressman Bobby 
Rush, the gentleman from Illinois who had the insight and the 
leadership to bring this legislation forward. I also would like to 
thank Mr. Hyde and Mr. Conyers for passing this bill out of the full 
Judiciary Committee.
  We are here on the floor today to vote on two amendments passed by 
the U.S. Senate two weeks ago. This bill passed the full House on May 
24, 1999. The first amendment amends the Immigration and Nationality 
Act that would loosen residency requirements for foreign physicians who 
serve in underserved areas in the United States. For those physicians, 
it would provide waivers of the requirement that an employer sponsor 
individuals seeking to live and work in the United States. This is a 
good amendment Mr. Speaker, as it will encourage physicians from other 
countries to aid the United States in areas and locales where there is 
a real health care shortage. This will not displace American doctors.
  The other amendment Mr. Speaker deals with the L visa. The L visa is 
a temporary, nonimmigrant visa allowing a U.S. company which is part of 
an international business to make intra-company transfers from overseas 
of foreign executives, managers, and employees with specialized 
knowledge to America. In 1990, Congress clarified that international 
accounting firms and their related management consulting practices 
would be able to use the L visas. The effect of this amendment would be 
to make sure that any international management consulting firm that 
separates from an international accounting firm, yet continues to 
maintain the qualifying worldwide organizational structure, may 
continue to use the L visa even if it is no longer connected to an 
accounting firm.

  The Registered Nurse Temporary Visa Program was created by the 
Immigration Nursing Relief Act of 1989 and expired in September 1997. 
The Immigration Nursing Relief Act was enacted in response to a 
nationwide shortage of nurses sufficient to disrupt the delivery of 
services to patients in some of health care institutions and to 
potentially place patients in jeopardy.
  I support H.R. 441 bill because it creates a new registered nurse 
temporary visa program that would sunset after 5 years. It would limit 
the number of visas that can be issued to 500 a year and hospitals 
would be able to petition for an alien nurse to serve those ``in 
need.''
  H.R. 441 would serve to decrease the nursing shortage in the United 
States, and set up a new H1-C visa program.
  I would also like to note that the American Nursing Association does 
not oppose this bill and supports the time limits placed on the bill.
  I now would like to yield five minutes to the bill's sponsor Mr. Rush 
of Illinois, again whose leadership on this issue has been tenacious as 
he has worked on this issue for well over a year, to limit the shortage 
of health care professionals not only in the 1st Congressional District 
of Illinois, but in the inner cities across this nation.
  I support these amendments as they are employer and employee 
friendly, Mr. Speaker. I urge my colleagues to support H.R. 441, as 
amended by the Senate.
  Mr. Speaker, I yield 5 minutes to the gentleman from Illinois (Mr. 
Rush).
  Mr. RUSH. Mr. Speaker, I want to thank the gentlewoman from Texas for 
yielding this time to me.
  Mr. Speaker, I want to also thank the gentlewoman from Texas for all 
of the work that she has done on behalf of this bill at the committee 
level and at the subcommittee level. I want to thank the gentleman from 
Illinois (Mr. Hyde), the chairman of the committee, for all his work. I 
want to also thank the ranking member the gentleman from Michigan (Mr. 
Conyers) for all the work that he did on behalf of this bill, and also 
I want to thank the gentleman from Texas (Mr. Smith), the chairman of 
the subcommittee, for all the work that he did on behalf of this bill.
  Mr. Speaker, as the sponsor of the Nursing Relief for Disadvantaged 
Areas Act of 1999, I also support certain provisions that were added in 
the Senate by unanimous consent and that enjoy strong bipartisan 
support. Specifically, I refer to a provision added by Senator Hatch 
which is merely a technical clarification to the L visa.
  As my colleagues know, the L visa is a temporary, nonimmigrant visa. 
The technical amendment permits an American company which is part of an 
international business, to transfer managers and employees to the 
United States from a foreign country. This amendment allows American 
companies to remain competitive.
  Additionally, another provision added by Senators Lott and Daschle 
allow foreign doctors to work for 5 years in disadvantaged areas, 
provided, and I repeat, provided that no American doctors are available 
to perform these jobs.

                              {time}  1615

  I want to assure my colleagues that these amendments will not take 
jobs away from our American doctors and these amendments are within the 
spirit of this legislation.
  Hence, I rise today to encourage my colleagues to vote for H.R. 441, 
as amended by the Senate. As you may know, my reason for introducing 
and encouraging support for this legislation is quite simple. It will 
assist the underserved communities of this Nation by providing adequate 
health care for their residents.
  Today there are some areas in this country which experience a 
scarcity of health professionals. Even though numbers indicate that no 
nursing shortage exists nationally, such an area exists in my district, 
the First District of Illinois. The Englewood community, a poor, urban 
neighborhood with a high incidence of crime, is primarily served by one 
hospital, and that hospital is the St. Bernard's Hospital. This small 
community hospital's emergency room averages approximately 31,000 
visits per day. Fifty percent of their patients are Medicaid recipients 
and 35 percent receive Medicare.
  The Immigration Nursing Relief 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. St. Bernard's hospital utilized the H-1A program to 
maintain an adequate nursing staff level.
  The H-1A program was vital to St. Bernard's continued existence. 
Prior to this program, St. Bernard hired temporary nurses. As a result, 
the hospital's nursing expenditures increased

[[Page H11324]]

by approximately $2 million in an effort to provide health care to its 
patients in 1992. This additional cost brought St. Bernard's close to 
closing its doors.
  The H-1A visa program expired on September 30, 1997. Currently, no 
program exists that would assist hospitals such as St. Bernard's in 
their efforts to retain qualified nurses. My legislation merely seeks 
to close a gap created by the expiration of the H-1A program.
  H.R. 441 prescribes that any hospital which seeks to hire foreign 
nurses under these provisions must meet the following stringent 
criteria: number one, be located in a health professional shortage 
area; number two, have at least 190 acute-care beds; number three, have 
a Medicare population of 35 percent; and, number four, have a Medicaid 
population of at least 28 percent.
  Mr. Speaker, these are stringent requirements. This bill needs the 
support of the Members of this body, and I encourage Members of this 
body to support this legislation and support H.R. 441.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I have no further requests for 
time, and I yield back the balance of my time.
  Mr. SMITH of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I urge all Members to vote to concur to the Senate 
amendment to H.R. 441 that will enable the bill to go to the 
President's desk and become the law of the land.
  Mr. HYDE. Mr. Speaker, I want to commend our colleague Bobby Rush for 
introducing this important bill and working over the last two years to 
ensure its enactment into law.
  Two years ago, Representative Rush and I were approached by St. 
Bernard Hospital and Health Care Center in Chicago. The hospital, which 
is the only source of health care for an entire impoverished section of 
the City of Chicago, was having great difficulty attracting sufficient 
American nurses. St. Bernard's and a number of other inner-city 
hospitals, perhaps because of the high crime rates in their 
neighborhoods, were having this problem. So were a number of rural 
hospitals. St. Bernard's felt that its only viable option to fully meet 
its nursing needs was to employ foreign nationals.
  There isn't a nationwide nursing shortage in the United States. So, 
there does not appear to be the support to implement a broad-based 
nurse visa program. However, a narrowly crafted program to help out 
hospitals in need is eminently justified. This is exactly what H.R. 441 
accomplishes. The bill 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 nurse, a hospital would have to 
meet four conditions. First, it would have to be located in a health 
professional shortage area as designated by the Department of Health 
and Human Services. Second, it would have to have at least 190 acute 
care beds. Third, a certain percentage of its patients would have to be 
Medicare patients. Fourth, a certain percentage of patients would have 
to be Medicaid patients.
  H.R. 441 meets an undisputed need. Thus, it is not opposed by the 
American nurses association. I was pleased to move the bill through the 
Judiciary Committee, and I urge my colleagues to support it.
  Mr. SMITH of Texas. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. LaHood). The question is on the motion 
offered by the gentleman from Texas (Mr. Smith) that the House suspend 
the rules and concur in the Senate amendment to H.R. 441.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the Senate amendment was 
concurred in.
  A motion to reconsider was laid on the table.

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