[Congressional Record Volume 164, Number 29 (Wednesday, February 14, 2018)]
[Senate]
[Pages S1115-S1116]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 2001. Ms. KLOBUCHAR (for herself and Ms. Heitkamp) submitted an
amendment intended to be proposed by her to the bill H.R. 2579, to
amend the Internal Revenue Code of 1986 to allow the premium tax credit
with respect to unsubsidized COBRA continuation coverage; which was
ordered to lie on the table; as follows:
At the appropriate place, insert the following:
DIVISION _--CONRAD STATE 30 AND PHYSICIAN ACCESS REAUTHORIZATION
SEC. 1. SHORT TITLE.
This division may be cited as the ``Conrad State 30 and
Physician Access Reauthorization Act''.
SEC. 2. CONRAD STATE 30 PROGRAM.
(a) Extension.--Section 220(c) of the Immigration and
Nationality Technical Corrections Act of 1994 (Public Law
103-416; 8 U.S.C. 1182 note) is amended by striking
``September 30, 2015'' and inserting ``September 30, 2021''.
(b) Effective Date.--The amendment made by subsection (a)
shall take effect as if enacted on April 28, 2017.
SEC. 3. EMPLOYMENT PROTECTIONS FOR PHYSICIANS.
(a) In General.--Section 214(l)(1) of the Immigration and
Nationality Act (8 U.S.C. 1184(l)(1) is amended--
(1) in the matter preceding subparagraph (A), by striking
``Attorney General'' and inserting ``Secretary of Homeland
Security'';
(2) in subparagraph (A), by striking ``Director of United
States Information Agency'' and inserting ``Secretary of
State'';
(3) in subparagraph (B), by inserting ``, except as
provided in paragraphs (7) and (8)'' before the semicolon at
the end; and
(4) in subparagraph (C), by striking clauses (i) and (ii)
and inserting the following:
``(i) the alien demonstrates a bona fide offer of full-time
employment at a health facility or health care organization,
which employment has been determined by the Secretary of
Homeland Security to be in the public interest; and
``(ii) the alien--
``(I) has accepted employment with the health facility or
health care organization in a geographic area or areas which
are designated by the Secretary of Health and Human Services
as having a shortage of health care professionals;
``(II) begins employment by the later of the date that is--
``(aa) 90 days after receiving such waiver;
``(bb) 90 days after completing graduate medical education
or training under a program approved pursuant to section
212(j)(1); or
``(cc) 90 days after receiving nonimmigrant status or
employment authorization, if the alien or the alien's
employer petitions for such nonimmigrant status or employment
authorization not later than 90 days after the date on which
the alien completes his or her graduate medical education or
training under a program approved pursuant to section
212(j)(1); and
``(III) agrees to continue to work for a total of not less
than 3 years in the status authorized for such employment
under this subsection unless--
``(aa) the Secretary of Homeland Security determines that
extenuating circumstances, including violations by the
employer of the employment agreement with the alien or of
labor and employment laws, exist that justify a lesser period
of employment at such facility or organization, in which case
the alien shall demonstrate, not later than 90 days after the
employment termination date (unless the Secretary determines
that extenuating circumstances would justify an extension),
another bona fide offer of employment at a health facility or
health care organization in a geographic area or areas which
are designated by the Secretary of Health and Human Services
as having a shortage of health care professionals, for the
remainder of such 3-year period;
``(bb) the interested State agency that requested the
waiver attests that extenuating circumstances including
violations by the employer of the employment agreement with
the alien or of labor and employment laws, exist that justify
a lesser period of employment at such facility or
organization in which case the alien shall demonstrate, not
later than 90 days after the employment termination date
(unless the Secretary determines that extenuating
circumstances would justify an extension), another bona fide
offer of employment at a health facility or health care
organization in a geographic area or areas which are
designated by the Secretary of Health and Human Services as
having a shortage of health care professionals, for the
remainder of such 3-year period; or
``(cc) if the alien elects not to pursue a determination of
extenuating circumstances pursuant to item (aa) or (bb), the
alien terminates the alien's employment relationship with
such facility or organization, in which case the alien shall
demonstrate, not later than 45 days after the employment
termination date, another bona fide offer of employment at a
health facility or health care organization in a geographic
area or areas, in the State that requested the alien's
waiver, which are designated by the Secretary of Health and
Human Services as having a shortage of health care
professionals, and agree to be employed for the remainder of
such 3-year period, and 1 additional year for each
termination under this subclause; and''.
(b) Allowable Visa Status for Physicians Fulfilling Waiver
Requirements in Medically Underserved Areas.--Section
214(l)(2) of such Act (8 U.S.C. 1184(l)(2)) is amended by
amending subparagraph (A) to read as follows:
``(A) Upon the request of an interested Federal agency or
an interested State agency for recommendation of a waiver
under this section by a physician who is maintaining valid
nonimmigrant status under section 101(a)(15)(J) and a
favorable recommendation by the Secretary of State, the
Secretary of Homeland Security may change the status of such
physician to that of an alien described in section
101(a)(15)(H)(i)(B). The numerical limitations contained in
subsection (g)(1)(A) shall not apply to any alien whose
status is changed under this subparagraph.''.
(c) Violation of Agreements.--Section 214(l)(3)(A) of such
Act (8 U.S.C. 1184(l)(3)(A)) is amended by inserting
``substantial requirement of an'' before ``agreement entered
into''.
(d) Physician Employment in Underserved Areas.--Section
214(l) of such Act (8 U.S.C. 1184(l)) is amended by adding at
the end the following:
``(4)(A) If an interested State agency denies the
application for a waiver under paragraph (1)(B) from a
physician pursuing graduate medical education or training
pursuant to section 101(a)(15)(J) because the State has
requested the maximum number of waivers permitted for that
fiscal year, the physician's nonimmigrant status shall be
extended for up to 6 months if the physician agrees to seek a
waiver under this subsection (except for paragraph
(1)(D)(ii)) to work for an employer described in paragraph
(1)(C) in a State that has not yet requested the maximum
number of waivers.
``(B) Such physician shall be authorized to work only for
the employer referred to in subparagraph (A) from the date on
which a new waiver application is filed with such State until
the earlier of--
``(i) the date on which the Secretary of Homeland Security
denies such waiver; or
``(ii) the date on which the Secretary approves an
application for change of status under paragraph (2)(A)
pursuant to the approval of such waiver.''.
(e) Contract Requirements.--Section 214(l) of such Act, as
amended by subsection (d), is further amended by adding at
the end the following:
``(5) An alien granted a waiver under paragraph (1)(C)
shall enter into an employment agreement with the contracting
health facility or health care organization that--
``(A) specifies the maximum number of on-call hours per
week (which may be a monthly average) that the alien will be
expected to be available and the compensation the alien will
receive for on-call time;
``(B) specifies--
``(i) whether the contracting facility or organization will
pay the alien's malpractice insurance premiums;
``(ii) whether the employer will provide malpractice
insurance; and
``(iii) the amount of such insurance that will be provided;
``(C) describes all of the work locations that the alien
will work and includes a statement that the contracting
facility or organization will not add additional work
locations without the approval of the Federal agency or State
agency that requested the waiver; and
``(D) does not include a non-compete provision.
``(6) An alien granted a waiver under this subsection whose
employment relationship with a health facility or health care
organization terminates under paragraph (1)(C)(ii) during the
3-year service period required under paragraph (1) shall be
considered to be maintaining lawful status in an authorized
period of stay during the 90-day period referred to in items
(aa) and (bb) of subclause
[[Page S1116]]
(III) of paragraph (1)(C)(ii) or the 45-day period referred
to in subclause (III)(cc) of such paragraph.''.
(f) Recapturing Waiver Slots Lost to Other States.--Section
214(l) of such Act, as amended by subsections (d) and (e), is
further amended by adding at the end the following:
``(7) If a recipient of a waiver under this subsection
terminates the recipient's employment with a health facility
or health care organization pursuant to paragraph (1)(C)(ii),
including termination of employment because of circumstances
described in paragraph (1)(C)(ii)(III), and accepts new
employment with such a facility or organization in a
different State, the State from which the alien is departing
may be accorded an additional waiver by the Secretary of
State for use in the fiscal year in which the alien's
employment was terminated.''.
SEC. 4. ALLOTMENT OF CONRAD 30 WAIVERS.
(a) In General.--Section 214(l) of the Immigration and
Nationality Act (8 U.S.C. 1184(l)), as amended by section 3,
is further amended by adding at the end the following:
``(8)(A)(i) All States shall be allotted a total of 35
waivers under paragraph (1)(B) for a fiscal year if 90
percent of the waivers available to the States receiving at
least 5 waivers were used in the previous fiscal year.
``(ii) When an allotment occurs under clause (i), all
States shall be allotted an additional 5 waivers under
paragraph (1)(B) for each subsequent fiscal year if 90
percent of the waivers available to the States receiving at
least 5 waivers were used in the previous fiscal year. If the
States are allotted 45 or more waivers for a fiscal year, the
States will only receive an additional increase of 5 waivers
the following fiscal year if 95 percent of the waivers
available to the States receiving at least 1 waiver were used
in the previous fiscal year.
``(B) Any increase in allotments under subparagraph (A)
shall be maintained indefinitely, unless in a fiscal year,
the total number of such waivers granted is 5 percent lower
than in the last year in which there was an increase in the
number of waivers allotted pursuant to this paragraph, in
which case--
``(i) the number of waivers allotted shall be decreased by
5 for all States beginning in the next fiscal year; and
``(ii) each additional 5 percent decrease in such waivers
granted from the last year in which there was an increase in
the allotment, shall result in an additional decrease of 5
waivers allotted for all States, provided that the number of
waivers allotted for all States shall not drop below 30.''.
(b) Academic Medical Centers.--Section 214(l)(1)(D) of such
Act is amended--
(1) in clause (ii), by striking ``and'' at the end;
(2) in clause (iii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(iv) in the case of a request by an interested State
agency--
``(I) the head of such agency determines that the alien is
to practice medicine in, or be on the faculty of a residency
program at, an academic medical center (as that term is
defined in section 411.355(e)(2) of title 42, Code of Federal
Regulations, or similar successor regulation), without regard
to whether such facility is located within an area designated
by the Secretary of Health and Human Services as having a
shortage of health care professionals; and
``(II) the head of such agency determines that--
``(aa) the alien physician's work is in the public
interest; and
``(bb) the grant of such waiver would not cause the number
of the waivers granted on behalf of aliens for such State for
a fiscal year (within the limitation in subparagraph (B) and
subject to paragraph (6)) in accordance with the conditions
of this clause to exceed 3.''.
SEC. 5. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, AND OTHER
PROVISIONS RELATED TO PHYSICIAN IMMIGRATION.
(a) Visa Eligibility.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of State
shall amend guidance in the Foreign Affairs Manual to clarify
that the expression of a future intention to seek a waiver
under section 214(l) of the Immigration and Nationality Act
(8 U.S.C. 1184(l)) by an alien coming to the United States to
receive graduate medical education or training, as described
in section 212(j) of such Act (8 U.S.C. 1182(j)), or to take
examinations required to receive such graduate medical
education or training, shall not, by itself, constitute
evidence of an intention to abandon a foreign residence for
purposes of obtaining a visa as a nonimmigrant or otherwise
obtaining or maintaining the status of a nonimmigrant.
(b) Applicability of Section 212(e) to Spouses and Children
of J-1 Exchange Visitors.--Section 212(e) of the Immigration
and Nationality Act (8 U.S.C. 1182(e)) is amended--
(1) by inserting ``(1)'' after ``(e)''; and
(2) by adding at the end the following
``(2) A spouse or child of an exchange visitor described in
section 101(a)(15)(J) shall not be subject to the
requirements under this subsection solely on account of such
spouse or child's derivative nonimmigrant status to an
exchange visitor who is subject to the requirements under
this subsection.''.
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