[House Report 106-135]
[From the U.S. Government Publishing Office]



106th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES

 1st Session                                                    106-135
_______________________________________________________________________


 
           NURSING RELIEF FOR DISADVANTAGED AREAS ACT OF 1999

_______________________________________________________________________


  May 12, 1999.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Smith of Texas, from the Committee on the Judiciary, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 441]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on the Judiciary, to whom was referred 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, having considered the same, reports favorably 
thereon without amendment and recommends that the bill do pass.

                           TABLE OF CONTENTS

                                                                  

                                                                 Page
Purpose and Summary........................................           2
Background and Need for the Legislation....................           2
Hearings...................................................           6
Committee Consideration....................................           6
Vote of the Committee......................................           6
Committee Oversight Findings...............................           6
Committee on Government Reform Findings....................           6
New Budget Authority and Tax Expenditures..................           6
Congressional Budget Office Cost Estimate..................           6
Constitutional Authority Statement.........................           8
Section-by-Section Analysis and Discussion.................           8
Changes in Existing Law Made by the Bill, as Reported......          13

                          Purpose and Summary

    H.R. 441 would create a new ``H-1C'' temporary visa program 
for registered nurses that would sunset after four years. The 
new program would be modeled after the expired ``H-1A'' program 
but would limit the number of visas that could be issued to 500 
a year and would only allow ``in-need'' hospitals who meet 
certain criteria to petition for alien nurses.

                Background and Need for the Legislation

I. The H-1A Registered Nurse Temporary Visa Program
    The H-1A program was created by the Immigration Nursing 
Relief Act of 1989 [INRA] \1\ and expired on September 1, 1995. 
Legislation enacted in the 104th Congress allowed nurses who 
had entered the United States under the program to stay and 
work as registered nurses until September 30, 1997.\2\ However, 
amendments to extend the H-1A program for 6 months were 
defeated both in the Judiciary Committee and on the House floor 
during consideration of immigration reform legislation in the 
104th Congress.\3\
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    \1\ Pub. L. No. 101-238 (1989). See sections 101(a)(15)(H)(i)(a) 
and 212(m) of the Immigration and Nationality Act (hereinafter cited as 
``INA'').
    \2\ Pub. L. 104-302 (1996).
    \3\ See Congressional Quarterly Almanac: 1996 at H-30.
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    The H-1A program had no numerical cap. In 1993, a 
representative year, 6,506 aliens were admitted pursuant to the 
H-1A program. Nurses could stay for an initial period of 3 
years, subject to extension up to a total of 5 years (6 years 
in case of extraordinary circumstances).\4\
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    \4\ INA sec. 212(m)(4).
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    INRA was enacted in response to a number of contrasting 
factors, including the existence of ``[a] nationwide nursing 
shortage severe enough to disrupt the delivery of services to 
patients in some U.S. health care institutions and potentially 
place patients in jeopardy'' and ``[c]oncern among labor 
organizations . . . that foreign workers [entering under the 
then-existing temporary visa program] were having, or, given 
their rate of entry, might come to have, a detrimental effect 
on the pay and working conditions of the domestic work force . 
. . .'' \5\
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    \5\ Immigration Nursing Relief Advisory Committee, Report to the 
Secretary of Labor on the Immigration Nursing Relief Act of 1989 11 
(1995)(``Report'').
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    Under the H-1A program, an alien had to:

          [have] 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 or Canada;
          [have] passed an appropriate examination . . . or 
        [have] a full and unrestricted license under State law 
        to practice professional nursing in the State of 
        intended employment; and
          is fully qualified and eligible under the laws . . . 
        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.\6\
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    \6\ INA section 212(m)(1)(A)-(C).

    Under the H-1A program, the intending employer had to 
attest that:
          [t]here would be a substantial disruption through no 
        fault of the [employer] in the delivery of health care 
        services . . . without the services of such an alien[,] 
        \7\
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    \7\ In order to meet the terms of this attestation, the employer 
generally could not have laid off registered nurses within the previous 
year. INA sec. 212(m)(2)(A).
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          [t]he employment of the alien will not adversely 
        affect the wages and working conditions of registered 
        nurses similarly employed[,]
          [t]he alien employed by the [employer] will be paid 
        the wage rate for registered nurses similarly employed 
        by the [employer,]
          [e]ither . . . the [employer] 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 [employer] 
        on [H-1A] registered nurses, or . . . the [employer] is 
        subject to an approved State plan for the recruitment 
        and retention of nurses[,]
          [t]here is not a strike or lockout in the course of a 
        labor dispute, and the employment of an [H-1A] alien is 
        not intended or designed to influence an election for a 
        bargaining representative for registered nurses of the 
        [employer, and]
          . . . notice of the [petitioning for H-1A nurses] has 
        been provided . . . to the bargaining representative of 
        the registered nurses at the [employer], or where there 
        is no such bargaining representative, notice of the 
        filing has been provided to the registered nurses 
        employed at the [employer's] facility . . . .\8\
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    \8\ INA section 212(m)(2)(A).

    The Labor Department had the responsibility of 
investigating complaints that an employer did not meet the 
conditions attested to or misrepresented a material fact in the 
attestation.\9\ If an employer was found to have committed a 
violation, the employer would be barred from getting new H-1A 
petitions approved for at least one year, could be fined up to 
$1,000 per violation, and could be required to provide back pay 
if H-1A nurses were underpaid.\10\
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    \9\ INA section 212(m)(2)(E).
    \10\ Id.
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II. The Immigration Nursing Relief Advisory Committee
    INRA established the Immigration Nursing Relief Advisory 
Committee to measure the impact of INRA on the nursing shortage 
and to advise on whether the H-1A program should be extended.
    The Committee found that:

    H-1A nurses . . . do not constitute a significant national 
presence.\11\ They fill multiple roles in the United States, 
working in a variety of positions: [1] Positions that are 
difficult to fill or for which they have special 
qualifications: e.g., intensive care units, labor and delivery 
units, operating rooms, psychiatric units, and long term care 
facilities; [2] Regular, bedside staff positions in hospitals 
and nursing homes; [3] Evening, night, and weekend shifts; and 
[4] Positions where their language, race, or ethnicity is 
considered of value in providing services to multi-ethnic 
patients.\12\
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    \11\ There were over 1.85 million registered nurses working in 
nursing in the United States in 1992. Report at Appendix F, page 45.
    \12\ Id. at 21.
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          [T]he New York-City-Newark, Chicago, Houston, Los 
        Angeles, and Miami [areas] have accounted for two-
        thirds of all petitions filed . . . .\13\
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    \13\ Id. at 22.
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          [O]ver 80 percent of approved petitions . . . were 
        for nurses from the Philippines.\14\
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    \14\ Id. at 25.
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          In the local labor markets studied . . . H-1A nurses 
        were [not] paid differently from U.S. nurses.\15\
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    \15\ Id. The national average salary for full-time staff nurses 
working in hospitals was $35,200 in 1992. Id. at Appendix F, page 64.
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          [T]here was no evidence of systematic differences in 
        work assignments given to H-1A . . . nurses.\16\
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    \16\ Id. at 26.
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          [T]here were no indications of problems with H-1A 
        nurses . . . in delivering care . . . .\17\
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    \17\ Id. at 27.
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          Although the national [nursing] shortage of the late 
        1980s has abated, this change could not be attributed 
        to INRA. Market adjustments--increasing wages, 
        increasing numbers of nursing graduates, and changing 
        demand--were much more powerful and, ultimately, 
        effective in ending the national shortage.\18\
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    \18\ Id. at 30.
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          The future labor market for registered nurses is 
        highly uncertain. . . . The most recent projections of 
        employment for RNs by the Bureau of Labor Statistics 
        indicate an increase of 40 percent by 2005, far greater 
        than the growth projected for employment generally. 
        Decreases in the number of nursing graduates may be 
        ahead in this decade with the possibility of RN 
        shortages again in the 21st century.\19\
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    \19\ Id. at 31-32 (footnotes omitted).

    Three Committee members--representing the AFL-CIO, the 
American Nurses Association, and the Service Employees 
International Union--filed dissenting views. They found that 
``[t]he overwhelming preponderance of evidence indicates that 
the nursing shortage of the 1980s was a transitory phenomenon. 
If anything, today there is a slight oversupply of nurses and 
that oversupply is likely to increase in the future.'' \20\ 
They also found that ``since 1990, the health care industry has 
been actively restructuring, a process that has been dominated 
by hospital downsizing. Today, hospitals are laying off nurses 
or restructuring their jobs to reduce or eliminate their 
bedside responsibilities.'' \21\
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    \20\ Id. at Appendix A, page 1.
    \21\ Id. at Appendix A, page 2.
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    The Committee recommended that:

    [The H-1A program should be extended with modifications] to 
balance both the continuing need for foreign nurses in certain 
specialties and localities for which there are not adequate 
domestic RNs and the need to continue to lessen employers' 
dependence on foreign RNs and protect the wages and working 
conditions of U.S. RNs. In addition . . . the uncertainty about 
future demand for RNs and the possibility of future shortages 
as evidenced by the cyclical nature of past RN shortages, 
argues for a more cautious approach to the elimination or 
reduction in temporary foreign RN entry into the United 
States.\22\
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    \22\ Id. at 35.

    The dissenters recommended that the H-1A program be allowed 
to sunset. However, ``[i]f the H-1A Visa program is retained 
then hospitals should be restricted to using H-1A nurses 
limited to those specific shortage areas or to meet special 
requirements, such as language ability.'' \23\
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    \23\ Id. at Appendix A, page 7.
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III. H.R. 441
    There does not appear to be a national nursing shortage 
today; however, a number of hospitals with unique circumstances 
are still experiencing great difficulty in attracting American 
nurses.\24\ Hospitals serving mostly poor patients have special 
difficulties. Some hospitals in rural areas might also. For 
example:
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    \24\ Neil Sampson, Acting Associate Administrator for Health 
Professions, Health Resources and Services Administration, U.S. 
Department of Health and Human Services, has stated that ``[t]he best 
information currently available indicates that there is not a national 
shortage of registered nurses. There are a few areas in which specialty 
and locality shortages persist.'' Hearing Before the Immigration and 
Claims Subcomm. of the House Judiciary Comm., 105th Cong., 1st Sess. 
(Nov. 5, 1997).

          St. Bernard Hospital and Health Care Center . . . is 
        located on the South side of Chicago in the Englewood 
        Community. It is the only remaining hospital in an area 
        with a census in excess of 100,000 and the patient base 
        is almost entirely poverty care or charity care. . . .
          St. Bernard almost closed its doors in 1992, 
        primarily because of its inability to attract health 
        care professionals, most importantly registered 
        nurses.\25\
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    \25\ Id. (statement on behalf of St. Bernard Hospital and Mercy 
Regional Medical Center).

    H.R. 441 bill has been drafted very narrowly to help 
precisely these kinds of hospitals. Thus, it is built around 
the area of consensus between the majority and dissenting 
members of Immigration Nursing Relief Advisory Committee.
    H.R. 441 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 
basic 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 (35%) of the employer's patients would have 
to be Medicare patients. Fourth, a certain percentage (28%) of 
patients would have to be Medicaid patients. The bill contains 
the most important safeguards found in the H-1A program and has 
added ones of its own.
    The American Nursing Association has written that: ``[w]ith 
regard to H.R. 441, ANA has taken a position of neutrality. 
However, ANA will adamantly oppose any amendments which seek to 
broaden the application of this visa or would lessen the 
protections afforded registered nurses under this measure.'' 
\26\
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    \26\ Letter from Beverly Malone, President, American Nurses 
Association, to U.S. Representative Sheila Jackson Lee (March 18, 
1999).
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                                Hearings

    No hearings were held on H.R. 441. However, the Committee's 
Subcommittee on Immigration and Claims held one day of hearings 
on its predecessor bill [H.R. 2759] in the 105th Congress on 
November 5, 1997. Testimony was received from U.S. 
Representative Bobby Rush; Neil Sampson, Acting Associate 
Administrator for Health Professions, Health Resources and 
Services Administration, U.S. Department of Health and Human 
Services; Ron Campbell, Vice President for Patient Care 
Services, St. Bernard Hospital and Health Care Center, Chicago, 
Illinois; Cheryl Peterson, Associate Director for Federal 
Government Relations, American Nurses Association; and Mark 
Stauder, President and Chief Operating Officer, Mercy Regional 
Medical Center, Laredo, Texas.

                        Committee Consideration

    On March 18, 1999, the Subcommittee on Immigration and 
Claims met in open session and ordered reported the bill H.R. 
441 by a voice vote, a quorum being present. On March 24, 1999, 
the Committee met in open session and ordered reported 
favorably the bill H.R. 441 by a voice vote, a quorum being 
present.

                         Vote of the Committee

    The bill was reported favorably by voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of Rule XIII of the Rules 
of the House of Representatives, the Committee reports that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of Rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

                Committee on Government Reform Findings

    No findings or recommendations of the Committee on 
Government Reform and Oversight were received as referred to in 
clause 3(c)(4) of Rule XIII of the Rules of the House of 
Representatives.

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of House Rule XIII is inapplicable because 
this legislation does not provide new budgetary authority or 
increased tax expenditures.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of Rule XIII of the Rules 
of the House of Representatives, the Committee sets forth, with 
respect to the bill H.R. 441, the following estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, April 2, 1999.
Hon. Henry J. Hyde,
Chairman, Committee on the Judiciary,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 441, the Nursing 
Relief for Disadvantaged Areas Act of 1999.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contacts are Mark 
Grabowicz (for costs of the Immigration and Naturalization 
Service), who can be reached at 226-2860, Christi H. Sadoti 
(for costs of the Department of Labor), who can be reached at 
226-2820, Lisa Cash Driskill (for the state and local impact), 
who can be reached at 225-3220, and John Harris (for the 
private-sector impact), who can be reached at 226-6910.
            Sincerely,

                                            Dan L. Crippen, Director.  
    Enclosure.

H.R. 441--Nursing Relief for Disadvantaged Areas Act of 1999
    CBO estimates that enacting H.R. 441 would have a 
negligible net impact on the federal budget. Because the bill 
would affect direct spending and receipts, pay-as-you-go 
procedures would apply. However, we estimate that the amounts 
involved would be much less than $500,000 a year. This 
legislation contains no intergovernmental mandates as defined 
in the Unfunded Mandates Reform Act (UMRA). Any costs incurred 
by state, local, or tribal governments would be a result of 
voluntary participation in the program established by this 
bill. H.R. 441 would impose a new private-sector mandate on 
employers of nonimmigrant nurses who come to the United States 
under the bill. CBO estimates that the costs of complying with 
this mandate would fall well below the statutory threshold 
established in UMRA ($100 million in 1996, adjusted annually 
for inflation).
    H.R. 441 would establish a new nonimmigrant category for 
nurses who would work in areas of the United States with 
shortages of health professionals. The bill would authorize the 
issuance of 500 nonimmigrant visas annually over the next four 
years for individuals in this category, and recipients could 
stay in the United States for three years. The fee charged for 
these visas would be $110, so enacting the bill could increase 
the amount of fees collected by the Immigration and 
Naturalization Service (INS) by about $55,000 annually if all 
500 visas were granted. The INS would spend the fees (without 
appropriation action), mostly in the year in which they were 
collected, so enacting H.R. 441 would result in a negligible 
net impact on INS spending.
    The bill would require the Department of Labor (DOL) to 
charge fees of up to $250 to facilities that file applications 
to hire immigrant nurses. This provision would result in the 
collection of fees totaling between $15,000 and $50,000 
annually, assuming all visas are granted and petitioning 
facilities apply to hire more than one worker. The spending of 
fees collected by DOL would be subject to appropriation action.
    In addition, the bill would increase civil monetary 
penalties for violations of certain laws relating to the hiring 
of nonimmigrant nurses. This action could result in the 
collection of additional receipts, but we estimate that any 
such amounts would be less than $500,000 per year.
    By creating a new nonimmigrant visa program for qualified 
nurses, the bill would allow certain health facilities, some of 
them operated by state and local public agencies, to increase 
the number of nurses they employ. In order to participate, 
these facilities would have to satisfy criteria established in 
the bill and pay the fee to DOL as described above. However, 
their participation in the program would be voluntary.
    H.R. 441 would impose a new private-sector mandate on 
employers of nonimmigrant nurses who come to the United States 
under the program established by the bill. Although employers 
who use nonimmigrant nurses would do so voluntarily, such 
employers would have to comply with requirements of the 
applicable federal immigration programs. They would be required 
to provide certain information, wages, working conditions, and 
rights to unionization commensurate with those of similarly 
employed nurses who are citizens or immigrants. These 
enforceable duties meet the definition of a private-sector 
mandate in UMRA because immigration processes are 
governmentally mandated and are not considered voluntary 
federal programs. CBO estimates that the direct cost of new 
mandates in H.R. 441 would be very small because the number of 
nonimmigrant nurses allowed to enter the United States under 
this legislation would be limited to 500 or fewer each year.
    The CBO staff contacts are Mark Grabowicz (for INS costs), 
who can be reached at 226-2860, Christi H. Sadoti (for DOL 
costs), who can be reached at 226-2820, Lisa Cash Driskill (for 
the state and local impact), who can be reached at 225-3220, 
and John Harris (for the private-sector impact), who can be 
reached at 226-6910. This estimate was approved by Robert A. 
Sunshine, Deputy Assistant Director for Budget Analysis.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of Rule XIII of the Rules of the 
House of Representatives, the Committee finds the authority for 
this legislation in Article I, section 8, clause 4 of the 
Constitution.

                      Section-By-Section Analysis

Section 1. Short title
    The Act may be cited as the ``Nursing Relief for 
Disadvantaged Areas Act of 1999.''
Section 2. Requirements for admission of nonimmigrant nurses in health 
        professional shortage areas during 4-year period
    Section 2(a) of the bill amends section 101(a)(15)(H)(i) of 
the Immigration and Nationality Act by adding a subclause (c) 
creating a nonimmigrant visa program for aliens to perform 
services as registered nurses. To qualify for an ``H-1C'' visa, 
an alien would have to meet the three qualifications set forth 
in section 2(b) of the bill and the facility for which the 
alien would perform nursing services must have an unexpired 
attestation on file and in effect with the U.S. Secretary of 
Labor, as described in section 2(b) of the bill.
    Section 2(b) of the bill amends section 212(m)(1) of the 
INA in order that it set forth the three qualifications an 
alien must possess. First, the alien must have 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. Second, the 
alien must have passed an appropriate examination or has a full 
and unrestricted license under State law to practice nursing in 
the State of intended employment. Third, the alien must be 
fully qualified and eligible under the laws governing the place 
of intended employment to engage in the practice of nursing as 
a registered nurse immediately upon admission to the United 
States and is authorized under such laws to be employed by the 
facility.
    Section 2(b) amends section 212(m)(2)(A) of the INA in 
order that it describe the attestation that a facility must 
make. The facility must attest that (1) it meets the 
requirements of section 212(m)(6) of the INA, (2) the 
employment of the alien will not adversely affect the wages and 
working conditions of registered nurses similarly employed, (3) 
the alien will be paid the wage rate for registered nurses 
similarly employed by the facility, (4) the facility has taken 
(after the date of enactment of this bill) and is taking timely 
and significant steps designed to recruit and retain sufficient 
registered nurses who are U.S. 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, (5) there is not a strike or 
lockout in the course of a labor dispute, the facility did not 
lay off and will not lay off a registered nurse employed by the 
facility within the period beginning 90 days before and ending 
90 days after the date of filing of any H-1C visa petition, 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, (6) at the time of the 
filing of the petition for H-1C nurses, 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 bargaining representative, notice of the 
filing has been provided to registered nurses employed at the 
facility through posting in conspicuous locations, (7) the 
facility will not, at any time, employ a number of aliens 
issued H-1C visas or otherwise provided H-1C nonimmigrant 
status that exceeds 33% of the total number of registered 
nurses employed by the facility, and (8) the facility will not, 
with respect to any alien issued an H-1C visa or otherwise 
provided H-1C status, authorize the alien to perform nursing 
services at any worksite other than a worksite controlled by 
the facility or transfer the place of employment of the alien 
from one worksite to another. A copy of the attestation shall 
be provided to registered nurses employed at the facility.
    Section 2(b) amends section 212(m)(2)(B) of the INA so that 
it provides a non-exclusive list of ``significant steps'' to 
recruit and retain registered nurses: (1) operating a training 
program for registered nurses at the facility or financing (or 
providing participation in) a training program for registered 
nurses elsewhere, (2) providing career development programs and 
other methods of facilitating health care workers to become 
registered nurses, (3) paying registered nurses wages at a rate 
higher than currently being paid to registered nurses similarly 
employed in the geographic area, and (4) providing reasonable 
opportunities for meaningful salary advancement by registered 
nurses. A facility does not need to take more than one step if 
it can demonstrate that taking a second step is not reasonable.
    Section 2(b) amends section 212(m)(2)(C) of the INA to 
provide that attestations shall expire on the later of (1) the 
end of the one-year period beginning on the date of its filing, 
or (2) the end of the period of admission of the last alien 
with respect to whose admission it was applied, and shall apply 
to petitions filed during the one-year period beginning on the 
date of its filing if the facility states in each such petition 
that it continues to comply with the conditions of the 
attestation.
    Section 2(b) amends section 212(m)(2)(D) of the INA to 
provide that a facility may meet the requirements of paragraph 
212(m)(2) with respect to more than one registered nurse in a 
single petition.
    Section 2(b) of the bill amends section 212(m)(2)(E) of the 
INA to provide that the Secretary of Labor shall compile and 
make available for public examination a list identifying 
facilities that have filed petitions for H-1C nonimmigrants 
(along with copies of attestations, accompanying documentation 
and petitions filed).
    Section 212(m)(2)(E) is also amended to provide that 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 attested to conditions or misrepresentation of a material 
fact in an attestation. Complaints may be filed by aggrieved 
persons or organizations (including bargaining 
representatives). The Secretary shall conduct an investigation 
if there is reasonable cause to believe that a violation has 
occurred. The Secretary shall provide for a determination 
within 180 days of the filing of a complaint as to whether or 
not a basis exists to make a finding that a violation has 
occurred, and provide notice and opportunity for a hearing to 
interested parties if the Secretary finds that a basis does 
exist. If the Secretary finds that a violation (failure to meet 
attested to conditions or misrepresentation of a material fact 
in an attestation) has occurred, the Secretary shall notify the 
Attorney General of such finding, and may, in addition, impose 
other appropriate administrative remedies (including civil 
monetary penalties not to exceed $1,000 per nurse per violation 
with a total penalty not to exceed $10,000 per violation). The 
Secretary shall order the payment of back pay as may be 
necessary to put a facility in compliance with the prevailing 
wage requirement. Upon receipt of notice that a violation has 
occurred, the Attorney General shall not approve H-1C petitions 
filed with respect to a facility during a period of at least 
one year.
    Section 2(b) of the bill creates a new section 212(m)(2)(F) 
of the INA providing for a filing fee for attestations (based 
on the costs to the Secretary of Labor of operating the H-1C 
program but not to exceed $250).
    Section 2(b) of the bill amends section 212(m)(3) of the 
INA to provide that the period of admission of an H-1C 
nonimmigrant shall be three years.
    Section 2(b) of the bill amends section 212(m)(4) of the 
INA to provide that the total number of nonimmigrant visas 
issued pursuant to H-1C petitions in a fiscal year shall not 
exceed 500. The number of visas issued for employment in each 
state in a fiscal year shall not exceed 25 for states with 
populations of less than 9,000,000 and 50 for states with 
larger populations. If the total number of visas available for 
a fiscal year quarter exceeds the number of qualified 
nonimmigrants who may be issued visas during those quarters, 
the visas made available shall be issued without regard to the 
per state limitations during the last fiscal year quarter.
    Section 2(b) of the bill amends section 212(m)(5) of the 
INA to provide that a facility participating in the H-1C 
program shall provide H-1C nonimmigrants with a wage rate and 
working conditions commensurate with those of nurses similarly 
employed by the facility, shall require H-1C nonimmigrants to 
work hours commensurate with those of nurses similarly employed 
by the facility, and shall not interfere with the right of H-1C 
nonimmigrants to join or organize a union.
    Section 2(b) of the bill creates a new section 212(m)(6) of 
the INA providing that for a facility to be able to participate 
in the H-1C program, it must be a hospital defined in section 
1886(d)(1)(B) of the Social Security Act, be located in a 
health professional shortage area (as of March 31, 1997, and as 
defined in section 332 of the Public Health Service Act), have 
not less than 190 acute care beds, and have not less than 35% 
of its total number of acute care impatient days made up of 
patients who were entitled to benefits under Part A of title 
XVIII of the Social Security Act and have not less than 28% 
made up of patients who were eligible for assistance under a 
State plan approved under title XIX of the Social Security 
Act).
    Section 2(b) of the bill creates a new section 212(m)(7) of 
the INA defining the term ``lay off'' for purposes of the H-1C 
program.
    Section 2(c) of the bill strikes the designation (at 
section 101(a)(15)(H)(i)(a) of the INA) of the expired ``H-1A'' 
nonimmigrant nursing program.
    Section 2(d) of the bill provides that not later than 90 
days after the bill's enactment, the Secretary of Labor (in 
consultation with the Secretary of Health and Human Services) 
and the Attorney General shall promulgate final or interim 
final regulations to carry out the H-1C program.
    Section 2(e) of the bill provides that facilities may file 
H-1C petitions only during the four year period beginning on 
the date that interim or final regulations are first 
promulgated.
Section 3. Recommendations for alternative remedy for nursing shortage
    Section 3 of the bill provides that by no later than the 
conclusion of the H-1C program, the Secretary of Health and 
Human Services and the Secretary of Labor are required to 
submit recommendations to Congress on a program to eliminate 
the dependence of certain hospitals on H-1C foreign nurses by 
providing for a permanent resolution to the current shortage of 
American nurses at some rural and urban locations. They also 
must recommend a program for more effectively enforcing the 
qualification and attestation requirements for nurses under the 
program. While this provision accords a 4-year period for the 
submission of the recommendations, it is anticipated that an 
effort will be made to submit them as soon as possible. This is 
particularly true of the recommendation for a program to 
enforce the qualification and attestation requirements for the 
nurses. Enforcement is an immediate need.
    This provision grants the Secretaries the discretion to 
determine what measures should be considered as 
recommendations. Possible measures might include the 
development of programs to recruit more college-educated 
persons into the nursing profession, programs to retain people 
who have already entered the profession, programs to provide 
financial assistance to young people who are willing to work in 
economically deprived rural and urban areas but do not have the 
financial means to pay for a nursing education, and studies to 
determine what factors would encourage experienced nurses to 
work in the rural and urban communities that are experiencing 
shortages. In addition, consideration might be given to 
expanding the federal programs that already address some of 
these problems and to the possibility of creating new federal 
programs. Finally, consideration might be given to ways of 
implementing the recommendations.
Section 4. Certification for certain alien nurses
    Section 4 of the bill provides a limited exemption from 
section 212(a)(5)(C) of the INA. That section provides for a 
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.
    Section 4 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 an 
approved equivalent independent 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) 
has passed the National Council Licensure Examination, (3) is 
the graduate of a nursing program in which the language of 
instruction was English, and either the Commission has 
designated the country where the nursing program is located 
within 30 days of the enactment of the bill based on an 
assessment that the quality of nursing education in that 
country and the English language proficiency of those who 
complete nursing programs in that country are of sufficient 
quality or the Commission and any approved credentialing 
organizations unanimously agree to the country's designation 
based on such an assessment, and (4) is a graduate of a nursing 
program which was in operation on or before the date of 
enactment of the bill or has been approved by unanimous 
agreement of the Commission and any approved credentialing 
organizations.
    The effective date of the amendments made by section 4 is 
the date of enactment of the bill, regardless of whether or not 
final regulations to carry out such amendments have been 
promulgated. The Commission or any approved equivalent 
independent credentialing organization must issue statements 
certifying the qualifications of the nurses not more than 35 
days after the receipt of completed applications for such 
statements.

H.L.C.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

                    IMMIGRATION AND NATIONALITY ACT



           *       *       *       *       *       *       *
                            TITLE I--GENERAL

                              definitions

    Section 101. (a) As used in this Act--
    (1)  * * *

           *       *       *       *       *       *       *

    (15) The term ``immigrant'' means every alien except an 
alien who is within one of the following classes of 
nonimmigrant aliens--
            (A)  * * *

           *       *       *       *       *       *       *

            (H) an alien (i) [(a) 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 each 
        facility (which facility shall include the petitioner 
        and each worksite, other than a private household 
        worksite, if the worksite is not the alien's employer 
        or controlled by the employer) for which the alien will 
        perform the services, or] (b) subject to section 
        212(j)(2), who is coming temporarily to the United 
        States to perform services (other than services 
        described in subclause (a) during the period in which 
        such subclause applies and other than services 
        described in subclause (ii)(a) or in subparagraph (O) 
        or (P)) in a specialty occupation described in section 
        214(i)(1) or as a fashion model, who meets the 
        requirements for the occupation specified in section 
        214(i)(2) or, in the case of a fashion model, is of 
        distinguished merit and ability, and with respect to 
        whom the Secretary of Labor determines and certifies to 
        the Attorney General that the intending employer has 
        filed with the Secretary an application under section 
        212(n)(1)[; or], 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 (ii)(a) having 
        a residence in a foreign country which he has no 
        intention of abandoning who is coming temporarily to 
        the United States to perform agricultural labor or 
        services, as defined by the Secretary of Labor in 
        regulations and including agricultural labor defined in 
        section 3121(g) of the Internal Revenue Code of 1954 
        and agriculture as defined in section 3(f) of the Fair 
        Labor Standards Act of 1938 (29 U.S.C. 203(f)), of a 
        temporary or seasonal nature, or (b) having a residence 
        in a foreign country which he has no intention of 
        abandoning who is coming temporarily to the United 
        States to perform other temporary service or labor if 
        unemployed persons capable of performing such service 
        or labor cannot be found in this country, but this 
        clause shall not apply to graduates of medical schools 
        coming to the United States to perform services as 
        members of the medical profession; or (iii) having a 
        residence in a foreign country which he has no 
        intention of abandoning who is coming temporarily to 
        the United States as a trainee, other than to receive 
        graduate medical education or training, in a training 
        program that is not designed primarily to provide 
        productive employment; and the alien spouse and minor 
        children of any such alien specified in this paragraph 
        if accompanying him or following to join him;

           *       *       *       *       *       *       *


Title II--Immigration

           *       *       *       *       *       *       *


 Chapter 2--Qualifications for Admission of Aliens; Travel Control of 
Citizens and Aliens

           *       *       *       *       *       *       *


 general classes of aliens ineligible to receive visas and ineligible 
               for admission; waivers of inadmissibility

      Sec. 212. (a) Classes of Aliens Ineligible for Visas or 
Admission.--Except as otherwise provided in this Act, aliens 
who are inadmissible under the following paragraphs are 
ineligible to receive visas and ineligible to be admitted to 
the United States:
            (1)  * * *

           *       *       *       *       *       *       *

            (5) Labor certification and qualifications for 
        certain immigrants.--
                    (A)  * * *

           *       *       *       *       *       *       *

                    (C) Uncertified foreign health-care 
                workers.--[Any alien who seeks] Subject to 
                subsection (r), any alien who seeks to enter 
                the United States for the purpose of performing 
                labor as a health-care worker, other than a 
                physician, is inadmissible unless the alien 
                presents to the consular officer, or, in the 
                case of an adjustment of status, the Attorney 
                General, a certificate from the Commission on 
                Graduates of Foreign Nursing Schools, or a 
                certificate from an equivalent independent 
                credentialing organization approved by the 
                Attorney General in consultation with the 
                Secretary of Health and Human Services, 
                verifying that--
                            (i)  * * *

           *       *       *       *       *       *       *

      [(m)(1) The qualifications referred to in section 
101(a)(15)(H)(i)(a), 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 or Canada;
            [(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)(a) is an attestation as to the following:
            [(i) There would be a substantial disruption 
        through no fault of the facility in the delivery of 
        health care services of the facility without the 
        services of such an alien or aliens.
            [(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) Either (I) 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, or (II) the facility 
        is subject to an approved State plan for the 
        recruitment and retention of nurses (described in 
        paragraph (3)).
            [(v) There is not a strike or lockout in the course 
        of a labor dispute, 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)(a), 
        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.
A facility is considered not to meet clause (i) (relating to an 
attestation of a substantial disruption in delivery of health 
care services) if the facility, within the previous year, laid 
off registered nurses. Notwithstanding the previous sentence, a 
facility that lays off a registered nurse other than a staff 
nurse still meets clause (i) if, in its attestation under this 
subparagraph, the facility has attested that it will not 
replace the nurse with a nonimmigrant described in section 
101(a)(15)(H)(i)(a) (either through promotion or otherwise) for 
a period of 1 year after the date of the lay off. 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 this subsection. In the case of an 
alien for whom an employer has filed an attestation under this 
subparagraph and who is performing services at a worksite other 
than the employer's or other than a worksite controlled by the 
employer, the Secretary may waive such requirements for the 
attestation for the worksite as may be appropriate in order to 
avoid duplicative attestations, in cases of temporary, 
emergency circumstances, with respect to information not within 
the knowledge of the attestor, or for other good cause.
      [(B) For purposes of subparagraph (A)(iv)(I), 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 
        nonnursing 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)(I). Nothing herein shall require a facility to take 
more than one step, if the facility can demonstrate that taking 
a second step is not reasonable.
      [(C) Subject to subparagraph (E), an attestation under 
subparagraph (A) shall--
            [(i) expire at the end of the 1-year period 
        beginning on the date of its filing with the Secretary 
        of Labor, and
            [(ii) apply to petitions filed during such 1-year 
        period 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)(a) 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 
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.
      [(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 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 1 year for nurses to 
be employed by the facility.
      [(v) In addition to the sanctions provided 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 (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.
      [(3) The Secretary of Labor shall provide for a process 
under which a State may submit to the Secretary a plan for the 
recruitment and retention of United States citizens and 
immigrants who are authorized to perform nursing services as 
registered nurses in facilities in the State. Such a plan may 
include counseling and educating health workers and other 
individuals concerning the employment opportunities available 
to registered nurses. The Secretary shall provide, on an annual 
basis in consultation with the Secretary of Health and Human 
Services, for the approval or disapproval of such a plan, for 
purposes of paragraph (2)(A)(iv)(II). Such a plan may not be 
considered to be approved with respect to the facility unless 
the plan provides for the taking of significant steps described 
in paragraph (2)(A)(iv)(I) with respect to registered nurses in 
the facility.
      [(4) The period of admission of an alien under section 
101(a)(15)(H)(i)(a) shall be for an initial period of not to 
exceed 3 years, subject to an extension for a period or 
periods, not to exceed a total period of admission of 5 years 
(or a total period of admission of 6 years in the case of 
extraordinary circumstances, as determined by the Attorney 
General).
      [(5) For purposes of this subsection and section 
101(a)(15)(H)(i)(a), the term ``facility'' includes an employer 
who employs registered nurses in a home setting.]
    (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 did not lay off and 
        will not lay off a registered nurse employed by the 
        facility within the period beginning 90 days before and 
        ending 90 days after the date of filing of any visa 
        petition, 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 the 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 
        Nursing Relief for Disadvantaged Areas Act of 1999. 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 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 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 (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 such visas 
issued for employment in each State in each fiscal year shall 
not exceed the following:
            (A) For States with populations of less than 
        9,000,000, based upon the 1990 decennial census of 
        population, 25 visas.
            (B) For States with populations of 9,000,000 or 
        more, based upon the 1990 decennial census of 
        population, 50 visas.
            (C) If the total number of visas available under 
        this paragraph for a fiscal year quarter exceeds the 
        number of qualified nonimmigrants who may be issued 
        such visas during those quarters, the visas made 
        available under this paragraph shall be issued without 
        regard to the numerical limitation under subparagraph 
        (A) or (B) of this paragraph during the last fiscal 
        year quarter.
    (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.
            (7) For purposes of paragraph (2)(A)(v), the term 
        ``lay off'', with respect to a worker--
                    (A) means to cause the worker's loss of 
                employment, other than through a discharge for 
                inadequate performance, violation of workplace 
                rules, cause, voluntary departure, voluntary 
                retirement, or the expiration of a grant or 
                contract; but
                    (B) does not include any situation in which 
                the worker is offered, as an alternative to 
                such loss of employment, a similar employment 
                opportunity with the same employer at 
                equivalent or higher compensation and benefits 
                than the position from which the employee was 
                discharged, regardless of whether or not the 
                employee accepts the offer.
        Nothing in this paragraph is intended to limit an 
        employee's or an employer's rights under a collective 
        bargaining agreement or other employment contract.

           *       *       *       *       *       *       *

    (r) 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 Nursing Relief 
                        for Disadvantaged Areas Act of 1999, 
                        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 Nursing Relief 
                for Disadvantaged Areas Act of 1999; 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.

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