[Federal Register Volume 63, Number 198 (Wednesday, October 14, 1998)]
[Rules and Regulations]
[Pages 55007-55012]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-27522]


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DEPARTMENT OF JUSTICE

Immigration and Naturalization Service

8 CFR Parts 212 and 245

[INS-1879-97]
RIN 1115-AE73


Interim Procedures for Certain Health Care Workers

AGENCY: Immigration and Naturalization Service, Justice.

ACTION: Interim rule with request for comments.

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SUMMARY: This interim rule, which has been drafted in consultation with 
the U.S. Department of Health and Human Services (HHS), amends 
regulations of the Immigration and Naturalization Service (Service or 
INS) in order to implement, on a temporary basis, certain portions of 
section 343 of the Illegal Immigration Reform and Immigrant 
Responsibility act of 1996 (IIRIRA) as they relate to prospective 
immigrants. Section 343, which was codified at section 212(a)(5)(C) of 
the Immigration and Nationality Act (Act or INA), provides that aliens 
coming to the United States to perform labor in covered health care 
occupations (other than as a physician) are inadmissible unless they 
present a certificate relating to their education, qualifications, and 
English language proficiency. This requirement is intended to ensure 
that aliens possess proficiency in the skills that affect the provision 
of health care services in the United States. This rule establishes a 
temporary mechanism to allow applicants for immigrant visas or 
adjustment of status in the fields of nursing and occupational therapy 
to satisfy the requirements of section 343 on a provisional basis. The 
Service expects to publish a proposed rule in the near future which 
will implement in full the provisions of section 343.

DATES:  Effective date: This rule is effective December 14, 1998.
    Comment date: Written comments must be submitted on or before 
February 11, 1999.

ADDRESSES: Please submit written comments, in triplicate, to the 
Director, Policy Directives and Instructions Branch, Immigration and 
Naturalization Service, 425 I Street NW., Room 5307, Washington, DC 
20536. To ensure proper handling, pleaser reference the INS No. 1879-97 
on your correspondence. Comments are available for public inspection at 
the above address by calling (202) 514-3048 to arrange for an 
appointment.

FOR FURTHER INFORMATION CONTACT:
John W. Brown, Adjudications Officer, Benefits Division, Immigration 
and Naturalization Service, 425 I Street NW., Room 3214, Washington, DC 
20536, telephone (202) 514-3240.

SUPPLEMENTARY INFORMATION: On September 30, 1996, President Clinton 
signed the Illegal Immigration Reform and Immigrant Responsibility Act 
(IIRIRA), Pub. L. 104-208. Section 343 of IIRIRA created a new ground 
of inadmissibility at section 212(a)(5)(C) of the Act for aliens coming 
to the United States to perform labor in certain health care 
occupations. Pursuant to section 343, any alien coming to the United 
States for the purpose of performing labor as a health care worker, 
other than as a physician, is inadmissible unless the alien presents to 
the consular officer, or, in the case or adjustment of status, the 
Attorney General, a certificate from the Commission on Graduates of 
Foreign Nursing Schools (CGFNS), or an equivalent independent 
credentialing organization approved by the Attorney General in 
consultation with the Secretary of HHS.
    Under section 343, the certificate must verify that: (1) The 
alien's education, training, license, and experience meet all 
applicable statutory and regulatory requirements for admission into the 
United States under the classification specified in the application; 
are comparable with that required for an American health care worker; 
are authentic and, in the case of a license, the alien's license is 
unencumbered; (2) the alien has the level of competence in oral and 
written English considered by the Secretary of HHS, in consultation 
with the Secretary of Education (DoE), to be appropriate for health 
care work of the kind in which the alien will be engaged, as shown by 
an appropriate score on one or more nationally recognized, commercially 
available, standardized assessments of the applicants ability to speak 
and write English; and, finally, (3) if a majority of states licensing 
the profession in which the alien intends to work recognize a test 
predicting the alien's success on the profession's licensing or 
certification examination, the alien has passed such a test, or has 
passed such an examination.
    Section 343 raises a number of important and difficult issues as to 
its scope and proper implementation and requires extensive coordination 
between the Service and other Federal agencies. Prior to the 
publication of this rule, the Service met with representatives of HHS, 
as well as the United States Trade Representative, the Department of 
Labor (DOL), the Department of State (DOS), the DoE, the Department of 
Commerce (DOC), the CGFNS, the National Board for Certification in 
Occupational Therapy (NBCOT), various professional organizations 
representing these health care occupations, and many other interested 
parties.

The Purpose of the Interim Rule

    The purpose of this interim rule is to establish temporary 
procedures which will: (1) Allow the immigration of certain health care 
workers into the United States on a permanent basis in order to prevent 
the disruption of critical health care services to the public; (2) 
provide for the immigration of certain health care workers who were 
petitioned on a permanent basis prior to the enactment of IIRIRA; and 
(3) establish a temporary mechanism to ensure that nurses and 
occupational therapists immigrating to this country have education, 
experience, and training which are equivalent to a United States worker 
in a similar occupation.
    This interim rule provides a temporary mechanism for implementing 
section 343 with respect to nurses and occupational therapists. Aliens 
who obtain a certificate in accordance with this interim rule will be 
deemed to have satisfied the education, training, and licensing 
requirements of section 343. Credentialing organizations verifying that 
an alien's education, training, license, and experience meet all 
applicable statutory and regulatory requirements for admission into the 
United States under the classification specified in the application are 
required to determine, to the best of their ability, whether the alien 
appears to be classifiable under section 203(b) of the Act. (The 
Service has substituted the term ``admission'' for the term ``entry,'' 
in conformity with section 308(f) of Pub. L. 104-208 which amended the 
Act.) Although credentialing organizations are required to make certain 
verifications in accordance with this interim rule, the Service is not 
in any way deferring or delegating to the credentialing organizations 
the authority to make binding determinations regarding the alien's 
admissibility into the United States.

[[Page 55008]]

    The decision to include nursing and occupational therapy in this 
interim rule was based on information from DOL that there is a 
sustained level of demand for foreign-trained workers in these two 
occupations. Moreover, organizations with an established track record 
in providing credentialing services exist for these two occupations. 
For the purposes of this interim rule, the Service finds that these two 
criteria allow the implementation of section 343 of IIRIRA on a 
temporary basis.
    For the purposes of this interim rule, the term ``sustained level 
of demand'' means the presence of an existing demand for foreign health 
care workers in a particular occupation that is expected to continue in 
the foreseeable future.
    The term ``organizations with an established track record'' means, 
for the purposes of this interim rule, an organization which has a 
record of issuing actual certificates, or documents similar to a 
certificate, that are generally accepted by the state regulatory bodies 
as certificates that an individual has met certain minimal 
qualifications.
    The two organizations identified in this rule, the CGFNS for nurses 
and the NBCOT for occupational therapists, are organizations which have 
been issuing certificates, or similar documents, for a period of years 
and which have attained credibility with the various professional and 
regulatory bodies which deal with the two occupations listed in this 
rule. Therefore, the NBCOT and the CGFNS both meet the two criteria 
identified for inclusion in this interim rule. The Service has not 
identified other credentialing organizations which have an established 
track record in providing credentialing services for these two 
occupations other than the two organizations discussed in this rule.
    During the period of time that the interim rule is in effect, the 
Service will entertain any requests to issue certificates from an 
organization which demonstrates a proven track record in issuing 
certificates for a health care occupation and where there is a 
sustained level of demand for foreign-trained individuals. Such 
organizations are encouraged to contact the Service at the address 
provided earlier in the rule.
    The implementation of this interim rule on a limited basis also 
allows the Service additional time to obtain comment on a number of 
issues which extend beyond near-term immigration issues in nursing and 
occupational therapy to other policy concerns, such as the overall 
impact on the public health and the domestic labor market for a variety 
of health care occupations.
    Given the complex nature of the requirements of section 343, the 
Service will publish a proposed rule in the near future which will, 
among other things, list all the occupations covered by section 343, 
further describe the procedures for obtaining and presenting the 
certificates, describe the standards required for an organization to 
obtain approval to issue certificates, and describe the procedure 
whereby an organization's authorization can be terminated by the 
Service. The Service believes that major issues such as the scope of 
covered occupations, the standards for obtaining authorization to issue 
certificates, and the procedure for termination of an organization's 
authority to issue certificates are better addressed through proposed 
rule making. The Service expects to publish the proposed rule as soon 
as possible, within approximately 1 year.

The Service's Temporary Policies and Their Effect

    The Service has issued a number of temporary policy guidelines 
which will continue to apply while the Service develops a rule fully 
implementing section 343.

Occupations Covered

    The current policy of the Service is that section 343 is applicable 
only to the seven occupations listed in the Joint Explanatory Statement 
of the Committee of Conference published in the Congressional Record of 
September 24, 1996, Nos. 132-133, page H10900. The seven occupations 
are: Nursing, physical therapy, occupational therapy, speech language 
pathology, medical technology, medical technician, and physician's 
assistant.

Nonimmigrant Health Care Workers

    In order to ensure that health care facilities remain fully staffed 
and are able to continue to provide the same level and quality of 
service to the United States public pending promulgation of a final 
rule, the Service and DOS have agreed to exercise authority under 
section 212 (d) (3) of the Act and temporarily waive the certification 
requirement of section 343 for aliens coming to the United States as 
nonimmigrant care workers. The Service and the DOS have agreed to 
extend from 6 months to 1 year the period for which such a waiver is 
granted. This policy will continue until a final rule is published 
which fully implements section 343.

Immigrant Health Care Workers

    There is a two-step process for an alien to become a permanent 
resident or enter the United States as an immigrant to perform labor as 
a health care worker. In general, a United States employer must file a 
Form I-140, Immigrant Petition for Alien Worker, with the Service with 
the appropriate supporting documentation. The Form I-140 petition 
establishes the alien's eligibility for the employment-based 
classification sought. Once the Form I-140 petition is approved by the 
Service, the alien may apply for an immigrant visa abroad at a consular 
post or apply for adjustment of status to that of a lawful permanent 
resident by filing a Form I-485, Application to Register Permanent 
Resident of Adjust Status in the United States.
    The Service has no statutory authority to waive the requirements of 
section 343 for aliens coming to the United States permanently as 
immigrants to perform health care services in this country. Thus, the 
Service has adopted an interim policy whereby, instead of denying the 
applications for adjustment of status filed by uncertified aliens 
seeking to perform labor on a permanent basis in covered health care 
occupation, such applications are held in abeyance pending promulgation 
of the implementing regulations. Similarly, the DOS has no statutory 
authority to issue immigrant visas to such uncertified aliens, and has 
held visa applications from such persons in abeyance as well. As a 
result, the number of applications for adjustment of status which have 
been held in abeyance and the number of aliens unable to obtain 
immigrant visas has grown to significant proportions. The four service 
centers have advised that they are holding in excess of 11,000 such 
adjustment cases in abeyance.

Who Is Affected by the Rule--Sec. 212.15(a), (b) and (c)

    This interim rule will apply to aliens coming to the United States 
as immigrants and to aliens applying for permanent residency to perform 
labor in the occupations of nurse and occupational therapist. This 
interim rule does not apply to any other health care occupation. The 
applications of aliens seeking to engage permanently in any of the 
other five health care occupations, i.e., physical therapy, speech 
language pathology, medical technology, medical technician, and 
physician's assistant, listed in the Joint Explanatory Statement 
previously cited, will continue to be held in abeyance pending 
promulgation of a final regulation implementing section 343.
    This interim rule does not affect the admission of nonimmigrant 
aliens coming to the United States to work

[[Page 55009]]

temporarily in any health care field. Nonimmigrants in the fields or 
nursing, occupational therapy, physical therapy, speech language 
pathology, medical technology, medical technician, or physician's 
assistant will continue to be admitted consistent with the Service's 
waiver policy previously described.
    At this time, the Service has not extended the application of 
section 343 beyond the seven occupations listed in the Joint 
Explanatory Statement of the Committee of Conference. The Service, in 
consultation with HHS, may include additional health care occupations 
in its forthcoming proposed rule and expects to seek public comment on 
whether such occupations should be affected by section 343. Until a 
final regulation implementing section 343 is promulgated, however, the 
Service (as well as DOS) will continue to deem both immigrants and 
nonimmigrants in occupations other than the seven listed above to be 
exempt from the requirements of section 343. Applications for permanent 
resident status filed by aliens to work in the occupations of speech 
language pathologist, medical technologist, medical technicians, 
physical therapists, and physician assistants, however, will continue 
to be held in abeyance until a final rule is published. Further, the 
DOS has notified the Service that it will continue its policy of not 
issuing immigrant visas to aliens coming to the United States to 
perform labor in these five occupations until a final rule is 
published.
    The Service has interpreted the term ``performing labor as a health 
care worker'' to mean providing direct or indirect health care services 
to a patient. Aliens coming to the United States to perform services in 
non-clinical health care occupations such as, but not limited to, 
medical teachers, medical researchers, managers of health care 
facilities, and medical consultants to the insurance industry, 
therefore, are not covered by the provisions of section 343. 
Individuals employed in these occupations do not perform patient care 
and, therefore, are not performing labor in a health care occupation as 
contemplated in the statute. Nevertheless, aliens who are indirectly 
involved in the performance of patient care, for example, supervisory 
nurses, must comply with the provisions of section 343.
    Since the statute specifically refers only to aliens who are 
seeking to enter the United States under section 203(b) of the Act for 
the purpose of performing labor as health care workers, section 343 
does not apply to the spouse and dependent children of such aliens. 
Dependent aliens are admitted to the United States for the primary 
purpose of family unity and are merely accompanying the principal 
alien. Therefore, the admissibility of dependent aliens is not affected 
by the provisions of section 343. For similar reasons, it is the 
position of the Service that an alien who has applied for adjustment of 
status under section 245 of the Act on the basis of a family-sponsored 
immigrant petition pursuant to section 203(a) of the Act or on the 
basis of an employment-based immigrant petition in a non-health care 
occupation does not have to comply with section 343 of IIRIRA.
    Additionally, an alien who applies for adjustment of status 
pursuant to sections 209, 210, 245a, 249 or any other section of the 
Act is not affected by the provisions of section 343 of IIRIRA. This 
distinction derives from the fact that section 343 of IIRIRA applies 
only to aliens who are coming to the United States for the primary 
purpose of performing labor as a health care worker. Aliens applying 
for adjustment of status under these statutory provisions, regardless 
of their ultimate professional goal, will not be deemed to be adjusting 
status for the purpose of performing labor as a health care worker.

Organization Granted Temporary Approval To Issue Certificates for 
Nurses and Occupational Therapists--Sec. 212.15(e)

    This rule grants temporary authorization to the CGFNS to issue 
certificates to aliens coming to the United States on a permanent basis 
to work in the field of nursing. This rule grants temporary 
authorization to the NBCOT to issue certificates to aliens coming to 
the United States on a permanent basis to work in the field of 
occupational therapy.
    Under this interim rule, CGFNS is authorized to issue certificates 
only for the occupation of nurse, for which it has an established track 
record of issuing certificates, and not for the occupation of 
occupational therapy. Since CGFNS does not have an established track 
record of issuing certificates for occupational therapists at this 
time, it will be limited to issuing certificates for occupation of 
nursing for the validity period of this interim rule.
    The Service defers consideration of whether CGFNS may be authorized 
to issue certificates for other health care occupations, including 
occupational therapy, until the promulgation of its forthcoming 
proposed rule.
    This interim rule authorizes NBCOT, on a temporary basis, to issue 
certificates in accordance with section 343 for the occupation of 
occupational therapy. NBCOT is authorized to issue such certificates 
solely because of NBCOT's proven track record in issuing certificates 
for the position of occupational therapist and the current acceptance 
of these certificates by the various state regulatory boards in the 
field of occupational therapy.
    Insofar as this interim rule addresses the certification 
requirements for aliens seeking to immigrate to the United States, the 
Service has determined that it is unnecessary to require that the 
certificate issued by CGFNS or NBCOT be valid for a specific period of 
time beyond the date of admission or adjustment of status. The Service 
may nevertheless consider imposing such a validity period in the 
context of promulgating its proposed rule.

English Language Requirement--Sec. 212.15(g)

    Purusant to section 343 of IIRIRA, HHS, in consultation with the 
Secretary of Education, is required to establish a level of competence 
in oral and written English which is appropriate for the health care 
work of the kind in which the alien will be engaged, as shown by an 
appropriate score on one or more nationally recognized, commercially 
available, standardized assessments of the applicant's ability to speak 
and write.
    The statute vests the Secretary of HHS with the ``sole discretion'' 
to determine the standardized tests and appropriate minimum scores 
required by section 343 of IIRIRA.
    The HHS has identified two testing services which conduct a 
nationally recognized, commercially available, standardized assessment 
as contemplated in the statute. The two testing services are the 
Educational Testing Service (ETAS) and the Michigan English Language 
Assessment Battery (MELAB). The new regulation at Sec. 212.15(g) lists 
the tests and appropriate scores as determined by HHS for each 
occupation.
    In developing the English language test scores, HHS consulted with 
the DoE and appropriate health care professional organizations. The HHS 
also examined a study sponsored in part by NBCOT entitled ``Standards 
for Examinations Assessing English as a Second Language'' in arriving 
at these scores. The scores reflect the current industry requirements 
for the occupations.
    Under this interim regulation, an organization approved to issue 
certificates may use either of the above-named testing services. It 
should be noted, however, that HHS has

[[Page 55010]]

determined that occupational therapists should only take the test 
administered by ETS. The HHS has advised the Service that it made this 
determination based on the fact that all 50 states have accepted the 
NBCOT requirements which list the ETS as the only acceptable 
examination.
    In addition, organizations authorized to issued certifications are 
encouraged to develop a test specifically designed to measure English 
language skills and seek HHS approval of the test. While HHS has 
identified MELAB and ETS for purposes of this interim rule, other 
testing services may submit information about their testing services to 
the Service so that HHS and the DOE could review whether the testing 
service should be included in the final rule.
    HHS has advised that graduates of health professional programs in 
Australia, Canada (except Quebec), Ireland, New Zealand, the United 
Kingdom, and the United States are exempt from the English language 
requirements of section 343 of IIRIRA for the duration of the interim 
rule. The HHS has determined that, for purposes of this rule, aliens 
who have graduated from these programs have competency in oral and 
written English because the level of English that they would need to 
graduate from these programs is deemed equivalent to the level that 
would be demonstrated by achieving the minimum passing score on the 
test described above.

Presentation of the Certificate--Sec. 212.15(d) and Sec. 245.14

    Section 343 of IIRIRA is codified in section 212(a) of the Act as a 
new ground of inadmissibility. In genral, grounds listed in section 
212(a) are bars to admission to the United states which must be 
overcome when an alien applies for admission. This interim rule 
provides that the certificate must be presented to a consular officer 
at the time that the alien applies for an immigrant visa and to the 
Service at the time of admission or adjustment of status. The 
certificate must be valid at the time the alien applies for an 
immigrant visa at a consular post abroad and seeks admission or 
adjustment of status to that of a permanent resident.
    The Service and the DOS will consider, in the context of the 
proposed rulemaking, whether it would be more efficient to review the 
certificate as part of the review of the alien's qualifications for 
classification at the time that a Form I-140 is adjudicated by the 
Service. In this regard, it should be noted that such a filing 
procedure has long been used with respect to labor certifications under 
section 212(a)(5)(A) of the Act.

Good Cause Exception

    This interim rule is effective 60 days from the date of publication 
in the Federal Register. The Service invites post-promulgation comments 
and will address any such comments in a final rule. For the following 
reasons, the Service finds that good cause exists for adopting this 
rule without the prior notice and comment period ordinarily required by 
5 U.S.C. 553. Although section 343 went into effect on September 30, 
1996, due to the complexities of the requirements of section 343, and 
the need to coordinate the interests and concerns of a great number of 
Federal agencies, the health care sector, and members of the affected 
public, the Service is still in the process of developing a proposed 
rule in order to solicit comment from the public. A continued delay in 
the implementation of this provision, however, could have a negative 
effect on the availability of health care in this country, particularly 
in medically under-served areas for nursing and occupational therapy, 
and will create a further backlog with respect to pending applications 
filed by aliens seeking to immigrate to perform labor in a health care 
occupation.

Regulatory Flexibility Act

    The Commissioner of the Immigration and Naturalization Service, in 
accordance with 5 U.S.C. 605(b), has reviewed this regulation and, by 
approving it, certifies that the rule will not have a significant 
economic impact on a substantial number of small entities. This rule 
has been drafted in a way to minimize the economic impact that it has 
on small business while meeting its intended objective. The health care 
workers who will be issued certificates are not considered small 
entities as the term is defined in 5 U.S.C. 601(6).

Unfunded Mandates Reform Act of 1995

    This rule will not result in the expenditure by State, local and 
tribal governments, in the aggregate, or by the private sector, of $100 
million or more in any 1 year, and it will not significantly or 
uniquely affect small governments. Therefore, no actions were deemed 
necessary under the provisions of the Unfunded Mandates Reform Act of 
1995.

Small Business Regulatory Enforcement Fairness Act of 1996

    This rule is not a major rule as defined by section 804 of the 
Small Business Regulatory Enforcement Act of 1996. This rule will not 
result in an annual effect on the economy of $100 million or more; a 
major increase in costs or prices; or significant adverse effects on 
competition, employment, investment, productivity, innovation, or on 
the ability of United States-based companies to compete with foreign-
based companies in domestic and export markets.

Executive Order 12866

    This rule is considered by the Department of Justice, Immigration 
and Naturalization Service, to be a ``significant regulatory action'' 
under Executive Order 12866, section 3(f), Regulatory Planning and 
Review. Accordingly, this regulation has been submitted to the Office 
of Management and Budget (OMB) for review.

Executive Order 12612

    The regulation adopted herein will not have substantial direct 
effects on the States, on the relationship between the National 
Government and the States, or on the distribution of power and 
responsibilities among the various levels of government. Therefore, in 
accordance with Executive Order 12612, it is determined that this rule 
does not have sufficient federalism implications to warrant the 
preparation of a Federalism Assessment.

Executive Order 12988 Civil Justice Reform

    This rule meets the applicable standards set forth in sections 3(a) 
and 3(b)(2) of E.O. 12988.

Paperwork Reduction Act of 1995

    The information required on the certificate for health care workers 
showing that the alien possesses proficiency in the skills that affect 
the provisions of health care services in the United State (as provided 
in Sec. 212.15(f)) is considered an information collection. Since a 
delay in issuing this interim rule could create a further backlog with 
respect to pending applications filed by aliens seeking to immigrate to 
perform labor in a health care occupation, the INS is using emergency 
review procedures, for review and clearance by the Office of Management 
and Budget (OMB) in accordance with the Paperwork Reduction Act (PRA) 
of 1995.
    The OMB approval has been requested by November 13, 1998. If 
granted, the emergency approval is only valid for 180 days. Comments 
concerning the information collection should be directed to: Office of 
Information and Regulatory Affairs

[[Page 55011]]

(OMB), OMB Desk Officer for the Immigration and Naturalization Service, 
Office of Management and Budget, Room 10235, Washington, DC 20503.
    During the first 60 days of this same period a regular review of 
this information will also be undertaken. Written comments are 
encouraged and will be accepted until December 14, 1998. Your comments 
should address one or more of the following points:
    (1) Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
    (2) Evaluate the accuracy of the agency's estimate of the burden of 
the proposed collection of information, including the validity of the 
methodology and assumptions used;
    (3) Enhance the quality, utility, and clarity of the information to 
be collected; and
    (4) Minimize the burden of the collection of information on those 
who are to respond, including through the use of appropriate automated, 
electronic, mechanical, or other technological collection techniques or 
other forms of information technology, e.g., permitting electronic 
submission of responses.
    The Service, in calculating the overall burden this requirement 
will place upon the public, estimates that approximately 7,000 
certificates will be issued annually. The Service also estimates that 
it will take the testing entity approximately 2 hours to comply with 
the requirements. This amounts to 14,000 total burden hours.
    Organizations and individuals interested in submitting comments 
regarding this burden estimate or any aspect of these information 
collection requirements, including suggestions for reducing the burden, 
should direct them to: Immigration and Naturalization Service, 
Director, Policy Directives and Instructions Branch (HQPDI), 425 I 
Street NW., Room 5307, Washington, DC 20536.

List of Subjects

8 CFR Part 212

    Administrative practice and procedures, Aliens, Immigration, 
Passports and visas, Reporting and recordkeeping requirements.

8 CFR Part 245

    Aliens, Immigration, Reporting and recordkeeping requirements.
    Accordingly, chapter I of title 8 of the Code of Federal 
Regulations is amended as follows:

PART 212--DOCUMENTARY REQUIREMENTS: NONIMMIGRANTS; WAIVERS; 
ADMISSION OF CERTAIN INADMISSIBLE ALIENS; PAROLE

    1. The authority citation for part 212 continues to read as 
follows:

    Authority: 8 U.S.C. 1101, 1102, 1103, 1182, 1184, 1187, 1225, 
1226, 1227, 1228, 1252; 8 CFR part 2.

    2. Section 212.15 is added to read as follows:


Sec. 212.15  Certificates for foreign health care workers.

    (a) Inadmissible aliens. With the exception of the aliens described 
in paragraph (b) of this section, any alien coming to the United States 
for the primary purpose of performing labor in a health care occupation 
listed in paragraph (c) of this section is inadmissible to the United 
States unless the alien presents a certificate as described in 
paragraph (f) of this section.
    (b) Inapplicability of the ground of inadmissibility. The following 
aliens are not subject to this ground of inadmissibility:
    (1) Aliens seeking admission to the United States to perform 
services in a non-clinical health care occupation. A non-clinical 
health-care occupation is one where the alien is not required to 
perform direct or indirect patient care. Occupations which are 
considered to be non-clinical include, but are not limited to, medical 
teachers, medical researchers, managers of health care facilities, and 
medical consultants to the insurance industry;
    (2) The spouse and dependent children of any immigrant alien who is 
seeking to immigrate in order to accompany or follow to join the 
principal alien; and
    (3) Any alien applying for adjustment of status to that of a 
permanent resident under any provision of law other than an alien who 
is seeking to immigrate on the basis of an employment-based immigrant 
visa petition which was filed for the purpose of obtaining the alien's 
services in a health care occupation described in paragraph (c) of this 
section.
    (c) Occupations affected by this provision. With the exception of 
the aliens described in paragraph (b) of this section, any alien 
seeking admission to the United States to perform labor in one of the 
following health care occupations, regardless of where he or she 
received his or her education or training, is subject to this 
provision:
    (1) Licensed Practical Nurses, Licensed Vocational Nurses, and 
Registered Nurses.
    (2) Occupational Therapists.
    (d) Presentation of the certificate. An alien described in 
paragraph (a) of this section who is applying for admission as an 
immigrant seeking to perform labor in a health care occupation as 
described in this section must present a certificate to a consular 
officer at the time of visa issuance and to the Service at the time of 
admission or adjustment of status. The certificate must be valid at the 
time of visa issuance and admission at a port-of-entry, or, if 
applicable, at the time of adjustment of status.
    (e) Organizations approved by the Service to issue certificates for 
health care workers. (1) The Commission on Graduates of Foreign Nursing 
Schools is authorized to issue certificates under section 343 for the 
occupation of nurse. (2) The National Board for Certification in 
Occupational Therapy is authorized by the Service to issue certificates 
under section 343 for the occupation of occupational therapist.
    (f) Contents of the certificate. A certificate must contain the 
following information:
    (1) The name and address of the certifying organization;
    (2) A point of contact where the organization may be contacted in 
order to verify the validity of the certificate;
    (3) The date of the certificate was issued;
    (4) The occupation for which the certificate was issued;
    (5) The alien's name, and date and place of birth;
    (6) Verification that the alien's education, training, license, and 
experience are comparable with that required for an American health 
care worker of the same type;
    (7) Verification that the alien's education, training, license, and 
experience are authentic and, in the case of a license, unencumbered;
    (8) Verification that the alien's education, training, license, and 
experience meet all applicable statutory and regulatory requirements 
for admission into the United States as an immigrant under section 
203(b) of the Act. This verification is not binding on the Service; and
    (9) Verification either that the alien has passed a test predicting 
success on the occupation's licensing or certification examination, 
provided such a test is recognized by a majority of States licensing 
the occupation for which the certificate is issued, or that the alien 
has passed the occupation's licensing or certification examination.
    (g) English testing requirement. (1) With the exception of those 
aliens described in paragraph (g)(2) of this

[[Page 55012]]

section, every alien must meet certain English language requirements in 
order to obtain a certificate. The Secretary of Health and Human 
Services has determined that an alien must have a passing score on one 
of the two tests listed in paragraph (g)(3) of this section before he 
or she can be granted a certificate.
    (2) Aliens exempt form the English language requirement. Aliens who 
have graduated from a college, university, or professional training 
school located in Australia, Canada (except Quebec), Ireland, New 
Zealand, the United Kingdom, and the United States are exempt from the 
English language requirement.
    (3) Approved testing services.
    (i) Michigan English Language Assessment Battery (MELAB).
    (ii) Test of English as a Foreign Language, Educational Testing 
Service (ETS).
    (4) Passing scores for various occupations. (i) Occupational 
therapists. An alien seeking to perform labor in the United States as 
an occupational therapist must obtain the following scores on the 
English tests administered by ETS: Test Of English as a Foreign 
Language (TOEFL), Paper-Based 560, Computer-Based 220; Test of Written 
English (TWE): 4.5; Test of Spoken English (TSE): 50. Certifying 
organizations shall not accept the results of the MELAB for the 
occupation of occupational therapists. Aliens seeking to obtain a 
certificate to work as an occupational therapist must take the test 
offered by the ETS. MELAB scores are not acceptable for these 
occupations.
    (ii) Registered nurses. An alien coming to the United States to 
perform labor as a registered nurse must obtain the following scores to 
obtain a certificate: ETS: TOEFL: Paper-Based 540, Computer-Based 207; 
TWE: 4.0; TSE: 50; MELAB: Final Score 79; Oral Interview: 3+.
    (iii) Licensed practical nurses and licensed vocational nurses. An 
alien coming to the United States to perform labor as a licensed 
practical nurse or licensed vocational nurse must have the following 
scores to be issued a certificate: ETS: TOEFL: Paper-Based 530, 
Computer-Based 197; TWE: 4.0; TSE: 50; MELAB: Final Score 77; Oral 
Interview: 3+.

PART 245--ADJUSTMENT OF STATUS TO THAT OF PERSON ADMITTED FOR 
PERMANENT RESIDENCE

    3. The authority citation for part 245 continues to read as 
follows:

    Authority: 8 U.S.C. 1101, 1103, 1182, 1255; 8 CFR part 2.

    4. Section 245.14 is added to read as follows:


Sec. 245.14.  Adjustment of status of certain health care workers.

    An alien applying for adjustment of status to perform labor in a 
health care occupation as described in 8 CFR 212.15(c) must present 
evidence at the time he or she applies for adjustment of status, and, 
if applicable, at the time of the interview on the application, that he 
or she has a valid certificate issued by the Commission on Graduates of 
Foreign Nursing Schools or the National Board of Certification in 
Occupational Therapy.

    Dated: October 6, 1998.
Doris Meissner,
Commissioner, Immigration and Naturalization Service.
[FR Doc. 98-27522 Filed 10-13-98; 8:45 am]
BILLING CODE 4410-01-M