II 

116TH CONGRESS 

1ST SESSION S. 948 

To provide incentives to physicians to practice in rural and medically 

underserved communities, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 28, 2019 

Ms. KLOBUCHAR (for herself, Ms. COLLINS, and Ms. ROSEN) introduced the 

following bill; which was read twice and referred to the Committee on the 

Judiciary 

A BILL 

To provide incentives to physicians to practice in rural and 

medically underserved communities, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Conrad State 30 and 

5 Physician Access Reauthorization Act’’. 

6 SEC. 2. CONRAD STATE 30 PROGRAM. 

7 (a) EXTENSION.—Section 220(c) of the Immigration 

8 and Nationality Technical Corrections Act of 1994 (Public 

9 Law 103–416; 8 U.S.C. 1182 note) is amended by striking 


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1 ‘‘September 30, 2015’’ and inserting ‘‘September 30, 

2 2021’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 subsection (a) shall take effect as if enacted on September 

5 30, 2018. 

6 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 

7 MEDICALLY UNDERSERVED COMMUNITIES. 

8 Section 201(b)(1) of the Immigration and Nationality 

9 Act (8 U.S.C. 1151(b)(1)) is amended by adding at the 

10 end the following: 

11 ‘‘(F)(i) Alien physicians who have completed 

12 service requirements of a waiver requested under 

13 section 203(b)(2)(B)(ii), including— 

14 ‘‘(I) alien physicians who completed such 

15 service before the date of the enactment of the 

16 Conrad State 30 and Physician Access Act; and 

17 ‘‘(II) the spouse or children of an alien 

18 physician described in subclause (I). 

19 ‘‘(ii) Nothing in this subparagraph may be con20 strued— 

21 ‘‘(I) to prevent the filing of a petition with 

22 the Secretary of Homeland Security for classi23 fication under section 204(a) or the filing of an 

24 application for adjustment of status under sec25 tion 245 by an alien physician described in this 


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1 subparagraph before the date by which such 

2 alien physician has completed the service de3 scribed in section 214(l) or worked full-time as 

4 a physician for an aggregate of 5 years at the 

5 location identified in the section 214(l) waiver 

6 or in an area or areas designated by the Sec7 retary of Health and Human Services as having 

8 a shortage of health care professionals; or 

9 ‘‘(II) to permit the Secretary of Homeland 

10 Security to grant a petition or application de11 scribed in subclause (I) until the alien has sat12 isfied all of the requirements of the waiver re13 ceived under section 214(l).’’. 

14 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

15 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY

16 REQUIREMENT.—Section 214(l)(1) of the Immigration 

17 and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 

18 (1) in the matter preceding subparagraph (A), 

19 by striking ‘‘Attorney General’’ and inserting ‘‘Sec20 retary of Homeland Security’’; 

21 (2) in subparagraph (A), by striking ‘‘Director 

22 of the United States Information Agency’’ and in23 serting ‘‘Secretary of State’’; 


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1 (3) in subparagraph (B), by inserting ‘‘, except 

2 as provided in paragraphs (7) and (8)’’ before the 

3 semicolon at the end; 

4 (4) in subparagraph (C), by striking clauses (i) 

5 and (ii) and inserting the following: 

6 ‘‘(i) the alien demonstrates a bona fide 

7 offer of full-time employment at a health facil8 ity or health care organization, which employ9 ment has been determined by the Secretary of 

10 Homeland Security to be in the public interest; 

11 ‘‘(ii) the alien— 

12 ‘‘(I) has accepted employment with 

13 the health facility or health care organiza14 tion in a geographic area or areas which 

15 are designated by the Secretary of Health 

16 and Human Services as having a shortage 

17 of health care professionals; 

18 ‘‘(II) begins employment by the later 

19 of the date that is— 

20 ‘‘(aa) 120 days after receiving 

21 such waiver; 

22 ‘‘(bb) 120 days after completing 

23 graduate medical education or train24 ing under a program approved pursu25 ant to section 212(j)(1); or 


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1 ‘‘(cc) 120 days after receiving 

2 nonimmigrant status or employment 

3 authorization, if the alien or the 

4 alien’s employer petitions for such 

5 nonimmigrant status or employment 

6 authorization not later than 120 days 

7 after the date on which the alien com8 pletes his or her graduate medical 

9 education or training under a pro10 gram approved pursuant to section 

11 212(j)(1); and 

12 ‘‘(III) agrees to continue to work for 

13 a total of not less than 3 years in the sta14 tus authorized for such employment under 

15 this subsection, except as provided in para16 graph (8).’’; and 

17 (5) in subparagraph (D), in the matter pre18 ceding clause (i), by inserting ‘‘(except as provided 

19 in paragraph (8))’’. 

20 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL21 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER22 SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 

23 U.S.C. 1184(l)(2)(A)) is amended to read as follows: 

24 ‘‘(A) Upon the request of an interested Federal 

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1 ommendation of a waiver under this section by a 

2 physician who is maintaining valid nonimmigrant 

3 status under section 101(a)(15)(J) and a favorable 

4 recommendation by the Secretary of State, the Sec5 retary of Homeland Security may change the status 

6 of such physician to any status authorized for em7 ployment under this Act. The numerical limitations 

8 contained in subsection (g)(1)(A) shall not apply to 

9 any alien whose status is changed under this sub10 paragraph.’’. 

11 (c) VIOLATION OF AGREEMENTS.—Section 

12 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

13 amended by inserting ‘‘substantial requirement of an’’ be14 fore ‘‘agreement entered into’’. 

15 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED

16 AREAS.—Section 214(l) of such Act (8 U.S.C. 1184(l)), 

17 as amended by this section, is further amended by adding 

18 at the end the following: 

19 ‘‘(4)(A) If an interested State agency denies the ap20 plication for a waiver under paragraph (1)(B) from a phy21 sician pursuing graduate medical education or training 

22 pursuant to section 101(a)(15)(J) because the State has 

23 requested the maximum number of waivers permitted for 

24 that fiscal year, the physician’s nonimmigrant status shall 

25 be extended for up to 6 months if the physician agrees 


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1 to seek a waiver under this subsection (except for para2 graph (1)(D)(ii)) to work for an employer described in 

3 paragraph (1)(C) in a State that has not yet requested 

4 the maximum number of waivers. 

5 ‘‘(B) Such physician shall be authorized to work only 

6 for the employer referred to in subparagraph (A) from the 

7 date on which a new waiver application is filed with such 

8 State until the earlier of— 

9 ‘‘(i) the date on which the Secretary of Home10 land Security denies such waiver; or 

11 ‘‘(ii) the date on which the Secretary approves 

12 an application for change of status under paragraph 

13 (2)(A) pursuant to the approval of such waiver.’’. 

14 (e) CONTRACT REQUIREMENTS.—Section 214(l) of 

15 such Act, as amended by this section, is further amended 

16 by adding at the end the following: 

17 ‘‘(5) An alien granted a waiver under paragraph 

18 (1)(C) shall enter into an employment agreement with the 

19 contracting health facility or health care organization 

20 that— 

21 ‘‘(A) specifies the maximum number of on-call 

22 hours per week (which may be a monthly average) 

23 that the alien will be expected to be available and 

24 the compensation the alien will receive for on-call 

25 time; 


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1 ‘‘(B) specifies— 

2 ‘‘(i) whether the contracting facility or or3 ganization will pay the alien’s malpractice in4 surance premiums; 

5 ‘‘(ii) whether the employer will provide 

6 malpractice insurance; and 

7 ‘‘(iii) the amount of such insurance that 

8 will be provided; 

9 ‘‘(C) describes all of the work locations that the 

10 alien will work and includes a statement that the 

11 contracting facility or organization will not add addi12 tional work locations without the approval of the 

13 Federal agency or State agency that requested the 

14 waiver; and 

15 ‘‘(D) does not include a non-compete provision. 

16 ‘‘(6) An alien granted a waiver under this subsection 

17 whose employment relationship with a health facility or 

18 health care organization terminates under paragraph 

19 (1)(C)(ii) during the 3-year service period required under 

20 paragraph (1) shall be considered to be maintaining lawful 

21 status in an authorized period of stay during the 120-day 

22 period referred to in items (aa) and (bb) of subclause (III) 

23 of paragraph (1)(C)(ii) or the 45-day period referred to 

24 in subclause (III)(cc) of such paragraph.’’. 


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1 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER

2 STATES.—Section 214(l) of such Act, as amended by this 

3 section, is further amended by adding at the end the fol4 lowing: 

5 ‘‘(7) If a recipient of a waiver under this subsection 

6 terminates the recipient’s employment with a health facil7 ity or health care organization pursuant to paragraph 

8 (1)(C)(ii), including termination of employment because of 

9 circumstances described in paragraph (1)(C)(ii)(III), and 

10 accepts new employment with such a facility or organiza11 tion in a different State, the State from which the alien 

12 is departing may be accorded an additional waiver by the 

13 Secretary of State for use in the fiscal year in which the 

14 alien’s employment was terminated.’’. 

15 (g) EXCEPTION TO 3-YEAR WORK REQUIREMENT.— 

16 Section 214(l) of such Act, as amended by this section, 

17 is further amended by adding at the end the following: 

18 ‘‘(8) The 3-year work requirement set forth in sub19 paragraphs (C) and (D) of paragraph (1) shall not apply 

20 if— 

21 ‘‘(A)(i) the Secretary of Homeland Security de22 termines that extenuating circumstances, including 

23 violations by the employer of the employment agree24 ment with the alien or of labor and employment 


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1 laws, exist that justify a lesser period of employment 

2 at such facility or organization; and 

3 ‘‘(ii) the alien demonstrates, not later than 120 

4 days after the employment termination date (unless 

5 the Secretary determines that extenuating cir6 cumstances would justify an extension), another 

7 bona fide offer of employment at a health facility or 

8 health care organization in a geographic area or 

9 areas which are designated by the Secretary of 

10 Health and Human Services as having a shortage of 

11 health care professionals, for the remainder of such 

12 3-year period; 

13 ‘‘(B)(i) the interested State agency that re14 quested the waiver attests that extenuating cir15 cumstances, including violations by the employer of 

16 the employment agreement with the alien or of labor 

17 and employment laws, exist that justify a lesser pe18 riod of employment at such facility or organization; 

19 and 

20 ‘‘(ii) the alien demonstrates, not later than 120 

21 days after the employment termination date (unless 

22 the Secretary determines that extenuating cir23 cumstances would justify an extension), another 

24 bona fide offer of employment at a health facility or 

25 health care organization in a geographic area or 


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1 areas which are designated by the Secretary of 

2 Health and Human Services as having a shortage of 

3 health care professionals, for the remainder of such 

4 3-year period; or 

5 ‘‘(C) the alien— 

6 ‘‘(i) elects not to pursue a determination of 

7 extenuating circumstances pursuant to sub8 clause (A) or (B); 

9 ‘‘(ii) terminates the alien’s employment re10 lationship with the health facility or health care 

11 organization at which the alien was employed; 

12 ‘‘(iii) demonstrates, not later than 45 days 

13 after the employment termination date, another 

14 bona fide offer of employment at a health facil15 ity or health care organization in a geographic 

16 area or areas, in the State that requested the 

17 alien’s waiver, which are designated by the Sec18 retary of Health and Human Services as having 

19 a shortage of health care professionals; and 

20 ‘‘(iv) agrees to be employed for the remain21 der of such 3-year period, and 1 additional year 

22 for each termination under clause (ii).’’. 

23 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 

24 (a) IN GENERAL.—Section 214(l) of the Immigration 

25 and Nationality Act (8 U.S.C. 1184(l)), as amended by 


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1 section 4, is further amended by adding at the end the 

2 following: 

3 ‘‘(8)(A)(i) All States shall be allotted a total of 35 

4 waivers under paragraph (1)(B) for a fiscal year if 90 per5 cent of the waivers available to the States receiving at 

6 least 5 waivers were used in the previous fiscal year. 

7 ‘‘(ii) When an allotment occurs under clause (i), all 

8 States shall be allotted an additional 5 waivers under 

9 paragraph (1)(B) for each subsequent fiscal year if 90 

10 percent of the waivers available to the States receiving at 

11 least 5 waivers were used in the previous fiscal year. If 

12 the States are allotted 45 or more waivers for a fiscal year, 

13 the States will only receive an additional increase of 5 

14 waivers the following fiscal year if 95 percent of the waiv15 ers available to the States receiving at least 1 waiver were 

16 used in the previous fiscal year. 

17 ‘‘(B) Any increase in allotments under subparagraph 

18 (A) shall be maintained indefinitely, unless in a fiscal year, 

19 the total number of such waivers granted is 5 percent 

20 lower than in the last year in which there was an increase 

21 in the number of waivers allotted pursuant to this para22 graph, in which case— 

23 ‘‘(i) the number of waivers allotted shall be de24 creased by 5 for all States beginning in the next fis25 cal year; and 


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1 ‘‘(ii) each additional 5 percent decrease in such 

2 waivers granted from the last year in which there 

3 was an increase in the allotment, shall result in an 

4 additional decrease of 5 waivers allotted for all 

5 States, provided that the number of waivers allotted 

6 for all States shall not drop below 30.’’. 

7 (b) ACADEMIC MEDICAL CENTERS.—Section 

8 214(l)(1)(D) of such Act is amended— 

9 (1) in clause (ii), by striking ‘‘and’’ at the end; 

10 (2) in clause (iii), by striking the period at the 

11 end and inserting ‘‘; and’’; and 

12 (3) by adding at the end the following: 

13 ‘‘(iv) in the case of a request by an inter14 ested State agency— 

15 ‘‘(I) the head of such agency deter16 mines that the alien is to practice medicine 

17 in, or be on the faculty of a residency pro18 gram at, an academic medical center (as 

19 that term is defined in section 

20 411.355(e)(2) of title 42, Code of Federal 

21 Regulations, or similar successor regula22 tion), without regard to whether such facil23 ity is located within an area designated by 

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1 ices as having a shortage of health care 

2 professionals; and 

3 ‘‘(II) the head of such agency deter4 mines that— 

5 ‘‘(aa) the alien physician’s work 

6 is in the public interest; and 

7 ‘‘(bb) the grant of such waiver 

8 would not cause the number of the 

9 waivers granted on behalf of aliens for 

10 such State for a fiscal year (within 

11 the limitation in subparagraph (B) 

12 and subject to paragraph (6)) in ac13 cordance with the conditions of this 

14 clause to exceed 3.’’. 

15 SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, 

16 AND OTHER PROVISIONS RELATED TO PHYSI17 CIAN IMMIGRATION. 

18 (a) DUAL INTENT FOR PHYSICIANS SEEKING GRAD19 UATE MEDICAL TRAINING.—Section 214(b) of the Immi20 gration and Nationality Act (8 U.S.C. 1184(b)) is amend21 ed by striking ‘‘(other than a nonimmigrant described in 

22 subparagraph (L) or (V) of section 101(a)(15), and other 

23 than a nonimmigrant described in any provision of section 

24 101(a)(15)(H)(i) except subclause (b1) of such section)’’ 

25 and inserting ‘‘(other than a nonimmigrant described in 


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1 subparagraph (L) or (V) of section 101(a)(15), a non2 immigrant described in any provision of section 

3 101(a)(15)(H)(i) (except subclause (b1) of such section), 

4 and an alien coming to the United States to receive grad5 uate medical education or training as described in section 

6 212(j) or to take examinations required to receive grad7 uate medical education or training as described in section 

8 212(j))’’. 

9 (b) PHYSICIAN NATIONAL INTEREST WAIVER CLARI10 FICATIONS.— 

11 (1) PRACTICE AND GEOGRAPHIC AREA.—Sec12 tion 203(b)(2)(B)(ii)(I) of the Immigration and Na13 tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 

14 amended by striking items (aa) and (bb) and insert15 ing the following: 

16 ‘‘(aa) the alien physician agrees to 

17 work on a full-time basis practicing pri18 mary care, specialty medicine, or a com19 bination thereof, in an area or areas des20 ignated by the Secretary of Health and 

21 Human Services as having a shortage of 

22 health care professionals, or at a health 

23 care facility under the jurisdiction of the 

24 Secretary of Veterans Affairs; or 


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1 ‘‘(bb) the alien physician is pursuing 

2 such waiver based upon service at a facility 

3 or facilities that serve patients who reside 

4 in a geographic area or areas designated 

5 by the Secretary of Health and Human 

6 Services as having a shortage of health 

7 care professionals (without regard to 

8 whether such facility or facilities are lo9 cated within such an area) and a Federal 

10 agency, or a local, county, regional, or 

11 State department of public health deter12 mines the alien physician’s work was or 

13 will be in the public interest.’’. 

14 (2) FIVE-YEAR SERVICE REQUIREMENT.—Sec15 tion 203(b)(2)(B)(ii) of the Immigration and Na16 tionality Act (8 U.S.C. 1153(B)(ii)) is amended— 

17 (A) by moving subclauses (II), (III), and 

18 (IV) 4 ems to the left; and 

19 (B) in subclause (II)— 

20 (i) by inserting ‘‘(aa)’’ after ‘‘(II)’’; 

21 and 

22 (ii) by adding at the end the fol23 lowing: 

24 ‘‘(bb) The 5-year service requirement 

25 under item (aa) shall begin on the date on 


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1 which the alien physician begins work in 

2 the shortage area in any legal status and 

3 not on the date on which an immigrant 

4 visa petition is filed or approved. Such 

5 service shall be aggregated without regard 

6 to when such service began and without re7 gard to whether such service began during 

8 or in conjunction with a course of graduate 

9 medical education. 

10 ‘‘(cc) An alien physician shall not be 

11 required to submit an employment contract 

12 with a term exceeding the balance of the 5- 

13 year commitment yet to be served or an 

14 employment contract dated within a min15 imum time period before filing a visa peti16 tion under this subsection. 

17 ‘‘(dd) An alien physician shall not be 

18 required to file additional immigrant visa 

19 petitions upon a change of work location 

20 from the location approved in the original 

21 national interest immigrant petition.’’. 

22 (c) TECHNICAL CLARIFICATION REGARDING AD23 VANCED DEGREE FOR PHYSICIANS.—Section 

24 203(b)(2)(A) of the Immigration and Nationality Act (8 

25 U.S.C. 1153(b)(2)(A)) is amended by adding at the end 


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1 the following: ‘‘An alien physician holding a foreign med2 ical degree that has been deemed sufficient for acceptance 

3 by an accredited United States medical residency or fel4 lowship program is a member of the professions holding 

5 an advanced degree or its equivalent.’’. 

6 (d) SHORT-TERM WORK AUTHORIZATION FOR PHY7 SICIANS COMPLETING THEIR RESIDENCIES.— 

8 (1) IN GENERAL.—A physician completing 

9 graduate medical education or training described in 

10 section 212(j) of the Immigration and Nationality 

11 Act (8 U.S.C. 1182(j)) as a nonimmigrant described 

12 in section 101(a)(15)(H)(i) of such Act (8 U.S.C. 

13 1101(a)(15)(H)(i))— 

14 (A) shall have such nonimmigrant status 

15 automatically extended until October 1 of the 

16 fiscal year for which a petition for a continu17 ation of such nonimmigrant status has been 

18 submitted in a timely manner and the employ19 ment start date for the beneficiary of such peti20 tion is October 1 of that fiscal year; and 

21 (B) shall be authorized to be employed in22 cident to status during the period between the 

23 filing of such petition and October 1 of such fis24 cal year. 


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1 (2) TERMINATION.—The physician’s status and 

2 employment authorization shall terminate on the 

3 date that is 30 days after the date on which a peti4 tion described in paragraph (1)(A) is rejected, de5 nied or revoked. 

6 (3) AUTOMATIC EXTENSION.—A physician’s 

7 status and employment authorization will automati8 cally extend to October 1 of the next fiscal year if 

9 all of the visas described in section 101(a)(15)(H)(i) 

10 of such Act that were authorized to be issued for the 

11 fiscal year have been issued. 

12 (e) APPLICABILITY OF SECTION 212(e) TO SPOUSES

13 AND CHILDREN OF J–1 EXCHANGE VISITORS.—A spouse 

14 or child of an exchange visitor described in section 

15 101(a)(15)(J) of the Immigration and Nationality Act (8 

16 U.S.C. 1101(a)(15)(J)) shall not be subject to the require17 ments under section 212(e) of such Act (8 U.S.C. 

18 1182(e)). 

Æ 


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