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[House Report 106-721]
[From the U.S. Government Publishing Office]

106th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     106-721

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                   INTERNATIONAL PATIENT ACT OF 1999

                                _______
                                

 July 11, 2000.--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. 2961]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on the Judiciary, to whom was referred the 
bill (H.R. 2961) amending the Immigration and Nationality Act 
to authorize a 3-year pilot program under which the Attorney 
General may extend the period for voluntary departure in the 
case of certain nonimmigrant aliens who require medical 
treatment in the United States and were admitted under the Visa 
Waiver Pilot Program, and for other purposes, having considered 
the same, reports favorably thereon without amendment and 
recommends that the bill do pass.

                           TABLE OF CONTENTS

                                                                  

                                                                 Page
Purpose and Summary........................................           1
Background and Need for the Legislation....................           2
Hearings...................................................           3
Committee Consideration....................................           3
Vote of the Committee......................................           3
Committee Oversight Findings...............................           3
Committee on Government Reform Findings....................           3
New Budget Authority and Tax Expenditures..................           3
Congressional Budget Office Cost Estimate..................           3
Constitutional Authority Statement.........................           5
Section-by-Section Analysis and Discussion.................           5
Changes in Existing Law Made by the Bill, as Reported......           6

                          Purpose and Summary

    H.R. 2961 would create a 3-year pilot program under which 
the Attorney General may extend the period of voluntary 
departure in the case of certain aliens who require medical 
treatment in the United States and were admitted under the Visa 
Waiver Pilot Program.

                Background and Need for the Legislation

    Aliens who seek to visit the United States temporarily for 
business or pleasure are admitted to the United States under 
section 101(a)(15)(B) of the Immigration and Nationality Act. 
B-1(business) visas are initially valid for up to 1 year and 
can be extended in increments of not more than 6 months 
each.\1\ B-2 (pleasure) visas are initially valid for up to 1 
year (with a minimum validity of 6 months), and can also be 
extended in increments of not more than 6 months.\2\
---------------------------------------------------------------------------
    \1\ 8 C.F.R. sec. 214.2(b)(1)(missionaries can receive extensions 
of up to 1 year).
    \2\ 8 C.F.R. sec. 214.2(b)(2).
---------------------------------------------------------------------------
    The visa waiver pilot program allows aliens traveling from 
certain designated countries to come to the United States as 
temporary visitors for business or pleasure without having to 
obtain ``B'' visas. The program authorizes the Attorney General 
to waive the visa requirement for aliens traveling from 
countries that have qualified on the basis of requirements set 
forth in section 217 of the INA. However, a visit cannot exceed 
90 days, and no extensions are available.\3\
---------------------------------------------------------------------------
    \3\ INA sec. 217(a)(1).
---------------------------------------------------------------------------
    The only relief that the Immigration and Naturalization 
Service can offer an alien admitted under the visa waiver pilot 
program who has a compelling need to remain in the U.S. for 
more than 90 days is to authorize the alien to depart 
voluntarily after a specified period of time pursuant to 
section 240B of the INA. This section allows the Attorney 
General to permit an alien who otherwise is no longer 
authorized to remain in the United States to depart voluntarily 
at the alien's own expense in lieu of being placed in removal 
proceedings or prior to the completion of such proceedings. 
However, the period of time after which the alien must depart 
can not exceed 120 days.\4\ Thus, an alien admitted under the 
visa waiver program who faces an emergency situation can be 
authorized to remain in the United States only for 120 days 
beyond the initial 90-day admission.
---------------------------------------------------------------------------
    \4\ INA sec. 240B(a)(2).
---------------------------------------------------------------------------
    While the 210-day period provided by the initial 90-day 
admission and the 120 days under ``voluntary departure'' is 
adequate to deal with most emergency situations, it does not 
meet the needs of a relatively few aliens who are admitted to 
the U.S. under the visa waiver program and seek to receive 
long-term medical treatment. H.R. 2961 would address this 
problem by establishing a 3-year pilot program authorizing the 
Attorney General to waive the 120-day cap on voluntary 
departure for a limited number of patients and attending family 
members who enter the U.S. under the visa waiver program.
    The legislation contains safeguards to ensure that only 
those truly in need of long-term medical care can obtain such a 
waiver. An alien seeking a waiver would be required to provide 
a comprehensive statement from the attending physician 
detailing the treatment sought and the alien's anticipated 
length of stay in the U.S. In addition, the alien and attending 
family members would be required to provide proof of their 
ability to pay for the treatment and their daily living 
expenses. The bill caps the total number of waivers at 300 
annually and limits the number of family members who can enjoy 
the benefits of a waiver. The bill also requires the INS to 
provide Congress with an annual report detailing the number of 
waivers granted each fiscal year and provides for the 
suspension of the Attorney General's authority to authorize 
such waivers during any period in which an annual report is 
past due.

                                Hearings

    No hearings were held on H.R. 2961.

                        Committee Consideration

    On September 30, 1999, the Subcommittee on Immigration and 
Claims met in open session and ordered favorably reported the 
bill H.R. 2961, without amendment, by a voice vote, a quorum 
being present. On October 5, 1999, the committee met in open 
session and ordered favorably reported the bill H.R. 2961, 
without amendment, by a voice vote, a quorum being present.

                         Vote of the Committee

    The committee adopted H.R. 2961 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 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. 2961, 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, October 18, 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. 2961, the 
International Patient 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 Immigration and Naturalization Service costs), 
who can be reached at 226-2860, Valerie Baxter (for effects on 
entitlement programs), who can be reached at 226-2820, and Lisa 
Cash Driskill (for the state and local impact), who can be 
reached at 225-3220.
            Sincerely,
                                  Dan L. Crippen, Director.

Enclosure

cc:
        Honorable John Conyers, Jr.
        Ranking Democratic Member
H.R. 2961--International Patient Act of 1999.
    Under the visa waiver pilot program administered by the 
Immigration and Naturalization Service (INS), visitors from 
certain foreign countries may stay in the United States for up 
to 90 days without obtaining a visa; under limited 
circumstances, these visitors may stay an additional 120 days. 
H.R. 2961 would permit the INS to waive this restriction for 
visitors who need to stay longer to receive medical treatment 
and who meet certain other conditions. The bill's provisions 
would be limited to 300 individuals (and their families) each 
year and would be effective from January 1, 2000, through 
December 31, 2002. The INS would be required to prepare an 
annual report to the Congress regarding any waivers granted 
under the bill.
    Enacting this bill would affect direct spending in fiscal 
years 2000 through 2003, but CBO estimates that the cost would 
not be significant in any single year. Because the bill would 
affect direct spending, pay-as-you-go procedures would apply. 
We estimate that the cost of administering the visa waiver 
pilot program, which is funded by immigration fees, would 
increase by less than $100,000 a year as a result of enacting 
this bill. Although H.R. 2961 could affect spending for 
emergency Medicaid services, CBO expects that any such costs 
would not be significant because the bill would require 
individuals to show they have the means to pay for the medical 
treatment and their living expenses.
    This legislation contains no intergovernmental or private-
sector mandates as defined in the Unfunded Mandates Reform Act, 
but it could have a very small effect on state, local, or 
tribal governments in the form of increases in emergency 
Medicaid spending.
    The CBO staff contacts are Mark Grabowicz (for INS costs), 
who can be reached at 226-2860, Valerie Baxter (for effects on 
entitlement programs), who can be reached at 226-2820, and Lisa 
Cash Driskill (for the state and local impact), who can be 
reached at 225-3220. This estimate was approved by Peter H. 
Fontaine, 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 and Discussion

Section 1. Short Title
Section 2. Three-Year Pilot Program to extend the Period for Voluntary 
        Departure for Certain Nonimmigrant Aliens Requiring Medical 
        Treatment Who Were Admitted to the United States under the Visa 
        Waiver Pilot Program
    Section 2 of the bill amends section 240B(a)(2) of the 
Immigration and Nationality Act to provide that permission to 
depart voluntarily from the United States under this section 
shall not be valid for a period exceeding 120 days except under 
the terms of a 3-year pilot program. During the period lasting 
from January 1, 2000, through December 31, 2002, the Attorney 
General may, in her discretion for humanitarian purposes, waive 
the 120 day limitation in the case of an alien who was admitted 
to the United States under the visa waiver pilot program and 
who seeks the waiver for the purpose of continuing to receive 
medical treatment in the United States from a physician 
associated with a health care facility. An alien patient 
seeking a waiver must submit to the Attorney General (1) a 
detailed diagnosis statement from the physician, which includes 
the treatment being sought and the expected time period the 
patient will be required to remain in the United States, (2) a 
statement from the health care facility containing an assurance 
that the patient's treatment is not being paid through any 
Federal or State public health assistance, that the patient's 
account has no outstanding balance, and that such facility will 
notify the Immigration and Naturalization Service when the 
patient is released or treatment is terminated, and (3) 
evidence of financial ability to support the patient's day-to-
day expenses while in the United States (including the expenses 
of any accompanying family member) and evidence that any such 
patient or family member is not receiving any form of public 
assistance.
    Waivers may be granted only upon a request submitted by a 
INS district office to INS headquarters. No more than 300 
waivers may be granted for any fiscal year for patients. 
Spouses, parents, brothers, sisters, sons, daughters and other 
family members of the patient who entered the United States 
accompanying the patient can also receive a waiver. However, 
only one adult family member may be granted a waiver for each 
patient (two adults if the patient is a dependent under the age 
of 18 or if one such adult family member is 55 or older or is 
physically handicapped).
    Not later than March 30 of each year, the INS Commissioner 
shall submit to the Congress an annual report regarding all 
waivers granted during the preceding fiscal year. The authority 
of the Attorney General to grant waivers shall be suspended 
during any period in which such an annual report is past due 
and has not been submitted.

         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):

          SECTION 240B OF THE IMMIGRATION AND NATIONALITY ACT

                          voluntary departure

    Sec. 240B. (a) Certain Conditions.--
            (1)  * * *
            [(2) Period.--Permission to depart voluntarily 
        under this subsection shall not be valid for a period 
        exceeding 120 days.]
            (2) Period.--
                    (A) In general.--Subject to subparagraph 
                (B), permission to depart voluntarily under 
                this subsection shall not be valid for a period 
                exceeding 120 days.
                    (B) 3-year pilot program waiver.--During 
                the period January 1, 2000, through December 
                31, 2002 and subject to subparagraphs (C) and 
                (D)(ii), the Attorney General may, in the 
                discretion of the Attorney General for 
                humanitarian purposes, waive application of 
                subparagraph (A) in the case of an alien--
                            (i) who was admitted to the United 
                        States as a nonimmigrant visitor 
                        (described in section 101(a)(15)(B)) 
                        under the provisions of the visa waiver 
                        pilot program established pursuant to 
                        section 217, seeks the waiver for the 
                        purpose of continuing to receive 
                        medical treatment in the United States 
                        from a physician associated with a 
                        health care facility, and submits to 
                        the Attorney General--
                                    (I) a detailed diagnosis 
                                statement from the physician, 
                                which includes the treatment 
                                being sought and the expected 
                                time period the alien will be 
                                required to remain in the 
                                United States;
                                    (II) a statement from the 
                                health care facility containing 
                                an assurance that the alien's 
                                treatment is not being paid 
                                through any Federal or State 
                                public health assistance, that 
                                the alien's account has no 
                                outstanding balance, and that 
                                such facility will notify the 
                                Service when the alien is 
                                released or treatment is 
                                terminated; and
                                    (III) evidence of financial 
                                ability to support the alien's 
                                day-to-day expenses while in 
                                the United States (including 
                                the expenses of any family 
                                member described in clause 
                                (ii)) and evidence that any 
                                such alien or family member is 
                                not receiving any form of 
                                public assistance; or
                            (ii) who--
                                    (I) is a spouse, parent, 
                                brother, sister, son, daughter, 
                                or other family member of a 
                                principal alien described in 
                                clause (i); and
                                    (II) entered the United 
                                States accompanying, and with 
                                the same status as, such 
                                principal alien.
                    (C) Waiver limitations.--
                            (i) Waivers under subparagraph (B) 
                        may be granted only upon a request 
                        submitted by a Service district office 
                        to Service headquarters.
                            (ii) Not more than 300 waivers may 
                        be granted for any fiscal year for a 
                        principal alien under subparagraph 
                        (B)(i).
                            (iii)(I) Except as provided in 
                        subclause (II), in the case of each 
                        principal alien described in 
                        subparagraph (B)(i) not more than 1 
                        adult may be granted a waiver under 
                        subparagraph (B)(ii).
                            (II) Not more than 2 adults may be 
                        granted a waiver under subparagraph 
                        (B)(ii) in a case in which--
                                    (aa) the principal alien 
                                described in subparagraph 
                                (B)(i) is a dependent under the 
                                age of 18; or
                                    (bb) 1 such adult is age 55 
                                or older or is physically 
                                handicapped.
                    (D) Report to congress; suspension of 
                waiver authority.--
                            (i) Not later than March 30 of each 
                        year, the Commissioner shall submit to 
                        the Congress an annual report regarding 
                        all waivers granted under subparagraph 
                        (B) during the preceding fiscal year.
                            (ii) Notwithstanding any other 
                        provision of law, the authority of the 
                        Attorney General under subparagraph (B) 
                        shall be suspended during any period in 
                        which an annual report under clause (i) 
                        is past due and has not been submitted.

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