II 

115TH CONGRESS 

1ST SESSION S. 898 

To provide incentives to physicians to practice in rural and medically 

underserved communities, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 7, 2017 

Ms. KLOBUCHAR (for herself, Ms. COLLINS, and Ms. HEITKAMP) 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 April 28, 

5 2017. 

6 SEC. 3. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

7 (a) IN GENERAL.—Section 214(l)(1) of the Immigra8 tion and Nationality Act (8 U.S.C. 1184(l)(1) is amend9 ed— 

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

11 by striking ‘‘Attorney General’’ and inserting ‘‘Sec12 retary of Homeland Security’’; 

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

14 of United States Information Agency’’ and inserting 

15 ‘‘Secretary of State’’; 

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

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

18 semicolon at the end; and 

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

20 and (ii) and inserting the following: 

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

22 offer of full-time employment at a health facil23 ity or health care organization, which employ24 ment has been determined by the Secretary of 


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1 Homeland Security to be in the public interest; 

2 and 

3 ‘‘(ii) the alien— 

4 ‘‘(I) has accepted employment with 

5 the health facility or health care organiza6 tion in a geographic area or areas which 

7 are designated by the Secretary of Health 

8 and Human Services as having a shortage 

9 of health care professionals; 

10 ‘‘(II) begins employment by the later 

11 of the date that is— 

12 ‘‘(aa) 90 days after receiving 

13 such waiver; 

14 ‘‘(bb) 90 days after completing 

15 graduate medical education or train16 ing under a program approved pursu17 ant to section 212(j)(1); or 

18 ‘‘(cc) 90 days after receiving non19 immigrant status or employment au20 thorization, if the alien or the alien’s 

21 employer petitions for such non22 immigrant status or employment au23 thorization not later than 90 days 

24 after the date on which the alien com25 pletes his or her graduate medical 


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1 education or training under a pro2 gram approved pursuant to section 

3 212(j)(1); and 

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

5 a total of not less than 3 years in the sta6 tus authorized for such employment under 

7 this subsection unless— 

8 ‘‘(aa) the Secretary of Homeland 

9 Security determines that extenuating 

10 circumstances, including violations by 

11 the employer of the employment 

12 agreement with the alien or of labor 

13 and employment laws, exist that jus14 tify a lesser period of employment at 

15 such facility or organization, in which 

16 case the alien shall demonstrate, not 

17 later than 90 days after the employ18 ment termination date (unless the 

19 Secretary determines that extenuating 

20 circumstances would justify an exten21 sion), another bona fide offer of em22 ployment at a health facility or health 

23 care organization in a geographic area 

24 or areas which are designated by the 

25 Secretary of Health and Human ServVerDate Sep 11 2014 01:57 Apr 18, 2017 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S898.IS S898

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1 ices as having a shortage of health 

2 care professionals, for the remainder 

3 of such 3-year period; 

4 ‘‘(bb) the interested State agency 

5 that requested the waiver attests that 

6 extenuating circumstances including 

7 violations by the employer of the em8 ployment agreement with the alien or 

9 of labor and employment laws, exist 

10 that justify a lesser period of employ11 ment at such facility or organization 

12 in which case the alien shall dem13 onstrate, not later than 90 days after 

14 the employment termination date (un15 less the Secretary determines that ex16 tenuating circumstances would justify 

17 an extension), another bona fide offer 

18 of employment at a health facility or 

19 health care organization in a geo20 graphic area or areas which are des21 ignated by the Secretary of Health 

22 and Human Services as having a 

23 shortage of health care professionals, 

24 for the remainder of such 3-year pe25 riod; or 


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1 ‘‘(cc) if the alien elects not to 

2 pursue a determination of extenuating 

3 circumstances pursuant to item (aa) 

4 or (bb), the alien terminates the 

5 alien’s employment relationship with 

6 such facility or organization, in which 

7 case the alien shall demonstrate, not 

8 later than 45 days after the employ9 ment termination date, another bona 

10 fide offer of employment at a health 

11 facility or health care organization in 

12 a geographic area or areas, in the 

13 State that requested the alien’s waiv14 er, which are designated by the Sec15 retary of Health and Human Services 

16 as having a shortage of health care 

17 professionals, and agree to be em18 ployed for the remainder of such 3- 

19 year period, and 1 additional year for 

20 each termination under this subclause; 

21 and’’. 

22 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL23 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER24 SERVED AREAS.—Section 214(l)(2) of such Act (8 U.S.C. 


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1 1184(l)(2)) is amended by amending subparagraph (A) to 

2 read as follows: 

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

4 agency or an interested State agency for rec5 ommendation of a waiver under this section by a 

6 physician who is maintaining valid nonimmigrant 

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

8 recommendation by the Secretary of State, the Sec9 retary of Homeland Security may change the status 

10 of such physician to that of an alien described in 

11 section 101(a)(15)(H)(i)(B). The numerical limita12 tions contained in subsection (g)(1)(A) shall not 

13 apply to any alien whose status is changed under 

14 this subparagraph.’’. 

15 (c) VIOLATION OF AGREEMENTS.—Section 

16 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

17 amended by inserting ‘‘substantial requirement of an’’ be18 fore ‘‘agreement entered into’’. 

19 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED

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

21 is amended by adding at the end the following: 

22 ‘‘(4)(A) If an interested State agency denies the ap23 plication for a waiver under paragraph (1)(B) from a phy24 sician pursuing graduate medical education or training 

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


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1 requested the maximum number of waivers permitted for 

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

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

4 to seek a waiver under this subsection (except for para5 graph (1)(D)(ii)) to work for an employer described in 

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

7 the maximum number of waivers. 

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

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

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

11 State until the earlier of— 

12 ‘‘(i) the date on which the Secretary of Home13 land Security denies such waiver; or 

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

15 an application for change of status under paragraph 

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

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

18 such Act, as amended by subsection (d), is further amend19 ed by adding at the end the following: 

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

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

22 contracting health facility or health care organization 

23 that— 

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

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


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1 that the alien will be expected to be available and 

2 the compensation the alien will receive for on-call 

3 time; 

4 ‘‘(B) specifies— 

5 ‘‘(i) whether the contracting facility or or6 ganization will pay the alien’s malpractice in7 surance premiums; 

8 ‘‘(ii) whether the employer will provide 

9 malpractice insurance; and 

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

11 will be provided; 

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

13 alien will work and includes a statement that the 

14 contracting facility or organization will not add addi15 tional work locations without the approval of the 

16 Federal agency or State agency that requested the 

17 waiver; and 

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

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

20 whose employment relationship with a health facility or 

21 health care organization terminates under paragraph 

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

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

24 status in an authorized period of stay during the 90-day 

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


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

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

3 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER

4 STATES.—Section 214(l) of such Act, as amended by sub5 sections (d) and (e), is further amended by adding at the 

6 end the following: 

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

8 terminates the recipient’s employment with a health facil9 ity or health care organization pursuant to paragraph 

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

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

12 accepts new employment with such a facility or organiza13 tion in a different State, the State from which the alien 

14 is departing may be accorded an additional waiver by the 

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

16 alien’s employment was terminated.’’. 

17 SEC. 4. ALLOTMENT OF CONRAD 30 WAIVERS. 

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

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

20 section 3, is further amended by adding at the end the 

21 following: 

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

23 waivers under paragraph (1)(B) for a fiscal year if 90 per24 cent of the waivers available to the States receiving at 

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


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

2 States shall be allotted an additional 5 waivers under 

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

4 percent of the waivers available to the States receiving at 

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

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

7 the States will only receive an additional increase of 5 

8 waivers the following fiscal year if 95 percent of the waiv9 ers available to the States receiving at least 1 waiver were 

10 used in the previous fiscal year. 

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

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

13 the total number of such waivers granted is 5 percent 

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

15 in the number of waivers allotted pursuant to this para16 graph, in which case— 

17 ‘‘(i) the number of waivers allotted shall be de18 creased by 5 for all States beginning in the next fis19 cal year; and 

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

21 waivers granted from the last year in which there 

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

23 additional decrease of 5 waivers allotted for all 

24 States, provided that the number of waivers allotted 

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


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1 (b) ACADEMIC MEDICAL CENTERS.—Section 

2 214(l)(1)(D) of such Act is amended— 

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

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

5 end and inserting ‘‘; and’’; and 

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

7 ‘‘(iv) in the case of a request by an inter8 ested State agency— 

9 ‘‘(I) the head of such agency deter10 mines that the alien is to practice medicine 

11 in, or be on the faculty of a residency pro12 gram at, an academic medical center (as 

13 that term is defined in section 

14 411.355(e)(2) of title 42, Code of Federal 

15 Regulations, or similar successor regula16 tion), without regard to whether such facil17 ity is located within an area designated by 

18 the Secretary of Health and Human Serv19 ices as having a shortage of health care 

20 professionals; and 

21 ‘‘(II) the head of such agency deter22 mines that— 

23 ‘‘(aa) the alien physician’s work 

24 is in the public interest; and 


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1 ‘‘(bb) the grant of such waiver 

2 would not cause the number of the 

3 waivers granted on behalf of aliens for 

4 such State for a fiscal year (within 

5 the limitation in subparagraph (B) 

6 and subject to paragraph (6)) in ac7 cordance with the conditions of this 

8 clause to exceed 3.’’. 

9 SEC. 5. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, 

10 AND OTHER PROVISIONS RELATED TO PHYSI11 CIAN IMMIGRATION. 

12 (a) VISA ELIGIBILITY.—Not later than 90 days after 

13 the date of the enactment of this Act, the Secretary of 

14 State shall amend guidance in the Foreign Affairs Manual 

15 to clarify that the expression of a future intention to seek 

16 a waiver under section 214(l) of the Immigration and Na17 tionality Act (8 U.S.C. 1184(l)) by an alien coming to the 

18 United States to receive graduate medical education or 

19 training, as described in section 212(j) of such Act (8 

20 U.S.C. 1182(j)), or to take examinations required to re21 ceive such graduate medical education or training, shall 

22 not, by itself, constitute evidence of an intention to aban23 don a foreign residence for purposes of obtaining a visa 

24 as a nonimmigrant or otherwise obtaining or maintaining 

25 the status of a nonimmigrant. 


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1 (b) APPLICABILITY OF SECTION 212(e) TO SPOUSES

2 AND CHILDREN OF J–1 EXCHANGE VISITORS.—Section 

3 212(e) of the Immigration and Nationality Act (8 U.S.C. 

4 1182(e)) is amended— 

5 (1) by inserting ‘‘(1)’’ after ‘‘(e)’’; and 

6 (2) by adding at the end the following 

7 ‘‘(2) A spouse or child of an exchange visitor de8 scribed in section 101(a)(15)(J) shall not be subject to 

9 the requirements under this subsection solely on account 

10 of such spouse or child’s derivative nonimmigrant status 

11 to an exchange visitor who is subject to the requirements 

12 under this subsection.’’. 

Æ 


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