I 

118TH CONGRESS 

2D SESSION H. R. 10007 

To amend the Immigration and Nationality Act to authorize the admission 

of nonimmigrant emergency medical technicians and paramedics. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 18, 2024 

Mr. HIGGINS of Louisiana introduced the following bill; which was referred 

to the Committee on the Judiciary 

A BILL 

To amend the Immigration and Nationality Act to authorize 

the admission of nonimmigrant emergency medical technicians and paramedics. 

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 ‘‘Paramedic and Emer5 gency Medical Technician Relief Act of 2024’’. 

6 SEC. 2. ESTABLISHMENT OF H–1D VISAS FOR EMTS AND 

7 PARAMEDICS. 

8 (a) NONIMMIGRANT CATEGORY.—Section 

9 101(a)(15)(H)(i) of the Immigration and Nationality Act 

10 (8 U.S.C. 1101(a)(15)(H)(i)) is amended by striking ‘‘; 


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1 or’’ at the end and inserting ‘‘, or (d) who is coming tem2 porarily to the United States to perform services as an 

3 emergency medical technician or paramedic, who meets 

4 the qualifications described in section 212(u) , and with 

5 respect to whom the Secretary of Labor determines and 

6 certifies to the Secretary of Homeland Security that an 

7 unexpired attestation is on file and in effect under section 

8 212(u)(2) for the employer; or’’. 

9 (b) REQUIREMENTS.—Section 212 of the Immigra10 tion and Nationality Act (8 U.S.C. 1182) is amended by 

11 adding at the end the following: 

12 ‘‘(u) REQUIREMENTS FOR ADMISSION OF NON13 IMMIGRANT EMTS AND PARAMEDICS.— 

14 ‘‘(1) QUALIFICATIONS.—The qualifications re15 ferred to in section 101(a)(15)(H)(i)(d), with respect 

16 to an alien who is coming to the United States to 

17 perform services as an emergency medical technician 

18 or paramedic, are that the alien— 

19 ‘‘(A) has, at a minimum, obtained emer20 gency medical technician, paramedic, or equiva21 lent pre-hospital care, education or training in 

22 a foreign country or in the United States; 

23 ‘‘(B) not later than 12 weeks before the 

24 alien’s intended first date of employment in the 

25 United States, has passed an appropriate examVerDate Sep 11 2014 00:45 Oct 25, 2024 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H10007.IH H10007

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1 ination (recognized in regulations promulgated 

2 in consultation with the Secretary of Health 

3 and Human Services) or has obtained the ap4 propriate certificate or license under State law 

5 to practice as an emergency medical technician 

6 or paramedic in the State of intended employ7 ment; 

8 ‘‘(C) not later than 12 weeks before the 

9 alien’s intended first date of employment in the 

10 United States, is fully qualified and eligible 

11 under the laws (including such temporary or in12 terim licensing requirements which authorize 

13 the emergency medical technician or paramedic 

14 to be employed) governing the place of intended 

15 employment to engage in practice as an emer16 gency medical technician or a paramedic imme17 diately upon admission to the United States; 

18 and 

19 ‘‘(D) not later than 12 weeks before the 

20 alien’s intended first date of employment in the 

21 United States, has passed appropriate criminal 

22 record checks and other background and data23 base checks, as determined by the Secretary of 

24 Homeland Security in coordination with the At25 torney General, including biometric data collecVerDate Sep 11 2014 00:45 Oct 25, 2024 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H10007.IH H10007

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1 tion, a review of the applicant’s criminal and 

2 immigration records, verification of the appli3 cant’s identity and travel history, and an as4 sessment of any potential risk the applicant 

5 poses to public safety or national security. 

6 ‘‘(2) ATTESTATION.— 

7 ‘‘(A) The attestation referred to in section 

8 101(a)(15)(H)(i)(d), with respect to an em9 ployer for which an alien will perform services, 

10 is an attestation as to the following: 

11 ‘‘(i) The employment of the alien will 

12 not adversely affect the wages and working 

13 conditions of emergency medical techni14 cians or paramedics, as applicable, simi15 larly employed. 

16 ‘‘(ii) The alien employed by the em17 ployer will be paid the wage rate for emer18 gency medical technicians or paramedics, 

19 as applicable, similarly employed by the 

20 employer. 

21 ‘‘(iii) The employer has taken and is 

22 taking timely and significant steps de23 signed to recruit and retain sufficient 

24 emergency medical technicians or para25 medics, as applicable, who are United 


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1 States citizens or immigrants who are au2 thorized to perform such services. 

3 ‘‘(iv) There is not a strike or lockout 

4 in the course of a labor dispute, the em5 ployer did not lay off and will not lay off 

6 an emergency medical technician or a 

7 paramedic, as applicable, employed by the 

8 employer within the period beginning 90 

9 days before and ending 90 days after the 

10 date of filing of any visa petition, and the 

11 employment of such an alien is not in12 tended or designed to influence an election 

13 for a bargaining representative for emer14 gency medical technicians or paramedics of 

15 the employer. 

16 ‘‘(v) At the time of the filing of the 

17 petition for emergency medical technicians 

18 or paramedics, as applicable, under section 

19 101(a)(15)(H)(i)(d), notice of the filing 

20 has been provided by the employer to the 

21 bargaining representative of the emergency 

22 medical technicians or paramedics em23 ployed by the employer or, where there is 

24 no such bargaining representative, notice 

25 of the filing has been provided to the emerVerDate Sep 11 2014 00:45 Oct 25, 2024 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H10007.IH H10007

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1 gency medical technicians or paramedics 

2 employed by the employer through posting 

3 in conspicuous locations or electronic noti4 fication to such employees. 

5 ‘‘(vi) The employer will not, at any 

6 time, employ a number of aliens issued 

7 visas or otherwise provided nonimmigrant 

8 status under section 1101(a)(15)(H)(i)(d) 

9 of this title as emergency medical techni10 cians or paramedics that exceeds 15 per11 cent of the total number of emergency 

12 medical technicians or paramedics, respec13 tively, employed by the employer. 

14 ‘‘(vii) The employer is affiliated with 

15 an emergency medical services education 

16 program approved by the applicable licens17 ing body of the State in which the alien 

18 will work. 

19 Nothing in clause (iii) shall be construed 

20 as requiring an employer to have taken sig21 nificant steps described in such clause be22 fore the effective date of the Paramedic 

23 and Emergency Medical Technician Relief 

24 Act of 2023. A copy of the attestation re25 ferred to in section 101(1)(15)(H)(i)(d) 


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1 shall be provided, within 30 days of the 

2 date of filing, to emergency medical techni3 cians or paramedics, as applicable, em4 ployed by the employer on the date of fil5 ing. 

6 ‘‘(B) For purposes of subparagraph 

7 (A)(iii), each of the following shall be consid8 ered a significant step reasonably designed to 

9 recruit and retain emergency medical techni10 cians or paramedics: 

11 ‘‘(i) Operating a training program for 

12 emergency medical technicians or para13 medics or financing (or providing partici14 pation in) a training program for emer15 gency medical technicians or paramedics. 

16 ‘‘(ii) Providing career development 

17 programs and other methods of facilitating 

18 nationals of the United States to become 

19 emergency medical technicians or para20 medics. 

21 ‘‘(iii) Paying emergency medical tech22 nicians or paramedics wages at a rate 

23 equal to or higher than currently being 

24 paid to emergency medical technicians or 


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1 paramedics similarly employed in the geo2 graphic area. 

3 ‘‘(iv) Providing reasonable opportuni4 ties for meaningful salary advancement by 

5 emergency medical technicians or para6 medics. 

7 The steps described in this subparagraph shall 

8 not be considered to be an exclusive list of the 

9 significant steps that may be taken to meet the 

10 conditions of subparagraph (A)(iii). Nothing in 

11 this subparagraph shall require an employer to 

12 take more than one step if the employer can 

13 demonstrate that taking a second step is not 

14 reasonable. 

15 ‘‘(C) Subject to subparagraph (E), an at16 testation under subparagraph (A)— 

17 ‘‘(i) shall expire on the date that is 

18 the later of— 

19 ‘‘(I) the end of the one-year pe20 riod beginning on the date of its filing 

21 with the Secretary of Labor; or 

22 ‘‘(II) the end of the period of ad23 mission under section 

24 101(a)(15)(H)(i)(d) of the last alien 

25 with respect to whose admission it 


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1 was applied (in accordance with clause 

2 (ii)); and 

3 ‘‘(ii) shall apply to petitions filed dur4 ing the one-year period beginning on the 

5 date of its filing with the Secretary of 

6 Labor if the employer states in each such 

7 petition that it continues to comply with 

8 the conditions in the attestation. 

9 ‘‘(D) An employer may meet the require10 ments under this paragraph with respect to 

11 more than one emergency medical technician or 

12 paramedic in a single petition. 

13 ‘‘(E)(i) The Secretary of Labor shall com14 pile and make publicly available online a list 

15 identifying employers which have filed petitions 

16 for nonimmigrants under section 

17 101(a)(15)(H)(i)(d) and, for each such em18 ployer, a copy of the employer’s attestation 

19 under subparagraph (A) (and accompanying 

20 documentation) and each such petition filed by 

21 the employer. 

22 ‘‘(ii) The Secretary of Labor shall establish 

23 a process, including reasonable time limits, for 

24 the receipt, investigation, and disposition of 

25 complaints respecting an employer’s failure to 


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1 meet conditions attested to or an employer’s 

2 misrepresentation of a material fact in an attes3 tation. Complaints may be filed by any ag4 grieved person or organization (including bar5 gaining representatives, associations deemed ap6 propriate by the Secretary, and other aggrieved 

7 parties as determined under regulations of the 

8 Secretary). The Secretary shall conduct an in9 vestigation under this clause if there is reason10 able cause to believe that an employer fails to 

11 meet conditions attested to. Subject to the time 

12 limits established under this clause, this sub13 paragraph shall apply regardless of whether an 

14 attestation is expired or unexpired at the time 

15 a complaint is filed. 

16 ‘‘(iii) Under such process, the Secretary 

17 shall provide, within 180 days after the date 

18 such a complaint is filed, for a determination as 

19 to whether or not a basis exists to make a find20 ing described in clause (iv). If the Secretary de21 termines that such a basis exists, the Secretary 

22 shall provide for notice of such determination to 

23 the interested parties and an opportunity for a 

24 hearing on the complaint within 60 days of the 

25 date of the determination. 


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1 ‘‘(iv) If the Secretary of Labor finds, after 

2 notice and opportunity for a hearing, that an 

3 employer (for which an attestation is made) has 

4 failed to meet a condition attested to or that 

5 there was a misrepresentation of material fact 

6 in the attestation, the Secretary of Labor shall 

7 notify the Secretary of Homeland Security of 

8 such finding and may, in addition, impose such 

9 other administrative remedies (including civil 

10 monetary penalties in an amount not to exceed 

11 $1,000 per emergency medical technician or 

12 paramedic per violation, with the total penalty 

13 not to exceed $10,000 per violation) as the Sec14 retary of Labor determines to be appropriate. 

15 Upon receipt of such notice, the Secretary of 

16 Homeland Security shall not approve petitions 

17 filed with respect to an employer during a pe18 riod of at least one year for emergency medical 

19 technicians or paramedics, as applicable to be 

20 employed by the employer. 

21 ‘‘(v) In addition to the sanctions provided 

22 for under clause (iv), if the Secretary of Labor 

23 finds, after notice and an opportunity for a 

24 hearing, that an employer has violated the con25 dition attested to under subparagraph (A)(ii) 


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1 (relating to payment of emergency medical tech2 nicians or paramedics at the prevailing wage 

3 rate), the Secretary shall order the employer to 

4 provide for payment of such amounts of back 

5 pay as may be required to comply with such 

6 condition. 

7 ‘‘(F)(i) The Secretary of Labor shall im8 pose on an employer filing an attestation under 

9 subparagraph (A) a filing fee, in an amount 

10 prescribed by the Secretary based on the costs 

11 of carrying out the Secretary’s duties under this 

12 subsection, but not exceeding $250. 

13 ‘‘(ii) Fees collected under this subpara14 graph shall be deposited in a fund established 

15 for this purpose in the Treasury of the United 

16 States. 

17 ‘‘(iii) The collected fees in the fund shall 

18 be available to the Secretary of Labor, to the 

19 extent and in such amounts as may be provided 

20 in appropriations Acts, to cover the costs de21 scribed in clause (i), in addition to any other 

22 funds that are available to the Secretary to 

23 cover such costs. 

24 ‘‘(3) PERIOD OF ADMISSION.—The period of 

25 admission of an alien under section 


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1 101(a)(15)(H)(i)(d) shall be 3 years, and may be ex2 tended for an additional 3-year period. 

3 ‘‘(4) NUMERICAL LIMITATION.— 

4 ‘‘(A) IN GENERAL.—The total number of 

5 aliens who may be issued visas or otherwise 

6 provided nonimmigrant status during any fiscal 

7 year under section 101(a)(15)(H)(i)(d) may not 

8 exceed 2,500. The numerical limitation under 

9 this subparagraph shall be allocated for a fiscal 

10 year so that the total number of aliens subject 

11 to such numerical limit who enter the United 

12 States pursuant to a visa or are accorded non13 immigrant status under section 

14 101(a)(15)(H)(i)(d) during the first 6 months 

15 of such fiscal year is not more than 1,250. 

16 ‘‘(B) ADJUSTMENT BY SECRETARY.—Be17 ginning in the fourth fiscal year that begins 

18 after the date of enactment of this paragraph, 

19 the Secretary of Homeland Security, in con20 sultation with the Secretary of Labor and other 

21 relevant stakeholders, may adjust the numerical 

22 limitation under subparagraph (A), as the Sec23 retary finds appropriate. In making such deter24 mination, the Secretary shall consider the fol25 lowing: 


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1 ‘‘(i) The current and projected de2 mand for emergency medical technicians 

3 and paramedics in the United States. 

4 ‘‘(ii) The capacity of United States 

5 educational and training institutions to 

6 produce emergency medical technicians 

7 and paramedics. 

8 ‘‘(iii) The potential impact of the ad9 mission of nonimmigrants under section 

10 101(a)(15)(H)(i)(d) on the domestic labor 

11 market, including wages, working condi12 tions, and employment opportunities for 

13 United States workers. 

14 ‘‘(iv) The need to balance the admis15 sion of foreign emergency medical techni16 cians and paramedics with the protection 

17 of United States workers and the pro18 motion of domestic workforce development 

19 initiatives. 

20 The Secretary of Homeland Security is authorized to 

21 grant exemptions from the numerical limitation 

22 under this paragraph in cases of extreme hardship, 

23 national interest, or other compelling circumstances, 

24 as determined on a case-by-case basis. 


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1 ‘‘(5) WAGE RATES; UNIONS.—An employer that 

2 has filed a petition under section 

3 101(a)(15)(H)(i)(d) to employ a nonimmigrant to 

4 perform emergency medical technician or paramedic 

5 services for the employer— 

6 ‘‘(A) shall provide the nonimmigrant a 

7 wage rate and working conditions commensu8 rate with those of emergency medical techni9 cians or paramedics, as applicable, similarly em10 ployed by the employer; 

11 ‘‘(B) shall require the nonimmigrant to 

12 work hours commensurate with those of emer13 gency medical technicians or paramedics, as ap14 plicable, similarly employed by the employer; 

15 and 

16 ‘‘(C) may not engage in any unfair labor 

17 practice listed in section 8 of the National 

18 Labor Relations Act (29 U.S.C. 158) with re19 spect to any such employee, or otherwise inter20 fere with the employee’s rights under section 7 

21 of such Act (29 U.S.C. 157). 

22 ‘‘(6) REPORT TO CONGRESS.—The Secretary of 

23 Homeland Security and the Secretary of Labor shall 

24 submit to Congress an annual report on admission 


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1 of nonimmigrants under section 101(a)(15)(H)(i)(d), 

2 which report shall include the following: 

3 ‘‘(A) The impact of the admission of such 

4 nonimmigrants on the emergency medical tech5 nician and paramedic workforce, as well as any 

6 instances of fraud, abuse, or non-compliance 

7 with the requirements under this subsection. 

8 ‘‘(B) The number of visas issued under 

9 such section and the number of applications re10 ceived during the previous fiscal year. 

11 ‘‘(C) The distribution of such non12 immigrants by geographic region, State, and 

13 type of employer. 

14 ‘‘(D) The prevailing wages paid to such 

15 nonimmigrants and any wage disparities with 

16 similarly employed United States workers. 

17 ‘‘(E) Any violations of labor conditions or 

18 program requirements identified by the Sec19 retary of Labor, including any action taken to 

20 address such a violation. 

21 ‘‘(F) Recommendations for improving the 

22 admission of such nonimmigrants or addressing 

23 any identified barriers to admission. 

24 ‘‘(7) MONITORING.—The Secretary of Home25 land Security and the Secretary of Labor shall deVerDate Sep 11 2014 00:45 Oct 25, 2024 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H10007.IH H10007

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1 velop and implement procedures to monitor employer 

2 compliance with the requirements under this sub3 section, including periodic site visits, audits, and in4 vestigations based on complaints or other credible 

5 information. 

6 ‘‘(8) DEFINITION.—For purposes of paragraph 

7 (2)(A)(iv), the term ‘lay off’, with respect to a work8 er has the meaning given such term in subsection 

9 (m).’’. 

10 SEC. 3. EFFECTIVE DATE. 

11 (a) IN GENERAL.—This Act and the amendments 

12 made by this Act shall take effect 180 days after the date 

13 of enactment of this Act. 

14 (b) REGULATIONS.—The Secretary of Homeland Se15 curity and the Secretary of Labor shall issue regulations 

16 and guidance as necessary to implement the amendments 

17 made by this Act, including the following: 

18 (1) Developing and publishing application forms 

19 and instructions for employers and aliens seeking 

20 admission under section 101(a)(15)(H)(i)(d) of the 

21 Immigration and Nationality Act (8 U.S.C. 

22 1101(a)(15)(H)). 

23 (2) Establishing procedures for conducting 

24 background checks and security screenings, and en25 forcing labor protections. 


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1 (3) Coordinating with other relevant govern2 ment agencies, such as the Federal Bureau of Inves3 tigation and State licensing boards, to ensure effec4 tive implementation and compliance with the re5 quirements under section 212(u) of the Immigration 

6 and Nationality Act (8 U.S.C. 1182). 

7 (4) Providing training and resources to Depart8 ment of Homeland Security and Department of 

9 Labor staff responsible for administering the admis10 sion of aliens under such section 

11 101(a)(15)(H)(i)(d), as well as any other relevant 

12 stakeholders. 

Æ 


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