II 

118TH CONGRESS 

1ST SESSION S. 665 

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 6, 2023 

Ms. KLOBUCHAR (for herself, Ms. COLLINS, Ms. ROSEN, Mr. TILLIS, Mr. 

KING, Mr. THUNE, Mr. MERKLEY, Mrs. CAPITO, Mr. COONS, Mr. PAUL, 

Mr. DURBIN, Mr. MORAN, Mrs. SHAHEEN, Mr. WICKER, Ms. SMITH, Mr. 

MARSHALL, Mr. BLUMENTHAL, Mr. CRAMER, and Mr. BOOZMAN) 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 


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

2 ‘‘September 30, 2015’’ and inserting ‘‘on the date that 

3 is 3 years after the date of the enactment of the Conrad 

4 State 30 and Physician Access Reauthorization Act’’. 

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

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

7 30, 2018. 

8 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 

9 MEDICALLY UNDERSERVED COMMUNITIES. 

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

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

12 end the following: 

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

14 service requirements of a waiver requested under 

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

16 ‘‘(I) alien physicians who completed such 

17 service before the date of the enactment of the 

18 Conrad State 30 and Physician Access Act; and 

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

20 physician described in subclause (I). 

21 ‘‘(ii) Nothing in this subparagraph may be con22 strued— 

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

24 the Secretary of Homeland Security for classi25 fication under section 204(a) or the filing of an 


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1 application for adjustment of status under sec2 tion 245 by an alien physician described in this 

3 subparagraph before the date by which such 

4 alien physician has completed the service de5 scribed in section 214(l) or worked full-time as 

6 a physician for an aggregate of 5 years at the 

7 location identified in the section 214(l) waiver 

8 or in an area or areas designated by the Sec9 retary of Health and Human Services as having 

10 a shortage of health care professionals; or 

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

12 Security to grant a petition or application de13 scribed in subclause (I) until the alien has sat14 isfied all of the requirements of the waiver re15 ceived under section 214(l).’’. 

16 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

17 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY

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

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

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

21 by striking ‘‘Attorney General’’ and inserting ‘‘Sec22 retary of Homeland Security’’; 

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

24 of the United States Information Agency’’ and in25 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 and 

12 ‘‘(ii) the alien— 

13 ‘‘(I) has accepted employment with 

14 the health facility or health care organiza15 tion in a geographic area or areas which 

16 are designated by the Secretary of Health 

17 and Human Services as having a shortage 

18 of health care professionals; 

19 ‘‘(II) begins employment by the later 

20 of the date that is— 

21 ‘‘(aa) 120 days after receiving 

22 such waiver; 

23 ‘‘(bb) 120 days after completing 

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1 ing under a program approved pursu2 ant to section 212(j)(1); or 

3 ‘‘(cc) 120 days after receiving 

4 nonimmigrant status or employment 

5 authorization, if the alien or the 

6 alien’s employer petitions for such 

7 nonimmigrant status or employment 

8 authorization not later than 120 days 

9 after the date on which the alien com10 pletes his or her graduate medical 

11 education or training under a pro12 gram approved pursuant to section 

13 212(j)(1); and 

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

15 a total of not less than 3 years in the sta16 tus authorized for such employment under 

17 this subsection, except as provided in para18 graph (8).’’; and 

19 (5) in subparagraph (D), in the matter pre20 ceding clause (i), by inserting ‘‘(except as provided 

21 in paragraph (8))’’. 

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

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


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

2 agency or an interested State agency for rec3 ommendation of a waiver under this section by a 

4 physician who is maintaining valid nonimmigrant 

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

6 recommendation by the Secretary of State, the Sec7 retary of Homeland Security may change the status 

8 of such physician to any status authorized for em9 ployment under this Act. The numerical limitations 

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

11 any alien whose status is changed under this sub12 paragraph.’’. 

13 (c) VIOLATION OF AGREEMENTS.—Section 

14 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

15 amended by inserting ‘‘substantial requirement of an’’ be16 fore ‘‘agreement entered into’’. 

17 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED

18 AREAS.—Section 214(l) of such Act, as amended by this 

19 section, is further amended by adding at the end the fol20 lowing: 

21 ‘‘(4)(A) If an interested State agency denies an appli22 cation for a waiver under paragraph (1)(B) from a physi23 cian pursuing graduate medical education or training pur24 suant to section 101(a)(15)(J) because the State has re25 quested the maximum number of waivers permitted for 


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

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

3 to seek a waiver under this subsection (except for para4 graph (1)(D)(ii)) to work for an employer described in 

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

6 the maximum number of waivers. 

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

8 for the employer referred to in subparagraph (A) during 

9 the period beginning on the date on which a new waiver 

10 application is filed with such State and ending on the ear11 lier 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 this section, is further amended 

19 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— 

7 ‘‘(I) has secured medical malpractice 

8 liability protection for the alien under sec9 tion 224(g) of the Public Health Service 

10 Act (42 U.S.C. 233(g)); or 

11 ‘‘(II) will pay the alien’s malpractice 

12 insurance premiums; 

13 ‘‘(ii) whether the employer will provide 

14 malpractice insurance for the alien; and 

15 ‘‘(iii) the amount of such liability protec16 tion that will be provided; 

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

18 alien will work and includes a statement that the 

19 contracting facility or organization will not add addi20 tional work locations without the approval of the 

21 Federal agency or State agency that requested the 

22 waiver; and 

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

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

25 whose employment relationship with a health facility or 


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1 health care organization terminates under paragraph 

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

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

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

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

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

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

8 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER

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

10 section, is further amended by adding at the end the fol11 lowing: 

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

13 terminates the recipient’s employment with a health facil14 ity or health care organization pursuant to paragraph 

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

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

17 accepts new employment with such a facility or organiza18 tion in a different State, the State from which the alien 

19 is departing may be accorded an additional waiver by the 

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

21 alien’s employment was terminated.’’. 

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

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

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


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1 ‘‘(8) The 3-year work requirement set forth in sub2 paragraphs (C) and (D) of paragraph (1) shall not apply 

3 if— 

4 ‘‘(A)(i) the Secretary of Homeland Security de5 termines that extenuating circumstances, including 

6 violations by the employer of the employment agree7 ment with the alien or of labor and employment 

8 laws, exist that justify a lesser period of employment 

9 at such facility or organization; and 

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

11 days after the employment termination date (unless 

12 the Secretary determines that extenuating cir13 cumstances would justify an extension), another 

14 bona fide offer of employment at a health facility or 

15 health care organization in a geographic area or 

16 areas which are designated by the Secretary of 

17 Health and Human Services as having a shortage of 

18 health care professionals, for the remainder of such 

19 3-year period; 

20 ‘‘(B)(i) the interested State agency that re21 quested the waiver attests that extenuating cir22 cumstances, including violations by the employer of 

23 the employment agreement with the alien or of labor 

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1 riod of employment at such facility or organization; 

2 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; or 

13 ‘‘(C) the alien— 

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

15 extenuating circumstances pursuant to sub16 clause (A) or (B); 

17 ‘‘(ii) terminates the alien’s employment re18 lationship with the health facility or health care 

19 organization at which the alien was employed; 

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

21 after the employment termination date, another 

22 bona fide offer of employment at a health facil23 ity or health care organization in a geographic 

24 area or areas, in the State that requested the 

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1 retary of Health and Human Services as having 

2 a shortage of health care professionals; and 

3 ‘‘(iv) agrees to be employed for the remain4 der of such 3-year period, and 1 additional year 

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

6 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 

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

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

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

10 following: 

11 ‘‘(9)(A)(i) All States shall be allotted a total of 35 

12 waivers under paragraph (1)(B) for a fiscal year if 90 per13 cent of the waivers available to the States receiving at 

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

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

16 States shall be allotted an additional 5 waivers under 

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

18 percent of the waivers available to the States receiving at 

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

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

21 the States will only receive an additional increase of 5 

22 waivers the following fiscal year if 95 percent of the waiv23 ers available to the States receiving at least 1 waiver were 

24 used in the previous fiscal year. 


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

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

3 the total number of such waivers granted is 5 percent 

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

5 in the number of waivers allotted pursuant to this para6 graph, in which case— 

7 ‘‘(i) the number of waivers allotted shall be de8 creased by 5 for all States beginning in the next fis9 cal year; and 

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

11 waivers granted from the last year in which there 

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

13 additional decrease of 5 waivers allotted for all 

14 States, provided that the number of waivers allotted 

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

16 (b) ACADEMIC MEDICAL CENTERS.—Section 

17 214(l)(1)(D) of such Act (8 U.S.C. 1184(l)(1)(D)) is 

18 amended— 

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

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

21 end and inserting ‘‘; and’’; and 

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

23 ‘‘(iv) in the case of a request by an inter24 ested State agency— 


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1 ‘‘(I) the head of such agency deter2 mines that the alien is to practice medicine 

3 in, or be on the faculty of a residency pro4 gram at, an academic medical center (as 

5 that term is defined in section 

6 411.355(e)(2) of title 42, Code of Federal 

7 Regulations, or similar successor regula8 tion), without regard to whether such facil9 ity is located within an area designated by 

10 the Secretary of Health and Human Serv11 ices as having a shortage of health care 

12 professionals; and 

13 ‘‘(II) the head of such agency deter14 mines that— 

15 ‘‘(aa) the alien physician’s work 

16 is in the public interest; and 

17 ‘‘(bb) the grant of such waiver 

18 would not cause the number of the 

19 waivers granted on behalf of aliens for 

20 such State for a fiscal year (within 

21 the limitation in subparagraph (B) 

22 and subject to paragraph (6)) in ac23 cordance with the conditions of this 

24 clause to exceed 3.’’. 


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

2 AND OTHER PROVISIONS RELATED TO PHYSI3 CIAN IMMIGRATION. 

4 (a) DUAL INTENT FOR PHYSICIANS SEEKING GRAD5 UATE MEDICAL TRAINING.—Section 214(b) of the Immi6 gration and Nationality Act (8 U.S.C. 1184(b)) is amend7 ed by striking ‘‘(other than a nonimmigrant described in 

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

9 than a nonimmigrant described in any provision of section 

10 101(a)(15)(H)(i) except subclause (b1) of such section)’’ 

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

12 subparagraph (L) or (V) of section 101(a)(15), a non13 immigrant described in any provision of section 

14 101(a)(15)(H)(i) (except subclause (b1) of such section), 

15 and an alien coming to the United States to receive grad16 uate medical education or training as described in section 

17 212(j) or to take examinations required to receive grad18 uate medical education or training as described in section 

19 212(j))’’. 

20 (b) PHYSICIAN NATIONAL INTEREST WAIVER CLARI21 FICATIONS.— 

22 (1) PRACTICE AND GEOGRAPHIC AREA.—Sec23 tion 203(b)(2)(B)(ii)(I) of the Immigration and Na24 tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 

25 amended by striking items (aa) and (bb) and insert26 ing the following: 


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1 ‘‘(aa) the alien physician agrees to 

2 work on a full-time basis practicing pri3 mary care, specialty medicine, or a com4 bination thereof, in an area or areas des5 ignated by the Secretary of Health and 

6 Human Services as having a shortage of 

7 health care professionals, or at a health 

8 care facility under the jurisdiction of the 

9 Secretary of Veterans Affairs; or 

10 ‘‘(bb) the alien physician is pursuing 

11 such waiver based upon service at a facility 

12 or facilities that serve patients who reside 

13 in a geographic area or areas designated 

14 by the Secretary of Health and Human 

15 Services as having a shortage of health 

16 care professionals (without regard to 

17 whether such facility or facilities are lo18 cated within such an area) and a Federal 

19 agency, or a local, county, regional, or 

20 State department of public health deter21 mines the alien physician’s work was or 

22 will be in the public interest.’’. 

23 (2) FIVE-YEAR SERVICE REQUIREMENT.—Sec24 tion 203(b)(2)(B)(ii) of the Immigration and Na25 tionality Act (8 U.S.C. 1153(B)(ii)) is amended— 


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

2 (IV) 4 ems to the left; and 

3 (B) in subclause (II)— 

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

5 and 

6 (ii) by adding at the end the fol7 lowing: 

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

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

10 which the alien physician begins work in 

11 the shortage area in any legal status and 

12 not on the date on which an immigrant 

13 visa petition is filed or approved. Such 

14 service shall be aggregated without regard 

15 to when such service began and without re16 gard to whether such service began during 

17 or in conjunction with a course of graduate 

18 medical education. 

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

20 required to submit an employment contract 

21 with a term exceeding the balance of the 5- 

22 year commitment yet to be served or an 

23 employment contract dated within a min24 imum time period before filing a visa peti25 tion under this subsection. 


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

2 required to file additional immigrant visa 

3 petitions upon a change of work location 

4 from the location approved in the original 

5 national interest immigrant petition.’’. 

6 (c) TECHNICAL CLARIFICATION REGARDING AD7 VANCED DEGREE FOR PHYSICIANS.—Section 

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

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

10 the following: ‘‘An alien physician holding a foreign med11 ical degree that has been deemed sufficient for acceptance 

12 by an accredited United States medical residency or fel13 lowship program is a member of the professions holding 

14 an advanced degree or its equivalent.’’. 

15 (d) SHORT-TERM WORK AUTHORIZATION FOR PHY16 SICIANS COMPLETING THEIR RESIDENCIES.— 

17 (1) IN GENERAL.—A physician completing 

18 graduate medical education or training described in 

19 section 212(j) of the Immigration and Nationality 

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

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

22 1101(a)(15)(H)(i))— 

23 (A) shall have such nonimmigrant status 

24 automatically extended until October 1 of the 

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1 ation of such nonimmigrant status has been 

2 submitted in a timely manner and the employ3 ment start date for the beneficiary of such peti4 tion is October 1 of that fiscal year; and 

5 (B) shall be authorized to be employed in6 cident to status during the period between the 

7 filing of such petition and October 1 of such fis8 cal year. 

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

10 employment authorization shall terminate on the 

11 date that is 30 days after the date on which a peti12 tion described in paragraph (1)(A) is rejected, de13 nied or revoked. 

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

15 status and employment authorization will automati16 cally extend to October 1 of the next fiscal year if 

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

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

19 fiscal year have been issued. 

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

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

22 or child of an exchange visitor described in section 

23 101(a)(15)(J) of the Immigration and Nationality Act (8 

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1 ments under section 212(e) of such Act (8 U.S.C. 

2 1182(e)). 

3 SEC. 7. ANNUAL CONRAD STATE 30 J–1 VISA WAIVER PRO4 GRAM STATISTICAL REPORT. 

5 The Director of U.S. Citizenship and Immigration 

6 Services shall submit an annual report to Congress and 

7 to the Department of Health and Human Services that 

8 identifies the number of aliens admitted during the most 

9 recently concluded fiscal year as a result of the Conrad 

10 State 30 J–1 Visa Waiver Program established under sec11 tions 212(e) and 214(l) of the Immigration and Nation12 ality Act (8 U.S.C. 1182(e) and 1184(l)), broken down 

13 by State. 

Æ 


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