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[House Report 112-153]
[From the U.S. Government Publishing Office]

112th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    112-153

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TO AMEND THE IMMIGRATION AND NATIONALITY ACT TO MODIFY THE REQUIREMENTS 
 FOR ADMISSION OF NONIMMIGRANT NURSES IN HEALTH PROFESSIONAL SHORTAGE 
                                 AREAS

                                _______
                                

 July 19, 2011.--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. 1933]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on the Judiciary, to whom was referred the 
bill (H.R. 1933) to amend the Immigration and Nationality Act 
to modify the requirements for admission of nonimmigrant nurses 
in health professional shortage areas, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
The Amendment....................................................     1
Purpose and Summary..............................................     2
Background and Need for the Legislation..........................     2
Hearings.........................................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
New Budget Authority and Tax Expenditures........................     4
Congressional Budget Office Cost Estimate........................     5
Performance Goals and Objectives.................................     6
Advisory on Earmarks.............................................     6
Section-by-Section Analysis......................................     6
Changes in Existing Law Made by the Bill, as Reported............     6

                             The Amendment

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. REQUIREMENTS FOR ADMISSION OF NONIMMIGRANT NURSES IN HEALTH 
                    PROFESSIONAL SHORTAGE AREAS.

  (a) Extension of Period of Authorized Admission.--Section 212(m)(3) 
of the Immigration and Nationality Act (8 U.S.C. 1182(m)(3)) is amended 
to read as follows:
  ``(3) The initial period of authorized admission as a nonimmigrant 
under section 101(a)(15)(H)(i)(c) shall be 3 years, and may be extended 
once for an additional 3-year period.''.
  (b) Number of Visas.--Section 212(m)(4) of the Immigration and 
Nationality Act (8 U.S.C. 1182(m)(4)) is amended by striking ``500.'' 
and inserting ``300.''.
  (c) Portability.--Section 214(n) of the Immigration and Nationality 
Act (8 U.S.C. 1184(n)) is amended by adding at the end the following:
  ``(3)(A) A nonimmigrant alien described in subparagraph (B) who was 
previously issued a visa or otherwise provided nonimmigrant status 
under section 101(a)(15)(H)(i)(c) is authorized to accept new 
employment performing services as a registered nurse for a facility 
described in section 212(m)(6) upon the filing by the prospective 
employer of a new petition on behalf of such nonimmigrant as provided 
under subsection (c). Employment authorization shall continue for such 
alien until the new petition is adjudicated. If the new petition is 
denied, such authorization shall cease.
  ``(B) A nonimmigrant alien described in this paragraph is a 
nonimmigrant alien--
          ``(i) who has been lawfully admitted into the United States;
          ``(ii) on whose behalf an employer has filed a nonfrivolous 
        petition for new employment before the date of expiration of 
        the period of stay authorized by the Secretary of Homeland 
        Security, except that, if a nonimmigrant described in section 
        101(a)(15)(H)(i)(c) is terminated or laid off by the 
        nonimmigrant's employer, or otherwise ceases employment with 
        the employer, such petition for new employment shall be filed 
        during the 45-day period beginning on the date of such 
        termination, lay off, or cessation; and
          ``(iii) who, subsequent to such lawful admission, has not 
        been employed without authorization in the United States before 
        the filing of such petition.''.
  (d) Applicability.--
          (1) In general.--During the 3-year period beginning on the 
        commencement date described in paragraph (2), the amendments 
        made by section 2 of the Nursing Relief for Disadvantaged Areas 
        Act of 1999 (Public Law 106-95), and the amendments made by 
        this section, shall apply to classification petitions filed for 
        nonimmigrant status. This period shall be in addition to the 
        period described in section 2(e) of the Nursing Relief for 
        Disadvantaged Areas Act of 1999.
          (2) Commencement date.--Not later than 60 days after the date 
        of the enactment of this Act, the Secretary of Homeland 
        Security shall determine whether regulations are necessary to 
        implement the amendments made by this section. If the Secretary 
        determines that no such regulations are necessary, the 
        commencement date described in this paragraph shall be the date 
        of such determination. If the Secretary determines that 
        regulations are necessary to implement any amendment made by 
        this section, the commencement date described in this paragraph 
        shall be the date on which such regulations (in final form) 
        take effect.

                          Purpose and Summary

    H.R. 1933 reauthorizes the H-1C nonimmigrant visa program 
for nurses and makes a number of modifications to the program.

                Background and Need for the Legislation

    A number of hospitals with unique circumstances experience 
a great difficulty in attracting American nurses. Hospitals 
serving mostly poor patients have special difficulties. Some 
hospitals in rural areas do also. For example:

        St. Bernard [Hospital and Health Care Center] . . . is 
        located on the south side of Chicago in the Englewood 
        community. Unfortunately, high rates of crime and high 
        poverty rates equal 31,000 visits to our emergency room 
        per year, which makes us the second largest for the 
        Chicago Fire Department's ambulance runs in the city.

        St. Bernard is Englewood's only remaining hospital and 
        has a patient base almost entirely of poverty care or 
        charity care. . . .

        We are considered by the State of Illinois as one of 
        the safety net hospitals in Chicago, and we are one of 
        only a handful of hospitals recognized by the Illinois 
        Department of Public Aid for special financial 
        recognition for our role in delivering quality care to 
        the indigent in the inner city of Chicago.

        We almost closed our doors in 1992, primarily because 
        of our inability to attract registered nurses.\1\
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    \1\The Health Professional Shortage Area Nursing Relief Act of 
1997: Hearing Before the Immigration and Claims Subcomm. of the House 
Judiciary Comm., 105th Cong., 1st Sess. at 15 (Nov. 5, 1997)(statement 
of Ron Campbell, Vice President, Patient Care Services, St. Bernard 
Hospital and Health Care Center).

    The ``Nursing Relief for Disadvantaged Areas Act of 1999'' 
created a new ``H-1C'' temporary visa program for registered 
nurses.\2\ The program was modeled after the expired ``H-1A'' 
temporary nursing visa program but limited the number of visas 
that could be issued to 500 per year and only allowed in-need 
hospitals that met certain criteria to petition for alien 
nurses. To be able to petition for an alien, an employer had to 
meet four basic conditions. First, the employer must have been 
located in a health professional shortage area as designated by 
the Department of Health and Human Services. Second, the 
employer must have had at least 190 acute-care beds. Third, a 
certain percentage (35%) of the employer's patients must have 
been Medicare patients. Fourth, a certain percentage (28%) of 
patients must have been Medicaid patients.
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    \2\See Pub. L. No. 106-95.
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    Employers had to make certain attestations pertaining to 
``payment of a wage which will not adversely affect wages and 
working conditions of similarly employed registered nurses; 
payment of wages to aliens at rates paid to other registered 
nurses similarly employed by the facility; taking timely and 
significant steps designed to recruit and retain U.S. nurses in 
order to reduce dependence on nonimmigrant nurses; absence of a 
strike/lockout or lay off of nurses; notice to workers of its 
intent to petition for H-1C nurses; percentages of H-1C nurses 
to be employed at the facility; and placement of H-1C nurses 
within the facility.''\3\
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    \3\65 Fed. Reg. 51138 (2000). For a full description of the terms 
of the H-1C program, see H. Rep. No. 106-135, at 8-13 (1999).
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    The Department of Labor has determined that the following 
hospitals are eligible for the program: Beaumont Regional 
Medical Center, Beaumont, TX; Beverly Hospital, Montebello, CA; 
Doctors Medical Center, Modesto, CA; Elizabeth General Medical 
Center, Elizabeth, NJ; Fairview Park Hospital, Dublin, GA; 
Lutheran Medical Center, St. Louis, MO; McAllen Medical Center, 
McAllen, TX; Mercy Medical Center, Baltimore, MD; Mercy 
Regional Medical Center, Laredo, TX; Peninsula Hospital Center, 
Far Rockaway, NY; Southeastern Regional Medical Center, 
Lumberton, NC; Southwest General Hospital, San Antonio, TX; St. 
Bernard Hospital, Chicago, IL; and Valley Baptist Medical 
Center, Harlingen, TX.\4\
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    \4\See 65 Fed. Reg. 51143 (2000); 75 Fed. Reg. 10396 (2010).
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    The Nursing Relief for Disadvantaged Areas Act of 1999 was 
enacted as a 4-year program (beginning on the effective date of 
implementing regulations) on November 12, 1999. The program 
expired in 2005 and was reauthorized in 2006 for an additional 
3 years.\5\ The program expired in December 2009 (but some H-1C 
nurses remain who received approval for 3-year stays before 
this date).
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    \5\See Pub. L. No. 109-423.
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    The Department of Labor reports that 499 nurses received 
visas under the program in fiscal year 2007 as did 110 in 
fiscal year 2008.\6\
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    \6\Information provided by the U.S. Department of Labor.
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    St. Bernard Hospital has indicated that:

        Because of the sunset, in combination with the extended 
        approval period for green cards, nurses are now forced 
        to leave our institution and the rate of loss continues 
        to increase. This loss cannot be sustained. As the only 
        hospital serving one of the most difficult sections of 
        Chicago, and perhaps the entire country, we need the 
        extension of the visa program to survive.\7\
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    \7\Letter from Sister Elizabeth Van Straten, President-Chief 
Executive Officer, St. Bernard Hospital and Health Care Center, to 
Lamar Smith (Dec. 15, 2010), on file with the Committee on the 
Judiciary.

    H.R. 1933 reauthorizes the program for an additional 3 
years. The number of visas that may be issued in each fiscal 
year cannot exceed 300. An alien may be admitted for 3 years 
and this stay may be extended once for an additional 3 years 
(the extension is new with H.R. 1933). The bill also allows H-
1C nurses to be able to switch employment between any of the H-
1C-eligible hospitals.

                                Hearings

    The Committee on the Judiciary held no hearings on H.R. 
1933.

                        Committee Consideration

    On June 23, 2011, the Committee met in open session and 
ordered the bill H.R. 1933 reported favorably, as amended, by 
voice vote, a quorum being present.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that there 
were no recorded votes during the Committee's consideration of 
H.R. 1933. The Committee approved by voice vote an amendment by 
Ms. Lofgren to allow H-1C nurses to be able to switch 
employment between any of the 14 H-1C-eligible hospitals.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee advises 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.

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of rule XIII of the Rules of the House of 
Representatives 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. 1933, 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, July 6, 2011.
Hon. Lamar Smith, 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. 1933, a bill to 
amend the Immigration and Nationality Act to modify the 
requirements for admission of nonimmigrant nurses in health 
professional shortage areas.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Mark 
Grabowicz, who can be reached at 226-2860.
            Sincerely,
                                      Douglas W. Elmendorf,
                                                  Director.

Enclosure

cc:
        Honorable John Conyers, Jr.
        Ranking Member
H.R. 1933--A bill to amend the Immigration and Nationality Act to 
        modify the requirements for admission of nonimmigrant nurses in 
        health professional shortage areas.
    CBO estimates that implementing H.R. 1933 would result in 
no significant cost to the Federal Government. Enacting the 
bill could affect direct spending; therefore, pay-as-you-go 
procedures apply. However, CBO estimates that any such effects 
would be insignificant for each year. H.R. 1933 would not 
affect revenues.
    H.R. 1933 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of State, local, or tribal 
governments.
    Current law permits foreign nurses to work temporarily in 
the United States in areas where there are shortages of 
qualified applicants. No more than 500 of those individuals may 
be admitted in each year, and they may remain in the United 
States for 3 years. H.R. 1933 would limit annual admissions to 
300 and would authorize those persons to extend their stay for 
an additional 3 years.
    The Department of State and the Department of Homeland 
Security (DHS) collect fees to admit those individuals. The DHS 
fees are classified as offsetting receipts (a credit against 
direct spending) and the department is authorized to spend such 
fees without further appropriation. The State Department fees 
are retained and spent by the Department. CBO estimates that 
enacting H.R. 1933 would have no significant effect on the 
collection and spending of such fees.
    The CBO staff contact for this estimate is Mark Grabowicz. 
The estimate was approved by Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                    Performance Goals and Objectives

    The Committee states that pursuant to clause 3(c)(4) of 
rule XIII of the Rules of the House of Representatives, H.R. 
1933 reauthorizes the H-1C nonimmigrant visa program for nurses 
and makes a number of modifications to the program.

                          Advisory on Earmarks

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 1933 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(e), 9(f), or 9(g) of Rule XXI.

                      Section-by-Section Analysis

    Sec. 1. Requirements for Admission of Nonimmigrant Nurses 
in Health Professional Shortage Areas.
    Subsection (a) amends section 212(m)(3) of the Immigration 
and Nationality Act to allow H-1C nonimmigrant nurses to 
request an extension of their period of authorized admission 
for an additional 3 years after the initial 3 year admission.
    Subsection (b) amends section 212(m)(4) of the INA to 
provide that the total number of nonimmigrant visas issued 
pursuant to H-1C petitions shall not exceed 300 in each fiscal 
year.
    Subsection (c) amends section 214(n) of the INA to provide 
that an H-1C alien (who has been lawfully admitted to the U.S., 
who has not since admission been employed without 
authorization, and on whose behalf an employer has filed a 
nonfrivolous petition for new employment before the date of 
expiration of the authorized period of stay except that if the 
alien is terminated or laid off by their employer, or otherwise 
cease employment, such petition for new employment shall be 
filed during the ensuing 45 day period) is authorized to accept 
new employment performing services as a registered nurse at any 
facility which qualifies for the H-1C program upon the filing 
by the prospective employer of a new petition on behalf of the 
alien. Employment authorization shall continue for such alien 
until the new petition is adjudicated. Once a petition is 
denied, such authorization shall cease.
    Subsection (d) provides that the H-1C program is 
reauthorized for the 3 year period beginning on the date (no 
later than 60 days after enactment) that the Secretary of 
Homeland Security determines that no regulations are necessary 
to implement the bill; however, if the Secretary determines 
(within this 60 day period) that regulations are necessary, the 
program is reauthorized for 3 years beginning on the date on 
which such regulations (in final form) take effect.

         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 italic, existing law in which no change is 
proposed is shown in roman):

IMMIGRATION AND NATIONALITY ACT

           *       *       *       *       *       *       *

TITLE II--IMMIGRATION

           *       *       *       *       *       *       *

 Chapter 2--Qualifications for Admission of Aliens; Travel Control of 
Citizens and Aliens

           *       *       *       *       *       *       *

 GENERAL CLASSES OF ALIENS INELIGIBLE TO RECEIVE VISAS AND INELIGIBLE 
               FOR ADMISSION; WAIVERS OF INADMISSIBILITY

  Sec. 212. (a) * * *

           *       *       *       *       *       *       *

  (m)(1) * * *

           *       *       *       *       *       *       *

  [(3) The period of admission of an alien under section 
101(a)(15)(H)(i)(c) shall be 3 years.]
  (3) The initial period of authorized admission as a 
nonimmigrant under section 101(a)(15)(H)(i)(c) shall be 3 
years, and may be extended once for an additional 3-year 
period.
  (4) The total number of nonimmigrant visas issued pursuant to 
petitions granted under section 101(a)(15)(H)(i)(c) in each 
fiscal year shall not exceed [500.] 300. The number of such 
visas issued for employment in each State in each fiscal year 
shall not exceed the following:
          (A) * * *

           *       *       *       *       *       *       *

                       ADMISSION OF NONIMMIGRANTS

  Sec. 214. (a) * * *

           *       *       *       *       *       *       *

  (n)(1) * * *

           *       *       *       *       *       *       *

  (3)(A) A nonimmigrant alien described in subparagraph (B) who 
was previously issued a visa or otherwise provided nonimmigrant 
status under section 101(a)(15)(H)(i)(c) is authorized to 
accept new employment performing services as a registered nurse 
for a facility described in section 212(m)(6) upon the filing 
by the prospective employer of a new petition on behalf of such 
nonimmigrant as provided under subsection (c). Employment 
authorization shall continue for such alien until the new 
petition is adjudicated. If the new petition is denied, such 
authorization shall cease.
  (B) A nonimmigrant alien described in this paragraph is a 
nonimmigrant alien--
          (i) who has been lawfully admitted into the United 
        States;
          (ii) on whose behalf an employer has filed a 
        nonfrivolous petition for new employment before the 
        date of expiration of the period of stay authorized by 
        the Secretary of Homeland Security, except that, if a 
        nonimmigrant described in section 101(a)(15)(H)(i)(c) 
        is terminated or laid off by the nonimmigrant's 
        employer, or otherwise ceases employment with the 
        employer, such petition for new employment shall be 
        filed during the 45-day period beginning on the date of 
        such termination, lay off, or cessation; and
          (iii) who, subsequent to such lawful admission, has 
        not been employed without authorization in the United 
        States before the filing of such petition.

           *       *       *       *       *       *       *

                                  
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