II 

112TH CONGRESS 

1ST SESSION S. 1979 

To provide incentives to physicians to practice in rural and medically 

underserved communities and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 12, 2011 

Mr. CONRAD (for himself and Mr. MORAN) 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 Im5 provement Act’’. 

6 SEC. 2. ELIMINATION OF SUNSET PROVISION OF CONRAD 

7 STATE 30 PROGRAM. 

8 Section 220(c) of the Immigration and Nationality 

9 Technical Corrections Act of 1994 (8 U.S.C. 1182 note) 

10 is amended by striking ‘‘and before September 30, 2012’’. 


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1 SEC. 3. RETAINING PHYSICIANS IN MEDICALLY UNDER2 SERVED COMMUNITIES. 

3 Section 203(b)(1) of the Immigration and Nationality 

4 Act (8 U.S.C. 1151(b)(1)) is amended— 

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

6 by striking ‘‘(A) through (C):’’ and inserting a colon; 

7 and 

8 (2) by adding at the end the following: 

9 ‘‘(D) CERTAIN PHYSICIANS WHO HAVE

10 SERVED IN MEDICALLY UNDERSERVED COMMU11 NITIES UNDER SECTION 214(l).— 

12 ‘‘(i) PHYSICIANS DESCRIBED.—An 

13 alien is described in this subparagraph if 

14 the alien has completed service require15 ments of a waiver or exemption requested 

16 under section 214(l), plus an additional 2 

17 years at the location identified in the sec18 tion 214(l) waiver or exemption or in an 

19 area or areas designated by the Secretary 

20 of Health and Human Services as having 

21 a shortage of health care professionals, in22 cluding alien physicians who completed 

23 such service before the date of enactment 

24 of the Conrad State 30 Improvement Act. 

25 ‘‘(ii) CONSTRUCTION.—Nothing in 

26 this subparagraph may be construed— 


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1 ‘‘(I) to prevent the filing of a pe2 tition with the Secretary of Homeland 

3 Security for classification under sec4 tion 204(a) or the filing of an applica5 tion for adjustment of status under 

6 section 245 by an alien physician de7 scribed in this subparagraph prior to 

8 the date by which such alien physician 

9 has completed the service described in 

10 section 214(l) or worked full-time as a 

11 physician for an aggregate of 5 years 

12 at the location identified in the section 

13 214(l) waiver or exemption or in an 

14 area or areas designated by the Sec15 retary of Health and Human Services 

16 as having a shortage of health care 

17 professionals; or 

18 ‘‘(II) to permit the Secretary of 

19 Homeland Security to grant such a 

20 petition or application until the alien 

21 has satisfied all the requirements of 

22 the waiver or exemption received 

23 under section 214(l).’’. 


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1 SEC. 4. INCENTIVES FOR PHYSICIANS TO PRACTICE IN 

2 MEDICALLY UNDERSERVED COMMUNITIES. 

3 Section 214(g) of the Immigration and Nationality 

4 Act (8 U.S.C. 1184(g)) is amended, by adding at the end 

5 the following: 

6 ‘‘(12) An alien physician described in section 

7 212(j)(2)(B) who entered or is seeking to enter the United 

8 States as a nonimmigrant described in section 

9 101(a)(15)(H)(i)(b) to pursue graduate medical education 

10 or training shall not be subject to the limitations described 

11 in paragraph (1) or (4), provided that the period of au12 thorized admission of such alien as an H–1B non13 immigrant may not extend beyond the 6-year period begin14 ning on the date on which the alien receives the exemption 

15 described in subparagraph (A), other than extensions au16 thorized by section 104 or 106 of the American Competi17 tiveness in the Twenty-First Century Act of 2000 (Public 

18 Law 106–313; 114 Stat. 1251) or an amendment made 

19 by such section, if an interested State agency submits a 

20 request for an exemption under section 214(l)(1)(B), but 

21 not 1 of the 10 waivers or exemptions described in sub22 section (l)(1)(D)(ii).’’. 


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1 SEC. 5. RESTRICTIONS ON WAIVERS AND PHYSICIAN PRO2 TECTIONS. 

3 (a) IN GENERAL.—Section 214(l)(1) of the Immigra4 tion and Nationality Act (8 U.S.C. 1184(l)(1)) is amend5 ed— 

6 (1) by amending the matter preceding subpara7 graph (A) to read as follows: 

8 ‘‘(1) In the case of a request by an interested State 

9 agency, or by an interested Federal agency, for a waiver 

10 by the Secretary of Homeland Security of the 2-year for11 eign residence requirement under section 212(e) on behalf 

12 of an alien described in clause (iii) of such section or in 

13 the case of a request to the Secretary of State for certifi14 cation of an exemption from the limitation described in 

15 paragraphs (1) and (4) of subsection (g) on behalf of an 

16 alien described in paragraph (12) of such subsection, the 

17 Secretary of Homeland Security and the Secretary of 

18 State shall not grant such waiver or exemption certifi19 cation unless—’’; 

20 (2) in subparagraph (A), by striking ‘‘United 

21 States Information Agency’’ and inserting ‘‘Sec22 retary of State’’; 

23 (3) in subparagraph (B), by striking ‘‘would 

24 not cause the number of waivers allotted for that 

25 State for that fiscal year to exceed 30;’’ and insert26 ing ‘‘or exemption would not cause the total number 


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1 of waivers plus the total number of exemptions allot2 ted for that State for that fiscal year to exceed 30, 

3 unless such allotment is increased pursuant to para4 graph (4);’’; 

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

6 and (ii) and inserting the following: 

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

8 offer of full-time employment, at a health care 

9 organization, which employment has been deter10 mined by the Secretary of Homeland Security 

11 to be in the public interest; 

12 ‘‘(ii) the alien agrees to begin employment 

13 with the health facility or health care organiza14 tion in a geographic area or areas which are 

15 designated by the Secretary of Health and 

16 Human Services as having a shortage of health 

17 care professionals by the later of the date that 

18 is 90 days after receiving such waiver or exemp19 tion, 90 days after completing graduate medical 

20 education or training under a program ap21 proved pursuant to section 212(j)(1), or 90 

22 days after receiving nonimmigrant status or 

23 employment authorization, and agrees to con24 tinue to work for a total of not less than 3 


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1 years in any status authorized for such employ2 ment under this subsection unless— 

3 ‘‘(I) the Secretary determines that ex4 tenuating circumstances exist that justify a 

5 lesser period of employment at such facility 

6 or organization, in which case the alien 

7 shall demonstrate another bona fide offer 

8 of employment at a health facility or 

9 health care organization, for the remainder 

10 of such 3-year period; 

11 ‘‘(II) the interested State agency that 

12 requested the waiver or exemption attests 

13 that extenuating circumstances exist that 

14 justify a lesser period of employment at 

15 such facility or organization in which case 

16 the alien shall demonstrate another bona 

17 fide offer of employment at a health facil18 ity or health care organization so des19 ignated by the Secretary of Health and 

20 Human services, for the remainder of such 

21 3-year period; or 

22 ‘‘(III) if the alien elects not to pursue 

23 a determination of extenuating circumstan24 ces pursuant to subclause (I) or (II), the 

25 alien terminates the alien’s employment reVerDate Mar 15 2010 00:53 Dec 17, 2011 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1979.IS S1979

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1 lationship with such facility or organiza2 tion, in which case the alien shall be em3 ployed for the remainder of such 3-year pe4 riod, and 1 additional year for each termi5 nation, at another health facility or health 

6 care organization in a geographic area or 

7 areas which are designated by the Sec8 retary of Health and Human Services as 

9 having a shortage of health care profes10 sionals;’’; and 

11 (5) in subparagraph (D)— 

12 (A) in clause (ii), by striking ‘‘would not 

13 cause the number of the waivers’’ and inserting 

14 ‘‘or exemption would not cause the total num15 ber of waivers and exemptions’’; and 

16 (B) in clause (iii), by inserting ‘‘or exemp17 tion’’ after ‘‘waiver’’. 

18 (b) CHANGE OF STATUS.—Section 214(l)(2)(A) of 

19 the Immigration and Nationality Act (8 U.S.C. 

20 1184(l)(2)(A)) is amended— 

21 (1) by striking ‘‘Attorney General’’ and insert22 ing ‘‘Secretary of Homeland Security’’; and 

23 (2) by inserting ‘‘described in section 

24 212(e)(iii)’’ after ‘‘status of an alien’’. 


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1 SEC. 6. ALLOTMENT OF WAIVERS AND EXTENSIONS; LIMI2 TATION OF WAIVERS OF PERIOD OF AUTHOR3 IZED ADMISSION; OTHER PHYSICIAN PRO4 TECTIONS. 

5 Section 214(l) of the Immigration and Nationality 

6 Act (8 U.S.C. 1184(l)) is amended by adding at the end 

7 the following: 

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

9 waivers and exemptions under paragraph (1)(B) for a fis10 cal year if, during the previous fiscal year, the total num11 ber of waivers and exemptions awarded to all the States 

12 is at least 90 percent of the total number of the waivers 

13 and exemptions available to the States that received 5 or 

14 more such waivers or exemptions. 

15 ‘‘(ii) When an allocation has occurred under clause 

16 (i), all States shall be allotted an additional 5 waivers and 

17 exemptions under paragraph (1)(B) for each subsequent 

18 fiscal year if, during the previous fiscal year, the total 

19 number of waivers and exemptions awarded to all the 

20 States is at least 90 percent of the total number of the 

21 waivers and exemptions available to the States that re22 ceived 5 or more such waivers or exemptions. 

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

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

25 the total number of such waivers and exemptions granted 

26 is 5 percent lower than in the last year in which there 


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1 was an increase in the number of waivers and exemptions 

2 allotted pursuant to this paragraph, in which case— 

3 ‘‘(i) the number of waivers and exemptions al4 lotted shall be decreased by 5 for all States begin5 ning in the next fiscal year; and 

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

7 waivers and exemptions granted from the last year 

8 in which there was an increase in the allotment, 

9 shall result in an additional decrease of 5 waivers 

10 and exemptions allotted for all States, provided that 

11 the number of waivers and exemptions allotted for 

12 all States shall not drop below 30. 

13 ‘‘(5) An alien granted a waiver or exemption under 

14 paragraph (1)(C) shall enter into an employment agree15 ment with the contracting health facility or health care 

16 organization that— 

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

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

19 that the alien will be expected to be available and 

20 the compensation the alien will receive for on-call 

21 time; 

22 ‘‘(B) specifies whether the contracting facility 

23 or organization will pay for the alien’s malpractice 

24 insurance premiums, including whether the employer 


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1 will provide malpractice insurance and, if so, the 

2 amount of such insurance that will be provided; 

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

4 alien will work and a statement that the contracting 

5 facility or organization will not add additional work 

6 locations without the approval of the Federal agency 

7 or State agency that requested the waiver or exemp8 tion; and 

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

10 ‘‘(6) An alien granted a waiver or exemption under 

11 paragraph (1)(C) whose employment relationship with a 

12 health facility or health care organization terminates dur13 ing the 3-year service period required by such para14 graph— 

15 ‘‘(A) shall have a period of 120 days beginning 

16 on the date of such termination of employment to 

17 submit to the Secretary of Homeland Security appli18 cations or petitions to commence employment with 

19 another contracting health facility or health care or20 ganization in a geographic area or areas which are 

21 designated by the Secretary of Health and Human 

22 Services as having a shortage of health care profes23 sionals; and 


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1 ‘‘(B) shall be considered to be maintaining law2 ful status in an authorized stay during the 120-day 

3 period referred to in subsection (A). 

4 ‘‘(7) Notwithstanding paragraph (1)— 

5 ‘‘(A) an alien that terminates the alien’s em6 ployment relationship with a health facility or health 

7 care organization, except under paragraph 

8 (1)(C)(ii)(III), shall not be eligible for an exemption 

9 from the limitations described in paragraphs (1) and 

10 (4) of subsection (g); and 

11 ‘‘(B) if such an alien was previously granted 

12 such exemption, the Secretary of Homeland Security 

13 shall rescind such exemption.’’. 

Æ 


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