II 

113TH CONGRESS 

1ST SESSION S. 616 

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 19, 2013 

Ms. KLOBUCHAR (for herself, Ms. HEITKAMP, Mr. MORAN, and Ms. COLLINS) 

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 Act’’. 

6 SEC. 2. CONRAD STATE 30 PROGRAM. 

7 Section 220(c) of the Immigration and Nationality 

8 Technical Corrections Act of 1994 (Public Law 103–416; 

9 8 U.S.C. 1182 note) is amended by striking ‘‘and before 

10 September 30, 2015’’. 


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1 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 

2 MEDICALLY UNDERSERVED COMMUNITIES. 

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

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

5 end the following: 

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

7 service requirements of a waiver requested under 

8 section 203(b)(2)(B)(ii), including alien physicians 

9 who completed such service before the date of the 

10 enactment of the Conrad State 30 and Physician Ac11 cess Act and any spouses or children of such alien 

12 physicians. 

13 ‘‘(ii) Nothing in this subparagraph may be con14 strued— 

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

16 the Secretary of Homeland Security for classi17 fication under section 204(a) or the filing of an 

18 application for adjustment of status under sec19 tion 245 by an alien physician described in this 

20 subparagraph prior to the date by which such 

21 alien physician has completed the service de22 scribed in section 214(l) or worked full-time as 

23 a physician for an aggregate of 5 years at the 

24 location identified in the section 214(l) waiver 

25 or in an area or areas designated by the SecVerDate Mar 15 2010 04:14 Mar 23, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S616.IS S616

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1 retary of Health and Human Services as having 

2 a shortage of health care professionals; or 

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

4 Security to grant such a petition or application 

5 until the alien has satisfied all the requirements 

6 of the waiver received under section 214(l).’’. 

7 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

8 (a) IN GENERAL.—Section 214(l)(1)(C) of the Immi9 gration and Nationality Act (8 U.S.C. 1184(l)(1)(C)) is 

10 amended by striking clauses (i) and (ii) and inserting the 

11 following: 

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

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

14 organization, which employment has been deter15 mined by the Secretary of Homeland Security 

16 to be in the public interest; and 

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

18 with the health facility or health care organiza19 tion in a geographic area or areas which are 

20 designated by the Secretary of Health and 

21 Human Services as having a shortage of health 

22 care professionals by the later of the date that 

23 is 90 days after receiving such waiver, 90 days 

24 after completing graduate medical education or 

25 training under a program approved pursuant to 


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1 section 212(j)(1), or 90 days after receiving 

2 nonimmigrant status or employment authoriza3 tion, and agrees to continue to work for a total 

4 of not less than 3 years in any status author5 ized for such employment under this subsection 

6 unless— 

7 ‘‘(I) the Secretary determines that ex8 tenuating circumstances exist that justify a 

9 lesser period of employment at such facility 

10 or organization, in which case the alien 

11 shall demonstrate another bona fide offer 

12 of employment at a health facility or 

13 health care organization, for the remainder 

14 of such 3-year period; 

15 ‘‘(II) the interested State agency that 

16 requested the waiver attests that extenu17 ating circumstances exist that justify a 

18 lesser period of employment at such facility 

19 or organization in which case the alien 

20 shall demonstrate another bona fide offer 

21 of employment at a health facility or 

22 health care organization so designated by 

23 the Secretary of Health and Human Serv24 ices, for the remainder of such 3-year pe25 riod; or 


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

2 a determination of extenuating cir3 cumstances pursuant to subclause (I) or 

4 (II), the alien terminates the alien’s em5 ployment relationship with such facility or 

6 organization, in which case the alien shall 

7 be employed for the remainder of such 3- 

8 year period, and 1 additional year for each 

9 termination, at another health facility or 

10 health care organization in a geographic 

11 area or areas which are designated by the 

12 Secretary of Health and Human Services 

13 as having a shortage of health care profes14 sionals; and’’. 

15 (b) CONTRACT REQUIREMENTS.—Section 214(l) of 

16 the Immigration and Nationality Act (8 U.S.C. 1184(l)) 

17 is amended by adding at the end the following: 

18 ‘‘(4) An alien granted a waiver under paragraph 

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

20 contracting health facility or health care organization 

21 that— 

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

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

24 that the alien will be expected to be available and 


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1 the compensation the alien will receive for on-call 

2 time; 

3 ‘‘(B) specifies whether the contracting facility 

4 or organization will pay for the alien’s malpractice 

5 insurance premiums, including whether the employer 

6 will provide malpractice insurance and, if so, the 

7 amount of such insurance that will be provided; 

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

9 alien will work and a statement that the contracting 

10 facility or organization will not add additional work 

11 locations without the approval of the Federal agency 

12 or State agency that requested the waiver; and 

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

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

15 (1)(C) whose employment relationship with a health facil16 ity or health care organization terminates during the 3- 

17 year service period required by such paragraph— 

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

19 on the date of such termination of employment to 

20 submit to the Secretary of Homeland Security appli21 cations or petitions to commence employment with 

22 another contracting health facility or health care or23 ganization in a geographic area or areas which are 

24 designated by the Secretary of Health and Human 


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1 Services as having a shortage of health care profes2 sionals; and 

3 ‘‘(B) shall be considered to be maintaining law4 ful status in an authorized stay during the 120-day 

5 period referred to in subsection (A).’’. 

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(b), is further amended by adding at the end the 

10 following: 

11 ‘‘(6)(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 allocation has occurred under clause 

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

17 under paragraph (1)(B) for each subsequent fiscal year 

18 if 90 percent of the waivers available to the States receiv19 ing at least 5 waivers were used in the previous fiscal year. 

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

21 year, the States will only receive an additional increase 

22 of 5 waivers the following fiscal year if 95 percent of the 

23 waivers available to the States receiving at least 1 waiver 

24 were 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 the Immigration and Nationality Act (8 

18 U.S.C. 1184(l)(1)(D)) is 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) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL21 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER22 SERVED AREAS.—Section 214(l)(2)(A) of the Immigration 

23 and Nationality Act (8 U.S.C. 1184(l)(2)(A)) is amended 

24 by striking ‘‘an alien described in section 

25 101(a)(15)(H)(i)(b).’’ and inserting ‘‘any status author26 ized for employment under this Act.’’. 


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1 (c) PHYSICIAN NATIONAL INTEREST WAIVER CLARI2 FICATIONS.— 

3 (1) PRACTICE AND GEOGRAPHIC AREA.—Sec4 tion 203(b)(2)(B)(ii)(I) of the Immigration and Na5 tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 

6 amended by striking items (aa) and (bb) and insert7 ing the following: 

8 ‘‘(aa) the alien physician agrees to 

9 work on a full-time basis practicing pri10 mary care, specialty medicine, or a com11 bination thereof, in an area or areas des12 ignated by the Secretary of Health and 

13 Human Services as having a shortage of 

14 health care professionals, or at a health 

15 care facility under the jurisdiction of the 

16 Secretary of Veterans Affairs; or 

17 ‘‘(bb) the alien physician is pursuing 

18 such waiver based upon service at a facility 

19 or facilities that serve patients who reside 

20 in a geographic area or areas designated 

21 by the Secretary of Health and Human 

22 Services as having a shortage of health 

23 care professionals (without regard to 

24 whether such facility or facilities are lo25 cated within such an area) and a Federal 


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1 agency, or a local, county, regional, or 

2 State department of public health deter3 mines the alien physician’s work was or 

4 will be in the public interest.’’. 

5 (2) FIVE-YEAR SERVICE REQUIREMENT.—Sec6 tion 203(b)(2)(B)(ii)(II) of the Immigration and Na7 tionality Act (8 U.S.C. 1153(B)(ii)(II)) is amend8 ed— 

9 (A) by inserting ‘‘(aa)’’ after ‘‘(II)’’; and 

10 (B) by adding at the end the following: 

11 ‘‘(bb) The 5-year service requirement of 

12 item (aa) shall be counted from the date the 

13 alien physician begins work in the shortage area 

14 in any legal status and not the date an immi15 grant visa petition is filed or approved. Such 

16 service shall be aggregated without regard to 

17 when such service began and without regard to 

18 whether such service began during or in con19 junction with a course of graduate medical edu20 cation. 

21 ‘‘(cc) An alien physician shall not be re22 quired to submit an employment contract with 

23 a term exceeding the balance of the 5-year com24 mitment yet to be served, nor an employment 

25 contract dated within a minimum time period 


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1 prior to filing of a visa petition pursuant to this 

2 subsection. 

3 ‘‘(dd) An alien physician shall not be re4 quired to file additional immigrant visa peti5 tions upon a change of work location from the 

6 location approved in the original national inter7 est immigrant petition.’’. 

8 (d) TECHNICAL CLARIFICATION REGARDING AD9 VANCED DEGREE FOR PHYSICIANS.—Section 

10 203(b)(2)(A) of the Immigration and Nationality Act (8 

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

12 ‘‘An alien physician holding a foreign medical degree that 

13 has been deemed sufficient for acceptance by an accredited 

14 United States medical residency or fellowship program is 

15 a member of the professions holding an advanced degree 

16 or its equivalent.’’. 

17 (e) SHORT-TERM WORK AUTHORIZATION FOR PHY18 SICIANS COMPLETING THEIR RESIDENCIES.—A physician 

19 completing graduate medical education or training as de20 scribed in section 212(j) of the Immigration and Nation21 ality Act (8 U.S.C. 1182(j)) as a nonimmigrant described 

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

23 1101(a)(15)(H)(i)) shall have such nonimmigrant status 

24 automatically extended until October 1 of the fiscal year 

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1 immigrant status has been submitted in a timely manner 

2 and where the employment start date for the beneficiary 

3 of such petition is October 1 of that fiscal year. Such phy4 sician shall be authorized to be employed incident to status 

5 during the period between the filing of such petition and 

6 October 1 of such fiscal year. However, the physician’s 

7 status and employment authorization shall terminate 30 

8 days from the date such petition is rejected, denied or re9 voked. A physician’s status and employment authorization 

10 will automatically extend to October 1 of the next fiscal 

11 year if all visas as described in such section 

12 101(a)(15)(H)(i) authorized to be issued for the fiscal 

13 year have been issued. 

14 (f) APPLICABILITY OF SECTION 212(e) TO SPOUSES

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

16 or child of an exchange visitor described in section 

17 101(a)(15)(J) of the Immigration and Nationality Act (8 

18 U.S.C. 1101(a)(15)(J)) shall not be subject to the require19 ments of section 212(e) of the Immigration and Nation20 ality Act (8 U.S.C. 1182(e)). 

Æ 


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