[Federal Register Volume 89, Number 216 (Thursday, November 7, 2024)]
[Notices]
[Pages 88294-88296]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-25854]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Standardized Tests and Minimum Passing Scores for Foreign Health 
Care Workers To Demonstrate English Language Proficiency

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services (HHS).

ACTION: Request for comments.

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SUMMARY: HRSA proposes modifications to the list of standardized tests 
and minimum passing scores for foreign health care workers to 
demonstrate English language proficiency pursuant to section 343 of the 
Illegal Immigration Reform and Immigrant Responsibility Act of 1996 
(IIRIRA).

DATES: Submit comments no later than December 9, 2024, 11:59 p.m. (ET).

ADDRESSES: You may submit comments by any of the following methods:
    <bullet> Federal Web-Based Portal: https://www.regulations.gov/. 
This is the preferred method for the submission of comments. Follow 
instructions for submitting comments. Include Billing Code 4165-15 in 
your comments. All submitted comments will be posted without changes to 
https://www.regulations.gov/. Please do not include any personally 
identifiable or confidential business information you do not want 
publicly disclosed.
    <bullet> Email: <a href="/cdn-cgi/l/email-protection#2d657f7e6c6e4240404843595e6d455f5e4c034a425b"><span class="__cf_email__" data-cfemail="88c0dadbc9cbe7e5e5ede6fcfbc8e0fafbe9a6efe7fe">[email protected]</span></a> and <a href="/cdn-cgi/l/email-protection#c68e94958799838a9686aeb4b5a7e8a1a9b0"><span class="__cf_email__" data-cfemail="31796362706e747d6171594342501f565e47">[email protected]</span></a> with 
the subject line: ``Billing Code 4165-15 Comments on Standardized Tests 
and Minimum Passing Scores for Foreign Health Care Workers.'' This is 
the alternative method for the submission of comments. Please do not 
include any personally identifiable or confidential business 
information you do not want publicly disclosed.

FOR FURTHER INFORMATION CONTACT: Tanchica West, Office of Special 
Health Initiatives, Office of Global Health, HRSA, 5600 Fishers Lane, 
Rockville, Maryland 20857, 301-443-4412.

SUPPLEMENTARY INFORMATION:

I. Background

    The purpose of this request is to solicit public comments regarding 
proposed modifications to the current list of tests and passing scores 
approved by HHS through HRSA pursuant to section 343 of the IIRIRA, 
Public Law 104-208 (8 U.S.C. 1182(a)(5)(C)) and implementing 
regulations promulgated by the Department of Homeland Security at 8 CFR 
212.15(g), to demonstrate English language proficiency for noncitizen 
health care workers. Demonstration of English language proficiency is 
an element of the certification requirements for certain noncitizen 
health care workers seeking admission to the United States for the 
primary purpose of performing labor in a covered health care 
occupation. HRSA is seeking public comments regarding proposed 
modifications to the current list of approved standardized tests and 
minimum passing scores required for certification of foreign health 
care workers to enhance consistency across approved tests.
    Public comments may include the submission of evaluation studies, 
concordance analysis and findings of concordance, or methodologies 
supporting the inclusion of a particular test or minimum passing score 
for demonstrating English language proficiency. In addition to evidence 
and justification, HRSA requests that comments include:
    (1) A bulleted summary of no more than five (5) pages (12-point 
font single spaced) and
    (2) The table (below) with responses for each applicable 
recommendation.
    Comments may address any aspect of the proposed modifications, and 
all comments will be considered.

[[Page 88295]]



                                       Summary of Recommendations on English Language Proficiency Tests and Scores
                                                              [12-point font single spaced]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                              Justification  and
           Test name                 Test section        Current score     Recommended score        impact             Evidence            Timeframe
--------------------------------------------------------------------------------------------------------------------------------------------------------
[Insert Name of Test]..........  [Insert what         [Insert current     [Insert             [Provide a brief    [Describe evidence  [Insert if this
                                  section of the       score for each      recommended score   description of      to support this     modification is
                                  test the             test by health      for each test by    why the             modification        time sensitive.
                                  modification         profession or       health profession   modification is     (i.e.,              If yes, describe
                                  refers to, i.e.,     occupation by       or occupation by    necessary.]         concordance         why.]
                                  overall,             level of degree.]   level of degree.]  [Provide a brief     analysis and
                                  listening,                                                   description of      findings,
                                  reading, writing,                                            potential impact    evaluation
                                  or speaking.]                                                of the              studies, and
                                                                                               modification if     other supporting
                                                                                               accepted.]          material to
                                                                                                                   substantiate this
                                                                                                                   recommendation).]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                   Summary of Administrative Comments on English Language Proficiency Tests and Scores
--------------------------------------------------------------------------------------------------------------------------------------------------------


 
                                                                                              Justification  and
           Test name                 Test section      Current language   Suggested language        impact             Evidence            Timeframe
--------------------------------------------------------------------------------------------------------------------------------------------------------
[Insert Name of Test]..........  [Insert what         [Insert             [Insert             [Provide            [Describe evidence  [Insert if this
                                  section of the       recommended         recommended         description of      to support this     modification is
                                  test the             modification by     modification by     why the             modification        time sensitive.
                                  modification         health profession   health profession   modification is     (i.e.,              If yes, describe
                                  refers to, i.e.,     or occupation by    or occupation by    necessary.]         concordance         why.]
                                  overall,             level of degree.]   level of degree.]  [Provide             analysis and
                                  listening,                                                   description of      findings,
                                  reading, writing,                                            potential impact    evaluation
                                  or speaking, if                                              of the              studies, and
                                  applicable.]                                                 modification if     other supporting
                                                                                               accepted.]          material to
                                                                                                                   substantiate this
                                                                                                                   recommendation).]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                         General
                                                              [Insert any other comments.]
--------------------------------------------------------------------------------------------------------------------------------------------------------

Proposed Modifications to the June 2022 List of Approved Standardized 
Tests and Minimum Passing Scores:

    (1) Cambridge English provides in-depth exams to prove knowledge of 
the English language.\1\ HRSA proposes the following modification to 
the listing:
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    \1\ See, Cambridge English website: https://cambridgeenglish.org.
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    a. Change the title of the tests from ``Cambridge Assessment 
English: B2 First, C1 Advanced, or C2 qualifications exams'' to 
``Cambridge English B2 First, C1 Advanced, or C2 Proficiency,'' because 
Cambridge English changed the name of the exams.
    b. The minimum passing scores for each of the occupations will 
remain unchanged.
    (2) Test of English as a Foreign Language internet-Based Test 
(TOEFL iBT) prepares test-takers for immigration to the United States 
by examining their English ability.\2\ HRSA proposes the following 
modifications to the listing:
---------------------------------------------------------------------------

    \2\ See,website for English as a Foreign Language (TOEFL) 
Internet-Based Test: https://www.ets.org/toefl/institutions/ibt/about.html.
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    a. Change the title from ``Test of English as a Foreign Language 
(TOEFL) internet-Based Test'' to ``Test of English as a Foreign 
Language internet-Based Test (TOEFL iBT),'' to reflect the 
organization's current name for the exam.
    b. Increase the overall passing score from an 81 to an 83 for 
registered nurses and Bachelor of Science level health care workers to 
enhance parity among minimum passing test scores across approved tests.
    c. Increase the minimum passing score for the ``Speaking'' section 
from 24 to 26 for registered nurses and Bachelor of Science level 
health care workers to enhance parity among minimum passing test scores 
across approved tests.
    d. There are no proposed changes to the minimum passing scores for 
health care workers holding less than a Bachelor of Science degree and 
occupational therapists/physical therapists.
    (3) HRSA understands that the TOEFL Paper-Based Test has been 
discontinued.\3\ HRSA therefore proposes the following modification to 
the listing:
---------------------------------------------------------------------------

    \3\ See, Test of English as a Foreign Language (TOEFL) website: 
https://www.ets.org/toefl.html.
---------------------------------------------------------------------------

    a. Remove the TOEFL Paper-Based Test from the list of standardized 
tests and minimum passing scores to demonstrate English language 
proficiency, since it is no longer available for test-takers.
    (4) Test of English in International Communication (TOEIC) 
(Listening and Reading) and TOEIC (Speaking and Writing) measure 
English comprehension skills and determines a test-taker's ability to 
communicate in English effectively and proficiently.\4\ HRSA proposes 
the following modifications to the listing:
---------------------------------------------------------------------------

    \4\ See, website for Test of English in International 
Communication (TOEIC) https://www.ets.org//toeic/test-takers/about.html.
---------------------------------------------------------------------------

    a. Increase the minimum passing score from 700 to 725 for 
``Listening and Reading'' for health care workers holding less than a 
Bachelor of Science degree to enhance parity among minimum passing test 
scores across approved tests.
    b. There are no proposed changes to the minimum passing score of 
160 for ``Speaking'' and 150 for ``Writing'' for registered nurses, 
Bachelor of Science level health care workers, and health care workers 
holding less than a Bachelor of Science degree.
    (5) The Occupational English Test (OET) is a language test designed 
to evaluate language skills of healthcare professionals in an English-
speaking environment.\5\ HRSA proposes the following modifications to 
the listing:
---------------------------------------------------------------------------

    \5\ See, website for the Occupational English Test (OET): 
https://oet.com/en-us.
---------------------------------------------------------------------------

    a. Change test scores from a letter-based scoring system to 
numerical values, as suggested by OET, to increase precision in scoring 
and overall parity across English language proficiency tests. For 
registered nurses and Bachelor of Science level health care workers, 
the current minimum passing score for ``Reading,'' ``Writing,'' and 
``Listening'' is a letter grade of C+ and a letter grade of B for 
``Speaking.'' HRSA proposes to replace these letter scores with the 
equivalent numeric scores of 300 for

[[Page 88296]]

``Reading,'' ``Writing,'' and ``Listening,'' and 350 for ``Speaking'' 
which, per consultation with OET, does not represent an increase or 
decrease in minimum passing test scores.
    b. For health care workers holding less than a Bachelor of Science 
degree, the current minimum passing score for ``Reading,'' ``Writing,'' 
and ``Listening'' is a letter grade of C and a letter grade of B for 
``Speaking.'' HRSA proposes to replace these letter scores with the 
equivalent numeric scores of 250 for ``Reading,'' ``Writing,'' 
``Listening,'' and 350 for ``Speaking'' which, per consultation with 
OET, does not represent an increase or decrease in minimum passing test 
scores.
    c. For occupational and physical therapists, there are currently no 
minimum passing tests scores listed for OET. HRSA proposes the minimum 
passing scores of 300 for ``Reading,'' ``Writing,'' and ``Listening'' 
and the score of 350 for ``Speaking'' to include versions of OET 
designed specifically for occupational and physical therapists.
    (6) Pearson PTE Academic is a computer-based exam that measures 
academic-level speaking, writing, reading, and listening skills.\6\ 
HRSA proposes the following modification to the listing:
---------------------------------------------------------------------------

    \6\ See, website for Pearson PTE Academic: https://www.pearsonpte.com/pte-academic.
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    a. Add a new passing minimum score of 63 for ``Speaking'' for 
registered nurses and Bachelor of Science level health care workers. 
Previously, no passing minimum score for ``Speaking'' was listed. HRSA 
proposes this change to enhance parity among minimum passing test 
scores.
    To reflect the aforementioned modifications*, HRSA proposes to 
update its website to replace the June 2022 listing of approved 
standardized tests and minimum passing scores with the following table, 
which reflects the information described above:
    * Proposed modifications are bolded and italicized for this 
document but will not appear in bold and italics when published on the 
website.

----------------------------------------------------------------------------------------------------------------
                                         Scores: occupational      Scores: registered
       English competency tests          therapists/physical     nurses and B.S. level     Scores: <B.S. level
                                              therapists          health care workers      health care workers
----------------------------------------------------------------------------------------------------------------
Cambridge English B2 First, C1         Cambridge English Scale  Cambridge English Scale  Cambridge English Scale
 Advanced, or C2 Proficiency.           185 overall and 185      176 overall and 185      169 overall and 185
                                        Speaking.                Speaking.                Speaking.
Educational Testing Service: TOEFL     Overall 89 with minimum  Overall 83 with minimum  Overall 77 with minimum
 Internet-Based Test.                   of 63 on Reading,        of 57 on Reading,        of 53 on Reading,
                                        Listening and Writing    Listening and Writing    Listening, and Writing
                                        and 26 on Speaking.      and 26 on Speaking.      and 24 on Speaking.
Educational Testing Service: TOEIC     Not applicable.........  725....................  725.
 (Listening and Reading).
Educational Testing Service: TOEIC     Not applicable.........  160 Speaking/150         160 Speaking/150
 (Speaking/Writing).                                             Writing.                 Writing.
International English Language         Not applicable.........  6.5 academic with        6 academic or general
 Testing System (IELTS).                                         minimum of 7 on          with minimum of 7 on
                                                                 Speaking.                Speaking.
Michigan English Test (MET)..........  Not applicable.........  Overall 55; minimum      Overall 55; minimum
                                                                 Speaking section score   Speaking section score
                                                                 of 55.                   of 55.
Occupational English Test (OET)......  Reading, Writing,        Reading, Writing,        Reading, Writing,
                                        Listening/300;           Listening/300;           Listening/250;
                                        Speaking 350.            Speaking 350.            Speaking 350.
Pearson PTE Academic.................  Not applicable.........  Overall 55; Reading,     Overall 55; Reading,
                                                                 Writing, Listening, no   Writing, Listening, no
                                                                 section below 50.        section below 50.
                                                                63 minimum for Speaking
----------------------------------------------------------------------------------------------------------------


Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2024-25854 Filed 11-6-24; 8:45 am]
BILLING CODE 4165-15-P


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