II 

114TH CONGRESS 

1ST SESSION S. 1189 

To provide incentives to physicians to practice in rural and medically 

underserved communities and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 5, 2015 

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 Sep 11 2014 04:30 May 13, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1189.IS S1189

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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, if the alien or the alien’s employer peti4 tions for such nonimmigrant status or employ5 ment authorization not later than 90 days after 

6 the date the alien completes his or her graduate 

7 medical education or training and agrees to 

8 continue to work for a total of not less than 3 

9 years in any status authorized for such employ10 ment under this subsection unless— 

11 ‘‘(I) the Secretary determines that ex12 tenuating circumstances exist that justify a 

13 lesser period of employment at such facility 

14 or organization, in which case the alien 

15 shall demonstrate another bona fide offer 

16 of employment at a health facility or 

17 health care organization, for the remainder 

18 of such 3-year period; 

19 ‘‘(II) the interested State agency that 

20 requested the waiver attests that extenu21 ating circumstances exist that justify a 

22 lesser period of employment at such facility 

23 or organization in which case the alien 

24 shall demonstrate another bona fide offer 

25 of employment at a health facility or 


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1 health care organization so designated by 

2 the Secretary of Health and Human Serv3 ices, for the remainder of such 3-year pe4 riod; or 

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

6 a determination of extenuating cir7 cumstances pursuant to subclause (I) or 

8 (II), the alien terminates the alien’s em9 ployment relationship with such facility or 

10 organization, in which case the alien shall 

11 be employed for the remainder of such 3- 

12 year period, and 1 additional year for each 

13 termination, at another health facility or 

14 health care organization in a geographic 

15 area or areas which are designated by the 

16 Secretary of Health and Human Services 

17 as having a shortage of health care profes18 sionals; and’’. 

19 (b) PHYSICIAN EMPLOYMENT IN UNDERSERVED

20 AREAS.—Section 214(l) of the Immigration and Nation21 ality Act (8 U.S.C. 1184(l)) is amended by adding at the 

22 end the following: 

23 ‘‘(4) If a physician pursuing graduate medical edu24 cation or training pursuant to section 101(a)(15)(J) ap25 plies for a waiver under paragraph (1)(B) with an interVerDate Sep 11 2014 04:30 May 13, 2015 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1189.IS S1189

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1 ested State agency and the application is denied because 

2 the State has requested the maximum number of waivers 

3 permitted for that fiscal year, the physician’s non4 immigrant status shall be extended for a period of up to 

5 6 months if the physician agrees to seek a waiver under 

6 this subsection (except for paragraph (1)(D)(ii)) to work 

7 for an interested State agency whose State has not yet 

8 requested the maximum number of waivers. The physician 

9 shall be authorized to work only for such interested State 

10 agency from the date on which a new waiver application 

11 is filed with the State until the date on which the Sec12 retary of Homeland Security denies such waiver or issues 

13 work authorization for such employment pursuant to the 

14 approval of such waiver.’’. 

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

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

17 as amended by subsection (b), is further amended by add18 ing at the end the following: 

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

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

21 contracting health facility or health care organization 

22 that— 

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

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

25 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 ‘‘(6) 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 subsections (b) and (c) of section 4, is further amended 

10 by adding at the end the following: 

11 ‘‘(7)(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 require12 ment of item (aa) shall be counted 

13 from the date the alien physician be14 gins work in the shortage area in any 

15 legal status and not the date an immi16 grant visa petition is filed or ap17 proved. Such service shall be aggre18 gated without regard to when such 

19 service began and without regard to 

20 whether such service began during or 

21 in conjunction with a course of grad22 uate medical education. 

23 ‘‘(cc) An alien physician shall not 

24 be required to submit an employment 

25 contract with a term exceeding the 


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1 balance of the 5-year commitment yet 

2 to be served, nor an employment con3 tract dated within a minimum time 

4 period prior to filing of a visa petition 

5 pursuant to this subsection. 

6 ‘‘(dd) An alien physician shall 

7 not be required to file additional im8 migrant visa petitions upon a change 

9 of work location from the location ap10 proved in the original national interest 

11 immigrant petition.’’. 

12 (d) TECHNICAL CLARIFICATION REGARDING AD13 VANCED DEGREE FOR PHYSICIANS.—Section 

14 203(b)(2)(A) of the Immigration and Nationality Act (8 

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

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

17 has been deemed sufficient for acceptance by an accredited 

18 United States medical residency or fellowship program is 

19 a member of the professions holding an advanced degree 

20 or its equivalent.’’. 

21 (e) SHORT-TERM WORK AUTHORIZATION FOR PHY22 SICIANS COMPLETING THEIR RESIDENCIES.—A physician 

23 completing graduate medical education or training as de24 scribed in section 212(j) of the Immigration and Nation25 ality Act (8 U.S.C. 1182(j)) as a nonimmigrant described 


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

2 1101(a)(15)(H)(i)) shall have such nonimmigrant status 

3 automatically extended until October 1 of the fiscal year 

4 for which a petition for a continuation of such non5 immigrant status has been submitted in a timely manner 

6 and where the employment start date for the beneficiary 

7 of such petition is October 1 of that fiscal year. Such phy8 sician shall be authorized to be employed incident to status 

9 during the period between the filing of such petition and 

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

11 status and employment authorization shall terminate 30 

12 days from the date such petition is rejected, denied or re13 voked. A physician’s status and employment authorization 

14 will automatically extend to October 1 of the next fiscal 

15 year if all visas as described in such section 

16 101(a)(15)(H)(i) authorized to be issued for the fiscal 

17 year have been issued. 

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

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

20 or child of an exchange visitor described in section 

21 101(a)(15)(J) of the Immigration and Nationality Act (8 

22 U.S.C. 1101(a)(15)(J)) shall not be subject to the require23 ments of section 212(e) of the Immigration and Nation24 ality Act (8 U.S.C. 1182(e)). 

Æ 


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