I 

116TH CONGRESS 

1ST SESSION H. R. 2895 

To provide incentives to physicians to practice in rural and medically 

underserved communities, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 22, 2019 

Mr. SCHNEIDER (for himself, Mr. BACON, and Ms. FINKENAUER) introduced 

the following bill; which was 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 Reauthorization Act’’. 

6 SEC. 2. CONRAD STATE 30 PROGRAM. 

7 (a) EXTENSION.—Section 220(c) of the Immigration 

8 and Nationality Technical Corrections Act of 1994 (Public 

9 Law 103–416; 8 U.S.C. 1182 note) is amended by striking 


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1 ‘‘September 30, 2015’’ and inserting ‘‘September 30, 

2 2021’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 subsection (a) shall take effect as if enacted on September 

5 30, 2018. 

6 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 

7 MEDICALLY UNDERSERVED COMMUNITIES. 

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

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

10 end the following: 

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

12 service requirements of a waiver requested under 

13 section 203(b)(2)(B)(ii), including— 

14 ‘‘(I) alien physicians who completed such 

15 service before the date of the enactment of the 

16 Conrad State 30 and Physician Access Act; and 

17 ‘‘(II) the spouse or children of an alien 

18 physician described in subclause (I). 

19 ‘‘(ii) Nothing in this subparagraph may be con20 strued— 

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

22 the Secretary of Homeland Security for classi23 fication under section 204(a) or the filing of an 

24 application for adjustment of status under sec25 tion 245 by an alien physician described in this 


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1 subparagraph before the date by which such 

2 alien physician has completed the service de3 scribed in section 214(l) or worked full-time as 

4 a physician for an aggregate of 5 years at the 

5 location identified in the section 214(l) waiver 

6 or in an area or areas designated by the Sec7 retary of Health and Human Services as having 

8 a shortage of health care professionals; or 

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

10 Security to grant a petition or application de11 scribed in subclause (I) until the alien has sat12 isfied all of the requirements of the waiver re13 ceived under section 214(l).’’. 

14 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

15 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY

16 REQUIREMENT.—Section 214(l)(1) of the Immigration 

17 and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 

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

19 by striking ‘‘Attorney General’’ and inserting ‘‘Sec20 retary of Homeland Security’’; 

21 (2) in subparagraph (A), by striking ‘‘Director 

22 of the United States Information Agency’’ and in23 serting ‘‘Secretary of State’’; 


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1 (3) in subparagraph (B), by inserting ‘‘, except 

2 as provided in paragraphs (7) and (8)’’ before the 

3 semicolon at the end; 

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

5 and (ii) and inserting the following: 

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

7 offer of full-time employment at a health facil8 ity or health care organization, which employ9 ment has been determined by the Secretary of 

10 Homeland Security to be in the public interest; 

11 ‘‘(ii) the alien— 

12 ‘‘(I) has accepted employment with 

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

15 are designated by the Secretary of Health 

16 and Human Services as having a shortage 

17 of health care professionals; 

18 ‘‘(II) begins employment by the later 

19 of the date that is— 

20 ‘‘(aa) 120 days after receiving 

21 such waiver; 

22 ‘‘(bb) 120 days after completing 

23 graduate medical education or train24 ing under a program approved pursu25 ant to section 212(j)(1); or 


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1 ‘‘(cc) 120 days after receiving 

2 nonimmigrant status or employment 

3 authorization, if the alien or the 

4 alien’s employer petitions for such 

5 nonimmigrant status or employment 

6 authorization not later than 120 days 

7 after the date on which the alien com8 pletes his or her graduate medical 

9 education or training under a pro10 gram approved pursuant to section 

11 212(j)(1); and 

12 ‘‘(III) agrees to continue to work for 

13 a total of not less than 3 years in the sta14 tus authorized for such employment under 

15 this subsection, except as provided in para16 graph (8).’’; and 

17 (5) in subparagraph (D), in the matter pre18 ceding clause (i), by inserting ‘‘(except as provided 

19 in paragraph (8))’’. 

20 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL21 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER22 SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 

23 U.S.C. 1184(l)(2)(A)) is amended to read as follows: 

24 ‘‘(A) Upon the request of an interested Federal 

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1 dation of a waiver under this section by a physician 

2 who is maintaining valid nonimmigrant status under 

3 section 101(a)(15)(J) and a favorable recommenda4 tion by the Secretary of State, the Secretary of 

5 Homeland Security may change the status of such 

6 physician to any status authorized for employment 

7 under this Act. The numerical limitations contained 

8 in subsection (g)(1)(A) shall not apply to any alien 

9 whose status is changed under this subparagraph.’’. 

10 (c) VIOLATION OF AGREEMENTS.—Section 

11 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

12 amended by inserting ‘‘substantial requirement of an’’ be13 fore ‘‘agreement entered into’’. 

14 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED

15 AREAS.—Section 214(l) of such Act (8 U.S.C. 1184(l)), 

16 as amended by this section, is further amended by adding 

17 at the end the following: 

18 ‘‘(4)(A) If an interested State agency denies the ap19 plication for a waiver under paragraph (1)(B) from a phy20 sician pursuing graduate medical education or training 

21 pursuant to section 101(a)(15)(J) because the State has 

22 requested the maximum number of waivers permitted for 

23 that fiscal year, the physician’s nonimmigrant status shall 

24 be extended for up to 6 months if the physician agrees 

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1 graph (1)(D)(ii)) to work for an employer described in 

2 paragraph (1)(C) in a State that has not yet requested 

3 the maximum number of waivers. 

4 ‘‘(B) Such physician shall be authorized to work only 

5 for the employer referred to in subparagraph (A) from the 

6 date on which a new waiver application is filed with such 

7 State until the earlier of— 

8 ‘‘(i) the date on which the Secretary of Home9 land Security denies such waiver; or 

10 ‘‘(ii) the date on which the Secretary approves 

11 an application for change of status under paragraph 

12 (2)(A) pursuant to the approval of such waiver.’’. 

13 (e) CONTRACT REQUIREMENTS.—Section 214(l) of 

14 such Act, as amended by this section, is further amended 

15 by adding at the end the following: 

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

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

18 contracting health facility or health care organization 

19 that— 

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

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

22 that the alien will be expected to be available and 

23 the compensation the alien will receive for on-call 

24 time; 

25 ‘‘(B) specifies— 


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1 ‘‘(i) whether the contracting facility or or2 ganization will pay the alien’s malpractice in3 surance premiums; 

4 ‘‘(ii) whether the employer will provide 

5 malpractice insurance; and 

6 ‘‘(iii) the amount of such insurance that 

7 will be provided; 

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

9 alien will work and includes a statement that the 

10 contracting facility or organization will not add addi11 tional work locations without the approval of the 

12 Federal agency or State agency that requested the 

13 waiver; and 

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

15 ‘‘(6) An alien granted a waiver under this subsection 

16 whose employment relationship with a health facility or 

17 health care organization terminates under paragraph 

18 (1)(C)(ii) during the 3-year service period required under 

19 paragraph (1) shall be considered to be maintaining lawful 

20 status in an authorized period of stay during the 120-day 

21 period referred to in items (aa) and (bb) of subclause (III) 

22 of paragraph (1)(C)(ii) or the 45-day period referred to 

23 in subclause (III)(cc) of such paragraph.’’. 

24 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER

25 STATES.—Section 214(l) of such Act, as amended by this 


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1 section, is further amended by adding at the end the fol2 lowing: 

3 ‘‘(7) If a recipient of a waiver under this subsection 

4 terminates the recipient’s employment with a health facil5 ity or health care organization pursuant to paragraph 

6 (1)(C)(ii), including termination of employment because of 

7 circumstances described in paragraph (1)(C)(ii)(III), and 

8 accepts new employment with such a facility or organiza9 tion in a different State, the State from which the alien 

10 is departing may be accorded an additional waiver by the 

11 Secretary of State for use in the fiscal year in which the 

12 alien’s employment was terminated.’’. 

13 (g) EXCEPTION TO 3-YEAR WORK REQUIREMENT.— 

14 Section 214(l) of such Act, as amended by this section, 

15 is further amended by adding at the end the following: 

16 ‘‘(8) The 3-year work requirement set forth in sub17 paragraphs (C) and (D) of paragraph (1) shall not apply 

18 if— 

19 ‘‘(A)(i) the Secretary of Homeland Security de20 termines that extenuating circumstances, including 

21 violations by the employer of the employment agree22 ment with the alien or of labor and employment 

23 laws, exist that justify a lesser period of employment 

24 at such facility or organization; and 


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1 ‘‘(ii) the alien demonstrates, not later than 120 

2 days after the employment termination date (unless 

3 the Secretary determines that extenuating cir4 cumstances would justify an extension), another 

5 bona fide offer of employment at a health facility or 

6 health care organization in a geographic area or 

7 areas which are designated by the Secretary of 

8 Health and Human Services as having a shortage of 

9 health care professionals, for the remainder of such 

10 3-year period; 

11 ‘‘(B)(i) the interested State agency that re12 quested the waiver attests that extenuating cir13 cumstances, including violations by the employer of 

14 the employment agreement with the alien or of labor 

15 and employment laws, exist that justify a lesser pe16 riod of employment at such facility or organization; 

17 and 

18 ‘‘(ii) the alien demonstrates, not later than 120 

19 days after the employment termination date (unless 

20 the Secretary determines that extenuating cir21 cumstances would justify an extension), another 

22 bona fide offer of employment at a health facility or 

23 health care organization in a geographic area or 

24 areas which are designated by the Secretary of 

25 Health and Human Services as having a shortage of 


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1 health care professionals, for the remainder of such 

2 3-year period; or 

3 ‘‘(C) the alien— 

4 ‘‘(i) elects not to pursue a determination of 

5 extenuating circumstances pursuant to sub6 clause (A) or (B); 

7 ‘‘(ii) terminates the alien’s employment re8 lationship with the health facility or health care 

9 organization at which the alien was employed; 

10 ‘‘(iii) demonstrates, not later than 45 days 

11 after the employment termination date, another 

12 bona fide offer of employment at a health facil13 ity or health care organization in a geographic 

14 area or areas, in the State that requested the 

15 alien’s waiver, which are designated by the Sec16 retary of Health and Human Services as having 

17 a shortage of health care professionals; and 

18 ‘‘(iv) agrees to be employed for the remain19 der of such 3-year period, and 1 additional year 

20 for each termination under clause (ii).’’. 

21 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 

22 (a) IN GENERAL.—Section 214(l) of the Immigration 

23 and Nationality Act (8 U.S.C. 1184(l)), as amended by 

24 section 4, is further amended by adding at the end the 

25 following: 


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

2 waivers under paragraph (1)(B) for a fiscal year if 90 per3 cent of the waivers available to the States receiving at 

4 least 5 waivers were used in the previous fiscal year. 

5 ‘‘(ii) When an allotment occurs under clause (i), all 

6 States shall be allotted an additional 5 waivers under 

7 paragraph (1)(B) for each subsequent fiscal year if 90 

8 percent of the waivers available to the States receiving at 

9 least 5 waivers were used in the previous fiscal year. If 

10 the States are allotted 45 or more waivers for a fiscal year, 

11 the States will only receive an additional increase of 5 

12 waivers the following fiscal year if 95 percent of the waiv13 ers available to the States receiving at least 1 waiver were 

14 used in the previous fiscal year. 

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

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

17 the total number of such waivers granted is 5 percent 

18 lower than in the last year in which there was an increase 

19 in the number of waivers allotted pursuant to this para20 graph, in which case— 

21 ‘‘(i) the number of waivers allotted shall be de22 creased by five for all States beginning in the next 

23 fiscal year; and 

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

25 waivers granted from the last year in which there 


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1 was an increase in the allotment, shall result in an 

2 additional decrease of 5 waivers allotted for all 

3 States, provided that the number of waivers allotted 

4 for all States shall not drop below 30.’’. 

5 (b) ACADEMIC MEDICAL CENTERS.—Section 

6 214(l)(1)(D) of such Act is amended— 

7 (1) in clause (ii), by striking ‘‘and’’ at the end; 

8 (2) in clause (iii), by striking the period at the 

9 end and inserting ‘‘; and’’; and 

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

11 ‘‘(iv) in the case of a request by an inter12 ested State agency— 

13 ‘‘(I) the head of such agency deter14 mines that the alien is to practice medicine 

15 in, or be on the faculty of a residency pro16 gram at, an academic medical center (as 

17 that term is defined in section 

18 411.355(e)(2) of title 42, Code of Federal 

19 Regulations, or similar successor regula20 tion), without regard to whether such facil21 ity is located within an area designated by 

22 the Secretary of Health and Human Serv23 ices as having a shortage of health care 

24 professionals; and 


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1 ‘‘(II) the head of such agency deter2 mines that— 

3 ‘‘(aa) the alien physician’s work 

4 is in the public interest; and 

5 ‘‘(bb) the grant of such waiver 

6 would not cause the number of the 

7 waivers granted on behalf of aliens for 

8 such State for a fiscal year (within 

9 the limitation in subparagraph (B) 

10 and subject to paragraph (6)) in ac11 cordance with the conditions of this 

12 clause to exceed 3.’’. 

13 SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, 

14 AND OTHER PROVISIONS RELATED TO PHYSI15 CIAN IMMIGRATION. 

16 (a) DUAL INTENT FOR PHYSICIANS SEEKING GRAD17 UATE MEDICAL TRAINING.—Section 214(b) of the Immi18 gration and Nationality Act (8 U.S.C. 1184(b)) is amend19 ed by striking ‘‘(other than a nonimmigrant described in 

20 subparagraph (L) or (V) of section 101(a)(15), and other 

21 than a nonimmigrant described in any provision of section 

22 101(a)(15)(H)(i) except subclause (b1) of such section)’’ 

23 and inserting ‘‘(other than a nonimmigrant described in 

24 subparagraph (L) or (V) of section 101(a)(15), a non25 immigrant described in any provision of section 


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1 101(a)(15)(H)(i) (except subclause (b1) of such section), 

2 and an alien coming to the United States to receive grad3 uate medical education or training as described in section 

4 212(j) or to take examinations required to receive grad5 uate medical education or training as described in section 

6 212(j))’’. 

7 (b) PHYSICIAN NATIONAL INTEREST WAIVER CLARI8 FICATIONS.— 

9 (1) PRACTICE AND GEOGRAPHIC AREA.—Sec10 tion 203(b)(2)(B)(ii)(I) of the Immigration and Na11 tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 

12 amended by striking items (aa) and (bb) and insert13 ing the following: 

14 ‘‘(aa) the alien physician agrees to 

15 work on a full-time basis practicing pri16 mary care, specialty medicine, or a com17 bination thereof, in an area or areas des18 ignated by the Secretary of Health and 

19 Human Services as having a shortage of 

20 health care professionals, or at a health 

21 care facility under the jurisdiction of the 

22 Secretary of Veterans Affairs; or 

23 ‘‘(bb) the alien physician is pursuing 

24 such waiver based upon service at a facility 

25 or facilities that serve patients who reside 


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1 in a geographic area or areas designated 

2 by the Secretary of Health and Human 

3 Services as having a shortage of health 

4 care professionals (without regard to 

5 whether such facility or facilities are lo6 cated within such an area) and a Federal 

7 agency, or a local, county, regional, or 

8 State department of public health deter9 mines the alien physician’s work was or 

10 will be in the public interest.’’. 

11 (2) FIVE-YEAR SERVICE REQUIREMENT.—Sec12 tion 203(b)(2)(B)(ii) of the Immigration and Na13 tionality Act (8 U.S.C. 1153(B)(ii)) is amended— 

14 (A) by moving subclauses (II), (III), and 

15 (IV) 4 ems to the left; and 

16 (B) in subclause (II)— 

17 (i) by inserting ‘‘(aa)’’ after ‘‘(II)’’; 

18 and 

19 (ii) by adding at the end the fol20 lowing: 

21 ‘‘(bb) The 5-year service requirement 

22 under item (aa) shall begin on the date on 

23 which the alien physician begins work in 

24 the shortage area in any legal status and 

25 not on the date on which an immigrant 


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1 visa petition is filed or approved. Such 

2 service shall be aggregated without regard 

3 to when such service began and without re4 gard to whether such service began during 

5 or in conjunction with a course of graduate 

6 medical education. 

7 ‘‘(cc) An alien physician shall not be 

8 required to submit an employment contract 

9 with a term exceeding the balance of the 5- 

10 year commitment yet to be served or an 

11 employment contract dated within a min12 imum time period before filing a visa peti13 tion under this subsection. 

14 ‘‘(dd) An alien physician shall not be 

15 required to file additional immigrant visa 

16 petitions upon a change of work location 

17 from the location approved in the original 

18 national interest immigrant petition.’’. 

19 (c) TECHNICAL CLARIFICATION REGARDING AD20 VANCED DEGREE FOR PHYSICIANS.—Section 

21 203(b)(2)(A) of the Immigration and Nationality Act (8 

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

23 the following: ‘‘An alien physician holding a foreign med24 ical degree that has been deemed sufficient for acceptance 

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1 lowship program is a member of the professions holding 

2 an advanced degree or its equivalent.’’. 

3 (d) SHORT-TERM WORK AUTHORIZATION FOR PHY4 SICIANS COMPLETING THEIR RESIDENCIES.— 

5 (1) IN GENERAL.—A physician completing 

6 graduate medical education or training described in 

7 section 212(j) of the Immigration and Nationality 

8 Act (8 U.S.C. 1182(j)) as a nonimmigrant described 

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

10 1101(a)(15)(H)(i))— 

11 (A) shall have such nonimmigrant status 

12 automatically extended until October 1 of the 

13 fiscal year for which a petition for a continu14 ation of such nonimmigrant status has been 

15 submitted in a timely manner and the employ16 ment start date for the beneficiary of such peti17 tion is October 1 of that fiscal year; and 

18 (B) shall be authorized to be employed in19 cident to status during the period between the 

20 filing of such petition and October 1 of such fis21 cal year. 

22 (2) TERMINATION.—The physician’s status and 

23 employment authorization shall terminate on the 

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1 tion described in paragraph (1)(A) is rejected, de2 nied or revoked. 

3 (3) AUTOMATIC EXTENSION.—A physician’s 

4 status and employment authorization will automati5 cally extend to October 1 of the next fiscal year if 

6 all of the visas described in section 101(a)(15)(H)(i) 

7 of such Act that were authorized to be issued for the 

8 fiscal year have been issued. 

9 (e) APPLICABILITY OF SECTION 212(e) TO SPOUSES

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

11 or child of an exchange visitor described in section 

12 101(a)(15)(J) of the Immigration and Nationality Act (8 

13 U.S.C. 1101(a)(15)(J)) shall not be subject to the require14 ments under section 212(e) of such Act (8 U.S.C. 

15 1182(e)). 

Æ 


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