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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4951 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4951

To provide incentives to physicians to practice in rural and medically 
            underserved communities, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 24, 2014

  Mr. Bera of California (for himself and Mr. Meadows) 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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Doctors Helping Heroes Act of 
2014''.

SEC. 2. CONRAD STATE 30 PROGRAM.

    Section 220(c) of the Immigration and Nationality Technical 
Corrections Act of 1994 (Public Law 103-416; 8 U.S.C. 1182 note) is 
amended by striking ``and before September 30, 2015''.

SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN MEDICALLY 
              UNDERSERVED COMMUNITIES.

    Section 201(b)(1) of the Immigration and Nationality Act (8 U.S.C. 
1151(b)(1)) is amended by adding at the end the following:
                    ``(F)(i) Alien physicians who have completed 
                service requirements of a waiver requested under 
                section 203(b)(2)(B)(ii), including alien physicians 
                who completed such service before the date of the 
                enactment of the Conrad State 30 and Physician Access 
                Act and any spouses or children of such alien 
                physicians.
                            ``(ii) Nothing in this subparagraph may be 
                        construed--
                                    ``(I) to prevent the filing of a 
                                petition with the Secretary of Homeland 
                                Security for classification under 
                                section 204(a) or the filing of an 
                                application for adjustment of status 
                                under section 245 by an alien physician 
                                described in this subparagraph prior to 
                                the date by which such alien physician 
                                has completed the service described in 
                                section 214(l) or worked full-time as a 
                                physician for an aggregate of 5 years 
                                at the location identified in the 
                                section 214(l) waiver or in an area or 
                                areas designated by the Secretary of 
                                Health and Human Services as having a 
                                shortage of health care professionals; 
                                or
                                    ``(II) to permit the Secretary of 
                                Homeland Security to grant such a 
                                petition or application until the alien 
                                has satisfied all the requirements of 
                                the waiver received under section 
                                214(l).''.

SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS.

    (a) In General.--Section 214(l)(1)(C) of the Immigration and 
Nationality Act (8 U.S.C. 1184(l)(1)(C)) is amended by striking clauses 
(i) and (ii) and inserting the following:
                            ``(i) the alien demonstrates a bona fide 
                        offer of full-time employment, at a health care 
                        organization, which employment has been 
                        determined by the Secretary of Homeland 
                        Security to be in the public interest; and
                            ``(ii) the alien agrees to begin employment 
                        with the health facility or health care 
                        organization in a geographic area or areas 
                        which are designated by the Secretary of Health 
                        and Human Services as having a shortage of 
                        health care professionals by the later of the 
                        date that is 90 days after receiving such 
                        waiver, 90 days after completing graduate 
                        medical education or training under a program 
                        approved pursuant to section 212(j)(1), or 90 
                        days after receiving nonimmigrant status or 
                        employment authorization, and agrees to 
                        continue to work for a total of not less than 3 
                        years in any status authorized for such 
                        employment under this subsection unless--
                                    ``(I) the Secretary determines that 
                                extenuating circumstances exist that 
                                justify a lesser period of employment 
                                at such facility or organization, in 
                                which case the alien shall demonstrate 
                                another bona fide offer of employment 
                                at a health facility or health care 
                                organization, for the remainder of such 
                                3-year period;
                                    ``(II) the interested State agency 
                                that requested the waiver attests that 
                                extenuating circumstances exist that 
                                justify a lesser period of employment 
                                at such facility or organization in 
                                which case the alien shall demonstrate 
                                another bona fide offer of employment 
                                at a health facility or health care 
                                organization so designated by the 
                                Secretary of Health and Human Services, 
                                for the remainder of such 3-year 
                                period; or
                                    ``(III) if the alien elects not to 
                                pursue a determination of extenuating 
                                circumstances pursuant to subclause (I) 
                                or (II), the alien terminates the 
                                alien's employment relationship with 
                                such facility or organization, in which 
                                case the alien shall be employed for 
                                the remainder of such 3-year period, 
                                and 1 additional year for each 
                                termination, at another health facility 
                                or health care organization in a 
                                geographic area or areas which are 
                                designated by the Secretary of Health 
                                and Human Services as having a shortage 
                                of health care professionals; and''.
    (b) Contract Requirements.--Section 214(l) of the Immigration and 
Nationality Act (8 U.S.C. 1184(l)) is amended by adding at the end the 
following:
            ``(4) An alien granted a waiver under paragraph (1)(C) 
        shall enter into an employment agreement with the contracting 
        health facility or health care organization that--
                    ``(A) specifies the maximum number of on-call hours 
                per week (which may be a monthly average) that the 
                alien will be expected to be available and the 
                compensation the alien will receive for on-call time;
                    ``(B) specifies whether the contracting facility or 
                organization will pay for the alien's malpractice 
                insurance premiums, including whether the employer will 
                provide malpractice insurance and, if so, the amount of 
                such insurance that will be provided;
                    ``(C) describes all of the work locations that the 
                alien will work and a statement that the contracting 
                facility or organization will not add additional work 
                locations without the approval of the Federal agency or 
                State agency that requested the waiver; and
                    ``(D) does not include a non-compete provision.
            ``(5) An alien granted a waiver under paragraph (1)(C) 
        whose employment relationship with a health facility or health 
        care organization terminates during the 3-year service period 
        required by such paragraph--
                    ``(A) shall have a period of 120 days beginning on 
                the date of such termination of employment to submit to 
                the Secretary of Homeland Security applications or 
                petitions to commence employment with another 
                contracting health facility or health care organization 
                in a geographic area or areas which are designated by 
                the Secretary of Health and Human Services as having a 
                shortage of health care professionals; and
                    ``(B) shall be considered to be maintaining lawful 
                status in an authorized stay during the 120-day period 
                referred to in subsection (A).''.

SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS.

    (a) In General.--Section 214(l) of the Immigration and Nationality 
Act (8 U.S.C. 1184(l)), as amended by section 4(b), is further amended 
by adding at the end the following:
            ``(6)(A)(i) All States shall be allotted a total of 35 
        waivers under paragraph (1)(B) for a fiscal year if 90 percent 
        of the waivers available to the States receiving at least 5 
        waivers were used in the previous fiscal year.
                            ``(ii) When an allocation has occurred 
                        under clause (i), all States shall be allotted 
                        an additional 5 waivers under paragraph (1)(B) 
                        for each subsequent fiscal year if 90 percent 
                        of the waivers available to the States 
                        receiving at least 5 waivers were used in the 
                        previous fiscal year. If the States are 
                        allotted 45 or more waivers for a fiscal year, 
                        the States will only receive an additional 
                        increase of 5 waivers the following fiscal year 
                        if 95 percent of the waivers available to the 
                        States receiving at least 1 waiver were used in 
                        the previous fiscal year.
                    ``(B) Any increase in allotments under subparagraph 
                (A) shall be maintained indefinitely, unless in a 
                fiscal year, the total number of such waivers granted 
                is 5 percent lower than in the last year in which there 
                was an increase in the number of waivers allotted 
                pursuant to this paragraph, in which case--
                            ``(i) the number of waivers allotted shall 
                        be decreased by 5 for all States beginning in 
                        the next fiscal year; and
                            ``(ii) each additional 5 percent decrease 
                        in such waivers granted from the last year in 
                        which there was an increase in the allotment, 
                        shall result in an additional decrease of 5 
                        waivers allotted for all States, provided that 
                        the number of waivers allotted for all States 
                        shall not drop below 30.''.
    (b) Academic Medical Centers.--Section 214(l)(1)(D) of the 
Immigration and Nationality Act (8 U.S.C. 1184(l)(1)(D)) is amended--
            (1) in clause (ii), by striking ``and'' at the end;
            (2) in clause (iii), by striking the period at the end and 
        inserting ``;''; and
            (3) by adding at the end the following:
                            ``(iv) in the case of a request by an 
                        interested State agency--
                                    ``(I) the head of such agency 
                                determines that the alien is to 
                                practice medicine in, or be on the 
                                faculty of a residency program at, an 
                                academic medical center (as that term 
                                is defined in section 411.355(e)(2) of 
                                title 42, Code of Federal Regulations, 
                                or similar successor regulation), 
                                without regard to whether such facility 
                                is located within an area designated by 
                                the Secretary of Health and Human 
                                Services as having a shortage of health 
                                care professionals; and
                                    ``(II) the head of such agency 
                                determines that--
                                            ``(aa) the alien 
                                        physician's work is in the 
                                        public interest; and
                                            ``(bb) the grant of such 
                                        waiver would not cause the 
                                        number of the waivers granted 
                                        on behalf of aliens for such 
                                        State for a fiscal year (within 
                                        the limitation in subparagraph 
                                        (B) and subject to paragraph 
                                        (6)) in accordance with the 
                                        conditions of this clause to 
                                        exceed 3; and''.

SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, AND OTHER PROVISIONS 
              RELATED TO PHYSICIAN IMMIGRATION.

    (a) Dual Intent for Physicians Seeking Graduate Medical Training.--
Section 214(b) of the Immigration and Nationality Act (8 U.S.C. 
1184(b)) is amended by striking ``(other than a nonimmigrant described 
in subparagraph (L) or (V) of section 101(a)(15), and other than a 
nonimmigrant described in any provision of section 101(a)(15)(H)(i) 
except subclause (b1) of such section)'' and inserting ``(other than a 
nonimmigrant described in subparagraph (L) or (V) of section 
101(a)(15), a nonimmigrant described in any provision of section 
101(a)(15)(H)(i), except subclause (b1) of such section, and an alien 
coming to the United States to receive graduate medical education or 
training as described in section 212(j) or to take examinations 
required to receive graduate medical education or training as described 
in section 212(j))''.
    (b) Allowable Visa Status for Physicians Fulfilling Waiver 
Requirements in Medically Underserved Areas.--Section 214(l)(2)(A) of 
the Immigration and Nationality Act (8 U.S.C. 1184(l)(2)(A)) is amended 
by striking ``an alien described in section 101(a)(15)(H)(i)(b).'' and 
inserting ``any status authorized for employment under this Act.''.
    (c) Physician National Interest Waiver Clarifications.--
            (1) Practice and geographic area.--Section 
        203(b)(2)(B)(ii)(I) of the Immigration and Nationality Act (8 
        U.S.C. 1153(b)(2)(B)(ii)(I)) is amended by striking items (aa) 
        and (bb) and inserting the following:
                                            ``(aa) the alien physician 
                                        agrees to work on a full-time 
                                        basis practicing primary care, 
                                        specialty medicine, or a 
                                        combination thereof, in an area 
                                        or areas designated by the 
                                        Secretary of Health and Human 
                                        Services as having a shortage 
                                        of health care professionals, 
                                        or at a health care facility 
                                        under the jurisdiction of the 
                                        Secretary of Veterans Affairs; 
                                        or
                                            ``(bb) the alien physician 
                                        is pursuing such waiver based 
                                        upon service at a facility or 
                                        facilities that serve patients 
                                        who reside in a geographic area 
                                        or areas designated by the 
                                        Secretary of Health and Human 
                                        Services as having a shortage 
                                        of health care professionals 
                                        (without regard to whether such 
                                        facility or facilities are 
                                        located within such an area) 
                                        and a Federal agency, or a 
                                        local, county, regional, or 
                                        State department of public 
                                        health determines the alien 
                                        physician's work was or will be 
                                        in the public interest.''.
            (2) Five-year service requirement.--Section 
        203(b)(2)(B)(ii)(II) of the Immigration and Nationality Act (8 
        U.S.C. 1153(B)(ii)(II)) is amended--
                    (A) by inserting ``(aa)'' after ``(II)''; and
                    (B) by adding at the end the following:
    ``(bb) The 5-year service requirement of item (aa) shall be counted 
from the date the alien physician begins work in the shortage area in 
any legal status and not the date an immigrant visa petition is filed 
or approved. Such service shall be aggregated without regard to when 
such service began and without regard to whether such service began 
during or in conjunction with a course of graduate medical education.
    ``(cc) An alien physician shall not be required to submit an 
employment contract with a term exceeding the balance of the 5-year 
commitment yet to be served, nor an employment contract dated within a 
minimum time period prior to filing of a visa petition pursuant to this 
subsection.
    ``(dd) An alien physician shall not be required to file additional 
immigrant visa petitions upon a change of work location from the 
location approved in the original national interest immigrant 
petition.''.
    (d) Technical Clarification Regarding Advanced Degree for 
Physicians.--Section 203(b)(2)(A) of the Immigration and Nationality 
Act (8 U.S.C. 1153(b)(2)(A)) is amended by adding at the end ``An alien 
physician holding a foreign medical degree that has been deemed 
sufficient for acceptance by an accredited United States medical 
residency or fellowship program is a member of the professions holding 
an advanced degree or its equivalent.''.
    (e) Short-Term Work Authorization for Physicians Completing Their 
Residencies.--A physician completing graduate medical education or 
training as described in section 212(j) of the Immigration and 
Nationality Act (8 U.S.C. 1182(j)) as a nonimmigrant described in 
section 101(a)(15)(H)(i) of such Act (8 U.S.C. 1101(a)(15)(H)(i)) shall 
have such nonimmigrant status automatically extended until October 1 of 
the fiscal year for which a petition for a continuation of such 
nonimmigrant status has been submitted in a timely manner and where the 
employment start date for the beneficiary of such petition is October 1 
of that fiscal year. Such physician shall be authorized to be employed 
incident to status during the period between the filing of such 
petition and October 1 of such fiscal year. However, the physician's 
status and employment authorization shall terminate 30 days from the 
date such petition is rejected, denied or revoked. A physician's status 
and employment authorization will automatically extend to October 1 of 
the next fiscal year if all visas as described in such section 
101(a)(15)(H)(i) authorized to be issued for the fiscal year have been 
issued.
    (f) Applicability of Section 212(e) to Spouses and Children of J-1 
Exchange Visitors.--A spouse or child of an exchange visitor described 
in section 101(a)(15)(J) of the Immigration and Nationality Act (8 
U.S.C. 1101(a)(15)(J)) shall not be subject to the requirements of 
section 212(e) of the Immigration and Nationality Act (8 U.S.C. 
1182(e)).

SEC. 7. VETERANS HEALTH CENTERS.

    Section 214(l) of the Immigration and Nationality Act (8 U.S.C. 
1184(l)), as amended by this Act, is further amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (B), by inserting before the 
                semicolon at the end the following: ``, except as 
                otherwise provided under subparagraph (E)''; and
                    (B) by adding at the end the following:
                    ``(E) in the case of a request by an interested 
                State agency--
                            ``(i) if the Secretary of Veterans Affairs 
                        determines that facilities of the Department 
                        are not capable of furnishing covered health 
                        services to eligible veterans because such 
                        facilities lack--
                                    ``(I) the required personnel who 
                                are appropriately trained and 
                                experienced; or
                                    ``(II) the ability to provide 
                                timely and reasonable access;
                            ``(ii) the head of such State agency 
                        determines that--
                                    ``(I) the alien is to practice 
                                medicine in a Veterans Health 
                                Administration Facility; and
                                    ``(II) the alien physician's work 
                                is in the public interest; and
                            ``(iii) the grant of such waiver would not 
                        cause the number of waivers allotted for that 
                        State for that fiscal year under this 
                        subparagraph to exceed 5.''; and
            (2) by adding at the end the following:
            ``(7) For purposes of paragraph (1)(E)--
                    ``(A) the term `covered health services' means, 
                with respect to an eligible veteran, any hospital care, 
                medical service, rehabilitative service, or 
                preventative health service that is authorized to be 
                provided by the Secretary to the veteran under chapter 
                17 of title 38, United States Code, or any other 
                provision of law; and
                    ``(B) the term `eligible veteran' means a veteran 
                enrolled in the health care system established under 
                section 1705(a) of title 38, United States Code, who 
                elects to receive care under section 1703.''.
                                 <all>
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