I 

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. 

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 ‘‘Doctors Helping He5 roes Act of 2014’’. 

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 com7 pleted service requirements of a waiver re8 quested under section 203(b)(2)(B)(ii), includ9 ing alien physicians who completed such service 

10 before the date of the enactment of the Conrad 

11 State 30 and Physician Access Act and any 

12 spouses or children of such alien physicians. 

13 ‘‘(ii) Nothing in this subparagraph 

14 may be construed— 

15 ‘‘(I) to prevent the filing of a pe16 tition with the Secretary of Homeland 

17 Security for classification under sec18 tion 204(a) or the filing of an applica19 tion for adjustment of status under 

20 section 245 by an alien physician de21 scribed in this subparagraph prior to 

22 the date by which such alien physician 

23 has completed the service described in 

24 section 214(l) or worked full-time as a 

25 physician for an aggregate of 5 years 

26 at the location identified in the section 


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1 214(l) waiver or in an area or areas 

2 designated by the Secretary of Health 

3 and Human Services as having a 

4 shortage of health care professionals; 

5 or 

6 ‘‘(II) to permit the Secretary of 

7 Homeland Security to grant such a 

8 petition or application until the alien 

9 has satisfied all the requirements of 

10 the waiver received under section 

11 214(l).’’. 

12 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

13 (a) IN GENERAL.—Section 214(l)(1)(C) of the Immi14 gration and Nationality Act (8 U.S.C. 1184(l)(1)(C)) is 

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

16 following: 

17 ‘‘(i) the alien demonstrates a bona 

18 fide offer of full-time employment, at a 

19 health care organization, which employ20 ment has been determined by the Secretary 

21 of Homeland Security to be in the public 

22 interest; and 

23 ‘‘(ii) the alien agrees to begin employ24 ment with the health facility or health care 

25 organization in a geographic area or areas 


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1 which are designated by the Secretary of 

2 Health and Human Services as having a 

3 shortage of health care professionals by the 

4 later of the date that is 90 days after re5 ceiving such waiver, 90 days after com6 pleting graduate medical education or 

7 training under a program approved pursu8 ant to section 212(j)(1), or 90 days after 

9 receiving nonimmigrant status or employ10 ment authorization, and agrees to continue 

11 to work for a total of not less than 3 years 

12 in any status authorized for such employ13 ment under this subsection unless— 

14 ‘‘(I) the Secretary determines 

15 that extenuating circumstances exist 

16 that justify a lesser period of employ17 ment at such facility or organization, 

18 in which case the alien shall dem19 onstrate another bona fide offer of 

20 employment at a health facility or 

21 health care organization, for the re22 mainder of such 3-year period; 

23 ‘‘(II) the interested State agency 

24 that requested the waiver attests that 

25 extenuating circumstances exist that 


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1 justify a lesser period of employment 

2 at such facility or organization in 

3 which case the alien shall demonstrate 

4 another bona fide offer of employment 

5 at a health facility or health care or6 ganization so designated by the Sec7 retary of Health and Human Services, 

8 for the remainder of such 3-year pe9 riod; or 

10 ‘‘(III) if the alien elects not to 

11 pursue a determination of extenuating 

12 circumstances pursuant to subclause 

13 (I) or (II), the alien terminates the 

14 alien’s employment relationship with 

15 such facility or organization, in which 

16 case the alien shall be employed for 

17 the remainder of such 3-year period, 

18 and 1 additional year for each termi19 nation, at another health facility or 

20 health care organization in a geo21 graphic area or areas which are des22 ignated by the Secretary of Health 

23 and Human Services as having a 

24 shortage of health care professionals; 

25 and’’. 


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

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

3 is amended by adding at the end the following: 

4 ‘‘(4) An alien granted a waiver under para5 graph (1)(C) shall enter into an employment agree6 ment with the contracting health facility or health 

7 care organization that— 

8 ‘‘(A) specifies the maximum number of on9 call hours per week (which may be a monthly 

10 average) that the alien will be expected to be 

11 available and the compensation the alien will re12 ceive for on-call time; 

13 ‘‘(B) specifies whether the contracting fa14 cility or organization will pay for the alien’s 

15 malpractice insurance premiums, including 

16 whether the employer will provide malpractice 

17 insurance and, if so, the amount of such insur18 ance that will be provided; 

19 ‘‘(C) describes all of the work locations 

20 that the alien will work and a statement that 

21 the contracting facility or organization will not 

22 add additional work locations without the ap23 proval of the Federal agency or State agency 

24 that requested the waiver; and 


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1 ‘‘(D) does not include a non-compete provi2 sion. 

3 ‘‘(5) An alien granted a waiver under para4 graph (1)(C) whose employment relationship with a 

5 health facility or health care organization terminates 

6 during the 3-year service period required by such 

7 paragraph— 

8 ‘‘(A) shall have a period of 120 days begin9 ning on the date of such termination of employ10 ment to submit to the Secretary of Homeland 

11 Security applications or petitions to commence 

12 employment with another contracting health fa13 cility or health care organization in a geo14 graphic area or areas which are designated by 

15 the Secretary of Health and Human Services as 

16 having a shortage of health care professionals; 

17 and 

18 ‘‘(B) shall be considered to be maintaining 

19 lawful status in an authorized stay during the 

20 120-day period referred to in subsection (A).’’. 

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

25 following: 


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

2 35 waivers under paragraph (1)(B) for a fiscal year 

3 if 90 percent of the waivers available to the States 

4 receiving at least 5 waivers were used in the pre5 vious fiscal year. 

6 ‘‘(ii) When an allocation has occurred 

7 under clause (i), all States shall be allotted 

8 an additional 5 waivers under paragraph 

9 (1)(B) for each subsequent fiscal year if 90 

10 percent of the waivers available to the 

11 States receiving at least 5 waivers were 

12 used in the previous fiscal year. If the 

13 States are allotted 45 or more waivers for 

14 a fiscal year, the States will only receive an 

15 additional increase of 5 waivers the fol16 lowing fiscal year if 95 percent of the waiv17 ers available to the States receiving at 

18 least 1 waiver were used in the previous 

19 fiscal year. 

20 ‘‘(B) Any increase in allotments under sub21 paragraph (A) shall be maintained indefinitely, 

22 unless in a fiscal year, the total number of such 

23 waivers granted is 5 percent lower than in the 

24 last year in which there was an increase in the 


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1 number of waivers allotted pursuant to this 

2 paragraph, in which case— 

3 ‘‘(i) the number of waivers allotted 

4 shall be decreased by 5 for all States be5 ginning in the next fiscal year; and 

6 ‘‘(ii) each additional 5 percent de7 crease in such waivers granted from the 

8 last year in which there was an increase in 

9 the allotment, shall result in an additional 

10 decrease of 5 waivers allotted for all 

11 States, provided that the number of waiv12 ers allotted for all States shall not drop 

13 below 30.’’. 

14 (b) ACADEMIC MEDICAL CENTERS.—Section 

15 214(l)(1)(D) of the Immigration and Nationality Act (8 

16 U.S.C. 1184(l)(1)(D)) is amended— 

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

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

19 end and inserting ‘‘;’’; and 

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

21 ‘‘(iv) in the case of a request by an in22 terested State agency— 

23 ‘‘(I) the head of such agency de24 termines that the alien is to practice 

25 medicine in, or be on the faculty of a 


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1 residency program at, an academic 

2 medical center (as that term is de3 fined in section 411.355(e)(2) of title 

4 42, Code of Federal Regulations, or 

5 similar successor regulation), without 

6 regard to whether such facility is lo7 cated within an area designated by 

8 the Secretary of Health and Human 

9 Services as having a shortage of 

10 health care professionals; and 

11 ‘‘(II) the head of such agency de12 termines that— 

13 ‘‘(aa) the alien physician’s 

14 work is in the public interest; 

15 and 

16 ‘‘(bb) the grant of such 

17 waiver would not cause the num18 ber of the waivers granted on be19 half of aliens for such State for 

20 a fiscal year (within the limita21 tion in subparagraph (B) and 

22 subject to paragraph (6)) in ac23 cordance with the conditions of 

24 this clause to exceed 3; and’’. 


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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 

9 agrees to work on a full-time 

10 basis practicing primary care, 

11 specialty medicine, or a combina12 tion thereof, in an area or areas 

13 designated by the Secretary of 

14 Health and Human Services as 

15 having a shortage of health care 

16 professionals, or at a health care 

17 facility under the jurisdiction of 

18 the Secretary of Veterans Affairs; 

19 or 

20 ‘‘(bb) the alien physician is 

21 pursuing such waiver based upon 

22 service at a facility or facilities 

23 that serve patients who reside in 

24 a geographic area or areas des25 ignated by the Secretary of 


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1 Health and Human Services as 

2 having a shortage of health care 

3 professionals (without regard to 

4 whether such facility or facilities 

5 are located within such an area) 

6 and a Federal agency, or a local, 

7 county, regional, or State depart8 ment of public health determines 

9 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)(II) of the Immigration and Na13 tionality Act (8 U.S.C. 1153(B)(ii)(II)) is amend14 ed— 

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

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

17 ‘‘(bb) The 5-year service requirement of item (aa) 

18 shall be counted from the date the alien physician begins 

19 work in the shortage area in any legal status and not the 

20 date an immigrant visa petition is filed or approved. Such 

21 service shall be aggregated without regard to when such 

22 service began and without regard to whether such service 

23 began during or in conjunction with a course of graduate 

24 medical education. 


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1 ‘‘(cc) An alien physician shall not be required to sub2 mit an employment contract with a term exceeding the 

3 balance of the 5-year commitment yet to be served, nor 

4 an employment contract dated within a minimum time pe5 riod prior to filing of a visa petition pursuant to this sub6 section. 

7 ‘‘(dd) An alien physician shall not be required to file 

8 additional immigrant visa petitions upon a change of work 

9 location from the location approved in the original national 

10 interest immigrant petition.’’. 

11 (d) TECHNICAL CLARIFICATION REGARDING AD12 VANCED DEGREE FOR PHYSICIANS.—Section 

13 203(b)(2)(A) of the Immigration and Nationality Act (8 

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

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

16 has been deemed sufficient for acceptance by an accredited 

17 United States medical residency or fellowship program is 

18 a member of the professions holding an advanced degree 

19 or its equivalent.’’. 

20 (e) SHORT-TERM WORK AUTHORIZATION FOR PHY21 SICIANS COMPLETING THEIR RESIDENCIES.—A physician 

22 completing graduate medical education or training as de23 scribed in section 212(j) of the Immigration and Nation24 ality Act (8 U.S.C. 1182(j)) as a nonimmigrant described 

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


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1 1101(a)(15)(H)(i)) shall have such nonimmigrant status 

2 automatically extended until October 1 of the fiscal year 

3 for which a petition for a continuation of such non4 immigrant status has been submitted in a timely manner 

5 and where the employment start date for the beneficiary 

6 of such petition is October 1 of that fiscal year. Such phy7 sician shall be authorized to be employed incident to status 

8 during the period between the filing of such petition and 

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

10 status and employment authorization shall terminate 30 

11 days from the date such petition is rejected, denied or re12 voked. A physician’s status and employment authorization 

13 will automatically extend to October 1 of the next fiscal 

14 year if all visas as described in such section 

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

16 year have been issued. 

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

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

19 or child of an exchange visitor described in section 

20 101(a)(15)(J) of the Immigration and Nationality Act (8 

21 U.S.C. 1101(a)(15)(J)) shall not be subject to the require22 ments of section 212(e) of the Immigration and Nation23 ality Act (8 U.S.C. 1182(e)). 


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1 SEC. 7. VETERANS HEALTH CENTERS. 

2 Section 214(l) of the Immigration and Nationality 

3 Act (8 U.S.C. 1184(l)), as amended by this Act, is further 

4 amended— 

5 (1) in paragraph (1)— 

6 (A) in subparagraph (B), by inserting be7 fore the semicolon at the end the following: ‘‘, 

8 except as otherwise provided under subpara9 graph (E)’’; and 

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

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

13 ‘‘(i) if the Secretary of Veterans Af14 fairs determines that facilities of the De15 partment are not capable of furnishing 

16 covered health services to eligible veterans 

17 because such facilities lack— 

18 ‘‘(I) the required personnel who 

19 are appropriately trained and experi20 enced; or 

21 ‘‘(II) the ability to provide timely 

22 and reasonable access; 

23 ‘‘(ii) the head of such State agency 

24 determines that— 


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1 ‘‘(I) the alien is to practice medi2 cine in a Veterans Health Administra3 tion Facility; and 

4 ‘‘(II) the alien physician’s work is 

5 in the public interest; and 

6 ‘‘(iii) the grant of such waiver would 

7 not cause the number of waivers allotted 

8 for that State for that fiscal year under 

9 this subparagraph to exceed 5.’’; and 

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

11 ‘‘(7) For purposes of paragraph (1)(E)— 

12 ‘‘(A) the term ‘covered health services’ 

13 means, with respect to an eligible veteran, any 

14 hospital care, medical service, rehabilitative 

15 service, or preventative health service that is 

16 authorized to be provided by the Secretary to 

17 the veteran under chapter 17 of title 38, United 

18 States Code, or any other provision of law; and 

19 ‘‘(B) the term ‘eligible veteran’ means a 

20 veteran enrolled in the health care system es21 tablished under section 1705(a) of title 38, 

22 United States Code, who elects to receive care 

23 under section 1703.’’. 

Æ 


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