I 

118TH CONGRESS 

1ST SESSION H. R. 4942 

To provide incentives to physicians to practice in rural and medically 

underserved communities, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 26, 2023 

Mr. SCHNEIDER (for himself, Mr. BACON, Ms. GARCIA of Texas, Mr. 

VALADAO, Mr. PANETTA, Ms. WILLIAMS of Georgia, Mr. MORELLE, Ms. 

WILD, Mr. POCAN, Mr. CORREA, Ms. ROSS, Mr. CLEAVER, Mr. 

MOULTON, Mr. FITZPATRICK, Ms. SEWELL, Mr. COSTA, Mr. CA ́RDENAS, 

Mr. CASTEN, Ms. DELBENE, Mr. VARGAS, Mr. HIGGINS of Louisiana, 

Mr. AUCHINCLOSS, Mr. GARAMENDI, Ms. JAYAPAL, Ms. MOORE of Wisconsin, Ms. KELLY of Illinois, Ms. BLUNT ROCHESTER, Mr. DAVIS of 

North Carolina, Mr. BERA, Ms. PINGREE, Mr. STANTON, Ms. 

VELA ́ZQUEZ, Ms. FOXX, Mr. VICENTE GONZALEZ of Texas, Mr. KILDEE, 

Mr. PASCRELL, Mr. DAVID SCOTT of Georgia, Mr. ALLRED, Mr. GOMEZ, 

Mr. CARBAJAL, Mrs. GONZA ́LEZ-COLO ́N, Mr. KRISHNAMOORTHI, Mr. 

MEUSER, Mr. KILMER, Ms. PETTERSEN, Mr. VASQUEZ, Mr. PHILLIPS, 

Ms. SCHOLTEN, Ms. SHERRILL, Mr. COLE, Mr. HIGGINS of New York, 

and Mr. GOTTHEIMER) 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Conrad State 30 and 

3 Physician Access Reauthorization Act’’. 

4 SEC. 2. CONRAD STATE 30 PROGRAM. 

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

6 and Nationality Technical Corrections Act of 1994 (Public 

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

8 ‘‘September 30, 2015’’ and inserting ‘‘on the date that 

9 is 3 years after the date of the enactment of the Conrad 

10 State 30 and Physician Access Reauthorization Act’’. 

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

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

13 30, 2018. 

14 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 

15 MEDICALLY UNDERSERVED COMMUNITIES. 

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

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

18 end the following: 

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

20 service requirements of a waiver requested under 

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

22 ‘‘(I) alien physicians who completed such 

23 service before the date of the enactment of the 

24 Conrad State 30 and Physician Access Act; and 

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

26 physician described in subclause (I). 


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1 ‘‘(ii) Nothing in this subparagraph may be con2 strued— 

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

4 the Secretary of Homeland Security for classi5 fication under section 204(a) or the filing of an 

6 application for adjustment of status under sec7 tion 245 by an alien physician described in this 

8 subparagraph before the date by which such 

9 alien physician has completed the service de10 scribed in section 214(l) or worked full-time as 

11 a physician for an aggregate of 5 years at the 

12 location identified in the section 214(l) waiver 

13 or in an area or areas designated by the Sec14 retary of Health and Human Services as having 

15 a shortage of health care professionals; or 

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

17 Security to grant a petition or application de18 scribed in subclause (I) until the alien has sat19 isfied all of the requirements of the waiver re20 ceived under section 214(l).’’. 

21 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

22 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY

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

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


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

2 by striking ‘‘Attorney General’’ and inserting ‘‘Sec3 retary of Homeland Security’’; 

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

5 of the United States Information Agency’’ and in6 serting ‘‘Secretary of State’’; 

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

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

9 semicolon at the end; 

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

11 and (ii) and inserting the following: 

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

13 offer of full-time employment at a health facil14 ity or health care organization, which employ15 ment has been determined by the Secretary of 

16 Homeland Security to be in the public interest; 

17 and 

18 ‘‘(ii) the alien— 

19 ‘‘(I) has accepted employment with 

20 the health facility or health care organiza21 tion in a geographic area or areas which 

22 are designated by the Secretary of Health 

23 and Human Services as having a shortage 

24 of health care professionals; 


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1 ‘‘(II) begins employment by the later 

2 of the date that is— 

3 ‘‘(aa) 120 days after receiving 

4 such waiver; 

5 ‘‘(bb) 120 days after completing 

6 graduate medical education or train7 ing under a program approved pursu8 ant to section 212(j)(1); or 

9 ‘‘(cc) 120 days after receiving 

10 nonimmigrant status or employment 

11 authorization, if the alien or the 

12 alien’s employer petitions for such 

13 nonimmigrant status or employment 

14 authorization not later than 120 days 

15 after the date on which the alien com16 pletes his or her graduate medical 

17 education or training under a pro18 gram approved pursuant to section 

19 212(j)(1); and 

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

21 a total of not less than 3 years in the sta22 tus authorized for such employment under 

23 this subsection, except as provided in para24 graph (8).’’; and 


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1 (5) in subparagraph (D), in the matter pre2 ceding clause (i), by inserting ‘‘(except as provided 

3 in paragraph (8))’’. 

4 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL5 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER6 SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 

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

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

9 agency or an interested State agency for rec10 ommendation of a waiver under this section by a 

11 physician who is maintaining valid nonimmigrant 

12 status under section 101(a)(15)(J) and a favorable 

13 recommendation by the Secretary of State, the Sec14 retary of Homeland Security may change the status 

15 of such physician to any status authorized for em16 ployment under this Act. The numerical limitations 

17 contained in subsection (g)(1)(A) shall not apply to 

18 any alien whose status is changed under this sub19 paragraph.’’. 

20 (c) VIOLATION OF AGREEMENTS.—Section 

21 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

22 amended by inserting ‘‘substantial requirement of an’’ be23 fore ‘‘agreement entered into’’. 

24 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED

25 AREAS.—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 ‘‘(4)(A) If an interested State agency denies an appli4 cation for a waiver under paragraph (1)(B) from a physi5 cian pursuing graduate medical education or training pur6 suant to section 101(a)(15)(J) because the State has re7 quested the maximum number of waivers permitted for 

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

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

10 to seek a waiver under this subsection (except for para11 graph (1)(D)(ii)) to work for an employer described in 

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

13 the maximum number of waivers. 

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

15 for the employer referred to in subparagraph (A) during 

16 the period beginning on the date on which a new waiver 

17 application is filed with such State and ending on the ear18 lier of— 

19 ‘‘(i) the date on which the Secretary of Home20 land Security denies such waiver; or 

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

22 an application for change of status under paragraph 

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


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

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

3 by adding at the end the following: 

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

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

6 contracting health facility or health care organization 

7 that— 

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

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

10 that the alien will be expected to be available and 

11 the compensation the alien will receive for on-call 

12 time; 

13 ‘‘(B) specifies— 

14 ‘‘(i) whether the contracting facility or or15 ganization— 

16 ‘‘(I) has secured medical malpractice 

17 liability protection for the alien under sec18 tion 224(g) of the Public Health Service 

19 Act (42 U.S.C. 233(g)); or 

20 ‘‘(II) will pay the alien’s malpractice 

21 insurance premiums; 

22 ‘‘(ii) whether the employer will provide 

23 malpractice insurance for the alien; and 

24 ‘‘(iii) the amount of such liability protec25 tion that will be provided; 


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

2 alien will work and includes a statement that the 

3 contracting facility or organization will not add addi4 tional work locations without the approval of the 

5 Federal agency or State agency that requested the 

6 waiver; and 

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

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

9 whose employment relationship with a health facility or 

10 health care organization terminates under paragraph 

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

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

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

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

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

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

17 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER

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

19 section, is further amended by adding at the end the fol20 lowing: 

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

22 terminates the recipient’s employment with a health facil23 ity or health care organization pursuant to paragraph 

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

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


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1 accepts new employment with such a facility or organiza2 tion in a different State, the State from which the alien 

3 is departing may be accorded an additional waiver by the 

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

5 alien’s employment was terminated.’’. 

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

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

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

9 ‘‘(8) The 3-year work requirement set forth in sub10 paragraphs (C) and (D) of paragraph (1) shall not apply 

11 if— 

12 ‘‘(A)(i) the Secretary of Homeland Security de13 termines that extenuating circumstances, including 

14 violations by the employer of the employment agree15 ment with the alien or of labor and employment 

16 laws, exist that justify a lesser period of employment 

17 at such facility or organization; 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; 

3 ‘‘(B)(i) the interested State agency that re4 quested the waiver attests that extenuating cir5 cumstances, including violations by the employer of 

6 the employment agreement with the alien or of labor 

7 and employment laws, exist that justify a lesser pe8 riod of employment at such facility or organization; 

9 and 

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

11 days after the employment termination date (unless 

12 the Secretary determines that extenuating cir13 cumstances would justify an extension), another 

14 bona fide offer of employment at a health facility or 

15 health care organization in a geographic area or 

16 areas which are designated by the Secretary of 

17 Health and Human Services as having a shortage of 

18 health care professionals, for the remainder of such 

19 3-year period; or 

20 ‘‘(C) the alien— 

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

22 extenuating circumstances pursuant to sub23 clause (A) or (B); 


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1 ‘‘(ii) terminates the alien’s employment re2 lationship with the health facility or health care 

3 organization at which the alien was employed; 

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

5 after the employment termination date, another 

6 bona fide offer of employment at a health facil7 ity or health care organization in a geographic 

8 area or areas, in the State that requested the 

9 alien’s waiver, which are designated by the Sec10 retary of Health and Human Services as having 

11 a shortage of health care professionals; and 

12 ‘‘(iv) agrees to be employed for the remain13 der of such 3-year period, and 1 additional year 

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

15 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 

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

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

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

19 following: 

20 ‘‘(9)(A)(i) All States shall be allotted a total of 35 

21 waivers under paragraph (1)(B) for a fiscal year if 90 per22 cent of the waivers available to the States receiving at 

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

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

25 States shall be allotted an additional 5 waivers under 


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

2 percent of the waivers available to the States receiving at 

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

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

5 the States will only receive an additional increase of 5 

6 waivers the following fiscal year if 95 percent of the waiv7 ers available to the States receiving at least 1 waiver were 

8 used in the previous fiscal year. 

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

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

11 the total number of such waivers granted is 5 percent 

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

13 in the number of waivers allotted pursuant to this para14 graph, in which case— 

15 ‘‘(i) the number of waivers allotted shall be de16 creased by 5 for all States beginning in the next fis17 cal year; and 

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

19 waivers granted from the last year in which there 

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

21 additional decrease of 5 waivers allotted for all 

22 States, provided that the number of waivers allotted 

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


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1 (b) ACADEMIC MEDICAL CENTERS.—Section 

2 214(l)(1)(D) of such Act (8 U.S.C. 1184(l)(1)(D)) is 

3 amended— 

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

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

6 end and inserting ‘‘; and’’; and 

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

8 ‘‘(iv) in the case of a request by an inter9 ested State agency— 

10 ‘‘(I) the head of such agency deter11 mines that the alien is to practice medicine 

12 in, or be on the faculty of a residency pro13 gram at, an academic medical center (as 

14 that term is defined in section 

15 411.355(e)(2) of title 42, Code of Federal 

16 Regulations, or similar successor regula17 tion), without regard to whether such facil18 ity is located within an area designated by 

19 the Secretary of Health and Human Serv20 ices as having a shortage of health care 

21 professionals; and 

22 ‘‘(II) the head of such agency deter23 mines that— 

24 ‘‘(aa) the alien physician’s work 

25 is in the public interest; and 


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1 ‘‘(bb) the grant of such waiver 

2 would not cause the number of the 

3 waivers granted on behalf of aliens for 

4 such State for a fiscal year (within 

5 the limitation in subparagraph (B) 

6 and subject to paragraph (6)) in ac7 cordance with the conditions of this 

8 clause to exceed 3.’’. 

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

10 AND OTHER PROVISIONS RELATED TO PHYSI11 CIAN IMMIGRATION. 

12 (a) DUAL INTENT FOR PHYSICIANS SEEKING GRAD13 UATE MEDICAL TRAINING.—Section 214(b) of the Immi14 gration and Nationality Act (8 U.S.C. 1184(b)) is amend15 ed by striking ‘‘(other than a nonimmigrant described in 

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

17 than a nonimmigrant described in any provision of section 

18 101(a)(15)(H)(i) except subclause (b1) of such section)’’ 

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

20 subparagraph (L) or (V) of section 101(a)(15), a non21 immigrant described in any provision of section 

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

23 and an alien coming to the United States to receive grad24 uate medical education or training as described in section 

25 212(j) or to take examinations required to receive gradVerDate Sep 11 2014 01:38 Aug 12, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H4942.IH H4942

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1 uate medical education or training as described in section 

2 212(j))’’. 

3 (b) PHYSICIAN NATIONAL INTEREST WAIVER CLARI4 FICATIONS.— 

5 (1) PRACTICE AND GEOGRAPHIC AREA.—Sec6 tion 203(b)(2)(B)(ii)(I) of the Immigration and Na7 tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 

8 amended by striking items (aa) and (bb) and insert9 ing the following: 

10 ‘‘(aa) the alien physician agrees to 

11 work on a full-time basis practicing pri12 mary care, specialty medicine, or a com13 bination thereof, in an area or areas des14 ignated by the Secretary of Health and 

15 Human Services as having a shortage of 

16 health care professionals, or at a health 

17 care facility under the jurisdiction of the 

18 Secretary of Veterans Affairs; or 

19 ‘‘(bb) the alien physician is pursuing 

20 such waiver based upon service at a facility 

21 or facilities that serve patients who reside 

22 in a geographic area or areas designated 

23 by the Secretary of Health and Human 

24 Services as having a shortage of health 

25 care professionals (without regard to 


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1 whether such facility or facilities are lo2 cated within such an area) and a Federal 

3 agency, or a local, county, regional, or 

4 State department of public health deter5 mines the alien physician’s work was or 

6 will be in the public interest.’’. 

7 (2) FIVE-YEAR SERVICE REQUIREMENT.—Sec8 tion 203(b)(2)(B)(ii) of the Immigration and Na9 tionality Act (8 U.S.C. 1153(B)(ii)) is amended— 

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

11 (IV) 4 ems to the left; and 

12 (B) in subclause (II)— 

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

14 and 

15 (ii) by adding at the end the fol16 lowing: 

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

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

19 which the alien physician begins work in 

20 the shortage area in any legal status and 

21 not on the date on which an immigrant 

22 visa petition is filed or approved. Such 

23 service shall be aggregated without regard 

24 to when such service began and without re25 gard to whether such service began during 


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1 or in conjunction with a course of graduate 

2 medical education. 

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

4 required to submit an employment contract 

5 with a term exceeding the balance of the 5- 

6 year commitment yet to be served or an 

7 employment contract dated within a min8 imum time period before filing a visa peti9 tion under this subsection. 

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

11 required to file additional immigrant visa 

12 petitions upon a change of work location 

13 from the location approved in the original 

14 national interest immigrant petition.’’. 

15 (c) TECHNICAL CLARIFICATION REGARDING AD16 VANCED DEGREE FOR PHYSICIANS.—Section 

17 203(b)(2)(A) of the Immigration and Nationality Act (8 

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

19 the following: ‘‘An alien physician holding a foreign med20 ical degree that has been deemed sufficient for acceptance 

21 by an accredited United States medical residency or fel22 lowship program is a member of the professions holding 

23 an advanced degree or its equivalent.’’. 

24 (d) SHORT-TERM WORK AUTHORIZATION FOR PHY25 SICIANS COMPLETING THEIR RESIDENCIES.— 


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1 (1) IN GENERAL.—A physician completing 

2 graduate medical education or training described in 

3 section 212(j) of the Immigration and Nationality 

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

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

6 1101(a)(15)(H)(i))— 

7 (A) shall have such nonimmigrant status 

8 automatically extended until October 1 of the 

9 fiscal year for which a petition for a continu10 ation of such nonimmigrant status has been 

11 submitted in a timely manner and the employ12 ment start date for the beneficiary of such peti13 tion is October 1 of that fiscal year; and 

14 (B) shall be authorized to be employed in15 cident to status during the period between the 

16 filing of such petition and October 1 of such fis17 cal year. 

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

19 employment authorization shall terminate on the 

20 date that is 30 days after the date on which a peti21 tion described in paragraph (1)(A) is rejected, de22 nied or revoked. 

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

24 status and employment authorization will automati25 cally extend to October 1 of the next fiscal year if 


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

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

3 fiscal year have been issued. 

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

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

6 or child of an exchange visitor described in section 

7 101(a)(15)(J) of the Immigration and Nationality Act (8 

8 U.S.C. 1101(a)(15)(J)) shall not be subject to the require9 ments under section 212(e) of such Act (8 U.S.C. 

10 1182(e)). 

11 SEC. 7. ANNUAL CONRAD STATE 30 J–1 VISA WAIVER PRO12 GRAM STATISTICAL REPORT. 

13 The Director of U.S. Citizenship and Immigration 

14 Services shall submit an annual report to Congress and 

15 to the Department of Health and Human Services that 

16 identifies the number of aliens admitted during the most 

17 recently concluded fiscal year as a result of the Conrad 

18 State 30 J–1 Visa Waiver Program established under sec19 tions 212(e) and 214(l) of the Immigration and Nation20 ality Act (8 U.S.C. 1182(e) and 1184(l)), broken down 

21 by State. 

Æ 


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