I 

117TH CONGRESS 

1ST SESSION H. R. 3541 

To provide incentives to physicians to practice in rural and medically 

underserved communities, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 25, 2021 

Mr. SCHNEIDER (for himself, Mr. BACON, Mr. DELGADO, Mr. MCKINLEY, 

Mrs. AXNE, Mr. BABIN, Mr. BERA, Ms. BLUNT ROCHESTER, Mr. 

BUTTERFIELD, Mr. CASTEN, Mr. CLEAVER, Mr. COSTA, Mr. DEFAZIO, 

Mr. FITZPATRICK, Mr. GARAMENDI, Ms. GARCIA of Texas, Miss 

GONZA ́LEZ-COLO ́N, Mr. HICE of Georgia, Mr. KELLER, Ms. KELLY of Illinois, Mr. KILDEE, Mr. KILMER, Mr. KRISHNAMOORTHI, Mr. LAWSON

of Florida, Mr. LONG, Mr. LUCAS, Mr. MAST, Mr. MULLIN, Mr. NORMAN, Mr. PANETTA, Mr. PETERS, Mr. POCAN, Mr. PRICE of North Carolina, Mr. RUSH, Mr. RYAN, Mr. SOTO, Ms. SPEIER, Mr. VAN DREW, and 

Ms. WILLIAMS of Georgia) 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’’. 


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1 SEC. 2. CONRAD STATE 30 PROGRAM. 

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

3 and Nationality Technical Corrections Act of 1994 (Public 

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

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

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

7 State 30 and Physician Access Reauthorization Act’’. 

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

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

10 30, 2018. 

11 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 

12 MEDICALLY UNDERSERVED COMMUNITIES. 

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

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

15 end the following: 

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

17 service requirements of a waiver requested under 

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

19 ‘‘(I) alien physicians who completed such 

20 service before the date of the enactment of the 

21 Conrad State 30 and Physician Access Act; and 

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

23 physician described in subclause (I). 

24 ‘‘(ii) Nothing in this subparagraph may be con25 strued— 


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

2 the Secretary of Homeland Security for classi3 fication under section 204(a) or the filing of an 

4 application for adjustment of status under sec5 tion 245 by an alien physician described in this 

6 subparagraph before the date by which such 

7 alien physician has completed the service de8 scribed in section 214(l) or worked full-time as 

9 a physician for an aggregate of 5 years at the 

10 location identified in the section 214(l) waiver 

11 or in an area or areas designated by the Sec12 retary of Health and Human Services as having 

13 a shortage of health care professionals; or 

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

15 Security to grant a petition or application de16 scribed in subclause (I) until the alien has sat17 isfied all of the requirements of the waiver re18 ceived under section 214(l).’’. 

19 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 

20 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY

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

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

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

24 by striking ‘‘Attorney General’’ and inserting ‘‘Sec25 retary of Homeland Security’’; 


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

2 of the United States Information Agency’’ and in3 serting ‘‘Secretary of State’’; 

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

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

6 semicolon at the end; 

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

8 and (ii) and inserting the following: 

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

10 offer of full-time employment at a health facil11 ity or health care organization, which employ12 ment has been determined by the Secretary of 

13 Homeland Security to be in the public interest; 

14 and 

15 ‘‘(ii) the alien— 

16 ‘‘(I) has accepted employment with 

17 the health facility or health care organiza18 tion in a geographic area or areas which 

19 are designated by the Secretary of Health 

20 and Human Services as having a shortage 

21 of health care professionals; 

22 ‘‘(II) begins employment by the later 

23 of the date that is— 

24 ‘‘(aa) 120 days after receiving 

25 such waiver; 


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1 ‘‘(bb) 120 days after completing 

2 graduate medical education or train3 ing under a program approved pursu4 ant to section 212(j)(1); or 

5 ‘‘(cc) 120 days after receiving 

6 nonimmigrant status or employment 

7 authorization, if the alien or the 

8 alien’s employer petitions for such 

9 nonimmigrant status or employment 

10 authorization not later than 120 days 

11 after the date on which the alien com12 pletes his or her graduate medical 

13 education or training under a pro14 gram approved pursuant to section 

15 212(j)(1); and 

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

17 a total of not less than 3 years in the sta18 tus authorized for such employment under 

19 this subsection, except as provided in para20 graph (8).’’; and 

21 (5) in subparagraph (D), in the matter pre22 ceding clause (i), by inserting ‘‘(except as provided 

23 in paragraph (8))’’. 

24 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL25 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDERVerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541

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1 SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 

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

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

4 agency or an interested State agency for rec5 ommendation of a waiver under this section by a 

6 physician who is maintaining valid nonimmigrant 

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

8 recommendation by the Secretary of State, the Sec9 retary of Homeland Security may change the status 

10 of such physician to any status authorized for em11 ployment under this Act. The numerical limitations 

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

13 any alien whose status is changed under this sub14 paragraph.’’. 

15 (c) VIOLATION OF AGREEMENTS.—Section 

16 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

17 amended by inserting ‘‘substantial requirement of an’’ be18 fore ‘‘agreement entered into’’. 

19 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED

20 AREAS.—Section 214(l) of such Act, as amended by this 

21 section, is further amended by adding at the end the fol22 lowing: 

23 ‘‘(4)(A) If an interested State agency denies an appli24 cation for a waiver under paragraph (1)(B) from a physi25 cian pursuing graduate medical education or training purVerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541

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1 suant to section 101(a)(15)(J) because the State has re2 quested the maximum number of waivers permitted for 

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

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

5 to seek a waiver under this subsection (except for para6 graph (1)(D)(ii)) to work for an employer described in 

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

8 the maximum number of waivers. 

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

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

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

12 application is filed with such State and ending on the ear13 lier of— 

14 ‘‘(i) the date on which the Secretary of Home15 land Security denies such waiver; or 

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

17 an application for change of status under paragraph 

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

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

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

21 by adding at the end the following: 

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

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

24 contracting health facility or health care organization 

25 that— 


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

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

3 that the alien will be expected to be available and 

4 the compensation the alien will receive for on-call 

5 time; 

6 ‘‘(B) specifies— 

7 ‘‘(i) whether the contracting facility or or8 ganization— 

9 ‘‘(I) has secured medical malpractice 

10 liability protection for the alien under sec11 tion 224(g) of the Public Health Service 

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

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

14 insurance premiums; 

15 ‘‘(ii) whether the employer will provide 

16 malpractice insurance for the alien; and 

17 ‘‘(iii) the amount of such liability protec18 tion that will be provided; 

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

20 alien will work and includes a statement that the 

21 contracting facility or organization will not add addi22 tional work locations without the approval of the 

23 Federal agency or State agency that requested the 

24 waiver; and 

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


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

2 whose employment relationship with a health facility or 

3 health care organization terminates under paragraph 

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

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

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

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

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

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

10 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER

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

12 section, is further amended by adding at the end the fol13 lowing: 

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

15 terminates the recipient’s employment with a health facil16 ity or health care organization pursuant to paragraph 

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

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

19 accepts new employment with such a facility or organiza20 tion in a different State, the State from which the alien 

21 is departing may be accorded an additional waiver by the 

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

23 alien’s employment was terminated.’’. 


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

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

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

4 ‘‘(8) The 3-year work requirement set forth in sub5 paragraphs (C) and (D) of paragraph (1) shall not apply 

6 if— 

7 ‘‘(A)(i) the Secretary of Homeland Security de8 termines that extenuating circumstances, including 

9 violations by the employer of the employment agree10 ment with the alien or of labor and employment 

11 laws, exist that justify a lesser period of employment 

12 at such facility or organization; and 

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

14 days after the employment termination date (unless 

15 the Secretary determines that extenuating cir16 cumstances would justify an extension), another 

17 bona fide offer of employment at a health facility or 

18 health care organization in a geographic area or 

19 areas which are designated by the Secretary of 

20 Health and Human Services as having a shortage of 

21 health care professionals, for the remainder of such 

22 3-year period; 

23 ‘‘(B)(i) the interested State agency that re24 quested the waiver attests that extenuating cir25 cumstances, including violations by the employer of 


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1 the employment agreement with the alien or of labor 

2 and employment laws, exist that justify a lesser pe3 riod of employment at such facility or organization; 

4 and 

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

6 days after the employment termination date (unless 

7 the Secretary determines that extenuating cir8 cumstances would justify an extension), another 

9 bona fide offer of employment at a health facility or 

10 health care organization in a geographic area or 

11 areas which are designated by the Secretary of 

12 Health and Human Services as having a shortage of 

13 health care professionals, for the remainder of such 

14 3-year period; or 

15 ‘‘(C) the alien— 

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

17 extenuating circumstances pursuant to sub18 clause (A) or (B); 

19 ‘‘(ii) terminates the alien’s employment re20 lationship with the health facility or health care 

21 organization at which the alien was employed; 

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

23 after the employment termination date, another 

24 bona fide offer of employment at a health facil25 ity or health care organization in a geographic 


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1 area or areas, in the State that requested the 

2 alien’s waiver, which are designated by the Sec3 retary of Health and Human Services as having 

4 a shortage of health care professionals; and 

5 ‘‘(iv) agrees to be employed for the remain6 der of such 3-year period, and 1 additional year 

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

8 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 

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

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

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

12 following: 

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

14 waivers under paragraph (1)(B) for a fiscal year if 90 per15 cent of the waivers available to the States receiving at 

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

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

18 States shall be allotted an additional 5 waivers under 

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

20 percent of the waivers available to the States receiving at 

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

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

23 the States will only receive an additional increase of 5 

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1 ers available to the States receiving at least 1 waiver were 

2 used in the previous fiscal year. 

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

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

5 the total number of such waivers granted is 5 percent 

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

7 in the number of waivers allotted pursuant to this para8 graph, in which case— 

9 ‘‘(i) the number of waivers allotted shall be de10 creased by 5 for all States beginning in the next fis11 cal year; and 

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

13 waivers granted from the last year in which there 

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

15 additional decrease of 5 waivers allotted for all 

16 States, provided that the number of waivers allotted 

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

18 (b) ACADEMIC MEDICAL CENTERS.—Section 

19 214(l)(1)(D) of such Act (8 U.S.C. 1184(l)(1)(D)) is 

20 amended— 

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

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

23 end and inserting ‘‘; and’’; and 

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


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1 ‘‘(iv) in the case of a request by an inter2 ested State agency— 

3 ‘‘(I) the head of such agency deter4 mines that the alien is to practice medicine 

5 in, or be on the faculty of a residency pro6 gram at, an academic medical center (as 

7 that term is defined in section 

8 411.355(e)(2) of title 42, Code of Federal 

9 Regulations, or similar successor regula10 tion), without regard to whether such facil11 ity is located within an area designated by 

12 the Secretary of Health and Human Serv13 ices as having a shortage of health care 

14 professionals; and 

15 ‘‘(II) the head of such agency deter16 mines that— 

17 ‘‘(aa) the alien physician’s work 

18 is in the public interest; and 

19 ‘‘(bb) the grant of such waiver 

20 would not cause the number of the 

21 waivers granted on behalf of aliens for 

22 such State for a fiscal year (within 

23 the limitation in subparagraph (B) 

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1 cordance with the conditions of this 

2 clause to exceed 3.’’. 

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

4 AND OTHER PROVISIONS RELATED TO PHYSI5 CIAN IMMIGRATION. 

6 (a) DUAL INTENT FOR PHYSICIANS SEEKING GRAD7 UATE MEDICAL TRAINING.—Section 214(b) of the Immi8 gration and Nationality Act (8 U.S.C. 1184(b)) is amend9 ed by striking ‘‘(other than a nonimmigrant described in 

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

11 than a nonimmigrant described in any provision of section 

12 101(a)(15)(H)(i) except subclause (b1) of such section)’’ 

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

14 subparagraph (L) or (V) of section 101(a)(15), a non15 immigrant described in any provision of section 

16 101(a)(15)(H)(i) (except subclause (b1) of such section), 

17 and an alien coming to the United States to receive grad18 uate medical education or training as described in section 

19 212(j) or to take examinations required to receive grad20 uate medical education or training as described in section 

21 212(j))’’. 

22 (b) PHYSICIAN NATIONAL INTEREST WAIVER CLARI23 FICATIONS.— 

24 (1) PRACTICE AND GEOGRAPHIC AREA.—Sec25 tion 203(b)(2)(B)(ii)(I) of the Immigration and NaVerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541

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1 tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 

2 amended by striking items (aa) and (bb) and insert3 ing the following: 

4 ‘‘(aa) the alien physician agrees to 

5 work on a full-time basis practicing pri6 mary care, specialty medicine, or a com7 bination thereof, in an area or areas des8 ignated by the Secretary of Health and 

9 Human Services as having a shortage of 

10 health care professionals, or at a health 

11 care facility under the jurisdiction of the 

12 Secretary of Veterans Affairs; or 

13 ‘‘(bb) the alien physician is pursuing 

14 such waiver based upon service at a facility 

15 or facilities that serve patients who reside 

16 in a geographic area or areas designated 

17 by the Secretary of Health and Human 

18 Services as having a shortage of health 

19 care professionals (without regard to 

20 whether such facility or facilities are lo21 cated within such an area) and a Federal 

22 agency, or a local, county, regional, or 

23 State department of public health deter24 mines the alien physician’s work was or 

25 will be in the public interest.’’. 


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1 (2) FIVE-YEAR SERVICE REQUIREMENT.—Sec2 tion 203(b)(2)(B)(ii) of the Immigration and Na3 tionality Act (8 U.S.C. 1153(B)(ii)) is amended— 

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

5 (IV) 4 ems to the left; and 

6 (B) in subclause (II)— 

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

8 and 

9 (ii) by adding at the end the fol10 lowing: 

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

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

13 which the alien physician begins work in 

14 the shortage area in any legal status and 

15 not on the date on which an immigrant 

16 visa petition is filed or approved. Such 

17 service shall be aggregated without regard 

18 to when such service began and without re19 gard to whether such service began during 

20 or in conjunction with a course of graduate 

21 medical education. 

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

23 required to submit an employment contract 

24 with a term exceeding the balance of the 5- 

25 year commitment yet to be served or an 


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1 employment contract dated within a min2 imum time period before filing a visa peti3 tion under this subsection. 

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

5 required to file additional immigrant visa 

6 petitions upon a change of work location 

7 from the location approved in the original 

8 national interest immigrant petition.’’. 

9 (c) TECHNICAL CLARIFICATION REGARDING AD10 VANCED DEGREE FOR PHYSICIANS.—Section 

11 203(b)(2)(A) of the Immigration and Nationality Act (8 

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

13 the following: ‘‘An alien physician holding a foreign med14 ical degree that has been deemed sufficient for acceptance 

15 by an accredited United States medical residency or fel16 lowship program is a member of the professions holding 

17 an advanced degree or its equivalent.’’. 

18 (d) SHORT-TERM WORK AUTHORIZATION FOR PHY19 SICIANS COMPLETING THEIR RESIDENCIES.— 

20 (1) IN GENERAL.—A physician completing 

21 graduate medical education or training described in 

22 section 212(j) of the Immigration and Nationality 

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

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

25 1101(a)(15)(H)(i))— 


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1 (A) shall have such nonimmigrant status 

2 automatically extended until October 1 of the 

3 fiscal year for which a petition for a continu4 ation of such nonimmigrant status has been 

5 submitted in a timely manner and the employ6 ment start date for the beneficiary of such peti7 tion is October 1 of that fiscal year; and 

8 (B) shall be authorized to be employed in9 cident to status during the period between the 

10 filing of such petition and October 1 of such fis11 cal year. 

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

13 employment authorization shall terminate on the 

14 date that is 30 days after the date on which a peti15 tion described in paragraph (1)(A) is rejected, de16 nied or revoked. 

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

18 status and employment authorization will automati19 cally extend to October 1 of the next fiscal year if 

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

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

22 fiscal year have been issued. 

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

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

25 or child of an exchange visitor described in section 


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1 101(a)(15)(J) of the Immigration and Nationality Act (8 

2 U.S.C. 1101(a)(15)(J)) shall not be subject to the require3 ments under section 212(e) of such Act (8 U.S.C. 

4 1182(e)). 

5 SEC. 7. ANNUAL CONRAD STATE 30 J-1 VISA WAIVER PRO6 GRAM STATISTICAL REPORT. 

7 The Director of U.S. Citizenship and Immigration 

8 Services shall submit an annual report to Congress and 

9 to the Department of Health and Human Services that 

10 identifies the number of aliens admitted during the most 

11 recently concluded fiscal year as a result of the Conrad 

12 State 30 J–1 Visa Waiver Program established under sec13 tions 212(e) and 214(l) of the Immigration and Nation14 ality Act (8 U.S.C. 1182(e) and 1184(l)), broken down 

15 by State. 

Æ 


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