‘‘(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 para-
graph, in which case— 
‘‘(i) the number of waivers allotted shall be de-
creased by 5 for all States beginning in the next fis-
cal 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’’; and 
(3) by adding at the end the following: 
‘‘(iv) in the case of a request by an inter-
ested State agency— 
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‘‘(I) the head of such agency deter-
mines that the alien is to practice medicine 
in, or be on the faculty of a residency pro-
gram 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 regula-
tion), without regard to whether such facil-
ity is located within an area designated by 
the Secretary of Health and Human Serv-
ices as having a shortage of health care 
professionals; and 
‘‘(II) the head of such agency deter-
mines 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 ac-
cordance with the conditions of this 
clause to exceed 3.’’. 
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SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, 
AND OTHER PROVISIONS RELATED TO PHYSI-
CIAN IMMIGRATION. 
(a) DUAL INTENT FOR PHYSICIANS SEEKING GRAD-
UATE MEDICAL TRAINING.—Section 214(b) of the Immi-
gration and Nationality Act (8 U.S.C. 1184(b)) is amend-
ed 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 non-
immigrant 
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 grad-
uate medical education or training as described in section 
212(j) or to take examinations required to receive grad-
uate medical education or training as described in section 
212(j))’’. 
(b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL-
FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER-
SERVED 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 author-
ized for employment under this Act.’’. 
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(c) PHYSICIAN NATIONAL INTEREST WAIVER CLARI-
FICATIONS.— 
(1) PRACTICE
AND
GEOGRAPHIC
AREA.—Sec-
tion 203(b)(2)(B)(ii)(I) of the Immigration and Na-
tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 
amended by striking items (aa) and (bb) and insert-
ing the following: 
‘‘(aa) the alien physician agrees to 
work on a full-time basis practicing pri-
mary care, specialty medicine, or a com-
bination thereof, in an area or areas des-
ignated 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 lo-
cated within such an area) and a Federal 
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