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 be-
ginning in the next fiscal year; and 
‘‘(ii) each additional 5 percent de-
crease 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 waiv-
ers 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 in-
terested State agency— 
‘‘(I) the head of such agency de-
termines that the alien is to practice 
medicine in, or be on the faculty of a 
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residency program at, an academic 
medical center (as that term is de-
fined in section 411.355(e)(2) of title 
42, Code of Federal Regulations, or 
similar successor regulation), without 
regard to whether such facility is lo-
cated 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 de-
termines that— 
‘‘(aa) the alien physician’s 
work is in the public interest; 
and 
‘‘(bb) the grant of such 
waiver would not cause the num-
ber of the waivers granted on be-
half of aliens for such State for 
a fiscal year (within the limita-
tion in subparagraph (B) and 
subject to paragraph (6)) in ac-
cordance with the conditions of 
this clause to exceed 3; and’’. 
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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 primary care, 
specialty medicine, or a combina-
tion 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 des-
ignated by the Secretary of 
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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 depart-
ment of public health determines 
the alien physician’s work was or 
will be in the public interest.’’. 
(2) FIVE-YEAR SERVICE REQUIREMENT.—Sec-
tion 203(b)(2)(B)(ii)(II) of the Immigration and Na-
tionality Act (8 U.S.C. 1153(B)(ii)(II)) is amend-
ed— 
(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. 
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‘‘(cc) An alien physician shall not be required to sub-
mit 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 pe-
riod prior to filing of a visa petition pursuant to this sub-
section. 
‘‘(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 AD-
VANCED
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 PHY-
SICIANS COMPLETING THEIR RESIDENCIES.—A physician 
completing graduate medical education or training as de-
scribed in section 212(j) of the Immigration and Nation-
ality Act (8 U.S.C. 1182(j)) as a nonimmigrant described 
section 
101(a)(15)(H)(i) 
of 
such 
Act 
(8 
U.S.C. 
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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 non-
immigrant 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 phy-
sician 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 re-
voked. 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 require-
ments of section 212(e) of the Immigration and Nation-
ality Act (8 U.S.C. 1182(e)). 
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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 be-
fore the semicolon at the end the following: ‘‘, 
except as otherwise provided under subpara-
graph (E)’’; and 
(B) by adding at the end the following: 
‘‘(E) in the case of a request by an inter-
ested State agency— 
‘‘(i) if the Secretary of Veterans Af-
fairs determines that facilities of the De-
partment are not capable of furnishing 
covered health services to eligible veterans 
because such facilities lack— 
‘‘(I) the required personnel who 
are appropriately trained and experi-
enced; or 
‘‘(II) the ability to provide timely 
and reasonable access; 
‘‘(ii) the head of such State agency 
determines that— 
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‘‘(I) the alien is to practice medi-
cine in a Veterans Health Administra-
tion 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; 
‘‘(B) the term ‘eligible veteran’ means a 
veteran enrolled in the health care system es-
tablished under section 1705(a) of title 38, 
United States Code, who elects to receive care 
under section 1703.’’. 
Æ 
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