I
105TH CONGRESS
1ST SESSION
H. R. 2759
To amend the Immigration and Nationality Act with respect to the require-
ments for the admission of nonimmigrant nurses who will practice in
health professional shortage areas.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 29, 1997
Mr. RUSH introduced the following bill; which was referred to the Committee
on the Judiciary
A BILL
To amend the Immigration and Nationality Act with respect
to the requirements for the admission of nonimmigrant
nurses who will practice in health professional shortage
areas.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Health Professional
Shortage Area Nursing Relief Act of 1997’’.
SEC. 
2. 
REQUIREMENTS 
FOR 
ADMISSION 
OF 
NON-
IMMIGRANT NURSES IN HEALTH PROFES-
SIONAL SHORTAGE AREAS DURING 5-YEAR
PERIOD.
(a) ESTABLISHMENT
OF
A NEW NONIMMIGRANT
CLASSIFICATION
FOR
NONIMMIGRANT
NURSES
IN
HEALTH
PROFESSIONAL
SHORTAGE
AREAS.—Section
101(a)(15)(H)(i) of the Immigration and Nationality Act
(8 U.S.C. 1101(a)(15)(H)(i)) is amended by adding at the
end the following: ‘‘, or (c) who is coming temporarily to
the United States to perform services as a registered
nurse, who meets the qualifications described in section
212(m)(1) and with respect to whom the Secretary of
Labor determines and certifies to the Attorney General
that an unexpired attestation is on file and in effect under
section 212(m)(2) for the facility described in section
212(m)(1)(5) for which the alien will perform the services,
or’’.
(b) REQUIREMENTS.—Subsection (m) of section 212
of the Immigration and Nationality Act (8 U.S.C. 1182)
is amended to read as follows:
‘‘(m)(1) The qualifications referred to in section
101(a)(15)(H)(i)(c), with respect to an alien who is com-
ing to the United States to perform nursing services for
a facility, are that the alien—
‘‘(A) has obtained a full and unrestricted li-
cense to practice professional nursing in the country
where the alien obtained nursing education or has
received nursing education in the United States;
‘‘(B) has passed an appropriate examination
(recognized in regulations promulgated in consulta-
tion with the Secretary of Health and Human Serv-
ices), has obtained a certificate from the Commis-
sion on Graduates of Foreign Nursing Schools (in
this subsection referred to as ‘CGFNS’) certifying
that the alien has fulfilled the necessary require-
ments for the CGFNS Qualifying Examination and
has passed both the Nursing and English Language
Proficiency sections of the CGFNS Qualifying Ex-
amination, or has graduated from a nursing school
in the United States and has a full and unrestricted
license under State law to practice professional nurs-
ing in the State of intended employment; and
‘‘(C) is fully qualified and eligible under the
laws (including such temporary or interim licensing
requirements which authorize the nurse to be em-
ployed) governing the place of intended employment
to engage in the practice of professional nursing as
a registered nurse immediately upon admission to
the United States and is authorized under such laws
to be employed by the facility.
The qualification described under subparagraph (B) con-
cerning the CGFNS Qualifying Examination shall only
apply prior to the date of promulgation of regulations
under section 212(a)(5)(C).
‘‘(2)(A) The attestation referred to in section
101(a)(15)(H)(i)(c), is an attestation as to the following:
‘‘(i) The facility meets all the requirements of
paragraph (4).
‘‘(ii) The employment of the alien will not ad-
versely affect the wages and working conditions of
registered nurses similarly employed.
‘‘(iii) The alien employed by the facility will be
paid the wage rate for registered nurses similarly
employed by the facility.
‘‘(iv) The facility has taken and is taking timely
and significant steps designed to recruit and retain
sufficient registered nurses who are United States
citizens or immigrants who are authorized to per-
form nursing services, in order to remove as quickly
and as reasonably possible the dependence of the fa-
cility on nonimmigrant registered nurses.
‘‘(v) There is not a strike or lockout in the
course of a labor dispute, nor has the facility laid off
registered nurses within the previous year other than
terminations for cause, and the employment of such
an alien is not intended or designed to influence an
election for a bargaining representative for reg-
istered nurses of the facility.
‘‘(vi) At the time of the filing of the petition for
registered nurses under section 101(a)(15)(H)(i)(c),
notice of the filing has been provided by the facility
to the bargaining representative of the registered
nurses at the facility or, where there is no such bar-
gaining representative, notice of the filing has been
provided to registered nurses employed at the facility
through posting in conspicuous locations.
Nothing in clause (iv) shall be construed as requiring a
facility to have taken significant steps described in such
clause before the date of the enactment of this subsection.
A copy of the attestation shall be provided, within 30 days
of the date of filing, to registered nurses employed at the
facility on the date of filing.
‘‘(B) For purposes of subparagraph (A)(iv), each of
the following shall be considered a significant step reason-
ably designed to recruit and retain registered nurses:
‘‘(i) Operating a training program for reg-
istered nurses at the facility or financing (or provid-
ing participation in) a training program for reg-
istered nurses elsewhere.
‘‘(ii) Providing career development programs
and other methods of facilitating health care work-
ers to become registered nurses.
‘‘(iii) Paying registered nurses wages at a rate
higher than currently being paid to registered nurses
similarly employed in the geographic area.
‘‘(iv) Providing adequate support services to
free registered nurses from administrative and other
non-nursing duties.
‘‘(v) Providing reasonable opportunities for
meaningful salary advancement by registered nurses.
The steps described in this subparagraph shall not be con-
sidered to be an exclusive list of the significant steps that
may be taken to meet the conditions of subparagraph
(A)(iv). Nothing in this subparagraph shall require a facil-
ity to take more than 1 step if the facility can demonstrate
that taking a second step is not reasonable.
‘‘(C) Subject to subparagraph (E), an attestation
under subparagraph (A) shall—
‘‘(i) expire at the end of the 1-year period be-
ginning on the date of its filing with the Secretary
of Labor; and
‘‘(v) In addition to the sanctions provided for under
clause (iv), if the Secretary of Labor finds, after notice
and an opportunity for a hearing, that a facility has vio-
lated the condition attested to under subparagraph (A)(iii)
(relating to payment of registered nurses at the prevailing
wage rate), the Secretary shall order the facility to provide
for payment of such amounts of back pay as may be re-
quired to comply with such condition.
‘‘(3) The period of admission of an alien under sec-
tion 101(a)(15)(H)(i)(c) shall be for an initial period of
not to exceed 3 years, subject to an extension for a period
or periods, not to exceed a total period of admission of
5 years.
‘‘(4) For purposes of this subsection and section
101(a)(15)(H)(i)(c), the term ‘facility’ means an employer
who—
‘‘(A) is located in a health professional shortage
area (as such term is defined in section 332 of the
Public Health Service Act (42 U.S.C. 254e) as of
March 31, 1997;
‘‘(B) is a subsection (d) hospital as described in
section 1886(d) of the Social Security Act (42
U.S.C. 1395ww(d)) with at least 190 licensed acute
care beds as reported by the Health Care Financing
Administration in its PPS XI data report;
‘‘(C) has at least 35 percent of its hospital
acute care inpatient days reimbursed under the med-
icare program under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et. seq.) as reported by the
Health Care Financing Administration in its PPS
XI data report; and
‘‘(D) has at least 28 percent of its hospital
acute care inpatient days reimbursed under the med-
icaid program under title XIX of the Social Security
Act (42 U.S.C. 1396 et. seq.) as reported by the
Health Care Financing Administration in its PPS
XI data report.’’.
(c) IMPLEMENTATION.— Not later than 90 days after
the date of enactment of this Act, the Secretary of Labor
(in consultation, to the extent required, with the Secretary
of Health and Human Services) and the Immigration and
the Naturalization Service shall publish final or interim
final regulations to carry out section 212(m)(1) of the Im-
migration and Nationality Act (as added by subsection
(b)), except that in the event any such regulations are not
published within 90 days after the date of enactment of
this Act, the regulations published to carry out and imple-
ment the Immigration Nursing Relief Act of 1989, in ef-
fect on September 30, 1995 (specifically including part
504 of title 29, Code of Federal Regulations and parts
621 and 655 of title 20, Code of Federal Regulations)
shall continue to apply.
(d) LIMITING
APPLICATION
OF
NONIMMIGRANT
CHANGES TO 5-YEAR PERIOD.—The amendments made
by this section shall apply to classification petitions filed
for nonimmigrant status only during the 5-year period be-
ginning on the date of enactment of this Act.
(e) ANNUAL LIMITATION ON PETITIONS GRANTED.—
The total number of nonimmigrant visas issued pursuant
to petitions granted under section 101(a)(15)(H)(i)(c) of
the Immigration and Nationality Act in each fiscal year
shall not exceed 500, not including extensions of non-
immigrant status under that section. The number of peti-
tions granted under such section 101(a)(15)(H)(i)(c) for
each State in each fiscal year shall not exceed the follow-
ing:
(1) For States with populations of less than
10,000,000 based upon the 1992 Census, 25 peti-
tions, not including extensions of nonimmigrant sta-
tus under that section.
(2) For States with populations of 10,000,000
or more based upon the 1992 census, 50 petitions,
not including extensions of nonimmigrant status
under that section.
(f) 
FULL
PRIOR
DISCLOSURE
TO
NON-
IMMIGRANT NURSES.—Prior to contracting with a
nonimmigrant under section 101(a)(15)(H)(i)(c) of
the Immigration and Nationality Act, an employer
sponsoring such a nonimmigrant must provide the
potential nonimmigrant nurse with detailed informa-
tion on the neighborhood, hospital, and working con-
ditions under which the nonimmigrant will be work-
ing.
(g) WORKING CONDITIONS.—An employer sponsor-
ing a nonimmigrant under section 101(a)(15)(H)(i)(c) of
the Immigration and Nationality Act shall—
(1) provide a wage rate and working conditions
commensurate with those of nurses similarly em-
ployed by the hospital; and
(2) require the nonimmigrant to work hours
commensurate with those of nurses similarly em-
ployed by the hospital; and
(3) not interfere with the right of the non-
immigrant to join or organize a union.
(h) TECHNICAL AMENDMENT.—Section 212(a)(5)(C)
of the Immigration and Nationality Act (8 U.S.C.
1182(a)(5)(C)) is amended in the matter preceding clause
(i) by striking ‘‘physician,’’ and inserting ‘‘physician, and,
until such time as final regulations are published concern-
ing this section, other than nonimmigrant health care
workers pursuant to section 101(a)(15)(H)(i)(C),’’.
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