I 
119TH CONGRESS 
1ST SESSION H. R. 1585 
To provide incentives to physicians to practice in rural and medically 
underserved communities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 25, 2025 
Mr. VALADAO (for himself, Mr. BACON, Mr. SCHNEIDER, and Ms. GARCIA of 
Texas) 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. 
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 ‘‘Conrad State 30 and 
Physician Access Reauthorization Act’’. 
SEC. 2. CONRAD STATE 30 PROGRAM. 
(a) EXTENSION.—Section 220(c) of the Immigration 
and Nationality Technical Corrections Act of 1994 (Public 
Law 103–416; 8 U.S.C. 1182 note) is amended by striking 
‘‘September 30, 2015’’ and inserting ‘‘on the date that 
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is 3 years after the date of the enactment of the Conrad 
State 30 and Physician Access Reauthorization Act’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect as if enacted on September 
30, 2018. 
SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 
MEDICALLY UNDERSERVED COMMUNITIES. 
Section 201(b)(1) of the Immigration and Nationality 
Act (8 U.S.C. 1151(b)(1)) is amended by adding at the 
end the following: 
‘‘(F)(i) Alien physicians who have completed 
service requirements of a waiver requested under 
section 203(b)(2)(B)(ii), including— 
‘‘(I) alien physicians who completed such 
service before the date of the enactment of the 
Conrad State 30 and Physician Access Act; and 
‘‘(II) the spouse or children of an alien 
physician described in subclause (I). 
‘‘(ii) Nothing in this subparagraph may be con-
strued— 
‘‘(I) to prevent the filing of a petition with 
the Secretary of Homeland Security for classi-
fication under section 204(a) or the filing of an 
application for adjustment of status under sec-
tion 245 by an alien physician described in this 
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subparagraph before the date by which such 
alien physician has completed the service de-
scribed in section 214(l) or worked full-time as 
a physician for an aggregate of 5 years at the 
location identified in the section 214(l) waiver 
or in an area or areas designated by the Sec-
retary of Health and Human Services as having 
a shortage of health care professionals; or 
‘‘(II) to permit the Secretary of Homeland 
Security to grant a petition or application de-
scribed in subclause (I) until the alien has sat-
isfied all of the requirements of the waiver re-
ceived under section 214(l).’’. 
SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 
(a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY 
REQUIREMENT.—Section 214(l)(1) of the Immigration 
and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘Attorney General’’ and inserting ‘‘Sec-
retary of Homeland Security’’; 
(2) in subparagraph (A), by striking ‘‘Director 
of the United States Information Agency’’ and in-
serting ‘‘Secretary of State’’; 
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(3) in subparagraph (B), by inserting ‘‘, except 
as provided in paragraphs (7) and (8)’’ before the 
semicolon at the end; 
(4) in subparagraph (C), by striking clauses (i) 
and (ii) and inserting the following: 
‘‘(i) the alien demonstrates a bona fide 
offer of full-time employment at a health facil-
ity or health care organization, which employ-
ment has been determined by the Secretary of 
Homeland Security to be in the public interest; 
and 
‘‘(ii) the alien— 
‘‘(I) has accepted employment with 
the health facility or health care organiza-
tion in a geographic area or areas which 
are designated by the Secretary of Health 
and Human Services as having a shortage 
of health care professionals; 
‘‘(II) begins employment by the later 
of the date that is— 
‘‘(aa) 120 days after receiving 
such waiver; 
‘‘(bb) 120 days after completing 
graduate medical education or train-
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ing under a program approved pursu-
ant to section 212(j)(1); or 
‘‘(cc) 120 days after receiving 
nonimmigrant status or employment 
authorization, if the alien or the 
alien’s employer petitions for such 
nonimmigrant status or employment 
authorization not later than 120 days 
after the date on which the alien com-
pletes his or her graduate medical 
education or training under a pro-
gram approved pursuant to section 
212(j)(1); and 
‘‘(III) agrees to continue to work for 
a total of not less than 3 years in the sta-
tus authorized for such employment under 
this subsection, except as provided in para-
graph (8).’’; and 
(5) in subparagraph (D), in the matter pre-
ceding clause (i), by inserting ‘‘(except as provided 
in paragraph (8))’’ after ‘‘3 years’’. 
(b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL-
FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER-
SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 
U.S.C. 1184(l)(2)(A)) is amended to read as follows: 
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‘‘(A) Upon the request of an interested Federal agen-
cy or an interested State agency for recommendation of 
a waiver under this section by a physician who is main-
taining 
valid 
nonimmigrant 
status 
under 
section 
101(a)(15)(J) and a favorable recommendation by the 
Secretary of State, the Secretary of Homeland Security 
may change the status of such physician to any status au-
thorized for employment under this Act. The numerical 
limitations contained in subsection (g)(1)(A) shall not 
apply to any alien whose status is changed under this sub-
paragraph.’’. 
(c) 
VIOLATION
OF
AGREEMENTS.—Section 
214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 
amended by inserting ‘‘substantial requirement of an’’ be-
fore ‘‘agreement entered into’’. 
(d) PHYSICIAN
EMPLOYMENT
IN
UNDERSERVED 
AREAS.—Section 214(l) of such Act, as amended by this 
section, is further amended by adding at the end the fol-
lowing: 
‘‘(4)(A) If an interested State agency denies an appli-
cation for a waiver under paragraph (1)(B) from a physi-
cian pursuing graduate medical education or training pur-
suant to section 101(a)(15)(J) because the State has re-
quested the maximum number of waivers permitted for 
that fiscal year, the physician’s nonimmigrant status shall 
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be extended for up to 6 months if the physician agrees 
to seek a waiver under this subsection (except for para-
graph (1)(D)(ii)) to work for an employer described in 
paragraph (1)(C) in a State that has not yet requested 
the maximum number of waivers. 
‘‘(B) Such physician shall be authorized to work only 
for the employer referred to in subparagraph (A) during 
the period beginning on the date on which a new waiver 
application is filed with such State and ending on the ear-
lier of— 
‘‘(i) the date on which the Secretary of Home-
land Security denies such waiver; or 
‘‘(ii) the date on which the Secretary approves 
an application for change of status under paragraph 
(2)(A) pursuant to the approval of such waiver.’’. 
(e) CONTRACT REQUIREMENTS.—Section 214(l) of 
such Act, as amended by this section, is further amended 
by adding at the end the following: 
‘‘(5) An alien granted a waiver under paragraph 
(1)(C) shall enter into an employment agreement with the 
contracting health facility or health care organization 
that— 
‘‘(A) specifies the maximum number of on-call 
hours per week (which may be a monthly average) 
that the alien will be expected to be available and 
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(1)(C)(ii) during the 3-year service period required under 
paragraph (1) shall be considered to be maintaining lawful 
status in an authorized period of stay during the 120-day 
period referred to in items (aa) and (bb) of subclause (III) 
of paragraph (1)(C)(ii) or the 45-day period referred to 
in subclause (III)(cc) of such paragraph.’’. 
(f) RECAPTURING WAIVER SLOTS LOST TO OTHER 
STATES.—Section 214(l) of such Act, as amended by this 
section, is further amended by adding at the end the fol-
lowing: 
‘‘(7) If a recipient of a waiver under this subsection 
terminates the recipient’s employment with a health facil-
ity or health care organization pursuant to paragraph 
(1)(C)(ii), including termination of employment because of 
circumstances described in paragraph (1)(C)(ii)(III), and 
accepts new employment with such a facility or organiza-
tion in a different State, the State from which the alien 
is departing may be accorded an additional waiver by the 
Secretary of State for use in the fiscal year in which the 
alien’s employment was terminated.’’. 
(g) EXCEPTION TO 3-YEAR WORK REQUIREMENT.— 
Section 214(l) of such Act, as amended by this section, 
is further amended by adding at the end the following: 
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‘‘(8) The 3-year work requirement set forth in sub-
paragraphs (C) and (D) of paragraph (1) shall not apply 
if— 
‘‘(A)(i) the Secretary of Homeland Security de-
termines that extenuating circumstances, including 
violations by the employer of the employment agree-
ment with the alien or of labor and employment 
laws, exist that justify a lesser period of employment 
at such facility or organization; and 
‘‘(ii) the alien demonstrates, not later than 120 
days after the employment termination date (unless 
the Secretary determines that extenuating cir-
cumstances would justify an extension), another 
bona fide offer of employment at a health facility or 
health care organization in a geographic area or 
areas which are designated by the Secretary of 
Health and Human Services as having a shortage of 
health care professionals, for the remainder of such 
3-year period; 
‘‘(B)(i) the interested State agency that re-
quested the waiver attests that extenuating cir-
cumstances, including violations by the employer of 
the employment agreement with the alien or of labor 
and employment laws, exist that justify a lesser pe-
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riod of employment at such facility or organization; 
and 
‘‘(ii) the alien demonstrates, not later than 120 
days after the employment termination date (unless 
the Secretary determines that extenuating cir-
cumstances would justify an extension), another 
bona fide offer of employment at a health facility or 
health care organization in a geographic area or 
areas which are designated by the Secretary of 
Health and Human Services as having a shortage of 
health care professionals, for the remainder of such 
3-year period; or 
‘‘(C) the alien— 
‘‘(i) elects not to pursue a determination of 
extenuating circumstances pursuant to sub-
clause (A) or (B); 
‘‘(ii) terminates the alien’s employment re-
lationship with the health facility or health care 
organization at which the alien was employed; 
‘‘(iii) demonstrates, not later than 45 days 
after the employment termination date, another 
bona fide offer of employment at a health facil-
ity or health care organization in a geographic 
area or areas, in the State that requested the 
alien’s waiver, which are designated by the Sec-
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retary of Health and Human Services as having 
a shortage of health care professionals; and 
‘‘(iv) agrees to be employed for the remain-
der of such 3-year period, and 1 additional year 
for each termination under clause (ii).’’. 
SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 
(a) IN GENERAL.—Section 214(l) of the Immigration 
and Nationality Act (8 U.S.C. 1184(l)), as amended by 
section 4, is further amended by adding at the end the 
following: 
‘‘(9)(A)(i) All States shall be allotted a total of 35 
waivers under paragraph (1)(B) for a fiscal year if 90 per-
cent of the waivers available to the States receiving at 
least 5 waivers were used in the previous fiscal year. 
‘‘(ii) When an allotment occurs under clause (i), all 
States shall be allotted an additional 5 waivers under 
paragraph (1)(B) for each subsequent fiscal year if 90 
percent of the waivers available to the States receiving at 
least 5 waivers were used in the previous fiscal year. If 
the States are allotted 45 or more waivers for a fiscal year, 
the States will only receive an additional increase of 5 
waivers the following fiscal year if 95 percent of the waiv-
ers available to the States receiving at least 1 waiver were 
used in the previous fiscal year. 
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‘‘(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 such Act (8 U.S.C. 1184(l)(1)(D)), as 
amended by section 4(a)(5), is further 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 described in section 
212(j) or to take examinations required to receive grad-
uate medical education or training described in section 
212(j))’’. 
(b) 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: 
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‘‘(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 
agency, or a local, county, regional, or 
State department of public health deter-
mines 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) of the Immigration and Na-
tionality Act (8 U.S.C. 1153(B)(ii)) is amended— 
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(A) by moving subclauses (II), (III), and 
(IV) 4 ems to the left; and 
(B) in subclause (II)— 
(i) by inserting ‘‘(aa)’’ after ‘‘(II)’’; 
and 
(ii) by adding at the end the fol-
lowing: 
‘‘(bb) The 5-year service requirement 
under item (aa) shall begin on the date on 
which the alien physician begins work in 
the shortage area in any legal status and 
not on the date on which an immigrant 
visa petition is filed or approved. Such 
service shall be aggregated without regard 
to when such service began and without re-
gard to whether such service began during 
or in conjunction with a course of graduate 
medical education. 
‘‘(cc) An alien physician shall not be 
required to submit an employment contract 
with a term exceeding the balance of the 5- 
year commitment yet to be served or an 
employment contract dated within a min-
imum time period before filing a visa peti-
tion under this subsection. 
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‘‘(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.’’. 
(c) 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 
the following: ‘‘An alien physician holding a foreign med-
ical degree that has been deemed sufficient for acceptance 
by an accredited United States medical residency or fel-
lowship program is a member of the professions holding 
an advanced degree or its equivalent.’’. 
(d) SHORT-TERM WORK AUTHORIZATION FOR PHY-
SICIANS COMPLETING THEIR RESIDENCIES.— 
(1) IN
GENERAL.—A physician completing 
graduate medical education or training described in 
section 212(j) of the Immigration and Nationality 
Act (8 U.S.C. 1182(j)) as a nonimmigrant described 
in section 101(a)(15)(H)(i) of such Act (8 U.S.C. 
1101(a)(15)(H)(i))— 
(A) shall have such nonimmigrant status 
automatically extended until October 1 of the 
fiscal year for which a petition for a continu-
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ation of such nonimmigrant status has been 
submitted in a timely manner and the employ-
ment start date for the beneficiary of such peti-
tion is October 1 of that fiscal year; and 
(B) shall be authorized to be employed in-
cident to status during the period between the 
filing of such petition and October 1 of such fis-
cal year. 
(2) TERMINATION.—The physician’s status and 
employment authorization shall terminate on the 
date that is 30 days after the date on which a peti-
tion described in paragraph (1)(A) is rejected, de-
nied or revoked. 
(3) AUTOMATIC
EXTENSION.—A physician’s 
status and employment authorization will automati-
cally extend to October 1 of the next fiscal year if 
all of the visas described in section 101(a)(15)(H)(i) 
of such Act that were authorized to be issued for the 
fiscal year have been issued. 
(e) 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-
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ments under section 212(e) of such Act (8 U.S.C. 
1182(e)). 
SEC. 7. ANNUAL CONRAD STATE 30 J–1 VISA WAIVER PRO-
GRAM STATISTICAL REPORT. 
The Director of U.S. Citizenship and Immigration 
Services shall submit an annual report to Congress and 
to the Department of Health and Human Services that 
identifies the number of aliens admitted during the most 
recently concluded fiscal year as a result of the Conrad 
State 30 J–1 Visa Waiver Program established under sec-
tions 212(e) and 214(l) of the Immigration and Nation-
ality Act (8 U.S.C. 1182(e) and 1184(l)), disaggregated 
by State. 
Æ 
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