IB 
Union Calendar No. 450 
108TH CONGRESS 
2D SESSION 
H. R. 4453 
[Report No. 108–730] 
To improve access to physicians in medically underserved areas. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 20, 2004 
Mr. MORAN of Kansas introduced the following bill; which was referred to the 
Committee on the Judiciary 
OCTOBER 5, 2004 
Additional sponsors: Mr. TURNER of Texas, Mr. STENHOLM, Mr. FROST, Ms. 
JACKSON-LEE of Texas, and Mr. POMEROY 
OCTOBER 5, 2004 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
A BILL 
To improve access to physicians in medically underserved 
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 ‘‘Access to Rural Physi-
cians Improvement Act of 2004’’. 
SEC. 2. WAIVER OF FOREIGN COUNTRY RESIDENCE RE-
QUIREMENT
WITH
RESPECT
TO
INTER-
NATIONAL MEDICAL GRADUATES. 
(a) EXTENSION OF DEADLINE.— 
(1) IN GENERAL.—Section 220(c) of the Immi-
gration and Nationality Technical Corrections Act of 
1994 (8 U.S.C. 1182 note) (as amended by section 
11018 of Public Law 107–273) is amended by strik-
ing ‘‘and before June 1, 2004.’’ and inserting ‘‘and 
before the date that is 1 year after the date of the 
enactment of the Access to Rural Physicians Im-
provement Act of 2004.’’. 
(2) EFFECTIVE DATES.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendment made by 
paragraph (1) shall take effect on the date of 
the enactment of this Act. 
(B) SPECIAL EFFECTIVE DATE.—With re-
spect only to aliens admitted to the United 
States under section 101(a)(15)(J) of the Im-
migration
and
Nationality
Act
(8
U.S.C. 
1101(a)(15)(J)), or acquiring status under such 
section after admission, during the period be-
ginning on June 1, 2004, and ending on the 
date of the enactment of this Act, the amend-
ment made by paragraph (1) shall take effect 
as if this Act were enacted on May 31, 2004. 
(b) EXEMPTION FROM H1B NUMERICAL LIMITA-
TIONS.— 
(1) IN GENERAL.—Section 214(l)(2)(A) of the 
Immigration
and
Nationality
Act
(8
U.S.C. 
1184(1)(2)(A) is amended by adding at the end the 
following: 
‘‘The
numerical
limitations
contained
in
subsection 
(g)(1)(A) shall not apply to any alien whose status is 
changed under the preceding sentence, if the alien ob-
tained a waiver of the 2-year foreign residence require-
ment upon a request by an interested State agency.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect as if this Act were 
enacted on September 30, 2003. 
SECTION 1. MODIFICATION OF VISA REQUIREMENTS WITH 
RESPECT 
TO 
INTERNATIONAL 
MEDICAL 
GRADUATES. 
(a) EXTENSION OF DEADLINE.— 
(1) IN GENERAL.—Section 220(c) of the Immi-
gration and Nationality Technical Corrections Act of 
1994 (8 U.S.C. 1182 note) (as amended by section
(1) by striking ‘‘except that,’’ and all that follows 
through the period at the end and inserting ‘‘except 
that—’’; and 
(2) by adding at the end the following: 
‘‘(i) in the case of a request by the Depart-
ment of Veterans Affairs, the alien shall not be 
required to practice medicine in a geographic 
area designated by the Secretary; and 
‘‘(ii) in the case of a request by an inter-
ested State agency, the head of such State agency 
determines that the alien is to practice medicine 
under such agreement in a facility that serves 
patients who reside in one or more geographic 
areas so designated by the Secretary of Health 
and Human Services (without regard to whether 
such facility is within such a designated geo-
graphic area), and 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 described in 
subparagraph (B)) in accordance with the condi-
tions of this clause to exceed 5.’’.
Union Calendar No. 450 
108TH CONGRESS 
2D SESSION 
H. R. 4453 
[Report No. 108–730] 
A BILL 
To improve access to physicians in medically 
underserved areas. 
OCTOBER 5, 2004 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed