219 
(B) to serve as national models of driving 
local health equity; and 
(2) in accordance with subsection (c), devel-
oping a strategic partnership with the community in 
which the institution is located. 
(b) DEVELOPING CAPACITY FOR INCREASING LOCAL 
HEALTH EQUITY.—As a condition on receipt of a grant 
under subsection (a), an institution of higher education 
shall agree to use such grant to build an evidence base 
for successful strategies for increasing local health equity, 
and to serve as a national model of driving local health 
equity, by supporting— 
(1) resources to strengthen institutional metrics 
and capacity to execute institution-wide health work-
force goals that can serve as models for increasing 
health equity in communities across the United 
States; 
(2) collaborations among a cohort of institu-
tions in implementing systemic change, partnership 
development, and programmatic efforts supportive of 
health equity goals across disciplines and popu-
lations; and 
(3) enhanced or newly developed data systems 
and research infrastructure capable of informing 
current and future workforce efforts and building a 
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220 
foundation for a broader research agenda targeting 
urban health disparities. 
(c) STRATEGIC PARTNERSHIPS.—As a condition on 
receipt of a grant under subsection (a), an institution of 
higher education shall agree to use the grant to develop 
a strategic partnership with the community in which such 
institution is located for the purposes of— 
(1) strengthening connections between such in-
stitution and the community— 
(A) to improve evaluation of, and address, 
the health and health workforce needs of such 
community; and 
(B) to engage such community in health 
workforce development; 
(2) developing, enhancing, or accelerating inno-
vative undergraduate and graduate programs in the 
biomedical sciences and health professions; and 
(3) strengthening pipeline programs in the bio-
medical sciences and health professions, including by 
developing partnerships between institutions of high-
er education and elementary schools and secondary 
schools to recruit the next generation of health pro-
fessionals earlier in the pipeline to a health care ca-
reer. 
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(d) ELIGIBLE INSTITUTION OF HIGHER EDUCATION 
DEFINED.—For purposes of this section, an ‘‘eligible in-
stitution of higher education’’ includes— 
(1) a program authorized under section 317(a) 
of the Higher Education Act of 1965 (20 U.S.C. 
1059d(a)); or 
(2) a professional or graduate institution de-
scribed in section 326 of such Act. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2023 through 2027. 
SEC. 3011. HEALTH PROFESSIONS WORKFORCE FUND. 
(a) ESTABLISHMENT.—There is established in the 
Health Resources and Services Administration of the De-
partment of Health and Human Services a Health Profes-
sions Workforce Fund to provide for expanded and sus-
tained national investment in the health professions and 
nursing workforce development programs under title VII 
and title VIII of the Public Health Service Act (42 U.S.C. 
292 et seq.; 42 U.S.C. 296 et seq.). 
(b) FUNDING.— 
(1) IN GENERAL.—There is authorized to be 
appropriated, and there is appropriated, out of any 
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monies in the Treasury not otherwise appropriated, 
to the Health Professions Workforce Fund— 
(A) $392,000,000 for fiscal year 2023; 
(B) $412,000,000 for fiscal year 2024; 
(C) $432,000,000 for fiscal year 2025; 
(D) $454,000,000 for fiscal year 2026; 
(E) $476,000,000 for fiscal year 2027; 
(F) $500,000,000 for fiscal year 2028; 
(G) $525,000,000 for fiscal year 2029; and 
(H) $552,000,000 for fiscal year 2030. 
(2) HEALTH
PROFESSIONS
EDUCATION
PRO-
GRAMS.—For the purpose of carrying out health 
professions education programs authorized under 
title VII of the Public Health Service Act (42 U.S.C. 
292 et seq.), in addition to any other amounts au-
thorized to be appropriated for such purpose, there 
is authorized to be appropriated out of any monies 
in the Health Professions Workforce Fund, the fol-
lowing: 
(A) $265,000,000 for fiscal year 2023. 
(B) $278,000,000 for fiscal year 2024. 
(C) $292,000,000 for fiscal year 2025. 
(D) $307,000,000 for fiscal year 2026. 
(E) $322,000,000 for fiscal year 2027. 
(F) $338,000,000 for fiscal year 2028. 
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(G) $355,000,000 for fiscal year 2029. 
(H) $373,000,000 for fiscal year 2030. 
(3) NURSING WORKFORCE DEVELOPMENT PRO-
GRAMS.—For the purpose of carrying out nursing 
workforce development programs authorized under 
title VIII of the Public Health Service Act (42 
U.S.C. 296 et seq.), in addition to any other 
amounts authorized to be appropriated for such pur-
pose, there is authorized to be appropriated out of 
any monies in the Health Professions Workforce 
Fund, the following: 
(A) $127,000,000 for fiscal year 2023. 
(B) $134,000,000 for fiscal year 2024. 
(C) $140,000,000 for fiscal year 2025. 
(D) $147,000,000 for fiscal year 2026. 
(E) $154,000,000 for fiscal year 2027. 
(F) $162,000,000 for fiscal year 2028. 
(G) $170,000,000 for fiscal year 2029. 
(H) $179,000,000 for fiscal year 2030. 
SEC. 3012. FUTURE ADVANCEMENT OF ACADEMIC NURS-
ING. 
(a) SUPPORT FOR NURSING EDUCATION AND THE 
FUTURE NURSING WORKFORCE.—Part D of title VIII of 
the Public Health Service Act (42 U.S.C. 296p et seq.) 
is amended by adding at the end the following: 
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‘‘SEC. 832. NURSING EDUCATION ENHANCEMENT AND MOD-
ERNIZATION 
GRANTS 
IN 
UNDERSERVED 
AREAS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, may award grants to schools of nursing 
(as defined in section 801) for— 
‘‘(1) increasing the number of faculty and stu-
dents at such schools in order to enhance the pre-
paredness of the United States for, and the ability 
of the United States to address and quickly respond 
to, public health emergencies declared under section 
319 and pandemics; or 
‘‘(2) the enhancement and modernization of 
nursing education programs. 
‘‘(b) PRIORITY.—In selecting grant recipients under 
this section, the Secretary shall give priority to schools of 
nursing that— 
‘‘(1) are located in a medically underserved 
community; 
‘‘(2) are located in a health professional short-
age area as defined under section 332(a); or 
‘‘(3) are institutions of higher education listed 
under section 371(a) of the Higher Education Act of 
1965. 
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‘‘(c) CONSIDERATION.—In awarding grants under 
this section, the Secretary, to the extent practicable, may 
ensure equitable distribution of awards among the geo-
graphic regions of the United States. 
‘‘(d) USE OF FUNDS.—A school of nursing that re-
ceives a grant under this section may use the funds award-
ed through such grant for activities that include— 
‘‘(1) enhancing enrollment and retention of stu-
dents at such school, with a priority for students 
from disadvantaged backgrounds (including racial or 
ethnic groups underrepresented in the nursing work-
force), individuals from rural and underserved areas, 
low-income individuals, and first generation college 
students (as defined in section 402A(h)(3) of the 
Higher Education Act of 1965); 
‘‘(2) creating, supporting, or modernizing edu-
cational programs and curriculum at such school; 
‘‘(3) retaining current faculty, and hiring new 
faculty, with an emphasis on faculty from racial or 
ethnic groups who are underrepresented in the nurs-
ing workforce; 
‘‘(4) modernizing infrastructure at such school, 
including audiovisual or other equipment, personal 
protective equipment, simulation and augmented re-
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ality resources, telehealth technologies, and virtual 
and physical laboratories; 
‘‘(5) partnering with a health care facility, 
nurse-managed health clinic, community health cen-
ter, or other facility that provides health care in 
order to provide educational opportunities for the 
purpose of establishing or expanding clinical edu-
cation; 
‘‘(6) enhancing and expanding nursing pro-
grams that prepare nurse researchers and scientists; 
‘‘(7) establishing nurse-led intradisciplinary and 
interprofessional educational partnerships; and 
‘‘(8) other activities that the Secretary deter-
mines further the development, improvement, and 
expansion of schools of nursing. 
‘‘(e) REPORTS FROM ENTITIES.—Each school of 
nursing awarded a grant under this section shall submit 
an annual report to the Secretary on the activities con-
ducted under such grant, and other information as the 
Secretary may require. 
‘‘(f) REPORT TO CONGRESS.—Not later than 5 years 
after the date of the enactment of this section, the Sec-
retary shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the Com-
mittee on Energy and Commerce of the House of Rep-
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resentatives a report that provides a summary of the ac-
tivities and outcomes associated with grants made under 
this section. Such report shall include— 
‘‘(1) a list of schools of nursing receiving grants 
under this section, including the primary geographic 
location of any school of nursing that was improved 
or expanded through such a grant; 
‘‘(2) the total number of students who are en-
rolled at or who have graduated from any school of 
nursing that was improved or expanded through a 
grant under this section, which such statistic shall— 
‘‘(A) to the extent such information is 
available, be deidentified and disaggregated by 
race, ethnicity, age, sex, geographic region, dis-
ability status, and other relevant factors; and 
‘‘(B) include an indication of the number 
of such students who are from racial or ethnic 
groups underrepresented in the nursing work-
force, such students who are from rural or un-
derserved areas, such students who are low-in-
come students, and such students who are first 
generation college students (as defined in sec-
tion 402A(h)(3) of the Higher Education Act of 
1965); 
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‘‘(3) to the extent such information is available, 
the effects of the grants awarded under this section 
on retaining and hiring of faculty, including any in-
crease in diverse faculty, the number of clinical edu-
cation partnerships, the modernization of nursing 
education infrastructure, and other ways this section 
helps address and quickly respond to public health 
emergencies and pandemics; 
‘‘(4) recommendations for improving the grants 
awarded under this section; and 
‘‘(5) any other considerations as the Secretary 
determines appropriate. 
‘‘(g) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $1,000,000,000, to remain available until ex-
pended.’’. 
(b) STRENGTHENING
NURSE
EDUCATION.—The 
heading of part D of title VIII of the Public Health Serv-
ice Act (42 U.S.C. 296p et seq.) is amended by striking 
‘‘BASIC’’. 
SEC. 3013. FINDINGS; SENSE OF CONGRESS RELATING TO 
GRADUATE MEDICAL EDUCATION. 
(a) FINDINGS.—Congress finds the following: 
(1) Projections by the Association of American 
Medical Colleges and other expert entities, such as 
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229 
the Health Resources and Services Administration, 
have indicated a nationwide shortage of up to 
121,900 physicians, split evenly between primary 
care and specialists, by 2032. 
(2) Primarily due to the growing and aging 
population, over the next decade, physician demand 
is expected to grow up to 17 percent. 
(3) The United States Census Bureau estimates 
that the United States population will grow from 
321,000,000 in 2015 to 347,000,000 in 2025. Fur-
ther, the number of Medicare beneficiaries is esti-
mated to increase from 47,800,000 in 2015 to ap-
proximately 66,000,000 in 2025. 
(4) Approximately 36 percent of practicing phy-
sicians are over the age of 55 and are likely to retire 
within the next decade. 
(5) A nationwide physician shortage will result 
in many individuals in the United States waiting 
longer and traveling farther for health care; seeking 
nonemergent care in emergency departments; and 
delaying treatment until the health care needs of 
such individuals become more serious, complex, and 
costly. 
(6) Changing demographics (such as an aging 
population), new health care delivery models (such 
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as medical homes), and other factors (such as dis-
aster preparedness) are contributing to a shortage of 
both generalist and specialist physicians. 
(7) These shortages will have the most severe 
impact on vulnerable and underserved populations, 
including racial and ethnic minorities and the ap-
proximately 20 percent of people in the United 
States who live in rural or inner-city locations des-
ignated as health professional shortage areas. 
(8) The health care utilization equity model of 
the Association of American Medical Colleges esti-
mates that if racial and ethnic minorities and indi-
viduals from rural areas utilized health care in a 
similar way to their Caucasian counterparts living in 
metropolitan areas, the physician shortage would re-
quire an additional 96,000 physicians. 
(9) To address the physician shortage in rural 
and medically underserved areas, medical education 
and training need to be accessible to underrep-
resented minorities (including individuals who are 
African American, Hispanic, Native American, or 
Native Hawaiian), and need to increase pathway 
programs for such underrepresented minorities who 
make up less than 12 percent of individuals enrolled 
in graduate medical education and for international 
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231 
students who make up 25 percent of individuals en-
rolled in graduate medical education. Immigration 
pathways like student, exchange-visitor, and employ-
ment visas, and programs like the National Interest 
Waiver and Conrad 30 J–1 Visa Waiver, help im-
prove health access across the United States. 
(10) United States medical school enrollment 
was expected to grow by 30 percent from 2018 to 
2019 to help reduce the shortage of quality physi-
cians in the United States. 
(11) An increase in United States medical 
school graduates must be accompanied by an in-
crease of 4,000 graduate medical education training 
positions each year. 
(12) Graduate medical education programs and 
teaching hospitals provide venues in which the next 
generation of physicians learns to work collabo-
ratively with other physicians and health profes-
sionals, adopt more efficient care delivery models 
(such as care coordination and medical homes), in-
corporate health information technology and elec-
tronic health records in every aspect of their work, 
apply new methods of assuring quality and safety, 
and participate in groundbreaking clinical and public 
health research. 
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232 
(13) The Medicare program under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.) 
(having more beneficiaries than any other health 
care program), supports its ‘‘fair share’’ of the costs 
associated with graduate medical education. 
(14) In general, the level of support of graduate 
medical education by the Medicare program has 
been capped since 1997 and has not been increased 
to support the expansion of graduate medical edu-
cation programs needed to avert the projected physi-
cian shortage or to accommodate the increase in 
United States medical school graduates. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that eliminating the limit of the number of residency 
positions that receive some level of Medicare support 
under section 1886(h) of the Social Security Act (42 
U.S.C. 1395ww(h)), also referred to as the Medical grad-
uate medical education cap, is critical to— 
(1) ensuring an appropriate supply of physi-
cians to meet the health care needs in the United 
States; 
(2) facilitating equitable access for all who seek 
health care; 
(3) increasing the racial and ethnic diversity of 
physicians in the United States; and 
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233 
(4) mitigating disparities in health and health 
care. 
SEC. 3014. CAREER SUPPORT FOR SKILLED, INTERNATION-
ALLY EDUCATED HEALTH PROFESSIONALS. 
(a) FINDINGS.—Congress finds the following: 
(1) According to a 2018 study, the State and 
local public health workforce has shrunk by more 
than 50,000 individuals since the beginning of the 
2008 Great Recession, and almost one quarter of in-
dividuals comprising the governmental public health 
workforce plan to leave or retire in the coming years. 
(2) Shortages are projected for other health 
professions, including within the fields of nursing 
(500,000 by 2025), dentistry (15,000 by 2025), 
pharmacy (38,000 by 2030), mental and behavioral 
health (236,880 by 2025), and primary care (46,000 
by 2025). 
(3) A nationwide health workforce shortage will 
result in serious health threats and more severe and 
costly health care needs, due to, in part, a delayed 
response to food-borne outbreaks, emerging infec-
tious diseases, natural disasters, fewer cancer 
screenings, and delayed treatment. 
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234 
(4) Vulnerable and underserved populations and 
health professional shortage areas will be most se-
verely impacted by the health workforce shortage. 
(5) According to the Migration Policy Institute, 
more than 2,000,000 college-educated immigrants in 
the United States today are unemployed or under-
employed in low- or semi-skilled jobs that fail to 
draw on their education and expertise. 
(6) Approximately 2 out of every 5 internation-
ally educated immigrants are unemployed or under-
employed. 
(7) According to the Drexel University Center 
for Labor Markets and Policy, underemployment for 
internationally educated immigrant women is 28 per-
cent higher than for their male counterparts. 
(8) According to the Drexel University Center 
for Labor Markets and Policy, the mean annual 
earnings 
of 
underemployed 
immigrants 
were 
$32,000, or 43 percent less than United States born 
college graduates employed in the college labor mar-
ket. 
(9) According to Upwardly Global and the Wel-
come Back Initiative, with proper guidance and sup-
port, underemployed skilled immigrants typically in-
crease their income by 215 percent to 900 percent. 
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(10) According to the Brookings Institution and 
the Partnership for a New American Economy, im-
migrants working in the health workforce are, on av-
erage, better educated than United States-born 
workers in the health workforce. 
(b) GRANTS TO ELIGIBLE ENTITIES.— 
(1) AUTHORITY
TO
PROVIDE
GRANTS.—The 
Secretary of Health and Human Services acting 
through the Bureau of Health Workforce within the 
Health Resources and Services Administration, the 
National Institute on Minority Health and Health 
Disparities, or the Office of Minority Health (in this 
section referred to as the ‘‘Secretary’’) may award 
grants to eligible entities to carry out activities de-
scribed in subsection (c). 
(2) ELIGIBILITY.—To be eligible to receive a 
grant under this section, an entity shall— 
(A) be a clinical, public health, or health 
services organization, a community-based or 
nonprofit entity, an academic institution, a 
faith-based organization, a State, county, or 
local government, an area health education cen-
ter, or another entity determined appropriate by 
the Secretary; and 
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236 
(B) submit to the Secretary an application 
at such time, in such manner, and containing 
such information as the Secretary may require. 
(c) AUTHORIZED ACTIVITIES.—A grant awarded 
under this section shall be used— 
(1) to provide services to assist unemployed and 
underemployed skilled immigrants, residing in the 
United States, who have legal, permanent work au-
thorization and who are internationally educated 
health professionals, enter into the health workforce 
of the United States with employment matching 
their health professional skills and education, and 
advance in employment to positions that better 
match their health professional education and exper-
tise; 
(2) to provide training opportunities to reduce 
barriers to entry and advancement in the health 
workforce for skilled, internationally educated immi-
grants; 
(3) to educate employers regarding the abilities 
and capacities of internationally educated health 
professionals; 
(4) to assist in the evaluation of foreign creden-
tials; 
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237 
(5) to support preceptorships for international 
medical graduates in hospital primary care training; 
and 
(6) to facilitate access to contextualized and ac-
celerated courses on English as a second language. 
SEC. 3015. STUDY AND REPORT ON STRATEGIES FOR IN-
CREASING DIVERSITY. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study on strategies for increasing 
the diversity of the health professional workforce. Such 
study shall include an analysis of strategies for increasing 
the number of health professionals from rural, lower in-
come, and underrepresented minority communities, includ-
ing which strategies are most effective for achieving such 
goal. 
(b) REPORT.—Not later than 2 years after the date 
of enactment of this Act, the Comptroller General shall 
submit to Congress a report on the study conducted under 
subsection (a), together with recommendations for such 
legislation and administrative action as the Comptroller 
General determines appropriate. 
SEC. 3016. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN-
TION. 
(a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec-
tion 220(c) of the Immigration and Nationality Technical 
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Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 
1182 note) is amended by striking ‘‘September 30, 2015’’ 
and inserting ‘‘September 30, 2022’’. 
(b) 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 com-
pleted service requirements for a national inter-
est 
waiver 
requested 
under 
section 
203(b)(2)(B)(ii), including— 
‘‘(I) alien physicians who completed 
such service before the date of the enact-
ment of the Health Equity and Account-
ability Act of 2022; and 
‘‘(II) the spouse or children of an 
alien physician described in subclause (I). 
‘‘(ii) Nothing in this subparagraph may be 
construed— 
‘‘(I) to prevent the filing of a petition 
with the Secretary of Homeland Security 
for classification under section 204(a) or 
the filing of an application for adjustment 
of status under section 245 by an alien 
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239 
physician described in clause (i) before the 
date on which such alien physician com-
pletes the service described in section 
214(l) or worked full-time as a physician 
for an aggregate of 5 years at the location 
identified in the waiver of the 2-year for-
eign residence requirement under section 
214(l) or in an area or areas designated by 
the Secretary of Health and Human Serv-
ices as having a shortage of health care 
professionals; or 
‘‘(II) to permit the Secretary of 
Homeland Security to grant a petition or 
application described in subclause (I) until 
the alien has satisfied all of the require-
ments of the waiver received under section 
214(l).’’. 
(c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 
(1) EXCEPTIONS
TO
2-YEAR
FOREIGN
RESI-
DENCY
REQUIREMENT.—Section 214(l)(1) of the 
Immigration 
and 
Nationality 
Act 
(8 
U.S.C. 
1184(l)(1)) is amended— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘Attorney General shall not’’ 
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240 
and inserting ‘‘Secretary of Homeland Security 
may not’’; 
(B) in subparagraph (A), by striking ‘‘Di-
rector of the United States Information Agen-
cy’’ and inserting ‘‘Secretary of State’’; 
(C) in subparagraph (B), by inserting ‘‘, 
except as provided in paragraphs (7) and (8)’’ 
before the semicolon at the end; 
(D) in subparagraph (C), by amending 
clauses (i) and (ii) to read as follows: 
‘‘(i) the alien demonstrates a bona 
fide offer of full-time employment at a 
health facility or health care organization, 
which employment 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 
organization in a geographic area or 
areas which are designated by the 
Secretary of Health and Human Serv-
ices as having a shortage of health 
care professionals; 
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241 
‘‘(II) begins employment by the 
later of the date that is— 
‘‘(aa) 120 days after receiv-
ing such waiver; 
‘‘(bb) 120 days after com-
pleting graduate medical edu-
cation or training under a pro-
gram approved pursuant to sec-
tion 212(j)(1); or 
‘‘(cc) 120 days after receiv-
ing nonimmigrant status or em-
ployment authorization, if the 
alien or the alien’s employer peti-
tions for such nonimmigrant sta-
tus or employment authorization 
not later than 120 days after the 
date on which the alien completes 
his or her graduate medical edu-
cation or training under a pro-
gram approved pursuant to sec-
tion 212(j)(1); and 
‘‘(III) agrees to continue to work 
for a total of not less than 3 years in 
the status authorized for such employ-
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242 
ment under this subsection, except as 
provided in paragraph (8); and’’; and 
(E) in subparagraph (D), in the matter 
preceding clause (i), by inserting ‘‘, subject to 
paragraph (8),’’ before ‘‘in the case’’. 
(2) ALLOWABLE VISA STATUS FOR PHYSICIANS 
FULFILLING WAIVER REQUIREMENTS IN MEDICALLY 
UNDERSERVED
AREAS.—Section 214(l)(2)(A) of 
such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 
read as follows: 
‘‘(A) Upon the request of an interested 
Federal agency or an interested State agency 
for recommendation of a waiver under this sec-
tion by a physician who is maintaining valid 
nonimmigrant 
status 
under 
section 
101(a)(15)(J) and received a favorable rec-
ommendation 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 set forth in subsection 
(g)(1)(A) shall not apply to any alien whose 
status is changed under this subparagraph.’’. 
(3) 
VIOLATION
OF
AGREEMENTS.—Section 
214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 
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243 
amended by inserting ‘‘substantial requirement of 
an’’ before ‘‘agreement entered into’’. 
(4) PHYSICIAN EMPLOYMENT IN UNDERSERVED 
AREAS.—Section 214(l) of such Act (8 U.S.C. 
1184(l)), as amended by this section, is further 
amended by adding at the end the following: 
‘‘(4)(A) If an interested State agency denies the 
application for a waiver under paragraph (1)(B) 
from a physician pursuing graduate medical edu-
cation or training pursuant to section 101(a)(15)(J) 
because the State has requested the maximum num-
ber of waivers permitted for that fiscal year, the 
physician’s nonimmigrant status shall be extended 
for up to 6 months if the physician agrees to seek 
a waiver under this subsection (except for paragraph 
(1)(D)(ii)) to work for an employer described in 
paragraph (1)(C) in a State that has not yet re-
quested the maximum number of waivers. 
‘‘(B) A physician described in subparagraph (A) 
may only work for the employer referred to in sub-
paragraph (A) during the period beginning on the 
date on which a new waiver application is filed with 
such State and ending on the earlier of— 
‘‘(i) the date on which the Secretary of 
Homeland Security denies such waiver; or 
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244 
‘‘(ii) the date on which the Secretary ap-
proves an application for change of status 
under paragraph (2)(A) pursuant to the ap-
proval of such waiver.’’. 
(5) 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 para-
graph (1)(C) shall enter into an employment agree-
ment 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 the compensation the alien will re-
ceive for on-call time; 
‘‘(B) specifies— 
‘‘(i) whether the contracting facility or 
organization will pay the alien’s mal-
practice insurance premiums; 
‘‘(ii) whether the employer will provide 
malpractice insurance; and 
‘‘(iii) the amount of such insurance 
that will be provided; 
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245 
‘‘(C) describes all of the work locations 
that the alien will work including a statement 
that the contracting facility or organization will 
not add additional work locations without the 
approval of the Federal agency or State agency 
that requested the waiver; and 
‘‘(D) does not include a non-compete provi-
sion. 
‘‘(6) An alien granted a waiver under this sub-
section whose employment relationship with a health 
facility or health care organization terminates under 
paragraph (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 sub-
clause (III)(cc) of such paragraph.’’. 
(6) RECAPTURING
WAIVER
SLOTS
LOST
TO 
OTHER
STATES.—Section 214(l) of such Act, as 
amended by this section, is further amended by add-
ing at the end the following: 
‘‘(7) If a recipient of a waiver under this sub-
section terminates the recipient’s employment with a 
health facility or health care organization pursuant 
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246 
to paragraph (1)(C)(ii), including termination of em-
ployment because of circumstances described in 
paragraph (1)(C)(ii)(III), and accepts new employ-
ment with such a facility or organization in a dif-
ferent State, the State from which the alien is de-
parting 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.’’. 
(7) EXCEPTION
TO
3-YEAR
WORK
REQUIRE-
MENT.—Section 214(l) of such Act, as amended by 
this section, is further amended by adding at the 
end the following: 
‘‘(8) The 3-year work requirement set forth in 
subparagraphs (C) and (D) of paragraph (1) shall 
not apply if— 
‘‘(A)(i) the Secretary of Homeland Secu-
rity determines that extenuating circumstances, 
including violations by the employer of the em-
ployment agreement with the alien or of labor 
and employment laws, exist that justify a lesser 
period of employment at such facility or organi-
zation; and 
‘‘(ii) not later than 120 days after the em-
ployment termination date (unless the Secretary 
determines 
that 
extenuating 
circumstances 
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247 
would justify an extension), the alien dem-
onstrates another bona fide offer of employment 
at a health facility or health care organization 
in a geographic area or areas which are des-
ignated 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 em-
ployer of the employment agreement 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 ex-
tenuating circumstances would justify an exten-
sion), 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 profes-
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248 
sionals, for the remainder of such 3-year period; 
or 
‘‘(C) the alien— 
‘‘(i) elects not to pursue a determina-
tion of extenuating circumstances pursuant 
to subparagraph (A) or (B); 
‘‘(ii) terminates the alien’s employ-
ment relationship with the health facility 
or health care organization at which the 
alien was employed; 
‘‘(iii) not later than 45 days after the 
employment 
termination 
date, 
dem-
onstrates another bona fide offer of em-
ployment at a health facility 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-
retary of Health and Human Services as 
having a shortage of health care profes-
sionals; and 
‘‘(iv) agrees to be employed for the re-
mainder of such 3-year period, and 1 addi-
tional year for each termination under 
clause (ii).’’. 
(d) ALLOTMENT OF CONRAD 30 WAIVERS.— 
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249 
(1) IN GENERAL.—Section 214(l) of the Immi-
gration and Nationality Act (8 U.S.C. 1184(l)), as 
amended by subsection (c), is further amended by 
adding at the end the following: 
‘‘(9)(A)(i) All States shall be allotted 35 waivers 
under paragraph (1)(B) for each fiscal year if 90 percent 
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. 
‘‘(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 such case— 
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250 
‘‘(i) the number of waivers allotted beginning in 
the next fiscal year shall be decreased by 5 for all 
States; 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.’’. 
(2) ACADEMIC
MEDICAL
CENTERS.—Section 
214(l)(1)(D) of such Act, as amended by subsection 
(c)(1)(E), is further amended— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(iv) in the case of a request by an inter-
ested State agency— 
‘‘(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 
defined in section 411.355(e)(2) of title 42, 
Code of Federal Regulations), without re-
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251 
gard to whether such facility is located 
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 deter-
mines that— 
‘‘(aa) the alien physician’s work 
is in the public interest; and 
‘‘(bb) subject to paragraph (6), 
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 to exceed 3, 
within the limitation under subpara-
graph (B).’’. 
(e) AMENDMENTS TO THE PROCEDURES, DEFINI-
TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN 
IMMIGRATION.— 
(1) DUAL
INTENT
FOR
PHYSICIANS
SEEKING 
GRADUATE MEDICAL TRAINING.—Section 214(b) of 
the Immigration and Nationality Act (8 U.S.C. 
1184(b)) is amended by striking ‘‘and other than a 
nonimmigrant described in any provision of section 
101(a)(15)(H)(i) except subclause (b1) of such sec-
tion)’’ and inserting ‘‘a nonimmigrant described in 
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252 
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 graduate medical 
education or training as described in section 212(j) 
or to take examinations required to receive graduate 
medical education or training as described in section 
212(j))’’. 
(2) PHYSICIAN
NATIONAL
INTEREST
WAIVER 
CLARIFICATIONS.— 
(A) PRACTICE AND GEOGRAPHIC AREA.— 
Section 203(b)(2)(B)(ii)(I) of the Immigration 
and 
Nationality 
Act 
(8 
U.S.C. 
1153(b)(2)(B)(ii)(I)) is amended by striking 
items (aa) and (bb) and inserting 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 
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253 
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.’’. 
(B) FIVE-YEAR SERVICE REQUIREMENT.— 
Section 203(b)(2)(B)(ii) of such Act is amend-
ed— 
(i) by moving subclauses (II), (III), 
and (IV) 4 ems to the left; and 
(ii) 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 
described in item (aa) shall begin on the 
date on which the alien physician begins 
work in the shortage area in any legal sta-
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254 
tus and not on the date on which an immi-
grant 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. 
‘‘(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. 
‘‘(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.’’. 
(3) TECHNICAL CLARIFICATION REGARDING AD-
VANCED
DEGREE
FOR
PHYSICIANS.—Section 
203(b)(2)(A) of such Act is amended by adding at 
the end the following: ‘‘An alien physician holding a 
foreign medical degree that has been deemed suffi-
cient for acceptance by an accredited United States 
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255 
medical residency or fellowship program shall be 
considered a member of the professions holding an 
advanced degree or its equivalent for purposes of 
this paragraph.’’. 
(4) SHORT-TERM
WORK
AUTHORIZATION
FOR 
PHYSICIANS COMPLETING THEIR RESIDENCIES.— 
(A) IN GENERAL.—A physician completing 
graduate medical education or training de-
scribed 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))— 
(i) shall have such nonimmigrant sta-
tus automatically extended until October 1 
of the fiscal year for which a petition for 
a continuation of such nonimmigrant sta-
tus has been submitted in a timely manner 
and the employment start date for the ben-
eficiary of such petition is October 1 of 
that fiscal year; and 
(ii) shall be authorized to be employed 
incident to status during the period be-
tween the filing of such petition and Octo-
ber 1 of such fiscal year. 
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256 
(B) TERMINATION.—The status and em-
ployment authorization of a physician described 
in subparagraph (A) shall terminate on the date 
that is 30 days after the date on which a peti-
tion described in clause (i)(I) is rejected, denied 
or revoked. 
(C) AUTOMATIC EXTENSION.—The status 
and employment authorization of a physician 
described in subparagraph (A) 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 the Immigration and Na-
tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 
were authorized to be issued for the fiscal year 
have been issued. 
(5) APPLICABILITY
OF
SECTION
212(e)
TO 
SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI-
TORS.—A spouse or child of an exchange visitor de-
scribed 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 requirements under section 
212(e) of such Act (8 U.S.C. 1182(e)). 
SEC. 3017. NATIONAL HISPANIC NURSES DAY. 
(a) FINDINGS.—Congress finds the following: 
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257 
(1) A special group of nurses in the Nation are 
the Hispanic nurses. 
(2) Hispanic nurses provide culturally and eth-
nically competent care and are educated to be sen-
sitive to regional and community customs of persons 
needing care. 
(3) Hispanic nurses are well-positioned to pro-
vide leadership to eliminate health care disparities 
that exist in the Nation. 
(4) Since 1975, the National Association of 
Hispanic Nurses (NAHN) has represented Hispanic 
nurses (RNs/LPNs) in the United States and is the 
only nursing organization for Hispanic nurses whose 
mission is to advance the health in Hispanic commu-
nities and to lead, promote, and advocate for edu-
cational, professional, and leadership opportunities 
for Hispanic nurses. 
(5) Since September is the month that has been 
set aside to honor the contributions of Hispanics, it 
is only fitting that Hispanic nurses be recognized 
and honored during this time for their outstanding 
contributions to their community and country. 
(6) The designation of an observation day will 
help to raise awareness of the accomplishments of 
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258 
Hispanic nurses and pave the way for the important 
work that they must continue to carry out. 
(7) Each February, the NAHN convenes nearly 
100 nursing leaders from academia, research, edu-
cation, and practice in the District of Columbia for 
a day on Capitol Hill promoting legislation that im-
proves the health of Hispanic communities. 
(8) Hispanic nurses are strong allies to Con-
gress as they help inform, educate, and work closely 
with legislators to improve the education, retention, 
recruitment, and practice of all nurses and, more 
importantly, the health and safety of the patients 
they care for. 
(9) Hispanic nurses add needed diversity to the 
nursing profession, and these nurses have engaged 
in numerous ways to support communities and the 
needs of an overlooked, under resourced, and under-
served population being severely impacted by 
COVID–19. 
(b) SENSE OF CONGRESS.—The Congress— 
(1) supports the goals and ideals, and the des-
ignation, of National Hispanic Nurses Day, as pro-
posed by the National Association of Hispanic 
Nurses; 
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259 
(2) recognizes the significant contributions of 
Hispanic nurses to the health care system of the 
United States; and 
(3) encourages the people of the United States 
to observe National Hispanic Nurses Day with ap-
propriate recognition, ceremonies, activities, and pro-
grams to demonstrate the importance of Hispanic 
nurses to the everyday lives of patients and the com-
munities they serve. 
SEC. 3018. EXPANDING MEDICAL EDUCATION. 
Subpart II of part C of title VII of the Public Health 
Service Act (42 U.S.C. 293m et seq.) is amended by add-
ing at the end the following: 
‘‘SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND 
SCHOOLS OF OSTEOPATHIC MEDICINE IN UN-
DERSERVED AREAS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, may award grants to institutions of high-
er education (including consortiums of such institutions) 
for the establishment, improvement, or expansion of a 
school of medicine or osteopathic medicine, or a branch 
campus of a school of medicine or osteopathic medicine. 
‘‘(b) PRIORITY.—In selecting grant recipients under 
this section, the Secretary shall give priority to any insti-
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260 
tution of higher education (or consortium of such institu-
tions) that— 
‘‘(1) proposes to use the grant for the establish-
ment of a school of medicine or osteopathic medi-
cine, or a branch campus of a school of medicine or 
osteopathic medicine, in an area— 
‘‘(A) in which no other such school is 
based; and 
‘‘(B) that is a medically underserved com-
munity or a health professional shortage area; 
or 
‘‘(2) is a minority-serving institution described 
in section 371(a) of the Higher Education Act of 
1965. 
‘‘(c) CONSIDERATIONS.—In awarding grants under 
this section, the Secretary, to the extent practicable, may 
ensure equitable distribution of awards among the geo-
graphical regions of the United States. 
‘‘(d) USE OF FUNDS.—An institution of higher edu-
cation (or a consortium of such institutions)— 
‘‘(1) shall use grant amounts received under 
this section to— 
‘‘(A) recruit, enroll, and retain students, 
including individuals who are from disadvan-
taged backgrounds (including racial and ethnic 
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261 
groups underrepresented among medical stu-
dents and health professions), individuals from 
rural and underserved areas, low-income indi-
viduals, and first generation college students, at 
a school of medicine or osteopathic medicine or 
branch campus of a school of medicine or osteo-
pathic medicine; and 
‘‘(B) develop, implement, and expand cur-
riculum that emphasizes care for rural and un-
derserved populations, including accessible and 
culturally and linguistically appropriate care 
and services, at such school or branch campus; 
and 
‘‘(2) may use grant amounts received under this 
section to— 
‘‘(A) plan and construct— 
‘‘(i) a school of medicine or osteo-
pathic medicine in an area in which no 
other such school is based; or 
‘‘(ii) a branch campus of a school of 
medicine or osteopathic medicine in an 
area in which no other such school is 
based; 
‘‘(B) plan, develop, and meet criteria for 
accreditation for a school of medicine or osteo-
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262 
pathic medicine or branch campus of a school 
of medicine or osteopathic medicine; 
‘‘(C) hire faculty, including faculty from 
racial and ethnic groups who are underrep-
resented among the medical and other health 
professions, and other staff to serve at such a 
school or branch campus; 
‘‘(D) support educational programs at such 
a school or branch campus; 
‘‘(E) modernize and expand infrastructure 
at such a school or branch campus; and 
‘‘(F) support other activities that the Sec-
retary determines further the establishment, 
improvement, or expansion of a school of medi-
cine or osteopathic medicine or branch campus 
of a school of medicine or osteopathic medicine. 
‘‘(e) APPLICATION.—To be eligible to receive a grant 
under subsection (a), an institution of higher education 
(or a consortium of such institutions), shall submit an ap-
plication to the Secretary at such time, in such manner, 
and containing such information as the Secretary may re-
quire, including a description of the institution’s or con-
sortium’s planned activities described in subsection (d). 
‘‘(f) REPORTING.— 
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263 
‘‘(1) REPORTS FROM ENTITIES.—Each institu-
tion of higher education, or consortium of such insti-
tutions, awarded a grant under this section shall 
submit an annual report to the Secretary on the ac-
tivities conducted under such grant, and other infor-
mation as the Secretary may require. 
‘‘(2) REPORT TO CONGRESS.—Not later than 5 
years after the date of enactment of this section and 
every 5 years thereafter, the Secretary shall submit 
to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on En-
ergy and Commerce of the House of Representatives 
a report that provides a summary of the activities 
and outcomes associated with grants made under 
this section. Such reports shall include— 
‘‘(A) a list of awardees, including their pri-
mary geographic location, and location of any 
school of medicine or osteopathic medicine, or a 
branch campus of school of medicine or osteo-
pathic medicine that was established, improved, 
or expanded under this program; 
‘‘(B) the total number of students (includ-
ing the number of students from racial and eth-
nic groups underrepresented among medical 
students and health professions, low-income 
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students, and first generation college students) 
who— 
‘‘(i) are enrolled at or who have grad-
uated from any school of medicine or os-
teopathic medicine, or a branch campus of 
school of medicine or osteopathic medicine, 
that was established, improved, or ex-
panded under this program, deidentified 
and disaggregated by race, ethnicity, age, 
sex, geographic region, disability status, 
and other relevant factors, to the extent 
such information is available; and 
‘‘(ii) who subsequently participate in 
an accredited internship or medical resi-
dency program upon graduation from any 
school of medicine or osteopathic medicine, 
or a branch campus of a school of medicine 
or osteopathic medicine, that was estab-
lished, improved, or expanded under this 
program, deidentified and disaggregated by 
race, ethnicity, age, sex, geographic region, 
disability status, medical specialty pursued, 
and other relevant factors, to the extent 
such information is available; 
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265 
‘‘(C) the effects of such program on the 
health care provider workforce, including any 
impact 
on 
demographic 
representation 
disaggregated by race, ethnicity, and sex, and 
the fields or specialties pursued by students 
who have graduated from any school of medi-
cine or osteopathic medicine, or a branch cam-
pus of school of medicine or osteopathic medi-
cine, that was established, improved, or ex-
panded under this program; 
‘‘(D) the effects of such program on health 
care access in underserved areas, including 
medically underserved communities and health 
professional shortage areas; and 
‘‘(E) recommendations for improving the 
program described in this section, and any 
other considerations as the Secretary deter-
mines appropriate. 
‘‘(3) PUBLIC
AVAILABILITY.—The Secretary 
shall make reports submitted under paragraph (2) 
publicly available on the internet website of the De-
partment of Health and Human Services. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) BRANCH CAMPUS.— 
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266 
‘‘(A) IN
GENERAL.—The term ‘branch 
campus’, with respect to a school of medicine or 
osteopathic medicine, means an additional loca-
tion of such school that is geographically apart 
and independent of the main campus, at which 
the school offers at least 50 percent of the pro-
gram leading to a degree of doctor of medicine 
or doctor of osteopathy that is offered at the 
main campus. 
‘‘(B) INDEPENDENCE
FROM
MAIN
CAM-
PUS.—For purposes of subparagraph (A), the 
location of a school described in such subpara-
graph shall be considered to be independent of 
the main campus described in such subpara-
graph if the location— 
‘‘(i) is permanent in nature; 
‘‘(ii) offers courses in educational pro-
grams leading to a degree, certificate, or 
other recognized educational credential; 
‘‘(iii) has its own faculty and adminis-
trative or supervisory organization; and 
‘‘(iv) has its own budgetary and hiring 
authority. 
‘‘(2) FIRST GENERATION COLLEGE STUDENT.— 
The term ‘first generation college student’ has the 
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267 
meaning given such term in section 402A(h)(3) of 
the Higher Education Act of 1965. 
‘‘(3) 
HEALTH
PROFESSIONAL
SHORTAGE 
AREA.—The term ‘health professional shortage area’ 
has the meaning given such term in section 332(a). 
‘‘(4) INSTITUTION OF HIGHER EDUCATION.— 
The term ‘institution of higher education’ has the 
meaning given such term in section 101 of the High-
er Education Act of 1965. 
‘‘(5) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ has the 
meaning given such term in section 799B(6). 
‘‘(h) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $1,000,000,000, to remain available until ex-
pended.’’. 
TITLE IV—IMPROVING HEALTH 
CARE ACCESS AND QUALITY 
SEC. 4000. DEFINITION. 
In this title and the amendments made by this title, 
the term ‘‘health care’’ includes all health care needed 
throughout the life cycle and the end of life. 
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268 
Subtitle A—Reducing Barriers to 
Accessing Care 
SEC. 4001. PROTECTING PROTECTED AREAS. 
Section 287 of the Immigration and Nationality Act 
(8 U.S.C. 1357) is amended— 
(1) by striking ‘‘Service’’ each place such term 
appears and inserting ‘‘Department of Homeland 
Security’’; 
(2) by striking ‘‘Attorney General’’ each place 
such term appears and inserting ‘‘Secretary of 
Homeland Security’’; 
(3) in subsection (f)(1), by striking ‘‘Commis-
sioner’’ and inserting ‘‘Director of U.S. Citizenship 
and Immigration Services’’; 
(4) in subsection (h)— 
(A) by striking ‘‘of the Immigration and 
Nationality Act’’; and 
(B) by striking ‘‘of such Act’’; and 
(5) by adding at the end the following: 
‘‘(i)(1) In this subsection: 
‘‘(A) The term ‘appropriate congressional com-
mittees’ means— 
‘‘(i) the Committee on Homeland Security 
and Governmental Affairs of the Senate; 
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269 
‘‘(ii) the Committee on the Judiciary of the 
Senate; 
‘‘(iii) the Committee on Homeland Security 
of the House of Representatives; and 
‘‘(iv) the Committee on the Judiciary of 
the House of Representatives. 
‘‘(B) The term ‘enforcement action’— 
‘‘(i) means an apprehension, arrest, inspec-
tion interview, request for identification, search, 
seizure, service of charging documents or sub-
poenas, or surveillance for the purposes of im-
migration enforcement; and 
‘‘(ii) includes an enforcement action at, or 
focused on, a protected area that is part of a 
joint case led by another law enforcement agen-
cy. 
‘‘(C) The term ‘exigent circumstances’ means a 
situation involving— 
‘‘(i) the imminent risk of death, violence, 
or physical harm to any person or property, in-
cluding a situation implicating terrorism or the 
national security of the United States; 
‘‘(ii) the immediate arrest or pursuit of a 
dangerous felon, terrorist suspect, or other indi-
vidual presenting an imminent danger; or 
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270 
‘‘(iii) the imminent risk of destruction of 
evidence that is material to an ongoing criminal 
case. 
‘‘(D) The term ‘protected area’ includes all of 
the physical space located within 1,000 feet of— 
‘‘(i) any medical treatment or mental 
health care facility, including any hospital, doc-
tor’s office, health clinic, alcohol or drug pre-
vention, counseling, or treatment facilities, sy-
ringe exchange services, vaccination, treatment, 
or testing sites, emergent or urgent care facil-
ity, sites that serve pregnant individuals, or 
community health centers; 
‘‘(ii) any public or private school, including 
any known and licensed day care facility, pre-
school, sites of early childhood programs, pri-
mary school, secondary school, postsecondary 
school (including colleges and universities), or 
other institution of learning (including voca-
tional or trade schools); 
‘‘(iii) any scholastic or education-related 
activity or event or before or after school pro-
gram, including field trips and interscholastic 
events; 
‘‘(iv) any school bus or school bus stop; 
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271 
‘‘(v) places where children gather such as 
a playground, recreation center, library, foster 
care facility, or group home for children; 
‘‘(vi) any physical structure of an organiza-
tion or subdivision of government that— 
‘‘(I) assists children, pregnant women, 
victims of crime or abuse, or individuals 
with significant mental or physical disabil-
ities; 
‘‘(II) provides social services and as-
sistance, including homeless shelters, com-
munity-based organizations, facilities that 
serve disabled persons, drug or alcohol 
counseling and treatment facilities, food 
banks or food pantries, and other places 
providing emergency and disaster services 
or assistance with food and nutrition, 
housing affordability and income or other 
services funded by State or local govern-
ment, charitable giving, the Special Sup-
plemental Nutrition Program for Women, 
Infants, and Children (WIC), Supple-
mental 
Nutrition 
Assistance 
Program 
(SNAP), Temporary Assistance for Needy 
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272 
Families (TANF), Social Security, or the 
United States Housing Act; or 
‘‘(III) provides hospice, palliative, or 
other available end-of-life care services to 
terminally ill persons; 
‘‘(vii) any church, synagogue, mosque, or 
other place of worship or religious study, in-
cluding buildings rented for the purpose of reli-
gious services, retreats, counseling, workshops, 
instruction, and education; 
‘‘(viii) any Federal, State, or local court-
house, including the office of an individual’s 
legal counsel or representative, and a probation, 
parole, or supervised release office; 
‘‘(ix) the site of a funeral, grave-side cere-
mony, rosary, wedding, or other religious cere-
mony or observance; 
‘‘(x) any public demonstration, such as a 
march, rally, or parade; 
‘‘(xi) any domestic violence shelter, rape 
crisis center, child advocacy center, supervised 
visitation center, family justice center, or victim 
services provider; 
‘‘(xii) congressional district offices; 
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273 
‘‘(xiii) indoor and outdoor premises of de-
partments of motor vehicles; 
‘‘(xiv) a place where disaster or emergency 
response and relief is provided, including evacu-
ation routes, places where shelter or emergency 
supplies, food, or water are distributed, or 
places where registration for disaster-relief as-
sistance or family reunification is underway; or 
‘‘(xv) any other location specified by the 
Secretary of Homeland Security for purposes of 
this subsection. 
‘‘(E) The term ‘prior approval’ means— 
‘‘(i) in the case of officers and agents of 
U.S. Immigration and Customs Enforcement, 
prior written approval to carry out an enforce-
ment action involving a specific individual or in-
dividuals authorized by— 
‘‘(I) the Assistant Director of Oper-
ations, Homeland Security Investigations; 
‘‘(II) the Executive Associate Direc-
tor, Homeland Security Investigations; 
‘‘(III) the Assistant Director for Field 
Operations, Enforcement and Removal Op-
erations; or 
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274 
‘‘(IV) the Executive Associate Direc-
tor for Field Operations, Enforcement and 
Removal Operations; 
‘‘(ii) in the case of officers and agents of 
U.S. Customs and Border Protection, prior 
written approval to carry out an enforcement 
action involving a specific individual or individ-
uals authorized by— 
‘‘(I) a Chief Patrol Agent; 
‘‘(II) the Director of Field Operations; 
‘‘(III) the Director of Air and Marine 
Operations; or 
‘‘(IV) the Internal Affairs Special 
Agent in Charge; and 
‘‘(iii) in the case of other Federal, State, 
or local law enforcement officers, to carry out 
an enforcement action involving a specific indi-
vidual or individuals authorized by— 
‘‘(I) the head of the Federal agency 
carrying out the enforcement action; or 
‘‘(II) the head of the State or local 
law enforcement agency carrying out the 
enforcement action. 
‘‘(2)(A) An enforcement action may not take place 
at, or be focused on, a protected area unless— 
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275 
‘‘(i) the action involves exigent circumstances; 
and 
‘‘(ii) prior approval for the enforcement action 
was obtained. 
‘‘(B) If an enforcement action is initiated pursuant 
to subparagraph (A) and the exigent circumstances per-
mitting the enforcement action cease, the enforcement ac-
tion shall be discontinued until such exigent circumstances 
reemerge. 
‘‘(C) If an enforcement action is carried out in viola-
tion of this subsection— 
‘‘(i) no information resulting from the enforce-
ment action may be entered into the record or re-
ceived into evidence in a removal proceeding result-
ing from the enforcement action; and 
‘‘(ii) the noncitizen who is the subject of such 
removal proceeding may file a motion for the imme-
diate termination of the removal proceeding. 
‘‘(3)(A) This subsection shall apply to any enforce-
ment action by officers or agents of the Department of 
Homeland Security, including— 
‘‘(i) officers or agents of U.S. Immigration and 
Customs Enforcement; 
‘‘(ii) officers or agents of U.S. Customs and 
Border Protection; and 
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279 
‘‘(C) to ensure that a subject of an enforcement 
action is not permitted to verify that the officers or 
agents that carried out such action complied with 
the restrictions set forth in this subsection. 
‘‘(6)(A) The Director of U.S. Immigration and Cus-
toms Enforcement and the Commissioner of U.S. Customs 
and Border Protection shall each submit an annual report 
to the appropriate congressional committees that includes 
the information set forth in subparagraph (B) with respect 
to the respective agency. 
‘‘(B) Each report submitted under subparagraph (A) 
shall include, with respect to the submitting agency during 
the reporting period— 
‘‘(i) the number of enforcement actions that 
were carried out at, or focused on, a protected area; 
‘‘(ii) the number of enforcement actions in 
which officers or agents were subsequently led to a 
protected area; and 
‘‘(iii) for each enforcement action described in 
clause (i) or (ii)— 
‘‘(I) the date on which it occurred; 
‘‘(II) the specific site, city, county, and 
State in which it occurred; 
‘‘(III) whether the site was a protected 
area and, if so— 
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281 
‘‘(IX) the percentage of all of the staff 
members and supervisors reporting to the offi-
cials listed in paragraph (4)(B) who completed 
the training required under paragraph (4)(A). 
‘‘(7) Nothing in the subsection may be construed— 
‘‘(A) to affect the authority of Federal, State, 
or local law enforcement agencies— 
‘‘(i) to enforce generally applicable Federal 
or State criminal laws unrelated to immigra-
tion; or 
‘‘(ii) to protect residents from imminent 
threats to public safety; or 
‘‘(B) to limit or override the protections pro-
vided in— 
‘‘(i) section 239; or 
‘‘(ii) section 384 of the Illegal Immigration 
Reform and Immigrant Responsibility Act of 
1996 (8 U.S.C. 1367).’’. 
SEC. 4002. REPEAL OF REQUIREMENT FOR DOCUMENTA-
TION EVIDENCING CITIZENSHIP OR NATION-
ALITY UNDER THE MEDICAID PROGRAM. 
(a) REPEAL.—Subsections (i)(22) and (x) of section 
1903 of the Social Security Act (42 U.S.C. 1396b) are 
each repealed. 
(b) CONFORMING AMENDMENTS.— 
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282 
(1) STATE
PAYMENTS
FOR
MEDICAL
ASSIST-
ANCE.—Section 1902 of the Social Security Act (42 
U.S.C. 1396a) is amended— 
(A) by amending paragraph (46) of sub-
section (a) to read as follows: 
‘‘(46) provide that information is requested and 
exchanged for purposes of income and eligibility 
verification in accordance with a State system which 
meets the requirements of section 1137 of this 
Act;’’; 
(B) in subsection (e)(13)(A)(i)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘sections 1902(a)(46)(B) 
and 1137(d)’’ and inserting ‘‘section 
1137(d)’’; and 
(ii) in subclause (IV), by striking 
‘‘1902(a)(46)(B) or’’; and 
(C) by striking subsection (ee). 
(2) PAYMENT TO STATES.—Section 1903 of the 
Social Security Act (42 U.S.C. 1396b) is amended— 
(A) in subsection (i), by redesignating 
paragraphs (23) through (27) as paragraphs 
(22) through (26), respectively; and 
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(B) by redesignating subsections (y), (z), 
and (aa) as subsections (x), (y), and (z), respec-
tively. 
(3) REPEAL.—Subsection (c) of section 6036 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 
note) is repealed. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. 
SEC. 4003. AVAILABILITY OF BASIC ASSISTANCE TO LAW-
FULLY PRESENT NONCITIZENS. 
(a) ELIMINATION OF ARBITRARY ELIGIBILITY RE-
STRICTIONS.—Sections 402, 403, 411, 412, 421, and 422 
of the Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1612, 1613, 1621, 1622, 
1631, and 1632) are repealed. 
(b) NOTIFICATION AND INFORMATION REPORTING.— 
Section 404 of the Personal Responsibility and Work Op-
portunity Reconciliation Act of 1996 (8 U.S.C. 1614) is 
amended by striking ‘‘, 402, or 403’’. 
(c) QUALIFIED NONCITIZENS.—Title IV of the Per-
sonal Responsibility and Work Opportunity Reconciliation 
Act of 1996 (8 U.S.C. 1601 et seq.) is amended— 
(1) in the header, by striking ‘‘ALIENS’’ and 
inserting ‘‘NONCITIZENS’’; 
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284 
(2) by striking ‘‘alien’’ each place it appears 
and inserting ‘‘noncitizen’’; 
(3) by striking ‘‘aliens’’ each place it appears 
and inserting ‘‘noncitizens’’; 
(4) by striking ‘‘alien’s’’ each place it appears 
and inserting ‘‘noncitizen’s’’; 
(5) by striking ‘‘an alien’’ each place that it ap-
pears and inserting ‘‘a noncitizen’’; 
(6) by striking ‘‘alien’’ each place that it ap-
pears and inserting ‘‘noncitizen’’; 
(7) by striking ‘‘qualified alien’’ each place that 
it appears and inserting ‘‘qualified noncitizen’’; 
(8) by striking ‘‘qualified aliens’’ each place 
that it appears and inserting ‘‘qualified noncitizens’’; 
(9) by striking ‘‘qualified alien’s’’ each place 
that it appears and inserting ‘‘qualified nonciti-
zen’s’’; and 
(10) in section 402— 
(A) in the header, by striking ‘‘QUALI-
FIED
ALIENS’’ and inserting ‘‘QUALIFIED 
NONCITIZENS’’; and 
(B) in subsection (a)(2)(L), by striking 
‘‘QUALIFIED
ALIENS’’ and inserting ‘‘QUALI-
FIED NONCITIZENS’’. 
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285 
(d) ACCESS TO BASIC SERVICES FOR LAWFULLY RE-
SIDING NONCITIZENS.—Section 431 of the Personal Re-
sponsibility and Work Opportunity Reconciliation Act of 
1996 (8 U.S.C. 1641) is amended— 
(1) in subsection (b)— 
(A) in the header, by striking ‘‘QUALIFIED 
ALIEN’’ and inserting ‘‘QUALIFIED NONCIT-
IZEN’’; 
(B) by striking ‘‘qualified alien’’ and in-
serting ‘‘qualified noncitizen’’; 
(C) by striking ‘‘alien’’ and inserting ‘‘non-
citizen’’; 
(D) by striking ‘‘an alien’’ and inserting ‘‘a 
noncitizen’’; and 
(E) by striking ‘‘benefit’’ and all that fol-
lows through the period at the end of the sub-
section and inserting ‘‘benefit, is lawfully 
present in the United States.’’; 
(2) in subsection (c)— 
(A) in the header, by striking ‘‘QUALIFIED 
ALIENS’’ and inserting ‘‘QUALIFIED NONCITI-
ZENS’’; 
(B) by striking ‘‘; or’’ at the end of para-
graph (3) and inserting ‘‘;’’; 
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286 
(C) by striking the period at the end of 
paragraph (4) and inserting ‘‘; or’’; and 
(D) by inserting after paragraph (4) the 
following new paragraph: 
‘‘(5) a noncitizen— 
‘‘(A) in a category that was treated as law-
fully present for purposes of section 1101 of the 
Patient Protection and Affordable Care Act of 
2010 (42 U.S.C. 18001); 
‘‘(B) who met the requirements of section 
402(a)(2)(D) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 
(8 U.S.C. 1612(a)(2)(D)) on or before January 
1, 2023; 
‘‘(C) who is granted special immigrant ju-
venile 
status 
as 
described 
by 
section 
101(a)(27)(J) of the Immigration and Nation-
ality Act (8 U.S.C. 1101(a)(27)(J)); 
‘‘(D) who has a pending, bona fide applica-
tion for nonimmigrant status under section 
101(a)(15)(U) of the Immigration and Nation-
ality Act (8 U.S.C. 1101(1)(15)(U)); 
‘‘(E) who was granted relief under the De-
ferred Action for Childhood Arrivals program; 
or 
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287 
‘‘(F) any other person who is not a citizen 
of the United States but who resides in a State 
or territory of the United States and is Feder-
ally authorized to be present in the United 
States.’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(d) NONCITIZEN.—For the purposes of this title, the 
term ‘noncitizen’ means any individual who is not a citizen 
of the United States.’’. 
(e) CHILD NUTRITION PROGRAMS.—Section 742 of 
the Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1615) is amended— 
(1) in subsection (a)— 
(A) in the header by striking ‘‘SCHOOL 
LUNCH AND BREAKFAST PROGRAMS’’ and in-
serting ‘‘CHILD NUTRITION PROGRAMS’’; 
(B) by striking ‘‘the school lunch pro-
gram’’ and inserting ‘‘any program’’; and 
(C) by striking ‘‘the school breakfast pro-
gram under section 4 of the’’ and inserting 
‘‘any program under the’’; and 
(2) in subsection (b)(1)— 
(A) by striking ‘‘Nothing in this Act shall 
prohibit or require a State to provide to an in-
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288 
dividual who is not a citizen or a qualified alien, 
as defined in section 431(b),’’ and inserting ‘‘A 
State shall not deny’’; and 
(B) by striking ‘‘paragraph (2)’’ and in-
serting ‘‘paragraph (2) on the basis of an indi-
vidual’s citizenship or citizenship, alienage, or 
immigration status’’. 
(f) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI-
TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 
Section 1108(h) of the Social Security Act (42 U.S.C. 
1308(h)) is amended— 
(1) by striking ‘‘Expenditures’’ and inserting: 
‘‘(1) Expenditures’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2) With respect to eligibility for benefits for 
the designated Federal program defined in para-
graph (3)(C) of section 402(b)(3)(c) (relating to the 
Medicaid program), paragraph (1) shall not apply to 
any individual who lawfully resides in 1 of the 50 
States or the District of Columbia in accordance 
with the Compacts of Free Association between the 
Government of the United States and the Govern-
ments of the Federated States of Micronesia, the 
Republic of the Marshall Islands, and the Republic 
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289 
of Palau and shall not apply, at the option of the 
Governor of Puerto Rico, the Virgin Islands, Guam, 
the Northern Mariana Islands, or American Samoa 
as communicated to the Secretary of Health and 
Human Services in writing, to any individual who 
lawfully resides in the respective territory in accord-
ance with such Compacts.’’. 
(g) CHILD HEALTH INSURANCE PROGRAM.—Section 
2107(e)(1) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended— 
(1) by striking subparagraph (O); and 
(2) by redesignating subparagraphs (P), (Q), 
(R), (S), (T), and (U) as subparagraphs (O), (P), 
(Q), (R), (S), and (T). 
(h) CONFORMING AMENDMENTS.— 
(1) SUPPLEMENTAL
FOOD
ASSISTANCE
PRO-
GRAM.—The Food and Nutrition Act of 2008 (7 
U.S.C. 2011 et seq.) is amended— 
(A) in section 5— 
(i) by striking subsection (i); and 
(ii) by redesignating subsections (j) 
through (n) as subsection (i) through (m), 
respectively; 
(B) in section 6— 
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290 
(i) in subsection (f), by striking ‘‘an 
alien lawfully admitted for permanent’’ and 
all that follows through the end of the sub-
section and inserting‘‘a noncitizen lawfully 
present in the United States.’’; and 
(ii) in subsection (s)(2), by striking 
‘‘(m), and (n)’’ and inserting ‘‘and (m)’’; 
and 
(C) in section 11(e)(2)(B)(v)(II) by strik-
ing ‘‘aliens’’ each place it appears and inserting 
‘‘noncitizens’’. 
(2) MEDICAID.—Section 1903(v) of the Social 
Security Act (42 U.S.C. 1396b(v)) is amended— 
(A) in paragraph (1), by striking ‘‘admit-
ted for’’ and all that follows through the end of 
the paragraph and inserting ‘‘present in the 
United States.’’; and 
(B) by striking paragraph (4). 
(3) HOUSING ASSISTANCE.—Section 214(a) of 
the Housing and Community Development Act of 
1980 (42 U.S.C. 1436a(a)) is amended— 
(A) by redesignating paragraphs (6) and 
(7) as paragraphs (7) and (8), respectively; and 
(B) by inserting after paragraph (5): 
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291 
‘‘(6) a qualified noncitizen as defined in section 
431 of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996 (8 U.S.C. 1641);’’. 
(4) GENERAL RULE ON NONCITIZENS’ ELIGI-
BILITY.—Section 401 of Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1611) is amended— 
(A) in section 401, in the header— 
(i) by striking ‘‘QUALIFIED ALIENS’’ 
and inserting ‘‘QUALIFIED
NONCITI-
ZENS’’; and 
(ii) by striking ‘‘ALIENS’’ and insert-
ing ‘‘NONCITIZENS’’; 
(B) by striking ‘‘qualified alien’’ wherever 
it occurs and inserting ‘‘qualified noncitizen’’; 
and 
(C) by striking ‘‘alien’’ wherever it occurs 
and inserting ‘‘noncitizen’’. 
(5) ASSISTANCE NOT TREATED AS DEBT AB-
SENT FRAUD.—Section 213A(b)(1)(A) of the Immi-
gration and Nationality Act is amended by striking 
‘‘benefit,’’ and inserting ‘‘benefit by fraud,’’. 
(i) PRESERVING ACCESS TO HEALTH CARE.—Sec-
tion 36B(c)(1)(B) of the Internal Revenue Code of 1986 
is amended to read as follows: 
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292 
‘‘(B) SPECIAL RULE FOR CERTAIN INDI-
VIDUALS LAWFULLY PRESENT IN THE UNITED 
STATES.—If— 
‘‘(i) a taxpayer has a household in-
come which is not greater than 100 per-
cent of an amount equal to the poverty line 
for a family of the size involved, 
‘‘(ii) the taxpayer is a non-citizen law-
fully present in the United States, 
‘‘(iii) the taxpayer is ineligible for 
minimum essential coverage under section 
5000A(f)(1)(A)(ii), and 
‘‘(iv) under the Medicaid eligibility 
criteria for non-citizens in effect on De-
cember 26, 2020, the taxpayer would be 
ineligible for such minimum essential cov-
erage by reason of the taxpayer’s immigra-
tion status, 
the taxpayer shall, for purposes of the credit 
under this section, be treated as an applicable 
taxpayer with a household income which is 
equal to 100 percent of the poverty line for a 
family of the size involved.’’. 
(j) FEDERAL AGENCY GUIDANCE.—Not later than 
180 days after the date of the enactment of this Act, each 
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