I 
118TH CONGRESS 
2D SESSION H. R. 10007 
To amend the Immigration and Nationality Act to authorize the admission 
of nonimmigrant emergency medical technicians and paramedics. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 18, 2024 
Mr. HIGGINS of Louisiana introduced the following bill; which was referred 
to the Committee on the Judiciary 
A BILL 
To amend the Immigration and Nationality Act to authorize 
the admission of nonimmigrant emergency medical tech-
nicians and paramedics. 
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 ‘‘Paramedic and Emer-
gency Medical Technician Relief Act of 2024’’. 
SEC. 2. ESTABLISHMENT OF H–1D VISAS FOR EMTS AND 
PARAMEDICS. 
(a) 
NONIMMIGRANT
CATEGORY.—Section 
101(a)(15)(H)(i) of the Immigration and Nationality Act 
(8 U.S.C. 1101(a)(15)(H)(i)) is amended by striking ‘‘; 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
or’’ at the end and inserting ‘‘, or (d) who is coming tem-
porarily to the United States to perform services as an 
emergency medical technician or paramedic, who meets 
the qualifications described in section 212(u) , and with 
respect to whom the Secretary of Labor determines and 
certifies to the Secretary of Homeland Security that an 
unexpired attestation is on file and in effect under section 
212(u)(2) for the employer; or’’. 
(b) REQUIREMENTS.—Section 212 of the Immigra-
tion and Nationality Act (8 U.S.C. 1182) is amended by 
adding at the end the following: 
‘‘(u) REQUIREMENTS
FOR
ADMISSION
OF
NON-
IMMIGRANT EMTS AND PARAMEDICS.— 
‘‘(1) QUALIFICATIONS.—The qualifications re-
ferred to in section 101(a)(15)(H)(i)(d), with respect 
to an alien who is coming to the United States to 
perform services as an emergency medical technician 
or paramedic, are that the alien— 
‘‘(A) has, at a minimum, obtained emer-
gency medical technician, paramedic, or equiva-
lent pre-hospital care, education or training in 
a foreign country or in the United States; 
‘‘(B) not later than 12 weeks before the 
alien’s intended first date of employment in the 
United States, has passed an appropriate exam-
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
ination (recognized in regulations promulgated 
in consultation with the Secretary of Health 
and Human Services) or has obtained the ap-
propriate certificate or license under State law 
to practice as an emergency medical technician 
or paramedic in the State of intended employ-
ment; 
‘‘(C) not later than 12 weeks before the 
alien’s intended first date of employment in the 
United States, is fully qualified and eligible 
under the laws (including such temporary or in-
terim licensing requirements which authorize 
the emergency medical technician or paramedic 
to be employed) governing the place of intended 
employment to engage in practice as an emer-
gency medical technician or a paramedic imme-
diately upon admission to the United States; 
and 
‘‘(D) not later than 12 weeks before the 
alien’s intended first date of employment in the 
United States, has passed appropriate criminal 
record checks and other background and data-
base checks, as determined by the Secretary of 
Homeland Security in coordination with the At-
torney General, including biometric data collec-
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
tion, a review of the applicant’s criminal and 
immigration records, verification of the appli-
cant’s identity and travel history, and an as-
sessment of any potential risk the applicant 
poses to public safety or national security. 
‘‘(2) ATTESTATION.— 
‘‘(A) The attestation referred to in section 
101(a)(15)(H)(i)(d), with respect to an em-
ployer for which an alien will perform services, 
is an attestation as to the following: 
‘‘(i) The employment of the alien will 
not adversely affect the wages and working 
conditions of emergency medical techni-
cians or paramedics, as applicable, simi-
larly employed. 
‘‘(ii) The alien employed by the em-
ployer will be paid the wage rate for emer-
gency medical technicians or paramedics, 
as applicable, similarly employed by the 
employer. 
‘‘(iii) The employer has taken and is 
taking timely and significant steps de-
signed to recruit and retain sufficient 
emergency medical technicians or para-
medics, as applicable, who are United 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
States citizens or immigrants who are au-
thorized to perform such services. 
‘‘(iv) There is not a strike or lockout 
in the course of a labor dispute, the em-
ployer did not lay off and will not lay off 
an emergency medical technician or a 
paramedic, as applicable, employed by the 
employer within the period beginning 90 
days before and ending 90 days after the 
date of filing of any visa petition, and the 
employment of such an alien is not in-
tended or designed to influence an election 
for a bargaining representative for emer-
gency medical technicians or paramedics of 
the employer. 
‘‘(v) At the time of the filing of the 
petition for emergency medical technicians 
or paramedics, as applicable, under section 
101(a)(15)(H)(i)(d), notice of the filing 
has been provided by the employer to the 
bargaining representative of the emergency 
medical technicians or paramedics em-
ployed by the employer or, where there is 
no such bargaining representative, notice 
of the filing has been provided to the emer-
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
gency medical technicians or paramedics 
employed by the employer through posting 
in conspicuous locations or electronic noti-
fication to such employees. 
‘‘(vi) The employer will not, at any 
time, employ a number of aliens issued 
visas or otherwise provided nonimmigrant 
status under section 1101(a)(15)(H)(i)(d) 
of this title as emergency medical techni-
cians or paramedics that exceeds 15 per-
cent of the total number of emergency 
medical technicians or paramedics, respec-
tively, employed by the employer. 
‘‘(vii) The employer is affiliated with 
an emergency medical services education 
program approved by the applicable licens-
ing body of the State in which the alien 
will work. 
Nothing in clause (iii) shall be construed 
as requiring an employer to have taken sig-
nificant steps described in such clause be-
fore the effective date of the Paramedic 
and Emergency Medical Technician Relief 
Act of 2023. A copy of the attestation re-
ferred to in section 101(1)(15)(H)(i)(d) 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
shall be provided, within 30 days of the 
date of filing, to emergency medical techni-
cians or paramedics, as applicable, em-
ployed by the employer on the date of fil-
ing. 
‘‘(B) 
For 
purposes 
of 
subparagraph 
(A)(iii), each of the following shall be consid-
ered a significant step reasonably designed to 
recruit and retain emergency medical techni-
cians or paramedics: 
‘‘(i) Operating a training program for 
emergency medical technicians or para-
medics or financing (or providing partici-
pation in) a training program for emer-
gency medical technicians or paramedics. 
‘‘(ii) Providing career development 
programs and other methods of facilitating 
nationals of the United States to become 
emergency medical technicians or para-
medics. 
‘‘(iii) Paying emergency medical tech-
nicians or paramedics wages at a rate 
equal to or higher than currently being 
paid to emergency medical technicians or 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
paramedics similarly employed in the geo-
graphic area. 
‘‘(iv) Providing reasonable opportuni-
ties for meaningful salary advancement by 
emergency medical technicians or para-
medics. 
The steps described in this subparagraph shall 
not be considered to be an exclusive list of the 
significant steps that may be taken to meet the 
conditions of subparagraph (A)(iii). Nothing in 
this subparagraph shall require an employer to 
take more than one step if the employer can 
demonstrate that taking a second step is not 
reasonable. 
‘‘(C) Subject to subparagraph (E), an at-
testation under subparagraph (A)— 
‘‘(i) shall expire on the date that is 
the later of— 
‘‘(I) the end of the one-year pe-
riod beginning on the date of its filing 
with the Secretary of Labor; or 
‘‘(II) the end of the period of ad-
mission 
under 
section 
101(a)(15)(H)(i)(d) of the last alien 
with respect to whose admission it 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
was applied (in accordance with clause 
(ii)); and 
‘‘(ii) shall apply to petitions filed dur-
ing the one-year period beginning on the 
date of its filing with the Secretary of 
Labor if the employer states in each such 
petition that it continues to comply with 
the conditions in the attestation. 
‘‘(D) An employer may meet the require-
ments under this paragraph with respect to 
more than one emergency medical technician or 
paramedic in a single petition. 
‘‘(E)(i) The Secretary of Labor shall com-
pile and make publicly available online a list 
identifying employers which have filed petitions 
for 
nonimmigrants 
under 
section 
101(a)(15)(H)(i)(d) and, for each such em-
ployer, a copy of the employer’s attestation 
under subparagraph (A) (and accompanying 
documentation) and each such petition filed by 
the employer. 
‘‘(ii) The Secretary of Labor shall establish 
a process, including reasonable time limits, for 
the receipt, investigation, and disposition of 
complaints respecting an employer’s failure to 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
meet conditions attested to or an employer’s 
misrepresentation of a material fact in an attes-
tation. Complaints may be filed by any ag-
grieved person or organization (including bar-
gaining representatives, associations deemed ap-
propriate by the Secretary, and other aggrieved 
parties as determined under regulations of the 
Secretary). The Secretary shall conduct an in-
vestigation under this clause if there is reason-
able cause to believe that an employer fails to 
meet conditions attested to. Subject to the time 
limits established under this clause, this sub-
paragraph shall apply regardless of whether an 
attestation is expired or unexpired at the time 
a complaint is filed. 
‘‘(iii) Under such process, the Secretary 
shall provide, within 180 days after the date 
such a complaint is filed, for a determination as 
to whether or not a basis exists to make a find-
ing described in clause (iv). If the Secretary de-
termines that such a basis exists, the Secretary 
shall provide for notice of such determination to 
the interested parties and an opportunity for a 
hearing on the complaint within 60 days of the 
date of the determination. 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(iv) If the Secretary of Labor finds, after 
notice and opportunity for a hearing, that an 
employer (for which an attestation is made) has 
failed to meet a condition attested to or that 
there was a misrepresentation of material fact 
in the attestation, the Secretary of Labor shall 
notify the Secretary of Homeland Security of 
such finding and may, in addition, impose such 
other administrative remedies (including civil 
monetary penalties in an amount not to exceed 
$1,000 per emergency medical technician or 
paramedic per violation, with the total penalty 
not to exceed $10,000 per violation) as the Sec-
retary of Labor determines to be appropriate. 
Upon receipt of such notice, the Secretary of 
Homeland Security shall not approve petitions 
filed with respect to an employer during a pe-
riod of at least one year for emergency medical 
technicians or paramedics, as applicable to be 
employed by the employer. 
‘‘(v) In addition to the sanctions provided 
for under clause (iv), if the Secretary of Labor 
finds, after notice and an opportunity for a 
hearing, that an employer has violated the con-
dition attested to under subparagraph (A)(ii) 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(relating to payment of emergency medical tech-
nicians or paramedics at the prevailing wage 
rate), the Secretary shall order the employer to 
provide for payment of such amounts of back 
pay as may be required to comply with such 
condition. 
‘‘(F)(i) The Secretary of Labor shall im-
pose on an employer filing an attestation under 
subparagraph (A) a filing fee, in an amount 
prescribed by the Secretary based on the costs 
of carrying out the Secretary’s duties under this 
subsection, but not exceeding $250. 
‘‘(ii) Fees collected under this subpara-
graph shall be deposited in a fund established 
for this purpose in the Treasury of the United 
States. 
‘‘(iii) The collected fees in the fund shall 
be available to the Secretary of Labor, to the 
extent and in such amounts as may be provided 
in appropriations Acts, to cover the costs de-
scribed in clause (i), in addition to any other 
funds that are available to the Secretary to 
cover such costs. 
‘‘(3) PERIOD
OF
ADMISSION.—The period of 
admission 
of 
an 
alien 
under 
section 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
101(a)(15)(H)(i)(d) shall be 3 years, and may be ex-
tended for an additional 3-year period. 
‘‘(4) NUMERICAL LIMITATION.— 
‘‘(A) IN GENERAL.—The total number of 
aliens who may be issued visas or otherwise 
provided nonimmigrant status during any fiscal 
year under section 101(a)(15)(H)(i)(d) may not 
exceed 2,500. The numerical limitation under 
this subparagraph shall be allocated for a fiscal 
year so that the total number of aliens subject 
to such numerical limit who enter the United 
States pursuant to a visa or are accorded non-
immigrant 
status 
under 
section 
101(a)(15)(H)(i)(d) during the first 6 months 
of such fiscal year is not more than 1,250. 
‘‘(B) ADJUSTMENT
BY
SECRETARY.—Be-
ginning in the fourth fiscal year that begins 
after the date of enactment of this paragraph, 
the Secretary of Homeland Security, in con-
sultation with the Secretary of Labor and other 
relevant stakeholders, may adjust the numerical 
limitation under subparagraph (A), as the Sec-
retary finds appropriate. In making such deter-
mination, the Secretary shall consider the fol-
lowing: 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(i) The current and projected de-
mand for emergency medical technicians 
and paramedics in the United States. 
‘‘(ii) The capacity of United States 
educational and training institutions to 
produce emergency medical technicians 
and paramedics. 
‘‘(iii) The potential impact of the ad-
mission of nonimmigrants under section 
101(a)(15)(H)(i)(d) on the domestic labor 
market, including wages, working condi-
tions, and employment opportunities for 
United States workers. 
‘‘(iv) The need to balance the admis-
sion of foreign emergency medical techni-
cians and paramedics with the protection 
of United States workers and the pro-
motion of domestic workforce development 
initiatives. 
The Secretary of Homeland Security is authorized to 
grant exemptions from the numerical limitation 
under this paragraph in cases of extreme hardship, 
national interest, or other compelling circumstances, 
as determined on a case-by-case basis. 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(5) WAGE RATES; UNIONS.—An employer that 
has 
filed 
a 
petition 
under 
section 
101(a)(15)(H)(i)(d) to employ a nonimmigrant to 
perform emergency medical technician or paramedic 
services for the employer— 
‘‘(A) shall provide the nonimmigrant a 
wage rate and working conditions commensu-
rate with those of emergency medical techni-
cians or paramedics, as applicable, similarly em-
ployed by the employer; 
‘‘(B) shall require the nonimmigrant to 
work hours commensurate with those of emer-
gency medical technicians or paramedics, as ap-
plicable, similarly employed by the employer; 
and 
‘‘(C) may not engage in any unfair labor 
practice listed in section 8 of the National 
Labor Relations Act (29 U.S.C. 158) with re-
spect to any such employee, or otherwise inter-
fere with the employee’s rights under section 7 
of such Act (29 U.S.C. 157). 
‘‘(6) REPORT TO CONGRESS.—The Secretary of 
Homeland Security and the Secretary of Labor shall 
submit to Congress an annual report on admission 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
of nonimmigrants under section 101(a)(15)(H)(i)(d), 
which report shall include the following: 
‘‘(A) The impact of the admission of such 
nonimmigrants on the emergency medical tech-
nician and paramedic workforce, as well as any 
instances of fraud, abuse, or non-compliance 
with the requirements under this subsection. 
‘‘(B) The number of visas issued under 
such section and the number of applications re-
ceived during the previous fiscal year. 
‘‘(C) 
The 
distribution 
of 
such 
non-
immigrants by geographic region, State, and 
type of employer. 
‘‘(D) The prevailing wages paid to such 
nonimmigrants and any wage disparities with 
similarly employed United States workers. 
‘‘(E) Any violations of labor conditions or 
program requirements identified by the Sec-
retary of Labor, including any action taken to 
address such a violation. 
‘‘(F) Recommendations for improving the 
admission of such nonimmigrants or addressing 
any identified barriers to admission. 
‘‘(7) MONITORING.—The Secretary of Home-
land Security and the Secretary of Labor shall de-
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
velop and implement procedures to monitor employer 
compliance with the requirements under this sub-
section, including periodic site visits, audits, and in-
vestigations based on complaints or other credible 
information. 
‘‘(8) DEFINITION.—For purposes of paragraph 
(2)(A)(iv), the term ‘lay off’, with respect to a work-
er has the meaning given such term in subsection 
(m).’’. 
SEC. 3. EFFECTIVE DATE. 
(a) IN GENERAL.—This Act and the amendments 
made by this Act shall take effect 180 days after the date 
of enactment of this Act. 
(b) REGULATIONS.—The Secretary of Homeland Se-
curity and the Secretary of Labor shall issue regulations 
and guidance as necessary to implement the amendments 
made by this Act, including the following: 
(1) Developing and publishing application forms 
and instructions for employers and aliens seeking 
admission under section 101(a)(15)(H)(i)(d) of the 
Immigration 
and 
Nationality 
Act 
(8 
U.S.C. 
1101(a)(15)(H)). 
(2) Establishing procedures for conducting 
background checks and security screenings, and en-
forcing labor protections. 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(3) Coordinating with other relevant govern-
ment agencies, such as the Federal Bureau of Inves-
tigation and State licensing boards, to ensure effec-
tive implementation and compliance with the re-
quirements under section 212(u) of the Immigration 
and Nationality Act (8 U.S.C. 1182). 
(4) Providing training and resources to Depart-
ment of Homeland Security and Department of 
Labor staff responsible for administering the admis-
sion 
of 
aliens 
under 
such 
section 
101(a)(15)(H)(i)(d), as well as any other relevant 
stakeholders. 
Æ 
VerDate Sep 11 2014 
00:45 Oct 25, 2024
Jkt 059200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6301
E:\BILLS\H10007.IH
H10007
kjohnson on DSK7ZCZBW3PROD with $$_JOB