H. R. 441—5
‘‘(A) shall provide the nonimmigrant a wage rate and
working conditions commensurate with those of nurses simi-
larly employed by the facility;
‘‘(B) shall require the nonimmigrant to work hours commen-
surate with those of nurses similarly employed by the facility;
and
‘‘(C) shall not interfere with the right of the nonimmigrant
to join or organize a union.
‘‘(6) 
For 
purposes 
of 
this 
subsection 
and 
section
101(a)(15)(H)(i)(c), the term ‘facility’ means a subsection (d) hospital
(as defined in section 1886(d)(1)(B) of the Social Security Act (42
U.S.C. 1395ww(d)(1)(B))) that meets the following requirements:
‘‘(A) As of March 31, 1997, the hospital was located in
a health professional shortage area (as defined in section 332
of the Public Health Service Act (42 U.S.C. 254e)).
‘‘(B) Based on its settled cost report filed under title XVIII
of the Social Security Act for its cost reporting period beginning
during fiscal year 1994—
‘‘(i) the hospital has not less than 190 licensed acute
care beds;
‘‘(ii) the number of the hospital’s inpatient days for
such period which were made up of patients who (for such
days) were entitled to benefits under part A of such title
is not less than 35 percent of the total number of such
hospital’s acute care inpatient days for such period; and
‘‘(iii) the number of the hospital’s inpatient days for
such period which were made up of patients who (for such
days) were eligible for medical assistance under a State
plan approved under title XIX of the Social Security Act,
is not less than 28 percent of the total number of such
hospital’s acute care inpatient days for such period.
‘‘(7) For purposes of paragraph (2)(A)(v), the term ‘lay off’,
with respect to a worker—
‘‘(A) means to cause the worker’s loss of employment,
other than through a discharge for inadequate performance,
violation of workplace rules, cause, voluntary departure,
voluntary retirement, or the expiration of a grant or con-
tract; but
‘‘(B) does not include any situation in which the worker
is offered, as an alternative to such loss of employment,
a similar employment opportunity with the same employer
at equivalent or higher compensation and benefits than
the position from which the employee was discharged,
regardless of whether or not the employee accepts the
offer.
Nothing in this paragraph is intended to limit an employee’s
or an employer’s rights under a collective bargaining agreement
or other employment contract.’’.
(c) REPEALER.—Clause (i) of section 101(a)(15)(H) of the
Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(H)(i)) is
amended by striking subclause (a).
(d) IMPLEMENTATION.—Not later than 90 days after the date
of the enactment of this Act, the Secretary of Labor (in consultation,
to the extent required, with the Secretary of Health and Human
Services) and the Attorney General shall promulgate final or interim
final regulations to carry out section 212(m) of the Immigration
and Nationality Act (as amended by subsection (b)).
H. R. 441—6
(e) LIMITING APPLICATION OF NONIMMIGRANT CHANGES TO 4-
YEAR PERIOD.—The amendments made by this section shall apply
to classification petitions filed for nonimmigrant status only during
the 4-year period beginning on the date that interim or final regula-
tions are first promulgated under subsection (d).
SEC. 
3. 
RECOMMENDATIONS 
FOR 
ALTERNATIVE 
REMEDY 
FOR
NURSING SHORTAGE.
Not later than the last day of the 4-year period described
in section 2(e), the Secretary of Health and Human Services and
the Secretary of Labor shall jointly submit to the Congress rec-
ommendations (including legislative specifications) with respect to
the following:
(1) A program to eliminate the dependence of facilities
described in section 212(m)(6) of the Immigration and Nation-
ality Act (as amended by section 2(b)) on nonimmigrant reg-
istered nurses by providing for a permanent solution to the
shortage of registered nurses who are United States citizens
or aliens lawfully admitted for permanent residence.
(2) A method of enforcing the requirements imposed on
facilities under sections 101(a)(15)(H)(i)(c) and 212(m) of the
Immigration and Nationality Act (as amended by section 2)
that would be more effective than the process described in
section 212(m)(2)(E) of such Act (as so amended).
SEC. 4. CERTIFICATION FOR CERTAIN ALIEN NURSES.
(a) IN GENERAL.—
(1) Section 212 of the Immigration and Nationality Act
(8 U.S.C. 1182) is amended by adding at the end the following
new subsection:
‘‘(r) Subsection (a)(5)(C) shall not apply to an alien who seeks
to enter the United States for the purpose of performing labor
as a nurse who presents to the consular officer (or in the case
of an adjustment of status, the Attorney General) a certified state-
ment from the Commission on Graduates of Foreign Nursing
Schools (or an equivalent independent credentialing organization
approved for the certification of nurses under subsection (a)(5)(C)
by the Attorney General in consultation with the Secretary of
Health and Human Services) that—
‘‘(1) the alien has a valid and unrestricted license as a
nurse in a State where the alien intends to be employed and
such State verifies that the foreign licenses of alien nurses
are authentic and unencumbered;
‘‘(2) the alien has passed the National Council Licensure
Examination (NCLEX);
‘‘(3) the alien is a graduate of a nursing program—
‘‘(A) in which the language of instruction was English;
‘‘(B) located in a country—
‘‘(i) designated by such commission not later than
30 days after the date of the enactment of the Nursing
Relief for Disadvantaged Areas Act of 1999, based on
such commission’s assessment that the quality of
nursing education in that country, and the English
language proficiency of those who complete such pro-
grams in that country, justify the country’s designation;
or
‘‘(ii) designated on the basis of such an assessment
by unanimous agreement of such commission and any
H. R. 441—7
equivalent credentialing organizations which have been
approved under subsection (a)(5)(C) for the certification
of nurses under this subsection; and
‘‘(C)(i) which was in operation on or before the date
of the enactment of the Nursing Relief for Disadvantaged
Areas Act of 1999; or
‘‘(ii) has been approved by unanimous agreement of
such 
commission 
and 
any 
equivalent 
credentialing
organizations which have been approved under subsection
(a)(5)(C) for the certification of nurses under this sub-
section.’’.
(2) Section 212(a)(5)(C) of the Immigration and Nationality
Act (8 U.S.C. 1182(a)(5)(C)) is amended by striking ‘‘Any alien
who seeks’’ and inserting ‘‘Subject to subsection (r), any alien
who seeks’’.
(b) EFFECTIVE DATE.—The amendments made by subsection
(a) shall take effect on the date of the enactment of this Act,
without regard to whether or not final regulations to carry out
such amendments have been promulgated by such date.
(c) ISSUANCE OF CERTIFIED STATEMENTS.—The Commission on
Graduates of Foreign Nursing Schools, or any approved equivalent
independent credentialing organization, shall issue certified state-
ments pursuant to the amendment under subsection (a) not more
than 35 days after the receipt of a complete application for such
a statement.
SEC. 5. NATIONAL INTEREST WAIVERS OF JOB OFFER REQUIREMENTS
FOR ALIENS WHO ARE MEMBERS OF THE PROFESSIONS
HOLDING ADVANCED DEGREES OR ALIENS OF EXCEP-
TIONAL ABILITY.
Section 203(b)(2)(B) of the Immigration and Nationality Act
(8 U.S.C. 1153(b)(2)(B)) is amended to read as follows:
‘‘(B) WAIVER OF JOB OFFER.—
‘‘(i) NATIONAL INTEREST WAIVER.—Subject to clause
(ii), the Attorney General may, when the Attorney
General deems it to be in the national interest, waive
the requirements of subparagraph (A) that an alien’s
services in the sciences, arts, professions, or business
be sought by an employer in the United States.
‘‘(ii) PHYSICIANS WORKING IN SHORTAGE AREAS OR
VETERANS FACILITIES.—
‘‘(I) IN GENERAL.—The Attorney General shall
grant a national interest waiver pursuant to clause
(i) on behalf of any alien physician with respect
to whom a petition for preference classification
has been filed under subparagraph (A) if—
‘‘(aa) the alien physician agrees to work
full time as a physician in an area or areas
designated 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; and
‘‘(bb) a Federal agency or a department
of public health in any State has previously
determined that the alien physician’s work in
H. R. 441—8
such an area or at such facility was in the
public interest.
‘‘(II) PROHIBITION.—No permanent resident
visa may be issued to an alien physician described
in subclause (I) by the Secretary of State under
section 204(b), and the Attorney General may not
adjust the status of such an alien physician from
that of a nonimmigrant alien to that of a perma-
nent resident alien under section 245, until such
time as the alien has worked full time as a physi-
cian for an aggregate of five years (not including
the time served in the status of an alien described
in section 101(a)(15)(J)), in an area or areas des-
ignated by the Secretary of Health and Human
Services as having a shortage of health care profes-
sionals or at a health care facility under the juris-
diction of the Secretary of Veterans Affairs.
‘‘(III) STATUTORY CONSTRUCTION.—Nothing in
this subparagraph may be construed to prevent
the filing of a petition with the Attorney General
for classification under section 204(a), or the filing
of an application for adjustment of status under
section 245, by an alien physician described in
subclause (I) prior to the date by which such alien
physician has completed the service described in
subclause (II).
‘‘(IV) EFFECTIVE DATE.—The requirements of
this subsection do not affect waivers on behalf
of 
alien 
physicians 
approved 
under 
section
203(b)(2)(B) before the enactment date of this sub-
section. In the case of a physician for whom an
application for a waiver was filed under section
203(b)(2)(B) prior to November 1, 1998, the
Attorney General shall grant a national interest
waiver pursuant to section 203(b)(2)(B) except that
the alien is required to have worked full time
as a physician for an aggregate of three years
(not including time served in the status of an
alien described in section 101(a)(15)(J)) before a
visa can be issued to the alien under section 204(b)
or the status of the alien is adjusted to permanent
resident under section 245.’’.
SEC. 6. FURTHER CLARIFICATION OF TREATMENT OF CERTAIN INTER-
NATIONAL ACCOUNTING FIRMS.
Section 206(a) of the Immigration Act of 1990 (8 U.S.C. 1101
note) is amended to read as follows:
‘‘(a) CLARIFICATION OF TREATMENT OF CERTAIN INTERNATIONAL
ACCOUNTING AND MANAGEMENT CONSULTING FIRMS.—In applying
sections 101(a)(15)(L) and 203(b)(1)(C) of the Immigration and
Nationality Act, and for no other purpose, in the case of a partner-
ship that is organized in the United States to provide accounting
or management consulting services and that markets its accounting
or management consulting services under an internationally recog-
nized name under an agreement with a worldwide coordinating
organization that is collectively owned and controlled by the member
accounting and management consulting firms or by the elected
H. R. 441—9
members (partners, shareholders, members, employees) thereof, an
entity that is organized outside the United States to provide
accounting or management consulting services shall be considered
to be an affiliate of the United States accounting or management
consulting partnership if it markets its accounting or management
consulting services under the same internationally recognized name
directly or indirectly under an agreement with the same worldwide
coordinating organization of which the United States partnership
is also a member. Those partnerships organized within the United
States and entities organized outside the United States which are
considered affiliates under this subsection shall continue to be
considered affiliates to the extent such firms enter into a plan
of association with a successor worldwide coordinating organization,
which need not be collectively owned and controlled.’’.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.