I 
115TH CONGRESS 
1ST SESSION H. R. 2141 
To provide incentives to physicians to practice in rural and medically 
underserved communities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 25, 2017 
Mr. SCHNEIDER (for himself and Mr. ISSA) introduced the following bill; 
which was referred to the Committee on the Judiciary 
A BILL 
To provide incentives to physicians to practice in rural and 
medically underserved communities, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Conrad State 30 and 
Physician Access Reauthorization Act’’. 
SEC. 2. CONRAD STATE 30 PROGRAM. 
(a) EXTENSION.—Section 220(c) of the Immigration 
and Nationality Technical Corrections Act of 1994 (Public 
Law 103–416; 8 U.S.C. 1182 note) is amended by striking 
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‘‘September 30, 2015’’ and inserting ‘‘September 30, 
2021’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect as if enacted on April 28, 
2017. 
SEC. 3. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 
(a) IN GENERAL.—Section 214(l)(1) of the Immigra-
tion and Nationality Act (8 U.S.C. 1184(l)(1)) is amend-
ed— 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘Attorney General’’ and inserting ‘‘Sec-
retary of Homeland Security’’; 
(2) in subparagraph (A), by striking ‘‘Director 
of United States Information Agency’’ and inserting 
‘‘Secretary of State’’; 
(3) in subparagraph (B), by inserting ‘‘, except 
as provided in paragraphs (7) and (8)’’ before the 
semicolon at the end; and 
(4) in subparagraph (C), by striking clauses (i) 
and (ii) and inserting the following: 
‘‘(i) the alien demonstrates a bona fide 
offer of full-time employment at a health facil-
ity or health care organization, which employ-
ment has been determined by the Secretary of 
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Homeland Security to be in the public interest; 
and 
‘‘(ii) the alien— 
‘‘(I) has accepted employment with 
the health facility or health care organiza-
tion in a geographic area or areas which 
are designated by the Secretary of Health 
and Human Services as having a shortage 
of health care professionals; 
‘‘(II) begins employment by the later 
of the date that is— 
‘‘(aa) 90 days after receiving 
such waiver; 
‘‘(bb) 90 days after completing 
graduate medical education or train-
ing under a program approved pursu-
ant to section 212(j)(1); or 
‘‘(cc) 90 days after receiving non-
immigrant status or employment au-
thorization, if the alien or the alien’s 
employer petitions for such non-
immigrant status or employment au-
thorization not later than 90 days 
after the date on which the alien com-
pletes his or her graduate medical 
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education or training under a pro-
gram approved pursuant to section 
212(j)(1); and 
‘‘(III) agrees to continue to work for 
a total of not less than 3 years in the sta-
tus authorized for such employment under 
this subsection unless— 
‘‘(aa) the Secretary of Homeland 
Security determines that extenuating 
circumstances, including violations by 
the employer of the employment 
agreement with the alien or of labor 
and employment laws, exist that jus-
tify a lesser period of employment at 
such facility or organization, in which 
case the alien shall demonstrate, not 
later than 90 days after the employ-
ment termination date (unless the 
Secretary determines that extenuating 
circumstances would justify an exten-
sion), another bona fide offer of em-
ployment at a health facility or health 
care organization in a geographic area 
or areas which are designated by the 
Secretary of Health and Human Serv-
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ices as having a shortage of health 
care professionals, for the remainder 
of such 3-year period; 
‘‘(bb) the interested State agency 
that requested the waiver attests 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 employ-
ment at such facility or organization 
in which case the alien shall dem-
onstrate, not later than 90 days after 
the employment termination date (un-
less the Secretary determines that ex-
tenuating circumstances would justify 
an extension), another bona fide offer 
of employment at a health facility or 
health care organization in a geo-
graphic 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 pe-
riod; or 
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‘‘(cc) if the alien elects not to 
pursue a determination of extenuating 
circumstances pursuant to item (aa) 
or (bb), the alien terminates the 
alien’s employment relationship with 
such facility or organization, in which 
case the alien shall demonstrate, not 
later than 45 days after the employ-
ment termination date, another bona 
fide offer of employment at a health 
facility or health care organization in 
a geographic area or areas, in the 
State that requested the alien’s waiv-
er, which are designated by the Sec-
retary of Health and Human Services 
as having a shortage of health care 
professionals, and agree to be em-
ployed for the remainder of such 3- 
year period, and 1 additional year for 
each termination under this subclause; 
and’’. 
(b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL-
FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER-
SERVED AREAS.—Section 214(l)(2) of such Act (8 U.S.C. 
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1184(l)(2)) is amended by amending subparagraph (A) to 
read as follows: 
‘‘(A) Upon the request of an interested Federal 
agency or an interested State agency for rec-
ommendation of a waiver under this section by a 
physician who is maintaining valid nonimmigrant 
status under section 101(a)(15)(J) and a favorable 
recommendation by the Secretary of State, the Sec-
retary of Homeland Security may change the status 
of such physician to that of an alien described in 
section 101(a)(15)(H)(i)(B). The numerical limita-
tions contained in subsection (g)(1)(A) shall not 
apply to any alien whose status is changed under 
this subparagraph.’’. 
(c) 
VIOLATION
OF
AGREEMENTS.—Section 
214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 
amended by inserting ‘‘substantial requirement of an’’ be-
fore ‘‘agreement entered into’’. 
(d) PHYSICIAN
EMPLOYMENT
IN
UNDERSERVED 
AREAS.—Section 214(l) of such Act (8 U.S.C. 1184(l)) 
is amended by adding at the end the following: 
‘‘(4)(A) If an interested State agency denies the ap-
plication for a waiver under paragraph (1)(B) from a phy-
sician pursuing graduate medical education or training 
pursuant to section 101(a)(15)(J) because the State has 
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requested the maximum number 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 para-
graph (1)(D)(ii)) to work for an employer described in 
paragraph (1)(C) in a State that has not yet requested 
the maximum number of waivers. 
‘‘(B) Such physician shall be authorized to work only 
for the employer referred to in subparagraph (A) from the 
date on which a new waiver application is filed with such 
State until the earlier of— 
‘‘(i) the date on which the Secretary of Home-
land Security denies such waiver; or 
‘‘(ii) the date on which the Secretary approves 
an application for change of status under paragraph 
(2)(A) pursuant to the approval of such waiver.’’. 
(e) CONTRACT REQUIREMENTS.—Section 214(l) of 
such Act, as amended by subsection (d), is further amend-
ed by adding at the end the following: 
‘‘(5) An alien granted a waiver under paragraph 
(1)(C) shall enter into an employment agreement with the 
contracting health facility or health care organization 
that— 
‘‘(A) specifies the maximum number of on-call 
hours per week (which may be a monthly average) 
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that the alien will be expected to be available and 
the compensation the alien will receive for on-call 
time; 
‘‘(B) specifies— 
‘‘(i) whether the contracting facility or or-
ganization will pay the alien’s malpractice in-
surance premiums; 
‘‘(ii) whether the employer will provide 
malpractice insurance; and 
‘‘(iii) the amount of such insurance that 
will be provided; 
‘‘(C) describes all of the work locations that the 
alien will work and includes a statement that the 
contracting facility or organization will not add addi-
tional work locations without the approval of the 
Federal agency or State agency that requested the 
waiver; and 
‘‘(D) does not include a non-compete provision. 
‘‘(6) An alien granted a waiver under this subsection 
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 90-day 
period referred to in items (aa) and (bb) of subclause (III) 
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of paragraph (1)(C)(ii) or the 45-day period referred to 
in subclause (III)(cc) of such paragraph.’’. 
(f) RECAPTURING WAIVER SLOTS LOST TO OTHER 
STATES.—Section 214(l) of such Act, as amended by sub-
sections (d) and (e), is further amended by adding at the 
end the following: 
‘‘(7) If a recipient of a waiver under this subsection 
terminates the recipient’s employment with a health facil-
ity or health care organization pursuant to paragraph 
(1)(C)(ii), including termination of employment because of 
circumstances described in paragraph (1)(C)(ii)(III), and 
accepts new employment with such a facility or organiza-
tion in a different State, the State from which the alien 
is departing may be accorded an additional waiver by the 
Secretary of State for use in the fiscal year in which the 
alien’s employment was terminated.’’. 
SEC. 4. ALLOTMENT OF CONRAD 30 WAIVERS. 
(a) IN GENERAL.—Section 214(l) of the Immigration 
and Nationality Act (8 U.S.C. 1184(l)), as amended by 
section 3, is further amended by adding at the end the 
following: 
‘‘(8)(A)(i) All States shall be allotted a total of 35 
waivers under paragraph (1)(B) for a fiscal year if 90 per-
cent of the waivers available to the States receiving at 
least 5 waivers were used in the previous fiscal year. 
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‘‘(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 which case— 
‘‘(i) the number of waivers allotted shall be de-
creased by five for all States beginning in the next 
fiscal year; and 
‘‘(ii) each additional 5 percent decrease in such 
waivers granted from the last year in which there 
was an increase in the allotment, shall result in an 
additional decrease of 5 waivers allotted for all 
States, provided that the number of waivers allotted 
for all States shall not drop below 30.’’. 
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(b) 
ACADEMIC
MEDICAL
CENTERS.—Section 
214(l)(1)(D) of such Act is amended— 
(1) in clause (ii), by striking ‘‘and’’ at the end; 
(2) in clause (iii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(iv) in the case of a request by an inter-
ested State agency— 
‘‘(I) the head of such agency deter-
mines that the alien is to practice medicine 
in, or be on the faculty of a residency pro-
gram at, an academic medical center (as 
that 
term 
is 
defined 
in 
section 
411.355(e)(2) of title 42, Code of Federal 
Regulations, or similar successor regula-
tion), without regard to whether such facil-
ity is located within an area designated by 
the Secretary of Health and Human Serv-
ices as having a shortage of health care 
professionals; and 
‘‘(II) the head of such agency deter-
mines that— 
‘‘(aa) the alien physician’s work 
is in the public interest; and 
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‘‘(bb) the grant of such waiver 
would not cause the number of the 
waivers granted on behalf of aliens for 
such State for a fiscal year (within 
the limitation in subparagraph (B) 
and subject to paragraph (6)) in ac-
cordance with the conditions of this 
clause to exceed three.’’. 
SEC. 5. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, 
AND OTHER PROVISIONS RELATED TO PHYSI-
CIAN IMMIGRATION. 
(a) VISA ELIGIBILITY.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary of 
State shall amend guidance in the Foreign Affairs Manual 
to clarify that the expression of a future intention to seek 
a waiver under section 214(l) of the Immigration and Na-
tionality Act (8 U.S.C. 1184(l)) by an alien coming to the 
United States to receive graduate medical education or 
training, as described in section 212(j) of such Act (8 
U.S.C. 1182(j)), or to take examinations required to re-
ceive such graduate medical education or training, shall 
not, by itself, constitute evidence of an intention to aban-
don a foreign residence for purposes of obtaining a visa 
as a nonimmigrant or otherwise obtaining or maintaining 
the status of a nonimmigrant. 
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(b) APPLICABILITY OF SECTION 212(e) TO SPOUSES 
AND CHILDREN OF J–1 EXCHANGE VISITORS.—Section 
212(e) of the Immigration and Nationality Act (8 U.S.C. 
1182(e)) is amended— 
(1) by inserting ‘‘(1)’’ after ‘‘(e)’’; and 
(2) by adding at the end the following 
‘‘(2) A spouse or child of an exchange visitor de-
scribed in section 101(a)(15)(J) shall not be subject to 
the requirements under this subsection solely on account 
of such spouse or child’s derivative nonimmigrant status 
to an exchange visitor who is subject to the requirements 
under this subsection.’’. 
Æ 
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