H. R. 441
One Hundred Sixth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Wednesday,
the sixth day of January, one thousand nine hundred and ninety-nine
An Act
To amend the Immigration and Nationality Act with respect to the requirements
for the admission of nonimmigrant nurses who will practice in health professional
shortage areas.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Nursing Relief for Disadvantaged
Areas Act of 1999’’.
SEC. 2. REQUIREMENTS FOR ADMISSION OF NONIMMIGRANT NURSES
IN HEALTH PROFESSIONAL SHORTAGE AREAS DURING
4-YEAR PERIOD.
(a) ESTABLISHMENT OF A NEW NONIMMIGRANT CLASSIFICATION
FOR NONIMMIGRANT NURSES IN HEALTH PROFESSIONAL SHORTAGE
AREAS.—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 ‘‘; or’’ at
the end and inserting the following: ‘‘, or (c) who is coming tempo-
rarily to the United States to perform services as a registered
nurse, who meets the qualifications described in section 212(m)(1),
and with respect to whom the Secretary of Labor determines and
certifies to the Attorney General that an unexpired attestation
is on file and in effect under section 212(m)(2) for the facility
(as defined in section 212(m)(6)) for which the alien will perform
the services; or’’.
(b) REQUIREMENTS.—Section 212(m) of the Immigration and
Nationality Act (8 U.S.C. 1182(m)) is amended to read as follows:
‘‘(m)(1) 
The 
qualifications 
referred 
to 
in 
section
101(a)(15)(H)(i)(c), with respect to an alien who is coming to the
United States to perform nursing services for a facility, are that
the alien—
‘‘(A) has obtained a full and unrestricted license to practice
professional nursing in the country where the alien obtained
nursing education or has received nursing education in the
United States;
‘‘(B) has passed an appropriate examination (recognized
in regulations promulgated in consultation with the Secretary
of Health and Human Services) or has a full and unrestricted
license under State law to practice professional nursing in
the State of intended employment; and
‘‘(C) is fully qualified and eligible under the laws (including
such temporary or interim licensing requirements which
authorize the nurse to be employed) governing the place of
intended employment to engage in the practice of professional
H. R. 441—2
nursing as a registered nurse immediately upon admission
to the United States and is authorized under such laws to
be employed by the facility.
‘‘(2)(A) The attestation referred to in section 101(a)(15)(H)(i)(c),
with respect to a facility for which an alien will perform services,
is an attestation as to the following:
‘‘(i) The facility meets all the requirements of paragraph
(6).
‘‘(ii) The employment of the alien will not adversely affect
the wages and working conditions of registered nurses similarly
employed.
‘‘(iii) The alien employed by the facility will be paid the
wage rate for registered nurses similarly employed by the
facility.
‘‘(iv) The facility has taken and is taking timely and signifi-
cant steps designed to recruit and retain sufficient registered
nurses who are United States citizens or immigrants who are
authorized to perform nursing services, in order to remove
as quickly as reasonably possible the dependence of the facility
on nonimmigrant registered nurses.
‘‘(v) There is not a strike or lockout in the course of a
labor dispute, the facility did not lay off and will not lay
off a registered nurse employed by the facility 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 intended or designed to influence an election
for a bargaining representative for registered nurses of the
facility.
‘‘(vi) At the time of the filing of the petition for registered
nurses under section 101(a)(15)(H)(i)(c), notice of the filing has
been provided by the facility to the bargaining representative
of the registered nurses at the facility or, where there is no
such bargaining representative, notice of the filing has been
provided to the registered nurses employed at the facility
through posting in conspicuous locations.
‘‘(vii) The facility will not, at any time, employ a number
of aliens issued visas or otherwise provided nonimmigrant
status under section 101(a)(15)(H)(i)(c) that exceeds 33 percent
of the total number of registered nurses employed by the
facility.
‘‘(viii) The facility will not, with respect to any alien issued
a visa or otherwise provided nonimmigrant status under section
101(a)(15)(H)(i)(c)—
‘‘(I) authorize the alien to perform nursing services
at any worksite other than a worksite controlled by the
facility; or
‘‘(II) transfer the place of employment of the alien
from one worksite to another.
Nothing in clause (iv) shall be construed as requiring a facility
to have taken significant steps described in such clause before
the date of the enactment of the Nursing Relief for Disadvan-
taged Areas Act of 1999. A copy of the attestation shall be
provided, within 30 days of the date of filing, to registered
nurses employed at the facility on the date of filing.
‘‘(B) For purposes of subparagraph (A)(iv), each of the following
shall be considered a significant step reasonably designed to recruit
and retain registered nurses:
H. R. 441—3
‘‘(i) Operating a training program for registered nurses
at the facility or financing (or providing participation in) a
training program for registered nurses elsewhere.
‘‘(ii) Providing career development programs and other
methods of facilitating health care workers to become registered
nurses.
‘‘(iii) Paying registered nurses wages at a rate higher than
currently being paid to registered nurses similarly employed
in the geographic area.
‘‘(iv) Providing reasonable opportunities for meaningful
salary advancement by registered nurses.
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)(iv). Nothing in this
subparagraph shall require a facility to take more than one step
if the facility can demonstrate that taking a second step is not
reasonable.
‘‘(C) Subject to subparagraph (E), an attestation under subpara-
graph (A)—
‘‘(i) shall expire on the date that is the later of—
‘‘(I) the end of the one-year period beginning on the
date of its filing with the Secretary of Labor; or
‘‘(II) the end of the period of admission under section
101(a)(15)(H)(i)(c) of the last alien with respect to whose
admission it was applied (in accordance with clause (ii));
and
‘‘(ii) shall apply to petitions filed during the one-year period
beginning on the date of its filing with the Secretary of Labor
if the facility states in each such petition that it continues
to comply with the conditions in the attestation.
‘‘(D) A facility may meet the requirements under this paragraph
with respect to more than one registered nurse in a single petition.
‘‘(E)(i) The Secretary of Labor shall compile and make available
for public examination in a timely manner in Washington, D.C.,
a list identifying facilities which have filed petitions for non-
immigrants under section 101(a)(15)(H)(i)(c) and, for each such
facility, a copy of the facility’s attestation under subparagraph
(A) (and accompanying documentation) and each such petition filed
by the facility.
‘‘(ii) The Secretary of Labor shall establish a process, including
reasonable time limits, for the receipt, investigation, and disposition
of complaints respecting a facility’s failure to meet conditions
attested to or a facility’s misrepresentation of a material fact in
an attestation. Complaints may be filed by any aggrieved person
or organization (including bargaining representatives, associations
deemed appropriate by the Secretary, and other aggrieved parties
as determined under regulations of the Secretary). The Secretary
shall conduct an investigation under this clause if there is reason-
able cause to believe that a facility fails to meet conditions attested
to. Subject to the time limits established under this clause, this
subparagraph 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 finding described
in clause (iv). If the Secretary determines that such a basis exists,
the Secretary shall provide for notice of such determination to
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the interested parties and an opportunity for a hearing on the
complaint within 60 days of the date of the determination.
‘‘(iv) If the Secretary of Labor finds, after notice and opportunity
for a hearing, that a facility (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
shall notify the Attorney General 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 nurse
per violation, with the total penalty not to exceed $10,000 per
violation) as the Secretary determines to be appropriate. Upon
receipt of such notice, the Attorney General shall not approve
petitions filed with respect to a facility during a period of at least
one year for nurses to be employed by the facility.
‘‘(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 a facility has violated the condition attested
to under subparagraph (A)(iii) (relating to payment of registered
nurses at the prevailing wage rate), the Secretary shall order the
facility 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 impose on a facility 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 subparagraph 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 described
in clause (i), in addition to any other funds that are available
to the Secretary to cover such costs.
‘‘(3) The period of admission of an alien under section
101(a)(15)(H)(i)(c) shall be 3 years.
‘‘(4) The total number of nonimmigrant visas issued pursuant
to petitions granted under section 101(a)(15)(H)(i)(c) in each fiscal
year shall not exceed 500. The number of such visas issued for
employment in each State in each fiscal year shall not exceed
the following:
‘‘(A) For States with populations of less than 9,000,000,
based upon the 1990 decennial census of population, 25 visas.
‘‘(B) For States with populations of 9,000,000 or more,
based upon the 1990 decennial census of population, 50 visas.
‘‘(C) If the total number of visas available under this para-
graph for a fiscal year quarter exceeds the number of qualified
nonimmigrants who may be issued such visas during those
quarters, the visas made available under this paragraph shall
be issued without regard to the numerical limitation under
subparagraph (A) or (B) of this paragraph during the last
fiscal year quarter.
‘‘(5) A facility that has filed a petition under section
101(a)(15)(H)(i)(c) to employ a nonimmigrant to perform nursing
services for the facility—