198 
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; 
(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. 314. 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 
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199 
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. 315. CONRAD STATE 30 AND PHYSICIAN RETENTION. 
(a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec-
tion 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 ‘‘September 30, 2015’’ 
and inserting ‘‘September 30, 2021’’. 
(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 of a waiver re-
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quested under section 203(b)(2)(B)(ii), includ-
ing— 
‘‘(I) alien physicians who completed 
such service before the date of the enact-
ment of the Conrad State 30 and Physi-
cian Access Act; 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 
physician described in this subparagraph 
before the date by which such alien physi-
cian has completed 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 section 214(l) 
waiver 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 
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201 
‘‘(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’’ and insert-
ing ‘‘Secretary of Homeland Security’’; 
(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 striking 
clauses (i) and (ii) and inserting the following: 
‘‘(i) the alien demonstrates a bona 
fide offer of full-time employment at a 
health facility or health care organization, 
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202 
which employment has been determined by 
the Secretary of Homeland Security to be 
in the public interest; 
‘‘(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; 
‘‘(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-
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203 
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-
ment under this subsection, except as 
provided in paragraph (8).’’; and 
(E) in subparagraph (D), in the matter 
preceding clause (i), by inserting ‘‘(except as 
provided in paragraph (8)). 
(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 
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204 
101(a)(15)(J) and a favorable recommendation 
by the Secretary of State, the Secretary of 
Homeland Security may change the status of 
such physician to any status authorized for em-
ployment under this Act. The numerical limita-
tions contained 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 
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 
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205 
(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) Such physician shall be authorized to 
work only for the employer referred to in subpara-
graph (A) from the date on which a new waiver ap-
plication is filed with such State until the earlier 
of— 
‘‘(i) the date on which the Secretary of 
Homeland Security denies such waiver; or 
‘‘(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 
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206 
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; 
‘‘(C) describes all of the work locations 
that the alien will work and includes a state-
ment that the contracting facility or organiza-
tion will not add additional work locations with-
out 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 
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207 
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 
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— 
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‘‘(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) 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-
sionals, 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 
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209 
‘‘(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-
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 subclause (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) demonstrates, not later than 45 
days after the employment termination 
date, another bona fide offer of employ-
ment at a health facility or health care or-
ganization in a geographic area or areas, 
in the State that requested the alien’s 
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212 
‘‘(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 
‘‘(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-
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213 
cordance with the conditions of this 
clause to exceed 3.’’. 
(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 ‘‘(other than a non-
immigrant described in subparagraph (L) or (V) of 
section 101(a)(15), 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 ‘‘(other than a nonimmigrant 
described in subparagraph (L) or (V) of section 
101(a)(15), a nonimmigrant described in any provi-
sion 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.— 
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214 
(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 
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-
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215 
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 the Immigration 
and Nationality Act (8 U.S.C. 1153(B)(ii)) is 
amended— 
(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 
under item (aa) shall begin on the date on 
which the alien physician begins work in 
the shortage area in any legal status and 
not on the date on which an immigrant 
visa petition is filed or approved. Such 
service shall be aggregated without regard 
to when such service began and without re-
gard to whether such service began during 
or in conjunction with a course of graduate 
medical education. 
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216 
‘‘(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 the Immigration and Nationality 
Act (8 U.S.C. 1153(b)(2)(A)) 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 
medical residency or fellowship program is a member 
of the professions holding an advanced degree or its 
equivalent.’’. 
(4) SHORT-TERM
WORK
AUTHORIZATION
FOR 
PHYSICIANS COMPLETING THEIR RESIDENCIES.— 
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217 
(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. 
(B) TERMINATION.—The physician’s sta-
tus and employment authorization shall termi-
nate on the date that is 30 days after the date 
on which a petition described in clause (i)(I) is 
rejected, denied or revoked. 
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218 
(C) AUTOMATIC
EXTENSION.—A physi-
cian’s status and employment authorization will 
automatically extend to October 1 of the next 
fiscal year if all of the visas described in section 
101(a)(15)(H)(i) of such Act that were author-
ized 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)). 
TITLE IV—IMPROVING HEALTH 
CARE ACCESS AND QUALITY 
Subtitle A—Improvement of 
Coverage 
SEC. 401. 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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219 
(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 (26) as paragraphs 
(22) through (25), respectively; and 
(B) by redesignating subsections (y) and 
(z) as subsections (x) and (y), respectively. 
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220 
(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 as if included in the enact-
ment of the Deficit Reduction Act of 2005. 
SEC. 402. REMOVING CITIZENSHIP AND IMMIGRATION BAR-
RIERS TO ACCESS TO AFFORDABLE HEALTH 
CARE UNDER ACA. 
(a) IN GENERAL.— 
(1) PREMIUM TAX CREDITS.—Section 36B of 
the Internal Revenue Code of 1986 is amended— 
(A) in subsection (c)(1)(B)— 
(i) by amending the heading to read 
as follows: ‘‘SPECIAL RULE FOR CERTAIN 
INDIVIDUALS
INELIGIBLE
FOR
MEDICAID 
DUE TO STATUS’’, and 
(ii) in clause (ii), by striking ‘‘lawfully 
present in the United States, but’’ and in-
serting ‘‘who’’, and 
(B) by striking subsection (e). 
(2) COST-SHARING REDUCTIONS.—Section 1402 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18071) is amended by striking sub-
section (e). 
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221 
(3) BASIC
HEALTH
PROGRAM
ELIGIBILITY.— 
Section 1331(e)(1)(B) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 
amended by striking ‘‘lawfully present in the United 
States’’. 
(4) RESTRICTIONS ON FEDERAL PAYMENTS.— 
Section 1412 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18082) is amended by 
striking subsection (d). 
(5) REQUIREMENT TO MAINTAIN MINIMUM ES-
SENTIAL COVERAGE.—Section 5000A(d) of the In-
ternal Revenue Code of 1986 is amended by striking 
paragraph (3) and by redesignating paragraph (4) 
as paragraph (3). 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1411(a) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18081(a)) is 
amended by striking paragraph (1) and redesig-
nating paragraphs (2), (3), and (4) as paragraphs 
(1), (2), and (3), respectively. 
(2) Section 1312(f) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18032(f)) is 
amended— 
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222 
(A) in the heading, by striking ‘‘; ACCESS 
LIMITED
TO CITIZENS
AND LAWFUL RESI-
DENTS’’; and 
(B) by striking paragraph (3). 
SEC. 403. STUDY ON THE UNINSURED. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall— 
(1) conduct a study, in accordance with the 
standards under section 3101 of the Public Health 
Service Act (42 U.S.C. 300kk), on the demographic 
characteristics of the population of individuals who 
do not have health insurance coverage or oral health 
coverage; and 
(2) predict, based on such study, the demo-
graphic characteristics of the population of individ-
uals who would remain without health insurance cov-
erage after the end of any annual open enrollment 
or any special enrollment period or upon enactment 
and implementation of any legislative changes to the 
Patient Protection and Affordable Care Act (Public 
Law 111–148) that affect the number of persons eli-
gible for coverage. 
(b) REPORTING REQUIREMENTS.— 
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223 
(1) IN GENERAL.—Not later than 12 months 
after the date of the enactment of this Act, the Sec-
retary shall submit to the Congress the results of 
the study under subsection (a)(1) and the prediction 
made under subsection (a)(2). 
(2) REPORTING OF DEMOGRAPHIC CHARACTER-
ISTICS.—The Secretary shall— 
(A) report the demographic characteristics 
under paragraphs (1) and (2) of subsection (a) 
on the basis of racial and ethnic group, and 
shall stratify the reporting on each racial and 
ethnic group by other demographic characteris-
tics that can impact access to health insurance 
coverage, such as sexual orientation, gender 
identity, primary language, disability status, 
sex, socioeconomic status, age group, and citi-
zenship and immigration status, in a manner 
consistent with title I of this Act, including the 
amendments made by such title; and 
(B) not use such report to engage in or an-
ticipate any deportation or immigration related 
enforcement action by any entity, including the 
Department of Homeland Security. 
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