I 
113TH CONGRESS 
2D SESSION 
H. R. 4951 
To provide incentives to physicians to practice in rural and medically 
underserved communities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 24, 2014 
Mr. BERA of California (for himself and Mr. MEADOWS) 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 ‘‘Doctors Helping He-
roes Act of 2014’’. 
SEC. 2. CONRAD STATE 30 PROGRAM. 
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 ‘‘and before 
September 30, 2015’’. 
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SEC. 3. 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-
quested under section 203(b)(2)(B)(ii), includ-
ing alien physicians who completed such service 
before the date of the enactment of the Conrad 
State 30 and Physician Access Act and any 
spouses or children of such alien physicians. 
‘‘(ii) Nothing in this subparagraph 
may be construed— 
‘‘(I) to prevent the filing of a pe-
tition with the Secretary of Homeland 
Security for classification under sec-
tion 204(a) or the filing of an applica-
tion for adjustment of status under 
section 245 by an alien physician de-
scribed in this subparagraph prior to 
the date by which such alien physician 
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 
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214(l) waiver or in an area or areas 
designated by the Secretary of Health 
and Human Services as having a 
shortage of health care professionals; 
or 
‘‘(II) to permit the Secretary of 
Homeland Security to grant such a 
petition or application until the alien 
has satisfied all the requirements of 
the waiver received under section 
214(l).’’. 
SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 
(a) IN GENERAL.—Section 214(l)(1)(C) of the Immi-
gration and Nationality Act (8 U.S.C. 1184(l)(1)(C)) is 
amended 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 care organization, which employ-
ment has been determined by the Secretary 
of Homeland Security to be in the public 
interest; and 
‘‘(ii) the alien agrees to begin employ-
ment with the health facility or health care 
organization in a geographic area or areas 
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which are designated by the Secretary of 
Health and Human Services as having a 
shortage of health care professionals by the 
later of the date that is 90 days after re-
ceiving such waiver, 90 days after com-
pleting graduate medical education or 
training under a program approved pursu-
ant to section 212(j)(1), or 90 days after 
receiving nonimmigrant status or employ-
ment authorization, and agrees to continue 
to work for a total of not less than 3 years 
in any status authorized for such employ-
ment under this subsection unless— 
‘‘(I) the Secretary determines 
that extenuating circumstances exist 
that justify a lesser period of employ-
ment at such facility or organization, 
in which case the alien shall dem-
onstrate another bona fide offer of 
employment at a health facility or 
health care organization, for the re-
mainder of such 3-year period; 
‘‘(II) the interested State agency 
that requested the waiver attests that 
extenuating circumstances exist that 
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justify a lesser period of employment 
at such facility or organization in 
which case the alien shall demonstrate 
another bona fide offer of employment 
at a health facility or health care or-
ganization so designated by the Sec-
retary of Health and Human Services, 
for the remainder of such 3-year pe-
riod; or 
‘‘(III) if the alien elects not to 
pursue a determination of extenuating 
circumstances pursuant to subclause 
(I) or (II), the alien terminates the 
alien’s employment relationship with 
such facility or organization, in which 
case the alien shall be employed for 
the remainder of such 3-year period, 
and 1 additional year for each termi-
nation, at another 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; 
and’’. 
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(b) CONTRACT REQUIREMENTS.—Section 214(l) of 
the Immigration and Nationality Act (8 U.S.C. 1184(l)) 
is amended by adding at the end the following: 
‘‘(4) 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 
available and the compensation the alien will re-
ceive for on-call time; 
‘‘(B) specifies whether the contracting fa-
cility or organization will pay for the alien’s 
malpractice 
insurance 
premiums, 
including 
whether the employer will provide malpractice 
insurance and, if so, the amount of such insur-
ance that will be provided; 
‘‘(C) describes all of the work locations 
that the alien will work and a statement that 
the contracting facility or organization will not 
add additional work locations without the ap-
proval of the Federal agency or State agency 
that requested the waiver; and 
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‘‘(D) does not include a non-compete provi-
sion. 
‘‘(5) An alien granted a waiver under para-
graph (1)(C) whose employment relationship with a 
health facility or health care organization terminates 
during the 3-year service period required by such 
paragraph— 
‘‘(A) shall have a period of 120 days begin-
ning on the date of such termination of employ-
ment to submit to the Secretary of Homeland 
Security applications or petitions to commence 
employment with another contracting health fa-
cility or health care organization in a geo-
graphic area or areas which are designated by 
the Secretary of Health and Human Services as 
having a shortage of health care professionals; 
and 
‘‘(B) shall be considered to be maintaining 
lawful status in an authorized stay during the 
120-day period referred to in subsection (A).’’. 
SEC. 5. 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 4(b), is further amended by adding at the end the 
following: 
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‘‘(6)(A)(i) All States shall be allotted a total of 
35 waivers under paragraph (1)(B) for a fiscal year 
if 90 percent of the waivers available to the States 
receiving at least 5 waivers were used in the pre-
vious fiscal year. 
‘‘(ii) When an allocation has occurred 
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 fol-
lowing 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 sub-
paragraph (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 
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number of waivers allotted pursuant to this 
paragraph, in which case— 
‘‘(i) the number of waivers allotted 
shall be decreased by 5 for all States be-
ginning in the next fiscal year; and 
‘‘(ii) each additional 5 percent de-
crease 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 waiv-
ers allotted for all States shall not drop 
below 30.’’. 
(b) 
ACADEMIC
MEDICAL
CENTERS.—Section 
214(l)(1)(D) of the Immigration and Nationality Act (8 
U.S.C. 1184(l)(1)(D)) 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 
(3) by adding at the end the following: 
‘‘(iv) in the case of a request by an in-
terested State agency— 
‘‘(I) the head of such agency de-
termines that the alien is to practice 
medicine in, or be on the faculty of a 
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residency program at, an academic 
medical center (as that term is de-
fined in section 411.355(e)(2) of title 
42, Code of Federal Regulations, or 
similar successor regulation), without 
regard to whether such facility is lo-
cated within an area designated by 
the Secretary of Health and Human 
Services as having a shortage of 
health care professionals; and 
‘‘(II) the head of such agency de-
termines that— 
‘‘(aa) the alien physician’s 
work is in the public interest; 
and 
‘‘(bb) the grant of such 
waiver would not cause the num-
ber of the waivers granted on be-
half of aliens for such State for 
a fiscal year (within the limita-
tion in subparagraph (B) and 
subject to paragraph (6)) in ac-
cordance with the conditions of 
this clause to exceed 3; and’’. 
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SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, 
AND OTHER PROVISIONS RELATED TO PHYSI-
CIAN IMMIGRATION. 
(a) DUAL INTENT FOR PHYSICIANS SEEKING GRAD-
UATE MEDICAL TRAINING.—Section 214(b) of the Immi-
gration and Nationality Act (8 U.S.C. 1184(b)) is amend-
ed by striking ‘‘(other than a nonimmigrant 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 section)’’ 
and inserting ‘‘(other than a nonimmigrant described in 
subparagraph (L) or (V) of section 101(a)(15), a non-
immigrant 
described 
in 
any 
provision 
of 
section 
101(a)(15)(H)(i), except subclause (b1) of such section, 
and an alien coming to the United States to receive grad-
uate medical education or training as described in section 
212(j) or to take examinations required to receive grad-
uate medical education or training as described in section 
212(j))’’. 
(b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL-
FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER-
SERVED AREAS.—Section 214(l)(2)(A) of the Immigration 
and Nationality Act (8 U.S.C. 1184(l)(2)(A)) is amended 
by 
striking 
‘‘an 
alien 
described 
in 
section 
101(a)(15)(H)(i)(b).’’ and inserting ‘‘any status author-
ized for employment under this Act.’’. 
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(c) PHYSICIAN NATIONAL INTEREST WAIVER CLARI-
FICATIONS.— 
(1) PRACTICE
AND
GEOGRAPHIC
AREA.—Sec-
tion 203(b)(2)(B)(ii)(I) of the Immigration and Na-
tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 
amended by striking items (aa) and (bb) and insert-
ing the following: 
‘‘(aa) the alien physician 
agrees to work on a full-time 
basis practicing primary care, 
specialty medicine, or a combina-
tion thereof, 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; 
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 des-
ignated by the Secretary of 
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Health and Human Services as 
having a shortage of health care 
professionals (without regard to 
whether such facility or facilities 
are located within such an area) 
and a Federal agency, or a local, 
county, regional, or State depart-
ment of public health determines 
the alien physician’s work was or 
will be in the public interest.’’. 
(2) FIVE-YEAR SERVICE REQUIREMENT.—Sec-
tion 203(b)(2)(B)(ii)(II) of the Immigration and Na-
tionality Act (8 U.S.C. 1153(B)(ii)(II)) is amend-
ed— 
(A) by inserting ‘‘(aa)’’ after ‘‘(II)’’; and 
(B) by adding at the end the following: 
‘‘(bb) The 5-year service requirement of item (aa) 
shall be counted from the date the alien physician begins 
work in the shortage area in any legal status and not the 
date an immigrant visa petition is filed or approved. Such 
service shall be aggregated without regard to when such 
service began and without regard to whether such service 
began during or in conjunction with a course of graduate 
medical education. 
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‘‘(cc) An alien physician shall not be required to sub-
mit an employment contract with a term exceeding the 
balance of the 5-year commitment yet to be served, nor 
an employment contract dated within a minimum time pe-
riod prior to filing of a visa petition pursuant to this sub-
section. 
‘‘(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.’’. 
(d) 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 
‘‘An alien physician holding a foreign medical degree that 
has been deemed sufficient 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.’’. 
(e) SHORT-TERM WORK AUTHORIZATION FOR PHY-
SICIANS COMPLETING THEIR RESIDENCIES.—A physician 
completing graduate medical education or training as de-
scribed in section 212(j) of the Immigration and Nation-
ality 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. 
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1101(a)(15)(H)(i)) shall have such nonimmigrant status 
automatically extended until October 1 of the fiscal year 
for which a petition for a continuation of such non-
immigrant status has been submitted in a timely manner 
and where the employment start date for the beneficiary 
of such petition is October 1 of that fiscal year. Such phy-
sician shall be authorized to be employed incident to status 
during the period between the filing of such petition and 
October 1 of such fiscal year. However, the physician’s 
status and employment authorization shall terminate 30 
days from the date such petition is rejected, denied or re-
voked. A physician’s status and employment authorization 
will automatically extend to October 1 of the next fiscal 
year 
if 
all 
visas 
as 
described 
in 
such 
section 
101(a)(15)(H)(i) authorized to be issued for the fiscal 
year have been issued. 
(f) APPLICABILITY OF SECTION 212(e) TO SPOUSES 
AND CHILDREN OF J–1 EXCHANGE VISITORS.—A spouse 
or child of an exchange visitor described 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 require-
ments of section 212(e) of the Immigration and Nation-
ality Act (8 U.S.C. 1182(e)). 
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SEC. 7. VETERANS HEALTH CENTERS. 
Section 214(l) of the Immigration and Nationality 
Act (8 U.S.C. 1184(l)), as amended by this Act, is further 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (B), by inserting be-
fore the semicolon at the end the following: ‘‘, 
except as otherwise provided under subpara-
graph (E)’’; and 
(B) by adding at the end the following: 
‘‘(E) in the case of a request by an inter-
ested State agency— 
‘‘(i) if the Secretary of Veterans Af-
fairs determines that facilities of the De-
partment are not capable of furnishing 
covered health services to eligible veterans 
because such facilities lack— 
‘‘(I) the required personnel who 
are appropriately trained and experi-
enced; or 
‘‘(II) the ability to provide timely 
and reasonable access; 
‘‘(ii) the head of such State agency 
determines that— 
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‘‘(I) the alien is to practice medi-
cine in a Veterans Health Administra-
tion Facility; and 
‘‘(II) the alien physician’s work is 
in the public interest; and 
‘‘(iii) the grant of such waiver would 
not cause the number of waivers allotted 
for that State for that fiscal year under 
this subparagraph to exceed 5.’’; and 
(2) by adding at the end the following: 
‘‘(7) For purposes of paragraph (1)(E)— 
‘‘(A) the term ‘covered health services’ 
means, with respect to an eligible veteran, any 
hospital care, medical service, rehabilitative 
service, or preventative health service that is 
authorized to be provided by the Secretary to 
the veteran under chapter 17 of title 38, United 
States Code, or any other provision of law; and 
‘‘(B) the term ‘eligible veteran’ means a 
veteran enrolled in the health care system es-
tablished under section 1705(a) of title 38, 
United States Code, who elects to receive care 
under section 1703.’’. 
Æ 
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