Nursing Relief for Disadvantaged Areas Act of 1999
PL 106-95 (H.R.441), enacted 11/12/1999

113 STAT. 1312 
PUBLIC LAW 106-95—NOV. 12, 1999 
Public Law 106-95 
106th Congress 
An Act 
N 
19 iQQQ 
"^^ amend the Immigration and Nationality Act with respect to the requirements 
——; 
for the admission of nonimmigrant nurses who will practice in health professional 
[H.R. 441] 
shortage areas. 
Be it enacted by the Senate and House of Representatives 
of 
Nursing Relief 
the United States of America in Congress assembled, 
for 
Disadvantaged 
SECTION 1. SHORT TITLE. 
1999^ '^ ° 
This Act may be cited as the "Nursing ReUef for Disadvantaged 
8 use 1101 note. 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 NationaUty 
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)(l), 
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)(l) 
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 emplo)anent; 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 
PUBLIC LAW 106-95—NOV. 12, 1999 
113 STAT. 1313 
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 worlang 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 emplojnnent 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(aX15)(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 Deadline, 
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: 
113 STAT. 1314 
PUBLIC LAW 106-95—NOV. 12, 1999 
"(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)— 
Expiration date. 
"(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. 
Deadlines. 
"(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 
Applicability. 
Records. 
Public 
information. 
Procedures. 
PUBLIC LAW 106-95—NOV. 12, 1999 
113 STAT. 1315 
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 facihty (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 carr3dng 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— 
113 STAT. 1316 
PUBLIC LAW 106-95—NOV. 12, 1999 
"(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)(l)(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 PubHc 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 Tinder 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). 
Deadline. 
(d) IMPLEMENTATION.—Not later than 90 days after the date 
Regulations. 
gf the enactment of this Act, the Secretary of Labor (in consultation, 
8 use 1182 note. ^^ ^^le 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)). 
PUBLIC LAW 106-95—NOV. 12, 1999 
113 STAT. 1317 
(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). 
8 use 1182 note. 
SEC. 
RECOMMENDATIONS 
FOR ALTERNATIVE 
REMEDY 
FOR 
8 USC 1182 note. 
NURSING SHORTAGE. 
Not later than the last day of the 4-year period described Deadline. 
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 £in adjustment of status, the Attorney General) a certified state-
ment fi"om 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 Deadline. 
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 
113 STAT. 1318 
PUBLIC LAW 106-95—NOV. 12, 1999 
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 Rehef 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 aUen 
who seeks" and inserting "Subject to subsection (r), any alien 
who seeks". 
8 use 1182 note. 
(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. 
Deadline. 
(c) ISSUANCE OF CERTIFIED STATEMENTS.—The Commission On 
8 use 1182 note. 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 
PUBLIC LAW 106-95—NOV. 12, 1999 
113 STAT. 1319 
such an area or at such faciUty was in the 
pubHc interest. 
"(II) PROHIBITION.—No permanent resident 
visa may be issued to an aUen 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 £in 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 g^lien 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. 
"(Ill) 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 
113 STAT. 1320 
PUBLIC LAW 106-95—NOV. 12, 1999 
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.". 
Approved November 12, 1999. 
LEGISLATIVE HISTORY—H.R. 441: 
HOUSE REPORTS: No. 106-135 (Comm. on the Judiciary). 
CONGRESSIONAL RECORD, Vol. 145 (1999): 
May 24, considered and passed House. 
Oct. 22, considered and passed Senate, amended. 
Nov. 2, House concurred in Senate amendment.