Conrad State 30 and Physician Access Reauthorization Act

I 117TH CONGRESS 1ST SESSION H. R. 3541 To provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 25, 2021 Mr. SCHNEIDER (for himself, Mr. BACON, Mr. DELGADO, Mr. MCKINLEY, Mrs. AXNE, Mr. BABIN, Mr. BERA, Ms. BLUNT ROCHESTER, Mr. BUTTERFIELD, Mr. CASTEN, Mr. CLEAVER, Mr. COSTA, Mr. DEFAZIO, Mr. FITZPATRICK, Mr. GARAMENDI, Ms. GARCIA of Texas, Miss GONZA´LEZ-COLO´N, Mr. HICE of Georgia, Mr. KELLER, Ms. KELLY of Il- linois, Mr. KILDEE, Mr. KILMER, Mr. KRISHNAMOORTHI, Mr. LAWSON of Florida, Mr. LONG, Mr. LUCAS, Mr. MAST, Mr. MULLIN, Mr. NOR- MAN, Mr. PANETTA, Mr. PETERS, Mr. POCAN, Mr. PRICE of North Caro- lina, Mr. RUSH, Mr. RYAN, Mr. SOTO, Ms. SPEIER, Mr. VAN DREW, and Ms. WILLIAMS of Georgia) introduced the following bill; which was re- ferred 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Conrad State 30 and 4 Physician Access Reauthorization Act’’. 5 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 3541 IH SEC. 2. CONRAD STATE 30 PROGRAM. 1 (a) EXTENSION.—Section 220(c) of the Immigration 2 and Nationality Technical Corrections Act of 1994 (Public 3 Law 103–416; 8 U.S.C. 1182 note) is amended by striking 4 ‘‘September 30, 2015’’ and inserting ‘‘on the date that 5 is 3 years after the date of the enactment of the Conrad 6 State 30 and Physician Access Reauthorization Act’’. 7 (b) EFFECTIVE DATE.—The amendment made by 8 subsection (a) shall take effect as if enacted on September 9 30, 2018. 10 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 11 MEDICALLY UNDERSERVED COMMUNITIES. 12 Section 201(b)(1) of the Immigration and Nationality 13 Act (8 U.S.C. 1151(b)(1)) is amended by adding at the 14 end the following: 15 ‘‘(F)(i) Alien physicians who have completed 16 service requirements of a waiver requested under 17 section 203(b)(2)(B)(ii), including— 18 ‘‘(I) alien physicians who completed such 19 service before the date of the enactment of the 20 Conrad State 30 and Physician Access Act; and 21 ‘‘(II) the spouse or children of an alien 22 physician described in subclause (I). 23 ‘‘(ii) Nothing in this subparagraph may be con- 24 strued— 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 3541 IH ‘‘(I) to prevent the filing of a petition with 1 the Secretary of Homeland Security for classi- 2 fication under section 204(a) or the filing of an 3 application for adjustment of status under sec- 4 tion 245 by an alien physician described in this 5 subparagraph before the date by which such 6 alien physician has completed the service de- 7 scribed in section 214(l) or worked full-time as 8 a physician for an aggregate of 5 years at the 9 location identified in the section 214(l) waiver 10 or in an area or areas designated by the Sec- 11 retary of Health and Human Services as having 12 a shortage of health care professionals; or 13 ‘‘(II) to permit the Secretary of Homeland 14 Security to grant a petition or application de- 15 scribed in subclause (I) until the alien has sat- 16 isfied all of the requirements of the waiver re- 17 ceived under section 214(l).’’. 18 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 19 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY 20 REQUIREMENT.—Section 214(l)(1) of the Immigration 21 and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 22 (1) in the matter preceding subparagraph (A), 23 by striking ‘‘Attorney General’’ and inserting ‘‘Sec- 24 retary of Homeland Security’’; 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 3541 IH (2) in subparagraph (A), by striking ‘‘Director 1 of the United States Information Agency’’ and in- 2 serting ‘‘Secretary of State’’; 3 (3) in subparagraph (B), by inserting ‘‘, except 4 as provided in paragraphs (7) and (8)’’ before the 5 semicolon at the end; 6 (4) in subparagraph (C), by striking clauses (i) 7 and (ii) and inserting the following: 8 ‘‘(i) the alien demonstrates a bona fide 9 offer of full-time employment at a health facil- 10 ity or health care organization, which employ- 11 ment has been determined by the Secretary of 12 Homeland Security to be in the public interest; 13 and 14 ‘‘(ii) the alien— 15 ‘‘(I) has accepted employment with 16 the health facility or health care organiza- 17 tion in a geographic area or areas which 18 are designated by the Secretary of Health 19 and Human Services as having a shortage 20 of health care professionals; 21 ‘‘(II) begins employment by the later 22 of the date that is— 23 ‘‘(aa) 120 days after receiving 24 such waiver; 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 3541 IH ‘‘(bb) 120 days after completing 1 graduate medical education or train- 2 ing under a program approved pursu- 3 ant to section 212(j)(1); or 4 ‘‘(cc) 120 days after receiving 5 nonimmigrant status or employment 6 authorization, if the alien or the 7 alien’s employer petitions for such 8 nonimmigrant status or employment 9 authorization not later than 120 days 10 after the date on which the alien com- 11 pletes his or her graduate medical 12 education or training under a pro- 13 gram approved pursuant to section 14 212(j)(1); and 15 ‘‘(III) agrees to continue to work for 16 a total of not less than 3 years in the sta- 17 tus authorized for such employment under 18 this subsection, except as provided in para- 19 graph (8).’’; and 20 (5) in subparagraph (D), in the matter pre- 21 ceding clause (i), by inserting ‘‘(except as provided 22 in paragraph (8))’’. 23 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL- 24 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER- 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 3541 IH SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 1 U.S.C. 1184(l)(2)(A)) is amended to read as follows: 2 ‘‘(A) Upon the request of an interested Federal 3 agency or an interested State agency for rec- 4 ommendation of a waiver under this section by a 5 physician who is maintaining valid nonimmigrant 6 status under section 101(a)(15)(J) and a favorable 7 recommendation by the Secretary of State, the Sec- 8 retary of Homeland Security may change the status 9 of such physician to any status authorized for em- 10 ployment under this Act. The numerical limitations 11 contained in subsection (g)(1)(A) shall not apply to 12 any alien whose status is changed under this sub- 13 paragraph.’’. 14 (c) VIOLATION OF AGREEMENTS.—Section 15 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 16 amended by inserting ‘‘substantial requirement of an’’ be- 17 fore ‘‘agreement entered into’’. 18 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED 19 AREAS.—Section 214(l) of such Act, as amended by this 20 section, is further amended by adding at the end the fol- 21 lowing: 22 ‘‘(4)(A) If an interested State agency denies an appli- 23 cation for a waiver under paragraph (1)(B) from a physi- 24 cian pursuing graduate medical education or training pur- 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 3541 IH suant to section 101(a)(15)(J) because the State has re- 1 quested the maximum number of waivers permitted for 2 that fiscal year, the physician’s nonimmigrant status shall 3 be extended for up to 6 months if the physician agrees 4 to seek a waiver under this subsection (except for para- 5 graph (1)(D)(ii)) to work for an employer described in 6 paragraph (1)(C) in a State that has not yet requested 7 the maximum number of waivers. 8 ‘‘(B) Such physician shall be authorized to work only 9 for the employer referred to in subparagraph (A) during 10 the period beginning on the date on which a new waiver 11 application is filed with such State and ending on the ear- 12 lier of— 13 ‘‘(i) the date on which the Secretary of Home- 14 land Security denies such waiver; or 15 ‘‘(ii) the date on which the Secretary approves 16 an application for change of status under paragraph 17 (2)(A) pursuant to the approval of such waiver.’’. 18 (e) CONTRACT REQUIREMENTS.—Section 214(l) of 19 such Act, as amended by this section, is further amended 20 by adding at the end the following: 21 ‘‘(5) An alien granted a waiver under paragraph 22 (1)(C) shall enter into an employment agreement with the 23 contracting health facility or health care organization 24 that— 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 3541 IH ‘‘(A) specifies the maximum number of on-call 1 hours per week (which may be a monthly average) 2 that the alien will be expected to be available and 3 the compensation the alien will receive for on-call 4 time; 5 ‘‘(B) specifies— 6 ‘‘(i) whether the contracting facility or or- 7 ganization— 8 ‘‘(I) has secured medical malpractice 9 liability protection for the alien under sec- 10 tion 224(g) of the Public Health Service 11 Act (42 U.S.C. 233(g)); or 12 ‘‘(II) will pay the alien’s malpractice 13 insurance premiums; 14 ‘‘(ii) whether the employer will provide 15 malpractice insurance for the alien; and 16 ‘‘(iii) the amount of such liability protec- 17 tion that will be provided; 18 ‘‘(C) describes all of the work locations that the 19 alien will work and includes a statement that the 20 contracting facility or organization will not add addi- 21 tional work locations without the approval of the 22 Federal agency or State agency that requested the 23 waiver; and 24 ‘‘(D) does not include a non-compete provision. 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 3541 IH ‘‘(6) An alien granted a waiver under this subsection 1 whose employment relationship with a health facility or 2 health care organization terminates under paragraph 3 (1)(C)(ii) during the 3-year service period required under 4 paragraph (1) shall be considered to be maintaining lawful 5 status in an authorized period of stay during the 120-day 6 period referred to in items (aa) and (bb) of subclause (III) 7 of paragraph (1)(C)(ii) or the 45-day period referred to 8 in subclause (III)(cc) of such paragraph.’’. 9 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER 10 STATES.—Section 214(l) of such Act, as amended by this 11 section, is further amended by adding at the end the fol- 12 lowing: 13 ‘‘(7) If a recipient of a waiver under this subsection 14 terminates the recipient’s employment with a health facil- 15 ity or health care organization pursuant to paragraph 16 (1)(C)(ii), including termination of employment because of 17 circumstances described in paragraph (1)(C)(ii)(III), and 18 accepts new employment with such a facility or organiza- 19 tion in a different State, the State from which the alien 20 is departing may be accorded an additional waiver by the 21 Secretary of State for use in the fiscal year in which the 22 alien’s employment was terminated.’’. 23 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 3541 IH (g) EXCEPTION TO 3-YEAR WORK REQUIREMENT.— 1 Section 214(l) of such Act, as amended by this section, 2 is further amended by adding at the end the following: 3 ‘‘(8) The 3-year work requirement set forth in sub- 4 paragraphs (C) and (D) of paragraph (1) shall not apply 5 if— 6 ‘‘(A)(i) the Secretary of Homeland Security de- 7 termines that extenuating circumstances, including 8 violations by the employer of the employment agree- 9 ment with the alien or of labor and employment 10 laws, exist that justify a lesser period of employment 11 at such facility or organization; and 12 ‘‘(ii) the alien demonstrates, not later than 120 13 days after the employment termination date (unless 14 the Secretary determines that extenuating cir- 15 cumstances would justify an extension), another 16 bona fide offer of employment at a health facility or 17 health care organization in a geographic area or 18 areas which are designated by the Secretary of 19 Health and Human Services as having a shortage of 20 health care professionals, for the remainder of such 21 3-year period; 22 ‘‘(B)(i) the interested State agency that re- 23 quested the waiver attests that extenuating cir- 24 cumstances, including violations by the employer of 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 3541 IH the employment agreement with the alien or of labor 1 and employment laws, exist that justify a lesser pe- 2 riod of employment at such facility or organization; 3 and 4 ‘‘(ii) the alien demonstrates, not later than 120 5 days after the employment termination date (unless 6 the Secretary determines that extenuating cir- 7 cumstances would justify an extension), another 8 bona fide offer of employment at a health facility or 9 health care organization in a geographic area or 10 areas which are designated by the Secretary of 11 Health and Human Services as having a shortage of 12 health care professionals, for the remainder of such 13 3-year period; or 14 ‘‘(C) the alien— 15 ‘‘(i) elects not to pursue a determination of 16 extenuating circumstances pursuant to sub- 17 clause (A) or (B); 18 ‘‘(ii) terminates the alien’s employment re- 19 lationship with the health facility or health care 20 organization at which the alien was employed; 21 ‘‘(iii) demonstrates, not later than 45 days 22 after the employment termination date, another 23 bona fide offer of employment at a health facil- 24 ity or health care organization in a geographic 25 VerDate Sep 11 2014 08:13 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3541.IH H3541 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 3541 IH area or areas, in the State that requested the 1 alien’s waiver, which are designated by the Sec- 2 retary of Health and Human Services as having 3 a shortage of health care professi [Text truncated for display. 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