Conrad State 30 and Physician Access Reauthorization Act

II 118TH CONGRESS 1ST SESSION S. 665 To provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 6, 2023 Ms. KLOBUCHAR (for herself, Ms. COLLINS, Ms. ROSEN, Mr. TILLIS, Mr. KING, Mr. THUNE, Mr. MERKLEY, Mrs. CAPITO, Mr. COONS, Mr. PAUL, Mr. DURBIN, Mr. MORAN, Mrs. SHAHEEN, Mr. WICKER, Ms. SMITH, Mr. MARSHALL, Mr. BLUMENTHAL, Mr. CRAMER, and Mr. BOOZMAN) intro- duced the following bill; which was read twice and referred to the Com- mittee 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 SEC. 2. CONRAD STATE 30 PROGRAM. 6 (a) EXTENSION.—Section 220(c) of the Immigration 7 and Nationality Technical Corrections Act of 1994 (Public 8 VerDate Sep 11 2014 21:51 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 2 •S 665 IS Law 103–416; 8 U.S.C. 1182 note) is amended by striking 1 ‘‘September 30, 2015’’ and inserting ‘‘on the date that 2 is 3 years after the date of the enactment of the Conrad 3 State 30 and Physician Access Reauthorization Act’’. 4 (b) EFFECTIVE DATE.—The amendment made by 5 subsection (a) shall take effect as if enacted on September 6 30, 2018. 7 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 8 MEDICALLY UNDERSERVED COMMUNITIES. 9 Section 201(b)(1) of the Immigration and Nationality 10 Act (8 U.S.C. 1151(b)(1)) is amended by adding at the 11 end the following: 12 ‘‘(F)(i) Alien physicians who have completed 13 service requirements of a waiver requested under 14 section 203(b)(2)(B)(ii), including— 15 ‘‘(I) alien physicians who completed such 16 service before the date of the enactment of the 17 Conrad State 30 and Physician Access Act; and 18 ‘‘(II) the spouse or children of an alien 19 physician described in subclause (I). 20 ‘‘(ii) Nothing in this subparagraph may be con- 21 strued— 22 ‘‘(I) to prevent the filing of a petition with 23 the Secretary of Homeland Security for classi- 24 fication under section 204(a) or the filing of an 25 VerDate Sep 11 2014 21:51 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 3 •S 665 IS application for adjustment of status under sec- 1 tion 245 by an alien physician described in this 2 subparagraph before the date by which such 3 alien physician has completed the service de- 4 scribed in section 214(l) or worked full-time as 5 a physician for an aggregate of 5 years at the 6 location identified in the section 214(l) waiver 7 or in an area or areas designated by the Sec- 8 retary of Health and Human Services as having 9 a shortage of health care professionals; or 10 ‘‘(II) to permit the Secretary of Homeland 11 Security to grant a petition or application de- 12 scribed in subclause (I) until the alien has sat- 13 isfied all of the requirements of the waiver re- 14 ceived under section 214(l).’’. 15 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 16 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY 17 REQUIREMENT.—Section 214(l)(1) of the Immigration 18 and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 19 (1) in the matter preceding subparagraph (A), 20 by striking ‘‘Attorney General’’ and inserting ‘‘Sec- 21 retary of Homeland Security’’; 22 (2) in subparagraph (A), by striking ‘‘Director 23 of the United States Information Agency’’ and in- 24 serting ‘‘Secretary of State’’; 25 VerDate Sep 11 2014 21:51 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 4 •S 665 IS (3) in subparagraph (B), by inserting ‘‘, except 1 as provided in paragraphs (7) and (8)’’ before the 2 semicolon at the end; 3 (4) in subparagraph (C), by striking clauses (i) 4 and (ii) and inserting the following: 5 ‘‘(i) the alien demonstrates a bona fide 6 offer of full-time employment at a health facil- 7 ity or health care organization, which employ- 8 ment has been determined by the Secretary of 9 Homeland Security to be in the public interest; 10 and 11 ‘‘(ii) the alien— 12 ‘‘(I) has accepted employment with 13 the health facility or health care organiza- 14 tion in a geographic area or areas which 15 are designated by the Secretary of Health 16 and Human Services as having a shortage 17 of health care professionals; 18 ‘‘(II) begins employment by the later 19 of the date that is— 20 ‘‘(aa) 120 days after receiving 21 such waiver; 22 ‘‘(bb) 120 days after completing 23 graduate medical education or train- 24 VerDate Sep 11 2014 02:35 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 5 •S 665 IS ing under a program approved pursu- 1 ant to section 212(j)(1); or 2 ‘‘(cc) 120 days after receiving 3 nonimmigrant status or employment 4 authorization, if the alien or the 5 alien’s employer petitions for such 6 nonimmigrant status or employment 7 authorization not later than 120 days 8 after the date on which the alien com- 9 pletes his or her graduate medical 10 education or training under a pro- 11 gram approved pursuant to section 12 212(j)(1); and 13 ‘‘(III) agrees to continue to work for 14 a total of not less than 3 years in the sta- 15 tus authorized for such employment under 16 this subsection, except as provided in para- 17 graph (8).’’; and 18 (5) in subparagraph (D), in the matter pre- 19 ceding clause (i), by inserting ‘‘(except as provided 20 in paragraph (8))’’. 21 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL- 22 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER- 23 SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 24 U.S.C. 1184(l)(2)(A)) is amended to read as follows: 25 VerDate Sep 11 2014 02:35 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 6 •S 665 IS ‘‘(A) Upon the request of an interested Federal 1 agency or an interested State agency for rec- 2 ommendation of a waiver under this section by a 3 physician who is maintaining valid nonimmigrant 4 status under section 101(a)(15)(J) and a favorable 5 recommendation by the Secretary of State, the Sec- 6 retary of Homeland Security may change the status 7 of such physician to any status authorized for em- 8 ployment under this Act. The numerical limitations 9 contained in subsection (g)(1)(A) shall not apply to 10 any alien whose status is changed under this sub- 11 paragraph.’’. 12 (c) VIOLATION OF AGREEMENTS.—Section 13 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 14 amended by inserting ‘‘substantial requirement of an’’ be- 15 fore ‘‘agreement entered into’’. 16 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED 17 AREAS.—Section 214(l) of such Act, as amended by this 18 section, is further amended by adding at the end the fol- 19 lowing: 20 ‘‘(4)(A) If an interested State agency denies an appli- 21 cation for a waiver under paragraph (1)(B) from a physi- 22 cian pursuing graduate medical education or training pur- 23 suant to section 101(a)(15)(J) because the State has re- 24 quested the maximum number of waivers permitted for 25 VerDate Sep 11 2014 02:35 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 7 •S 665 IS that fiscal year, the physician’s nonimmigrant status shall 1 be extended for up to 6 months if the physician agrees 2 to seek a waiver under this subsection (except for para- 3 graph (1)(D)(ii)) to work for an employer described in 4 paragraph (1)(C) in a State that has not yet requested 5 the maximum number of waivers. 6 ‘‘(B) Such physician shall be authorized to work only 7 for the employer referred to in subparagraph (A) during 8 the period beginning on the date on which a new waiver 9 application is filed with such State and ending on the ear- 10 lier of— 11 ‘‘(i) the date on which the Secretary of Home- 12 land Security denies such waiver; or 13 ‘‘(ii) the date on which the Secretary approves 14 an application for change of status under paragraph 15 (2)(A) pursuant to the approval of such waiver.’’. 16 (e) CONTRACT REQUIREMENTS.—Section 214(l) of 17 such Act, as amended by this section, is further amended 18 by adding at the end the following: 19 ‘‘(5) An alien granted a waiver under paragraph 20 (1)(C) shall enter into an employment agreement with the 21 contracting health facility or health care organization 22 that— 23 ‘‘(A) specifies the maximum number of on-call 24 hours per week (which may be a monthly average) 25 VerDate Sep 11 2014 02:35 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 8 •S 665 IS that the alien will be expected to be available and 1 the compensation the alien will receive for on-call 2 time; 3 ‘‘(B) specifies— 4 ‘‘(i) whether the contracting facility or or- 5 ganization— 6 ‘‘(I) has secured medical malpractice 7 liability protection for the alien under sec- 8 tion 224(g) of the Public Health Service 9 Act (42 U.S.C. 233(g)); or 10 ‘‘(II) will pay the alien’s malpractice 11 insurance premiums; 12 ‘‘(ii) whether the employer will provide 13 malpractice insurance for the alien; and 14 ‘‘(iii) the amount of such liability protec- 15 tion that will be provided; 16 ‘‘(C) describes all of the work locations that the 17 alien will work and includes a statement that the 18 contracting facility or organization will not add addi- 19 tional work locations without the approval of the 20 Federal agency or State agency that requested the 21 waiver; and 22 ‘‘(D) does not include a non-compete provision. 23 ‘‘(6) An alien granted a waiver under this subsection 24 whose employment relationship with a health facility or 25 VerDate Sep 11 2014 02:35 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 9 •S 665 IS health care organization terminates under paragraph 1 (1)(C)(ii) during the 3-year service period required under 2 paragraph (1) shall be considered to be maintaining lawful 3 status in an authorized period of stay during the 120-day 4 period referred to in items (aa) and (bb) of subclause (III) 5 of paragraph (1)(C)(ii) or the 45-day period referred to 6 in subclause (III)(cc) of such paragraph.’’. 7 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER 8 STATES.—Section 214(l) of such Act, as amended by this 9 section, is further amended by adding at the end the fol- 10 lowing: 11 ‘‘(7) If a recipient of a waiver under this subsection 12 terminates the recipient’s employment with a health facil- 13 ity or health care organization pursuant to paragraph 14 (1)(C)(ii), including termination of employment because of 15 circumstances described in paragraph (1)(C)(ii)(III), and 16 accepts new employment with such a facility or organiza- 17 tion in a different State, the State from which the alien 18 is departing may be accorded an additional waiver by the 19 Secretary of State for use in the fiscal year in which the 20 alien’s employment was terminated.’’. 21 (g) EXCEPTION TO 3-YEAR WORK REQUIREMENT.— 22 Section 214(l) of such Act, as amended by this section, 23 is further amended by adding at the end the following: 24 VerDate Sep 11 2014 02:35 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 10 •S 665 IS ‘‘(8) The 3-year work requirement set forth in sub- 1 paragraphs (C) and (D) of paragraph (1) shall not apply 2 if— 3 ‘‘(A)(i) the Secretary of Homeland Security de- 4 termines that extenuating circumstances, including 5 violations by the employer of the employment agree- 6 ment with the alien or of labor and employment 7 laws, exist that justify a lesser period of employment 8 at such facility or organization; and 9 ‘‘(ii) the alien demonstrates, not later than 120 10 days after the employment termination date (unless 11 the Secretary determines that extenuating cir- 12 cumstances would justify an extension), another 13 bona fide offer of employment at a health facility or 14 health care organization in a geographic area or 15 areas which are designated by the Secretary of 16 Health and Human Services as having a shortage of 17 health care professionals, for the remainder of such 18 3-year period; 19 ‘‘(B)(i) the interested State agency that re- 20 quested the waiver attests that extenuating cir- 21 cumstances, including violations by the employer of 22 the employment agreement with the alien or of labor 23 and employment laws, exist that justify a lesser pe- 24 VerDate Sep 11 2014 21:51 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 11 •S 665 IS riod of employment at such facility or organization; 1 and 2 ‘‘(ii) the alien demonstrates, not later than 120 3 days after the employment termination date (unless 4 the Secretary determines that extenuating cir- 5 cumstances would justify an extension), another 6 bona fide offer of employment at a health facility or 7 health care organization in a geographic area or 8 areas which are designated by the Secretary of 9 Health and Human Services as having a shortage of 10 health care professionals, for the remainder of such 11 3-year period; or 12 ‘‘(C) the alien— 13 ‘‘(i) elects not to pursue a determination of 14 extenuating circumstances pursuant to sub- 15 clause (A) or (B); 16 ‘‘(ii) terminates the alien’s employment re- 17 lationship with the health facility or health care 18 organization at which the alien was employed; 19 ‘‘(iii) demonstrates, not later than 45 days 20 after the employment termination date, another 21 bona fide offer of employment at a health facil- 22 ity or health care organization in a geographic 23 area or areas, in the State that requested the 24 alien’s waiver, which are designated by the Sec- 25 VerDate Sep 11 2014 21:51 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S665.IS S665 kjohnson on DSK79L0C42PROD with BILLS 12 •S 665 IS retary of Health and Human Services as having 1 a shortage of health care professionals; and 2 ‘‘(iv) agrees to be employed for the remain- 3 der of such 3-year period, and 1 additional year 4 for each termination under clause (ii).’’. 5 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 6 (a) IN GENERAL.—Section 214(l) of the Immigration 7 and Nationality Act (8 U.S.C. 1184(l)), as amended by 8 section 4, is further amended by adding [Text truncated for display. Full text available on Congress.gov.]