Conrad State 30 and Physician Access Reauthorization Act

II 116TH CONGRESS 1ST SESSION S. 948 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 28, 2019 Ms. KLOBUCHAR (for herself, Ms. COLLINS, and Ms. ROSEN) introduced the following bill; which was read twice and 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- 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 Law 103–416; 8 U.S.C. 1182 note) is amended by striking 9 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 2 •S 948 IS ‘‘September 30, 2015’’ and inserting ‘‘September 30, 1 2021’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 subsection (a) shall take effect as if enacted on September 4 30, 2018. 5 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 6 MEDICALLY UNDERSERVED COMMUNITIES. 7 Section 201(b)(1) of the Immigration and Nationality 8 Act (8 U.S.C. 1151(b)(1)) is amended by adding at the 9 end the following: 10 ‘‘(F)(i) Alien physicians who have completed 11 service requirements of a waiver requested under 12 section 203(b)(2)(B)(ii), including— 13 ‘‘(I) alien physicians who completed such 14 service before the date of the enactment of the 15 Conrad State 30 and Physician Access Act; and 16 ‘‘(II) the spouse or children of an alien 17 physician described in subclause (I). 18 ‘‘(ii) Nothing in this subparagraph may be con- 19 strued— 20 ‘‘(I) to prevent the filing of a petition with 21 the Secretary of Homeland Security for classi- 22 fication under section 204(a) or the filing of an 23 application for adjustment of status under sec- 24 tion 245 by an alien physician described in this 25 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 3 •S 948 IS subparagraph before the date by which such 1 alien physician has completed the service de- 2 scribed in section 214(l) or worked full-time as 3 a physician for an aggregate of 5 years at the 4 location identified in the section 214(l) waiver 5 or in an area or areas designated by the Sec- 6 retary of Health and Human Services as having 7 a shortage of health care professionals; or 8 ‘‘(II) to permit the Secretary of Homeland 9 Security to grant a petition or application de- 10 scribed in subclause (I) until the alien has sat- 11 isfied all of the requirements of the waiver re- 12 ceived under section 214(l).’’. 13 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 14 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY 15 REQUIREMENT.—Section 214(l)(1) of the Immigration 16 and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 17 (1) in the matter preceding subparagraph (A), 18 by striking ‘‘Attorney General’’ and inserting ‘‘Sec- 19 retary of Homeland Security’’; 20 (2) in subparagraph (A), by striking ‘‘Director 21 of the United States Information Agency’’ and in- 22 serting ‘‘Secretary of State’’; 23 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 4 •S 948 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 ‘‘(ii) the alien— 11 ‘‘(I) has accepted employment with 12 the health facility or health care organiza- 13 tion in a geographic area or areas which 14 are designated by the Secretary of Health 15 and Human Services as having a shortage 16 of health care professionals; 17 ‘‘(II) begins employment by the later 18 of the date that is— 19 ‘‘(aa) 120 days after receiving 20 such waiver; 21 ‘‘(bb) 120 days after completing 22 graduate medical education or train- 23 ing under a program approved pursu- 24 ant to section 212(j)(1); or 25 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 5 •S 948 IS ‘‘(cc) 120 days after receiving 1 nonimmigrant status or employment 2 authorization, if the alien or the 3 alien’s employer petitions for such 4 nonimmigrant status or employment 5 authorization not later than 120 days 6 after the date on which the alien com- 7 pletes his or her graduate medical 8 education or training under a pro- 9 gram approved pursuant to section 10 212(j)(1); and 11 ‘‘(III) agrees to continue to work for 12 a total of not less than 3 years in the sta- 13 tus authorized for such employment under 14 this subsection, except as provided in para- 15 graph (8).’’; and 16 (5) in subparagraph (D), in the matter pre- 17 ceding clause (i), by inserting ‘‘(except as provided 18 in paragraph (8))’’. 19 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL- 20 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER- 21 SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 22 U.S.C. 1184(l)(2)(A)) is amended to read as follows: 23 ‘‘(A) Upon the request of an interested Federal 24 agency or an interested State agency for rec- 25 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 6 •S 948 IS ommendation of a waiver under this section by a 1 physician who is maintaining valid nonimmigrant 2 status under section 101(a)(15)(J) and a favorable 3 recommendation by the Secretary of State, the Sec- 4 retary of Homeland Security may change the status 5 of such physician to any status authorized for em- 6 ployment under this Act. The numerical limitations 7 contained in subsection (g)(1)(A) shall not apply to 8 any alien whose status is changed under this sub- 9 paragraph.’’. 10 (c) VIOLATION OF AGREEMENTS.—Section 11 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 12 amended by inserting ‘‘substantial requirement of an’’ be- 13 fore ‘‘agreement entered into’’. 14 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED 15 AREAS.—Section 214(l) of such Act (8 U.S.C. 1184(l)), 16 as amended by this section, is further amended by adding 17 at the end the following: 18 ‘‘(4)(A) If an interested State agency denies the ap- 19 plication for a waiver under paragraph (1)(B) from a phy- 20 sician pursuing graduate medical education or training 21 pursuant to section 101(a)(15)(J) because the State has 22 requested the maximum number of waivers permitted for 23 that fiscal year, the physician’s nonimmigrant status shall 24 be extended for up to 6 months if the physician agrees 25 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 7 •S 948 IS to seek a waiver under this subsection (except for para- 1 graph (1)(D)(ii)) to work for an employer described in 2 paragraph (1)(C) in a State that has not yet requested 3 the maximum number of waivers. 4 ‘‘(B) Such physician shall be authorized to work only 5 for the employer referred to in subparagraph (A) from the 6 date on which a new waiver application is filed with such 7 State until the earlier of— 8 ‘‘(i) the date on which the Secretary of Home- 9 land Security denies such waiver; or 10 ‘‘(ii) the date on which the Secretary approves 11 an application for change of status under paragraph 12 (2)(A) pursuant to the approval of such waiver.’’. 13 (e) CONTRACT REQUIREMENTS.—Section 214(l) of 14 such Act, as amended by this section, is further amended 15 by adding at the end the following: 16 ‘‘(5) An alien granted a waiver under paragraph 17 (1)(C) shall enter into an employment agreement with the 18 contracting health facility or health care organization 19 that— 20 ‘‘(A) specifies the maximum number of on-call 21 hours per week (which may be a monthly average) 22 that the alien will be expected to be available and 23 the compensation the alien will receive for on-call 24 time; 25 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 8 •S 948 IS ‘‘(B) specifies— 1 ‘‘(i) whether the contracting facility or or- 2 ganization will pay the alien’s malpractice in- 3 surance premiums; 4 ‘‘(ii) whether the employer will provide 5 malpractice insurance; and 6 ‘‘(iii) the amount of such insurance that 7 will be provided; 8 ‘‘(C) describes all of the work locations that the 9 alien will work and includes a statement that the 10 contracting facility or organization will not add addi- 11 tional work locations without the approval of the 12 Federal agency or State agency that requested the 13 waiver; and 14 ‘‘(D) does not include a non-compete provision. 15 ‘‘(6) An alien granted a waiver under this subsection 16 whose employment relationship with a health facility or 17 health care organization terminates under paragraph 18 (1)(C)(ii) during the 3-year service period required under 19 paragraph (1) shall be considered to be maintaining lawful 20 status in an authorized period of stay during the 120-day 21 period referred to in items (aa) and (bb) of subclause (III) 22 of paragraph (1)(C)(ii) or the 45-day period referred to 23 in subclause (III)(cc) of such paragraph.’’. 24 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 9 •S 948 IS (f) RECAPTURING WAIVER SLOTS LOST TO OTHER 1 STATES.—Section 214(l) of such Act, as amended by this 2 section, is further amended by adding at the end the fol- 3 lowing: 4 ‘‘(7) If a recipient of a waiver under this subsection 5 terminates the recipient’s employment with a health facil- 6 ity or health care organization pursuant to paragraph 7 (1)(C)(ii), including termination of employment because of 8 circumstances described in paragraph (1)(C)(ii)(III), and 9 accepts new employment with such a facility or organiza- 10 tion in a different State, the State from which the alien 11 is departing may be accorded an additional waiver by the 12 Secretary of State for use in the fiscal year in which the 13 alien’s employment was terminated.’’. 14 (g) EXCEPTION TO 3-YEAR WORK REQUIREMENT.— 15 Section 214(l) of such Act, as amended by this section, 16 is further amended by adding at the end the following: 17 ‘‘(8) The 3-year work requirement set forth in sub- 18 paragraphs (C) and (D) of paragraph (1) shall not apply 19 if— 20 ‘‘(A)(i) the Secretary of Homeland Security de- 21 termines that extenuating circumstances, including 22 violations by the employer of the employment agree- 23 ment with the alien or of labor and employment 24 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 10 •S 948 IS laws, exist that justify a lesser period of employment 1 at such facility or organization; 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; 12 ‘‘(B)(i) the interested State agency that re- 13 quested the waiver attests that extenuating cir- 14 cumstances, including violations by the employer of 15 the employment agreement with the alien or of labor 16 and employment laws, exist that justify a lesser pe- 17 riod of employment at such facility or organization; 18 and 19 ‘‘(ii) the alien demonstrates, not later than 120 20 days after the employment termination date (unless 21 the Secretary determines that extenuating cir- 22 cumstances would justify an extension), another 23 bona fide offer of employment at a health facility or 24 health care organization in a geographic area or 25 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 11 •S 948 IS areas which are designated by the Secretary of 1 Health and Human Services as having a shortage of 2 health care professionals, for the remainder of such 3 3-year period; or 4 ‘‘(C) the alien— 5 ‘‘(i) elects not to pursue a determination of 6 extenuating circumstances pursuant to sub- 7 clause (A) or (B); 8 ‘‘(ii) terminates the alien’s employment re- 9 lationship with the health facility or health care 10 organization at which the alien was employed; 11 ‘‘(iii) demonstrates, not later than 45 days 12 after the employment termination date, another 13 bona fide offer of employment at a health facil- 14 ity or health care organization in a geographic 15 area or areas, in the State that requested the 16 alien’s waiver, which are designated by the Sec- 17 retary of Health and Human Services as having 18 a shortage of health care professionals; and 19 ‘‘(iv) agrees to be employed for the remain- 20 der of such 3-year period, and 1 additional year 21 for each termination under clause (ii).’’. 22 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 23 (a) IN GENERAL.—Section 214(l) of the Immigration 24 and Nationality Act (8 U.S.C. 1184(l)), as amended by 25 VerDate Sep 11 2014 04:01 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 pbinns on DSK79D2C42PROD with BILLS 12 •S 948 IS section 4, is further amended by adding at the end the 1 following: 2 ‘‘(8)(A)(i) All States shall be allotted a total of 35 3 waivers under paragraph (1)(B) for a fiscal year if 90 per- 4 cent of the waivers available to the States receiving at 5 least 5 waivers were used in the previous fiscal year. 6 ‘‘(ii) When an allotment occurs under clause (i), all 7 States shall be allotted an additional 5 waivers under 8 paragraph (1)(B) for each subsequent fiscal year if 90 9 percent of the waivers available to the States receiving at 10 least 5 waivers were used in the previous fiscal [Text truncated for display. Full text available on Congress.gov.]