119-s709

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 709 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 709

To provide incentives to physicians to practice in rural and medically 
 underserved communities, and for other purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 February 25, 2025

 Ms. Klobuchar (for herself, Ms. Collins, Ms. Rosen, and Mr. Tillis) 
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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Conrad State 30 and Physician Access 
Reauthorization Act''.

SEC. 2. CONRAD STATE 30 PROGRAM.

    (a) Extension.--

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 ``September 30, 2015'' and inserting ``on 
the date that is 3 years after the date of the enactment of the Conrad 
State 30 and Physician Access Reauthorization Act''.

    (b) Effective Date.--The amendment made by subsection

    (a) shall 
take effect as if enacted on September 30, 2018.

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 completed service 
 requirements of a waiver requested under 

section 203

    (b)

    (2)
        (B)
            (ii) , including--
 ``
            (I) alien physicians who completed such service 
 before the date of the enactment of the Conrad State 30 
 and Physician Access Act; and
 ``
            (II) the spouse or children of an alien physician 
 described in subclause
            (I) .
 ``
            (ii) Nothing in this subparagraph may be construed--
 ``
            (I) to prevent the filing of a petition with the 
 Secretary of Homeland Security 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 this subparagraph before 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 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 a petition or application described in 
 subclause
            (I) until the alien has satisfied all of the 
 requirements of the waiver received under 

section 214
            (l) .''.

SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS.

    (a) Exceptions to 2-Year Foreign Residency Requirement.--

Section 214
            (l) (1) of the Immigration and Nationality Act (8 U.S.C. 1184
            (l) (1) ) 
is amended--

    (1) in the matter preceding subparagraph
        (A) , by striking 
 ``Attorney General'' and inserting ``Secretary of Homeland 
 Security'';

    (2) in subparagraph
        (A) , by striking ``Director of the 
 United States Information Agency'' and inserting ``Secretary of 
 State'';

    (3) in subparagraph
        (B) , by inserting ``, except as 
 provided in paragraphs

    (7) and

    (8) '' before the semicolon at 
 the end;

    (4) in subparagraph
            (C) , 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 facility or health 
 care organization, which employment has been determined 
 by the Secretary of Homeland Security to be in the 
 public interest; and
 ``
            (ii) the alien--
 ``
            (I) has accepted employment with the 
 health facility or health care organization in 
 a geographic area or areas which are designated 
 by the Secretary of Health and Human Services 
 as having a shortage of health care 
 professionals;
 ``
            (II) begins employment by the later of 
 the date that is--
 ``

    (aa) 120 days after receiving 
 such waiver;
 ``

    (bb) 120 days after completing 
 graduate medical education or training 
 under a program approved pursuant to 
 

section 212

    (j)

    (1) ; or
 ``
            (cc) 120 days after receiving 
 nonimmigrant status or employment 
 authorization, if the alien or the 
 alien's employer petitions for such 
 nonimmigrant status or employment 
 authorization not later than 120 days 
 after the date on which the alien 
 completes his or her graduate medical 
 education or training under a program 
 approved pursuant to 

section 212

    (j)

    (1) ; 
 and
 ``
            (III) agrees to continue to work for a 
 total of not less than 3 years in the status 
 authorized for such employment under this 
 subsection, except as provided in paragraph

    (8) .''; and

    (5) in subparagraph
            (D) , in the matter preceding clause
            (i) , by inserting ``(except as provided in paragraph

    (8) )'' 
 after ``3 years''.

    (b) Allowable Visa Status for Physicians Fulfilling Waiver 
Requirements in Medically Underserved Areas.--

Section 214
            (l) (2)
        (A) of 
such Act (8 U.S.C. 1184
            (l) (2)
        (A) ) is amended to read as follows:
 ``
        (A) Upon the request of an interested Federal agency or an 
interested State agency for recommendation of a waiver under this 
section by a physician who is maintaining valid nonimmigrant status 
under 

section 101

    (a)

    (15)
        (J) and a favorable recommendation by the 
Secretary of State, the Secretary of Homeland Security may change the 
status of such physician to any status authorized for employment under 
this Act. The numerical limitations contained in subsection

    (g)

    (1)
        (A) shall not apply to any alien whose status is changed under this 
subparagraph.''.
            (c) Violation of Agreements.--

Section 214
            (l) (3)
        (A) of such Act (8 
U.S.C. 1184
            (l) (3)
        (A) ) is amended by inserting ``substantial requirement 
of an'' before ``agreement entered into''.
            (d) Physician Employment in Underserved Areas.--

Section 214
            (l) of 
such Act, as amended by this section, is further amended by adding at 
the end the following:
 ``

    (4)
        (A) If an interested State agency denies an application for a 
waiver under paragraph

    (1)
        (B) from a physician pursuing graduate 
medical education or training pursuant to 

section 101

    (a)

    (15)
        (J) because 
the State has requested the maximum number of waivers permitted for 
that fiscal year, the physician's nonimmigrant status shall be extended 
for up to 6 months if the physician agrees to seek a waiver under this 
subsection (except for paragraph

    (1)
            (D) 
            (ii) ) to work for an employer 
described in paragraph

    (1)
            (C) in a State that has not yet requested the 
maximum number of waivers.
 ``
        (B) Such physician shall be authorized to work only for the 
employer referred to in subparagraph
        (A) during the period beginning on 
the date on which a new waiver application is filed with such State and 
ending on the earlier of--
 ``
            (i) the date on which the Secretary of Homeland Security 
 denies such waiver; or
 ``
            (ii) the date on which the Secretary approves an 
 application for change of status under paragraph

    (2)
        (A) pursuant to the approval of such waiver.''.

    (e) Contract Requirements.--

Section 214
            (l) of such Act, as amended 
by this section, is further amended by adding at the end the following:
 ``

    (5) An alien granted a waiver under paragraph

    (1)
            (C) shall enter 
into an employment agreement 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 
 receive for on-call time;
 ``
        (B) specifies--
 ``
            (i) whether the contracting facility or 
 organization--
 ``
            (I) has secured medical malpractice 
 liability protection for the alien under 
 

section 224

    (g) of the Public Health Service Act 
 (42 U.S.C. 233

    (g) ); or
 ``
            (II) will pay the alien's malpractice 
 insurance premiums;
 ``
            (ii) whether the employer will provide 
 malpractice insurance for the alien; and
 ``
            (iii) the amount of such liability protection 
 that will be provided;
 ``
            (C) describes all of the work locations that the alien 
 will work and includes a statement that the contracting 
 facility or organization will not add additional work locations 
 without the approval of the Federal agency or State agency that 
 requested the waiver; and
 ``
            (D) does not include a non-compete provision.
 ``

    (6) An alien granted a waiver under this subsection whose 
employment relationship with a health facility or health care 
organization terminates under paragraph

    (1)
            (C) 
            (ii) during the 3-year 
service period required under paragraph

    (1) shall be considered to be 
maintaining lawful status in an authorized period of stay during the 
120-day period referred to in items

    (aa) and

    (bb) of subclause
            (III) of 
paragraph

    (1)
            (C) 
            (ii) or the 45-day period referred to in subclause
            (III) 
            (cc) of such paragraph.''.

    (f) Recapturing Waiver Slots Lost to Other States.--

Section 214
            (l) of such Act, as amended by this section, is further amended by adding 
at the end the following:
 ``

    (7) If a recipient of a waiver under this subsection terminates 
the recipient's employment with a health facility or health care 
organization pursuant to paragraph

    (1)
            (C) 
            (ii) , including termination of 
employment because of circumstances described in paragraph

    (1)
            (C) 
            (ii) 
            (III) , and accepts new employment with such a facility or 
organization in a different State, the State from which the alien is 
departing may be accorded an additional waiver by the Secretary of 
State for use in the fiscal year in which the alien's employment was 
terminated.''.

    (g) Exception to 3-Year Work Requirement.--

Section 214
            (l) of such 
Act, as amended by this section, is further amended by adding at the 
end the following:
 ``

    (8) The 3-year work requirement set forth in subparagraphs
            (C) and
            (D) of paragraph

    (1) shall not apply if--
 ``
        (A)
            (i) the Secretary of Homeland Security determines that 
 extenuating circumstances, including violations by the employer 
 of the employment agreement with the alien or of labor and 
 employment laws, exist that justify a lesser period of 
 employment at such facility or organization; and
 ``
            (ii) the alien demonstrates, not later than 120 days 
 after the employment termination date (unless the Secretary 
 determines that extenuating circumstances would justify an 
 extension), another bona fide offer of employment at a health 
 facility or health care organization in a geographic area or 
 areas which are designated by the Secretary of Health and Human 
 Services as having a shortage of health care professionals, for 
 the remainder of such 3-year period;
 ``
        (B)
            (i) the interested State agency that requested the 
 waiver attests that extenuating circumstances, including 
 violations by the employer of the employment agreement with the 
 alien or of labor and employment laws, exist that justify a 
 lesser period of employment at such facility or organization; 
 and
 ``
            (ii) the alien demonstrates, not later than 120 days 
 after the employment termination date (unless the Secretary 
 determines that extenuating circumstances would justify an 
 extension), another bona fide offer of employment at a health 
 facility or health care organization in a geographic area or 
 areas which are designated by the Secretary of Health and Human 
 Services as having a shortage of health care professionals, for 
 the remainder of such 3-year period; or
 ``
            (C) the alien--
 ``
            (i) elects not to pursue a determination of 
 extenuating circumstances pursuant to subclause
        (A) or
        (B) ;
 ``
            (ii) terminates the alien's employment 
 relationship with the health facility or health care 
 organization at which the alien was employed;
 ``
            (iii) demonstrates, not later than 45 days after 
 the employment termination date, another bona fide 
 offer of employment at a health facility or health care 
 organization in a geographic area or areas, in the 
 State that requested the alien's waiver, which are 
 designated by the Secretary of Health and Human 
 Services as having a shortage of health care 
 professionals; and
 ``
            (iv) agrees to be employed for the remainder of 
 such 3-year period, and 1 additional year for each 
 termination under clause
            (ii) .''.

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, is further amended by 
adding at the end the following:
 ``

    (9)
        (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 
previous fiscal year.
 ``
            (ii) When an allotment occurs 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 
following fiscal year if 95 percent of the waivers available to the 
States receiving at least 1 waiver were used in the previous fiscal 
year.
 ``
        (B) Any increase in allotments under subparagraph
        (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 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 beginning in the next fiscal year; and
 ``
            (ii) each additional 5 percent decrease 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 
 waivers allotted for all States shall not drop below 30.''.

    (b) Academic Medical Centers.--

Section 214
            (l) (1)
            (D) of such Act (8 
U.S.C. 1184
            (l) (1)
            (D) ), as amended by 

section 4

    (a)

    (5) , is further 
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''; and

    (3) by adding at the end the following:
 ``
            (iv) in the case of a request by an interested 
 State agency--
 ``
            (I) the head of such agency determines 
 that the alien is to practice medicine in, or 
 be on the faculty of a residency program at, an 
 academic medical center (as that term is 
 defined in 

section 411.355

    (e)

    (2) of title 42, 
 Code of Federal Regulations, or similar 
 successor regulation), without regard to 
 whether such facility is located 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 determines 
 that--
 ``

    (aa) the alien physician's work 
 is in the public interest; and
 ``

    (bb) the grant of such waiver 
 would not cause the number of the 
 waivers granted on behalf of aliens for 
 such State for a fiscal year (within 
 the limitation in subparagraph
        (B) and 
 subject to paragraph

    (6) ) in accordance 
 with the conditions of this clause to 
 exceed 3.''.

SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, AND OTHER PROVISIONS 
 RELATED TO PHYSICIAN IMMIGRATION.

    (a) Dual Intent for Physicians Seeking Graduate Medical Training.--

Section 214

    (b) of the Immigration and Nationality Act (8 U.S.C. 
1184

    (b) ) is amended 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 nonimmigrant 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 graduate medical education or 
training described in 

section 212

    (j) or to take examinations required 
to receive graduate medical education or training described in 

section 212

    (j) )''.

    (b) Physician National Interest Waiver Clarifications.--

    (1) Practice and geographic area.--

Section 203

    (b)

    (2)
        (B)
            (ii) 
            (I) of the Immigration and Nationality Act (8 
 U.S.C. 1153

    (b)

    (2)
        (B)
            (ii) 
            (I) ) is amended by striking items

    (aa) and

    (bb) and inserting the following:
 ``

    (aa) the alien physician agrees to work 
 on a full-time basis practicing primary care, 
 specialty medicine, or a combination 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 designated by the 
 Secretary of 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 department of public health determines 
 the alien physician's work was or will be in 
 the public interest.''.

    (2) Five-year service requirement.--

Section 203

    (b)

    (2)
        (B)
            (ii) of the Immigration and Nationality Act (8 
 U.S.C. 1153
        (B)
            (ii) ) is amended--
        (A) by moving subclauses
            (II) ,
            (III) , and
            (IV) 4 
 ems to the left; and
        (B) in subclause
            (II) --
            (i) by inserting ``

    (aa) '' after ``
            (II) ''; 
 and
            (ii) by adding at the end the following:
 ``

    (bb) The 5-year service requirement under 
 item

    (aa) shall begin on the date on which the 
 alien physician begins work in the shortage 
 area in any legal status and not on the date on 
 which 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.
 ``
            (cc) An alien physician shall not be 
 required to submit an employment contract with 
 a term exceeding the balance of the 5-year 
 commitment yet to be served or an employment 
 contract dated within a minimum time period 
 before filing a visa petition under this 
 subsection.
 ``
            (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.''.
            (c) Technical Clarification Regarding Advanced 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 the 
following: ``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.''.
            (d) Short-Term Work Authorization for Physicians Completing Their 
Residencies.--

    (1) In general.--A physician completing graduate medical 
 education or training described in 

section 212

    (j) of the 
 Immigration and Nationality 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. 1101

    (a)

    (15)
        (H)
            (i) )--
        (A) shall have such nonimmigrant status 
 automatically extended until October 1 of the fiscal 
 year for which a petition for a continuation of such 
 nonimmigrant status has been submitted in a timely 
 manner and the employment start date for the 
 beneficiary of such petition is October 1 of that 
 fiscal year; and
        (B) 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.

    (2) Termination.--The physician's status and employment 
 authorization shall terminate on the date that is 30 days after 
 the date on which a petition described in paragraph

    (1)
        (A) is 
 rejected, denied or revoked.

    (3) Automatic extension.--A physician's status and 
 employment authorization will automatically extend to October 1 
 of the next fiscal year if all of the visas described in 
 

section 101

    (a)

    (15)
        (H)
            (i) of such Act that were authorized to be 
 issued for the fiscal year have been issued.

    (e) 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 requirements under 

section 212

    (e) of such Act (8 U.S.C. 1182

    (e) ).

SEC. 7. ANNUAL CONRAD STATE 30 J-1 VISA WAIVER PROGRAM STATISTICAL 
 REPORT.

 The Director of U.S. Citizenship and Immigration Services shall 
submit an annual report to Congress and to the Department of Health and 
Human Services that identifies the number of aliens admitted during the 
most recently concluded fiscal year as a result of the Conrad State 30 
J-1 Visa Waiver Program established under sections 212

    (e) and 214
            (l) of 
the Immigration and Nationality Act (8 U.S.C. 1182

    (e) and 1184
            (l) ), 
disaggregated by State.
 <all>