,,ii #aacth ,,congress #ast ,session ,s4 #faf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ai1 #bjac ,ms4 ,klobuchar 7for herself1 ,ms4 ,heitkamp1 ,mr4 ,moran1 and ,ms4 ,collins7 introduced the following bill2 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 purposes4 #a4 ,short title ,this ,act may be cited as the ,conrad ,state #cj and ,physician ,access ,act4 #b4 ,conrad ,state #cj ,program ,section #bbj7;c7 of the ,immigration and ,nationality ,technical ,corrections ,act of #aiid 7,public ,law #ajc-daf2 #h ,u4,s4,c4 #aahb note7 is amended by striking and before ,september #cj1 #bjae4 #c4 ,retaining physicians who have practiced in medically underserved communities ,section #bja7;b77#a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaea7;b77#a77 is amended by adding at the end the following3 7,f7 7i7 ,alien physicians who have completed service requirements of a waiver requested under section #bjc7;b77#b77;,b77ii71 including alien physicians who completed such service before the date of the enactment of the ,conrad ,state #cj and ,physician ,access ,act and any spouses or children of such alien physicians4 7ii7 ,nothing in this subparagraph may be construed-- 7,i7 to prevent the filing of a petition with the ,secretary of ,homeland ,security for classification under section #bjd7;a7 or the filing of an application for adjustment of status under section #bde by an alien physician described in this subparagraph prior to the date by which such alien physician has completed the service described in section #bad7l7 or worked full-time as a physician for an aggregate of #e years at the location identified in the section #bad7l7 waiver or in an area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 or 7,,ii7 to permit the ,secretary of ,homeland ,security to grant such a petition or application until the alien has satisfied all the requirements of the waiver received under section #bad7l74 4 #d4 ,employment protections for physicians 7a7 ,in general ,section #bad7l77#a77;,c7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#a77;,c77 is amended by striking clauses 7i7 and 7ii7 and inserting the following3 7i7 the alien demonstrates a bona fide offer of full-time employment1 at a health care organization1 which employment has been determined by the ,secretary of ,homeland ,security to be in the public interest2 and 7ii7 the alien agrees to begin 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 by the later of the date that is #ij days after receiving such waiver1 #ij days after completing graduate medical education or training under a program approved pursuant to section #bab7;j77#a71 or #ij days after receiving nonimmigrant status or employment authorization1 and agrees to continue to work for a total of not less than #c years in any status authorized for such employment under this subsection unless-- 7,i7 the ,secretary determines that extenuating circumstances exist that justify a lesser period of employment at such facility or organization1 in which case the alien shall demonstrate another bona fide offer of employment at a health facility or health care organization1 for the remainder of such #c-year period2 7,,ii7 the interested ,state agency that requested the waiver attests that extenuating circumstances exist that justify a lesser period of employment at such facility or organization in which case the alien shall demonstrate another bona fide offer of employment at a health facility or health care organization so designated by the ,secretary of ,health and ,human ,services1 for the remainder of such #c-year period2 or 7,,iii7 if the alien elects not to pursue a determination of extenuating circumstances pursuant to subclause 7,i7 or 7,,ii71 the alien terminates the alien's employment relationship with such facility or organization1 in which case the alien shall be employed for the remainder of such #c-year period1 and #a additional year for each termination1 at another 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 professionals2 and 4 7b7 ,contract requirements ,section #bad7l7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77 is amended by adding at the end the following3 7#d7 ,an alien granted a waiver under paragraph 7#a77;,c7 shall enter into an employment agreement with the contracting health facility or health care organization that-- 7,a7 specifies the maximum number of on-call hours per week 7which may be a monthly average7 that the alien will be expected to be available and the compensation the alien will receive for on-call time2 7,b7 specifies whether the contracting facility or organization will pay for the alien's malpractice insurance premiums1 including whether the employer will provide malpractice insurance and1 if so1 the amount of such insurance that will be provided2 7,c7 describes all of the work locations that the alien will work and 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 waiver2 and 7,d7 does not include a non-compete provision4 7#e7 ,an alien granted a waiver under paragraph 7#a77;,c7 whose employment relationship with a health facility or health care organization terminates during the #c-year service period required by such paragraph-- 7,a7 shall have a period of #abj days beginning on the date of such termination of employment to submit to the ,secretary of ,homeland ,security applications or petitions to commence employment with another contracting 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 professionals2 and 7,b7 shall be considered to be maintaining lawful status in an authorized stay during the #abj-;day period referred to in subsection 7,a74 4 #e4 ,allotment of ,conrad #cj waivers 7a7 ,in general ,section #bad7l7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l771 as amended by section #d7;b71 is further amended by adding at the end the following3 7#f7 7,a7 7i7 ,all ,states shall be allotted a total of #ce waivers under paragraph 7#a77;,b7 for a fiscal year if #ij percent of the waivers available to the ,states receiving at least #e waivers were used in the previous fiscal year4 7ii7 ,when an allocation has occurred under clause 7i71 all ,states shall be allotted an additional #e waivers under paragraph 7#a77;,b7 for each subsequent fiscal year if #ij percent of the waivers available to the ,states receiving at least #e waivers were used in the previous fiscal year4 ,if the ,states are allotted #de or more waivers for a fiscal year1 the ,states will only receive an additional increase of #e waivers the following fiscal year if #ie percent of the waivers available to the ,states receiving at least #a waiver were used in the previous fiscal year4 7,b7 ,any increase in allotments under subparagraph 7,a7 shall be maintained indefinitely1 unless in a fiscal year1 the total number of such waivers granted is #e percent lower than in the last year in which there was an increase in the number of waivers allotted pursuant to this paragraph1 in which case-- 7i7 the number of waivers allotted shall be decreased by #e for all ,states beginning in the next fiscal year2 and 7ii7 each additional #e percent decrease in such waivers granted from the last year in which there was an increase in the allotment1 shall result in an additional decrease of #e waivers allotted for all ,states1 provided that the number of waivers allotted for all ,states shall not drop below #cj4 4 7b7 ,academic medical centers ,section #bad7l77#a77;,d7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#a77;,d77 is amended-- 7#a7 in clause 7ii71 by striking and at the end2 7#b7 in clause 7iii71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7iv7 in the case of a request by an interested ,state agency-- 7,i7 the head of such agency determines that the alien is to practice medicine in1 or be on the faculty of a residency program at1 an academic medical center 7as that term is defined in section #daa4cee7;e77#b7 of title #db1 ,code of ,federal ,regulations1 or similar successor regulation71 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 professionals2 and 7,,ii7 the head of such agency determines that-- 7aa7 the alien physician's work is in the public interest2 and 7bb7 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 7within the limitation in subparagraph 7,b7 and subject to paragraph 7#f77 in accordance with the conditions of this clause to exceed #c4 4 #f4 ,amendments to the procedures1 definitions1 and other provisions related to physician immigration 7a7 ,dual intent for physicians seeking graduate medical training ,section #bad7;b7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7;b77 is amended by striking 7other than a nonimmigrant described in subparagraph 7,l7 or 7,v7 of section #aja7;a77#ae71 and other than a nonimmigrant described in any provision of section #aja7;a77#ae77;,h77i7 except subclause 7b#a7 of such section7 and inserting 7other than a nonimmigrant described in subparagraph 7,l7 or 7,v7 of section #aja7;a77#ae71 a nonimmigrant described in any provision of section #aja7;a77#ae77;,h77i71 except subclause 7b#a7 of such section1 and an alien coming to the ,united ,states to receive graduate medical education or training as described in section #bab7;j7 or to take examinations required to receive graduate medical education or training as described in section #bab7;j774 7b7 ,allowable visa status for physicians fulfilling waiver requirements in medically underserved areas ,section #bad7l77#b77;,a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#b77;,a77 is amended by striking an alien described in section #aja7;a77#ae77;,h77i77b74 and inserting any status authorized for employment under this ,act44 7c7 ,physician national interest waiver clarifications 7#a7 ,practice and geographic area ,section #bjc7;b77#b77;,b77ii77,i7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaec7;b77#b77;,b77ii77,i77 is amended by striking items 7aa7 and 7bb7 and inserting the following3 7aa7 the alien physician agrees to work on a full-time basis practicing primary care1 specialty medicine1 or a combination thereof1 in an area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 or at a health care facility under the jurisdiction of the ,secretary of ,veterans ,affairs2 or 7bb7 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 7without regard to whether such facility or facilities are located within such an area7 and a ,federal agency1 or a local1 county1 regional1 or ,state department of public health determines the alien physician's work was or will be in the public interest4 4 7#b7 ,five-year service requirement ,section #bjc7;b77#b77;,b77ii77,,ii7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaec7;,b77ii77,,ii77 is amended-- 7,a7 by inserting 7aa7 after 7,,ii72 and 7,b7 by adding at the end the following3 7bb7 ,the #e-year service requirement of item 7aa7 shall be counted from the date the alien physician begins work in the shortage area in any legal status and not the date an immigrant visa petition is filed or approved4 ,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 education4 7cc7 ,an alien physician shall not be required to submit an employment contract with a term exceeding the balance of the #e-year commitment yet to be served1 nor an employment contract dated within a minimum time period prior to filing of a visa petition pursuant to this subsection4 7dd7 ,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 petition4 4 7d7 ,technical clarification regarding advanced degree for physicians ,section #bjc7;b77#b77;,a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaec7;b77#b77;,a77 is amended by adding at the end ,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 equivalent44 7e7 ,short-,term work authorization for physicians completing their residencies ,a physician completing graduate medical education or training as described in section #bab7;j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahb7;j77 as a nonimmigrant described section #aja7;a77#ae77;,h77i7 of such ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77 shall have such nonimmigrant status automatically extended until ,october #a of the fiscal year for which a petition for a continuation of such nonimmigrant status has been submitted in a timely manner and where the employment start date for the beneficiary of such petition is ,october #a of that fiscal year4 ,such physician shall be authorized to be employed incident to status during the period between the filing of such petition and ,october #a of such fiscal year4 ,however1 the physician's status and employment authorization shall terminate #cj days from the date such petition is rejected1 denied or revoked4 ,a physician's status and employment authorization will automatically extend to ,october #a of the next fiscal year if all visas as described in such section #aja7;a77#ae77;,h77i7 authorized to be issued for the fiscal year have been issued4 7f7 ,applicability of section #bab7;e7 to spouses and children of ,j-#a exchange visitors ,a spouse or child of an exchange visitor described in section #aja7;a77#ae77;,j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,j77 shall not be subject to the requirements of section #bab7;e7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahb7;e774