,,ii  #aac? ,,congress  #a/ ,session    
,s4 #faf  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #ai1 #bjac ,ms4   
,klobu*> 7= h]self1 ,ms4 ,heitkamp1 ,mr4
 ,moran1 & ,ms4 ,coll9s7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ! ,judici>y  ,a      
,,bill  ,to provide inc5tives to        
physicians to practice 9 rural &        
m$ically und]s]v$ communities & = o!r   
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,conrad ,/ate #cj &        
,physician ,access ,act4  #b4 ,conrad   
,/ate #cj ,program ,section #bbj7;c7 ( !
 ,immigration & ,nationality ,te*nical  
,corrections ,act ( #aiid 7,public ,law 
#ajc-daf2 #h ,u4,s4,c4 #aahb note7 is   
am5d$ by /rik+ & be=e ,septemb] #cj1    
#bjae4  #c4 ,reta9+ physicians :o h     
practic$ 9 m$ically und]s]v$ communities
 ,section #bja7;b77#a7 ( ! ,immigration 
& ,nationality ,act 7#h ,u4,s4,c4       
#aaea7;b77#a77 is am5d$ by add+ at ! end
 ! foll[+3  7,f7 7i7 ,ali5 physicians :o
 h complet$ s]vice requirem5ts ( a waiv]

 reque/$ "u section                     
#bjc7;b77#b77;,b77ii71 includ+ ali5     
physicians :o complet$ su* s]vice be=e !
 date ( ! enactm5t ( ! ,conrad ,/ate #cj
 & ,physician ,access ,act & any sp\ses 
or *ildr5 ( su* ali5 physicians4  7ii7  
,no?+ 9 ?is subp>agraph may be con/ru$--
  7,i7 to prev5t ! fil+ ( a petition ) !
 ,secret>y ( ,homel& ,security =        
classification "u section #bjd7;a7 or ! 
fil+ ( an application = adju/m5t ( /atus
 "u section #bde by an ali5 physician   
describ$ 9 ?is subp>agraph prior to !   
date by :i* su* ali5 physician has      
complet$ ! s]vice describ$ 9 section    
#bad7l7 or work$ full-"t z a physician =
 an aggregate ( #e ye>s at ! location   
id5tifi$ 9 ! section #bad7l7 waiv] or 9 
an area or areas designat$ by !         
,secret>y ( ,heal? & ,human ,s]vices z  
hav+ a %ortage ( heal? c>e pr(essionals2
 or  7,,ii7 to p]mit ! ,secret>y (      
,homel& ,security to grant su* a        
petition or application until ! ali5 has
 satisfi$ all ! requirem5ts ( ! waiv]   

receiv$ "u section #bad7l74  4  #d4     
,employm5t protections = physicians  7a7
 ,9 g5]al ,section #bad7l77#a77;,c7 ( ! 
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aahd7l77#a77;,c77 is am5d$ by
 /rik+ clauses 7i7 & 7ii7 & ins]t+ !    
foll[+3  7i7 ! ali5 demon/rates a bona  
fide (f] ( full-"t employm5t1 at a heal?
 c>e organization1 :i* employm5t has be5
 det]m9$ by ! ,secret>y ( ,homel&       
,security to be 9 ! public int]e/2 &    
7ii7 ! ali5 agrees to beg9 employm5t ) !
 heal? facility or heal? c>e            
organization 9 a geographic area or     
areas :i* are designat$ by ! ,secret>y (
 ,heal? & ,human ,s]vices z hav+ a      
%ortage ( heal? c>e pr(essionals by !   
lat] ( ! date t is #ij days aft] receiv+
 su* waiv]1 #ij days aft] complet+      
graduate m$ical education or tra9+ "u a 
program approv$ pursuant to section     
#bab7;j77#a71 or #ij days aft] receiv+  
nonimmigrant /atus or employm5t         
au?orization1 & agrees to cont9ue to "w 
= a total ( n less ?an #c ye>s 9 any    

/atus au?oriz$ = su* employm5t "u ?is   
subsection unless--  7,i7 ! ,secret>y   
det]m9es t ext5uat+ circum/ances exi/ t 
ju/ify a less] p]iod ( employm5t at su* 
facility or organization1 9 :i* case !  
ali5 %all demon/rate ano!r bona fide (f]
 ( employm5t at a heal? facility or     
heal? c>e organization1 = ! rema9d] (   
su* #c-ye> p]iod2  7,,ii7 ! int]e/$     
,/ate ag5cy t reque/$ ! waiv] atte/s t  
ext5uat+ circum/ances exi/ t ju/ify a   
less] p]iod ( employm5t at su* facility 
or organization 9 :i* case ! ali5 %all  
demon/rate ano!r bona fide (f] (        
employm5t at a heal? facility or heal?  
c>e organization s designat$ by !       
,secret>y ( ,heal? & ,human ,s]vices1 = 
! rema9d] ( su* #c-ye> p]iod2 or        
7,,iii7 if ! ali5 elects n to pursue a  
det]m9ation ( ext5uat+ circum/ances     
pursuant to subclause 7,i7 or 7,,ii71 ! 
ali5 t]m9ates ! ali5's employm5t        
relation%ip ) su* facility or           
organization1 9 :i* case ! ali5 %all be 
employ$ = ! rema9d] ( su* #c-ye> p]iod1 

& #a additional ye> = ea* t]m9ation1 at 
ano!r heal? facility or heal? c>e       
organization 9 a geographic area or     
areas :i* are designat$ by ! ,secret>y (
 ,heal? & ,human ,s]vices z hav+ a      
%ortage ( heal? c>e pr(essionals2 &  4  
7b7 ,contract requirem5ts ,section      
#bad7l7 ( ! ,immigration & ,nationality 
,act 7#h ,u4,s4,c4 #aahd7l77 is am5d$ by
 add+ at ! end ! foll[+3  7#d7 ,an ali5 
grant$ a waiv] "u p>agraph 7#a77;,c7    
%all ent] into an employm5t agreem5t ) !
 contract+ heal? facility or heal? c>e  
organization t--  7,a7 specifies !      
maximum numb] ( on-call h\rs p] week    
7:i* may be a mon?ly av]age7 t ! ali5 w 
be expect$ to be available & !          
comp5sation ! ali5 w receive = on-call  
"t2  7,b7 specifies :e!r ! contract+    
facility or organization w pay = !      
ali5's malpractice insurance premiums1  
includ+ :e!r ! employ] w provide        
malpractice insurance &1 if s1 ! am\nt (
 su* insurance t w be provid$2  7,c7    
describes all ( ! "w locations t ! ali5 

w "w & a /atem5t t ! contract+ facility 
or organization w n add additional "w   
locations )\t ! approval ( ! ,f$]al     
ag5cy or ,/ate ag5cy t reque/$ ! waiv]2 
&  7,d7 does n include a non-compete    
provision4  7#e7 ,an ali5 grant$ a waiv]
 "u p>agraph 7#a77;,c7 ^: employm5t     
relation%ip ) a heal? facility or heal? 
c>e organization t]m9ates dur+ ! #c-ye> 
s]vice p]iod requir$ by su* p>agraph--  
7,a7 %all h a p]iod ( #abj days beg9n+  
on ! date ( su* t]m9ation ( employm5t to
 submit to ! ,secret>y ( ,homel&        
,security applications or petitions to  
comm5ce employm5t ) ano!r contract+     
heal? facility or heal? c>e organization
 9 a geographic area or areas :i* are   
designat$ by ! ,secret>y ( ,heal? &     
,human ,s]vices z hav+ a %ortage ( heal?
 c>e pr(essionals2 &  7,b7 %all be      
consid]$ to be ma9ta9+ lawful /atus 9 an
 au?oriz$ /ay dur+ ! #abj-;day p]iod    
ref]r$ to 9 subsection 7,a74  4  #e4    
,allotm5t ( ,conrad #cj waiv]s  7a7 ,9  
g5]al ,section #bad7l7 ( ! ,immigration 

& ,nationality ,act 7#h ,u4,s4,c4       
#aahd7l771 z am5d$ by section #d7;b71 is
 fur!r am5d$ by add+ at ! end ! foll[+3 
7#f7 7,a7 7i7 ,all ,/ates %all be       
allott$ a total ( #ce waiv]s "u p>agraph
 7#a77;,b7 = a fiscal ye> if #ij p]c5t (
 ! waiv]s available to ! ,/ates receiv+ 
at lea/ #e waiv]s 7 us$ 9 ! previ\s     
fiscal ye>4  7ii7 ,:5 an allocation has 
occurr$ "u clause 7i71 all ,/ates %all  
be allott$ an additional #e waiv]s "u   
p>agraph 7#a77;,b7 = ea* subsequ5t      
fiscal ye> if #ij p]c5t ( ! waiv]s      
available to ! ,/ates receiv+ at lea/ #e
 waiv]s 7 us$ 9 ! previ\s fiscal ye>4   
,if ! ,/ates are allott$ #de or m waiv]s
 = a fiscal ye>1 ! ,/ates w only receive
 an additional increase ( #e waiv]s !   
foll[+ fiscal ye> if #ie p]c5t ( !      
waiv]s available to ! ,/ates receiv+ at 
lea/ #a waiv] 7 us$ 9 ! previ\s fiscal  
ye>4  7,b7 ,any increase 9 allotm5ts "u 
subp>agraph 7,a7 %all be ma9ta9$        
indef9itely1 unless 9 a fiscal ye>1 !   
total numb] ( su* waiv]s grant$ is #e   

p]c5t l[] ?an 9 ! la/ ye> 9 :i* !re 0 an
 increase 9 ! numb] ( waiv]s allott$    
pursuant to ?is p>agraph1 9 :i* case--  
7i7 ! numb] ( waiv]s allott$ %all be    
decreas$ by #e = all ,/ates beg9n+ 9 !  
next fiscal ye>2 &  7ii7 ea* additional 
#e p]c5t decrease 9 su* waiv]s grant$ f 
! la/ ye> 9 :i* !re 0 an increase 9 !   
allotm5t1 %all result 9 an additional   
decrease ( #e waiv]s allott$ = all      
,/ates1 provid$ t ! numb] ( waiv]s      
allott$ = all ,/ates %all n drop bel[   
#cj4  4  7b7 ,academic m$ical c5t]s     
,section #bad7l77#a77;,d7 ( !           
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aahd7l77#a77;,d77 is am5d$-- 
7#a7 9 clause 7ii71 by /rik+ & at ! end2
  7#b7 9 clause 7iii71 by /rik+ ! p]iod 
at ! end & ins]t+ 2 &2 &  7#c7 by add+  
at ! end ! foll[+3  7iv7 9 ! case ( a   
reque/ by an int]e/$ ,/ate ag5cy--  7,i7
 ! head ( su* ag5cy det]m9es t ! ali5 is
 to practice m$ic9e 91 or be on !       
faculty ( a resid5cy program at1 an     
academic m$ical c5t] 7z t t]m is def9$ 9

 section #daa4cee7;e77#b7 ( title #db1  
,code ( ,f$]al ,regulations1 or simil>  
successor regulation71 )\t reg>d to :e!r
 su* facility is locat$ )9 an area      
designat$ by ! ,secret>y ( ,heal? &     
,human ,s]vices z hav+ a %ortage ( heal?
 c>e pr(essionals2 &  7,,ii7 ! head (   
su* ag5cy det]m9es t--  7aa7 ! ali5     
physician's "w is 9 ! public int]e/2 &  
7bb7 ! grant ( su* waiv] w\ld n cause ! 
numb] ( ! waiv]s grant$ on behalf (     
ali5s = su* ,/ate = a fiscal ye> 7)9 !  
limitation 9 subp>agraph 7,b7 & subject 
to p>agraph 7#f77 9 accordance ) !      
conditions ( ?is clause to exce$ #c4  4 
#f4 ,am5dm5ts to ! proc$ures1           
def9itions1 & o!r provisions relat$ to  
physician immigration  7a7 ,dual int5t =
 physicians seek+ graduate m$ical tra9+ 
,section #bad7;b7 ( ! ,immigration &    
,nationality ,act 7#h ,u4,s4,c4         
#aahd7;b77 is am5d$ by /rik+ 7o!r ?an a 
nonimmigrant describ$ 9 subp>agraph 7,l7
 or 7,v7 ( section #aja7;a77#ae71 & o!r 
?an a nonimmigrant describ$ 9 any       

provision ( section                     
#aja7;a77#ae77;,h77i7 except subclause  
7b#a7 ( su* section7 & ins]t+ 7o!r ?an a
 nonimmigrant describ$ 9 subp>agraph    
7,l7 or 7,v7 ( section #aja7;a77#ae71 a 
nonimmigrant describ$ 9 any provision ( 
section #aja7;a77#ae77;,h77i71 except   
subclause 7b#a7 ( su* section1 & an ali5
 com+ to ! ,unit$ ,/ates to receive     
graduate m$ical education or tra9+ z    
describ$ 9 section #bab7;j7 or to take  
exam9ations requir$ to receive graduate 
m$ical education or tra9+ z describ$ 9  
section #bab7;j774  7b7 ,all[able visa  
/atus = physicians fulfill+ waiv]       
requirem5ts 9 m$ically und]s]v$ areas   
,section #bad7l77#b77;,a7 ( !           
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aahd7l77#b77;,a77 is am5d$ by
 /rik+ an ali5 describ$ 9 section       
#aja7;a77#ae77;,h77i77b74 & ins]t+ any  
/atus au?oriz$ = employm5t "u ?is ,act44
  7c7 ,physician national int]e/ waiv]  
cl>ifications  7#a7 ,practice &         
geographic area ,section                

#bjc7;b77#b77;,b77ii77,i7 ( !           
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aaec7;b77#b77;,b77ii77,i77 is
 am5d$ by /rik+ items 7aa7 & 7bb7 &     
ins]t+ ! foll[+3  7aa7 ! ali5 physician 
agrees to "w on a full-"t basis practic+
 prim>y c>e1 specialty m$ic9e1 or a     
comb9ation !re(1 9 an area or areas     
designat$ by ! ,secret>y ( ,heal? &     
,human ,s]vices z hav+ a %ortage ( heal?
 c>e pr(essionals1 or at a heal? c>e    
facility "u ! jurisdiction ( ! ,secret>y
 ( ,vet]ans ,affairs2 or  7bb7 ! ali5   
physician is pursu+ su* waiv] bas$ ^u   
s]vice at a facility or facilities t    
s]ve pati5ts :o reside 9 a geographic   
area or areas designat$ by ! ,secret>y (
 ,heal? & ,human ,s]vices z hav+ a      
%ortage ( heal? c>e pr(essionals 7)\t   
reg>d to :e!r su* facility or facilities
 are locat$ )9 su* an area7 & a ,f$]al  
ag5cy1 or a local1 c\nty1 regional1 or  
,/ate dep>tm5t ( public heal? det]m9es !
 ali5 physician's "w 0 or w be 9 !      
public int]e/4  4  7#b7 ,five-ye> s]vice

 requirem5t ,section                    
#bjc7;b77#b77;,b77ii77,,ii7 ( !         
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aaec7;,b77ii77,,ii77 is      
am5d$--  7,a7 by ins]t+ 7aa7 aft]       
7,,ii72 &  7,b7 by add+ at ! end !      
foll[+3  7bb7 ,! #e-ye> s]vice          
requirem5t ( item 7aa7 %all be c\nt$ f !
 date ! ali5 physician beg9s "w 9 !     
%ortage area 9 any legal /atus & n !    
date an immigrant visa petition is fil$ 
or approv$4 ,su* s]vice %all be         
aggregat$ )\t reg>d to :5 su* s]vice    
began & )\t reg>d to :e!r su* s]vice    
began dur+ or 9 conjunction ) a c\rse ( 
graduate m$ical education4  7cc7 ,an    
ali5 physician %all n be requir$ to     
submit an employm5t contract ) a t]m    
exce$+ ! balance ( ! #e-ye> commitm5t   
yet to be s]v$1 nor an employm5t        
contract dat$ )9 a m9imum "t p]iod prior
 to fil+ ( a visa petition pursuant to  
?is subsection4  7dd7 ,an ali5 physician
 %all n be requir$ to file additional   
immigrant visa petitions ^u a *ange ( "w

 location f ! location approv$ 9 !      
orig9al national int]e/ immigrant       
petition4  4  7d7 ,te*nical cl>ification
 reg>d+ advanc$ degree = physicians     
,section #bjc7;b77#b77;,a7 ( !          
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aaec7;b77#b77;,a77 is am5d$  
by add+ at ! end ,an ali5 physician     
hold+ a =eign m$ical degree t has be5   
deem$ suffici5t = acceptance by an      
accr$it$ ,unit$ ,/ates m$ical resid5cy  
or fell[%ip program is a memb] ( !      
pr(essions hold+ an advanc$ degree or   
its equival5t44  7e7 ,%ort-,t]m "w      
au?orization = physicians complet+ _!   
resid5cies ,a physician complet+        
graduate m$ical education or tra9+ z    
describ$ 9 section #bab7;j7 ( !         
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aahb7;j77 z a nonimmigrant   
describ$ section #aja7;a77#ae77;,h77i7 (
 su* ,act 7#h ,u4,s4,c4                 
#aaja7;a77#ae77;,h77i77 %all h su*      
nonimmigrant /atus automatically ext5d$ 
until ,octob] #a ( ! fiscal ye> = :i* a 

petition = a cont9uation ( su*          
nonimmigrant /atus has be5 submitt$ 9 a 
timely mann] & :]e ! employm5t />t date 
= ! b5efici>y ( su* petition is ,octob] 
#a ( t fiscal ye>4 ,su* physician %all  
be au?oriz$ to be employ$ incid5t to    
/atus dur+ ! p]iod betwe5 ! fil+ ( su*  
petition & ,octob] #a ( su* fiscal ye>4 
,h[ev]1 ! physician's /atus & employm5t 
au?orization %all t]m9ate #cj days f !  
date su* petition is reject$1 d5i$ or   
revok$4 ,a physician's /atus & employm5t
 au?orization w automatically ext5d to  
,octob] #a ( ! next fiscal ye> if all   
visas z describ$ 9 su* section          
#aja7;a77#ae77;,h77i7 au?oriz$ to be    
issu$ = ! fiscal ye> h be5 issu$4  7f7  
,applicability ( section #bab7;e7 to    
sp\ses & *ildr5 ( ,j-#a ex*ange visitors
 ,a sp\se or *ild ( an ex*ange visitor  
describ$ 9 section #aja7;a77#ae77;,j7 ( 
! ,immigration & ,nationality ,act 7#h  
,u4,s4,c4 #aaja7;a77#ae77;,j77 %all n be
 subject to ! requirem5ts ( section     
#bab7;e7 ( ! ,immigration & ,nationality

 ,act 7#h ,u4,s4,c4 #aahb7;e774