,,ii #aaeth ,,congress #ast ,session ,s4 #hih ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #g1 #bjag,ms4 ,klobuchar 7for herself1 ,ms4 ,collins1 and ,ms4 ,heitkamp7 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 communities1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,conrad ,state #cj and ,physician ,access ,reauthorization ,act4 #b4 ,conrad ,state #cj program 7a7 ,extension ,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 ,september #cj1 #bjae and inserting ,september #cj1 #bjba4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect as if enacted on ,april #bh1 #bjag4 #c4 ,employment protections for physicians 7a7 ,in general ,section #bad7l77#a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#a7 is amended-- 7#a7 in the matter preceding subparagraph 7,a71 by striking ,attorney ,general and inserting ,secretary of ,homeland ,security2 7#b7 in subparagraph 7,a71 by striking ,director of ,united ,states ,information ,agency and inserting ,secretary of ,state2 7#c7 in subparagraph 7,b71 by inserting 1 except as provided in paragraphs 7#g7 and 7#h7 before the semicolon at the end2 and 7#d7 in subparagraph 7,c71 by striking clauses 7i7 and 7ii7 and inserting the following3 7i7 the alien demonstrates a bona fide offer of full-time employment at a health facility or health care organization1 which employment has been determined by the ,secretary of ,homeland ,security to be in the public interest2 and 7ii7 the alien-- 7,i7 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 professionals2 7,,ii7 begins employment by the later of the date that is-- 7aa7 #ij days after receiving such waiver2 7bb7 #ij days after completing graduate medical education or training under a program approved pursuant to section #bab7;j77#a72 or 7cc7 #ij days after receiving nonimmigrant status or employment authorization1 if the alien or the alien's employer petitions for such nonimmigrant status or employment authorization not later than #ij days after the date on which the alien completes his or her graduate medical education or training under a program approved pursuant to section #bab7;j77#a72 and 7,,iii7 agrees to continue to work for a total of not less than #c years in the status authorized for such employment under this subsection unless-- 7aa7 the ,secretary of ,homeland ,security determines that extenuating circumstances1 including violations by the employer of the employment agreement with the alien or of labor and employment laws1 exist that justify a lesser period of employment at such facility or organization1 in which case the alien shall demonstrate1 not later than #ij days after the employment termination date 7unless the ,secretary determines that extenuating circumstances would justify an extension71 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 professionals1 for the remainder of such #c-year period2 7bb7 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 laws1 exist that justify a lesser period of employment at such facility or organization in which case the alien shall demonstrate1 not later than #ij days after the employment termination date 7unless the ,secretary determines that extenuating circumstances would justify an extension71 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 professionals1 for the remainder of such #c-year period2 or 7cc7 if the alien elects not to pursue a determination of extenuating circumstances pursuant to item 7aa7 or 7bb71 the alien terminates the alien's employment relationship with such facility or organization1 in which case the alien shall demonstrate1 not later than #de days after the employment termination date1 another bona fide offer of employment at a health facility or health care organization in a geographic area or areas1 in the ,state that requested the alien's waiver1 which are designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 and agree to be employed for the remainder of such #c-year period1 and #a additional year for each termination under this subclause2 and 4 7b7 ,allowable visa status for physicians fulfilling waiver requirements in medically underserved areas ,section #bad7l77#b7 of such ,act 7#h ,u4,s4,c4 #aahd7l77#b77 is amended by amending subparagraph 7,a7 to read as follows3 7,a7 ,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 #aja7;a77#ae77;,j7 and a favorable recommendation by the ,secretary of ,state1 the ,secretary of ,homeland ,security may change the status of such physician to that of an alien described in section #aja7;a77#ae77;,h77i77,b74 ,the numerical limitations contained in subsection 7g77#a77;,a7 shall not apply to any alien whose status is changed under this subparagraph4 4 7c7 ,violation of agreements ,section #bad7l77#c77;,a7 of such ,act 7#h ,u4,s4,c4 #aahd7l77#c77;,a77 is amended by inserting substantial requirement of an before agreement entered into4 7d7 ,physician employment in underserved areas ,section #bad7l7 of such ,act 7#h ,u4,s4,c4 #aahd7l77 is amended by adding at the end the following3 7#d7 7,a7 ,if an interested ,state agency denies the application for a waiver under paragraph 7#a77;,b7 from a physician pursuing graduate medical education or training pursuant to section #aja7;a77#ae77;,j7 because the ,state has requested the maximum number of waivers permitted for that fiscal year1 the physician's nonimmigrant status shall be extended for up to #f months if the physician agrees to seek a waiver under this subsection 7except for paragraph 7#a77;,d77ii77 to work for an employer described in paragraph 7#a77;,c7 in a ,state that has not yet requested the maximum number of waivers4 7,b7 ,such physician shall be authorized to work only for the employer referred to in subparagraph 7,a7 from the date on which a new waiver application is filed with such ,state until the earlier of-- 7i7 the date on which the ,secretary of ,homeland ,security denies such waiver2 or 7ii7 the date on which the ,secretary approves an application for change of status under paragraph 7#b77;,a7 pursuant to the approval of such waiver4 4 7e7 ,contract requirements ,section #bad7l7 of such ,act1 as amended by subsection 7d71 is further amended by adding at the end the following3 7#e7 ,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-- 7i7 whether the contracting facility or organization will pay the alien's malpractice insurance premiums2 7ii7 whether the employer will provide malpractice insurance2 and 7iii7 the amount of such insurance that will be provided2 7,c7 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 waiver2 and 7,d7 does not include a non-compete provision4 7#f7 ,an alien granted a waiver under this subsection whose employment relationship with a health facility or health care organization terminates under paragraph 7#a77;,c77ii7 during the #c-year service period required under paragraph 7#a7 shall be considered to be maintaining lawful status in an authorized period of stay during the #ij-;day period referred to in items 7aa7 and 7bb7 of subclause 7,,iii7 of paragraph 7#a77;,c77ii7 or the #de-;day period referred to in subclause 7,,iii77cc7 of such paragraph4 4 7f7 ,recapturing waiver slots lost to other states ,section #bad7l7 of such ,act1 as amended by subsections 7d7 and 7e71 is further amended by adding at the end the following3 7#g7 ,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 7#a77;,c77ii71 including termination of employment because of circumstances described in paragraph 7#a77;,c77ii77,,iii71 and accepts new employment with such a facility or organization in a different ,state1 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 terminated4 4 #d4 ,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 #c1 is further amended by adding at the end the following3 7#h7 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 allotment occurs 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 such ,act 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 #e4 ,amendments to the procedures1 definitions1 and other provisions related to physician immigration 7a7 ,visa eligibility ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,state shall amend guidance in the ,foreign ,affairs ,manual to clarify that the expression of a future intention to seek a waiver under section #bad7l7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77 by an alien coming to the ,united ,states to receive graduate medical education or training1 as described in section #bab7;j7 of such ,act 7#h ,u4,s4,c4 #aahb7;j771 or to take examinations required to receive such graduate medical education or training1 shall not1 by itself1 constitute evidence of an intention to abandon a foreign residence for purposes of obtaining a visa as a nonimmigrant or otherwise obtaining or maintaining the status of a nonimmigrant4 7b7 ,applicability of section #bab7;e7 to spouses and children of ,j-#a exchange visitors ,section #bab7;e7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahb7;e77 is amended-- 7#a7 by inserting 7#a7 after 7e72 and 7#b7 by adding at the end the following 7#b7 ,a spouse or child of an exchange visitor described in section #aja7;a77#ae77;,j7 shall not be subject to the requirements under this subsection solely on account of such spouse or child's derivative nonimmigrant status to an exchange visitor who is subject to the requirements under this subsection4 4