,,ii  #aae? ,,congress  #a/ ,session    
,s4 #hih  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,april #g1 #bjag,ms4   
,klobu*> 7= h]self1 ,ms4 ,coll9s1 & ,ms4
 ,heitkamp7 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$ically und]s]v$ communities1 &
 = o!r purposes4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,conrad ,/ate #cj &
 ,physician ,access ,reau?orization     
,act4  #b4 ,conrad ,/ate #cj program    
7a7 ,ext5sion ,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+ ,septemb] #cj1 #bjae &   
ins]t+ ,septemb] #cj1 #bjba4  7b7       
,effective date ,! am5dm5t made by      
subsection 7a7 %all take effect z if    
enact$ on ,april #bh1 #bjag4  #c4       
,employm5t protections = physicians  7a7
 ,9 g5]al ,section #bad7l77#a7 ( !      
,immigration & ,nationality ,act 7#h    

,u4,s4,c4 #aahd7l77#a7 is am5d$--  7#a7 
9 ! matt] prec$+ subp>agraph 7,a71 by   
/rik+ ,attorney ,g5]al & ins]t+         
,secret>y ( ,homel& ,security2  7#b7 9  
subp>agraph 7,a71 by /rik+ ,director (  
,unit$ ,/ates ,in=mation ,ag5cy & ins]t+
 ,secret>y ( ,/ate2  7#c7 9 subp>agraph 
7,b71 by ins]t+ 1 except z provid$ 9    
p>agraphs 7#g7 & 7#h7 be=e ! semicolon  
at ! end2 &  7#d7 9 subp>agraph 7,c71 by
 /rik+ clauses 7i7 & 7ii7 & ins]t+ !    
foll[+3  7i7 ! ali5 demon/rates a bona  
fide (f] ( full-"t employm5t at a heal? 
facility or heal? c>e organization1 :i* 
employm5t has be5 det]m9$ by ! ,secret>y
 ( ,homel& ,security to be 9 ! public   
int]e/2 &  7ii7 ! ali5-- 7,i7 has       
accept$ 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(essionals2
  7,,ii7 beg9s employm5t by ! lat] ( !  
date t is-- 7aa7 #ij days aft] receiv+  
su* waiv]2  7bb7 #ij days aft] complet+ 

graduate m$ical education or tra9+ "u a 
program approv$ pursuant to section     
#bab7;j77#a72 or  7cc7 #ij days aft]    
receiv+ nonimmigrant /atus or employm5t 
au?orization1 if ! ali5 or ! ali5's     
employ] petitions = su* nonimmigrant    
/atus or employm5t au?orization n lat]  
?an #ij days aft] ! date on :i* ! ali5  
completes 8 or h] graduate m$ical       
education or tra9+ "u a program approv$ 
pursuant to section #bab7;j77#a72 &     
7,,iii7 agrees to cont9ue to "w = a     
total ( n less ?an #c ye>s 9 ! /atus    
au?oriz$ = su* employm5t "u ?is         
subsection unless--  7aa7 ! ,secret>y ( 
,homel& ,security det]m9es t ext5uat+   
circum/ances1 includ+ violations by !   
employ] ( ! employm5t agreem5t ) ! ali5 
or ( labor & employm5t laws1 exi/ t     
ju/ify a less] p]iod ( employm5t at su* 
facility or organization1 9 :i* case !  
ali5 %all demon/rate1 n lat] ?an #ij    
days aft] ! employm5t t]m9ation date    
7unless ! ,secret>y det]m9es t ext5uat+ 
circum/ances w\ld ju/ify an ext5sion71  

ano!r bona fide (f] ( employm5t at a    
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(essionals1 = ! rema9d] ( su*    
#c-ye> p]iod2  7bb7 ! int]e/$ ,/ate     
ag5cy t reque/$ ! waiv] atte/s t        
ext5uat+ circum/ances includ+ violations
 by ! employ] ( ! employm5t agreem5t ) !
 ali5 or ( labor & employm5t laws1 exi/ 
t ju/ify a less] p]iod ( employm5t at   
su* facility or organization 9 :i* case 
! ali5 %all demon/rate1 n lat] ?an #ij  
days aft] ! employm5t t]m9ation date    
7unless ! ,secret>y det]m9es t ext5uat+ 
circum/ances w\ld ju/ify an ext5sion71  
ano!r bona fide (f] ( employm5t at a    
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(essionals1 = ! rema9d] ( su*    
#c-ye> p]iod2 or  7cc7 if ! ali5 elects 
n to pursue a det]m9ation ( ext5uat+    

circum/ances pursuant to item 7aa7 or   
7bb71 ! ali5 t]m9ates ! ali5's employm5t
 relation%ip ) su* facility or          
organization1 9 :i* case ! ali5 %all    
demon/rate1 n lat] ?an #de days aft] !  
employm5t t]m9ation date1 ano!r bona    
fide (f] ( employm5t at a heal? facility
 or heal? c>e organization 9 a          
geographic area or areas1 9 ! ,/ate t   
reque/$ ! ali5's waiv]1 :i* are         
designat$ by ! ,secret>y ( ,heal? &     
,human ,s]vices z hav+ a %ortage ( heal?
 c>e pr(essionals1 & agree to be employ$
 = ! rema9d] ( su* #c-ye> p]iod1 & #a   
additional ye> = ea* t]m9ation "u ?is   
subclause2 &  4  7b7 ,all[able visa     
/atus = physicians fulfill+ waiv]       
requirem5ts 9 m$ically und]s]v$ areas   
,section #bad7l77#b7 ( su* ,act 7#h     
,u4,s4,c4 #aahd7l77#b77 is am5d$ by     
am5d+ subp>agraph 7,a7 to read z foll[s3
  7,a7 ,^u ! reque/ ( an int]e/$ ,f$]al 
ag5cy or an int]e/$ ,/ate ag5cy =       
recomm5dation ( a waiv] "u ?is section  
by a physician :o is ma9ta9+ valid      

nonimmigrant /atus "u section           
#aja7;a77#ae77;,j7 & a favorable        
recomm5dation by ! ,secret>y ( ,/ate1 ! 
,secret>y ( ,homel& ,security may *ange 
! /atus ( su* physician to t ( an ali5  
describ$ 9 section                      
#aja7;a77#ae77;,h77i77,b74 ,! num]ical  
limitations conta9$ 9 subsection        
7g77#a77;,a7 %all n apply to any ali5 ^:
 /atus is *ang$ "u ?is subp>agraph4  4  
7c7 ,violation ( agreem5ts ,section     
#bad7l77#c77;,a7 ( su* ,act 7#h         
,u4,s4,c4 #aahd7l77#c77;,a77 is am5d$ by
 ins]t+ sub/antial requirem5t ( an be=e 
agreem5t ent]$ into4  7d7 ,physician    
employm5t 9 und]s]v$ areas ,section     
#bad7l7 ( su* ,act 7#h ,u4,s4,c4        
#aahd7l77 is am5d$ by add+ at ! end !   
foll[+3  7#d7 7,a7 ,if an int]e/$ ,/ate 
ag5cy d5ies ! application = a waiv] "u  
p>agraph 7#a77;,b7 f a physician pursu+ 
graduate m$ical education or tra9+      
pursuant to section #aja7;a77#ae77;,j7  
because ! ,/ate has reque/$ ! maximum   
numb] ( waiv]s p]mitt$ = t fiscal ye>1 !

 physician's nonimmigrant /atus %all be 
ext5d$ = up to #f mon?s if ! physician  
agrees to seek a waiv] "u ?is subsection
 7except = p>agraph 7#a77;,d77ii77 to "w
 = an employ] describ$ 9 p>agraph       
7#a77;,c7 9 a ,/ate t has n yet reque/$ 
! maximum numb] ( waiv]s4  7,b7 ,su*    
physician %all be au?oriz$ to "w only = 
! employ] ref]r$ to 9 subp>agraph 7,a7 f
 ! date on :i* a new waiv] application  
is fil$ ) su* ,/ate until ! e>li] (--   
7i7 ! date on :i* ! ,secret>y ( ,homel& 
,security d5ies su* waiv]2 or  7ii7 !   
date on :i* ! ,secret>y approves an     
application = *ange ( /atus "u p>agraph 
7#b77;,a7 pursuant to ! approval ( su*  
waiv]4  4  7e7 ,contract requirem5ts    
,section #bad7l7 ( su* ,act1 z am5d$ by 
subsection 7d71 is fur!r am5d$ by add+  
at ! end ! foll[+3  7#e7 ,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-- 7i7 :e!r !        
contract+ facility or organization w pay
 ! ali5's malpractice insurance         
premiums2  7ii7 :e!r ! employ] w provide
 malpractice insurance2 &  7iii7 ! am\nt
 ( su* insurance t w be provid$2  7,c7  
describes all ( ! "w locations t ! ali5 
w "w & includes a /atem5t t ! contract+ 
facility or organization w n add        
additional "w locations )\t ! approval (
 ! ,f$]al ag5cy or ,/ate ag5cy t reque/$
 ! waiv]2 &  7,d7 does n include a      
non-compete provision4  7#f7 ,an ali5   
grant$ a waiv] "u ?is subsection ^:     
employm5t relation%ip ) a heal? facility
 or heal? c>e organization t]m9ates "u  
p>agraph 7#a77;,c77ii7 dur+ ! #c-ye>    
s]vice p]iod requir$ "u p>agraph 7#a7   
%all be consid]$ to be ma9ta9+ lawful   
/atus 9 an au?oriz$ p]iod ( /ay dur+ !  
#ij-;day p]iod ref]r$ to 9 items 7aa7 & 
7bb7 ( subclause 7,,iii7 ( p>agraph     

7#a77;,c77ii7 or ! #de-;day p]iod ref]r$
 to 9 subclause 7,,iii77cc7 ( su*       
p>agraph4  4  7f7 ,recaptur+ waiv] slots
 lo/ to o!r /ates ,section #bad7l7 ( su*
 ,act1 z am5d$ by subsections 7d7 & 7e71
 is fur!r am5d$ by add+ at ! end !      
foll[+3  7#g7 ,if a recipi5t ( a waiv]  
"u ?is subsection t]m9ates ! recipi5t's 
employm5t ) a heal? facility or heal?   
c>e organization pursuant to p>agraph   
7#a77;,c77ii71 includ+ t]m9ation (      
employm5t because ( circum/ances        
describ$ 9 p>agraph                     
7#a77;,c77ii77,,iii71 & accepts new     
employm5t ) su* a facility or           
organization 9 a diff]5t ,/ate1 ! ,/ate 
f :i* ! ali5 is dep>t+ may be accord$ an
 additional waiv] by ! ,secret>y ( ,/ate
 = use 9 ! fiscal ye> 9 :i* ! ali5's    
employm5t 0 t]m9at$4  4  #d4 ,allotm5t (
 ,conrad #cj waiv]s  7a7 ,9 g5]al       
,section #bad7l7 ( ! ,immigration &     
,nationality ,act 7#h ,u4,s4,c4         
#aahd7l771 z am5d$ by section #c1 is    
fur!r am5d$ by add+ at ! end ! foll[+3  

7#h7 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 allotm5t occurs
 "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$ical c5t]s     
,section #bad7l77#a77;,d7 ( su* ,act is 
am5d$-- 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 
#e4 ,am5dm5ts to ! proc$ures1           
def9itions1 & o!r provisions relat$ to  
physician immigration  7a7 ,visa        
eligibility ,n lat] ?an #ij days aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,/ate %all am5d guidance 9 !
 ,=eign ,affairs ,manual to cl>ify t !  
expression ( a future int5tion to seek a
 waiv] "u section #bad7l7 ( !           
,immigration & ,nationality ,act 7#h    
,u4,s4,c4 #aahd7l77 by an ali5 com+ to !
 ,unit$ ,/ates to receive graduate      
m$ical education or tra9+1 z describ$ 9 
section #bab7;j7 ( su* ,act 7#h         

,u4,s4,c4 #aahb7;j771 or to take        
exam9ations requir$ to receive su*      
graduate m$ical education or tra9+1 %all
 n1 by itself1 con/itute evid5ce ( an   
int5tion to ab&on a =eign resid5ce =    
purposes ( obta9+ a visa z a            
nonimmigrant or o!rwise obta9+ or       
ma9ta9+ ! /atus ( a nonimmigrant4  7b7  
,applicability ( section #bab7;e7 to    
sp\ses & *ildr5 ( ,j-#a ex*ange visitors
 ,section #bab7;e7 ( ! ,immigration &   
,nationality ,act 7#h ,u4,s4,c4         
#aahb7;e77 is am5d$--  7#a7 by ins]t+   
7#a7 aft] 7e72 &  7#b7 by add+ at ! end 
! foll[+  7#b7 ,a sp\se or *ild ( an    
ex*ange visitor describ$ 9 section      
#aja7;a77#ae77;,j7 %all n be subject to 
! requirem5ts "u ?is subsection solely  
on acc\nt ( su* sp\se or *ild's         
d]ivative nonimmigrant /atus to an      
ex*ange visitor :o is subject to !      
requirem5ts "u ?is subsection4  4