,,ii #aafth ,,congress #ast ,session ,s4 #idh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #bh1 #bjai,ms4 ,klobuchar 7for herself1 ,ms4 ,collins1 and ,ms4 ,rosen7 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 ,september #cj1 #bjah4 #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-- 7,i7 alien physicians who completed such service before the date of the enactment of the ,conrad ,state #cj and ,physician ,access ,act2 and 7,,ii7 the spouse or children of an alien physician described in subclause 7,i74 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 before 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 a petition or application described in subclause 7,i7 until the alien has satisfied all of the requirements of the waiver received under section #bad7l74 4 #d4 ,employment protections for physicians 7a7 ,exceptions to #b-,year foreign residency requirement ,section #bad7l77#a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#a77 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 the ,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 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 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 #abj days after receiving such waiver2 7bb7 #abj days after completing graduate medical education or training under a program approved pursuant to section #bab7;j77#a72 or 7cc7 #abj 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 #abj 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 subsection1 except as provided in paragraph 7#h74 2 and 7#e7 in subparagraph 7,d71 in the matter preceding clause 7i71 by inserting 7except as provided in paragraph 7#h774 7b7 ,allowable visa status for physicians fulfilling waiver requirements in medically underserved areas ,section #bad7l77#b77;,a7 of such ,act 7#h ,u4,s4,c4 #aahd7l77#b77;,a77 is amended 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 any status authorized for employment under this ,act4 ,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 #aahd7l771 as amended by this section1 is further 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 this section1 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 #abj-;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 this section1 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 7g7 ,exception to #c-,year work requirement ,section #bad7l7 of such ,act1 as amended by this section1 is further amended by adding at the end the following3 7#h7 ,the #c-year work requirement set forth in subparagraphs 7,c7 and 7,d7 of paragraph 7#a7 shall not apply if-- 7,a7 7i7 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 organization2 and 7ii7 the alien demonstrates1 not later than #abj 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 7,b7 7i7 the interested ,state agency that requested the waiver attests 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 organization2 and 7ii7 the alien demonstrates1 not later than #abj 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 7,c7 the alien-- 7i7 elects not to pursue a determination of extenuating circumstances pursuant to subclause 7,a7 or 7,b72 7ii7 terminates the alien's employment relationship with the health facility or health care organization at which the alien was employed2 7iii7 demonstrates1 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 professionals2 and 7iv7 agrees to be employed for the remainder of such #c-year period1 and #a additional year for each termination under clause 7ii74 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 #d1 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 #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;,h77i7 7except subclause 7b#a7 of such section71 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 ,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;,b77ii7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaec7;,b77ii77 is amended-- 7,a7 by moving subclauses 7,,ii71 7,,iii71 and 7,,iv7 #d ems to the left2 and 7,b7 in subclause 7,,ii7-- 7i7 by inserting 7aa7 after 7,,ii72 and 7ii7 by adding at the end the following3 7bb7 ,the #e-year service requirement under item 7aa7 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 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 served or an employment contract dated within a minimum time period before filing a visa petition under 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 7c7 ,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 the following3 ,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 7d7 ,short-,term work authorization for physicians completing their residencies 7#a7 ,in general ,a physician completing graduate medical education or training described in section #bab7;j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahb7;j77 as a nonimmigrant described in section #aja7;a77#ae77;,h77i7 of such ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77-- 7,a7 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 the employment start date for the beneficiary of such petition is ,october #a of that fiscal year2 and 7,b7 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 7#b7 ,termination ,the physician's status and employment authorization shall terminate on the date that is #cj days after the date on which a petition described in paragraph 7#a77;,a7 is rejected1 denied or revoked4 7#c7 ,automatic extension ,a physician's status and employment authorization will automatically extend to ,october #a of the next fiscal year if all of the visas described in section #aja7;a77#ae77;,h77i7 of such ,act that were authorized to be issued for the fiscal year have been issued4 7e7 ,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 under section #bab7;e7 of such ,act 7#h ,u4,s4,c4 #aahb7;e774