II
119THCONGRESS
1
STSESSION S. 709
To provide incentives to physicians to practice in rural and medically
underserved communities, and for other purposes.
IN THE SENATE OF THE UNITED STATES
FEBRUARY25, 2025
Ms. K
LOBUCHAR(for herself, Ms. COLLINS, Ms. ROSEN, and Mr. TILLIS) in-
troduced the following bill; which was read twice and referred to the Com-
mittee on the Judiciary
A BILL
To provide incentives to physicians to practice in rural and
medically underserved communities, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Conrad State 30 and 4
Physician Access Reauthorization Act’’. 5
SEC. 2. CONRAD STATE 30 PROGRAM. 6
(a) E
XTENSION.—Section 220(c) of the Immigration 7
and Nationality Technical Corrections Act of 1994 (Public 8
Law 103–416; 8 U.S.C. 1182 note) is amended by striking 9
‘‘September 30, 2015’’ and inserting ‘‘on the date that 10
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is 3 years after the date of the enactment of the Conrad 1
State 30 and Physician Access Reauthorization Act’’. 2
(b) E
FFECTIVEDATE.—The amendment made by 3
subsection (a) shall take effect as if enacted on September 4
30, 2018. 5
SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 6
MEDICALLY UNDERSERVED COMMUNITIES. 7
Section 201(b)(1) of the Immigration and Nationality 8
Act (8 U.S.C. 1151(b)(1)) is amended by adding at the 9
end the following: 10
‘‘(F)(i) Alien physicians who have completed 11
service requirements of a waiver requested under 12
section 203(b)(2)(B)(ii), including— 13
‘‘(I) alien physicians who completed such 14
service before the date of the enactment of the 15
Conrad State 30 and Physician Access Act; and 16
‘‘(II) the spouse or children of an alien 17
physician described in subclause (I). 18
‘‘(ii) Nothing in this subparagraph may be con-19
strued— 20
‘‘(I) to prevent the filing of a petition with 21
the Secretary of Homeland Security for classi-22
fication under section 204(a) or the filing of an 23
application for adjustment of status under sec-24
tion 245 by an alien physician described in this 25
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subparagraph before the date by which such 1
alien physician has completed the service de-2
scribed in section 214(l) or worked full-time as 3
a physician for an aggregate of 5 years at the 4
location identified in the section 214(l) waiver 5
or in an area or areas designated by the Sec-6
retary of Health and Human Services as having 7
a shortage of health care professionals; or 8
‘‘(II) to permit the Secretary of Homeland 9
Security to grant a petition or application de-10
scribed in subclause (I) until the alien has sat-11
isfied all of the requirements of the waiver re-12
ceived under section 214(l).’’. 13
SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 14
(a) E
XCEPTIONS TO2-YEARFOREIGNRESIDENCY 15
R
EQUIREMENT.—Section 214(l)(1) of the Immigration 16
and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 17
(1) in the matter preceding subparagraph (A), 18
by striking ‘‘Attorney General’’ and inserting ‘‘Sec-19
retary of Homeland Security’’; 20
(2) in subparagraph (A), by striking ‘‘Director 21
of the United States Information Agency’’ and in-22
serting ‘‘Secretary of State’’; 23
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(3) in subparagraph (B), by inserting ‘‘, except 1
as provided in paragraphs (7) and (8)’’ before the 2
semicolon at the end; 3
(4) in subparagraph (C), by striking clauses (i) 4
and (ii) and inserting the following: 5
‘‘(i) the alien demonstrates a bona fide 6
offer of full-time employment at a health facil-7
ity or health care organization, which employ-8
ment has been determined by the Secretary of 9
Homeland Security to be in the public interest; 10
and 11
‘‘(ii) the alien— 12
‘‘(I) has accepted employment with 13
the health facility or health care organiza-14
tion in a geographic area or areas which 15
are designated by the Secretary of Health 16
and Human Services as having a shortage 17
of health care professionals; 18
‘‘(II) begins employment by the later 19
of the date that is— 20
‘‘(aa) 120 days after receiving 21
such waiver; 22
‘‘(bb) 120 days after completing 23
graduate medical education or train-24
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ing under a program approved pursu-1
ant to section 212(j)(1); or 2
‘‘(cc) 120 days after receiving 3
nonimmigrant status or employment 4
authorization, if the alien or the 5
alien’s employer petitions for such 6
nonimmigrant status or employment 7
authorization not later than 120 days 8
after the date on which the alien com-9
pletes his or her graduate medical 10
education or training under a pro-11
gram approved pursuant to section 12
212(j)(1); and 13
‘‘(III) agrees to continue to work for 14
a total of not less than 3 years in the sta-15
tus authorized for such employment under 16
this subsection, except as provided in para-17
graph (8).’’; and 18
(5) in subparagraph (D), in the matter pre-19
ceding clause (i), by inserting ‘‘(except as provided 20
in paragraph (8))’’ after ‘‘3 years’’. 21
(b) A
LLOWABLEVISASTATUS FORPHYSICIANSFUL-22
FILLINGWAIVERREQUIREMENTS INMEDICALLYUNDER-23
SERVEDAREAS.—Section 214(l)(2)(A) of such Act (8 24
U.S.C. 1184(l)(2)(A)) is amended to read as follows: 25
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‘‘(A) Upon the request of an interested Federal agen-1
cy or an interested State agency for recommendation of 2
a waiver under this section by a physician who is main-3
taining valid nonimmigrant status under section 4
101(a)(15)(J) and a favorable recommendation by the 5
Secretary of State, the Secretary of Homeland Security 6
may change the status of such physician to any status au-7
thorized for employment under this Act. The numerical 8
limitations contained in subsection (g)(1)(A) shall not 9
apply to any alien whose status is changed under this sub-10
paragraph.’’. 11
(c) V
IOLATION OF AGREEMENTS.—Section 12
214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 13
amended by inserting ‘‘substantial requirement of an’’ be-14
fore ‘‘agreement entered into’’. 15
(d) P
HYSICIANEMPLOYMENT IN UNDERSERVED 16
A
REAS.—Section 214(l) of such Act, as amended by this 17
section, is further amended by adding at the end the fol-18
lowing: 19
‘‘(4)(A) If an interested State agency denies an appli-20
cation for a waiver under paragraph (1)(B) from a physi-21
cian pursuing graduate medical education or training pur-22
suant to section 101(a)(15)(J) because the State has re-23
quested the maximum number of waivers permitted for 24
that fiscal year, the physician’s nonimmigrant status shall 25
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be extended for up to 6 months if the physician agrees 1
to seek a waiver under this subsection (except for para-2
graph (1)(D)(ii)) to work for an employer described in 3
paragraph (1)(C) in a State that has not yet requested 4
the maximum number of waivers. 5
‘‘(B) Such physician shall be authorized to work only 6
for the employer referred to in subparagraph (A) during 7
the period beginning on the date on which a new waiver 8
application is filed with such State and ending on the ear-9
lier of— 10
‘‘(i) the date on which the Secretary of Home-11
land Security denies such waiver; or 12
‘‘(ii) the date on which the Secretary approves 13
an application for change of status under paragraph 14
(2)(A) pursuant to the approval of such waiver.’’. 15
(e) C
ONTRACTREQUIREMENTS.—Section 214(l) of 16
such Act, as amended by this section, is further amended 17
by adding at the end the following: 18
‘‘(5) An alien granted a waiver under paragraph 19
(1)(C) shall enter into an employment agreement with the 20
contracting health facility or health care organization 21
that— 22
‘‘(A) specifies the maximum number of on-call 23
hours per week (which may be a monthly average) 24
that the alien will be expected to be available and 25
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the compensation the alien will receive for on-call 1
time; 2
‘‘(B) specifies— 3
‘‘(i) whether the contracting facility or or-4
ganization— 5
‘‘(I) has secured medical malpractice 6
liability protection for the alien under sec-7
tion 224(g) of the Public Health Service 8
Act (42 U.S.C. 233(g)); or 9
‘‘(II) will pay the alien’s malpractice 10
insurance premiums; 11
‘‘(ii) whether the employer will provide 12
malpractice insurance for the alien; and 13
‘‘(iii) the amount of such liability protec-14
tion that will be provided; 15
‘‘(C) describes all of the work locations that the 16
alien will work and includes a statement that the 17
contracting facility or organization will not add addi-18
tional work locations without the approval of the 19
Federal agency or State agency that requested the 20
waiver; and 21
‘‘(D) does not include a non-compete provision. 22
‘‘(6) An alien granted a waiver under this subsection 23
whose employment relationship with a health facility or 24
health care organization terminates under paragraph 25
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(1)(C)(ii) during the 3-year service period required under 1
paragraph (1) shall be considered to be maintaining lawful 2
status in an authorized period of stay during the 120-day 3
period referred to in items (aa) and (bb) of subclause (III) 4
of paragraph (1)(C)(ii) or the 45-day period referred to 5
in subclause (III)(cc) of such paragraph.’’. 6
(f) R
ECAPTURINGWAIVERSLOTSLOST TOOTHER 7
S
TATES.—Section 214(l) of such Act, as amended by this 8
section, is further amended by adding at the end the fol-9
lowing: 10
‘‘(7) If a recipient of a waiver under this subsection 11
terminates the recipient’s employment with a health facil-12
ity or health care organization pursuant to paragraph 13
(1)(C)(ii), including termination of employment because of 14
circumstances described in paragraph (1)(C)(ii)(III), and 15
accepts new employment with such a facility or organiza-16
tion in a different State, the State from which the alien 17
is departing may be accorded an additional waiver by the 18
Secretary of State for use in the fiscal year in which the 19
alien’s employment was terminated.’’. 20
(g) E
XCEPTION TO3-YEARWORKREQUIREMENT.— 21
Section 214(l) of such Act, as amended by this section, 22
is further amended by adding at the end the following: 23
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‘‘(8) The 3-year work requirement set forth in sub-1
paragraphs (C) and (D) of paragraph (1) shall not apply 2
if— 3
‘‘(A)(i) the Secretary of Homeland Security de-4
termines that extenuating circumstances, including 5
violations by the employer of the employment agree-6
ment with the alien or of labor and employment 7
laws, exist that justify a lesser period of employment 8
at such facility or organization; and 9
‘‘(ii) the alien demonstrates, not later than 120 10
days after the employment termination date (unless 11
the Secretary determines that extenuating cir-12
cumstances would justify an extension), another 13
bona fide offer of employment at a health facility or 14
health care organization in a geographic area or 15
areas which are designated by the Secretary of 16
Health and Human Services as having a shortage of 17
health care professionals, for the remainder of such 18
3-year period; 19
‘‘(B)(i) the interested State agency that re-20
quested the waiver attests that extenuating cir-21
cumstances, including violations by the employer of 22
the employment agreement with the alien or of labor 23
and employment laws, exist that justify a lesser pe-24
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riod of employment at such facility or organization; 1
and 2
‘‘(ii) the alien demonstrates, not later than 120 3
days after the employment termination date (unless 4
the Secretary determines that extenuating cir-5
cumstances would justify an extension), another 6
bona fide offer of employment at a health facility or 7
health care organization in a geographic area or 8
areas which are designated by the Secretary of 9
Health and Human Services as having a shortage of 10
health care professionals, for the remainder of such 11
3-year period; or 12
‘‘(C) the alien— 13
‘‘(i) elects not to pursue a determination of 14
extenuating circumstances pursuant to sub-15
clause (A) or (B); 16
‘‘(ii) terminates the alien’s employment re-17
lationship with the health facility or health care 18
organization at which the alien was employed; 19
‘‘(iii) demonstrates, not later than 45 days 20
after the employment termination date, another 21
bona fide offer of employment at a health facil-22
ity or health care organization in a geographic 23
area or areas, in the State that requested the 24
alien’s waiver, which are designated by the Sec-25
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retary of Health and Human Services as having 1
a shortage of health care professionals; and 2
‘‘(iv) agrees to be employed for the remain-3
der of such 3-year period, and 1 additional year 4
for each termination under clause (ii).’’. 5
SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 6
(a) I
NGENERAL.—Section 214(l) of the Immigration 7
and Nationality Act (8 U.S.C. 1184(l)), as amended by 8
section 4, is further amended by adding at the end the 9
following: 10
‘‘(9)(A)(i) All States shall be allotted a total of 35 11
waivers under paragraph (1)(B) for a fiscal year if 90 per-12
cent of the waivers available to the States receiving at 13
least 5 waivers were used in the previous fiscal year. 14
‘‘(ii) When an allotment occurs under clause (i), all 15
States shall be allotted an additional 5 waivers under 16
paragraph (1)(B) for each subsequent fiscal year if 90 17
percent of the waivers available to the States receiving at 18
least 5 waivers were used in the previous fiscal year. If 19
the States are allotted 45 or more waivers for a fiscal year, 20
the States will only receive an additional increase of 5 21
waivers the following fiscal year if 95 percent of the waiv-22
ers available to the States receiving at least 1 waiver were 23
used in the previous fiscal year. 24
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‘‘(B) Any increase in allotments under subparagraph 1
(A) shall be maintained indefinitely, unless in a fiscal year, 2
the total number of such waivers granted is 5 percent 3
lower than in the last year in which there was an increase 4
in the number of waivers allotted pursuant to this para-5
graph, in which case— 6
‘‘(i) the number of waivers allotted shall be de-7
creased by 5 for all States beginning in the next fis-8
cal year; and 9
‘‘(ii) each additional 5 percent decrease in such 10
waivers granted from the last year in which there 11
was an increase in the allotment, shall result in an 12
additional decrease of 5 waivers allotted for all 13
States, provided that the number of waivers allotted 14
for all States shall not drop below 30.’’. 15
(b) A
CADEMIC MEDICAL CENTERS.—Section 16
214(l)(1)(D) of such Act (8 U.S.C. 1184(l)(1)(D)), as 17
amended by section 4(a)(5), is further amended— 18
(1) in clause (ii), by striking ‘‘and’’ at the end; 19
(2) in clause (iii), by striking the period at the 20
end and inserting ‘‘; and’’; and 21
(3) by adding at the end the following: 22
‘‘(iv) in the case of a request by an inter-23
ested State agency— 24
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‘‘(I) the head of such agency deter-1
mines that the alien is to practice medicine 2
in, or be on the faculty of a residency pro-3
gram at, an academic medical center (as 4
that term is defined in section 5
411.355(e)(2) of title 42, Code of Federal 6
Regulations, or similar successor regula-7
tion), without regard to whether such facil-8
ity is located within an area designated by 9
the Secretary of Health and Human Serv-10
ices as having a shortage of health care 11
professionals; and 12
‘‘(II) the head of such agency deter-13
mines that— 14
‘‘(aa) the alien physician’s work 15
is in the public interest; and 16
‘‘(bb) the grant of such waiver 17
would not cause the number of the 18
waivers granted on behalf of aliens for 19
such State for a fiscal year (within 20
the limitation in subparagraph (B) 21
and subject to paragraph (6)) in ac-22
cordance with the conditions of this 23
clause to exceed 3.’’. 24
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SEC. 6. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, 1
AND OTHER PROVISIONS RELATED TO PHYSI-2
CIAN IMMIGRATION. 3
(a) D
UALINTENT FORPHYSICIANSSEEKINGGRAD-4
UATEMEDICALTRAINING.—Section 214(b) of the Immi-5
gration and Nationality Act (8 U.S.C. 1184(b)) is amend-6
ed by striking ‘‘(other than a nonimmigrant described in 7
subparagraph (L) or (V) of section 101(a)(15), and other 8
than a nonimmigrant described in any provision of section 9
101(a)(15)(H)(i) except subclause (b1) of such section)’’ 10
and inserting ‘‘(other than a nonimmigrant described in 11
subparagraph (L) or (V) of section 101(a)(15), a non-12
immigrant described in any provision of section 13
101(a)(15)(H)(i) (except subclause (b1) of such section), 14
and an alien coming to the United States to receive grad-15
uate medical education or training described in section 16
212(j) or to take examinations required to receive grad-17
uate medical education or training described in section 18
212(j))’’. 19
(b) P
HYSICIANNATIONALINTERESTWAIVERCLARI-20
FICATIONS.— 21
(1) P
RACTICE AND GEOGRAPHIC AREA .—Sec-22
tion 203(b)(2)(B)(ii)(I) of the Immigration and Na-23
tionality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is 24
amended by striking items (aa) and (bb) and insert-25
ing the following: 26
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‘‘(aa) the alien physician agrees to 1
work on a full-time basis practicing pri-2
mary care, specialty medicine, or a com-3
bination thereof, in an area or areas des-4
ignated by the Secretary of Health and 5
Human Services as having a shortage of 6
health care professionals, or at a health 7
care facility under the jurisdiction of the 8
Secretary of Veterans Affairs; or 9
‘‘(bb) the alien physician is pursuing 10
such waiver based upon service at a facility 11
or facilities that serve patients who reside 12
in a geographic area or areas designated 13
by the Secretary of Health and Human 14
Services as having a shortage of health 15
care professionals (without regard to 16
whether such facility or facilities are lo-17
cated within such an area) and a Federal 18
agency, or a local, county, regional, or 19
State department of public health deter-20
mines the alien physician’s work was or 21
will be in the public interest.’’. 22
(2) F
IVE-YEAR SERVICE REQUIREMENT .—Sec-23
tion 203(b)(2)(B)(ii) of the Immigration and Na-24
tionality Act (8 U.S.C. 1153(B)(ii)) is amended— 25
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(A) by moving subclauses (II), (III), and 1
(IV) 4 ems to the left; and 2
(B) in subclause (II)— 3
(i) by inserting ‘‘(aa)’’ after ‘‘(II)’’; 4
and 5
(ii) by adding at the end the fol-6
lowing: 7
‘‘(bb) The 5-year service requirement 8
under item (aa) shall begin on the date on 9
which the alien physician begins work in 10
the shortage area in any legal status and 11
not on the date on which an immigrant 12
visa petition is filed or approved. Such 13
service shall be aggregated without regard 14
to when such service began and without re-15
gard to whether such service began during 16
or in conjunction with a course of graduate 17
medical education. 18
‘‘(cc) An alien physician shall not be 19
required to submit an employment contract 20
with a term exceeding the balance of the 5- 21
year commitment yet to be served or an 22
employment contract dated within a min-23
imum time period before filing a visa peti-24
tion under this subsection. 25
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‘‘(dd) An alien physician shall not be 1
required to file additional immigrant visa 2
petitions upon a change of work location 3
from the location approved in the original 4
national interest immigrant petition.’’. 5
(c) T
ECHNICALCLARIFICATIONREGARDINGAD-6
VANCED DEGREE FOR PHYSICIANS.—Section 7
203(b)(2)(A) of the Immigration and Nationality Act (8 8
U.S.C. 1153(b)(2)(A)) is amended by adding at the end 9
the following: ‘‘An alien physician holding a foreign med-10
ical degree that has been deemed sufficient for acceptance 11
by an accredited United States medical residency or fel-12
lowship program is a member of the professions holding 13
an advanced degree or its equivalent.’’. 14
(d) S
HORT-TERMWORKAUTHORIZATION FOR PHY-15
SICIANSCOMPLETINGTHEIRRESIDENCIES.— 16
(1) I
N GENERAL.—A physician completing 17
graduate medical education or training described in 18
section 212(j) of the Immigration and Nationality 19
Act (8 U.S.C. 1182(j)) as a nonimmigrant described 20
in section 101(a)(15)(H)(i) of such Act (8 U.S.C. 21
1101(a)(15)(H)(i))— 22
(A) shall have such nonimmigrant status 23
automatically extended until October 1 of the 24
fiscal year for which a petition for a continu-25
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ation of such nonimmigrant status has been 1
submitted in a timely manner and the employ-2
ment start date for the beneficiary of such peti-3
tion is October 1 of that fiscal year; and 4
(B) shall be authorized to be employed in-5
cident to status during the period between the 6
filing of such petition and October 1 of such fis-7
cal year. 8
(2) T
ERMINATION.—The physician’s status and 9
employment authorization shall terminate on the 10
date that is 30 days after the date on which a peti-11
tion described in paragraph (1)(A) is rejected, de-12
nied or revoked. 13
(3) A
UTOMATIC EXTENSION .—A physician’s 14
status and employment authorization will automati-15
cally extend to October 1 of the next fiscal year if 16
all of the visas described in section 101(a)(15)(H)(i) 17
of such Act that were authorized to be issued for the 18
fiscal year have been issued. 19
(e) A
PPLICABILITY OFSECTION212(e) TOSPOUSES 20
ANDCHILDREN OFJ–1 EXCHANGEVISITORS.—A spouse 21
or child of an exchange visitor described in section 22
101(a)(15)(J) of the Immigration and Nationality Act (8 23
U.S.C. 1101(a)(15)(J)) shall not be subject to the require-24
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ments under section 212(e) of such Act (8 U.S.C. 1
1182(e)). 2
SEC. 7. ANNUAL CONRAD STATE 30 J–1 VISA WAIVER PRO-3
GRAM STATISTICAL REPORT. 4
The Director of U.S. Citizenship and Immigration 5
Services shall submit an annual report to Congress and 6
to the Department of Health and Human Services that 7
identifies the number of aliens admitted during the most 8
recently concluded fiscal year as a result of the Conrad 9
State 30 J–1 Visa Waiver Program established under sec-10
tions 212(e) and 214(l) of the Immigration and Nation-11
ality Act (8 U.S.C. 1182(e) and 1184(l)), disaggregated 12
by State. 13
Æ
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ssavage on LAPJG3WLY3PROD with BILLS