H.R. 1585 — Conrad State 30 and Physician Access Reauthorization Act

This section extends the Conrad State 30 program—under which states may request waivers of the two-year foreign residence requirement for J-1 nonimmigrant physicians who agree to work in health professional shortage areas—through the date that is three years after enactment of the Conrad State 30 and Physician Access Reauthorization Act (from September 30, 2015). The extension takes effect as if enacted on September 30, 2018.

This section adds to the list of aliens not subject to worldwide numerical limitations on immigrant visas or permanent resident status alien physicians who have completed service requirements of a waiver requested under INA §203(b)(2)(B)(ii) (i.e., Conrad State 30 program waivers under INA §214(l) for J-1 nonimmigrant physicians agreeing to work three years in health professional shortage areas), including such physicians who completed service before enactment of this Act and their spouses and children (INA §201(b)(1)(F)). It clarifies that such physicians may file employment-based immigrant petitions or adjustment-of-status applications before completing service or an aggregate of five years of full-time employment in the waiver-designated location or shortage area but that approvals cannot be granted until requirements are met.

This section amends INA §214(l), which provides waivers of the two-year foreign residence requirement for J-1 nonimmigrant physicians who work for three years in health professional shortage areas designated by HHS. Specifically, it (1) updates references from "Attorney General" to "Secretary of Homeland Security," "Director of the United States Information Agency" to "Secretary of State," and adds exceptions to certain waiver conditions; (2) revises waiver eligibility under paragraph (1)(C) to require a bona fide public-interest job offer, employment in a shortage area, commencement within 120 days of waiver approval, medical training completion, or status petition, and a three-year commitment (except as provided); (3) authorizes DHS to change a physician's status to any employment-authorized nonimmigrant status without numerical limits upon waiver approval; (4) deems substantial breach required to trigger penalties for violating waiver agreements; (5) extends status up to six months if a state denies a waiver due to its annual cap, allowing the physician to seek a waiver from another state and work for that employer pending decision; (6) requires employment contracts to specify on-call hours and compensation, malpractice coverage (including under PHS Act §224(g) (42 U.S.C. 233(g)) or premium payments), work locations (without unapproved additions), and no non-compete clauses; and (7) grants 120- or 45-day lawful status if employment ends during the three-year service period. (Thus, these changes enhance employment flexibility, protections, and malpractice safeguards for physicians serving underserved areas while preserving state waiver allocation limits.)

This section establishes an adjustable nationwide allotment formula for Conrad 30 waivers (i.e., state-recommended J-1 visa waivers for foreign physicians committing to three years of service in health professional shortage areas), initially increasing per-state allotments to 35 waivers (from 30) in a fiscal year if states receiving at least five waivers used 90% of available waivers the prior year, with additional 5-waiver increases per state in subsequent years upon continued 90% usage (or 95% once allotments reach 45 or more per state by states receiving at least one waiver), indefinite maintenance of increases unless usage falls 5% below the prior peak increase year (triggering 5-waiver decreases per state, with further 5% drops yielding additional decreases, floored at 30 per state); and authorizes up to three such waivers per state per fiscal year for physicians practicing at or serving on the faculty of academic medical centers (as defined in 42 CFR 411.355(e)(2)), without regard to shortage-area location, if determined to be in the public interest.

This section amends the Immigration and Nationality Act to facilitate physician immigration in five respects. **(a) Dual intent.** It expands the exceptions to the presumption of immigrant intent for nonimmigrants under INA §214(b) to include aliens coming to the United States for graduate medical education or training (or related examinations) described in INA §212(j) (i.e., inadmissibility for medical professionals lacking requisite U.S.-equivalent education). **(b) National interest waiver (NIW) for employment-based immigrant visas.** (1) It revises INA §203(b)(2)(B)(ii)(I) to broaden qualifying service for the NIW (i.e., waiver of job offer and labor certification for physicians serving the national interest) by allowing full-time practice of primary care, specialty medicine, or both in Health and Human Services-designated health professional shortage areas or Veterans Affairs facilities; or service at facilities (regardless of location) that serve shortage-area patients, as determined in the public interest by a federal agency or local/state public health department. (2) It clarifies INA §203(b)(2)(B)(ii) to provide that the five-year service requirement begins upon starting work in a qualifying area (in any legal status), may be aggregated across time and statuses (including during graduate medical education), and does not require contracts exceeding the remaining service term, contracts filed within a minimum pre-petition period, or new petitions upon work location changes. **(c) Advanced degree equivalency.** It amends INA §203(b)(2)(A) to deem a foreign medical degree qualifying as an advanced degree (or equivalent) for EB-2 immigrant classification if accepted by an accredited U.S. medical residency or fellowship program. **(d) H-1B extensions for residency completion.** It provides automatic extension of H-1B nonimmigrant status (under INA §101(a)(15)(H)(i)) for physicians completing graduate medical education under INA §212(j) until October 1 of the relevant fiscal year if a timely continuation petition is filed with an October 1 start date; authorizes employment incident to status pending that date; terminates status and authorization 30 days after petition rejection, denial, or revocation; and automatically extends both to the next fiscal year's October 1 if that year's H-1B visas are exhausted. **(e) J-1 dependents.** It exempts spouses and children of J-1 exchange visitors (under INA §101(a)(15)(J)) from INA §212(e)'s two-year foreign residency requirement.

This section directs the Director of U.S. Citizenship and Immigration Services to submit an annual report to Congress and the Department of Health and Human Services identifying the number of aliens admitted during the most recently concluded fiscal year under the Conrad State 30 J-1 Visa Waiver Program (i.e., state-issued waivers of the two-year foreign residency requirement for up to 30 J-1 nonimmigrant physicians per state who commit to practicing in underserved areas), disaggregated by state.