S. 709 — Conrad State 30 and Physician Access Reauthorization Act

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

This section adds to the aliens exempt from worldwide numerical limits on immigrant visas under INA §201(b)(1) (8 U.S.C. 1151(b)(1)) 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 visa holders agreeing to work three years in health professional shortage areas), including physicians who completed such service before enactment of the Conrad State 30 and Physician Access Act and their spouses and children. It clarifies that such aliens may file petitions for classification or adjustment of status before completing service (or an aggregate five years of full-time employment in the waiver location or a designated shortage area) but that approvals cannot be granted until requirements are met. (Thus, these physicians and family members do not count against family-sponsored, employment-based, or diversity immigrant visa caps.)

This section revises the J-1 visa waiver program for physicians under INA §214(l) (i.e., Conrad 30 program, under which states may request up to 30 waivers per fiscal year for physicians to work three years in underserved areas in lieu of returning home) as follows: (1) updates outdated agency references to the Secretary of Homeland Security and Secretary of State; (2) requires waiver recipients under new subparagraph (C) to have a bona fide full-time job offer deemed in the public interest, work in HHS-designated health professional shortage areas, begin employment within 120 days of waiver approval, graduate medical education completion, or employment authorization (whichever is latest), and commit to three years of service; (3) permits change of status to any employment-authorized nonimmigrant visa without numerical limits (previously limited to H-1B); (4) limits penalties to substantial violations of waiver agreements; (5) extends nonimmigrant status up to six months—and authorizes work for a qualifying employer—if a state denies a waiver due to its annual cap, allowing pursuit of a waiver from another state; (6) mandates employment contracts specifying on-call hours and compensation, malpractice coverage details (including under PHS Act §224(g) [42 U.S.C. 233(g)] for federal liability protection), fixed work locations without later additions, and no non-compete clauses; and (7) provides a 120- or 45-day lawful status period if employment ends during the three-year service obligation.

This section modifies the Conrad 30 waiver program (i.e., INA waivers of the two-year foreign residence requirement for J-1 nonimmigrant physicians who agree to work in health professional shortage areas) by (1) establishing an automatic adjustment to states' annual waiver allotments—increasing from 30 to 35 waivers per state if 90% of waivers available to states receiving at least five were used in the prior fiscal year, with additional five-waiver increases in subsequent years upon meeting the threshold (95% usage by states receiving at least one waiver once allotments reach 45 or more), maintained indefinitely unless usage falls 5% below the prior increase year (triggering stepwise five-waiver decreases per state, not below 30); and (2) authorizing up to three waivers per state per fiscal year for physicians practicing at or serving on the faculty of an academic medical center (as defined in 42 CFR 411.355(e)(2)), without regard to shortage-area designation, if the state agency determines it serves the public interest.

This section amends the Immigration and Nationality Act to facilitate physician immigration in several ways. Specifically, it (1) expands the dual intent exception under INA §214(b)—allowing nonimmigrant visa applicants to express immigrant intent without visa denial—to include aliens seeking graduate medical education or training under INA §212(j) or taking related examinations (in addition to existing exceptions for L, V, and most H-1B nonimmigrants except H-1B1); (2) revises INA §203(b)(2)(B)(ii)(I) national interest waiver (NIW) requirements for physicians by replacing prior service location rules with options to (aa) work full-time in primary care, specialty medicine, or both in Health and Human Services-designated health professional shortage areas or Veterans Affairs facilities, or (bb) serve facilities treating shortage-area patients (regardless of facility location) if deemed in the public interest by a federal agency or local/state health department; (3) clarifies under INA §203(b)(2)(B)(ii)(II) that the five-year NIW service commitment starts upon beginning shortage-area work in any legal status (not visa petition filing/approval), aggregates all prior service (including during training), and eliminates requirements for contracts exceeding remaining service time, recent dating, or new petitions upon work location changes; (4) deems under INA §203(b)(2)(A) a foreign medical degree accepted by a U.S. residency or fellowship program equivalent to an advanced degree for NIW eligibility; (5) provides H-1B physicians completing INA §212(j) graduate medical training with automatic status/employment authorization extensions until October 1 of the relevant fiscal year for timely filed continuation petitions (terminating 30 days after denial/rejection/revocation), plus automatic one-year extensions if fiscal-year H-1B visas are exhausted; and (6) exempts spouses and children of J-1 exchange visitors 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 prior fiscal year under the Conrad State 30 J-1 Visa Waiver Program—under which states may recommend up to 30 waivers per year of the two-year foreign residence requirement (INA §212(e)) for J-1 nonimmigrant physicians who commit to working in health professional shortage areas (INA §214(l))—disaggregated by state.