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Version 00 · Introduced in House · Feb 25, 2025
Conrad State 30 and Physician Access Reauthorization Act
This bill modifies the Conrad 30 Waiver program, which incentivizes qualified foreign physicians to serve in underserved communities. It also extends statutory authority for the program for three years from this bill's enactment.
Individuals coming to the United States under a J-1 nonimmigrant visa to receive medical training typically must leave the country and reside for two years abroad before being eligible to apply for an immigrant visa or permanent residence. The Conrad program waives this requirement for individuals who meet certain qualifications, including serving for a number of years at a health care facility in an underserved area.
Showing the opening paragraphs of the official summary.
The bill increases the number of waivers that a state may obtain each fiscal year from 30 to 35 if a certain number of waivers were used the previous year, and provides for further adjustments depending on demand.
A physician may be employed at an academic medical center to meet the Conrad program's employment requirements if the physician's work is in the public interest, even if the medical center is not in an underserved area.
Employment contracts for physicians under the Conrad program shall contain certain information, such as the maximum number of on-call hours per week the physician shall have to work.
Certain physicians (along with the physician's spouse and children) shall be exempt from the direct annual numerical limits on immigration, including those physicians that have met certain requirements related to visas for physicians to serve in underserved areas.
People & committees
Rep. Valadao, David G. [R-CA-22] · R–CA
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
Referred to the House Committee on the Judiciary.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Oct 8, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-25 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This proposal would extend the Conrad State 30 physician immigration waiver program and change employment rules for participating foreign physicians. It would require clearer contracts, prohibit noncompete clauses, and provide ways to change employers while completing required service. It would also adjust waiver availability, create a limited exception for academic medical centers outside shortage areas, and change immigration rules for physicians and some family members. These are proposed changes, not evidence of enacted law.
inserting on the date that is 3 years after the date of the enactment of the Conrad State 30 and Physician Access Reauthorization Act.
(D) does not include a non-compete provision.
agrees to be employed for the remainder of such 3-year period, and 1 additional year for each termination under clause (ii).
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 professionals
A spouse or child of an exchange visitor described in section 101(a)(15)(J) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be subject to the requirements under section 212(e) of such Act (8 U.S.C. 1182(e)).
2025-02-25: Introduced in House
The bill names itself the Conrad State 30 and Physician Access Reauthorization Act. It would replace a September 30, 2015 date in the cited program law with a date three years after enactment, with that amendment taking effect as if enacted on September 30, 2018.
This Act may be cited as the Conrad State 30 and Physician Access Reauthorization Act.
is amended by striking September 30, 2015 and inserting on the date that is 3 years after the date of the enactment of the Conrad State 30 and Physician Access Reauthorization Act. (b) Effective date The amendment made by subsection (a) shall take effect as if enacted on September 30, 2018.
Section 3 would add a category to Immigration and Nationality Act section 201(b)(1) for foreign physicians who completed service required by the specified waiver. It expressly includes physicians who completed service before enactment and spouses or children of those physicians. The surrounding statute is not supplied, limiting what can be established about this category's operation.
Section 201(b)(1) of the Immigration and Nationality Act (8 U.S.C. 1151(b)(1)) is amended by adding at the end the following: (F) (i) Alien physicians who have completed service requirements of a waiver requested under section 203(b)(2)(B)(ii), including— (I) alien physicians who completed such service before the date of the enactment of the Conrad State 30 and Physician Access Act; and (II) the spouse or children of an alien physician described in subclause (I).
The new category would not prevent covered physicians from filing immigration petitions or applications to adjust their immigration status before completing the specified service. It would not permit approval until all requirements of their section 214(l) waiver were satisfied.
Nothing in this subparagraph may be construed— (I) to prevent the filing of a petition with the Secretary of Homeland Security for classification under section 204(a) or the filing of an application for adjustment of status under section 245 by an alien physician described in this subparagraph before the date by which such alien physician has completed the service described in section 214(l) or worked full-time as a physician for an aggregate of 5 years at the location identified in the section 214(l) waiver or in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals; or (II) to permit the Secretary of Homeland Security to grant a petition or application described in subclause (I) until the alien has satisfied all of the requirements of the waiver received under section 214(l).
For exceptions to the two-year foreign residency requirement, the bill would replace references to the Attorney General and the United States Information Agency director with the Homeland Security and State secretaries. It would require a genuine full-time employment offer that Homeland Security determines serves the public interest, accepted work in a federally designated health professional shortage area, and generally at least three years of service.
(a) Exceptions to 2-Year foreign residency requirement
by striking Attorney General and inserting Secretary of Homeland Security; (2) in subparagraph (A), by striking Director of the United States Information Agency and inserting Secretary of State
(i) the alien demonstrates a bona fide offer of full-time employment at a health facility or health care organization, which employment has been determined by the Secretary of Homeland Security to be in the public interest; and (ii) the alien— (I) 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 professionals
agrees to continue to work for a total of not less than 3 years in the status authorized for such employment under this subsection, except as provided in paragraph (8).
The employment-start deadline would use the latest applicable date: 120 days after receiving the waiver, completing qualifying medical training, or receiving nonimmigrant status or work authorization. The last option would require the physician or employer to petition for that status or authorization within 120 days after training ends.
begins employment by the later of the date that is— (aa) 120 days after receiving such waiver; (bb) 120 days after completing graduate medical education or training under a program approved pursuant to section 212(j)(1); or (cc) 120 days after receiving nonimmigrant status or employment authorization, if the alien or the alien’s employer petitions for such nonimmigrant status or employment authorization not later than 120 days after the date on which the alien completes his or her graduate medical education or training under a program approved pursuant to section 212(j)(1)
With an interested federal or state agency's waiver request and a favorable State Department recommendation, Homeland Security could change a physician's valid J exchange-visitor status to any immigration status that authorizes employment. The numerical limit cited in subsection (g)(1)(A) would not apply to someone whose status changes through this provision; that limit's underlying text is not supplied.
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 101(a)(15)(J) and a favorable recommendation by the Secretary of State, the Secretary of Homeland Security may change the status of such physician to any status authorized for employment under this Act. The numerical limitations contained in subsection (g)(1)(A) shall not apply to any alien whose status is changed under this subparagraph.
The agreement-violation provision would be amended to refer to a 'substantial requirement of an' agreement. Because the surrounding provision is absent, the supplied text does not establish the full enforcement consequences.
(c) Violation of agreements Section 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is amended by inserting substantial requirement of an before agreement entered into.
A physician pursuing graduate medical education or training in J exchange-visitor status whose waiver application was denied because the state reached its annual limit would receive up to six additional months of nonimmigrant status if they agreed to seek a qualifying waiver in a state with available slots. After the new application was filed, work would be authorized only for the specified employer until the earlier of waiver denial or approval of the related change of status.
If an interested State agency denies an application for a waiver under paragraph (1)(B) from a physician pursuing graduate medical education or training pursuant to section 101(a)(15)(J) because the State has requested the maximum number of waivers permitted for that fiscal year, the physician’s nonimmigrant status shall be extended for up to 6 months if the physician agrees to seek a waiver under this subsection (except for paragraph (1)(D)(ii)) to work for an employer described in paragraph (1)(C) in a State that has not yet requested the maximum number of waivers.
Such physician shall be authorized to work only for the employer referred to in subparagraph (A) during the period beginning on the date on which a new waiver application is filed with such State and ending on the earlier of— (i) the date on which the Secretary of Homeland Security denies such waiver; or (ii) the date on which the Secretary approves an application for change of status under paragraph (2)(A) pursuant to the approval of such waiver.
Covered employment contracts would have to specify maximum on-call hours and compensation, disclose malpractice protection and insurance arrangements, and identify every work location. Additional locations would require approval from the agency that requested the waiver. Contracts could not include a noncompete clause restricting work for other employers.
An alien granted a waiver under paragraph (1)(C) shall enter into an employment agreement with the contracting health facility or health care organization that— (A) specifies the maximum number of on-call hours per week (which may be a monthly average) that the alien will be expected to be available and the compensation the alien will receive for on-call time
(B) specifies— (i) whether the contracting facility or organization— (I) has secured medical malpractice liability protection for the alien under section 224(g) of the Public Health Service Act (42 U.S.C. 233(g)); or (II) will pay the alien’s malpractice insurance premiums; (ii) whether the employer will provide malpractice insurance for the alien; and (iii) the amount of such liability protection that will be provided
(C) 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 waiver; and (D) does not include a non-compete provision.
A new paragraph would treat covered physicians whose employment ends during their three-year service period as maintaining lawful status during specified 120-day or 45-day periods. Its internal references do not match the numbered provisions supplied in the bill, leaving the precise application uncertain.
(6) An alien granted a waiver under this subsection whose employment relationship with a health facility or health care organization terminates under paragraph (1)(C)(ii) during the 3-year service period required under paragraph (1) shall be considered to be maintaining lawful status in an authorized period of stay during the 120-day period referred to in items (aa) and (bb) of subclause (III) of paragraph (1)(C)(ii) or the 45-day period referred to in subclause (III)(cc) of such paragraph.
(III) agrees to continue to work for a total of not less than 3 years in the status authorized for such employment under this subsection, except as provided in paragraph (8).
When a waiver physician ends covered employment and takes a new qualifying job in another state, the State Department could give the departing state one additional waiver for the fiscal year in which the employment ended. The replacement slot would be discretionary.
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 (1)(C)(ii), including termination of employment because of circumstances described in paragraph (1)(C)(ii)(III), and accepts new employment with such a facility or organization in a different State, 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 terminated.
Physicians could leave an employer before completing three years when Homeland Security determines, or the requesting state agency attests, that extenuating circumstances justify it. Examples include employer violations of the contract or employment laws. The physician would need another genuine shortage-area job offer within 120 days, subject to a Homeland Security extension, and would still have to complete the remaining service.
(A) (i) the Secretary of Homeland Security determines that extenuating circumstances, including violations by the employer of the employment agreement with the alien or of labor and employment laws, exist that justify a lesser period of employment at such facility or organization; and (ii) the alien demonstrates, not later than 120 days after the employment termination date (unless the Secretary determines that extenuating circumstances would justify an extension), 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 professionals, for the remainder of such 3-year period
(B) (i) the interested State agency that requested the waiver attests that extenuating circumstances, including violations by the employer of the employment agreement with the alien or of labor and employment laws, exist that justify a lesser period of employment at such facility or organization; and (ii) the alien demonstrates, not later than 120 days after the employment termination date (unless the Secretary determines that extenuating circumstances would justify an extension), 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 professionals, for the remainder of such 3-year period
A physician could instead change employers without seeking an extenuating-circumstances determination. They would need another genuine shortage-area job offer within 45 days, in the state that requested the waiver, and would owe the remaining service plus one additional year for each such termination.
(C) the alien— (i) elects not to pursue a determination of extenuating circumstances pursuant to subclause (A) or (B); (ii) terminates the alien’s employment relationship with the health facility or health care organization at which the alien was employed; (iii) demonstrates, not later than 45 days after the employment termination date, another bona fide offer of employment at a health facility or health care organization in a geographic area or areas, in the State that requested the alien’s waiver, which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals; and (iv) agrees to be employed for the remainder of such 3-year period, and 1 additional year for each termination under clause (ii).
State waiver allotments would rise to 35 when 90 percent of available waivers in states receiving at least five waivers were used in the previous fiscal year. Further increases would be five waivers at a time under the same threshold. Once allotments reached 45 or more, another increase would require 95 percent use among states receiving at least one waiver.
(i) All States shall be allotted a total of 35 waivers under paragraph (1)(B) for a fiscal year if 90 percent of the waivers available to the States receiving at least 5 waivers were used in the previous fiscal year. (ii) When an allotment occurs under clause (i), all States shall be allotted an additional 5 waivers under paragraph (1)(B) for each subsequent fiscal year if 90 percent of the waivers available to the States receiving at least 5 waivers were used in the previous fiscal year. If the States are allotted 45 or more waivers for a fiscal year, the States will only receive an additional increase of 5 waivers the following fiscal year if 95 percent of the waivers available to the States receiving at least 1 waiver were used in the previous fiscal year.
Increased allotments would remain in place unless total waivers granted fell by five percent from the last year with an allotment increase. That would reduce each state's allotment by five the next fiscal year, with further five-waiver reductions for each additional five-percent decline. Allotments could not fall below 30.
Any increase in allotments under subparagraph (A) shall be maintained indefinitely, unless in a fiscal year, the total number of such waivers granted is 5 percent lower than in the last year in which there was an increase in the number of waivers allotted pursuant to this paragraph, in which case— (i) the number of waivers allotted shall be decreased by 5 for all States beginning in the next fiscal year; and (ii) each additional 5 percent decrease in such waivers granted from the last year in which there was an increase in the allotment, shall result in an additional decrease of 5 waivers allotted for all States, provided that the number of waivers allotted for all States shall not drop below 30.
A state agency could request waivers for physicians practicing medicine or serving as residency-program faculty at qualifying academic medical centers even outside shortage areas. The agency head would have to find the work in the public interest. This pathway would be limited to three waivers per state per fiscal year within the referenced overall limit.
(iv) in the case of a request by an interested State agency— (I) the head of such agency determines that the alien is to practice medicine in, or be on the faculty of a residency program at, an academic medical center (as that term is defined in section 411.355(e)(2) of title 42, Code of Federal Regulations, or similar successor regulation), 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 professionals; and (II) the head of such agency determines that— (aa) the alien physician’s work is in the public interest; and (bb) 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 (within the limitation in subparagraph (B) and subject to paragraph (6)) in accordance with the conditions of this clause to exceed 3.
Under a provision titled 'Dual intent for physicians seeking graduate medical training,' the bill would add people coming for qualifying medical training or required examinations to the exceptions listed in section 214(b). The underlying rule is not reproduced, so the exact legal effect of that exception cannot be fully explained from this bundle.
(a) Dual intent for physicians seeking graduate medical training
inserting (other than a nonimmigrant described in subparagraph (L) or (V) of section 101(a)(15), a nonimmigrant described in any provision of section 101(a)(15)(H)(i) (except subclause (b1) of such section), and an alien coming to the United States to receive graduate medical education or training described in section 212(j) or to take examinations required to receive graduate medical education or training described in section 212(j)).
For the physician national-interest immigration waiver, the replacement eligibility language would expressly include full-time primary care, specialty medicine, or both in designated shortage areas, or work at a Veterans Affairs health facility. The bill does not reproduce all underlying waiver requirements.
(b) Physician national interest waiver clarifications
the alien physician agrees to work on a full-time basis practicing primary care, specialty medicine, or a combination thereof, in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals, or at a health care facility under the jurisdiction of the Secretary of Veterans Affairs
An alternative national-interest waiver pathway would cover service at facilities treating patients who live in shortage areas, even if the facilities are elsewhere. A federal agency or a local, county, regional, or state public health department would have to determine that the physician's work was or would be in the public interest.
(bb) 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 (without regard to whether such facility or facilities are located within such an area) and a Federal agency, or a local, county, regional, or State department of public health determines the alien physician’s work was or will be in the public interest.
The five-year service clock for this waiver would start when the physician began shortage-area work in any legal status, rather than when an immigrant visa petition was filed or approved. Service would be added together regardless of when it began, including service beginning during or alongside graduate medical education.
The 5-year service requirement under item (aa) 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 approved. 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 education.
Physicians would not have to submit contracts longer than their remaining five-year service commitment or contracts dated within a specified recent period before filing. A change in work location would not require another immigrant visa petition.
(cc) An alien physician shall not be required to submit an employment contract with a term exceeding the balance of the 5-year commitment yet to be served or an employment contract dated within a minimum time period before filing a visa petition under this subsection. (dd) 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 petition.
For the amended immigration classification, a foreign medical degree accepted as sufficient by an accredited U.S. medical residency or fellowship program would qualify its holder as a professional with an advanced degree or its equivalent.
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 equivalent.
Physicians completing qualifying medical training in the specified H nonimmigrant status would receive an automatic extension to October 1 when a timely petition sought continued status with an October 1 employment start date. They would also be authorized to work between petition filing and that date.
A physician completing graduate medical education or training described in section 212(j) of the Immigration and Nationality Act (8 U.S.C. 1182(j)) as a nonimmigrant described in section 101(a)(15)(H)(i) of such Act (8 U.S.C. 1101(a)(15)(H)(i))— (A) shall have such nonimmigrant status automatically extended until October 1 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 1 of that fiscal year; and (B) shall be authorized to be employed incident to status during the period between the filing of such petition and October 1 of such fiscal year.
That extended status and work authorization would end 30 days after the petition was rejected, denied, or revoked. If all authorized visas in the cited H category had been issued for the fiscal year, status and work authorization would automatically extend to October 1 of the next fiscal year.
(2) Termination The physician’s status and employment authorization shall terminate on the date that is 30 days after the date on which a petition described in paragraph (1)(A) is rejected, denied or revoked. (3) Automatic extension A physician’s status and employment authorization will automatically extend to October 1 of the next fiscal year if all of the visas described in section 101(a)(15)(H)(i) of such Act that were authorized to be issued for the fiscal year have been issued.
Spouses and children of J exchange visitors would be exempt from the requirements of Immigration and Nationality Act section 212(e). The provision is not limited to physicians' families. The requirements being removed are not reproduced in the supplied text.
A spouse or child of an exchange visitor described in section 101(a)(15)(J) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be subject to the requirements under section 212(e) of such Act (8 U.S.C. 1182(e)).
The U.S. Citizenship and Immigration Services director would have to report annually to Congress and the Department of Health and Human Services on people admitted through the Conrad State 30 program in the most recently completed fiscal year, with separate counts for each state.
The Director of U.S. Citizenship and Immigration Services shall submit an annual report to Congress and to the Department of Health and Human Services that identifies the number of aliens admitted during the most recently concluded fiscal year as a result of the Conrad State 30 J–1 Visa Waiver Program established under sections 212(e) and 214(l) of the Immigration and Nationality Act (8 U.S.C. 1182(e) and 1184(l)), disaggregated by State.
The supplied October 8, 2026 source snapshot records introduction in the House and referral to the House Judiciary Committee on February 25, 2025. It does not establish what happened after those recorded actions.
Source snapshot updated 2026-10-08T14:49:41Z. 2025-02-25: Referred to the House Committee on the Judiciary. 2025-02-25: Introduced in House
A closer look
Reviewed version: Introduced in House · 2025-02-25. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated rider was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish the absence of riders in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials. Formal earmark disclosures were not supplied.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
The supplied text contains specific exceptions warranting scrutiny as targeted benefits. This classification does not establish improper purpose or an adverse effect.
Qualifying academic medical centers and physicians practicing or teaching there would receive a narrow exception to the shortage-area location condition. A state agency head would have to find the work in the public interest, and the pathway would be capped at three waivers per state per fiscal year within the referenced overall limit. This exception relates directly to the bill's physician-placement policy.
(iv) in the case of a request by an interested State agency— (I) the head of such agency determines that the alien is to practice medicine in, or be on the faculty of a residency program at, an academic medical center (as that term is defined in section 411.355(e)(2) of title 42, Code of Federal Regulations, or similar successor regulation), 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 professionals; and (II) the head of such agency determines that— (aa) the alien physician’s work is in the public interest; and (bb) 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 (within the limitation in subparagraph (B) and subject to paragraph (6)) in accordance with the conditions of this clause to exceed 3.
Spouses and children of J exchange visitors would receive an express exemption from section 212(e)'s requirements. This family-specific exception extends beyond physician families, although it remains related to the bill's immigration-waiver subject. The underlying statutory requirements are not reproduced, limiting assessment of the exemption's full scope.
A spouse or child of an exchange visitor described in section 101(a)(15)(J) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be subject to the requirements under section 212(e) of such Act (8 U.S.C. 1182(e)).
Full text preserved for this analysis. Legislative record snapshot: Oct 8, 2026. How PlainBill uses AI