This Act may be cited as the `Nursing Relief for Disadvantaged Areas Act of 1999'.

1. have a full and unrestricted license as a nurse in their home countries or must have been educated in the United States
2. pass an appropriate examination (to be determined by HHS), or have a full and unrestricted license to practice as an RN in the state of intended employment
3. must be fully qualified and eligible under all state laws and regulations to practice as an RN in the state of intended employment immediately upon admission to the United States.

1. the employer is a hospital (as defined under Section 1886(d)(1)(B) of the Social Security Act)^* and is located in a designated health professional shortage area as of March 31, 1997, has at least 190 acute care beds, and that, since 1994, ahs had at least 35% of its patients entitled to Medicare, and at least 28% Medicaid;
2. employment of the nurse will not adversely affect wages and working conditions of similarly employed nurses;
3. the nurse will be paid the same rate as other registered nurses similarly employed at the facility;
4. the facility has taken and is taking timely and significant steps to recruit and retain U.S. citizen or immigrant registered nurses
5. there is not a strike or lockout in the course of a labor dispute, the facility did not lay off and will not lay off a registered nurse employed by the facility with in the 90 days before and the 90 days after the date of filing a visa petition for the H-1C nurse and the employment of an H-1C nurse is not intended or designed to influence union activity (layoff means loss of employment other than through discharge for inadequate performance, violation of workplace rules, cause, voluntary departure, voluntary retirement, or expiration of a grant or contract but does not include any situation in which the work is offered, as an alternative to termination, a similar employment opportunity with the same employer at equivalent or higher compensation and benefits, regardless of whether the alternative job offer is accepted).
6. notice of the filing is provided to the bargaining representative for registered nurses at the facility or, if no bargaining representative, has been posted to employees in conspicuous locations;
7. that the facility will never employ H-1C nurses as more than 33% of its total registered nursing staff;
8. the H-1C nurse will not work at any worksite not directly controlled by the employer or transfer the H-1C nurse to another worksite during the course of the nurse's employment.

• No facility is required to have taken timely and significant steps to recruit and retain U.S. nurses until after the enactment of this act.
• Significant steps will include (non-exclusive list):

1. operating a training program for nurses at the facility or financing (or providing participation in) a program elsewhere;
2. providing career development programs and other methods to encourage other health care workers to become registered nurses;
3. paying a wage to registered nurses higher than the prevailing wage;
4. providing "reasonable opportunities for meaningful salary advancement" by RNs.

• Facilities do not need to take more than one step if a second step is "not reasonable"
• Attestations are valid for one year from date of filing, or the last day that any H-1C nurse is employed under the attestation (whichever is later), and can be used for filing petitions for one year from the date of its filing.

DOL may collect a fee of up to $250 per attestation to cover DOL's costs for administering the program.

H-1C nurses may be admitted for three years. No extensions are provided.

1. the physician agrees to work full time in a designated health professional shortage area or in VA hospital; and
2. A federal agency or State department of public health has determined that the physicians work is in the public interest

• The physician may not be eligible for an immigrant visa or adjustment of status until such time as he or she has worked full time as a physician in a shortage area or VA hospital for an "aggregate" of five years (not including time in J-1 status). However, petitions and adjustment applications can be filed prior to the date the five years' service is completed.
• This section does not apply to waivers approved before the date of enactment. However, in the case of a physician for whom a national interest waiver was filed before November 1, 1998, the AG shall approve the waiver as long as the physician has worked in the shortage area or VA facility for at least three years (not including time as J-1).

39BS9024

(B) As used in this section, the term ''subsection (d) hospital'' means a hospital located in one of the fifty States or the District of Columbia other than -

(i) a psychiatric hospital (as defined in section 1395x(f) of this title),

(ii) a rehabilitation hospital (as defined by the Secretary),

(iii) a hospital whose inpatients are predominantly individuals under 18 years of age,

(iv)(I) a hospital which has an average inpatient length of stay (as determined by the Secretary) of greater than 25 days, or (II) a hospital that first received payment under this subsection in 1986 which has an average inpatient length of stay (as determined by the Secretary) of greater than 20 days and that has 80 percent or more of its annual Medicare inpatient discharges with a principal diagnosis that reflects a finding of neoplastic disease in the 12-month cost reporting period ending in fiscal year 1997, or

(v)(I) a hospital that the Secretary has classified, at any time on or before December 31, 1990, (or, in the case of a hospital that, as of December 19, 1989, is located in a State operating a demonstration project under section 1395f(b) of this title, on or before December 31, 1991) for purposes of applying exceptions and adjustments to payment amounts under this subsection, as a hospital involved extensively in treatment for or research on cancer, or¹ (II) a hospital that was recognized as a comprehensive cancer center or clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of April 20,1983, that is located in a State which, as of December 19, 1989, was not operating a demonstration project under section 1395f(b) of this title, that applied and was denied, on or before December 31, 1990, for classification as a hospital involved extensively in treatment for or research on cancer under this clause (as in effect on the day before August 5, 1997), that as of August 5, 1997, is licensed for less than 50 acute care beds, and that demonstrates for the 4-year period ending on December 31, 1996, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E);

and, in accordance with regulations of the Secretary, does not include a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital (as defined by the Secretary). A hospital that was classified by the Secretary on or before September 30, 1995, as a hospital described in clause (iv) shall continue to be so classified notwithstanding that it is located in the same building as, or on the same campus as, another hospital.