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Showing posts with label Conrad 30. Show all posts
Showing posts with label Conrad 30. Show all posts

Friday, April 28, 2017

Navigating Uncertain Times: Whew - That Was Close!


Navigating Uncertain Times:  Friday Roundup

Friday April 28, 2017

 

Whew!  That was close… [Check in again next week]

In the midst of loud announcements and unseen tinkering with the immigration system, it may have been lost on many persons that several key immigration programs nearly suffocated today.  But instead they were resuscitated just in time to live for…(wait for it)… one more…week.

The EB-5 Regional Center program (which attracts large fund investments from abroad to create additional jobs for American workers) was tethered to the ‘Continuing Resolution’ that Congress had passed in December of 2016 to keep the U.S. Government from ‘shutting down’.

Another very popular program – the Conrad 30 J-1 Visa Waiver Program - is an integral tool for rural healthcare systems to attract physicians to their medically underserved areas by giving physicians trained in the U.S. with a J-1 visa the opportunity to provide healthcare where other doctors are reticent to go, without having to return to their home country for 2 years before seeking to return to the U.S. to serve.

Also, religious workers who are not ministers have relied upon another program – the R-visa – to come to the U.S. to serve in religious institutions.  This was also saved by the approval of Congress to continue funding the U.S. Government budget with a Continuing Resolution.

That’s the good news.

The bad news is that the continuing resolution that keeps these programs functioning is valid for only 7 days.

And then we get to see if they (our representatives in the U.S. Congress) will pass another bill next week to keep these important immigration programs active.  If we’re lucky, we can keep it going perhaps as much as another 4 months!

I have to imagine that the founding fathers of the United States of America envisioned a much better functioning government than what we are now living with.   

So check back next week to see what happens…

Have a nice weekend,

HS&D Immigration

Friday, March 17, 2017

Navigating Uncertain Times: Friday Roundup


Navigating Uncertain Times:  Friday Roundup


Friday March 17, 2017


Happy St. Patrick’s Day!


As most schoolkids know, unless you intentionally want to get pinched – you had better wear green today.

One of the more enjoyable American holidays is St. Patrick’s Day.  No demands on your celebration.  You wear green, maybe you eat corned beef and potatoes or perhaps raise ‘a pint o’ Guinness’.  It is said that on St. Patrick’s Day, everyone is Irish.  We at least try to claim a little Irish heritage on this day.

But it wasn’t always so…

This might be a good moment to pause and reflect that a century ago, the Irish were unwanted immigrants.  They were marginalized and feared because their migration to the U.S. was somehow tainting what it meant to be ‘American’.

Adopting distinctive Irish traditions and heritage into our national culture has enriched our country and gives us reason to celebrate one of the fundamental features of American society: our rich diversity.  It’s a good time to remember that it’s okay to embrace new and different cultures, traditions, heritage…and people.

So enjoy!  Celebrate!  And remember who you are… and where you came from

Slainte!

HSD immigration group


In other news…

Travel Ban 2.0

On Wednesday, a federal district judge in Hawaii granted the state’s Motion for a Temporary Restraining Order on the implementation of  Sections 2 and 6 of President Trump’s revised Executive Order temporarily banning admission of immigrants from 6 predominately Muslim countries and refugees.  The Executive Order was scheduled to go into effect yesterday, but the TRO suspends its implementation until a hearing can be held on its merits.

Last week we alluded to the possibility that the origin and heritage of the Executive Order has so stained it that it cannot be separated from the President’s prior expression of intent to exclude persons of the Islamic faith from entering the U.S.  The federal district judge’s Opinion echoed that very problem in finding that the Executive Order was in violation of the Establishment Clause, the First Amendment to the U.S. Constitution.  [ As interpreted by the courts, the 1st Amendment states that the government cannot take action “respecting an Establishment of Religion, or prohibit the free exercise thereof….” ]. Exercising the analysis set forth in the 1971 seminal U.S. Supreme Court case Lemon v. Kurtzman, the Hawaii District Court found that the government action did not have a ‘primarily secular purpose’ and therefore violated the ‘Establishment’ clause.  Additional evidence from the U.S. Dept. of Homeland Security concluding that the country of origin provided an insufficient link to the likelihood that a person might commit a terrorist act was entered into the Record and served to undermine the government’s own argument that its purpose was for the sake of national security.  It would seem that for the Administration to succeed, it would need to convince a court – perhaps the U.S. Supreme Court – that the President’s valid legal authority to make decisions regarding who may be admitted to the U.S. supersedes any limitation on that authority expressed in the Establishment Clause of the U.S. Constitution and/or other discrimination prohibitions found in federal law.

Stay tuned…

The Federal Budget

Perhaps one of the more obscure immigration-related news items this week was the issuance of the President’s new Budget Proposal.  One of the recommendations found in the proposed Budget was the elimination of the Appalachian Regional Commission ('ARC') and the Delta Regional Authority, ('DRA') among other regional commissions.

How does that affect immigration?

Because the Appalachian Regional Commission and Delta Regional Authority offer J-1 visa waivers to primary care physicians who are willing to provide direct patient healthcare to persons living in medically underserved areas – or more specifically, where there is a shortage of primary care physicians.

This is important because in many states that offer J-1 visa waivers to attract physicians to underserved areas, the primary program is what is known as the ‘Conrad 30’ J-1 visa waiver program.  As the name indicates, there are only 30 slots available for physicians who want to secure a J-1 visa waiver. 

[For explanation, foreign physicians who come to the U.S. to train in Residency programs often get a ‘J-1 visa’ to enter the U.S.  The catch is that the physician is required to return to her home country for 2 years before she can seek an H-1B visa that allows her to provide direct patient care.  A ‘waiver’ of that 2-year home residency requirement allows the new Residency graduate to immediately practice medicine in the U.S.].

Many states use up the allotment of 30 J-1 waivers under the Conrad 30 program fairly quickly.  Fortunately, the ARC and DRA provide an unlimited supply of J-1 Waivers for physicians who are not able to get a Conrad 30 waiver.  The ARC and DRA waivers are a bit more complicated, rigorous and narrowly defined than a Conrad 30 Waiver, but they at least offer an alternative for physicians who are willing to serve where other primary care doctors avoid serving.  In fact, some states like Virginia require physicians who qualify for a J-1 Waiver under the ARC program to seek a waiver there first – so that it can preserve the limited 30 Conrad waivers for physicians who have no other alternatives.

The Budget process may end up preserving the Appalachian Regional Commission – and the many other valuable services that it provides, for the sake of persons living in medically underserved areas and the foreign physicians who serve them. 

Comprehensive Immigration Reform

This takes the prize as the most unexpected news item this week - but there seems to be ‘chatter’ that the turbulent immigration developments over the past two months have somehow energized momentum for comprehensive immigration reform.  In a bi-partisan sort of way!

If this is an accurate development, it would be most welcome.  As you may recall, there was a remarkably successful period of bi-partisan collaboration on a Senate Bill in 2013.  Led by a ‘gang of eight’ Republican and Democratic senators, a Bill that ‘fixed’ many of dysfunctions of our immigration system – both on security and accommodation of visas – and passed fairly easily.  Unfortunately, it languished in the House of Representatives until it ultimately died with no action taken.

If in fact there is a renewed interest in coming to agreement on how to repair our immigration system, this would be a very positive development.

Have a nice weekend –

HSD Immigration Group

Friday, March 10, 2017

Navigating Uncertain Times: Friday Roundup


Friday March 10, 2017



H-1B Alert!


Summary:

As most people know, the President issued a new and revised ‘Travel Ban’ this week – which we will discuss in more detail later – but a more obscure announcement was made that can have a wide-ranging impact on foreign nationals already living here on H-1B visas.

USCIS announced that it would be suspending ‘Premium Processing’ of H-1B visas beginning on April 3, 2017 (the first day of receiving new H-1B visas under the ‘H-1B cap’).

Those who will be most greatly affected by this development will by physicians who are completing their residencies in J-1 status – and need a Conrad 30 J-1 waiver to file a new H-1B petition.


H-1B Premium Processing Suspension

Late last Friday, USCIS announced that it was temporarily suspending ‘Premium Processing’ for all H-1B petitions filed on or after April 3, 2017.  It will be suspended ‘up to 6 months’.

And they are serious about it.  In fact, if one mistakenly files a ‘Premium Processing’ request after April 3, 2017 with the regular filing fee and the Premium Processing fee on the same check, they will reject the entire H-1B package petition.

Here’s why it matters:

As you may know, ‘Premium Processing’ is an application that one can file to request expedited processing of the H-1B petition.  It is accompanied by a filing fee of $1,225 – in exchange for a guaranteed decision within 15 calendar days.  This used to be a luxury – back when the normal processing times for H-1B visas was 4-5 months.

But now, the current processing time for someone filing an H-1B extension to continue working in H-1B status in our region is approximately 8-9 months.  Since employers are prohibited from filing an H-1B petition more than 6 months ahead of time, it is nearly impossible to get a new H-1B extension Approval Notice before the present H-1B status expires under regular processing. 

Since federal law and regulations permit a foreign employee working in H-1B status to continue working for 240 days following the expiration date of her existing H-1B status if her employer files an extension before her H-1B status expires, this would not be a particularly big deal…except that most states now issue driver’s licenses with an expiration date that corresponds to the H-1B validity date.  Thus, while someone who has timely filed an H-1B extension may still work, she cannot drive to work.

Thus, since most driver’s license offices require an H-1B Approval Notice to renew a driver’s license,  for about the past year it has become routine for foreign employees in H-1B status to use Premium Processing – just so that they continue driving to work.

 So the ability to use Premium Processing can make a big difference to employees in H-1B status.

But it’s an even bigger deal to a Physician who intends to use H-1B status to provide clinical care to patients following her Medical Residency.

Most foreign-educated physicians who complete their Medical Residencies in the U.S. complete their training using a J-1 visa.  But there is a catch.  The J-1 visa status requires the Physician visa holder to return home for 2 years following completion of her Residency in J-1 status.

Unless she gets a waiver of the 2-year home residency requirement

Typically, this is done with a Conrad 30 J-1 visa waiver.

Without going into great detail about the process, it is sufficient to say that it’s a lengthy process going through several state and federal agencies over several months before getting a decision.  But here’s a peculiarity of the Conrad 30 program:  it requires the Physician to begin work in H-1B status within 90 days of receiving an Approval of the J-1 Waiver.  Since nearly all Physician residencies conclude on the same day – (June 30) – this means that there is a window of time to get the J-1 waiver approved.  For a July 1 start date, one must actually get the Approval sometime after April 1.

What’s more, some states – like Tennessee – won’t issue an unrestricted Medical License until the Physician completes her Residency.  On the other hand, Conrad 30 J-1 waiver recipients are exempt from the H-1B cap – so we don’t have to worry about trying to get a petition filed on April 1 (while the Physician is still in Residency).

But the bottom line is – by the time the Physician is ready to file an H-1B petition, it is usually already May, June or July.

Luckily, we always had Premium Processing to make sure the Physician could begin work within 2 weeks of Residency completion….   I think you can see the problem.

If the Physician’s employer cannot use Premium Processing… and the processing time is 8-9 months… it’s possible that a Physician completes her Residency in June, but cannot begin to work until February of the following year. 

We can hope that perhaps USCIS will reinstate Premium Processing  sometime in October or November, but that is well past the 90-day window in which the Physician is mandated to begin employment,(not to mention that it is a long time after Residency just waiting to begin work).

It’s still a big deal.   

 

The Trump Travel Ban: version 2.0

On Monday of this week, the President issued a second Executive Order addressing the admission of refugees and certain persons from certain countries into the U.S.

The second effort is much narrower and tailored to address the flaws in the first ban which the 9th Circuit Court of Appeals concluded were unenforceable.

Here is a snapshot view of some of the major differences:

·         Iraqi nationals were removed from the list of foreign nationals from predominately Muslim countries who were prohibited from admission to the U.S.

·         It eliminates the ban on persons from the remaining 6 predominately Muslim countries who have ‘green cards’

·         It re-establishes a 120-day ban on the admission of any refugees – but Syrian refugees are no longer ‘indefinitely’ banned; they are subject to the same 120 day ban just as other refugees

·         It reduces the total number of refugees resettled in the U.S. under the U.S. Refugee Assistance Program from 110,000 to 50,000

·         It no longer gives a preference to ‘religious minorities’ [most likely Christians in predominately-Muslim countries]

 

Several states have already filed lawsuits to block the new travel ban, fundamentally on the same basis as before.  However, since the Travel Ban 2.0 was crafted more carefully to avoid some of the legal flaws that led to the demise of the first ban, the outcome will be less predictable.

Here is a sample summary of some of the issues presented by the new Executive Order banning travel:

·         It appears that there is still an evidentiary weakness in naming Syria, Iran, Libya, Somalia, Sudan and Yemen as countries from which its citizens are prohibited from entering the U.S. because of fear that they may commit harm when they arrive in the U.S.  Although the sectarian violence and conflict in these countries is well-known, the relationship between the threat that exists in these countries with the threat that their citizens pose to the U.S. is tenuous from an historical precedent.

 

·         In the absence of historical precedent, the court may decide that a ‘blanket’ ban on entire nations is not well-suited  - ‘too broad’ - for the intended purpose of the ban.  A court may decide that the Department of Homeland Security and Department of State can ameliorate this perceived threat by less-dramatic means, such as simply scrutinizing the background of citizens from these countries on a ‘case-by-case’ basis.

 

·         The core intent and effect of the ‘Travel Ban’ is inextricably derived from the President’s earlier pledges to create a ban to prevent persons of the Islamic faith from entering the U.S.  Such a ban is clearly unconstitutional.  However, the Travel bans 1.0 and 2.0 maintain a restriction from at least 6 countries that are predominately populated by persons of the Islamic faith.  This tainted legacy of the ‘Travel Ban’ will be hard to disentangle from the very real security threats that the U.S. indeed faces from individuals and groups around the world who want to do harm to the U.S.  The origin and history of these ‘Travel Bans’ may doom their viability.

 

·         One final point to consider:  the Executive Order banning admission of certain persons from certain countries is stated to be ‘temporary’.  It’s a 90-day ban on nationals of the 6 predominately-Muslim countries and a 120 day ban on refugees.  The indefinite ban on Syrian refugees has been removed, so it is fair to consider whether or not this Executive Order is actually a temporary restriction.  A brief suspension of immigration benefits in response to an imminent threat – for the purpose of addressing security measures – would not in itself seem to be unreasonable.  The question for the courts would be – are the security measures actually in response to a verifiably real – or simply perceived – threat; if so, what actions are the Department of Homeland Security and Department of State taking to institute necessary ‘fixes’ to the system; and has the Administration placed too many restrictions on the ability to reinstate the normal travel accessibility once the ‘review measures’ and ‘fixes’ have been concluded after 90 or 120 days?

 

This is why our Constitution created a third and independent branch of the U.S. Government: to examine and determine whether or not an Executive action as controversial as this adheres to the body of law established by the Courts’ interpretation of the U.S. Constitution throughout our history.

 

Stay tuned as these cases make their way through our Court system.   

Thursday, July 30, 2015

Is There a Doctor In The House…or Senate?

 

A long-term patient known as ‘Conrad’ is about to expire on September 30, 2015 unless Congress can resuscitate it and provide a permanent cure.

The ‘Conrad 30’ Program, named after former North Dakota Senator Kent Conrad - the law’s original sponsor, is a program for foreign physicians who come to the U.S. with a J-1 visa to complete their medical residency.  The J-1 visa permits foreign medical graduates to receive education and training in a Residency program in the U.S.  However, one of the terms of the J-1 visa – also known as an ‘exchange-visitor’ visa – is that it requires the visa holder to return to his or her home residence for 2 years before being eligible to adjust status or change to another type of visa that permits her to practice medicine in the U.S.  In other words, the newly-trained physician must return home for 2 years before being able to practice medicine in the U.S… unless….

…the physician is able to get a ‘waiver’ of the 2-year home residency requirement found in §212(e) of the Immigration & Nationality Act.

There are several ways in which any J-1 visa holder may request a ‘waiver’ of the 2-year home residency requirement; among these are ‘subject to persecution’ if she were to return to her home residence, exceptional hardship, and other scenarios with very high standards that not everyone can meet.  But physicians have a friend in ‘Conrad’.

The ‘Conrad 30’ program is designed specifically for physicians who desire a waiver of the 2-year home residency requirement.  Each state runs its own ‘Conrad 30’ program with its own set of guidelines, but there are a few fundamental terms that all ‘Conrad 30’ programs share; among those are that a physician must be willing to serve at least 3 years in H-1B visa status working at least 40 hours/week in a federally-designated medically underserved area providing primary care – and sometimes specialty care – to the underserved population.   You already know why it’s named ‘Conrad’; the ‘30’ stands for the number of slots available in each state for physicians willing to serve in these medically underserved areas.

Although there are some other programs that provide ‘waivers’ for physicians in J-1 visa status, (for example, Appalachian Regional Commission, the U.S. Department of Health & Human Services, U.S. Dept. of Veterans Affairs, etc.), these other programs have narrow restrictions that limit their availability.  It is recognized that the Conrad 30 program is likely the most useful waiver program for physicians in J-1 status.

However, the original Conrad 30 program had a ‘sunset’ date that has been extended by Congress to keep the program alive for years.

Unless you’ve been in a coma for the past several years, you must recognize that the volatility and rancor of our elected leaders in Congress make the prognosis of their cooperation on an immigration bill anything but certain.
 This year presents a risk that the program will die due to the negligence – and perhaps the intentional refusal of care - of our politicians.

The good news is that Senators Klobuchar of Minnesota and Heitkamp of North Dakota have introduced a Bill in the Senate, (S. 1189) that not only extends the life of the Conrad 30 program, but makes it a permanent federal law by removing the ‘sunset’ provisions.

Known as the ‘Conrad State 30 and Physician Access Act’, this bill would also clarify certain elements of the National Interest Waiver for physicians and permitting the spouses of H-1B visa-holding physicians to change status to other types of visas besides the ‘H-4’ derivative visa, among other things.

The ‘Conrad State 30’ Program is a powerful incentive for healthcare systems in rural, urban and other medically underserved areas to attract and keep physicians to care for communities in need of primary care medical services.  Many healthcare systems rely heavily upon the benefits of the Conrad 30 program to staff their hospitals and facilities - and foreign medical graduates recognize the valuable benefit it provides for them; its demise would impact these communities disproportionately.

So if you were waiting for the right opportunity to contact your U.S. Senator or Representative on an issue that overwhelmingly affects the health of small, rural communities, this would be a good time to ask for their support of Senate Bill 1189 – before it’s too late.