New Requirements for Foreign Health Care Professionals
Posted Aug 01, 2003

Historically, a foreign health care professional seeking a nonimmigrant work visa has enjoyed a waiver from the certification requirement for health care workers. Legislation passed into law in 1996 created a new requirement that health care workers obtain a certificate to verify their educational and licensure credentials in order to work in the U.S. Since 1996, this rule was only applicable to health care workers seeking permanent residency. On July 25, 2003, the U.S. Department of Homeland Security (DHS) published a new regulation removing the waiver and requiring that both immigrant and nonimmigrant health care workers obtain the certification as a criteria for obtaining employment in the U.S. Although other provisions of the new regulation become effective as of September 23, 2003, the waiver of the certificate requirement for nonimmigrant health care workers is extended until July 26, 2004.  

Nonimmigrant visas are issued to foreign nationals who wish to temporarily enter the United States. All nonimmigrant work visa categories are subject to the new regulation, including the popular H1B visa, the TN visa (available to Canadian and Mexican nationals) and J and O visas. The regulation does not apply to F-1, J-1, or H-3 nonimmigrants coming to the U.S. for school or practical training.

The DHS recognized the potential hardship to nonimmigrant health care workers already present in the U.S. and to those who have applications pending, but who do not presently have a certificate, if the rule were effective upon publication. Accordingly, the DHS extended the waiver of the certificate requirement until July 26, 2004. Pursuant to the waiver, a nonimmigrant health care worker is admissible to the U.S. without the certification, but must obtain the certification within one year.

The VisaScreen Certificate, issued by the International Commission on Healthcare Professionals (ICHP) has become the most commonly issued certificate. ICHP is a division of the Commission on Graduates of Foreign Nursing Schools (CGFNS). Other credentialing organizations are authorized to issue certificates. These include the National Board for Certification in Occupational Therapy (NBCOT) and the Foreign Credentialing Commission on Physical Therapy (FCCPT). The DHS maintains a list of all organizations authorized to issue certificates to certain health care workers, available on the BCIS WebSite.

Classes of Affected Health Care Workers

The law dictates that an applicant is inadmissible unless s/he presents a certificate verifying that his/her education, training, license, and experience meet all requirements for entry to the United States, and that the applicant is competent in both spoken and written English. Except for physicians who are exempt from this requirement, the new regulation applies to a broad class of health care workers who fall within one of the following seven categories: nurses, physical therapists, occupational therapists, speech-language pathologists and audiologists, medical technologists (also known as clinical laboratory scientists), medical technicians (also known as clinical laboratory technicians), and physician assistants.

Details of the VisaScreen Certificate

The VisaScreen Certificate is generally representative of the requirements for certification. It is comprised of three parts, with an additional fourth requirement for nurses. The first part is an educational review, which ensures that the applicant's education meets all applicable, statutory and regulatory requirements for the profession in which the applicant intends to practice and is comparable to that of a U.S. graduate seeking licensure.

The second component of the VisaScreen Certificate is the licensure review, which evaluates initial and all current and past licenses. Validations provided directly to ICHP by the issuing / validating institution affirm that the applicant has completed all practice requirements and that the registration or licensure is authentic and has no encumbrances. As a practical matter, applicants should be aware that satisfying the licensure review requires correspondence between CGFNS and the licensing authorities that issued all past licenses to the applicant. Sufficient time should be allowed for the licensing authority to process and forward the required paperwork to CGFNS on behalf of the applicant.

The third component of the VisaScreen Certificate is the English language proficiency assessment, which confirms that the applicant has demonstrated the required competency in oral and written English by submitting passing scores on tests approved by the U.S. Departments of Education, and Health and Human Services. To fulfill this requirement, applicants may take either the Test of English as a Foreign Language (TOEFL), Test of Written English (TWE) and Test of Spoken English (TSE), administered by the Educational Testing Service (ETS); or the Test of English for International Communication (TOEIC), administered by the Chauncey Group, along with the TSE and TWE, administered by ETS; or the International English Language Testing System (IELTS), administered by Cambridge ESOL Examinations, the British Council and IDP Education Australia. Scores from the TOEFL/TWE, TSE, IELTS, or TOEIC are accepted by the CGFNS.

Certain applicants may be exempt from the English language proficiency requirement. Applicants who have graduated from a college, university, or professional school located in Australia, Canada (except Quebec), Ireland, New Zealand, the United Kingdom, or the United States, whose language of instruction was English and whose textbook language was English, are exempt from the foreign language requirements. All English language proficiency scores are valid for up to two years from the date of administration.

Finally, the fourth component of the VisaScreen Certificate is applicable to those health care workers who wish to obtain an occupational visa to practice as nurses in the United States. Nurse applicants must present a CGFNS Certificate or a passing score on the NCLEX-RN® examination as proof of their nursing knowledge.

Time Considerations

Health care workers need to be mindful of the time required to obtain the certification. It is not uncommon for the process of gathering documentation and issuing the certificate to take 3 to 4 months. According to the new regulation, the DHS has stated that the credentialing organization should take no more than 60 days to issue the certificate or risk losing its authorization. Waivers may be available to health care workers who are not issued a certificate within 60 days. However, the 60-day clock does not start running until the applicant has gathered all documentation from his/her nursing school and licensing organization. This could add weeks or months to the overall timeframe. Applicants are well advised to apply for the certificate immediately after deciding to work in the U.S. Once issued, certificates are valid for 5 years and must be presented each time the nonimmigrant health care worker seeks admission to the U.S.

Conclusion

The laws establishing the requirements for applicants seeking entry to the United States for work in the health care industry continue to rapidly evolve and change. The Law Office of Sheela Murthy is committed to providing MurthyDotCom and MurthyBulletin readers the most current information pertinent to health care professionals.