Visa Screen Certification Requirement for Foreign Healthcare Workers

C&G Review
Fall 2005

As of July 26, 2005, any foreign healthcare worker seeking to enter the United States or, for those already here, change to/extend temporary (nonimmigrant) or permanent (immigrant) visa status must present a Visa Screen Certificate proving that his or her credentials have been certified by an appropriate agency to meet minimum government standards. In general, the Visa Screen requirement consists of an educational analysis, licensure validation, English language proficiency assessment, and, for nurses, an exam of nursing knowledge.

The educational review 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 the education of a U.S. graduate seeking licensure.

The licensure review evaluates initial and all current and past licenses to assure that they are valid and unencumbered. The English language proficiency assessment confirms that the applicant has demonstrated the required competency in oral and written English by submitting scores on tests approved by the U.S. Departments of Education and Health and Human Services. To satisfy this requirement, applicants must pass one of the following: (i) the Test of English as a Foreign Language (TOEFL), plus the Test of Written English (TWE) and the Test of Spoken English (TSE); (ii) the Test for International Communications (TOEIC), plus the TSE and the TWE; or (iii) the International English Language Testing Service (IELTS).

Nurse applicants who wish to obtain an occupational visa to practice as nurses in the United States must present a Certificate from the Commission on Graduates for Foreign Nursing Schools (CGFNS) or a passing score on the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

After the applicant has successfully completed the screening program, he or she is awarded a Visa Screen Certificate, which must be presented to a U.S. Citizenship and Immigration Services officer or, if the applicant is making an application abroad, to a U.S. consular officer as part of a visa application.

These requirements date back to July 25, 2003, when the Department of Homeland Security (“DHS”) published a final regulation, initially effective September 23, 2003, establishing that certain nonimmigrant healthcare workers must obtain certification in accordance with the Immigration and Nationality Act under a phased-in process. The seven healthcare occupations requiring certification are:

Nurses (licensed practical nurses, licensed vocational nurses, and registered nurses)
Physical therapists
Occupational therapists
Speech language pathologists and audiologists
Medical technologists (also known as clinical laboratory technicians)
Medical technicians (also known as clinical laboratory technicians)
Physician assistants

The Code of Federal Regulations lists the organizations approved to issue certifications in the above occupations. Currently, the CGFNS is authorized to issue healthcare workers certificates in all seven occupations. The National Board for Certification in Occupational Therapy is authorized to issue certificates for occupational therapists only. The Foreign Credentialing Commission on Physical Therapy is authorized to issue certificates for physical therapists only.

These rules also require nonimmigrant healthcare workers, i.e., those present in the United States in a temporary visa category, to obtain certification and document valid certification each time they apply for admission, extension of stay, or change of status. These rules do not apply to foreign nationals admitted to perform services in nonclinical healthcare occupations (e.g., teachers, researchers, or managers with healthcare facilities), aliens coming to receiving training (e.g., F-1s, H-3s, H-1Bs, or J-1s), or spouses and dependent children.

Before the September 23, 2003 effective date of these regulations, the DHS agreed to waive this ground of inadmissibility for a period of one year after publication of the final rule, i.e., up to and including July 25, 2004.

On July 25, 2004, the DHS waived the requirements for Canadian and Mexican health care workers seeking to enter the United States to work in a Trade NAFTA (TN) category subject to two conditions: (i) the worker must have been employed in a TN status before September 23, 2003; and (ii) the worker must have held a valid license from a U.S. jurisdiction before September 23, 2003.

Therefore, effective July 26, 2005, all previous and existing waivers of the visa screen certification requirement expired and any foreign healthcare worker seeking to enter the United States or change/extend temporary (nonimmigrant) or permanent (immigrant) visa status must present the appropriate certification.

For more information, please contact mphillips@cohenlaw.com or acastrodale@cohenlaw.com