News July 2004

Foreign Health Care Workers at Risk of Losing Work Authorization

The Issue: A 1996 immigration law requires health care workers in certain health care occupations to obtain a health care certificate (popularly known as a VisaScreen certificate) before being admitted to the United States, extending their status, or receiving work authorization. Health care workers in the following occupations are subject to this requirement: nurses, including RNs and LVNs/LPNs, physical therapists, occupational therapists, speech-language pathologists, medical technologists (also known as clinical laboratory scientists), medical technicians (also known as clinical laboratory technicians) and physician assistants.

To avoid disrupting health care staffing requirements, the U.S. government temporarily allowed a "blanket" automatic waiver of this requirement for health care workers on nonimmigrant visas (such as H-1Bs, TN NAFTA professionals, and E-2 employees of foreign-owned businesses). The government required "green card" immigrants to obtain the certificate before allowing them to be admitted to the United States.

Effective July 26, 2004, this automatic blanket waiver will end. After that date, the government will no longer admit foreign nationals to the United States to work in covered health care occupations until those individuals are certified. Thus, a health care worker who returns from a trip outside the U.S. will not be admitted unless the worker presents the VisaScreen Certificate. Foreign nationals already working in the United States on temporary (nonimmigrant) work authorizations will be unable to extend their work authorizations until they obtain the certification.

ACTION REQUIRED: Please consider taking the following three steps:

Audit Your Workforce: Immediately audit your workforce to ensure that foreign national health care workers employed under temporary work authorizations have obtained their certificates. Health care workers lacking the certificate should immediately begin applying for it so that they can timely extend their current work authorization. They also should remain in the United States until they receive the certificate. Health care workers should be cautioned against traveling outside of the United States (including U.S. territories such as Puerto Rico and the Virgin Islands) after July 26 unless they already have the required certificate.

Send Letters to DHS Secretary Tom Ridge: Send a letter to Tom Ridge urging him to extend the automatic blanket waiver for another two years. You can easily send these letters through this link:

Send Letters to your Senators and Representatives: It is important that your elected officials understand the negative consequences of not extending the automatic blanket waiver. You can easily send these letters through this link:

Background: Failure to obtain the certification could result in significant work interruptions for those foreign nationals needing to extend their temporary work authorizations. Health care workers who travel risk being turned away when they seek to return to the United States.

Three organizations currently are authorized to issue the health care certificate. The Commission on Graduates of Foreign Nursing Schools (CGFNS) may issue certificates for all of the above listed occupations. Its web address is The National Board for Certification in Occupational Therapy is authorized to issue certificates for occupational therapists. Its web address is The Foreign Credentialing Commission on Physical Therapy is authorized to issue certificates for physical therapists. Its web address is


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