by MELISSA McGINLEY
Although President Clinton signed the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) into law more than a year ago, delays in implementation are frustrating foreign health care workers wishing to practice in the U.S. and fueling the debate over who will administer the Act's new screening program.
Section 343 of IIRIRA added a certification requirement for aliens wishing to enter the US health care workforce on immigrant or non-immigrant visas. Applicants must now produce a certificate proving they've met comparable education, experience, and licensure requirements, and possess oral and written competence in English, before a visa can be granted. However, because the Immigration and Naturalization Service (INS) has yet to finalize regulations for pre-screening, Section 343 requirements are currently being waived for immigrant visas. Non-immigrant visas are not being issued at this time, but applicants seeking to change or extend their status may receive a one-year extension of stay.
Much of the controversy generated by this legislation has centered, not on the stricter entrance requirements, but on IIRIRA's naming of the Commission on Graduates of Foreign Nursing Schools (CGFNS) as its credentialing body. (Other accrediting bodies, the Act states, must be approved by the Attorney General and the Secretary of Health and Human Services.) Not only did CGFNS's existing program fail to meet IIRIRA's requirements, but groups like the National Board of Certification of Occupational Therapists (NBCOT) and the Federation of State Boards of Physical Therapy (FSBPT) argue CGFNS lacks the expertise necessary to certify non-nursing professions.
In response to these objections, the Department of Health and Human Services (DHHS) drafted criteria for eligible certifying agencies, which are still under consideration. DHHS says agencies must be "independent and free of material conflicts of interest," demonstrate the ability to evaluate foreign credentials as well as proficiency in English, and be able to conduct the examinations overseas.
In the meantime, a division of CGFNS, The International Commission on Healthcare Professions, developed VisaScreen and informed INS it would implement the program on August 25, 1997. INS replied it would "not accept any certifications issued by CGFNS or any equivalent independent credentialing organization prior to the promulgation of INS regulations implementing section 343." Therefore, Betsy Ranslow, NBCOT's international program director, cautions foreign applicants to consider whether VisaScreen's $325 base price is worth the cost at this time.
INS has not set a date for finalizing its regulations. Despite a proposed amendment to delay implemention of Section 343 until September 30, 1998, Ranslow said she had heard the rules might be finalized "anywhere between now and next spring."
When the Act is implemented, nurses, physical and occupational therapists, and physician assistants will be among the professionals affected. Physicians are excluded from the Act.