Can Anyone Help Me?
What is a Health Care Worker
Certification?
A health care worker certification identifies and documents
that a foreign health care worker has met minimum requirements
for training, licensure, and English proficiency in order to
be able to fulfill their professional role as a(n):
- Licensed practical nurse, licensed vocational nurse, or
registered nurse
- Occupational therapist
- Physical therapist
- Speech language pathologist and audiologist
- Medical technologist (clinical laboratory scientist)
- Physician assistant
- Medical technician (clinical laboratory technician)
Who Must Obtain a Health Care
Worker Certification?
Any non-U.S. citizen coming to the United States for employment
as a health care worker (other than a physician) cannot be admitted
unless he or she presents a certificate from either the Commission
on Graduates of Foreign Nursing Schools (CGFNS) or a certificate
of equal standing from an organization with equivalent credentials.
These requirements apply to both immigrant and nonimmigrant
applicants. Regarding visa classification, nonimmigrant health
care workers will most likely be in H-1C, H-1B, J, O, or TN
non-immigrant categories. Any non-immigrants coming to receive
training in a health care occupation will not be required to
obtain certification. Such health care workers will most likely
be in F-1, J-1 (aliens coming to undertake a training program
in a medical field) and H-3 nonimmigrant classifications. Please
note that each of these visa classifications has additional
requirements. Please go to our Nonimmigrant
Visa or our Immigrant
Visa Classification pages for more information on visa categories.
Are Nonimmigrants Subject to
the Health Care Worker Certification Requirements?
Yes, as of July 26, 2004, if a nonimmigrant is seeking to be
admitted to the United States, is changing status, and/or is
requesting an extension of stay, he or she must provide evidence
of health care worker certification if the primary purpose for
coming to or remaining in the United States is employment in
one of the affected health care occupations.
Previously, under section 212(d)(3) of the Act, the CIS and
the Department of State waived Health Care Worker certification
requirements for nonimmigrants, while requiring it for immigrants.
After careful consideration of the statute and legislative history,
it has been determined that nonimmigrants are also subject to
the certification requirements.
Which Organizations Are Currently
Authorized to Issue Health Care Worker Certificates?
The following organizations are authorized to issue certificates
for the following health care occupations:
Which English Language Testing
Organizations Are Approved for Purposes of Health Care Worker
Certification?
Every alien must meet certain English language requirements
in order to obtain a certificate unless otherwise exempted.
The following testing services had been approved:
- Educational
Testing Service (ETS)
- Test
of English in International Communication (TOEIC)
- International
English Language Testing System (IELTS)
What are the Acceptable English
Language Test Scores for Health Care Worker Certification?
The statute vests the Secretary of Health and Human Services
with the sole discretion to determine the minimum scores required
for a Health Care Worker Certification.
- Occupational and physical therapists. An
alien seeking to perform labor in the United States as an
occupational or physical therapist must obtain the following
scores on the English tests:
ETS: Test Of English as a Foreign Language (TOEFL): Paper-Based
560, Computer-Based 220; Test of Written English (TWE): 4.5;
Test of Spoken English (TSE): 50.
Important: The certifying organizations shall
not accept the results of the TOEIC, or the IELTS for the
occupations of occupational therapy or physical therapy.
- Registered nurses and other health care workers
requiring the attainment of a baccalaureate degree.
An alien coming to the United States to perform labor as a
registered nurse (other than a nurse presenting a certified
statement under section 212(r) of the Act) or to perform labor
in another health care occupation requiring a baccalaureate
degree (other than occupational or physical therapy) must
obtain one of the following combinations of scores to obtain
a certificate:
ETS: TOEFL: Paper-Based 540, Computer-Based 207; TWE: 4.0;
TSE: 50;
TOEIC Service International: TOEIC: 725; plus TWE: 4.0 and
TSE: 50; or
IELTS: 6.5 overall with a spoken band score of 7.0. This would
require the Academic module.
- Occupations requiring less than a baccalaureate
degree. An alien coming to the United States to perform
labor in a health care occupation that does not require a
baccalaureate degree must obtain one of the following combinations
of scores to obtain a certificate:
ETS: TOEFL: Paper-Based 530, Computer-Based 197; TWE: 4.0;
TSE: 50;
TOEIC Service International: TOEIC: 700; plus TWE 4.0 and
TSE: 50; or
IELTS: 6.0 overall with a spoken band score of 7.0. This would
allow either the Academic or the General module.
Questions and Answers about Exemptions
for Certain Health Care Workers
Q: Are foreign health care workers - trained
in the United States or in possession of a valid state license
- subject to the health care certification requirement?
A: Yes. While Congress provided certain nurses
with a less rigorous, alternative certification process, it
did not provide a less rigorous alternative certification option
to state-licensed foreign health care workers. Possession of
a state license does not exempt a foreign health care worker
from compliance with the certification requirement. Similarly,
health care workers who have been trained in the United States
are not exempt from the certification requirement.
Q: Are there any accommodations for foreign
health care workers who have been trained in the United States?
A: Yes. Foreign health care workers may be
automatically deemed to have met the English language and/or
educational comparability requirements if they have graduated
from certain programs or from programs in certain countries.
The following groups may be deemed to have met the English
language requirements:
- Graduates of health professional programs in Australia,
Canada (except Quebec), Ireland, New Zealand, the United Kingdom,
and the United States.
- Alien nurses who are presenting the alternate certified
statement under section 212(r) of the Act.
- For nurses, graduation from an entry-level program accredited
by the National League for Nursing Accreditation Commission
(NLNAC) or the Commission on Collegiate Nursing Education
(CCNE);
- For occupational therapists, graduation from a program accredited
by the Accreditation Council for Occupational Therapy Education
(ACOTE) of the American Occupational Therapy Association (AOTA);
- For physical therapists, graduation from a program accredited
by the Commission on Accreditation in Physical Therapy Education
(CAPTE) of the American Physical Therapy Association (APTA);
and
- For speech language pathologists and audiologists, graduation
from a program accredited by the Council on Academic Accreditation
in Audiology and Speech Language Pathology (CAA) of the American
Speech-Language-Hearing Association (ASHA).
The following groups may be deemed to have met the educational
comparability requirements:
- For nurses, graduation from an entry-level program accredited
by the National League for Nursing Accreditation Commission
(NLNAC) or the Commission on Collegiate Nursing Education
(CCNE);
- For occupational therapists, graduation from a program accredited
by the Accreditation Council for Occupational Therapy Education
(ACOTE) of the American Occupational Therapy Association (AOTA);
- For physical therapists, graduation from a program accredited
by the Commission on Accreditation in Physical Therapy Education
(CAPTE) of the American Physical Therapy Association (APTA);
and
- For speech language pathologists and audiologists, graduation
from a program accredited by the Council on Academic Accreditation
in Audiology and Speech Language Pathology (CAA) of the American
Speech-Language-Hearing Association (ASHA).
Q: Are dependents subject to the health care
worker certification requirement?
A: No. For example, if you are here as an L-2
nonimmigrant, your primary purpose for entering the United States
is to join your spouse. Since an L-2 nonimmigrant spouse is
authorized employment, you may engage in employment as a health
care worker without obtaining the certification. This will also
apply to other dependents who are accompanying a principal alien
and who are employment authorized within their dependent status.
Issuing Health Care Worker Certificates
How does an organization apply for
authorization to issue health care worker certificates?
As of September 23, 2003, organizations must apply for authorization
to issue health care worker certificates by filing CIS Form
I-905 (Application for Authorization to issue Health Care Worker
Certificates). Form I-905 is available online
and at your local Field
Office.
What kind of information does an
organization need to provide to the CIS in order to obtain authorization
to issue the certificates? The instructions to the
Form I-905 list the kind of information that must be provided
in support of the Form I-905. That information is also contained
at 8 CFR 212.15(k). In general, the organization must demonstrate
that it meets four guiding principles:
- The organization is independent and free of material conflicts
of interest regarding whether an alien receives a visa;
- The organization has an ability to evaluate both the foreign
credentials appropriate for the profession, and the results
of examinations for proficiency in the English language appropriate
for the health care field in which the alien will be engaged;
- The organization can maintain comprehensive and current
information on foreign educational institutions, ministries
of health, and foreign health care licensing jurisdictions;
and
- If the health care field is one for which a majority of
the states require a predictor examination (currently, this
is done only for nursing), the organization should demonstrate
an ability to conduct the examination outside the United States.
How long may an organization be authorized
to issue health care worker certificates?
Authorization to issue health care worker certificates will be
good for a period of 5 years from the date of approval. An organization
must renew its authorization to issue certificates by filing a
new application, with fee, for Form I-905.
Can an organization appeal?
If your petition is denied, the denial letter will tell you how
to appeal. Generally, you may file a Notice of Appeal along with
the required fee with the office that issued the denial letter
within 33 days of receiving the denial. Once the fee is collected
and the form is processed, the appeal will be referred to the
Administrative Appeals Office (AAO) in Washington, D.C. Sending
the appeal directly to the AAO will delay the process and may
result in an untimely filing of the appeal. For more information,
see How
Do I Appeal?. Please click here for more information on CIS
offices.
Where Can an Employer File a
Petition?
An employer who is seeking authorization to employ a health
care worker should file Form I-129, Petition for Nonimmigrant
Worker, or Form I-140, Petition for Immigrant Worker, with the
CIS service center that serves the area where they are located.
Please see our CIS
field office home page for more information on CIS office
locations. Forms and CIS' guide to nonimmigrant and immigrant
worker petitions are available by calling 1-800-870-3676, or
by submitting a request through our forms
by mail system. For further information on filing fees,
please see CIS
filing fees.
How Does an Employer Find out
the Status of a Petition?
If you are the petitioning employer, contact the CIS Service
Center that received your Form I-129 or Form I-140. You should
be prepared to provide the CIS staff with specific information
about the petition. Please click here for complete instructions
on checking the status
of your application. Click here for information on CIS
offices.
Where Can I Find the Law?
The complete requirements for health care worker certification
can be found in the Immigration and Nationality Act (Act) at
section 212
(a)(5)(C). The alternative requirements for nurses are at
section 212
(r) of the Act. The specific eligibility requirements and
procedures for applying for health care worker certification
are included in the Code of Federal Regulations [CFR] at 8
CFR ?12.15.
Frequently Asked Questions
See Final
Regulation on Certification of Foreign Health Care Workers
DHS
Implements Statutory Requirements for Health Care Workers, 07/29/03
and DHS
Announces New Requirement for Health Care Workers, 07/29/03.
