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INS Releases Long Awaited Health Care Worker Regulations
by Greg Siskind

Responding to the threat of a lawsuit, the INS has finally released regulations dealing with health care workers. Part of the 1996 immigration law made health care workers other than physicians inadmissible unless they present evidence that they have been certified by an independent credentialing organization. Immigrant health care workers must be certified to show that their education and training are comparable to a US worker in the same area, that they have the necessary level of competency in oral and written English, and that they are licensed in the state in which they intend to work. The health care workers covered are nurses, physical therapists, occupational therapists, speech-language pathologists, medical technologists, medical technicians and physician assistants.

Because of the difficulty in creating the regulations to implement this law, shortly after it was passed the INS decided that it would create a blanket waiver for people in these professions seeking to enter on a nonimmigrant visa. However, there is no waiver for people seeking to immigrate, and the delay in implementing the rules has created serious problems. In the past, the INS has issued rules covering nurses, occupational therapists and physical therapists. This new rule, which will become effective on March 19, covers speech-language pathologists, medical technologists, medical technicians and physician assistants. While comments will be accepted on the rule, the INS felt that given the time lapsed since the law was created, and the difficulty in creating a final rule to address it, an interim rule should be issued.

The interim rule authorizes the Commission on Graduates of Foreign Nursing Schools (CGFNS) to issue certificates for the remaining professions. CGFNS already issues certificates for nurses, occupational therapists and physical therapists.

Along with authorizing CGFNS to issue certificates, the interim rule also lists the required passing scores for English language tests. The test may be taken from the Educational Testing Service (ETS) or the Michigan English Language Assessment Battery (MELAB). Speech-language pathologists, medical technologists and physician assistants must obtain the following scores:


Test of English as a Foreign Language 540 paper based, 207 computer based
Test of Written English 4.0
Test of Spoken English 50


Final score 79
Oral Interview 3+

For medical technicians, the required score are


Test of English as a Foreign Language 530 paper based, 197 computer based
Test of Written English 4.0
Test of Spoken English 50


Final score 77
Oral Interview 3+

People who have graduated from schools in the following countries are exempt from the English language testing requirement: Australia, Canada (except Quebec), Ireland, New Zealand, the United Kingdom and the United States.

According to the interim rule, the INS should, within the next six months, initiate the processes for creating a final rule. However, even after this, it will likely take a few years to have the final rule ready for implementation.

About The Author

Gregory Siskind has experience handling all aspects of immigration and nationality law and has represented numerous clients throughout the world. Mr. Siskind provides consultations to corporations and individuals on immigration law issues and handles cases before the Immigration and Naturalization Service, the Department of State, the Department of Labor and other government agencies. Gregory Siskind is also committed to community service. He regularly provides free legal services to indigent immigration clients and speaks at community forums to offer information on immigration issues. After graduating magna cum laude from Vanderbilt University, Gregory Siskind went on to receive his law degree from the University of Chicago. For the past several years, he has been an active member of the American Immigration Lawyers Association and he currently serves as a member of the organization's Technology Committee. He is the current committee chair for the Nashville Bar Association's International Section. Greg is a member of the American Bar Association where he serves on the LPM Publishing Board as Marketing Vice Chairman and on the Council of the Law Practice Management Section. He is also a member of the Tennessee Bar Association, the Nashville Bar Association and the Memphis Bar Association. He serves on the board of the British American Business Association of Tennessee. And he serves on the Board of Directors of the Hebrew Immigrant Aid Society and on the executive boards of the Jewish Family Service agencies in Nashville and Memphis, Tennessee. He recently was named one of the Top 40 executives under age 40 in his hometown of Memphis, Tennessee.

Greg regularly writes on the subject of immigration law. He has written several hundred articles on the subject and is also the author of the new book The J Visa Guidebook, published by Matthew Bender and Company, one of the nation's leading legal publishers. He is working on another book for Matthew Bender on entertainment and sports immigration.

Greg is also, in many ways, a pioneer in the use of the Internet in the legal profession. He was one of the first lawyers in the country (and the very first immigration lawyer) to set up a web site for his practice. And he was the first attorney in the world to distribute a firm newsletter via e-mail listserv. Mr. Siskind is the author of the American Bar Association's best selling book, The Lawyer's Guide to Marketing on the Internet. He has been interviewed and profiled in a number of leading publications and media including USA Today, the New York Times, the Wall Street Journal, Lawyers Weekly, the ABA Journal, the National Law Journal, American Lawyer, Law Practice Management Magazine, National Public Radio's All Things Considered and the Washington Post. As one of the leading experts in the country on the use of the Internet in a legal practice, Greg speaks regularly at forums across the United States, Canada and Europe.

In his personal life, Greg is the husband of Audrey Siskind and the proud father of Eden Shoshana and Lily Jordana. He also enjoys collecting rare newspapers and running in marathons and triathlons. He can be reached by email at

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