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To Renew Or Not To Renew. The Impact Of Visa Retrogression On Healthcare Workers: Healthcare Certificate Renewals

by Donna Rae Richardson

In Sherry Neal's thorough and thoughtful article in, the author states that CGFNS International and the Foreign Credentialing Commission on Physical Therapy (FCCPT), disagree on when a healthcare certificate needs to be renewed. That statement does not reflect the most important aspect of the issue. The difference between FCCPT's and CGFNS International's process on renewals stem directly from initially ambiguous USCIS regulations, but CGFNS has clarified its interpretation in consultation with USCIS.

CGFNS International requested guidance regarding the requirement for renewals as far back as 2006 because of conflicting opinions from certification organizations, applicants, and employers. In its annual I-905 report to USCIS, CGFNS International referred to its renewal policy and the scarcity of direction in the regulation which it believed caused confusion among the affected parties. CGFNS International submitted its renewal policy consistent with 8CFR212.15(d) (i) to USCIS and it was accepted without question.

Likewise, CGFNS International submitted its processes regarding establishing English Proficiency to USCIS and received no objection to what it believed to be a logical procedure. If the applicant could document practice in the U.S. for at least 27-36 months, with at least nine of them in the year before the submission of the renewal, that would be sufficient evidence to demonstrate continued English Proficiency.

CGFNS International is aware that FCCPT offered a two -step process for certification of PTs until September 1, 2009. We are also cognizant of the fact that their new process may effectively disenfranchise those who previously were deemed to have had a comparable education and were certified for an occupational visa.

CGFNS International has considered the issue of comparable education of PTs each year in its Physical Therapy Professional Standards Committee. The standards to be used for this assessment has been subject to thorough and intense discussion and deliberations by this Committee.

When questions were raised in 2009 about the standards used for determining comparability of PT education, CGFNS International, FCCPT and others submitted their respective analyses and policies to USCIS. Upon consultation with immigration counsel and review of the regulatory language, it was determined that Section 343 sub-paragraph I and II are the germane and controlling paragraphs in Section 343 on this issue.

Sub-para (II) as applied to education requires that the VisaScreen(r) certificate verify that the alien's education is "comparable with that required for an American health-care worker of the same type." We interpret this rule as requiring CGFNS to determine: (i) whether the foreign national possess a foreign degree that in fact is comparable to the actual degree required by CIS for the occupational classification used; and (ii) whether the alien's education meets the educational requirements established by the state of intended employment.

Accordingly, CGFNS International has determined that it will use the following education comparability tools when evaluating a Physical Therapist for VisaScreen: Visa Credentials Assessment(r) who is educated outside of the United States:

  • FSBPT's Course Work Tool (CWT) version required by the applicant's state of intended employment.
  • CGFNS International's Education Comparability Tool (ECT)

However, the curriculum must meet the requirements as specified in an education comparability tool designed specifically to reference CAPTE standards. CGFNS International's ICHP Physical Therapy Professional Standards state that both the FSBPT Coursework Tool (CWT) for physical Therapists and the CGFNS International Education Comparability Tool (ECT) for Physical Therapists are acceptable instruments for this assessment. In addition, it is the position of the United States Citizenship and Immigration Services (USCIS) that if a Physical Therapist is not licensed from the state in which he/she will be working, the requirements for licensure (including degree and educational requirements) in the state of intended employment should be used to determine whether the applicant is qualified to perform in physical therapy for immigration purposes. Therefore, when the FSBPT's CWT is utilized, CGFNS International will use the version of the CWT required by the VisaScreen(r) applicant's state of intended employment.

Although the author of the article believes USCIS policies have been confusing and asks for clarification, we believe the USCIS memo from Barbara Velarde, Chief, Service Center Operations, makes it clear which educational standards should control.

Indeed, CGFNS International does accept FCCPT certificate holders who need to renew their certification. However, we may treat them only as initial applicants when CGFNS International has no records on hand and must therefore secure all educational and licensure documentation anew.
Certainly, if FCCPT was amenable to verifying to CGFNS that it issued a (now discontinued) Type II Certificate to a PT applicant for VisaScreen, then CGFNS International would only have to update licensure and establish English Proficiency -- which would shorten the processing time of a renewal.

We believe our renewal policy for PTs initially reviewed by the FCCPT but now seeking a VisaScreen through CGFNS minimizes the very real possibility of disenfranchising previously certified and qualified PTs. It also guarantees the inclusion and retention of those experienced PTs who have practiced in the U.S. and who have demonstrated their competency in the practice of their profession in the United States.

About The Author

Donna Rae Richardson is the Director of Governmental Affairs and Professional Standards for CGFNS. Previously, she was the Community Outreach Coordinator for the Womenís Health Initiative of the Nationís Capital and Director of Clinical Trials Programs at Howard University Cancer Center that increased minority physician and patient participation in clinical trials. She also served as an Assistant Professor of Nursing and Medicine at Howard University. A registered nurse and attorney, Ms. Richardson is counsel to the law firm of Joan Wilbon and Associates. As Director of Governmental Affairs of the American Nurses Association, she directed the legislative and regulatory policies that led to the Nursing Immigration Relief Act and occupational health protections for nurses. Prior to that, she was an attorney at the Department of Labor. She is a recognized speaker and resource on foreign-educated nurses, HIV policy, womenís health research, occupational health for nurses and clinical trial recruitment. Ms. Richardson was honored by Washington High School in Massillon, Ohio, in 2007 as a Distinguished Citizen for her career in health and law.

The opinions expressed in this article do not necessarily reflect the opinion of ILW.COM.