Health Care Worker Certification
Foreign nationals seeking admission to perform labor as health care workers, other than physicians, are only admissible to the United States if they present certification from a USCIS-approved credentialing organization verifying that the worker has met the minimum requirements for training, licensure, and English proficiency in his or her field.
Specifically, the certification verifies the foreign national has:
- Education, training, licensing, and experience that:
- The necessary level of competence in oral and written English as shown by passage of one or more nationally recognized, commercially available, standardized test of the applicant’s ability to speak and write; and
- a. a predictor test (if the majority of States licensing the profession in which the foreign national intends to work recognize a test predicting a worker’s success on the profession’s licensing or certification examination), or
- b. the actual licensing or certification examination.
Health Care Occupations Requiring a Certification
The following health care occupations require a certification under 8 CFR 212.15(c):
- nurses (licensed practical nurses, licensed vocational nurses, and registered nurses ),
- physical therapists,
- occupational therapists,
- speech-language pathologists and audiologists,
- medical technologists (also known as clinical laboratory scientists),
- medical technicians (also known as clinical laboratory technicians) and
- physician assistants.
Please note: Nurses have an alternative certification process. A foreign nurse may present a certified statement from the Commission on Graduates of Foreign Nursing Schools or an approved equivalent independent credentialing organization verifying that the foreign nurse:
- has a valid and unrestricted license in the State of intended employment;
- has a foreign license that is authentic and unencumbered;
- passed the National Council Licensure Examination (NCLEX ); and
- graduated from certain English language nursing programs.
See section 212(r) of the Immigration and Nationality Act (INA).
Providing Valid Health Care Worker Certification
A foreign national worker in an affected health care occupation must present a valid health care worker certification each time he or she:
- seeks admission into the United States,
- changes status,
- extends status, or
- adjusts status.
The certification requirement is no longer applicable once the worker is a lawful permanent resident.
Organizations Authorized to Issue Health Care Worker Certifications
The following organizations are authorized to issue certifications for the following health care occupations:
- The Commission on Graduates of Foreign Nursing Schools (CGFNS) is authorized to issue certifications to all 7 health care occupations.
- The National Board for Certification in Occupational Therapy (NBCOT) is authorized to issue certifications for occupational therapists.
- The Foreign Credentialing Commission on Physical Therapy (FCCPT) is authorized to issue certifications for physical therapists.
These organizations are approved by the Secretary of Homeland Security in consultation with the Secretary of Health and Human Services. See Pub. L. No. 107-296, 116 Stat. 2135.
Submitting Health Care Worker Certifications
For immigrant petitions, there is a two-step process:
Step 1: Generally, the Form I-140, Immigrant Petition for Alien Worker, is first filed by an employer on behalf of the prospective foreign national worker. In adjudicating the I-140 petition, USCIS reviews all eligibility requirements. This review includes examination of the beneficiary’s educational qualifications.
Step 2: If the foreign national worker is in the United States, he or she may file a Form I-485, Application to Register Permanent Residence or Adjust Status. It is only upon the filing of an I-485 that the health care worker certification is required and will be used to determine admissibility for adjustment of status.
If the foreign national worker is living outside the United States or living in the United States, but chooses to apply for an immigrant visa abroad, USCIS will send the approved petition to the Department of State’s (DOS) National Visa Center (NVC), where it will remain until an immigrant visa number is available. The foreign national worker must present the health care certification to the consular officer at the time of visa issuance.
For nonimmigrant petitions seeking admission, an extension of stay, or a change of status, there are two considerations:
Consideration 1: The petitioning employer files a Form I-129, Petition for a Nonimmigrant Worker, for approval of the foreign national worker’s classification as a nonimmigrant. In adjudicating the petition for the classification requested, USCIS reviews all eligibility requirements, including licensure, if applicable. The health care certification must be presented at the time of visa issuance or admission (if the foreign national worker is visa-exempt).
Consideration 2: If the foreign national is already in the United States, the Form I-129 may also serve as an application to extend the period of the foreign national's authorized stay or to change his or her status. Although the Form I-129 petition classification may be approved, the application for an extension of stay or change of status will be denied if the petitioner fails to submit the health care worker certification required by law. See 8 CFR 212.15(a).
Please note: USCIS does not accept health care worker certification as the sole evidence that the foreign worker has met the minimum requirement for the given position and is, therefore, eligible for the requested visa classification. While the health care worker certification verifies the worker’s credentials for admissibility into the United States under INA 212(a)(5)(C), it is not binding on DHS. See 8 CFR 212.15(f)(1)(iii).
Role of Certification in the USCIS Adjudication Process
USCIS uses the certification to verify the worker’s credentials for admissibility into the United States. See INA 212(a)(5)(C). Additionally, USCIS must ensure that the health care worker also meets educational requirements for the classification and any applicable licensure requirements. In reviewing the worker’s educational documents, USCIS considers the education credential evaluator’s opinion in conjunction with a review of the foreign national’s relevant education credentials (if submitted), and other available credible resource material regarding the equivalency of the education credentials to college degrees obtained in the United States.
In the course of the adjudication, USCIS may refer to educational equivalency resources to clarify an individual’s academic credentials, although information from such sources is not binding. For example, if one of the resources indicates that a Bachelor’s degree from the home country of the foreign national worker represents a level of education that is comparable to a Bachelor's degree in the United States, the degree would not qualify the individual for the EB-2 advanced degree category unless he or she also has five years of post-baccalaureate progressive experience. In such cases, USCIS may issue a Request for Evidence asking the petitioner to provide evidence demonstrating that the beneficiary has either a United States advanced degree or foreign equivalent degree or has a United States bachelor’s degree or a foreign equivalent degree, and evidence in the form of letters from current or former employer(s) showing that the beneficiary has at least five years of progressive post-baccalaureate experience in the specialty.
USCIS Criteria for Educational Equivalency
The USCIS criteria for educational equivalency are explained in the eligibility requirements for the specific nonimmigrant or immigrant classification.
For instance, employment-based second preference immigrant petitions (EB-2) for members of the professions holding an advanced degree must establish, among other requirements, that the worker has met the minimum requirements for the position. Specifically, the beneficiary must have an advanced degree. See 8 CFR 204.5(k)(2).
To demonstrate that the foreign national is a professional holding an advanced degree, the petition must be accompanied by:
(A) An official academic record showing that the foreign national has a United States advanced degree or a foreign equivalent degree; or
(B) An official academic record showing that the foreign national has a United States baccalaureate degree or a foreign equivalent degree, and evidence in the form of letters from current or former employer(s) showing that the foreign national has at least five years of progressive post-baccalaureate experience in the specialty. See 8 CFR 204.5(k)(3)(i).
Health Care Credentialing Organizations’ Criteria for Educational Equivalency
The credentialing organizations’ educational equivalency criteria are also guided by the statutory and regulatory requirements for the particular nonimmigrant or immigrant classification. The certification process sets guidelines for educational equivalency that focus on the:
- verification of the applicant’s education,
- verification of all licenses to practice in the occupation, and
- compliance with English language proficiency requirements.
The credentialing organizations must evaluate the worker’s education to ensure that it:
- is comparable to a U.S. education,
- meets the minimum educational requirements for licensure (in the State of intended employment), and
- meets the minimum educational requirements for the requested classification.
However, the credentialing organization’s evaluation is not binding on DHS. See 8 CFR 212.15(f)(1)(iii).
Renewing the Health Care Certification
A foreign worker’s certification must be used for any admission into the United States, extension or change of status within the United States, or adjustment of status within 5 years of the date that it is issued. See 8 CFR 212.15(n)(4). For this reason, the certification is only valid for 5 years. This ensures that the individual continues to meet the regulatory requirements for issuance of the certification. Therefore, if the foreign worker has not used the certification because he or she has not been admitted to the United States or adjusted his or her status within 5 years of when the certification was obtained, a new certification is required at the time he or she seeks adjustment of status, to change or extend status with USCIS, or when seeking visa issuance by DOS or admission at the port of entry.
Please note that certification does not remove requirements for licensure, if applicable.
However, the credentialing organization must have a formal policy for renewing the certification if an individual’s original certification expires before admission to the United States or application for adjustment of status. See 8 CFR 212.15(k)(4)(viii). The credentialing organization is limited to updating information on licensure to determine the existence of any adverse actions and the need to re-establish English competency, and therefore does not re-evaluate the educational credentials when renewing the certification.