Health Care Worker Regulations

[Federal Register: January 16, 2001 (Volume 66, Number 10)]
[Rules and Regulations]
[Page 3440-3444]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16ja01-2]

[[Page 3440]]

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DEPARTMENT OF JUSTICE

Immigration and Naturalization Service

8 CFR Part 212

[INS No. 2089-00]
RIN 1115-AE73

Additional Authorization To Issue Certificates for Foreign Health
Care Workers; Speech-Language Pathologists and Audiologists, Medical
Technologists and Technicians, and Physician Assistants

AGENCY: Immigration and Naturalization Service, Justice.

ACTION: Interim rule with request for comments.

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SUMMARY: This interim rule amends the regulations of the Immigration
and Naturalization Service (Service), to enable the Commission on
Graduates of Foreign Nursing Schools (CGFNS) to issue certificates to
aliens seeking admission as, or adjustment of status to permanent
residents on the basis of the following occupations: Speech language
pathologist and audiologists, medical technologist (also known as
``clinical laboratory scientist''), physician assistant, and medical
technician (also known as ``clinical laboratory technician''). The
Service has consulted with the Department of Health and Human Services
before promulgating this interim regulation. This rule ensures that
foreign health care workers have the same training, education and
licensure as similarly employed United States workers.

DATES: Effective Date: This interim rule is effective March 19, 2001.
    Comment date: Written comments must be submitted on or before March
19, 2001.

ADDRESSES: Please submit written comments, in triplicate, to the
Director, Policy Directives and Instructions Branch, Immigration and
Naturalization Service, 425 I Street NW., Room 4034, Washington, DC
20536. To ensure proper handling, please reference the INS No. 2089-00
on your correspondence. Comments are available for public inspection at
the above address by calling (202) 514-3048 to arrange for an
appointment.

FOR FURTHER INFORMATION CONTACT: John W. Brown, Adjudications Officer,
Adjudications Division, Immigration and Naturalization Service, 425 I
Street NW., Room 3214, Washington, DC 20536, telephone (202) 353-8177.

SUPPLEMENTARY INFORMATION:

What Are the Provisions of 8 U.S.C. 1182(a)(5)(C)?

    The Illegal Immigration Reform and Immigrant Responsibility Act
(IIRIRA), Public Law No. 104-208, section 343, 110 Stat. 3009, 636-37
(1996) created a new ground of inadmissibility now codified at 8 U.S.C.
1182(a)(5)(C), section 212(a)(5)(C) of the Immigration and Nationality
Act (Act). It provides that an alien who seeks to enter the United
States for the purpose of performing labor as a health care worker,
other than a physician, is inadmissible unless the alien presents a
certificate from CGFNS or an equivalent independent credentialing
organization approved by the Attorney General in consultation with the
Secretary of Health and Human Services (HHS) verifying:
    (1) that the alien's education, training, license, and experience
meet all applicable statutory and regulatory requirements for admission
into the United States under the classification specified in the
application; are comparable with that required for an American health
care worker of the same type; are authentic and, in the case of a
license, unencumbered;
    (2) the alien has the level of competence in oral and written
English considered by the Secretary of HHS, in consultation with the
Secretary of Education, to be appropriate for health care work of the
kind in which the alien will be engaged, as shown by an appropriate
score on one or more nationally recognized, commercially available,
standardized assessments of the applicant's ability to speak and write
English; and,
    (3) if a majority of States licensing the profession in which the
alien intends to work recognize a test predicting an applicant's
success on the profession's licensing or certification examination, the
alien has passed such a test, or has passed such an examination.
Section 212(r) of the Act mandates separate certification procedures
for certain aliens.

How Has the Service Implemented 8 U.S.C. 1182(a)(5)(C)?

    Section 212(a)(5)(C) of the Act became effective upon enactment on
September 30, 1996. Shortly thereafter, the Service met and conferred
with HHS, the Department of Labor (DOL), the Department of Education
(DOE), the Department of Commerce (DOC), the Office of the United
States Trade Representative (USTR), and the Department of State (DOS)
to reach consensus on the best approach for implementation. In addition
to meetings among the affected agencies, several meetings were held
with interested organizations including CGFNS, the American
Occupational Therapists Association, the National Board for
Certification in Occupational Therapy (NBCOT), the Federated State
Board of Physical Therapy, and the American Physical Therapy
Association.
    The Service in consultation with HHS initially identified, on the
basis of the legislative history, seven categories of health care
workers subject to the provisions of 8 U.S.C. 1182(a)(5)(C). The seven
categories are nurses, physical therapists, occupational therapists,
speech-language pathologists, medical technologists (also known as
``clinical laboratory scientist''), medical technicians (also known as
``clinical laboratory technicians'') and physician assistants. Upon the
suggestion of HHS, this rule lists the alternative terms ``clinical
laboratory scientist'' and ``clinical laboratory technician'' to
reflect both the legislative history and current health professions
categorizations.
    After weighing the complexity of the implementation issues,
anticipating the length of time for rule making, and considering the
need for health care facilities across the country to remain fully
staffed and provide a high quality of service to the public, the DOS
and the Service agreed to exercise their statutory discretion under 8
U.S.C. 1182(d)(3), section 212(d)(3) of the Act, and have granted a
blanket waiver of inadmissibility to nonimmigrant health care workers
until final regulations are promulgated. The blanket waiver of
inadmissibility applies to nonimmigrant health care workers already in
possession of nonimmigrant visas and visa exempt aliens, including
Canadians applying for classification pursuant to 8 U.S.C. 1184(e),
section 214(e) of the Act (TN classification). The Service published an
interim rule (First Interim Rule) in the Federal Register on October
14, 1998 at 63 FR 55007 in which the adoption of this policy regarding
nonimmigrant health care workers was announced. The First Interim Rule
amended 8 CFR part 212 and 245. A formal application or fee is not
required for a nonimmigrant health care worker to obtain the waiver.
Nonimmigrant health care workers are admitted on a multiple entry Form
I-94 for 1 year. In addition, otherwise admissible dependents are also
authorized admission into the United States for the specific dates of
stay authorized for the principal alien. A new waiver is not required
if the nonimmigrant health care worker makes an application for
admission to the United States during

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the validity period of the previously issued Form I-94. Nonimmigrants
applying for TN classification are not required to pay the admission
fee described at 8 CFR 214.6(f) when applying for admission during the
validity period of the previously issued Form I-94. Finally,
nonimmigrant health care workers are eligible for extensions of the
waiver and corresponding extensions of stay in increments of 1 year.
    The Services has issued two interim rules implementing the
certification requirements of section 212(a)(15)(C) of the Act with
respect to immigrant health care workers. The First Interim Rule,
previously referenced, and a Second Interim Rule which was published in
the Federal Register on April 30, 1999 at 64 FR 23174. The Second
Interim Rule also amended 8 CFR part 212.

What Were the Provisions of the 1st and 2nd Interim Rules?

    The First Interim Rule temporarily enabled CGFNS to issue
certificates to immigrants coming to the United States to work in the
field of nursing, and temporarily authorized NBCOT to issue
certificates in the field of occupational therapy. The Service adopted
the First Interim Rule without the notice and comment period ordinarily
required by 5 U.S.C. 553 because it found that delay in the
implementation of 8 U.S.C. 1182(a)(5)(C) could adversely affect the
provision of health care, particularly in medically under-served areas
for nursing and occupational therapy. Given this context, the Service
identified two criteria for the selection of certifying organizations
on a temporary basis:
    (1) That a sustained level of demand for foreign workers for the
particular occupation exists; and
    (2) That an organization with an established track record in
providing credentialing services exists.
    The First Interim Rule defined the term ``sustained level of
demand'' as the presence of an existing demand for foreign health care
workers in a particular occupation that is expected to continue in the
foreseeable future. The term ``organizations with an established track
record'' was defined as an organization which has a record of issuing
actual certificates, or documents similar to a certificate, that are
generally accepted by the state regulatory bodies as certificates that
an individual has met certain minimal qualifications. The Service
found, on the basis of information provided by DOL, that there was a
sustained level of demand for foreign workers in nursing and
occupational therapy. After consultation with HHS, CGFNS and NBCOT were
found to qualify as organizations with an established track record in
providing credentialing services for nursing and occupational therapy
respectively. As required by 8 U.S.C. 212(a)(5)(C), the rule also
established the appropriate English language competency levels for
foreign nurses and occupational therapists, and specified exemptions
from English language proficiency testing.
    The First Interim Rule provided that the Service would apply the
two criteria to other organizations seeking authorization to issue
certificates while the interim rule remained in effect. Finally, the
Service deferred consideration of whether CGFNS is authorized to issue
certificates for other health care occupations.
    The Second Interim Rule temporarily enabled CGFNS to issue
certificates to immigrants coming to the United States to work in the
fields of occupational therapy and physical therapy, and temporarily
authorized the Foreign Credentialing Commission on Physical Therapy
(FCCPT) to issue certificates in physical therapy. As with the First
Interim Rule, the Service adopted the Second Interim Rule without the
notice and comment period ordinarily required by 5 U.S.C. 553 because
it found that delay in the implementation of 8 U.S.C. 1182(a)(5)(C)
could adversely affect the provision of health care in medically under-
served areas. The Service, in consultation with HHS, evaluated CGFNS'
and FCCPT's applications for authorization to issue certificates under
the criteria promulgated by the First Interim Rule. The Service found
that both CGFNS and FCCPT met the ``establishment or proven track
record'' criterion. With respect to the second criterion, the Service
relied on its findings in the First Interim Rule to conclude that there
was a sustained level of demand for occupational therapists. In
addition, after considering data compiled by DOL, the Service concluded
that there was a sustained level of demand for physical therapists that
could adversely affect the provision of health care in medically under-
served areas. The Second Interim Rule also established the appropriate
English language competency levels for physical therapists.

Why Is the Service Promulgating a Third Interim Rule To Implement 8
U.S.C. 1182(a)(5)(C)?

    After careful consideration, the Service believes that it is in the
public interest to temporarily adopt this rule without notice and
comment procedures, and that it would be impracticable to do otherwise.
The Service will invite post promulgation comments to this temporary
rule. In addition the Service anticipates publishing a Notice of
Proposed Rule Making (NPRM) within the next 6 months.
    The IIRIRA was a major, complex legislative scheme, which
significantly changed existing immigration law and imposed many
administrative duties upon the Service. Many provisions of the IIRIRA,
including section 343 became immediately effective. The Service had a
tremendous responsibility to rapidly promulgate numerous regulations
implementing the new provisions of the law. Since enactment of the
IIRIRA, the Service has diligently worked on an NPRM to implement 8
U.S.C. 1182(a)(5)(C) via ordinary notice and comment procedure, but has
experienced considerable administrative difficulty in coordinating the
needs and concerns of the large number of federal agencies and private
interested parties affected by 8 U.S.C. 1182(a)(5)(C). Several
substantive issues require the technical expertise of other agencies
and further consultation before they can be definitively addressed. For
example, the provisions of 8 U.S.C. 1182(a)(5)(C) may affect United
States obligations under international treaties to facilitate the
movement of professionals. Second, the Service is required to further
define which, if any, other health care occupations fall under the
ambit of the statute. Because of the delays in promulgating the larger
rule, the Service believes the promulgation of this regulation as an
interim rule is imperative to enable the Service to execute its
adjudicative functions and to eliminate a growing backlog of pending
immigrant applications filed by aliens seeking to immigrate to the
United States as speech language pathologists and audiologists, medical
technologists, physicians assistants and medical technicians. The
Service has held such immigrant petitions in abeyance until
promulgation of implementing regulations and as a result, certain
immigrant health care workers have suffered extended periods of
separation from family members and petitioning employers have been
forced to operate without needed employees.

What Criteria Will the Service Use To Evaluate Organizations
Applying for Authority to Issue Certifications?

    The Service will continue to use the ``proven track record''
criterion previously promulgated in the First and Second Interim Rules.
The legislative history of the IIRIRA indicates that the factors to be
considered for selection of

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credentialing organizations are the following (1) the independence and
freedom of material conflicts of interest of the organization regarding
whether an alien receives a visa; (2) whether the organization has the
ability to evaluate credentials and English competency; (3) whether the
organization maintains comprehensive and current information on foreign
educational institutions; and (4) whether the organization can conduct
examinations outside of the United States. See H.R. REP. NO. 104-828 at
227 (1996). The Service intends to fully address each of these factors
in the NPRM. However since this is a temporary rule, the Service
believes that the ``proven track record'' criterion adequately
addresses the factors outlined in the legislative history.
    After careful consideration, the Service has decided it will not
use the ``sustained level of demand'' criterion utilized in the First
and Second Interim Rules. As discussed supra, the Service promulgated
those interim rules under the rationale that failure to process
immigrant petitions for certain health care occupations would adversely
affect the provision of health care in medically under-served areas.
Given that rationale for promulgation of those interim rules,
``sustained level of demand'' was initially an important consideration
in the approval of credentialing organizations. In contrast, the
Service is promulgating this interim rule because it has experienced
tremendous administrative difficulty in promulgating permanent
regulations due to the complexity of the issues to be addressed, and
because the Service is unable to execute its adjudicative functions
with respect to a growing backlog of petitions without an implementing
regulation. Therefore, ``sustained level of demand'' is not a relevant
consideration at this time because the Service is unable to execute its
adjudicative function with respect to these occupations.

What Is the Purpose of This Interim Rule?

    The purpose of this interim rule is to provide notice that CGFNS
may issue certificates pursuant to section 212(a)(5)(C) of the Act, on
a temporary basis, to foreign health care workers coming to the United
States as immigrants or applicants for adjustment of status to work in
the occupations of speech-language pathologists and audiologists,
medical technologists (clinical laboratory scientists), physician
assistants, and medical technicians (clinical laboratory technicians).
    This rule does not establish procedures for the Service to accept
certificates issued by CGFNS or equivalent credentialing organizations
to aliens seeking temporary admission to the United States to perform
services in a health care occupation. An alien's application for
admission as a nonimmigrant will be processed pursuant to the Service's
temporary policies previously described.
    This interim rule also lists the passing scores for the English
language tests for the occupations of speech-language pathologists and
audiologists, medical technologists (clinical laboratory scientists),
physician assistants, and medical technicians (clinical laboratory
technicians). This interim rule also amends the regulations concerning
what organizations may administer the English language tests to reflect
recent changes concerning one of the testing organizations.

Has CGFNS Shown That It Has an Established Track Record?

    Based on consultations with HHS, the Service finds that CGFNS has
an established track record in issuing certificates for speech-language
pathologists and audiologists, medical technologists (clinical
laboratory scientists), physician assistants and medical technicians
(clinical laboratory technicians). In addition to 20 years of
experience in evaluating the credentials of foreign nurses, CGFNS has
experience beyond nursing with regard to educational comparability and
credentials evaluation. CGFNS has an extensive database covering
health-related academic programs in foreign countries, much of which is
applicable beyond nursing. Finally CGFNS, through their credential
evaluation service, has evaluated foreign credentials, including
educational degrees and foreign licenses for psychiatric technicians,
physician assistants, emergency medical technicians and other
occupations. With the establishment of ``Professional Standards
Committees'' CGFNS has developed certification standards that may be
used to assess comparability for the occupations of speech language
pathologists and audiologists, medical technologists (clinical
laboratory scientists), physician assistants and medical technicians
(clinical laboratory technicians).

What Are the Passing English Test Scores for Speech-Language
Pathologists and Audiologists, Medical Technologist (Clinical
Laboratory Scientists), and Physician Assistants?

    In order to obtain a certificate, the alien must demonstrate to the
credentialing organization that he or she has passed either the English
tests given by the Educational Testing Service or the Michigan English
Language Assessment Battery (MELAB). In order to obtain a certificate
an alien must be competent in written, oral, and spoken English.
    The HHS has determined that speech-language pathologists and
audiologists, medical technologists (clinical laboratory scientists),
and physician assistants must obtain the following scores on the
English tests administered by the Educational Testing Service (ETS):
Test of English as a Foreign Language (TOEFL): paper-based 540,
computer-based 207; Test of Written English (TWE): 4.0; Test of Spoken
English (TSE): 50.
    The HHS has determined that speech-language pathologists and
audiologists, medical technologists (clinical laboratory scientists),
and physician assistants must obtain the following scores on the
English tests administered by the Michigan English Language Assessment
Battery (MELAB): Final Score 79; Oral Interview 3+. It is noted that,
effective June 30, 2000, the MELAB Oral Interview Speaking Test is no
longer being given overseas and is only being administered in the
United States and Canada. Applicants may take MELAB Parts 1, 2 and 3,
plus the TSE offered by the ETS. In addition, the exemptions for the
English language tests described in Sec. 212.15(g)(2) apply to the
occupations of speech-language pathologists and audiologists, medical
technologists (clinical laboratory scientists), and physician
assistants.

What Are the Passing English Test Scores for Medical Technicians
(Clinical Laboratory Technicians)?

    In order to obtain a certificate, the alien must demonstrate to the
credentialing organization that he or she has passed either the English
tests given by the Educational Testing Service or the Michigan English
Language Assessment Battery (MELAB). In order to obtain a certificate
an alien must be competent in written, oral, and spoken English.
    The HHS has determined that medical technicians (clinical
laboratory technicians) must obtain the following scores on the English
tests administered by ETS: TOEFL: paper-based 530, computer-based 197;
TWE: 4.0; TSE: 50.
    The HHS has determined that medical technicians (clinical
laboratory technicians) must obtain the following scores on the English
tests administered by the MELAB: Final Score 77; Oral Interview 3+.
Again, the MELAB Oral Interview Speaking Test is no longer being given
overseas and is only being

[[Page 3443]]

administered in the United States and Canada. Applicants may take MELAB
Parts 1, 2 and 3, plus the TSE offered by the ETS. In addition, the
exemptions for the English language tests described in
Sec. 212.15(g)(2) apply to the occupation of medical technicians
(clinical laboratory technicians).

What Aliens Are Exempt From the English Tests?

    According to Sec. 212.15(g)(1), aliens who have graduated from a
college, university, or professional training school located in
Australia, Canada, (except Quebec), Ireland, New Zealand, the United
Kingdom, and the United States are exempt from the English language
requirement.

Does This Interim Rule Alter Any of the Service's Policies With
Respect to the Admission of Nonimmigrant Health Care Workers?

    No, this rule enables CGFNS to issue certificates to foreign health
care workers seeking admission as immigrants or adjustment of status in
the occupations previously discussed. It does not alter any of the
Service's policies with respect to the admission of nonimmigrant aliens
coming to perform services in health care occupations that were
described in the first interim rule.

How Does This Rule Amend the Existing Regulation?

    This interim rule amends the regulation at Sec. 212.15(c) by adding
the occupations of speech-language pathologists and audiologists,
medical technologists (clinical laboratory scientists), physician
assistants, and medical technicians (clinical laboratory technicians)
to the list of occupations.
    This interim rule also amends the regulation at Sec. 212.15(e) to
add the occupations of speech-language pathologists and audiologists,
medical technologists (clinical laboratory scientists), physician
assistants, and medical technicians (clinical laboratory technicians)
to the list of occupations for which CGFNS can issue certificates.
    Finally, this interim rule amends the regulation at Sec. 212.15(g)
to list the passing English scores for the occupations of speech-
language pathologists and audiologists, medical technologists (clinical
laboratory scientists), physician assistants, and medical technicians
(clinical laboratory technicians). This interim rule further amends the
regulations at Sec. 212.15(g) by describing the changes in testing that
have been instituted by MELAB.

Good Cause Exception

    This interim rule is effective 60 days from the date of publication
in the Federal Register, and the Service invites post-promulgation
comments to be weighed and considered in the forthcoming NPRM. For the
following reasons, the Service for good cause finds that it is in the
public interest to temporarily adopt this rule without notice and
comment procedures, and that it would be impracticable to do otherwise.
    First, the Service has diligently worked on an NPRM for 8 U.S.C.
1182(a)(5)(C), but has experienced considerable administrative
difficulty in coordinating the needs and concerns of the large number
of federal agencies and private interested parties affected by 8 U.S.C.
1182(a)(5)(C). Several substantive issues, including how the provisions
of 8 U.S.C. 1182(a)(5)(C) affect United States obligations under
international treaties, and how to define which occupations fall under
the ambit of the statute, require the technical expertise of other
agencies and further consultation before they can be definitively
addressed.
    Second, the Service believes that promulgation of this regulation
as an interim rule is imperative to enable the Service to execute its
adjudicative functions with respect to pending immigrant applications
filed by aliens seeking to immigrate to the United States as speech
language pathologists, medical technologists, physician assistants and
medical technicians. Such immigrant applications have been held in
abeyance until promulgation of implementing regulations resulting in a
backlog. Further, because these immigrant applications have been held
in abeyance, certain immigrant health care workers have unfortunately
suffered extended periods of separation from family members and
petitioning employers have been forced to operate without needed
employees. In the long term, the Service's continued policy with
respect to these immigrants could have the unintended consequence of
chilling future immigration of alien health care workers in these
occupations.
    While the Service plans to issue an NPRM in 6 months that covers
more than this interim rule, it does not anticipate speedy promulgation
of a final rule due to the numerous public comments expected in
response to the NPRM. In light of this, the Service finds that it would
be contrary to the public interest to continue to hold these immigrant
applications in abeyance pending final rules when the admission or
adjustment of these aliens under temporary procedures will only serve
to benefit the public health.

Regulatory Flexibility Act

    The Commissioner of the Immigration and Naturalization Service, in
accordance with 5 U.S.C. 605(b), has reviewed this regulation and, by
approving it, certifies that this rule will not have a significant
economic impact on a substantial number of small entities. This rule
has been drafted in a way to minimize the economic impact that it has
on small business while meeting its intended objective. The health care
workers who will be issued certificates are not considered small
entities as the term is defined in 5 U.S.C. 601(6).

Unfunded Mandates Reform Act of 1995

    This rule will not result in the expenditure by State, local and
tribal governments, in the aggregate, or by the private sector, of $100
million or more in any 1 year, and it will not significantly or
uniquely affect small governments. Therefore, no actions were deemed
necessary under the provisions of the Unfunded Mandates Reform Act of
1995.

Small Business Regulatory Enforcement Fairness Act of 1996

    This rule is not a major rule as defined by section 804 of the
Small Business Regulatory Enforcement Act of 1996. This rule will not
result in an annual effect on the economy of $100 million or more; a
major increase in costs or prices; or significant adverse effects on
competition, employment, investment, productivity, innovation, or on
the ability of United States-based companies to compete with foreign-
based companies in domestic and export markets.

Executive Order 12866

    This rule is considered by the Department of Justice, Immigration
and Naturalization Service, to be a ``significant regulatory action''
under E.O. 12866, section 3(f), Regulatory Planning and Review.
Accordingly, this rule has been submitted to the Office of Management
and Budget (OMB) for review.

Executive Order 13132

    This rule will not have substantial direct effects on the States,
on the relationship between the National Government and the States, or
on the distribution of power and responsibilities among the various
levels of government. Therefore, in

[[Page 3444]]

accordance with section 6 of Executive Order 13132, it is determined
that this rule does not have sufficient federalism implications to
warrant the preparation of a federalism summary impact statement.

Executive Order 12988 Civil Justice Reform

    This rule meets the applicable standards set forth in sections 3(a)
and 3(b)(2) of Executive Order 12988.

Paperwork Reduction Act

    The information required on the certificate for health care workers
showing that the alien possesses proficiency in the skills that affect
the provision of health care services in the United States (as provided
in Sec. 212.15(f)) is considered an information collection that has
been approved for use by the Office of Management and Budget (OMB)
under OMB control number 1115-0226. It is estimated that the number of
respondents will increase as a result of adding the five additional
health care occupations listed in Sec. 212.15(c). Accordingly, the
Service will submit an adjustment form to OMB increasing the total
annual burden hours.

List of Subjects in 8 CFR Part 212

    Administrative practice and procedures, Aliens, Immigration,
Passports and visas, Reporting and recordkeeping requirements.

    Accordingly, part 212 of chapter I of title 8 of the Code of
Federal Regulations is amended as follows:

PART 212--DOCUMENTARY REQUIREMENTS: NONIMMIGRANTS; WAIVERS;
ADMISSION OF CERTAIN INADMISSIBLE ALIENS; PAROLE

    1. The authority citation for part 212 continues to read as
follows:

    Authority: 8 U.S.C. 1101, 1102, 1103, 1182, 1184, 1187, 1225,
1226, 1227, 1228, 1252; 8 CFR part 2.

    2. Section 212.15 is amended by:
    a. Adding new paragraphs (c)(4) through (c)(7);
    b. Revising paragraph (e)(1);
    c. Revising paragraph (g)(3)(i); and
    d. Adding new paragraphs (g)(4)(iv) and (g)(4)(v), to read as
follows:

Sec. 212.15  Certificates for foreign health care workers.

* * * * *
    (c) * * *
    (4) Speech-Language Pathologists and Audiologists.
    (5) Medical Technologists (Clinical Laboratory Scientists).
    (6) Physician Assistants.
    (7) Medical Technicians (Clinical Laboratory Technicians).
* * * * *
    (e) * * *
    (1) The Commission on Graduates of Foreign Nursing Schools may
issue certificates pursuant to 8 U.S.C. 1182(a)(5)(C), and section
212(a)(5)(C) of the Act for the occupations of nurse (licensed
practical nurse, licensed vocational nurse, and registered nurse),
physical therapist, occupational therapist, speech-language pathologist
and audiologist, medical technologist (clinical laboratory scientist),
physician assistant, and medical technician (clinical laboratory
technician).
* * * * *
    (g) * * *
    (3) * * *
    (i) Michigan English Language Assessment Battery (MELAB). Effective
June 30, 2000, the MELAB Oral Interview Speaking Test is no longer
being given overseas and is only being administered in the United
States and Canada. Applicants may take MELAB Parts 1, 2, and 3, plus
the Test of Spoken English offered by the Educational Testing Service.
* * * * *
    (4) * * *
    (iv) Speech-language pathologists and Audiologists, medical
technologists (clinical laboratory scientists), and physician
assistants. An alien coming to the United States to perform labor as a
speech-language pathologist and audiologist, a medical technologist
(clinical laboratory scientist), or a physician assistant must have the
following scores to be issued a certificate: ETS: TOEFL: Paper-Based
540, Computer-Based 207; TWE: 4.0; TSE: 50; MELAB: Final Score 79; Oral
Interview: 3+.
    (v) Medical technicians (clinical laboratory technicians). An alien
coming to the United States to perform labor as a medical technician
(clinical laboratory technician) must have the following scores to be
issued a certificate: ETS: TOEFL: Paper-Based 530, Computer-Based 197;
TWE: 4.0; TSE: 50; MELAB: Final Score 77; Oral Interview: 3+.

    Dated: November 28, 2000.
Mary Ann Wyrsch,
Acting Commissioner, Immigration and Naturalization Service.
[FR Doc. 01-1203 Filed 1-12-01; 8:45 am]
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