On July 25, 2003, the Department of Homeland Security (DHS - formerly INS) ruled that beginning July 2004, Health Care Worker Certification (commonly referred to as Visa Screen) will be required of seven healthcare occupations including nonimmigrant TN workers. Occupations covered by the rule are: (1) Registered Nurses; (2) Occupational Therapists; (3) Physical Therapists; (4) Speech Language Pathologists and Audiologists; (5) Medical Technologists/Clinical Laboratory Scientists; (6) Physician Assistants; and (7) Medical Technicians/Clinical Laboratory Technicians. Certification was previously required for professionals in these occupations who applied for Green Cards through employment based petitions. Current Green Card holders, and some family based Green Card applicants will not be required to obtain certification.

The DHS has granted a one year waiver to July 26, 2004 to allow time to obtain certification. TN workers entering the U.S. (or if already in the U.S., changing or extending their status) on and after July 26, 2004 must present Health Care Worker Certification. Workers with TN expiration dates later than July 26, 2004 who leave the U.S. during the period of validity of their TN are subject to inspection on their return and if returning after July 26, 2004 may be required to present certification. Workers with TN expiration dates later than July 26, 2004 who do not leave the country after that date may consider their "deadline" to obtain certification to be deferred until the next time they apply for a new TN.

Current and future TN workers should take action quickly to secure certification and not wait to the last minute to apply. U.S. healthcare employers should address the issue with their TN workers immediately. We estimate it will take three to five months to complete the process. There will undoubtedly be processing and other unforeseen delays, and as a result, workers who defer action will wait longer to come here and workers already here will risk interruptions to their employment and status.

The DHS considered this country's obligations to Canada under NAFTA but determined that the certification requirement was intended to apply to all nonimmigrant (and immigrant) health care workers. Another unfortunate aspect of the rule is that citizens of foreign countries who received education and training in the U.S. are not exempt from the certification requirement. However, DHS has indicated that these applications will be streamlined, allowing exemptions for the English language proficiency and the education equivalence review. Foreign nationals who have valid state license in the U.S. must also obtain certification.

Health Care Worker Certification verifies that: (1) the worker's education, training, license and experience are comparable with that required for an American health care worker; (2) the worker is competent in oral and written English (Note that graduates of health profession programs in Canada (except Quebec), are deemed to have met the English language requirements.); (3) the worker's license is unencumbered; and (4) the worker has passed the state licensing examination (NCLEX) or a predictor examination (CGFNS - we do not recommend this for Canadian nurses).
The certificate will be valid for five years. If a nonimmigrant foreign national seeks to enter the U.S or change status more than five years after a certificate is issued, they will have to obtain a new certificate. The purpose of the five year expiration date is to ensure that when the certificate is submitted, the holder still has the appropriate language and technical skills to perform the duties of the occupation.

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