Matter of H-V-P-

March 9, 2016 PM-602-0129 Policy Memorandum SUBJECT: Matter of H-V-P-, Adopted Decision 2016-01 (AAO Feb. 9, 2016) This policy memorandum (PM) designates the attached decision of the Administrative Appeals Office (AAO) in Matter of H-V-P- as an Adopted Decision. Accordingly, this adopted decision establishes policy guidance that applies to and binds all USCIS employees. USCIS personnel are directed to follow the reasoning in this decision in similar cases. Matter of H-V-P- clarifies that, in addition to primary care physicians, medical specialists who agree to practice in any area designated by the Secretary of Health and Human Services as having a shortage of health care professionals may be eligible for the physician national interest waiver under section 203(b)(2)(B)(ii) of the Immigration and Nationality Act. Use This PM is intended solely for the guidance of USCIS personnel in the performance of their official duties. It is not intended to, does not, and may not be relied upon to create any right or benefit, substantive or procedural, enforceable at law or by any individual or other party in removal proceedings, in litigation with the United States, or in any other form or manner. Contact Information Questions or suggestions regarding this PM should be addressed through appropriate directorate channels to the AAO.

2016年3月9日 PM-602-0129 政策备忘录 主题：Matter of H-V-P-，采纳决定2016-01（AAO 2016年2月9日） 本政策备忘录（PM）将行政上诉办公室（AAO）在Matter of H-V-P-案中的附随决定指定为采纳决定。因此，本采纳决定确立了适用于并约束所有USCIS雇员的政策指导。USCIS人员被指示在类似案件中遵循本决定中的推理。 Matter of H-V-P-澄清，除初级保健医生外，同意在卫生与公众服务部部长指定的任何存在卫生保健专业人员短缺的地区执业的医学专家，可能有资格获得《移民与国籍法》第203(b)(2)(B)(ii)条规定的医生国家利益豁免。 使用 本PM仅供USCIS人员在履行公务时作为指导。其无意、也不会、且不得被依赖以创设任何权利或利益，无论是实体性的还是程序性的，可在法律上或由任何个人或其他当事方在驱逐程序中、在与美国的诉讼中、或以任何其他形式或方式强制执行。 联系信息 有关本PM的问题或建议应通过适当的局渠道向AAO提出。

ADMINISTRATIVE APPEALS OFFICE U.S. CITIZENSHIP AND IMMIGRATION SERVICES

行政上诉办公室 美国公民及移民服务局

DEPARTMENT OF HOMELAND SECURITY

国土安全部

February 9, 2016[1]

2016年2月9日[1]

In addition to primary care physicians, medical specialists who agree to practice in any area designated by the Secretary of Health and Human Services as having a shortage of health care professionals may be eligible for the physician national interest waiver under section 203(b)(2)(B)(ii) of the Immigration and Nationality Act. The Petitioner, a physician, seeks an immigrant visa petition as a member of the professions holding an advanced degree as set forth in section 203(b)(2) of the Immigration and Nationality Act (the Act), 8 U.S.C. § 1153(b)(2). In addition, the Petitioner seeks a “national interest” waiver (NIW) from the requirement of a job offer by a U.S. employer. Section 203(b)(2)(B)(ii) of the Act not only authorizes but requires that such a waiver be afforded to a physician who meets several conditions, most notably for our purposes: (1) that the physician would work in a medically underserved area as designated by the Secretary of Health and Human Services (HHS); and (2) that a Federal agency or State public health department certifies the physician’s work is in the public interest. The Director, Texas Service Center, denied the petition because he found that the Petitioner’s past and prospective work as a specialty care physician did not make him eligible for the national interest waiver. The Director then certified the case to us for review.2 The issue presented is whether eligibility for the physician NIW is available to medical specialists even though the HHS designations ostensibly are limited to only primary care physicians. Upon de novo review, we will withdraw the Director’s decision and approve the petition.

除初级保健医生外，同意在卫生与公众服务部部长指定的任何存在卫生保健专业人员短缺的地区执业的医学专家，可能有资格获得《移民与国籍法》第203(b)(2)(B)(ii)条规定的医生国家利益豁免。 申请人是一名医生，寻求作为《移民与国籍法》（该法）第203(b)(2)条、8 U.S.C. § 1153(b)(2)规定的持有高级学位的专业人士成员获得移民签证申请。此外，申请人寻求豁免美国雇主提供工作机会要求的“国家利益”豁免（NIW）。该法第203(b)(2)(B)(ii)条不仅授权而且要求向满足若干条件的医生提供此类豁免，就我们的目的而言最值得注意的是：（1）该医生将在卫生与公众服务部（HHS）部长指定的医疗服务不足地区工作；以及（2）联邦机构或州公共卫生部门证明该医生的工作符合公共利益。 德克萨斯服务中心主任拒绝了该申请，因为他认定申请人过去和未来作为专科护理医生的工作并未使其有资格获得国家利益豁免。主任随后将案件认证给我们进行审查。2 提出的问题是，医学专家是否有资格获得医生NIW，尽管HHS的指定表面上仅限于初级保健医生。经重新审查，我们将撤回主任的决定并批准该申请。

1 On March 9, 2016, U.S. Citizenship and Immigration Services designated this Administrative Appeals Office (AAO) decision as an Adopted Decision. The original AAO decision is Matter of H-V-P-, ID# 16270 (AAO Feb. 9, 2016). 2 8 C.F.R. § 103.4(a) permits Department of Homeland Security (DHS) components to certify their decision for further review by the appropriate appellate authority when the matter involves an unusually complex or novel issue of law or fact.

1 2016年3月9日，美国公民及移民服务局将本行政上诉办公室（AAO）决定指定为采纳决定。原始的AAO决定为Matter of H-V-P-，ID# 16270（AAO 2016年2月9日）。 2 8 C.F.R. § 103.4(a)允许国土安全部（DHS）组成部分在事项涉及异常复杂或新颖的法律或事实问题时，将其决定认证给适当的上诉机构进一步审查。

Matter of H-V-P- Adopted Decision

Matter of H-V-P- 采纳决定

I. LAW AND POLICY Section 203(b) of the Act states, in pertinent part:

I. 法律与政策 该法第203(b)条相关规定如下：

(2) Aliens who are members of the professions holding advanced degrees or aliens of exceptional ability.

（2）属于持有高级学位的专业人士成员或具有杰出能力的外国人。

(A) In general. Visas shall be made available . . . to qualified immigrants who are members of the professions holding advanced degrees or their equivalent or who because of their exceptional ability in the sciences, arts, or business, will substantially benefit prospectively the national economy, cultural or educational interests, or welfare of the United States, and whose services in the sciences, arts, professions, or business are sought by an employer in the United States. (B) Waiver of job offer

（A）一般规定。签证应提供给……符合条件的移民，即属于持有高级学位或同等学历的专业人士成员，或因其在科学、艺术或商业方面的杰出能力，将实质性惠及美国未来的国家经济、文化或教育利益或福利，且其在美国的科学、艺术、专业或商业服务由美国雇主寻求。 （B）工作机会豁免

(i) National interest waiver. Subject to clause (ii), the Attorney General[3] may, when the Attorney General deems it to be in the national interest, waive the requirements of subparagraph (A) that an alien's services in the sciences, arts, professions, or business be sought by an employer in the United States. (ii) Physicians working in shortage areas or veteran facilities.

（i）国家利益豁免。在符合第（ii）项的前提下，司法部长[3]可在其认为符合国家利益时，豁免第（A）项关于外国人在科学、艺术、专业或商业方面的服务须由美国雇主寻求的要求。 （ii）在短缺地区或退伍军人设施工作的医生。

(I) In general. The Attorney General shall grant a national interest waiver pursuant to clause (i) on behalf of any alien physician with respect to whom a petition for preference classification has been filed under subparagraph (A) if –

（I）一般规定。司法部长应依据第（i）项，为任何已根据第（A）项提交优先分类申请的外国医生授予国家利益豁免，如果——

(aa) the alien physician agrees to work full time as a physician in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals or at a health care facility under the jurisdiction of the Secretary of Veterans Affairs; and (bb) a Federal agency or a department of public health in any State has previously determined that the alien physician's work in such an area or at such facility was in the public interest.

（aa）该外国医生同意在卫生与公众服务部部长指定的存在卫生保健专业人员短缺的一个或多个地区，或在退伍军人事务部部长管辖下的卫生保健设施，全职担任医生；并且 （bb）联邦机构或任何州的公共卫生部门先前已确定该外国医生在此类地区或此类设施的工作符合公共利益。

3 Pursuant to section 1517 of the Homeland Security Act of 2002 (HSA), Pub. L. No. 107-296, 116 Stat. 2135, 2311 (codified at 6 U.S.C. § 557 (2012)), any reference to the Attorney General in a provision of the Act describing functions that were transferred from the Attorney General or other Department of Justice official to the DHS by the HSA “shall be deemed to refer to the Secretary” of DHS. See also 6 U.S.C. § 542 note (2012); 8 U.S.C. § 1551 note (2012).

3 根据2002年《国土安全法》（HSA）第1517条，Pub. L. No. 107-296, 116 Stat. 2135, 2311（编于6 U.S.C. § 557 (2012)），该法条款中描述由HSA从司法部长或其他司法部官员转移至DHS的职能时，任何对司法部长的提及“应视为指”DHS部长。另见6 U.S.C. § 542注（2012）；8 U.S.C. § 1551注（2012）。

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Matter of H-V-P- Adopted Decision

Matter of H-V-P- 采纳决定

The regulation at 8 C.F.R. § 204.12(a) requires a petitioner seeking a waiver under section 203(b)(2)(B)(ii) of the Act to establish the following:

8 C.F.R. § 204.12(a)的规定要求寻求该法第203(b)(2)(B)(ii)条豁免的申请人确立以下事项：

(1) The physician agrees to work full-time (40 hours per week) in a clinical practice for an aggregate of 5 years (not including time served in J-1 nonimmigrant status); and (2) The service is;

（1）该医生同意在临床实践中全职工作（每周40小时），总计5年（不包括以J-1非移民身份服务的时间）；并且 （2）服务是：

(i) In a geographical area or areas designated by the Secretary of Health and Human Services (HHS) as a Medically Underserved Area, a Primary Medical Health Professional Shortage Area, or a Mental Health Professional Shortage Area, and in a medical speciality that is within the scope of the Secretary's designation for the geographical area or areas; or (ii) At a health care facility under the jurisdiction of the Secretary of Veterans Affairs (VA); and (3) A Federal agency or the department of public health of a State, territory of the United States, or the District of Columbia, has previously determined that the physician's work in that area or facility is in the public interest. (Emphasis added.) The regulation at 8 C.F.R. § 204.12(c) goes on to set forth evidence that a petitioner must submit, including, in part, documentation that the physician will serve “[i]n a geographical area or areas designated by the Secretary of HHS as having a shortage of health care professionals and in a medical speciality that is within the scope of the Secretary’s designation for the geographical area or areas” (or in a VA facility). 8 C.F.R. § 204.12(c)(2) (emphasis added).4 In the preamble to the 2000 rule implementing the physician NIW, the legacy Immigration and Naturalization Service (INS) noted that HHS limited its medical care shortage designations to certain general areas of practice (which we will refer to as “primary medical care” or “primary care”).5 The INS accordingly stated that it would limit physician NIWs to these areas of primary care as well, notwithstanding the statute’s use of the term “any physician.” See National Interest Waivers for Second Preference Employment-Based Immigrant Physicians Serving in Medically Underserved Areas or at Department of Veterans Affairs Facilities, 65 Fed. Reg. 53889, 53890 (Sept. 6, 2000). In 2006, the U.S. Court of Appeals for the Ninth Circuit struck down several parts of the regulations relating to physician NIWs, but did not address a challenge to the requirement under 8 C.F.R. § 204.12(c) that the physician’s service be within the scope of the HHS designation. Schneider v.

（i）在卫生与公众服务部（HHS）部长指定的医疗服务不足地区、初级医疗保健专业人员短缺地区或心理健康专业人员短缺地区的一个或多个地理区域内，并且属于部长对该一个或多个地理区域指定范围内的医学专科；或 （ii）在退伍军人事务部（VA）部长管辖下的卫生保健设施；并且 （3）联邦机构或美国某州、美国领地或哥伦比亚特区的公共卫生部门先前已确定该医生在该地区或设施的工作符合公共利益。 （强调为后加。）8 C.F.R. § 204.12(c)的规定进一步列出了申请人必须提交的证据，部分包括证明该医生将服务于“[在]HHS部长指定的存在卫生保健专业人员短缺的一个或多个地理区域内，并且属于部长对该一个或多个地理区域指定范围内的医学专科”（或在VA设施）的文件。8 C.F.R. § 204.12(c)(2)（强调为后加）。4 在实施医生NIW的2000年规则的前言中，原移民与归化局（INS）指出，HHS将其医疗保健短缺指定限于某些一般执业领域（我们将称为“初级医疗保健”或“初级保健”）。5 因此，INS表示，尽管法规使用了“任何医生”一词，它也将把医生NIW限于这些初级保健领域。见National Interest Waivers for Second Preference Employment-Based Immigrant Physicians Serving in Medically Underserved Areas or at Department of Veterans Affairs Facilities, 65 Fed. Reg. 53889, 53890（2000年9月6日）。 2006年，美国第九巡回上诉法院推翻了与医生NIW相关的若干规定部分，但未处理对8 C.F.R. § 204.12(c)中医生的服务须在HHS指定范围内的要求的挑战。Schneider v.

4 Both regulatory provisions cited above use the term “speciality,” whereas other agency materials use the term “specialty.” We consider those terms to be interchangeable. 5 Those areas of practice were family or general medicine, pediatrics, general internal medicine, obstetrics/gynecology, and psychiatry. 65 Fed. Reg. 53889, 53890.

4 上述两项法规条款均使用“speciality”一词，而其他机构材料使用“specialty”一词。我们认为这些术语可互换。 5 这些执业领域为家庭或普通医学、儿科、普通内科、产科/妇科和精神病学。65 Fed. Reg. 53889, 53890。

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Matter of H-V-P- Adopted Decision

Matter of H-V-P- 采纳决定

Chertoff, 450 F.3d 944, 959-960 (9th Cir. 2006). In the wake of the Schneider decision, United States Citizenship and Immigration Services (USCIS) issued a policy memorandum revising the USCIS Adjudicator’s Field Manual (AFM) and providing interim procedures for adjudicating physician NIWs. This memorandum stated, “USCIS is expanding the fields of medical specialty that may qualify physicians for NIWs by accepting petitions on behalf of physicians who provide specialty care.”6 (Emphasis in original.) The Schneider Memorandum went on to note: “The Nursing Relief Act [creating the mandatory physician NIW] requires USCIS to recognize HHS designations of health professionals without limitation to primary care. In following HHS’ designations of MUP [Medically Underserved Population] and PSA [Physician Scarcity Area], USCIS will now recognize NIW physicians in primary and specialty care.” Id. at 7 (reference omitted).

Chertoff, 450 F.3d 944, 959-960（9th Cir. 2006）。在Schneider判决之后，美国公民及移民服务局（USCIS）发布了一份政策备忘录，修订了USCIS裁决者现场手册（AFM），并提供了裁决医生NIW的临时程序。该备忘录指出，“USCIS正在扩大可能使医生有资格获得NIW的医学专科领域，接受代表提供专科护理的医生提交的申请。”6（强调为原文所加。）Schneider备忘录进一步指出：“《护理救济法》[创设强制性医生NIW]要求USCIS承认HHS对卫生专业人员的指定，而不限于初级保健。在遵循HHS对MUP[医疗服务不足人群]和PSA[医生稀缺地区]的指定时，USCIS现在将承认初级和专科护理中的NIW医生。”同上，第7页（引用省略）。

II. PERTINENT FACTS AND PROCEDURAL HISTORY The Petitioner filed Form I-140, Immigrant Petition for Alien Worker, seeking an immigrant visa petition under section 203(b)(2)(A) of the Act as a member of the professions holding an advanced degree, with an accompanying request for a national interest waiver under section 203(b)(2)(B)(ii). As supporting evidence, the Petitioner submitted a letter from the Illinois Department of Public Health in accordance with section 203(b)(2)(B)(ii)(I)(bb) of the Act, stating that the Petitioner’s services are in the public interest, as well as documentation indicating that HHS designated his medical practice site as a Health Professional Shortage Area (HPSA) and a Medically Underserved Area/Population (MUA/P). The Director issued a notice of intent to deny (NOID) the Form I-140, however, noting that the Petitioner’s current field of practice (hematology-oncology) is a specialty practice area, and stating that only primary medical care practitioners are eligible for a physician NIW based on service in an HPSA, or MUA/P. The Director pointed out that HHS had designated the Petitioner’s practice site as an HPSA as well as a MUA/P. These HHS designations, the Director observed, relate to a lack of primary medical care providers, while only HHS’ Physician Scarcity Area (PSA) designation encompasses both primary care and specialty care. Citing the Schneider Memorandum, he stated that any service in a medical specialty must be performed in a PSA, not in an HSPA or MUA/P. In a letter responding to the NOID, the Petitioner argued that the Director misconstrued the Schneider Memorandum because that memorandum states that service by a specialty care physician in any area HHS designates as having a shortage of physicians will qualify for the NIW, including service within an HPSA or MUA/P. The Petitioner also stated that HHS no longer maintains and updates shortage designation information for PSAs, submitting a publication by HHS’ Centers for Medicare & Medicaid Services about the “sunset” of its PSA bonus payment program on January 1, 2008.

II. 相关事实与程序历史 申请人提交了I-140表，即外籍工人移民申请，依据该法第203(b)(2)(A)条，以持有高级学位的专业人士身份寻求移民签证申请，并附随依据该法第203(b)(2)(B)(ii)条提出的国家利益豁免请求。作为支持证据，申请人依据该法第203(b)(2)(B)(ii)(I)(bb)条提交了伊利诺伊州公共卫生部的一封信函，说明申请人的服务符合公共利益，以及表明HHS将其医疗执业地点指定为卫生专业人员短缺地区（HPSA）和医疗资源不足地区/人群（MUA/P）的文件。 然而，主任签发了拒绝I-140表的意向通知（NOID），指出申请人当前的执业领域（血液肿瘤科）属于专科执业领域，并称只有初级医疗执业者才有资格基于在HPSA或MUA/P中的服务获得医生NIW。主任指出，HHS已将申请人的执业地点指定为HPSA以及MUA/P。主任认为，这些HHS指定涉及初级医疗提供者的缺乏，而只有HHS的医生稀缺地区（PSA）指定才同时涵盖初级医疗和专科医疗。他援引Schneider备忘录称，任何医疗专科服务必须在PSA中提供，而非在HSPA或MUA/P中提供。 在回应NOID的信函中，申请人主张主任曲解了Schneider备忘录，因为该备忘录规定，专科医疗医生在HHS指定为医生短缺的任何地区（包括在HPSA或MUA/P内）提供服务将有资格获得NIW。申请人还称，HHS不再维护和更新PSA的短缺指定信息，并提交了HHS联邦医疗保险和医疗补助服务中心关于其PSA奖金支付计划于2008年1月1日“日落”的出版物。

6 Memorandum from Michael Aytes, Associate Director, Domestic Operations, USCIS, HQ 70/6.2, Interim guidance for adjudicating national interest waiver (NIW) petitions and related adjustment applications for physicians serving in medically underserved areas in light of Schneider v. Chertoff, 450 F.3d 944 (9th Cir. 2006) (“Schneider decision”) 2 (Jan. 23, 2007) http://www.uscis.gov/sites/default/files/USCIS/Laws/Memoranda/ Static_Files_Memoranda/schneiderintrm012307.pdf (Schneider Memorandum).

6 国内行动处副处长 Michael Aytes 备忘录，USCIS，HQ 70/6.2，关于根据 Schneider v. Chertoff, 450 F.3d 944 (9th Cir. 2006)（“Schneider 判决”）裁决在医疗服务不足地区服务的医生的国家利益豁免（NIW）申请及相关调整身份申请的临时指南 2（2007年1月23日）http://www.uscis.gov/sites/default/files/USCIS/Laws/Memoranda/Static_Files_Memoranda/schneiderintrm012307.pdf（Schneider 备忘录）。

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Matter of H-V-P- Adopted Decision

Matter of H-V-P- 已采纳决定

The Director then denied the Form I-140, finding that the Petitioner’s service as a hematologist- oncologist in an area designated as an HPSA and MUA/P is not qualifying service for the purpose of NIW eligibility. The Director noted that, under 8 C.F.R. § 204.12(a)(2), a physician must practice “in a medical specialty that is within the scope of the Secretary’s designation for the geographical area or area,” and that HHS does not consider specialty care physicians in its HPSA and MUA/P designations. The Director again cited the Schneider Memorandum as the basis for his decision, and certified his decision for our review under 8 C.F.R. § 103.4(a). In his brief to us on certification, the Petitioner contends that the Director’s decision is contrary to the purpose and structure of the statute, is contrary to the Schneider Memorandum, and represents a departure from agency practice in the years since the Schneider Memorandum. The Petitioner submits a letter from the Illinois Department of Public Health, stating that “the HPSA shortage designation system is the most reliable and accurate system for measuring shortages of physicians, both primary and specialty care, in communities in Illinois.” The letter further explains that the “input for the HPSA is not just the number of primary care physicians in a particular area, but includes extensive and diverse demographic data on the community,” and that specialists and primary care physicians “work side by side providing care to the same patients.” The Petitioner also submits a letter from the chair of the department of medicine at Cook County Health and Hospitals System, who maintains that internists and specialists “function together as an integrated team” within the department “providing care for the same population of patients.” The Petitioner has also submitted an amicus curiae brief prepared jointly by the American Immigration Council, the American Immigration Lawyers Association, and the International Medical Group Taskforce.7 In their brief, amici argue (1) that the statute mandates a non-discretionary waiver for “any alien physician” practicing in a designated shortage area, (2) that HPSAs and MUA/Ps are the most accurate and current indication of a shortage area, and (3) that, even though these HHS programs only look at primary care doctors in their calculation, other factors (such as distance and poverty) pertain equally to primary and specialty care. The brief was supported by sworn declarations from four immigration attorneys who attest to USCIS’ practice of routinely approving NIWs for specialty care physicians since USCIS issued the Schneider Memorandum in 2007.

随后，主任拒绝了I-140表，认定申请人作为血液肿瘤科医生在被指定为HPSA和MUA/P的地区服务不属于NIW资格目的的合格服务。主任指出，根据8 C.F.R. § 204.12(a)(2)，医生必须“在部长对该地理区域或地区指定范围内的医疗专科”执业，而HHS在其HPSA和MUA/P指定中不考虑专科医疗医生。主任再次援引Schneider备忘录作为其决定的依据，并依据8 C.F.R. § 103.4(a)将其决定提交本局复核。 在其提交本局的认证简报中，申请人主张主任的决定违背了该法的目的和结构，违背了Schneider备忘录，并且偏离了Schneider备忘录发布以来多年的机构实践。申请人提交了伊利诺伊州公共卫生部的一封信函，称“HPSA短缺指定系统是衡量伊利诺伊州社区初级和专科医疗医生短缺的最可靠和准确的系统。”该信函进一步解释称，“HPSA的输入不仅仅是某一特定地区的初级医疗医生数量，还包括关于社区的广泛和多样化的人口统计数据”，并且专科医生和初级医疗医生“并肩工作，为相同的患者提供护理”。申请人还提交了库克县卫生和医院系统内科系主任的一封信函，该主任主张内科医生和专科医生在该系内“作为一个综合团队运作”，“为相同的人群提供护理”。 申请人还提交了一份由美国移民委员会、美国移民律师协会和国际医疗集团工作组共同编写的法庭之友简报。7 在其简报中，法庭之友主张（1）该法强制要求为在指定短缺地区执业的“任何外籍医生”提供非自由裁量的豁免，（2）HPSA和MUA/P是最准确和最新的短缺地区指示，以及（3）即使这些HHS项目在计算中仅考虑初级医疗医生，其他因素（如距离和贫困）同样适用于初级和专科医疗。该简报得到了四名移民律师的宣誓声明的支持，他们证明自USCIS于2007年发布Schneider备忘录以来，USCIS有 routinely 批准专科医疗医生NIW的实践。

III. ANALYSIS This matter requires us to resolve how to adjudicate an immigration law classification that depends upon certain findings by a sister department in its administration of a health care program. Section 203(b)(2)(B)(ii) of the Act states that a NIW shall be granted to “any alien physician” who will work in an area designated as having a shortage of health care professionals, and makes no mention of limitations relating to the physician’s practice area. In making this waiver mandatory in the Nursing Relief Act, Congress clearly intended to improve the accessibility of medical care in

III. 分析 本事项要求我们解决如何裁决一项移民法分类，该分类取决于姐妹部门在其医疗保健项目管理中的某些认定。 该法第203(b)(2)(B)(ii)条规定，NIW应授予将在被指定为卫生保健专业人员短缺地区工作的“任何外籍医生”，并未提及与医生执业领域相关的限制。在《护理救济法》中将此豁免设为强制性时，国会明确意图通过为愿意在此类地区全职执业五年或以上的医生提供美国雇主工作邀请的豁免，来改善

7 The AAO appreciates the thoughtful statements of amici who helped inform this certification.

7 AAO感谢法庭之友的深思熟虑的陈述，他们为本认证提供了参考。

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underserved areas by providing a waiver of a job offer from a U.S. employer if the physician was willing to practice full time in such an area for five years or more. The framework it created to do so requires first that HHS has designated the area the physician intends to practice in as “having a shortage of health care professionals,” and secondly, that a Federal agency or State department of public health has determined that the physician’s services in that area are “in the public interest.” The regulation at 8 C.F.R. § 204.12(a)(2)(i) adds a requirement that the physician’s area of medical specialty is within the scope of the HHS designation for that area. As noted above, HHS does not single out specialty areas of medical practice in its HPSA and MUA/P designations. While at one time it may have done so with PSAs, that program sunset in 2008 and those designations are no longer effective; the only designations that currently exist relate to primary medical care. To read this regulation as requiring an affirmative HHS certification of a shortage of specialty care effectively bars all specialist physicians from ever receiving a NIW, no matter how urgently their services may be needed. Were we to construe the regulation to require an HHS designation only under a program that ended in 2008, we would frustrate the statutory scheme Congress enacted to improve access to medical care in underserved areas. Moreover, the Petitioner has submitted persuasive arguments and probative evidence that the HPSA and MUA/P designations do not necessarily denote a shortage solely of primary medical care physicians. While the designations may only count primary care physicians in their calculus, this is reportedly due to the difficulty of incorporating an analysis that includes the availability of physicians practicing in a large number of specialties. We also note that the letter from the Illinois Department of Public Health mentioned above states that the HPSA designation is the best way to measure shortages of both primary and specialty care physicians in that State. Finally, the Schneider Memorandum already acknowledged this broader set of relevant HHS programs to inform physician NIW adjudications. While the Director is correct that the Schneider Memorandum specifically referenced the PSA designation in certain instances, the Schneider Memorandum also stated that the statute “requires USCIS to recognize HHS designations of health professionals without limitation to primary care.” Schneider Memorandum, supra, at 7. An accompanying update to the USCIS AFM instructed that USCIS would now accept petitions from both primary care and specialty care doctors who agree to work in shortage areas, “i.e. Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), Medically Underserved Population (MUP), and Physician Scarcity Areas (PSA).” Schneider Memorandum, at 11. Accordingly, USCIS began approving NIW petitions on behalf of specialty care physicians in all designation categories following the issuance of the Schneider Memorandum in 2007, and that practice has continued to this day.

医疗资源不足地区医疗保健的可及性。其为此创建的框架首先要求HHS已将医生打算执业的地区指定为“卫生保健专业人员短缺”，其次，联邦机构或州公共卫生部已认定该医生在该地区的服务“符合公共利益”。 8 C.F.R. § 204.12(a)(2)(i)的法规增加了一项要求，即医生的医疗专科领域在该地区HHS指定范围内。如上所述，HHS在其HPSA和MUA/P指定中并未单独列出医疗执业专科领域。虽然它曾经可能通过PSA这样做，但该计划于2008年日落，那些指定不再有效；目前存在的唯一指定涉及初级医疗。 将这一法规解读为要求HHS对专科医疗短缺作出肯定性认证，实际上使所有专科医生永远无法获得NIW，无论其服务多么迫切需要。如果我们将该法规解释为仅要求在一个于2008年结束的项目下的HHS指定，我们将破坏国会为改善医疗资源不足地区医疗保健可及性而颁布的法定方案。 此外，申请人提交了有说服力的论据和证明性证据，表明HPSA和MUA/P指定不一定仅表示初级医疗医生的短缺。虽然这些指定在计算中可能仅计入初级医疗医生，但据报道这是由于难以纳入包含大量专科执业医生可用性的分析。我们还注意到，上述伊利诺伊州公共卫生部的信函称，HPSA指定是衡量该州初级和专科医疗医生短缺的最佳方式。 最后，Schneider备忘录已经承认了这一更广泛的相关HHS项目集，以指导医生NIW裁决。虽然主任正确地指出Schneider备忘录在某些情况下特别引用了PSA指定，但Schneider备忘录还指出，该法“要求USCIS承认HHS对卫生专业人员的指定，不限于初级医疗。”Schneider备忘录，supra，第7页。USCIS AFM的随附更新指示，USCIS现在将接受同意在短缺地区工作的初级医疗和专科医疗医生的申请，“即卫生专业人员短缺地区（HPSA）、医疗资源不足地区（MUA）、医疗资源不足人群（MUP）和医生稀缺地区（PSA）。”Schneider备忘录，第11页。因此，在2007年发布Schneider备忘录后，USCIS开始批准所有指定类别中专科医疗医生的NIW申请，并且该实践一直持续至今。

IV. CONCLUSION The Petitioner demonstrated that he is practicing in the specialty of hematology-oncology in an area designated by HHS as having a shortage of health care professionals. As the Petitioner has satisfied

IV. 结论 申请人证明其在HHS指定为卫生保健专业人员短缺地区的地区从事血液肿瘤专科执业。由于申请人已满足

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the other applicable statutory and regulatory requirements, we conclude that he has demonstrated eligibility for immigrant classification as a member of the professions holding an advanced degree, as well as an accompanying physician NIW. In visa petition proceedings, it is the Petitioner’s burden to establish eligibility for the immigration benefit sought. Section 291 of the Act, 8 U.S.C. § 1361; Matter of Otiende, 26 I&N Dec. 127, 128 (BIA 2013). Here, that burden has been met. ORDER: The initial decision of the Director, Texas Service Center is withdrawn, and the petition is approved. Cite as Matter of H-V-P-, Adopted Decision 2016-01 (AAO Feb. 9, 2016)

其他适用的法定和监管要求，我们认定其已证明符合作为持有高级学位的专业人士类别移民分类的资格，以及随附的医师国家利益豁免。 在签证申请程序中，申请人负有证明其符合所寻求移民福利资格的责任。该法第291条，8 U.S.C. § 1361；Matter of Otiende, 26 I&N Dec. 127, 128 (BIA 2013)。在此，该责任已履行。 命令： 德克萨斯服务中心主任的初步决定予以撤回，申请予以批准。 引用为 Matter of H-V-P-, Adopted Decision 2016-01 (AAO Feb. 9, 2016)

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