The law passed by Congress in 1996 created a new requirement that health care workers must obtain certification to verify their educational and licensure credentials in order to work in the U.S. From 1996 to September 23, 2003, this rule was applied only to health care workers seeking lawful permanent resident status in the United States.

As of September 23, 2003, the requirement was extended and applies not only to health care workers seeking lawful permanent residence, but also those health care workers seeking to apply for initial nonimmigrant, temporary classifications or extensions of their current nonimmigrant classifications.

The DOS's final rule mandates that U.S. consulates and embassies abroad can only issue immigrant or nonimmigrant visas to foreign nationals seeking visas to work within certain health care professions if they provide certificates from proper credentialing organizations. The certificates must be issued by either the Council of Graduates of Foreign Nursing Schools (CGFNS) or an equivalent independent credentialing organization approved by the Department of Homeland Security in consultation with the Department of Health and Human Services.

A health care worker is required to obtain certification to verify that the foreign or even U.S. education, license, and experience are equivalent to those of a U.S. health care worker, and that s/he has the required fluency in English to provide health care services to patients in the United States. Moreover, a health care worker has to show that s/he has successfully passed any licensing exam if the majority of states licensing the profession recognize a test that predicts an applicant's chances of success in the health care profession.

The law continues to apply only to individuals applying for immigrant or nonimmigrant classification to work as one of the following seven occupations: 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.

The certificate requirement does not apply to health care workers who will perform nonclinical services such as medical teachers, researchers, and managers of health care facilities. Nor does the certificate requirement apply to those coming to the U.S. as students or to receive training.