Historically, there has been some confusion related to the minimum qualifications for entry into particular health care occupations and which health care occupations qualify as specialty occupations. Though use of the U.S. Bureau of Labor Statistics' Occupational Outlook Handbook is encouraged, the United States Citizenship and Immigration Services (USCIS) has clarified that adjudicators must also consult other authoritative sources, such as state licensing boards, when determining whether a proposed H-1B job is in a specialty occupation. Certain health care professions, such as registered nurse, may not qualify as specialty occupations if they do not minimally require the completion of a Bachelor's degree or higher. Those health care professions that are considered specialty occupations, and typically require a license, will be adjudicated by the USCIS according to the H-1B procedures discussed below.

H-1B Employees With A License

Most health care occupations require a license, restricted or unrestricted, to practice in the profession. If the H-1B employee possesses the appropriate license required in the state of employment, the USCIS adjudicator should not "look beyond the license" when evaluating the H-1B employee's qualifications for the position. In other words, an H-1B employee is considered to be automatically qualified for the specialty occupation if they have received the required state license for the profession. It is important to note, however, that the H-1B employee must be admissible in all other respects to be granted H-1B visa status.

Unrestricted Licenses

If an H-1B employee has an unrestricted license to practice in the health care profession, the renewal period on the license should not be considered by the USCIS adjudicator when determining the period of H-1B approval. The USCIS adjudicator should approve the H-1B petition for the full period requested, up to a maximum of three years.

Restricted Licenses

If an H-1B employee has a restricted license, the validity of the license is taken into consideration by the USCIS adjudicator when granting H-1B approval or H-1B renewal. The USCIS adjudicator should only grant H-1B status for as long as the H-1B employee's license is valid or one year, whichever is longer.

H-1B Employees Without A License

In certain situations, an H 1B employee's licensure is contingent upon having an approved H-1B petition and obtaining H-1B approval is contingent upon having received the requisite license. To alleviate this "catch-22," the USCIS will grant temporary H-1B approval for a one year period. This provides the H-1B employee ample time to obtain the license required for the profession. The H-1B employee, however, is not permitted to work in the occupation without the license and H-1B extensions will be denied if the necessary license is not obtained. Further, H-1B employees that are licensed in a different state are treated as not having a license and can receive temporary H-1B approval to facilitate licensure in the appropriate state.