Frequently Asked Questions about the Proposed Regulation for the Medical Examination of Aliens – Revisions to Medical Screening Process

Immigrants and refugees must undergo a medical exam as part of the immigration process for entry into the United States. The exam includes screening for any illness defined as a communicable disease of public health significance. Those immigrants and refugees found to have these diseases may not enter the United States or adjust immigration status.

The screening process, along with this list of diseases are outlined in federal regulations (42 CFR part 34), which are administered by the Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC). If new diseases emerge or as more is learned about diseases already on this list, regulatory changes can be made to alter the disease list. HHS and CDC are proposing changes to the regulations to update the language and remove some diseases from the list.

Why is CDC proposing to revise the Regulations for Medical Examination of Aliens?

Through this Notice of Proposed Rule Making (NPRM), HHS/CDC is proposing an update to 42 CFR part 34 to reflect modern terminology and plain language used in medicine by public health partners. Over time, CDC and other agencies involved in medical exams of immigrants and refugees have issued guidance and rules to supplement these regulations. The proposed changes will consolidate and formalize these practices. These updates will ensure regulations for the medical screening of immigrants and refugees are based upon current medical practices and scientific principles.

What are the key proposed changes to the Regulations for the Medical Examination of Aliens?

CDC proposes to

• remove three sexually transmitted infections, chancroid, lymphogranuloma venerum, granuloma inguinale, from the list of disease within the definition of a “communicable disease of public health significance;”
• update the “notification of the health-related grounds of inadmissibility” to require proof of vaccinations to align with existing requirements in the Immigration and Nationality Act (INA);
• revise the definitions and evaluation criteria for mental disorders, drug abuse, and drug addiction;
• clarify and revise the evaluation requirements for tuberculosis screening;
• clarify the appeal process for the HHS/CDC-appointed medical review board that convenes to reexamine a medical condition to include a subject matter expert; and
• update the titles and designations of federal agencies within the text of the regulation.

What does “alien” mean under this proposed regulation?

An “alien” (a term used under the Immigration and Nationality Act) is any person not a citizen or lawful permanent resident of the United States. Some types of aliens include immigrants, refugees, asylees, or parolees as defined below:

• An immigrant is either a person from another country admitted to the United States as a lawful permanent resident or a person in the United States who adjusts visa status to be a lawful permanent resident.
• A refugee is any person who is outside his or her country of nationality who is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution based on race, religion, nationality, particular social group, or political opinion.
• An asylee is considered the same as a refugee, except that an asylee applies for asylum status either upon arrival at a U.S. port of entry or after entry into the United States.
• A parolee is a person from another country who appears to be inadmissible to the inspecting officer, but is allowed into the United States for urgent humanitarian reasons or when his or her entry is determined to be for significant public benefit.

Who conducts the medical examination of aliens?

Immigrants and refugees must undergo a medical exam as part of the immigration process for entry into the United States or adjustment of immigration status. The exam includes screening for any illness defined as a communicable disease of public health significance. The medical exams are conducted by doctors in other countries and in the United States. The doctors who screen applicants outside of the United States are called “panel physicians.” The doctors who screen applicants already in the United States who are applying to change their visa status to lawful permanent resident (LPR) are called “civil surgeons.”

What diseases can currently prevent immigrants and refugees from coming to the United States?

As of January 2010, communicable diseases of public health significance that can prevent entry to the United States fall into three categories. Immigrants and refugees may not be allowed to enter the United States if one of these diseases is detected during the medical exam.

• Any of the following diseases listed in 42 CFR part 34: active tuberculosis, infectious syphilis, gonorrhea, infectious leprosy (Hansen’s disease), chancroid, lymphogranuloma venereum, and granuloma inguinale.
• Quarantinable diseases designated by any Presidential Executive Order. The current list of diseases includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndrome (SARS), and influenza caused by novel or re-emergent influenza (pandemic flu).
• Diseases that are reportable as a public health emergency of international concern to the World Health Organization under the International Health Regulations of 2005. These diseases currently include polio, smallpox, SARS, pandemic flu and other public health emergencies of international concern.

What happens when an applicant applying to enter the United States is determined to have a “communicable disease of public health significance?”

An applicant with a communicable disease of public health significance will be evaluated on the severity of the disease and the nature of their condition. Once an applicant receives treatment or recovers from their condition, they would be eligible to enter the United States if they are no longer a significant health risk to others and meet all other requirements.

Why is CDC proposing to remove these three diseases?

Through this NPRM, HHS/CDC proposes to remove three uncommon health conditions (chancroid, lymphogranuloma venerum, granuloma inguinale) from the list of communicable diseases of public health significance in 42 CFR part 34. Current medical knowledge and practice does not support these three diseases as conditions that would prevent someone from entering the United States. These diseases are not very common, there is little risk of importation, they cannot be transmitted through casual contact, and they can easily be treated. To modernize and streamline the regulations to truly address diseases of public health significance, CDC is proposing removal of these sexually transmitted infections.

Will the rule change increase the risk that Americans will contract these infections?

Allowing non-U.S. citizens with these infections into the United States will not pose a risk to the public’s health through casual contact. Chancroid, lymphogranuloma venerum, and granuloma inguinale are not very common, are all preventable, and are not spread through casual contact or day-to-day activities. These infections are spread through sexual contact and can be easily treated.
It is important to remember that any risk posed by people with these infections is not a result of their nationality. The risk of spreading sexually transmitted infections only increases when a person engages in specific behaviors, such as having unprotected sex.

Are these proposed regulations available for public comment?

Yes. The NPRM will be publically available for comment for 60 days. Comments must be submitted by August 24, 2015. HHS and CDC will carefully review all public comments and decide whether to make any changes based upon those comments. HHS and CDC will then publish a final rule containing these changes. Any change would become effective at the time specified in the final rule. To make a comment on the proposed regulation, visit the Federal Register notice.

Where can I make comments on the Notice of Proposed Rulemaking (NPRM) for this rule?

Comments can be submitted, identified by the Regulatory Information Number *(RIN) 0920-AA28 or the docket number CDC-2015-0045 by any of the following methods:

• Federal e-Rulemaking Portal: www.regulations.gov. Follow the instructions for submitting comments.
• Mail: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., MS E-03, Atlanta, GA, 30333, ATTN: Part 34
• Hand Delivery/Courier: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., MS E-03, Atlanta, GA, 30329, ATTN: Part 34.

Where can I view comments made to this NPRM?

Comments may be viewed at www.regulations.gov, docket number CDC-2015-0045.

Why is CDC republishing portions of the 2008 Interim Final Rule Revising Medical Examination of Aliens in this NPRM?

In October 2008, CDC published an Interim Final Rule (IFR) revising 42 CFR Part 34 (Medical Examination of Aliens) to update screening for communicable diseases of public health significance. CDC is republishing portions of the 2008 IFR in an effort to provide the public with a full opportunity to comment on these sets of regulations. Visit CDC’s page on the Interim Final Rule Revising Medical Examination of Aliens for more information.

Where can I find more information about these proposed regulations?

For more information visit the Federal Register notice.