Frequently Asked Questions about the Final Rule 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 their immigration status until they have been appropriately treated and are no longer infectious.

The medical 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). HHS and CDC have made changes to the regulations to update the language and remove some diseases from the list.

Why did CDC revise the Regulations for Medical Examination of Aliens?

Through this final rule, HHS/CDC updated 42 CFR part 34 to reflect modern terminology and plain language used in medicine by public health practitioners. Over time, CDC and other agencies involved in medical exams of immigrants and refugees have issued guidance and rules to supplement these regulations. Today’s changes consolidate and formalize these practices. These updates also ensure regulations for the medical screening of immigrants and refugees are based upon current medical practices and scientific principles.

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

Today’s final rule:

• removes 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;”
• updates 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 ;
• revises the definitions and evaluation criteria for mental disorders, drug abuse, and drug addiction;
• clarifies and revises the evaluation requirements for tuberculosis screening;
• clarifies  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
• updates the titles and designations of federal agencies within the text of the regulation.

What does “alien” mean under this 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?

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 now prevent immigrants and refugees from coming to the United States?

Communicable diseases of public health significance that can prevent entry to the United States fall into three categories. Effective March 28, 2016, immigrants and refugees will not be allowed to enter the United States if one of the diseases listed in the first category is detected during the medical exam.

• Any of the following diseases listed in 42 CFR part 34: active tuberculosis, infectious syphilis, gonorrhea, and infectious leprosy (Hansen’s disease).
• Quarantinable communicable diseases are designated by Presidential Executive Order.  The current list of diseases includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, and influenza caused by novel or re-emergent influenza viruses (pandemic flu).
• Communicable diseases that may pose a public health emergency of international concern if the disease meets certain risk factors and either poses a threat of being imported into the U.S. or affects the health of the U.S. population.
• Communicable diseases for which a single cases requires notification to the World Health Organization (WHO) as an event that may constitute a public health emergency of international concern.  These communicable diseases currently include pandemic flue, polio, SARS, and smallpox.
• Any other communicable disease the occurrence of which requires notification to the WHO as an event that may constitute a public health emergency of international concern under the International Health Regulations (2005).

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 did CDC remove these three diseases?

Through this final rule, HHS/CDC removed 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 has removed 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 increases only when a person engages in specific behaviors, such as having unprotected sex.

What diseases are specifically listed as communicable diseases of public health significance?

At this time, infectious active tuberculosis (TB), Hansen’s disease (leprosy), gonorrhea, and/or infectious syphilis are specifically named as communicable diseases of public health significance.  CDC constantly reviews the list of diseases in the regulations and will continue to assess each of these remaining diseases as a communicable disease of public health significance through further scientific review.  If CDC seeks to remove any of these diseases in the future, it will do so through changes in these regulations.

When are these changes effective?

These changes are effective March 28, 2016.

Can I make comments on the final rule?

No. The comment period for this rulemaking ended on August 24, 2015.

Where can I view comments made to the NPRM?

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

Where can I find more information about this final rule?

For more information visit the Federal Register notice.