2004 Legislation
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SENATE BILL NO. 1291 – Doctor, foreign-trained, rural area


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S1291.................................................by HEALTH AND WELFARE
IDAHO CONRAD J-1 VISA WAIVER - Adds to existing law to adopt the Idaho
Conrad J-1 Visa Waiver Program to authorize the Department of Health and
Welfare to recommend foreign trained physicians to locate in underserved
areas of Idaho for a limited time; to define the application and approval
procedures; to provide criteria for community participation; and to provide
limits which apply to the program.
02/09    Senate intro - 1st rdg - to printing
02/10    Rpt prt - to Health/Wel
02/11    Rpt out - rec d/p - to 2nd rdg
02/12    2nd rdg - to 3rd rdg
02/17    3rd rdg - PASSED - 32-0-3
      AYES -- Bailey, Bunderson, Burkett, Calabretta, Cameron, Compton,
      Darrington, Davis, Gannon, Geddes, Goedde, Hill, Ingram, Kennedy,
      Keough, Little, Lodge, Malepeai, Marley, McKenzie, McWilliams, Noble,
      Noh, Pearce, Richardson, Schroeder, Sorensen, Stegner, Stennett,
      Sweet, Werk, Williams
      NAYS -- None
      Absent and excused -- Andreason, Brandt, Burtenshaw
    Floor Sponsor - Bailey
    Title apvd - to House
02/18    House intro - 1st rdg - to Health/Wel
03/05    Rpt out - rec d/p - to 2nd rdg
03/08    2nd rdg - to 3rd rdg
03/09    3rd rdg - PASSED - 69-1-0
      AYES -- Andersen, Barraclough, Barrett, Bauer, Bayer, Bedke, Bell,
      Black, Block, Boe, Bolz, Bradford, Campbell, Cannon, Clark, Collins,
      Crow, Cuddy, Deal, Denney, Douglas, Eberle, Edmunson, Ellsworth,
      Eskridge, Field(18), Field(23), Gagner, Garrett, Harwood, Henbest,
      Jaquet, Jones, Kellogg, Kulczyk, Lake, Langford, Langhorst, Martinez,
      McGeachin, Meyer, Miller, Mitchell, Moyle, Naccarato, Nielsen,
      Pasley-Stuart, Raybould, Ridinger, Ring, Ringo, Roberts, Robison,
      Rydalch, Sali, Sayler, Schaefer, Shepherd, Shirley, Skippen,
      Smith(30), Smith(24), Smylie, Snodgrass, Stevenson, Trail, Wills,
      Wood, Mr. Speaker
      NAYS -- McKague
      Absent and excused -- None
    Floor Sponsors - McGeachin & Ring
    Title apvd - to Senate
03/10    To enrol
03/11    Rpt enrol - Pres signed
03/12    Sp signed
03/15    To Governor
03/19    Governor signed
         Session Law Chapter 128
         Effective: 07/01/04

Bill Text

  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                       IN THE SENATE
                                    SENATE BILL NO. 1291
                              BY HEALTH AND WELFARE COMMITTEE
  1                                        AN ACT
 16    Be It Enacted by the Legislature of the State of Idaho:
 17        SECTION  1.  That Title 39, Idaho Code, be, and the same is hereby amended
 18    by the addition thereto of a NEW CHAPTER, to be known and designated as  Chap-
 19    ter 61, Title 39, Idaho Code, and to read as follows:
 20                                      CHAPTER 61
 21                         IDAHO CONRAD J-1 VISA WAIVER PROGRAM
 22        39-6101.  SHORT TITLE. This chapter shall be known and may be cited as the
 23    "Idaho Conrad J-1 Visa Waiver Program."
 24        39-6102.  PURPOSE. The "Idaho Conrad J-1 Visa Waiver Program" would autho-
 25    rize  the  state  of Idaho department of health and welfare to recommend up to
 26    thirty (30)  foreign trained physicians per federal fiscal year to  locate  in
 27    communities  that are federally designated as having a health workforce short-
 28    age. Final approval of J-1 visa waiver requests are made by the  U.S.  depart-
 29    ment  of  state  and the bureau of citizenship and immigration services. Under
 30    this chapter, rural and underserved communities in  Idaho  would  be  able  to
 31    apply  for  the  placement  of a foreign trained physician after demonstrating
 32    that they  are  unable  to  recruit  an  American  physician,  and  all  other
 33    recruitment/placement possibilities have proven to be inaccessible.
 34        39-6103.  SEVERABILITY. The provisions of this chapter are hereby declared
 35    to  be  severable  and  if any provision of this chapter or the application of
 36    such provision to any person or circumstance is declared invalid for any  rea-
 37    son,  such declaration shall not affect the validity of the remaining portions
 38    of this chapter.
 39        39-6104.  INCORPORATION  BY  REFERENCE.  P.L.  103-416,  amended  by  P.L.
  1    107-273, November 2, 2002, 8  U.S.C. 1184(l) and 22 CFR sec.  514.44(e),  F.R.
  2    volume 60,  No. 197, and 18 U.S.C. 1001 are incorporated by reference.
  3        39-6105.  DEFINITIONS. As used in this chapter:
  4        (1)  "Applicant"  means a health care facility that seeks to employ a phy-
  5    sician  and is requesting state support of a visa waiver.
  6        (2)  "Area of underservice" means a health professional shortage  area  in
  7    primary  care  or  mental health, a medically underserved area, or a medically
  8    underserved population, federally designated by the secretary  of  health  and
  9    human services.
 10        (3)  "Department" means the Idaho department of health and welfare.
 11        (4)  "De-designation  threshold"  means the number of full-time equivalent
 12    primary care physicians necessary to remove the federal designation as an area
 13    of underservice.
 14        (5)  "Employment contract" means a legally binding agreement  between  the
 15    applicant  and  the  physician named in the visa waiver application which con-
 16    tains all terms and conditions of employment, including, but not  limited  to,
 17    the  salary,  benefits, length of employment and any other consideration owing
 18    under the agreement. The employment contract must meet all state  and  federal
 19    criteria, including labor and immigration rules.
 20        (6)  "Federal fiscal year" means the twelve (12) months which commence the
 21    first  day of October in each year and close on the thirtieth day of September
 22    of the following year.
 23        (7)  "Full time" means a working week of a minimum of forty (40) hours  at
 24    a health care facility.
 25        (8)  "Health  care facility" means an entity with an active Idaho taxpayer
 26    identification number doing business or proposing to do business in the  prac-
 27    tice  location  where  the  physician would be employed, whose stated purposes
 28    include the delivery of primary medical or mental health care.
 29        (9)  "Interested government agency" means an agency that has the authority
 30    from the United States department of state to submit  requests  for  J-1  visa
 31    waivers of foreign physician petitioners on behalf of public interest.
 32        (10) "J-1 visa" means an entrance permit into the United States for a for-
 33    eign   trained   physician  who  is  a  nonimmigrant  admitted  under  section
 34    101(a)(15)(J) of the United States information and education exchange  act  or
 35    who  acquired  such  status  or who acquired exchange visitor status under the
 36    act.
 37        (11) "New start" means a health care facility as defined in subsection (8)
 38    of this section, that has been in existence for twelve (12) months or less.
 39        (12) "Physician" means the foreign physician, named  in  the  visa  waiver
 40    application,  who requires a waiver to remain in the United States to practice
 41    medicine.
 42        (13) "Primary care"  means  a  medical  doctor  or  doctor  of  osteopathy
 43    licensed  in pediatrics, family medicine, internal medicine, obstetrics, gyne-
 44    cology, or psychiatry.
 45        (14) "Sliding  fee  discount  schedule"  means   a   written   delineation
 46    documenting  the  value  of  charge  discounts  granted to patients based upon
 47    financial hardship and federal poverty guidelines.
 48        (15) "Unmet need" means a vacancy or shortage of primary care health  phy-
 49    sicians experienced by a community or population, as defined by federally des-
 50    ignated   health   professional   shortage   areas  or  medically  underserved
 51    areas/populations.
 52        (16) "Vacancy" means a full-time physician  practice  opportunity  in  the
 53    delivery of primary care services.
 54        (17) "Visa  waiver" means a federal action that waives the requirement for
  1    a foreign physician, in the United States on a J-1 visa, to return to his home
  2    country for a two (2) year period following medical residency training.
  3        39-6106.  GENERAL REQUIREMENTS AND LIMITATIONS. (1) Visa  waiver  request.
  4    The department may only submit a visa waiver request when:
  5        (a)  The application contains all of the required information and documen-
  6        tation; and
  7        (b)  The application meets all state and federal criteria; and
  8        (c)  Foreign  exchange physicians having a J-1 case number assigned by the
  9        United States department of state have paid all federal  processing  fees;
 10        and
 11        (d)  The applicant has paid the state of Idaho application processing fee.
 12        (2)  Limitations of department actions.
 13        (a)  Prior  to  submission  of  an application, the department may provide
 14        information to the applicant on preparing a complete application.
 15        (b)  The department will not be responsible for adding any information  to
 16        incomplete application packets.
 17        (c)  For  applicants  who  have benefitted from department waiver requests
 18        previously, the applicant's history of compliance will be a  consideration
 19        in future decisions for waiver requests.
 20        (d)  In  any  single  program  year, a health care facility in any one (1)
 21        area of underservice:
 22             (i)   Will not be allotted more than two (2) waiver request  applica-
 23             tions; and
 24             (ii)  Will  not  exceed  by more than one and nine-tenths (1.9) full-
 25             time equivalents, the number of physicians needed  to  eliminate  the
 26             physician shortage as defined by the current de-designation threshold
 27             in any single program year.
 28        (e)  The  shortage area designation must be current on the date the United
 29        States department of state reviews and recommends the application  and  on
 30        the date the immigration agency approves the J-1 visa waiver. Any applica-
 31        tion that is being submitted to the department at the end of the three (3)
 32        year  health professional shortage area designation cycle may be summarily
 33        denied if the renewal is not obtained.
 34             (i)   Participation by the department in the Idaho  conrad  J-1  visa
 35             waiver program is completely discretionary and voluntary. The depart-
 36             ment  may  elect  not  to participate in the program at any time. The
 37             submission of a complete waiver package does not ensure  the  depart-
 38             ment  will  recommend  a waiver. The department reserves the right to
 39             recommend or decline any request for a waiver.
 40             (ii)  The department, its employees or agents are  held  harmless  of
 41             any  perceived  consequence for the denial of a waiver petitioner, or
 42             the approved placement of one that is not favorable.
 43             (iii) Application procedures for Idaho conrad J-1 visa waiver  physi-
 44             cian  placements  were developed by the department in compliance with
 45             P.L. 103-416 and subsequent revisions. They are  subject  to  updates
 46             and  changes  at  any  time. Interpretation of these procedures rests
 47             solely with the department in consultation with the appropriate  fed-
 48             eral agencies.
 49        39-6107.  APPLIED  PRINCIPLES.  (1) Option of last resort. The visa waiver
 50    program is considered a final source for recruiting qualified  physicians.  It
 51    is  not  a  substitute  for broad recruiting efforts for graduates from United
 52    States medical schools, but an option of last  resort.  Any  application  that
 53    qualifies  for  consideration  under any other interested government agency or
  1    federal program, such as the one administered by the department of health  and
  2    human  services,  must  be  submitted  under that program in lieu of the Idaho
  3    conrad J-1 visa waiver program.
  4        (2)  Waiver request applications will only be considered for  health  care
  5    facilities  that  can  provide evidence of sustained active recruitment over a
  6    period of at least six (6) months for the primary care vacancy in the practice
  7    location.
  8        (3)  The visa waiver program will be used to assist health care facilities
  9    that can document the provision of primary health care services to  all  resi-
 10    dents of the federally designated underserved area. When a federal designation
 11    is  for  an underserved population, the health care facility must document the
 12    provision of care to, and assure access by, the underserved population.
 13        39-6108.  CRITERIA FOR APPLICANTS. (1) Applicants must be existing  health
 14    care facilities that:
 15        (a)  Have an active taxpayer identification number in Idaho; and
 16        (b)  Have provided medical or mental health care in Idaho for a minimum of
 17        twelve  (12)  months  prior  to  submitting  the  application, or meet the
 18        requirements for a new start as defined in this chapter.
 19        (2)  The waiver request to the department must come  from  a  U.S.  health
 20    care  facility  on behalf of the physician and not directly from the physician
 21    or his representative.
 22        (3)  J-1 visa waiver petitioners with fellowship  training  must  contract
 23    with employers to provide primary care services full time.
 24        (4)  Applicants must not be former J-1 visa waiver physicians who are cur-
 25    rently fulfilling their required three (3) year obligation.
 26        (5)  Applicants may not submit waiver requests for a relative.
 27        (6)  Applicants  must  accept  all patients regardless of their ability to
 28    pay.
 29        (7)  Except for state institutional and correctional facilities designated
 30    as federal shortage areas, the applicant must:
 31        (a)  Serve medicare clients, medicaid clients, low-income  clients,  unin-
 32        sured clients, and the population of the federal designation.
 33        (b)  Agree to implement a sliding fee discount schedule. The schedule must
 34        be:
 35             (i)   Available in Spanish (where applicable) and English; and
 36             (ii)  Posted conspicuously; and
 37             (iii) Distributed  in  hard  copy on request to individuals making or
 38             keeping appointments with that physician.
 39        (8)  Applicants must have a signed employment contract with the physician,
 40    and guarantee wages for the three (3) years of the contract.
 41        (9)  Applicants must cooperate in providing the department with clarifying
 42    information, verifying information already provided, or in  any  investigation
 43    of the applicant's financial status and payer mix.
 44        (10) Applicants  must first apply through any organization with federal or
 45    interested governmental agency authority which  submits  waiver  requests  for
 46    Idaho's  underserved  rural areas. Documentation which fully explains why this
 47    route was not taken for placement is required as part of the application.
 48        (11) The physician's name and practice location will be made available  to
 49    the  public as a provider of primary health who accepts medicare, medicaid and
 50    utilizes a sliding fee schedule for the low-income population.
 51        (12) An assurance letter that the health care  facility,  its  principals,
 52    and  the J-1 petitioning physician are not under investigation for, under pro-
 53    bation for, or under restriction for medicare  or  medicaid  fraud,  or  other
 54    violations  of law or licensure restrictions that may indicate that it may not
  1    be in the public interest that a waiver of the two  (2)  year  home  residency
  2    requirement be granted, must be provided.
  3        (13) The  applicant and its principals must be free of default on any fed-
  4    eral or state scholarship or loan  repayment  program  such  as  the  national
  5    health service corps or by the state.
  6        39-6109.  CONTRACT  REQUIREMENTS.  Throughout  the  period  of obligation,
  7    regardless of physician's visa status, the employment contract must:
  8        (1)  Meet state and federal requirements;
  9        (2)  Not prevent the physician from providing medical services in the des-
 10    ignated shortage area after the term of employment. A noncompetition clause or
 11    any provision that purports to limit the J-1 visa waiver  physician's  ability
 12    to  remain  in  the area upon completion of the contract term is prohibited by
 13    regulation;
 14        (3)  State that the physician must serve medicare clients,  medicaid  cli-
 15    ents, low-income clients, uninsured clients, and the population of the federal
 16    designation for the area of underservice full time;
 17        (4)  Include a notarized statement by the physician that he agrees to meet
 18    the  requirements set forth in section 214(l) of the immigration and national-
 19    ity act;
 20        (5)  Guarantee the physician a base salary of at least ninety-five percent
 21    (95%) of step II of the local prevailing wage for the field of practice in the
 22    area to be served;
 23        (6)  Specify that benefits offered are not included as part of  base  sal-
 24    ary;
 25        (7)  Include  leave  (annual, sick, continuing medical education and holi-
 26    day);
 27        (8)  State that amendments shall adhere to  state  and  federal  J-1  visa
 28    waiver requirements;
 29        (9)  Acknowledge  that  the contract may be terminated only with cause and
 30    cannot be terminated by mutual agreement until the statutorily required  three
 31    (3) years have expired;
 32        (10) Be assignable only by the employer to a successor with concurrence of
 33    the department;
 34        (11) Include  the  practice  site address, the days and hours of practice,
 35    field of medicine, and a statement that  on-call  and  travel  times  are  not
 36    included in the minimum hours;
 37        (12) Not  commence  until after the physician's J-1 waiver and appropriate
 38    work authorization are approved and his residency program  has  been  success-
 39    fully completed. The contract shall affirm that no transfer or other modifica-
 40    tion  regarding the duration of contract dates will be approved unless extenu-
 41    ating circumstances are shown to exist, as determined by  the  department  and
 42    approved  by  the United States attorney general in accordance with applicable
 43    federal rules and regulations;
 44        (13) Not be subject to changes which result in  termination  of  contract,
 45    change  in  practice scope, or relocation from a site approved in the applica-
 46    tion. Any proposed changes must be presented in writing to the department  for
 47    consideration  and  approval  at  least thirty (30) days prior to the proposed
 48    change. Moving or placement of a physician to a location that was not approved
 49    by the department will result in the physician and applicant being in  noncom-
 50    pliance  with  the  program  and  will  be reported as such to the immigration
 51    agency. It will also limit the applicant's future participation  in  the  pro-
 52    gram;
 53        (14) Be  signed  by both the J-1 visa waiver petitioning physician and the
 54    applicant employer, and the date it is signed must be clear.
  1        39-6110.  CRITERIA FOR PROPOSED PRACTICE LOCATION. (1) The proposed  prac-
  2    tice location must be located in:
  3        (a)  A  federally  designated  primary  care  health professional shortage
  4        area; or
  5        (b)  A federally designated mental health professional shortage  area  for
  6        psychiatrists; or
  7        (c)  An  area having a federal designation as a medically underserved area
  8        or a medically underserved population; or
  9        (d)  A combination of federally designated areas.
 10        (2)  If a new practice location is planned, additional criteria apply. New
 11    practice locations must:
 12        (a)  Have the legal, financial, and organizational structure necessary  to
 13        provide  a  stable  practice environment, and must provide a business plan
 14        that supports this information;
 15        (b)  Support a full-time physician practice;
 16        (c)  Have written referral plans that describe how patients using the  new
 17        primary care location will be connected to existing secondary and tertiary
 18        care if needed.
 19        39-6111.  CRITERIA  FOR  THE PHYSICIAN. (1)  The physician must not have a
 20    J-1 visa waiver pending for any other employment offer,  and  must  provide  a
 21    notarized statement testifying to this fact.
 22        (2)  The  physician  must have the qualifications described in recruitment
 23    efforts for a specific vacancy.
 24        (3)  Physicians must:
 25        (a)  Provide direct patient care full time; and
 26        (b)  Be trained in:
 27             (i)   Family medicine; or
 28             (ii)  Internal medicine; or
 29             (iii) Pediatrics; or
 30             (iv)  Obstetrics and gynecology; or
 31             (v)   Psychiatry and its subspecialties.
 32        (4)  Physicians must have an active Idaho medical license.  The  physician
 33    may  be participating in an accredited residency program for this application,
 34    but must have successfully completed the third  year of their residency train-
 35    ing program for their employment contract to be activated. The physician  must
 36    have  an  unrestricted  license to practice in the state of Idaho and be board
 37    certified or eligible in his respective  medical  specialty.  A  copy  of  the
 38    license must be included in the waiver request.
 39        (5)  Physicians must have at least one (1) recommendation from their resi-
 40    dency program that:
 41        (a)  Addresses  the  physician's interpersonal and professional ability to
 42        effectively care for diverse and low-income persons in the United  States;
 43        and
 44        (b)  Describes  an  ability  to work well with supervisory and subordinate
 45        medical staff, and adapt to the  culture  of  United  States  health  care
 46        facilities; and
 47        (c)  Documents the level of specialty training, if any; and
 48        (d)  Is  prepared  on  residency program letterhead and is signed by resi-
 49        dency program staff or faculty; and
 50        (e)  Includes name, title, relationship to physician, address,  and  tele-
 51        phone number of signatory.
 52        (6)  The  physician  must agree with all provisions of the employment con-
 53    tract as described herein. Other negotiable terms of the contract are  between
 54    the physician and the hiring agency.
  1        (7)  The physician must:
  2        (a)  Agree  to  work full time for no less than three (3) years in an area
  3        of underservice in the state of Idaho; and
  4        (b)  Provide health care to medicare and medicaid beneficiaries; and
  5        (c)  Post and implement a sliding fee discount schedule; and
  6        (d)  Serve the low-income population; and
  7        (e)  Serve the uninsured population; and
  8        (f)  Serve the shortage designation population; or
  9        (g)  Serve the population of  a  local,  state,  or  federal  governmental
 10        institution or corrections facility as an employee of the institution.
 12    Notification of waiver status and commencement of employment must be submitted
 13    to the department upon receipt of written notification of  approval  from  the
 14    immigration agency. This notification must include the date the three (3) year
 15    obligation  commences,  and  a  copy  of the notification of approval from the
 16    immigration agency.
 17        (2)  The physician and the applicant must, on commencement of practice and
 18    annually thereafter or more frequently as determined by  the  department,  and
 19    upon  expiration  of  the  first  three  (3) years of the contract, verify the
 20    physician's  practice  site  address  and  field  of  practice.  Further,  for
 21    population-designated health professional shortage areas,  documentation  that
 22    the population the physician was to serve was indeed served must be submitted.
 23    This will include the facility's payer mix, the number of patients seen by the
 24    physician,  and  the  payer  mix  of those patients. When submitting the final
 25    report, the physician must indicate whether he intends to remain in the short-
 26    age area to practice.
 27        (3)  Sites receiving waiver approval must agree to report to  the  depart-
 28    ment  on  the  status  of  the  physician's activities at the beginning of the
 29    physician's employment and every year thereafter during  the  three  (3)  year
 30    waiver  service  period.  Failure  to provide these reports within thirty (30)
 31    days of the annual anniversary date of approval of the J-1 visa in an accurate
 32    manner or failure to demonstrate good faith in utilizing  a  physician's  ser-
 33    vices in accordance with these policies will jeopardize future eligibility for
 34    placements  and  will be cause for reporting and referral to the United States
 35    department of state and immigration agency.  This  referral  could  ultimately
 36    lead to deportation proceedings against the J-1 physician.
 37        (4)  Any  amendments  made to the required elements of the employment con-
 38    tract during the first three (3) years for primary  care  physicians  of  con-
 39    tracted  employment must be reported to the department for review. The depart-
 40    ment will complete review and provide notice of  approval  or  declination  of
 41    such amendments within thirty (30) calendar days of receipt.
 42        39-6113.  APPLICATION FEE. At the time the application is submitted to the
 43    department, an administrative fee must be paid to the department by the appli-
 44    cant.  The  fee  amount  will be determined by the director of the department,
 45    will not be less than one thousand dollars ($1,000), and may be revised at the
 46    beginning of the state fiscal year by the director based on costs to  adminis-
 47    ter the program. The fee is nonrefundable.
 49    Applications  for  the  Idaho conrad J-1 visa waiver program must include, but
 50    not be limited to, the following:
 51        (a)  Evidence the applicant has no other mechanism through another process
 52        or interested government agency to apply for a J-1  visa  waiver  for  the
  1        physician;
  2        (b)  Evidence of recruiting efforts over a minimum of six (6) months prior
  3        to  when the physician applied for the vacancy; this must include regional
  4        and national print advertising stating  the  position  available  and  the
  5        practice  site  location and at least six (6) certified letters to medical
  6        schools to advertise the vacancy. Copies of advertisements submitted  must
  7        show  the  publication  date.  Advertisements  run at the time of or after
  8        preparation of the employment contract are unusable. Online advertisements
  9        must show dates the advertisements were online. Contracts with recruitment
 10        firms are allowable as evidence in lieu of print advertisements or letters
 11        if the activities described in this section are provided  under  contract.
 12        Recruitment firm contracts must be included if applicable;
 13        (c)  Evidence the physician selected for the position visited the practice
 14        site;
 15        (d)  A  mailing  list  of  physicians who applied for the position and the
 16        reason they were not selected;
 17        (e)  Evidence the applicant has been providing medical  or  mental  health
 18        care  in  Idaho  for at least twelve (12) months or meets the requirements
 19        for a new start as defined in this chapter. This includes, but may not  be
 20        limited  to,  the  Idaho taxpayer identification number, facility address,
 21        fax and telephone numbers, and staffing list;
 22        (f)  A copy of an employment contract between the physician and the appli-
 23        cant for no less than three (3) years;
 24        (g)  Evidence the employment site is in a designated area of underservice;
 25        (h)  The request must be submitted by the applicant or applicant's  repre-
 26        sentative.  The  letter must be written on the applicant's letterhead sta-
 27        tionery, which includes address, telephone and fax numbers, if  any.  Let-
 28        ters, contracts and forms must contain original signatures;
 29        (i)  A  copy  of the sliding fee scale which the health care facility must
 30        agree to implement and post;
 31        (j)  A copy of the physician's license to practice medicine;
 32        (k)  Legible copies of all IAP-66/DS 2019 forms (certificate of  eligibil-
 33        ity  for exchange visitor status), covering every period the physician was
 34        in J-1 status, submitted in chronological order;
 35        (l)  Legible copies (front and back) of all I-94 entry and departure cards
 36        for the physician and family members;
 37        (m)  The physician's curriculum vitae;
 38        (n)  A statement of "no objection from the government" of the  physician's
 39        country  of  nationality,  if applicable. The government of the country to
 40        which the physician is otherwise contractually obliged to return must fur-
 41        nish a letter to the director of the United  States  department  of  state
 42        with  a  statement in writing that there is no objection to such waiver in
 43        cases where the physician's medical education or training is funded by the
 44        government of the physician's home country. Whether or not there  is  for-
 45        eign  government  funding can be determined from examining the physician's
 46        IAP-66 form. This letter must be in English and follow the procedures  and
 47        format outlined in federal register volume 60, number 197, published Octo-
 48        ber 12, 1995 (or subsequent revisions);
 49        (o)  Payment  of   the  department's administrative application processing
 50        fee;
 51        (p)  Federal form G-28 or letterhead from the law office, if the physician
 52        is being represented by an attorney, with telephone and fax numbers, and a
 53        contact name and address;
 54        (q)  A copy of the United States department of  state  issued  instruction
 55        sheet with case number.
  1        (2)  The  state may require any other documentation or information for the
  2    support and approval process in the waiver application on the part of the phy-
  3    sician or the applicant.
  4        (3)  These requirements are subject to change without notice.
  5        (4)  Idaho conrad J-1 visa waiver program application forms  and  instruc-
  6    tions are available and may be requested from the department.
  7        (5)  The physician's case number must appear on each page. The case number
  8    is assigned by the United States department of state.
  9        (6)  All  required  information  and  documentation must be submitted in a
 10    single package with all documents presented per instructions that will be pro-
 11    vided by the department upon request. One (1) single-sided,  unbound  original
 12    and  one (1) single-sided, unbound copy must be included. Waiver requests that
 13    do not comply with these requirements and the  instructions  provided  by  the
 14    department will not be considered.
 16    state, or federal institutions which offer primary care services and are  fed-
 17    erally  designated as a shortage facility accompanied by a health professional
 18    shortage area score may submit an application. Physician services may be  lim-
 19    ited  to  the  population  of  the  institution.  All  other state and federal
 20    requirements must be met.
 21        39-6116.  DEPARTMENT REVIEW AND ACTION. (1)  The  department  will  review
 22    applications for completeness in date order received.
 23        (2)  Applications  submitted for physicians with language skills appropri-
 24    ate to the community they wish to serve will be given priority.
 25        (3)  Selection preference will be  given  to  applications  received  from
 26    HPSAs having the greatest unmet need for primary care physicians.
 27        (4)  Applications must be mailed, sent by commercial carrier, or delivered
 28    in  person. Applications may not be sent electronically. The department is not
 29    responsible for applications or related materials lost in the mail.
 30        (5)  The department may limit the time period  during  which  applications
 31    may  be submitted including refusing to process applications after the depart-
 32    ment has submitted requests for all applications allowed in  a  given  federal
 33    fiscal year.
 34        (6)  In  the  event an applicant for a J-1 visa waiver submits an applica-
 35    tion to the department, the department will acknowledge receipt of the copy of
 36    the application within five (5) business days of receipt.
 37        (7)  The department will review applications within fifteen  (15)  working
 38    days  of  receipt  of  the application to determine if the application is com-
 39    plete, and provide a written explanation of missing items.
 40        (8)  An additional fee will not be charged for incomplete applications  if
 41    the missing items are provided within thirty (30) calendar days of the date on
 42    the  letter  of  explanation  from  the  department. If new information is not
 43    received within this time frame, the  application  will  be  returned  to  the
 44    applicant. The application fee will not be returned.
 45        (9)  The  department  will  return  applications  and  application fees to
 46    applicants having had two (2) approved J-1 visa waiver requests in the current
 47    federal fiscal year for the shortage area, applications received  that  exceed
 48    the  de-designation  threshold  limit,  and applications received after thirty
 49    (30) placements have been recommended.
 50        (10) The department will review complete applications against the criteria
 51    specified in this chapter.
 52        (11) The department may:
 53        (a)  Request additional clarifying information;
  1        (b)  Verify information presented;
  2        (c)  Investigate the financial status of the applicant;
  3        (d)  Request verification of the health care facility's payer mix for  the
  4        previous twelve (12) to eighteen (18) months.
  5        (e)  Return the application as incomplete if the applicant does not supply
  6        the  requested  clarifying  information in its entirety within thirty (30)
  7        days of request. The application fee is nonrefundable. Incomplete applica-
  8        tions must be resubmitted with the application fee.  Resubmitted  applica-
  9        tions  will  be  considered  new applications and will be reviewed in date
 10        order received.
 11        (12) The department may request the director of the United States  depart-
 12    ment of state to recommend that the immigration agency grant the waiver.
 13        (13) The  department  will notify the applicant in writing of action taken
 14    by the department. If the decision is to decline the J-1 visa waiver  request,
 15    the  department  will  provide an explanation of how the application failed to
 16    meet the stated criterion or criteria. The application fee is nonrefundable.
 17        (14) The department may deny a visa waiver request  or,  prior  to  United
 18    States department of state approval, may withdraw a visa waiver recommendation
 19    for cause, which shall include the following:
 20        (a)  The application is not consistent with state or federal criteria;
 21        (b)  Fraud;
 22        (c)  Misrepresentation;
 23        (d)  False statements;
 24        (e)  Misleading statements;
 25        (f)  Evasion  or suppression of material facts in the visa waiver applica-
 26        tion or in any of its required documentation and supporting materials;
 27        (g)  Incomplete or insufficient information;
 28        (h)  Allowable number of recommendations for the area  or  year  has  been
 29        met.
 30        (15) Applications  denied may be resubmitted with concerns addressed, with
 31    the application fee. Resubmitted applications will be considered new  applica-
 32    tions and will be reviewed in date order received.
 33        (16) The  department  retains  the authority to audit, monitor and conduct
 34    unannounced site visits.
 35        39-6117.  ELIGIBILITY FOR FUTURE PARTICIPATION. Health care facilities may
 36    be denied future participation in the Idaho conrad J-1 visa waiver program if:
 37        (1)  The required annual reports are  not  submitted  in  a  complete  and
 38    timely manner;
 39        (2)  A  physician  does not serve the designated shortage area or shortage
 40    population approved at the time of placement for the full three (3)  years  of
 41    employment.  This  does not apply only if the approved site is in a designated
 42    health professional shortage area that loses its designation after the  physi-
 43    cian begins employment;
 44        (3)  A  physician  does  not remain employed by the applicant for the full
 45    three (3) years of employment;
 46        (4)  The applicant or physician  is  not  in  compliance  with  the  terms
 47    defined in this chapter or any federal requirements.
 48        39-6118.  DEPARTMENT RESPONSIBILITY TO REPORT. The department shall report
 49    to  the  United  States  department of state and the immigration agency if the
 50    applicant or physician is determined to be out of compliance with any  of  the
 51    provisions  of  this  chapter  or  if the physician is determined to have left
 52    employment in the federally designated area.

Statement of Purpose / Fiscal Impact

                     STATEMENT  OF  PURPOSE
                           RS 13528C2
The Conrad or State J-1 Visa Waiver Program would authorize the
State of Idaho Department of Health and Welfare to recommend up to
30 (thirty) foreign trained physicians per federal fiscal year to
locate in communities that are federally designated as having a
health workforce shortage.  Final approval of J-1 Visa Waiver
requests are made by the U.S. Department of State and the Bureau of
Citizenship and Immigration Services.  Under this proposed program,
rural and underserved communities in Idaho would be able to apply
for the placement of a foreign trained physician after
demonstrating that they are unable to recruit an American
physician, and all other recruitment/placement possibilities have
proven to be inaccessible.

                         FISCAL  IMPACT
The administration of a Conrad/J-1 Visa Waiver Program in Idaho
will be funded by receipts generated from levying a processing fee
for each application received. The fee amount will be $1,000.00 per
application, and may be revised at the beginning of each state
fiscal year by the Director of the Department based on costs to
administer the program.  The number of applications processed
cannot exceed 30.  Fiscal Impact to communities seeking this
resource is estimated at $2,000 for FY 2005.  The processing fee
will support the time of a Program Specialist, clerical support,
and travel expenses associated with processing the application,
providing technical assistance, monitoring and program evaluation.
Other than the obligatory fee, there are no federal or state funds
to support this program.  There is no impact to the General Fund.

Name:     Richard Schultz
Agency:   Department of Health and Welfare
Phone:    334-6996

Statement of Purpose/Fiscal Impact                      S 1291