J-1 Visa Waiver Program(Conrad 30)

July 26, 201845th Annual Arizona Rural Health Conference

Ashley Neves | Workforce Health Planning Consultant

Arizona Department of Health Services

Arizona State HospitalDivision of Public Health

ServicesDivision of Policy and

Operations

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Primary Care OfficeCore Function: • Serves as the Primary Care Office for Arizona• Develops and implements strategies for strengthening primary care

and health care delivery system• Administers programs to increase the number of providers and

improve services in underserved areas• Identifies areas that need improved health services and assist with

federal/state shortage designations• Provides technical assistance to statewide partners

Workforce Programs• J-1 Visa Wavier Program

• National Interest Waiver Program

• Arizona State Loan Repayment Program (SLRP)

• National Health Service Corps– Provide technical assistance for the Scholarship Programs and Loan Repayment

Program

• Nurse Corps – Provide technical assistance for the Scholarship Programs and Loan Repayment

Programs

Agenda• Understanding the benefits of the J1 Visa Waiver Program

• Learning the basic program requirements and expectations

• Understand program application time frames for better recruitment planning and coordination

• Identifying tools to help recruit J1 physicians

Goal of the J-1 Program

• Improving the accessibility of health care services in rural underserved

areas in Arizona.

Problem

• People who are uninsured, low-income, members of racial and ethnic minority groups, or living in rural or inner-city areas are likely to lack a usual source of care.

• Arizona is facing a statewide provider shortage especially in rural areas.

Problem

605 Physicians to eliminate 187 primary care HPSAs

456 Dentists to eliminate 183 dental HPSAs

233 Psychiatrists to eliminate 176 mental HPSAs

AZ J1 Visa Waiver Program (Conrad 30 Program)

What is a J1 Visa?– Temporary, Nonimmigrant Status– Clinical Resident or Fellow– Duration limited to seven years– Limited exclusively to Graduate Medical Education (i.e., no

moonlighting)– Spouse is able to work– Mandatory, across-the-board, two-year home residence

obligation

AZ J1 Visa Waiver Program (Conrad 30 Program)

RELEVANCE OF TWO-YEAR HOME RESIDENCE OBLIGATION:• Disqualifies J-1 from H-1B visa and/or permanent residence status unless:

– Obtains Waiver of obligation; or– Returns to home country for two years

J-1 WAIVER OPTIONS:– Interested Governmental Agency (IGA)– State Department of Health– Exceptional Hardship– Persecution

Know the players:• States• Federal Government• Employers• Physicians

ROLE OF STATES:• J-1 Waiver Recommendations

• Physician Need Statement for NIW• Monitoring

ROLE OF FEDERAL GOVERNMENT:• Final J-1 Waiver Approval• Adjudicating H-1B Petition

• Adjudicating Permanent Residence (Green Card)

ROLE OF EMPLOYER:• J-1 Waiver Application

• Filing H-1B Petition• Sponsoring Permanent Residence

ROLE OF PHYSICIAN:• Assure site is in designated MUA/HPSA

• Knowledge of program expectations including reporting requirements

• Adhere to state and federal policy

Roles of those Involved

Advantages• Community

– Improve access to care • Physician

– Pathway to citizenship (Green Card) – Don’t have to return to their home country

• Employer– Three year commitment is required with a possible two year

extension if pursuing National Interest Waiver– Provider cannot move unless there are extenuating circumstances– Cost savings– Two J1 physicians are allowed per site per year– Recruitment and Retention tool

Physician Eligibility

• Be licensed or eligible for an AZ medical License

• Primary Care Providers– Family Medicine– General Internal Medicine– Obstetrics/Gynecology– Pediatrics– Hospitalists– Psychiatrists

• Specialists (when an exceptional need for the specialty is substantiated)

• Providing services in a federally designated primary and mental HPSA, MUA, or MUP

• Have a valid offer of full-time employment and contract to work at an eligible service site for at least 3 years. (40 hours per week or 160 hours per month)

Service Site Eligibility• Health Professional Shortage Area

(HPSA) or federally designated Medically Underserved Area or Population (MUA/P)

• Accept all patients regardless of their ability to pay

• Accept State Medicaid (AHCCCS) and Medicare

• Charge patients at the usual and prevailing rates in the area

• Provide services to those who have no health insurance coverage

• Use a sliding fee schedule for all patients who are uninsured and at or below 200% of Federal Poverty Guidelines.

• Post a notice of discount • Have proof of unsuccessful

recruitment efforts of a US citizen physician for at least 6 months prior to the J-1 application submission.

• Have been operational and providing care for at least 6 months as of the date of the request

• Have the financial means to support the J-1 physician for at least 3 years (salary, benefits and malpractice insurance expenses)

Timeframes• AZ Department of Health Services (ADHS) Processing Time

– Application period opens October 1st of each year– Application period closes November 30th of each year– 8-12 weeks to review

• Department of State (DOS) Processing Time– 4-6 weeks

• U.S. Citizenship & Immigration Services (USCIS) Processing Time– 2-6 weeks

Total processing time: 3.5-6 months

Waiver Slots • 30 available slots each federal fiscal year October

1 through November 30– 22 slots Primary Care Physicians or Psychiatrists – 7 slots for specialists– 1 discretionary slot

• If slots remain available at the end for the first application period, the program will begin accepting applications for its second cycle and again for a third cycle.

Application ProcessA J-1 applicant must submit: 1. Application (notarized)2. Service Site Application (notarized)3. Supporting Documentation

All forms can be found on our website at: https://www.azdhs.gov/prevention/health-systems-

development/workforce-programs/j-1-visa-waiver/index.php#applications-process

Supporting Documents• DS-3035 Review Application Form,

Data Sheet• A letter from the head of the

organization that wishes to hire the J-1 physicians

• Signed valid contract of full time employment

• Evidence the facility is in a HPSA, MUA, or MUP

• Physicians IAP-66/DS-2019 forms• Resume / CV• G-28 Form• Description of the J-1 Physician’s

proposed responsibilities and schedule

• Documentation demonstrating unsuccessful recruitment efforts for at least 6 months or longer prior to submitting the application.

• Physician Application• Service Site Application (one for

each site)• Sliding Discount- to Fee Schedule

(SFS), policy/procedure, and SFS notice

• 3 letter of community support on letterhead

• Copy of Physician’s license or license application

*** all documents must have the case number on it.

• J-1 Visa Waiver Program ManagerBureau of Women’s and Children’s HealthArizona Department of Health Services150 N. 18th Avenue, Suite 320Phoenix, AZ 85007

Where to Submit

**We will not accept any documents via email.

Tracking the Service

• Signatures must be notarized. • Submitted to ADHS quarterly

Reporting Period To be submitted by the 10th business day:

January – March April

April – June July

July – September October

October - December January

• Is a national, non-profit organization that works to improve rural and underserved communities’ access to qualify healthcare through: – Recruitment of physicians and other healthcare

professionals, – Development of community-based recruitment and

retention activities, and – National advocacy relative to rural and underserved

healthcare workforce issues.

https://www.3rnet.org/

Patricia Tarango, Bureau Chief, Bureau of Women’s and Children’s Health, ADHSEmail: Patricia.Tarango@azdhs.govPhone: (602) 542-1436

Ana Lyn Roscetti, Workforce Section Manager, Bureau of Women’s and Children’s Health, ADHSEmail: ana.lyn.roscetti@azdhs.govPhone: (602) 542-1066

Ashley Neves, Workforce Health Planning Consultant, Bureau of Women’s and Children’s Health, ADHSEmail: ashley.neves@azdhs.govPhone: (602) 542-1211

Tracy Lenartz, Designations Specialist/Health Planning ConsultantEmail: Tracy.Lenartz@azdhs.govPhone: (602) 542-1772

ARIZONA PRIMARY OFFICE CONTACT INFORMATION

Questions?