State-30 Program of Kansas

Description of Waiver Review Process


The Governor of the state of Kansas has designated the Kansas Department of Health and Environment (KDHE) as the agency to review applications and make recommendations to the Waiver Review Division of the U.S. Department of State. The Waiver Review Division then makes recommendations to the US Bureau of Citizenship and Immigration Service concerning such waivers.

KDHE action is limited to recommending that a waiver be granted where it furthers an agency policy.  This action is discretionary and is not the equivalent of granting the waiver.

Eligible applicants, employers, or their attorneys, should download the following application guidelines by clicking here.


An eligible practice site must be located in a medically underserved community designated by the US Department of Health and Human Services (DHHS) as a primary care or mental health care Health Professional Shortage Area (HPSA),  or a Medically Underserved Area (MUA), or the practice site  must serve a Medically Underserved Population (MUP). Only the number of primary care physicians needed to eliminate a Health Professional Shortage Area designation will be recommended. Specialty requests are considered on a case by case basis and shall not exceed 20% of total waivers available to the state annually.

Requests will not be reviewed more than six months before the J-1 physician´s current IAP-66 expires.  Incomplete requests will be held for review until all required documents are received. The review cycle begins on October 1 with complete applications numbered sequentially beginning with one (1) each year.  After thirty (30) case numbers are assigned, the remaining cases will be assigned a priority number and carried over to the next fiscal year for processing.

Requirements

. The federal government now mandates that all J-1 Visa Waiver applicants must apply for a case number from the U.S. Department of State. This federal regulation requires completing and submitting a Data Sheet that may only be obtained through the U.S. Department of State.

. Kansas participation in the waiver program is intended to assist local communities to assure that their residents have access to physician services. The program focuses on primary care defined as general  medicine, internal medicine, family practice, general pediatrics, obstetrics/ gynecology, emergency medicine and psychiatry.  However, a limited number of sub-specialists may be recommended annually, up to 20% of the total authorized. In addition to the primary care shortage designation for the practice location, evidence of unmet need for non-primary care specialties must be demonstrated by the applicant. This may include past utilization data, population to physician ratios, waiting times for referrals from safety net providers, medical school faculty vacancy, or other measures of underservice.

. Application must be made by the legal entity making the contract offer to the physician seeking a J-1 visa waiver, including facilities, institutions, rural health clinics, community health centers, primary care clinics, medical centers, hospitals or private practices located in Kansas. Applications will only be accepted when there is a confirmed physician contract pending. 

. Waiver requests must be submitted to the Kansas Department of Health and Environment by the employer or the employer's representative.  The letter of need must be written on the employer's letterhead stationery, which includes the address, phone number, and fax number, if any.  Letters of need and forms must contain original signatures.

. The employer must show evidence of open recruitment and that hiring a J-1 physician is a last resort.  A physician not encumbered by the J-1 home residence requirement, who applies for and is qualified for the job advertised, must be offered the position. 

. The medical practice must be located in a  HPSA or MUA.  Evidence should include the street address, fax and telephone numbers.  The facility must accept all patients regardless of ability to pay. 

. The J-1 physician must have or be eligible for a medical license from the Kansas Board of Healing Arts.

. The J-1 physician is responsible for negotiating a contract for a minimum of 3 years to provide care at least 40 hours per week, at least 4 days per week, in the appropriate specialty.

. By federal regulation, the J-1 physician must commence practice within 90 days of receiving a waiver.  The  U.S. Department of State and the Immigration and Naturalization Service will be notified if a J-1 physician is found not to have reported or not to be practicing  medicine at least 40 hours per week in the location for which the recommendation was made. 

. KDHE  must be notified when the J-1 physician does not report for duty. The employer and/or   J-1 physician must notify KDHE  of any breach or termination of contract.  Transfers must be cleared with KDHE  before the transfer occurs so that it can be determined if the new area is also underserved.

. Requests for a J-1 physician to practice in a population-designated HPSA or an MUP must show that it posts a sliding-scale fee schedule and income eligibility information in its waiting room.

. The waiver request must contain letters of community support from each of the following: community leaders (mayor, commissioners, other elected officials, chamber of commerce, etc.) local physicians, local hospital administrator(s), and the county health department.


Limitations:
Requests will be limited to two per employer each annual cycle. The cycle for the start-up year shall be October 1, 2002 to September 30, 2003.  
A former J-1 physician currently fulfilling his/her required 3-year obligation may not serve as the employer of a new waiver candidate. 
KDHE will not accept applications to recommend a waiver for a relative or acquaintance of the employer.

Physician Recruitment:
KDHE  policy is that a waiver recommendation by the state health agency is a measure of last resort.  As such, the medical facility must prove that other avenues, regionally and nationally, to secure a physician not bound by the 2- year home residence requirement have been undertaken over a period of at least the six months prior to preparing/signing a contract.  
Recruitment efforts must include regional and national print advertising stating the position available and the practice site location.   One acceptable regional recruitment effort is to list the position in Kansas Connections a quarterly newsletter and placed on the University of Kansas Medical School website for Kansas Healthcare Job Opportunities.  Job listing forms are available from the Rural Health Education and Services of the University of Kansas School of Medicine and are accessible by calling 1-888-503-4221.

Contracts:
The contact must include all of the following information:
 a)  guaranteed 3-year base salary
 b)  benefits
 c)  health insurance
 d)  field of practice, practice site name and address for 40 hours for at least 4
      days per week, not including travel and on-call time
 e)  leave (annual, sick, continuing medical education, holidays)
 f)   commencement date begins within 90 days of receipt of J-1 visa waiver
 g)  statement that amendments shall adhere to State and Federal J-1 visa
      waiver requirements

For the statutorily-required 3 years, there can be no changes to the contract that would result in the J-1 physician leaving the agreed-upon site or ceasing to serve the patients he/she has agreed to serve in the manner agreed upon.    It is recommended that each party have its own legal representation in preparation of the contract.

Other contract terms and conditions:
. May be terminated only with cause and cannot be terminated by mutual
  agreement until the statutorily-required 3 years have expired.
. Must contain a sentence stating what field of medicine the J-1 physician will
  practice a minimum of 40 hours per week and the practice site address. 
  Include the days and hours of practice, and a statement that on-call and travel
  times are not included in the minimum hours.
. A non-competition clause or any provision that purports to limit the J-1
  physician's ability to remain in the area upon completion of the contract term is
  prohibited.
. May include a liquidation clause.  However, any clauses that would require the
  J-1 physician to pay a sum to the employer for experience gained on the job or
  for the J-1 physician remaining in the area after the contract has ended are not
  allowed.

Reporting Requirements: 
The physician and the Chief Executive Officer of the employing entity must provide annual reports to the KDHE Waiver Review Program (Physician-Employer Report Form).    The first report must be submitted within 30 days after employment begins, and every 12 months thereafter, until the 3 year commitment is complete. Further, in agreements to serve in population-designated HPSAs, documentation must be submitted demonstrating that the relevant underserved population was indeed served. What constitutes adequate proof will vary depending upon the circumstances but should include a report of Medicare, Medicaid/ HealthWave and self-pay revenue, and number of patients served by pay category, if available. When submitting the final report, the physician must indicate whether he/she intends to remain in the shortage area to practice. If a report is not submitted, penalties for default will be implemented.
Although not required for submission, KDHE may request to see copies of the following: 
 . position recruitments ads with visible publication date(s);
 . advertising bills and payment receipts;
 . contracts with recruitment firm(s) ;
 . all other physician CVs submitted in response to recruitment efforts;
 . if an American citizen or permanent resident physician applied for the
   position,  a detailed justification of why they were not hired;
 . current Federal, state, or other published, recognized-source prevailing wage
   document;
 . evidence that the J-1 physician selected for the position has visited the
   practice site (travel and hotel receipts, etc.); and,
 . list of primary care physicians, including J-1 and H-1b, National Health
   Service Corp and State loan-repayment physicians, currently practicing in the
   HPSA.

Ongoing site evaluation:
KDHE will  monitor provider practice and patient access and follow up on any complaints that the practice refuses care to patients.  KDHE may use Medicaid claims data and waiting times for referrals from safety net providers if necessary to monitor access concerns.   Past compliance with the program guidelines will affect an employer´s future applications.

Penalties for Default:
Physicians – A letter to Immigration and Naturalization Services with a recommendation for deportation.
Employers – Ineligibility  to participate in the Kansas  J-1 Visa Waiver Program for a period of two years.
 
  These requirements are subject to revision without prior written notice.

Contact the Primary Care Office Director at (785) 296-2742 or email bhuske@kdheks.gov.