J -1 visa waiver applications must be submitted by health care facilities in New Jersey that are licensed by the Department to provide comprehensive preventive and primary care to a significant proportion of the low income and uninsured population, preferably in a community setting. Health care facilities that are eligible to recruit and hire J-1 visa physicians must be located in a federally designated Health Professional Shortage Area, have a written policy stating that all patients are accepted regardless of ability to pay, post a sliding fee scale in the waiting room and accept Medicare and Medicaid assignments.
Facilities interested in employing a J-1 visa holder should complete a background check on the candidate to ensure that he/she is not out of status for more than six months.
The following information must be provided with the application:
- Letter from Facility. The Chief Executive Officer of the facility must submit a brief cover letter requesting that the Department sponsor the J-1 visa waiver applicant as an "Interested Government Agency". The letter should also state that the Chief Executive Officer has read, initialed all the requirements and signed the sponsor's agreement.
- Description and Unmet Need. This section should provide a geographic description of the area and quantify the critical unmet need. Statistics must be provided to demonstrate that the physician's specialty is greatly needed in the area, and that the specialty in question is generally not available to the indigent population. Comparison of these statistics with county, state and national figures should be provided.
Documentation must be provided demonstrating where eighty percent of the patients using primary care services at the facility originate from. Facilities must demonstrate that at least fifty percent of the encounters are to Medicaid and uninsured persons. The Department's measure of adequate volume is based on the number of active indigent patients and encounters. For the purpose of J-1 visa wavier application review, productivity levels recognized by the Department, for each specialty, are based on the most current minimum productivity standards established by the Medical Group Management Association's National Survey, the American Medical Association's Physician Market Place Statistics or Health Resources and Services Administration, Bureau of Primary productivity requirement level used is 4200 medical encounters per full-time Health Care Provider. This is the minimum primary care equivalent (FTE) medical provider. The State 30 program reserves the right to confirm patient service statistics submitted to the program on a continuing basis.
A description of the health care facility must also be provided, including the nature and extent of its medical services to the low income population. Demonstrate how the physician will meet the need, and that an adequate volume exists to justify the placement of a physician at the facility.
- HPSA Documentation. Documentation must be provided that the J -1 physician agrees to practice in a geographic area designated by the Secretary of Health and Human Services as having a shortage of health care professionals. The facility must reference the list of federally designated HPSAs published in the most recent Federal Register.
- Health Care Resource Inventory. Provide a list of health care resources in the area including but not limited to, primary care facilities, hospitals, and number of primary care physicians, by specialty.
- Primary Care Program. Describe the facility's primary care program, including staffing, hours of operation, and arrangements for secondary tertiary and after hours care. Provide a weekly staffing schedule for the J-1 physician.
- Physician Qualifications. Describe the physician's unique qualifications to meet the primary care needs of the low income population, proposed responsibilities and the cultural match of the physician with the racial and ethnic populations of the area. Include any prior experience the physician has had treating patients similar to those in the service area (e.g. AIDS, homeless).
- Recruitment Efforts. Describe recruitment efforts over the past year, prior to date of J-1 visa waiver application. It must be clearly demonstrated that the facility has made a reasonable good faith effort to recruit a board certified U.S. physician for the same job opportunity in the same salary range immediately preceding the request for the waiver. Copies of recruitment efforts along with a comprehensive summary of recruitment efforts must be provided. The copies must specifically identify the recruiting agency and physician type.
- Sliding Fee Scale. The facility must charge persons receiving health services at the usual and customary rate prevailing in the area, except that health services must be provided on a sliding fee scale for persons under 200 percent of poverty, or at no charge for persons unable to pay for these services. Documentation of the sliding fee scale must be provided (include as Attachment C). In addition, persons must be charged for services to the extent that payment will be made by a third party authorized or under legal obligation to pay the charges.
- Nondiscrimination. The facility/J-1 physician must provide health services to individuals in the area without discriminating against them because (a) they are unable to pay for those services or (b) payment for these health services will be made under part A or B of Title XVIII of the Social Security Act 142 U.S.C. 1396 ("Medicare") or under a State plan for medical assistance approved under Title XIX of that Act 142 U.S.C 1396 ("Medicaid").
- Assignment. The facility/J-1 physician must assignment under Section 1842 (b) (3) (ii) of the Social Security Act as full payment for all services for which payment may be made under Part B of Title XVIII of such Act ("Medicare").
- Medicaid. The facility/J-1 physician must enter into an appropriate agreement with the State agency which administers the State plan for medical assistance under Title XIX of the Social Security Act (Medicaid) to provide services to individuals entitled to medical assistance under the plan.
- Reporting Requirements. The applicant agrees to submit an initial and annual reports to the Department of Health upon approval of the waiver request. An initial report should be submitted when the physician begins employment at the facility. The annual report must be submitted at the end of each six-month period of each approved year of employment at the facility until the four-year commitment is complete. Participation in the program will be contingent on the submission of timely and accurate reports. Minimum reporting requirements will include the number of hours worked per month, and the number of uninsured and Medicaid patients that were served, including a breakdown of those provided care under a sliding fee scale. A form will be provided when the New Jersey Department of Health is notified of the approved waiver request.
- Employment Contract. The application must state unequivocally that a four year contract is being offered to the physician. A copy of the fully executed contract must be submitted before the physician begins employment at the facility. (See section 8 under Physician Requirements.)
- Compensation. Documentation must be provided that the J-1 physician will receive a salary and benefits at least equal to the income of a comparably qualified physician member of the organization, and that is consistent with the prevailing wage in the geographic area.
- Retention. Provide a short and long range plan for the retention of the physician during and beyond the four year obligation.