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Overview

Background
Federal law requires that foreign physicians seeking to pursue graduate medical education or training in the United States obtain a J -1 exchange visitor visa. The J-1 visa allow physicians to remain in the U.S. until their studies are completed. However, upon completion of their studies, the physicians must return to their home country for at least two years before they are able to return to the United States.

Changes in the Immigration and Nationality Technical Corrections Act (Public Law 103-416), allow each State Department of Public Health or its equivalent to sponsor up to thirty (30) foreign trained physicians each fiscal year. The State 30 Program, as it is commonly referred to, affords J-1 visa holders the privilege of waiving their two-year foreign residency requirement in exchange for providing primary medical care in federally designated Health Professional Shortage Areas (HPSAs).

The Department 's policy is completely discretionary, voluntary and may be modified or terminated at any time. The submission of a complete waiver package to the Department does not ensure that the Department will recommend a waiver. In all instances, the Department reserves the right to recommend or decline any request for a waiver.

In order to facilitate review of the waiver requests by the New Jersey Department of Health, the request for waiver should come from a health care facility on behalf of a J-1 physician, and not directly from a J-1 physician or physician's representative.

All of the required information and documentation must be submitted in a single package with documents presented in the order set forth. All documents must contain the case number assigned by the U.S. Department of State. Waiver requests that do not comply with these requirements will be returned to the submitting health care facility for revision.

For more information contact Linda D. Anderson at (609) 292-1495 or by e-mail at linda.anderson@doh.state.nj.us

Definition of Primary Care
For the purpose of the State 30 program, primary care physicians are defined as family practice, obstetrics, gynecology, general pediatrics and internal medicine.

Conditions
The New Jersey Department of Health will consider recommending a waiver of the foreign residence requirement on behalf of physicians holding J-1 visas who have been admitted to the United States under the following conditions, among others.

The Department will only accept applications from facilities providing comprehensive primary health care services and licensed by the Department's Licensing and Certification Program. The applicant health facility must provide proof of licensor status. With extraordinary documented justification, a waiver of this requirement may be requested for a health care facility not licensed by the Department.

The Department is reviewing the possibility of expanding its J-1 physician placement options to include Medically Underserved Areas (MUAs) along with HPSAs. Until the designated MUAs are updated and there is a mechanism in place to ensure ongoing updates, the Department will continue to accept applications for J-1 physician placement only in HPSAs designated by the Secretary of the Department of Health and Human Services.

The physician must demonstrate a bona fide offer of employment from the health care facility and must agree to work forty (40) hours per week delivering primary care services, for at least four (4) years in a geographic area designated by the Secretary of Health and Human Services as having a shortage of health care professionals, and in a facility which accepts Medicaid and Medicare as well as medically indigent patients. The forty hours a week of primary care service must be performed during normal office hours, or hours which best serve the community, and may not be performed in less than four days a week, with no more than twelve hours of work to be performed in any twenty-four hour period. A weekly schedule must be included in all waiver requests. Travel or on-call time may not be included in the forty hours. Up to twenty percent of this time may be dedicated to resident and/or medical student supervision and teaching, if the teaching activity does not reduce productivity below that of an average primary care practitioner in private practice.

Placement of primary care physicians in hospital outpatient departments will be based on documentation provided by the hospital that the services are not available in the community through publicly or privately subsidized facilities or private practitioners, as well as on the ability of the facility to demonstrate the provision of comprehensive, continuous primary care services, among other factors.

A copy of a letter of "no objection" must be provided from the physician's home government. For specific conditions requiring a "no objection letter", see Physician section, #3 of the Guidelines.

If the physician obtains a waiver under Public Law 103-416 and thereafter fails to fulfill the terms of his or her employment contract with the health care facility named in the waiver application, he or she becomes subject to the two-year foreign residence requirement, and is ineligible to apply for an immigrant visa, permanent residence, or any other change of nonimmigrant status until the two-year foreign residence requirement is met.


The physician must be licensed to practice or provide proof of eligibility to practice in New Jersey.

Index

Section 1: Waiver Review Process
The information packet details the information/documentation that is needed to submit an appropriate application for review.

The required information and documentation in its entirety must be submitted in a single package with documents presented in the order set forth under the guidelines. Waiver requests that do not comply with these requirements will be returned.

Upon receipt of all required materials, the application will be reviewed by the Primary Care Coordinator in Maternal, Child, and Community Health Services.

If the Department feels it is in the public interest that the J-1 physician remains in the United States, the Department will send a letter and the application to the U.S. Department of State (DOS) requesting a favorable recommendation to the United States Immigration and Naturalization Service (INS) for granting a waiver.

Please note that the J-1 visa waiver is only one step in a multi-part process. A waiver is necessary but not sufficient to obtain a foreign physician's services. A waiver simply eliminates the requirement that the physician return to his/her home country for two years before he/she can return to the United States.

It is important to note that the waiver of the two-year requirement is not a visa. Physicians going through the state waiver program are eligible for, and must make an application to the United States Immigration and Naturalization Service for H (1) (B) visa status. Permanent residence visa status will not be permitted until the physician's four years of obligatory service in a health professional shortage area has been fulfilled.

You may call the Primary Care Office at (609) 292-1495 for status updates on waiver applications pending at the Department until the requesting health facility is notified of the Department's decision. The requesting health facility will be notified of the Department's decision. If the Department recommends a waiver to the DOS, that office, or the Immigration and Naturalization Service should be contacted regarding the status of the waiver.

The DOS checks with the organization(s) that issued the "Certificate of Eligibility for Exchange Visitor Status (J-l)", bringing the person into the United States. If that organization (this can also be the country of origin) has no objection to the person being granted the waiver, and the case has the necessary documentation DOS will forward the package to the INS with a favorable recommendation.

Upon receipt of the DOS recommendation, INS may grant a waiver of the two-year home residence requirement to the physician. Processing time at INS can vary anywhere from two weeks to several months.

Section 2: Waiver Request Guidelines and Documentation

Employer
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:

  1. 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.

  2. 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 originated 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. The minimum primary care equivalent (FTE) medical provider 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. This description must demonstrate how the physician will meet the need, and that an adequate volume exists to justify the placement of a physician at the facility.

  3. 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.

  4. 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.

  5. 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.

  6. 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).

  7. 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.

  8. 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.

  9. 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").

  10. Assignment. The facility/J-1 physician must accept an 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).

  11. 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.

  12. Reporting Requirements. The applicant must agree 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 within 30 days of the end of each approved six (6) month period 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.

  13. Employment Contract. The application must state 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.)

  14. 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.

  15. Retention. The application must provide a short and long-range plan for the retention of the physician during and beyond the four year obligation.


Physician
The requesting applicant physician must initial that all the required enclosures have been included in the application package for review by the Department.

  1. Waiver Review Application Data Sheet. The Wavier Review Application data sheet must be legible, completed and signed by the physician.

  2. DS 2019. The request must include copies of all DS 2019 "Certificate of Eligibility for Exchange visitor (J-1) Status" for the physician, INS forms 1-94 for the physician and any family members, and proof of passage of examination required by INS.

  3. No Objection Letter. If the J-1 physician's medical education/training was funded by the physician's home government, the waiver application request must include a copy of the "no objection" letter from the home government. If there was no funding provided by the J-1 physician's home government, this must be indicated on the Physician Agreement.

  4. Physician Curriculum Vitae and Letters of Recommendation. The request must contain a complete vitae of the physician and three letters of recommendation, within three years prior to submission of application, from medical professionals personally familiar with the physician's qualifications, work, and personal integrity.

  5. New Jersey Medical License. Physicians must have completed a United States residency in primary care and provide a copy of their current New Jersey medical license or proof of New Jersey licensor eligibility. Upon receipt of the license, a copy shall be forwarded to the New Jersey Department of Health prior to forwarding the waiver application to the U.S. Department of State. Copies of all internship, residency and fellowship certificates must be provided, as well as board certification certificates.

  6. Board Certification/Eligibility. Physicians must be board eligible, and become board certified within one year of receiving their waiver. If the physician does not become board eligible within one year of the program, he/she will no longer be eligible to participate.

  7. Specialty. Physicians who have training in family practice and obstetrics/gynecology will receive priority for sponsorship, if the applicant and the organization meet the other criteria. Physicians in general pediatrics and internal medicine are also eligible, however, the need in the area for the services of the specific specialty must be well documented. Physicians with subspecialties or fellowship experience are not considered to be primary care physicians for the purpose of this program, and are generally not eligible for participation. Under exceptional circumstances, e.g. a documented continuous and pervasive lack of access by the indigent population to a specific subspecialty, applications from subspecialists will be considered . Physicians must also be trained in the specialty in which they are practicing.

  8. Employment Contract. The physician must demonstrate a bona fide offer of employment from the health care facility (copy of the complete contract). The contract shall not include a non-compete clause enforceable against the J-1 physician. If the physician obtains a waiver under Public Law 103-416 and thereafter fails to fulfill the terms of his or her employment contract with the health care facility named in the waiver application, he or she becomes subject to the two-year foreign residence requirement, and is ineligible to apply for an nonimmigrant visa, permanent residence, or any other change of nonimmigrant status until the two-year foreign residence requirement is met.

    The contract must specify the following:

    1. the physician must agree to work at the health care facility in which he/she is employed for a total of not less than four (4) years;

    2. the physician must practice medicine a minimum of forty (40) hours per week in the geographic area or areas which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals; and,

    3. the physician must agree to begin employment at such facility within ninety (90) days of receiving a waiver.

  9. Affidavit. The physician must provide an affidavit in which he or she avers that their medical license has never been suspended or revoked and that they are not subject to any criminal investigation or proceedings by any medical licensing authority.

  10. Non-Pending Declaration. The J-1 physician must sign and date the statement that avers he or she does not have a pending, nor is submitting another application request to any United States Government department or agency, or any State Department of Public Health or its equivalent during the pendency of this application with the New Jersey Department of Health.

  11. Relocation. Relocation by the physician from an approved site to a new site must be approved by the New Jersey Department of Health in writing prior to the move.

An original and one unbound copy of the application must be submitted to Linda D. Anderson, Maternal, Child, and Community Health Services, New Jersey Department of Health, Division of Family Health Services, 50 E. State Street, PO Box 364, Trenton, NJ 08625-0364. Every item requested in the application and Guidelines should be clearly labeled. J-1 visa waiver applications that do not comply with the required information and documentation, including attachments and enclosures, in its entirety will be returned to the applicant.

This web-based package contains everything necessary to apply to the New Jersey Department of Health for a waiver of home residency requirements. If you have any questions, please contact Linda D. Anderson at (609) 292-1495.

This program and components of this package are subject to change without notice. The J-1 Visa Waiver/State 30 Program Guidelines are reviewed at least annually. However, program changes may occur more frequently as required by federal guidance.

Some health facilities have elected to employ attorneys or qualified consultants to review the waiver package or to assist in the preparation and submission of the required U.S. Immigration and Naturalization Service forms and documentation.


Department of Health

P. O. Box 360, Trenton, NJ 08625-0360
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