16 Del. Admin. Code § 4104-6.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 4104-6.0 - Application Process

6.1 Sponsoring Site Pre-Approval Application Requirements . The Site Application (see Appendix A for Application forms) must, at a minimum, include the following:

6.1.1 Site Application Form

6.1.1.1Sponsoring Site: Provide the name, address, county, telephone number, fax number and the e-mail address of site requesting approval to hire a J-1 physician. Also, the site must specify whether it is a for-profit or not-for-profit business.

6.1.1.2Practice Site: Provide the name, address and county of actual practice site (s) where the requested J-1 physician would practice, if different from the primary location of the sponsoring site.

6.1.1.3Recruitment Contact: Provide the name, address, county, telephone number, fax number and e-mail address of the individual responsible for physician recruitment.

6.1.1.4Site Data Regarding Active Clients: Provide the total number of active patients at the practice site in the previous calendar year. Indicate total patients, as applicable, for primary care, specialty care and mental health services. Provide pro-rated or estimated annual totals if the site was not operational for the entire previous calendar year. For new sites, estimate the number of patients anticipated for the next year. Of the total number of patients, provide the percentage of all current patients, broken out by given age groups, making payment by conventional insurance plans, Medicare, Medicaid or on a sliding fee scale.A copy of the sliding fee scale must be submitted.

6.1.1.5 Sites approved to participate in the Conrad State 30/J-1 Visa Waiver Program must also participate in state programs designed to increased access to care for the uninsured/under insured such as the Community Healthcare Access Program (CHAP), the VIPII provider network, and, if appropriate other charitable programs. Sponsoring sites must verify that they will enroll in the VIPII Program within 30 days of site approval (if they are not already network members). To enroll in the VIP program, call the Medical Society of Delaware at 302-224-5190 (select option 1). To enroll in CHAP, please call 2-1-2 or 302-744-1040.

6.1.1.6Staffing Levels: Provide the total number of budgeted full-time equivalent providers currently on staff. Also include the number of J-1 physicians requested, by specialty, and the projected hire date of each.

6.1.1.7Practice Site Hours of Operation: Indicate the normal operating hours of the practice site(s) by the days of the week. If hours of operation vary by practitioner, please specify.

6.1.1.8Proposed J-1 Physician Weekly Work Schedule: Indicate the proposed weekly work schedule of the proposed J-1 physician(s). Include the number of hours (with start and end times) and the location (hospital/practice site(s)). The schedule must indicate the amount of time the J-1 physician is actually providing services; do not include travel or on-call time.

6.1.2 Needs Assessment. Sponsoring sites are encouraged to work with their local hospital and their community to complete the needs assessment. A comprehensive, data driven needs assessment must be completed, which, at a minimum, includes the following:

6.1.2.1 Description of the service area in which the sponsoring site's patients are located.

6.1.2.2 Geographic Service Area Health Resource Inventory. Description of the other health care resources located within the same service area including physicians (by specialty), hospitals, clinics, urgent care centers and any other available outpatient care facilities. Also include the location of the nearest available source of outpatient based services, which offers a sliding fee scale to patients with limited financial resources and that provides services similar to those that are being provided by the requested J-1 physician. Indicate the distance to that site.

6.1.2.3 Documentation of whether the sponsoring site's service area is located within a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA). If in a HPSA or MUA, please indicate the following: HPSA Type(s), HPSA Service Area Number, HPSA FIPS State/County Code and the sponsoring site's primary service area (by City/County).

6.1.2.4 Documentation of a shortage in the defined service area for the particular physician specialty being requested under the J-1 Visa Waiver Program.

6.1.2.4.1 Provide statistics demonstrating the need for a specialty and/or sub-specialty in the sponsoring site's service area.

6.1.2.4.2 Document that the specialty and/or sub-specialty is not available to the underserved population in the service area.

6.1.2.4.3 Describe how a J-1 physician would be used to meet the needs of the underserved population in the service area. Indicate if unique qualifications, such as cultural match or experience with the service area's underserved population, are sought to meet a particular need.

6.1.3 Retention. The sponsoring site must provide thorough, written documentation of plans to retain the J-1 physician in the service area upon completion of the three-year practice obligation. Specifically, this plan must include short and long-term strategies that will not only keep the physician in the service area, but also will encourage the physician to continue to practice the specialty for which he/she was hired including but not limited to malpractice insurance, partnership opportunities, if applicable, annual and sick leave, a competitive salary and salary increases and a health and/or benefits package.

6.1.3.1 Non-compete language and/or clauses in employment contracts are strictly prohibited.

6.1.3.2 Imposing financial penalties or prohibiting a physician from establishing a competing practice when the employment arrangement ends is considered a barrier to the program's purposes of the recruitment and the retention of a physician to a medically underserved area.

6.1.3.3 The employment contract may not contain any Restrictive Covenants or Non-Compete Clauses or similar language, regardless of how they may be labeled.

6.1.4 Contract

6.1.4.1 The employment contract that will be offered to the J-1 physician(s) must be submitted for review to the J-1 Board and at a minimum, include the following:

6.1.4.1.1 Name and address of the sponsoring site.

6.1.4.1.2 Name and address of the location of the sponsoring site's practice. If the J-1 physician will work at more than one site, include the days and hours of practice at each site and a breakdown in the amount of time the physician will practice at each site.

6.1.4.1.3 A statement that the J-1 physician will work not less than four days per week or more than 12 hours in a 24 hour period. The hours must be performed during normal office hours or hours which best meet the needs of the community (e.g. evenings and/or weekends). Travel and on-call time cannot be included.

6.1.4.1.4 A statement that the site will employ the physician on a full-time basis (minimum of 40 hours per week, not including time spent in travel and/or on-call).

6.1.4.1.5 A statement that the J-1 physician will commence practice within 90 days of receiving a waiver and will practice on a full-time basis for at least three years.

6.1.4.2 Non-compete language and/or clauses are strictly prohibited. The employment contract may not include a restrictive covenant or non-compete clause. Please see 6.1.3 above.

6.1.5 Proof of Failed Recruitment Attempts. The sponsoring site must provide proof that attempts have been made to hire a physician with United States citizenship throughout the past six months to no avail. This section must include a written description of the failed attempts to recruit as well as back up documentation including, but not limited to, medical journal and newspaper advertisements, letters to medical residency programs and/or medical schools, etc. Please state any attempts to gain recruitment support from the hospital within the practice site's geographic service area, and if applicable, indicate effort s to use the Delaware State Loan Repayment Program, the National Rural Recruitment and Retention Network (3R Net at www.3RNet.org), and the National Health Service Corp. to recruit a US citizen.

6.1.6 Letters of Support. The sponsoring site must submit at least three letters of support from community members without financial interest in the practice site who reside in the site(s) service area. Each letter must indicate the benefits of, or need for, the placement of a J-1 physician with the sponsoring site. At least one letter must be from an elected public official. At least one letter must be from a medical professional. At least one letter must be from an individual representing the patient population.

6.1.7 Sponsoring Site Waiver Agreement. The director or applicant official of the sponsoring site must initial each of the statements indicating agreement to comply with requirements of the Delaware Conrad State 30/J-1 Visa Waiver Program. The form must also be signed and dated to include the title of the applicant official.

6.1.8 Signature. The director or applying official of the sponsoring site must provide an original, dated application with a live signature (using blue ink). This signature binds the site to the information provided and verifies that the form has been completed with accurate and current information.

6.1.9 Non-refundable processing fee of $200

6.1.9.1 The director or applying official of the sponsoring site must provide a non-refundable processing fee of $200 at the time the application is submitted. The check will be made payable to the State of Delaware and mailed to the following address:

Conrad State 30 Program Manager

Delaware Division of Public Health

417 Federal Street, Jesse Cooper Building

Dover, Delaware 19901

6.1.9.2 Without payment of the processing fee the application will be deemed incomplete and will not be processed.

6.2 J-1 Physician Application Requirements

6.2.1 Applications will only be accepted from J-1 physician applicants who already have an employment contract with a pre-approved sponsoring site (see section IV above). The completed application must include the original application package and two complete copies. Applicants are also encouraged to submit a complete application in electronic format (CD or e-mail). No more than 30 physician applications will be approved each federal fiscal year (October 1-September 30). DHSS reserves the right to recommend or decline any request for a waiver.

6.2.2 The J-1 Physician Application (see Appendix C for application forms) must, at a minimum, include the following:

6.2.2.1 Letter from the Director of the Sponsoring Site

The director of a pre-approved sponsoring site must submit a letter requesting a Delaware Health and Social Services (DHSS) recommendation to the U.S. Department of State, Bureau of Consular Affairs Waiver Review Division (DOS) (or other Federal approving agency) that a J-1 physician be given a waiver of the requirement to return to their country of nationality. The letter must include, or attach, each of the following:

6.2.2.1.1 Description of the J-1 physician's qualifications, proposed responsibilities and how his/her employment will meet the unmet health care needs of the medically underserved community.

6.2.2.1.2 If the J-1 physician will be practicing in a HPSA or MUA that is based on a population group, the employer must provide adequate documentation of the medical care that will be provided to this group of patients.

6.2.2.1.3 Confirmation that the sponsoring site and the J-1 physician participate in or have applied to participate in the CHAP or VIPII Program. J-1 physicians must apply to participate in the program within 30 days of executing an employment contract with a sponsoring site. To enroll in the VIP program, call the Medical Society of Delaware at 302-224-5190 (select option 1). To enroll in CHAP, please call 2-1-1 or 302-744-1040. Once enrolled, the physician must notify the J-1 Program manager.

6.2.2.1.4 Certification that the J-1 physician will provide medical care services to Medicare, Medicaid and medically underserved patients, without discrimination based upon ability to pay for such services (i.e. self-pay, sliding fee scale, charity care). Enclose a copy of the sliding fee scale or policy for discounting charges.

6.2.2.1.5 Completed Physician Data Sheet (copy enclosed).

6.2.2.1.6 Copy of the J-1 physician's curriculum vitae (CV).

6.2.2.1.7 Evidence of eligibility for a Delaware medical license.

6.2.2.1.8 At least three letters of recommendation from persons familiar with the J-1 physician's work.

6.2.2.1.9 A signed statement from the J-1 physician agreeing to the contractual requirements set forth in Section 214 (k)(1) (B) and (C) of the Immigration and Nationality Act.

6.2.2.1.10 Copies of all IAP-66 forms issued to the J-1 physician seeking the waiver.

6.2.3 Employment Contract

6.2.3.1 The employment contract must be submitted for review to the J-1 Board and at a minimum, include the following:

*	Name and address of the sponsoring site.

*	Name and address of the location of the sponsoring site's practice. If the J-1 physician will work at more than one site, include the days and hours of practice at each site and a breakdown in the amount of time the physician will practice at each site.

*

A statement that the J-1 physician will work not less than four days per week or more than 12 hours in a 24 hour period. The hours must be performed during normal office hours or non-traditional hours that best meet the needs of the community (e.g. evenings and/or weekends). Travel and on-call time can not be included.

*	A statement that the site will employ the physician on a full-time basis (minimum of 40 hours per week, not including time spent in travel and/or on-call).

*	Statement that the J-1 physician will commence practice within 90 days of receiving a waiver and will practice on a full-time basis for at least three years.

*	The employment contract may not contain any Restrictive Covenants or Non-Compete Clauses or similar language, regardless of how they may be labeled.

*	It must include a competitive salary.

*	Personal time including vacation and sick leave must be specified.

*	A breakdown of all proposed benefits must be provided.

6.2.4 Letter of No Objection from Home Country

6.2.4.1 A statement that the physician's home country has no objection to the physician receiving a waiver of the foreign residence requirement must be included if the J-1 physician received funding from his or her home country for medical education or training in the United States. The Certification Regarding Contractual Obligation to Home County (HD1061F) letter must be submitted directly to the following address by the J-1 physician applicant:

Waiver Review Division

Department of State

Bureau of Consular Affairs, Visa Office

CA/VO/L/W Room, L603

2401 E Street, NW

Washington, DC 20522-0106

6.2.4.2 A copy of this letter must be included in the application packet.

6.2.5 Submission of Payment of the Department of State 'User Fee Required for Waiver Processing'

6.2.5.1 The J-1 physician applicant must provide proof that the $215.00 processing fee has been sent to the DOS. A copy of the payment (i.e. check or money order) is considered sufficient proof. DHSS will not handle the submission of this fee. The fee must be mailed directly to the DOS at the time the J-1 Visa Waiver Application packet is submitted to DHSS. The submission of the fee must adhere to the following requirements:

6.2.5.1.1 A copy of the Physician Data Sheet and two self-addressed, stamped, legal-size envelopes must accompany the $215.00 DOS user fee. The applicant's full name, date of birth and social security number must be included on the check or money order, which must be drawn on a bank or other institution located in the United States and made payable to the United States DOS in U.S. currency. If the applicant resides outside the U.S. at the time of application, remittance may be made by bank international money order of foreign draft drawn on an institution in the U.S. and made payable to the United States DOS in U.S. currency. The envelopes will be used to inform the applicant of 1) the case number, which must be included on all future correspondence with DOS, and 2) the approval determination.

6.2.5.1.2 The address to which you must submit these items follows, depending on whether the United States Postal Service or a Courier Service is selected:

If Sending Via United States Postal Service:		If Sending Via Courier Service:
US Department of State		US Department of State
Waiver Review Division		Waiver Review Division (Box 952137)
Post Office Box 952137		1005 Convention Plaza
St. Louis, MO 63195-2137		St. Louis, MO 63101-1200

6.2.6 J-1 Visa Waiver Statements. The J-1 physician applicant must sign and include the enclosed 'J-1 Physician Waiver Statements.'

6.2.7 J-1 Visa Waiver Affidavit and Agreement. The J-1 physician applicant must include a notarized 'J-1 Visa Waiver Affidavit and Agreement.' The document must contain the J-1 physician applicant's live, notarized signature (in blue ink).

6.2.8 J-1 Visa Waiver Application Checklist. The enclosed checklist must accompany the application. The J-1 physician applicant must initial each item on the checklist as proof and assurance that each item is included in the waiver application packet.

6.2.9 Non-refundable $250 processing fee

6.2.9.1 A non-refundable processing fee of $250 shall be charged to each pre-approved site to process the waiver request application for each J-1 physician that the site plans to employ. The check will be made payable to the State of Delaware and mailed to the following address:

Conrad State 30 Program Manager

Delaware Division of Public Health

417 Federal Street, Jesse Cooper Building

Dover, Delaware 19901

6.2.9.2 Without payment of the processing fee the application will be deemed incomplete and will not be processed.

16 Del. Admin. Code § 4104-6.0

17 DE Reg. 233( 8/1/2013)(Final)