Pennsylvania Waiver Programs

Pennsylvania Waiver Programs

Ed NaugleDirector, Division of Health Professions

Development

Jackie AustinPublic Health Program Administrator

Department of Health l Bureau of Health Planning625 Forster Street l Harrisburg, PA 17120717.772.5298 l Fax: 717.705.6525www.health.state.pa.us


• To assure access to primary care by persons or population groups living in one of the following

health professional shortage areas (HPSA) medically underserved areas (MUA) medically underserved population (MUP)

• To recruit and retain primary care physicians within designated shortage areas of the commonwealth

• To support medically underserved communities with documented inability to recruit physicians

Department of Health Program Objectives


Priorities for Waiver Placement

• Priority 1: Applications for primary care physicians who will provide services at out-patient sites located in HPSAs or MUA/Ps.

• Priority 2: Applications for physicians (including specialists) who will be employed at the following practice sites where need for the physicians is sufficiently documented

Critical Access HospitalsSmall Rural HospitalsFederally Qualified Health Centers (and Look-a-likes)Certified Rural Health ClinicsPrimary care outpatient facilities not located in a HPSA or MUA/P [Flex 10]

• Priority 3: Applications for specialty physicians located in an MUA/P or HPSA or for a Flex 10 slot


Primary Care Physician or Specialist

Commitment of 3 years in exchange for required 2-

year home residency

Employment within 90 days from date USCIS grants the

waiver

Practice Site must be located in a HPSA or MUA/P

Must be available to begin work or in the last year of their

residency or fellowship to apply

Limited to 30 participants per year

Primary Care Physician Only

Commitment of 3 years in exchange for required 2- year

home residency

Employment within 90 days from date USCIS grants the

waiver

Practice Site must be located in a HPSA within one of 52

counties designated by ARC

Inpatient practice sites must have own designation as a

HPSA

Unlimited number of participants

Primary Care Physician or Specialist with current PA

license

Commitment of a total of 5 years in exchange for exemption of the labor

certification process

Contract or letter to show period of time to be covered

Practice site must be located in a HPSA or MUA/P

Must document compelling public health interest

Conrad 30 J-1

Unlimited number of participants

NIWARC J-1

Conrad 30 J-1 FLEX 10Practice site can not be located within a HPSA or

MUA/P but must show they serve the population from a

HPSA/MUA/P

Practice site must provide a patient of origin study for a full year to document at least 20%

of patient encounters

Limited to a total of 10 per FFY and one Flex waiver per

organizations EIN # per year


Schedule for Review and Recommendations of ApplicationsBased on Federal Fiscal Year

Initial Application Period: September 30-December 15Second Application Period: January 1 – June 15Final Application Period: July 1- September 15


J-1 Participation Criteria

Practice a minimum of 40 clinical hours in direct patient care per weekAgree to serve for three yearsContract may not contain a non-compete clause that would cause the international medical graduate (IMG) to leave the area upon termination of a contractThe practice site must agree to serve patients with Medical Assistance, Medicare, and those who are uninsured or underinsured.A sliding fee scale policy and charges which are based on the current poverty guidelines. The submission must list the discounted charges available to individuals and families up to and including those at 200% poverty level.


J-1 Participation Criteria (cont.)

A signed statement that another pending waiver application has not been filedA no objection letter if funds were received from his or her home country for medical educationSigned statement of agreement of the policies of the J-1 Waiver ProgramDemonstration from the sponsor of unsuccessful efforts to recruit an American physician for the vacancy


Common Obstacles or Omissions

Letter of NeedDescription of recruitment effortDocumentation of all sub-specialty in the county in which the practice site is located (only for specialists)

Charity Care PolicyService to all patients without regard to the ability to payPolicy of non-discriminationDiscounted/sliding fee scale based upon current Federal Poverty Guidelines up to 200% poverty and apply the schedule equally, consistently, on a continuous basis, to all recipients of services


Common Obstacles or Omissions (continued)

ContractPractice site address(s) and site application address(s) do not matchStatement that IMG will begin working within 90 days from the date the USCIS grants waiverEmployment start and end dates in the contactNon-compete or covenant clause

Prevailing WageDepartment of Labor official wageIMG salary must be at or above prevailing wage


Pennsylvania Department of

Health

United States Department of State (USDOS)

United States Citizenship and

Immigration Services (USCIS)

Application Flow for J-1


Pennsylvania Department of

Health

Pennsylvania Governor’s

Office

Appalachian Regional

Commission

United States Department of State (USDOS)

United States Citizenship and

Immigration Services (USCIS)

Application Flow for ARC Waivers


Pennsylvania Department of Health

United States Citizenship and Immigration Services (USCIS)

Application Flow for NIW waivers


Thank you for your time!

Documents

Pennsylvania Waiver Programs