1. Pennsylvania Waiver Programs Ed Naugle Director, Division of Health Professions Development Jackie Austin Public Health Program Administrator Department of Health l Bureau of Health Planning 625 Forster Street l Harrisburg, PA 17120 717.772.5298 l Fax: 717.705.6525 www.health.state.pa.us

2. Pennsylvania Waiver Programs 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

3. Pennsylvania Waiver Programs 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 Hospitals Small Rural Hospitals Federally Qualified Health Centers (and Look-a-likes) Certified Rural Health Clinics Primary 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

4. Pennsylvania Waiver Programs 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 NIW ARC J-1 Conrad 30 J-1 FLEX 10 Practice site can not be located within a HPSA or MUA/P but must show they serve the population from a HPSA/MUA/P Conrad 30 J-1 FLEX 10 Practice 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

5. Pennsylvania Waiver Programs Schedule for Review and Recommendations of Applications Based on Federal Fiscal Year Initial Application Period: September 30-December 15 Second Application Period: January 1 – June 15 Final Application Period: July 1- September 15

6. Pennsylvania Waiver Programs J-1 Participation Criteria Practice a minimum of 40 clinical hours in direct patient care per week Agree to serve for three years Contract may not contain a non-compete clause that would cause the international medical graduate (IMG) to leave the area upon termination of a contract The 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.

7. Pennsylvania Waiver Programs J-1 Participation Criteria (cont.) A signed statement that another pending waiver application has not been filed A no objection letter if funds were received from his or her home country for medical education Signed statement of agreement of the policies of the J-1 Waiver Program Demonstration from the sponsor of unsuccessful efforts to recruit an American physician for the vacancy

8. Pennsylvania Waiver Programs Common Obstacles or Omissions Letter of Need Description of recruitment effort Documentation of all sub-specialty in the county in which the practice site is located (only for specialists) Charity Care Policy Service to all patients without regard to the ability to pay Policy of non-discrimination Discounted/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

9. Pennsylvania Waiver Programs Common Obstacles or Omissions (continued) Contract Practice site address(s) and site application address(s) do not match Statement that IMG will begin working within 90 days from the date the USCIS grants waiver Employment start and end dates in the contact Non-compete or covenant clause Prevailing Wage Department of Labor official wage IMG salary must be at or above prevailing wage

10. Pennsylvania Waiver Programs Pennsylvania Department of Health United States Department of State (USDOS) United States Citizenship and Immigration Services (USCIS) Application Flow for J-1

11. Pennsylvania Waiver Programs 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

12. Pennsylvania Waiver Programs Pennsylvania Department of Health United States Citizenship and Immigration Services (USCIS) Application Flow for NIW waivers

13. Pennsylvania Waiver Programs Thank you for your time!