J-1 Visa Waiver Review and Recommendation Process for the State of Minnesota

The state of Minnesota is committed to assisting all residents of Minnesota in accessing quality, affordable health care. Therefore, the Minnesota Department of Health, through its Office of Rural Health and Primary Care, is prepared to consider recommending a waiver of the foreign residence requirement on behalf of physicians holding J-1 visas, under certain conditions.

The Minnesota Department of Health's participation is completely discretionary and voluntary and may be modified or discontinued at any time. The submission of a complete waiver package to the Minnesota Department of Health (the Department) does not ensure that the Minnesota Department of Health 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 waiver requests by the Minnesota Department of Health, the request for waiver should come from a United States 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:
Lorry Colaizy
651-201-3851 or 800-366-5424 (in Minnesota)


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Samples of Available Forms

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Section 1: Description of Waiver Process

Requests for a waiver of the foreign residence requirement should be made by local health care facilities directly to the Minnesota Department of Health, Office of Rural Health and Primary care. Upon request, an information packet will be sent detailing the information and documentation needed to submit an appropriate case file for review.

Each case will be reviewed by the Office of Rural Health and Primary Care (ORHPC) to determine whether the application is complete. If all materials are in order, the initial review process should take approximately three weeks.

Only thirty (30) waivers can be granted per state per federal fiscal year (October 1 through September 30). As applications are received, ORHPC will assign a review number to ensure that applications will be reviewed in the order they are received. A Conrad State 30 number will not be assigned until the application has been reviewed for form and substance and has been determined to be ready to submit to the U. S. Department of State.

If, during the application review, ORHPC finds that the Employment Contract is missing any required provision or contains any provision that is not permitted, the application will be removed from the list for review and returned to the applicant. No Conrad State 30 number will be assigned to the returned application. The applicant may resubmit the application with a complying contract, at which time ORHPC will assign a new review number and review priority. It will no longer be permissible to amend an Employment Contract while the application is under review. All required contractual provisions must be in the contract or contemporaneous attachments, not in subsequent letters of understanding, addenda or amendments. Contract provisions that are contradictory or include research activities or teaching that is not incidental to direct patient care are not permitted.

The ORHPC will make the decision whether to recommend a request for a waiver of the home residence requirement. If the decision is in the affirmative, the case file, along with necessary cover letters, will be sent to the United States Department of State. The complete state process may take up to 30 days.

Definitions

For purposes of the waiver guidelines, an “organization” is an entity listed as the “employer” in the employment contract, which is included in a J-1 visa waiver application filed on behalf of an international physician; or an entity that contracts with a multi-specialty physician practice to provide physician staffing. All applications submitted by the same organization must be prioritized (first, second, third etc.) and filed by the organization, not by departments within the organization. Each submitted application must be for the employment of only one international physician. Each application must be submitted separately and each facility may submit only one application at a time.

A “facility” is the place where the physician will practice. It may be different from the employer’s principal business location and it may be one of the employer’s practice sites.

A waiver application must include a letter from the “head of the facility” where the physician will practice. This should be the person who will have day-to-day management responsibility for the facility and the physician, including scheduling of physicians. If the letter is signed by anyone else in the organization, the application must also include a written statement from the person with day-to-day management responsibility for the facility explaining that they have read and understand the Minnesota J-1 visa waiver guidelines and will comply with state and federal waiver requirements.

“Charity Care” or “Indigent Care” is the value of fees discounted to patients by the facility based on the patients’ ability to pay. It does not include bad debt or fees discounted by programs (i.e., Medicare or Medicaid) in which the facility participates.

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Section 2: Waiver Request Guidelines and Documentation

PROGRAM GUIDELINES

  • The application must demonstrate a bona fide offer and acceptance of full-time employment at a health facility (a copy of the complete contract) and must agree to begin employment at such facility within 90 days of receiving a waiver.
  • The offer must contain a provision, and the physician must agree, to work at the health care facility in which he/she is employed for a total of not less than 3 years and not less than 40 hours per week.
  • The physician must practice primary care or specialty medicine full-time in the geographic area or areas which are designated by the Secretary of Health and Human Services as a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA).
  • The waiver application must demonstrate that the facility has an in-place sliding fee schedule or similar written indigent care policy for determining discounts or charity care based on the patient’s ability to pay. The policy must be posted in a place that is accessible to patients and potential patients.
  • Recruitment/retention efforts must be described. It must be clearly demonstrated that a suitable replacement for the physician cannot be found through recruitment or any other means. In addition, the health care facility's long range plans for retention of the physician must be detailed.
  • The physician, prior to employment, must meet all medical licensure requirements for the state of Minnesota.
  • The application must include copies of all DS-2019 (formerly IAP-66) forms "Certificate of Eligibility for Exchange Visitor (J-1) Status" and DHS forms I-94 for the physician and any family members. If the physician is contractually obligated to return to her/his home country, a copy of a letter is required from the home country stating that the home country has no objection to the physician remaining in the United States.
  • The request must contain a complete vitae of the physician.
  • The facility must commit that it will not facilitate the process of acquiring permanent residence for the physician until he/she has been employed in accordance with these requirements for at least two years.
  • The program applies to physicians who have been admitted to the United States in, or have acquired, a J-1 visa status before September 30, 2012.

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Section 3: J-1 Visa Waiver Information Sheet For Foreign Physicians

Federal laws require foreign physicians seeking to pursue graduate medical education or training in the U.S. to obtain a J-1 exchange visitor visa. The J-1 visa allows 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 will be able to return to the U.S.

Physicians who are subject to, but do not wish to comply with, the two-year home country residence requirement may apply for a waiver of that requirement under any one of the four grounds provided by the U.S. Immigration law:

  • Exceptional hardship to his/her U.S. citizen or permanent resident spouse or child.
  • Persecution if forced to return to home country.
  • A statement supporting a waiver from an interested U.S. government agency.
  • A statement supporting a waiver from a state department of public health or its equivalent.

The Minnesota 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 U.S. under a J-1 visa before September 30, 2012, under the following conditions:

  • A waiver request to the Department of Health must come from a U.S. health care facility on behalf of a J-1 physician and not directly from a J-1 physician or physician's representative.
  • The physician must be a primary care or specialty physician applying for a waiver to work in a Health Professional Shortage Area or Medically Underserved Area designated by the Secretary of Health and Human Services.
  • The physician must demonstrate a bona fide offer of employment at a health facility and must agree to work 40 hours per week for at least three years for a Medicare and Medicaid certified medical facility which also accepts medically indigent patients.
  • If the physician fails to fulfill the terms of the contract with the health care facility, they would not be eligible to apply for an immigrant visa or permanent residence unless they returned to their home country for two years.
  • There will be a limit of 30 waiver requests per state per fiscal year.

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Section 4: Waiver Package Checklist

Submit your request including all of the following information to:

Lawrence Colaizy
Minnesota Department of Health
Office of Rural Health and Primary Care
Golden Rule Bldg., Suite 220
P.O. Box 64882
St. Paul, Minnesota 55164-0882
All documents must include the case number assigned by the U.S. Department of State.

1. Summary of Situation. A letter from the head of the facility at which the physician will be employed that:

  • Requests that the Minnesota Department of Health act as an interested government agency and recommend a waiver for the J-1 physician;
  • Summarizes how the health care facility has attempted to locate qualified U.S. physicians;
  • Describes the physician's qualifications, proposed responsibilities and how their employment will satisfy important unmet health care needs of a medically underserved community; and
  • States unequivocally that the facility is offering the physician at least three years of employment in a job consistent with the Department's mission, a description of the critical need of the facility's service area and how the facility will assure that the physician will serve that need.


2. Description of the medical facility: Provide a detailed description of the health care facility, including the nature and extent of its medical services. Include a copy of the charity care policy and describe how it is made available.

3. Valid contract of employment with health care facility of not less than three (3) years and not less than 40 hours per week.

4. List of Health Care Professional Shortage Areas (HPSAs), Medically Underserved Areas/Populations (MUA/MUPs) and documentation from state/local health care officials stating need for the services of the physician.

5. Recruitment and retention efforts: (Copies of advertisements, agreements with placement services, etc.). The U.S. Department of State requires this information and if it is not available, submit a strongly-worded, detailed statement describing recruitment efforts. Also submit a statement detailing the plans for retaining the physician during and beyond the 3-year obligation.

6. Effect on area of waiver denial

7. Qualifications: proof of Minnesota medical licensure eligibility

8. Physician curriculum vitae and letters of recommendation

9. Physician's immigration documents: Copies of all DS-2019 (formerly IAP-66) forms of the physician, Copies of I-94 of physician and family members, Proof of passage of examinations required by the United States Citizenship and Immigration Services (USCIS)

10. Completed Waiver Review Application Data Sheet

11. Completed J-1 Visa Waiver Policy Affidavit and Agreement

12. Valid offer of employment with health care organization for at least three years

13. Physician statement of whether contractually obligated to return to home country, and if so obligated, statement of non-objection from home government.

14. Original package and two unbound copies of entire package.

Updated Monday, 24-Mar-2014 14:26:56 CDT