Review and Recommendation Process for the State of Minnesota
- Procedure for Receiving a J-1 Visa Waiver Application Case Number
- Section 1: Description of Waiver Process
- Section 2: Waiver Request Guidelines and Documentation
- Section 3: J-1 Visa Waiver Information Sheet for Foreign Physicians
- Section 4: Waiver Package Checklist
- Sample Forms
The State of Minnesota is committed to assisting all residents of Minnesota in obtaining access to quality, affordable health care. Therefore, the Minnesota Department of Health, through its Office of Rural Health and Primary Care, is prepared to consider recommending up to 30 waivers of the foreign residence requirement on behalf of physicians holding J-1 visas each year, 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, registered to do business in Minnesota, 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 without further review.
For more information, contact:
Darwin Flores Trujillo
651-201-3850 or 800-366-5424 (in Minnesota)
Procedure for Receiving a J-1 Visa Waiver Application Case Number
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.
Applications will be accept by the Minnesota Office of Rural Health and Primary Care between September 15 and the last business day of November.
Submissions received by the Minnesota Office of Rural Health and Primary Care will be date-stamp and an email will be sent notifying the applicant’s representative that the application has been received.
Applications received by October 15 will be guaranteed an initial review for minimum legal requirements. If the application is incomplete, the Department will notify the applicant’s representative via email and in writing via paper mail. The applicant will have until the last business day in November to address the issues identified and submit requested information or materials. If the applicant does not respond to the notification within the given deadline or if the supplemental materials or information fails to address the issues identified by the Department, the application will be deemed incomplete and not considered for approval.
Applications received after October 15 will not be guaranteed an initial review for minimum legal requirements.
MDH will announce soon after the last day in November whether or not 30 complete applications have been received. If 30 complete applications have not been received by the deadline, MDH will post an announcement on this website, and applications will be received on a first-come, first-served basis, until 30 complete applications have been received. Previously submitted, but incomplete applications may be resubmitted once complete.
Each application will be reviewed by the Office of Rural Health and Primary Care (ORHPC) to determine whether the application is complete. Applications that meet the minimum requirements will be forwarded to a review committee for selection of up to 30 applications that best meet the needs of the state. The review will be competitive based on a comparison of all qualified applications filed before the application deadline.
Only thirty (30) waivers can be granted per state per federal fiscal year (October 1 through September 30). A J-1 visa waiver will not be recommended by the state until the application has been reviewed and selected by the review committee. Up to 30 applications selected will be submitted to the U. S. Department of State for subsequent federal review.
If, during the initial review, ORHPC finds that the application is missing any required provision or contains any provision that is not permitted, the application will be removed from consideration and returned to the applicant. No returned J-1 visa application will be considered for recommendation. It will no longer be permissible to amend an application after it has been submitted for 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 recommendation letters, will be sent to the United States Department of State.
For purposes of these 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 must be filed by the employer 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.
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 application 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” 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.
Section 2: Waiver Request Guidelines and Documentation
- 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 of direct patient care.
- The physician must practice primary or specialty care 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. 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 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 program applies to physicians who have been admitted to the United States in, or have acquired, a J-1 visa status before September 30, 2015.
Section 3: J-1 Visa Waiver Information Sheet For International Physicians
Federal laws require international 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 work in 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, under the following conditions:
- A waiver request to the Department of Health must come from a U.S. health care facility, registered to do business in Minnesota, 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 of direct patient care 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 federal fiscal year.
Section 4: Waiver Package Checklist
Submit your request including all of the following information to:
Darwin Flores Trujillo
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
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 that will improve access to healthcare for underserved Minnesotans, 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.
3. A copy of the charity care policy and describe how it is made available.
4. Valid contract of employment with the health care facility of not less than three (3) years and not less than 40 hours per week of direct patient care.
5. List of Health Care Professional Shortage Areas (HPSAs), Medically Underserved Areas/Populations (MUA/MUPs).
6. 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. It is acceptable to submit a single copy of the position posting with a list of publications used and dates published.
7. A one to three page letter from the facility director explaining any issues specific to the application that will help the review committee select J-1 visa waivers that best meet the needs of the state. In determining which applications will receive a waiver recommendation, the review committee may weight any relevant factor listed in the application, in comparison to the other applications submitted. For Minnesota’s J1 Visa Waiver Program, the highest priority recruitment challenges are for primary care and/or rural locations. Factors the Review Committee may find significant include, but are not limited to:
- The number of standard waivers/Flex waivers. The review committee may not recommend all of the available 10 Flex waivers if there are a large number of high priority standard waiver applications.
- The potential impact on underserved populations in the service area. Specifically in Flex or specialty physician applications, explain how the placement of this physician will support the overall delivery of primary care to the underserved.
- The proportion of charity care provided by the facility (show the calculations). Applicants who provide higher levels of charity care will be given priority over those with lower levels of charity care or inappropriate calculations of charity care.
- The percentage of the facility's patients who are Medicare and Medicaid eligible (show the calculations). Applicants with higher percentage of Medicare/Medicaid patients may be given priority as an indicator of the impact on the underserved.
- Amount of time recruiting for the position. Applicants who have been recruiting for this position for an extended period of time will get preference over those that have recently begun recruitment.
- The number of primary care/specialty care applications. The Department expects that at least 15 of the 30 available waivers will be for primary care.
- The distribution of rural and urban applications received. More weight will be given to applications with the greatest impact on rural and urban underserved populations.
- The number of recent waivers approved for the applying health care facility/health system, including the retention history for those waivers. Applicants who have historically been unable to retain international physicians will receive a lower priority in the review.
- The reasonableness of any non-compete or liquidated damages clause in the contract. The review committee cannot dictate contract terms, but they are free to give applications with unreasonable contract terms a lower priority.
- The factors related to the retention of the physician, including efforts by the facility and/or previous connections of the doctor to the area/state. The review committee may consider factors such as family already in the area as a higher priority.
- Any extenuating circumstances specific to the applicant's situation. The review committee may consider any unique, unanticipated circumstances; for example, a sudden, unexpected loss of a physician, leaving the facility without physician coverage.
It is the responsibility of each applicant to include and explain the most relevant factors the review committee should consider in making its selections.
8. Documentation of Minnesota medical license or active application.
9. Physician curriculum vitae and up to three letters of recommendation.
10. Physician's immigration documents: Copies of all DS-2019 forms of the physician, copies of I-94 of physician and family members, a copy of certification by the Educational Commission for Foreign Medical Graduates (ECFMG), and proof of passage of all steps of the United States Medical Licensing Examination (USMLE).
11. Completed Waiver Review Application Data Sheet
12. Completed J-1 Visa Waiver Policy Affidavit and Agreement
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 one unbound copy of entire package.
- J-1 Visa Waiver Policy Affidavit and Agreement
- Waiver Review Application Data Sheet
- Procedure for Receiving a J-1 Visa Waiver Application Case Number