PURPOSE: This rule outlines the Department of Health and Senior Services’ J-1 visa waiver recommendation process in accordance with section 214(l) of the Immigration and Nationality Act.

1. (1) The following definitions shall be used in the interpretation of this rule:

   1. (A) Department means the Missouri Department of Health and Senior Services;
   2. (B) Director means the director of the Missouri Department of Health and Senior Services;
   3. (C) Health Professional Shortage Area (HPSA) means a geographic area, population group, or facility designated by the United States Department of Health and Human Services, Health Resources and Services Administration with a shortage of primary care, dental, or mental health providers and services;
   4. (D) Primary Care Specialty means a physician practicing Family Medicine, General Internal Medicine, General Pediatrics, General Obstetrics and Gynecology, or General Psychiatry; and
   5. (E) Primary Care Physician means a physician practicing in one (1) of the Primary Care Specialties in (1)(D).

2. (2) A waiver request must come from a Missouri health care facility on behalf of a J-1 Visa physician. All of the required information and documentation, as required by the United States Department of State, J-1 Visa Waiver Program, must be submitted in a single application package with the documents presented in the order as prescribed in subsections (2)(A)-(H). Waiver requests that do not comply with these requirements will not be considered. The required documents include:

   1. (A) A completed Form DS-3035, J-1 Visa Waiver Recommendation Application;

   2. (B) An employment contract between the physician and the health care facility employing the physician named in the waiver application that includes the following:

      1. 1. The name and address of the health

care facility;

1. 2. A statement that the physician agrees

to begin employment with the employer within ninety (90) days of receiving the waiver;

1. 3. A statement that indicates the physi-

cian’s specialty;

1. 4. The specific geographical area or

areas where the physician will practice medicine;

1. 5. A statement by the physician that he

or she agrees to meet the requirements set forth in the Immigration and Nationality Action, Section 214(l);

1. 6. An employment period of at least

three (3) years in a designated HPSA; and

1. 7. A full-time schedule of at least forty

1. (40) hours per week in direct patient care in the HPSA;

   1. (C) Proof that the location where the physician will practice medicine is in a designated HPSA;
   2. (D) Copies of all Forms IAP-66 or DS- 2019, Certificate of Eligibility for Exchange Visitor (J-1) Status;
   3. (E) A copy of the physician’s curriculum vitae;
   4. (F) Proof of eligibility for licensure with the Missouri Board of Healing Arts;
   5. (G) A copy of the statement of no objection from the physician’s country of nationality or last residence, if the physician is contractually obligated to return to the home country; and
   6. (H) An original and one (1) unbound copy of the entire application package shall be included.
2. (3) Application packages will be accepted between October 1 and October 31 of the current year. Each application package received by the department will be reviewed for completeness. Complete applications are those which include all required documentation, as listed in subsections (2)(A)-(H). Complete applications will be forwarded for approval by the director or his/her designee in the priority as outlined in sections (4)-(6). Upon approval, the department will send the request to the appropriate federal authorities.

3. (4) The department’s J-1 Visa Waiver Program will give priority to those physicians in one (1) of the following primary care specialties: Family Medicine, General Pediatrics, General Obstetrics and Gynecology, General Internal Medicine, or General Psychiatry. Primary Care Physician applications that meet all applicable requirements will always receive an available selection regardless of the location or HPSA score of the application. If the department receives more than thirty (30) completed application packages between October 1 and October 31, application packages will be prioritized in the following order:

   1. (A) Primary Care Physicians will be prioritized before other specialties;

   2. (B) HPSA score of the health care facility employing the physician. Higher HPSA scores will be prioritized before lower HPSA scores.

      1. 1. In the event that up to six (6) Prima-

ry Care Physician applications are received, each Congressional district will be allotted three (3) J-1 Visa Waiver recommendations for specialists. Primary Care Physician applications will not impact other recommendations. If a Congressional district fails to fill its allotted recommendations, those recommendations in excess will be returned to the remaining pool of available recommendations. If a Congressional district has more than three (3) applications, the applications will be recommended based on HPSA score.

1. 2. In the event that seven (7) or more,

but no more than fourteen (14), Primary Care Physician applications are received, each Congressional district will be allotted two (2) J-1 Visa Waiver recommendations for specialists. Primary Care Physician applications will not impact other recommendations. If a Congressional district fails to fill its allotted recommendations, those recommendations in excess will be returned to the remaining pool of available recommendations. If a Congressional district has more than two (2) applications, the applications will be recommended based on HPSA score.

1. 3. In the event that fifteen (15) or more,

but no more than twenty-two (22), Primary Care Physician applications are received, each Congressional district will be allotted one (1) J-1 Visa Waiver recommendation for a specialist. Primary Care Physician applications will not impact other recommendations. If a Congressional district fails to fill its allotted recommendations, those recommendations in excess will be returned back to the remaining pool of available recommendations. If a Congressional district has more than one (1) application, the application will be recommended based on HPSA score.

1. 4. In the event that more than twenty-

two (22) primary care physician applications are received, all remaining applications will be recommended based on the highest HPSA score of the specialist(s).

1. 5. In the event that more than thirty (30)

Primary Care Physician applications are received, all applications will be recommended based on the highest HPSA score. 19 CSR 10-4

1. (5) In addition to the eligible physicians set forth in section (4), waivers may be recommended for other specialties and subspecialties.

   1. (A) Physicians trained in other specialties may be considered for recommendation for a J-1 Visa Waiver based on the following criteria:

      1. 1. Vacant recommendation slots must be

available; and

1. 2. The specialty physician’s application

must comply with all other requirements of the J-1 Visa Program.

1. (B) The number of specialty recommendations in any given program year will be determined by the number of available recommendation slots after all application packages for primary care physicians as outlined in section

1. (4) are reviewed. If more application packages are received for specialists than the department has recommendations available, priority will be determined by the HPSA score of the location of the health care facility employing the physician. (i.e. higher Primary Care HPSA scores will be assigned higher priority.)

   1. (C) In the event that there are fewer remaining J-1Visa Waiver recommendations available than applicants, and with all of those applications having equal status in priority, remaining J-1Visa Waiver(s) will be recommended by lottery.

2. (6) If the department recommends less than thirty (30) physicians for J-1 Visa Waivers for application packages received between October 1 and October 31 of the current year, application packages will continue to be accepted, reviewed for completeness, and recommended in the order of the date they are received for any specialty until all available slots are filled.

   1. (A) In the event that there are fewer remaining waivers than applicants, and with all of those applicants having equal status in priority, remaining waiver(s) will be recommended by lottery.
3. (7) It is the responsibility of the physician and the employer to meet Missouri’s licensing and credentialing requirements as delineated by the Missouri Board of Healing Arts.

4. (8) A physician who is practicing under a J-1 Visa in another state who wishes to practice in a HPSA in Missouri and obtain a J-1 Visa Waiver may do so only under the following conditions:

   1. (A) The physician must complete the J-1 Visa Waiver Application process in Missouri and obtain a Missouri medical license prior to commencing practice; AND SENIOR SERVICES
   2. (B) The physician should make no plans for the transfer or to move personal possessions until the department has approved the request. The physician retains sole responsibility for notifying the employer of the intent to transfer, and payment of any financial penalty caused by a breach of contract, as determined by the employer; and
   3. (C) All other J-1 Visa Waiver requirements remain in effect.

5. (9) A physician with a J-1 Visa Waiver who is practicing in Missouri and who wishes to transfer to another HPSA in Missouri may do so under the following conditions:

   1. (A) At least sixty (60) days in advance of the proposed change, the physician must notify the department of the new practice site address, telephone number, site director, and the effective date of the proposed change;
   2. (B) The reason for the transfer must be explained in the written notice;
   3. (C) A new J-1 Visa Waiver employer contract must be submitted to the department prior to approval of the transfer; and
   4. (D) The physician should make no plans for the transfer or moving of personal possessions until the department has issued written approval of the transfer. The physician retains sole responsibility for notifying the employer of the intent to transfer and payment of any financial penalty caused by a breach of contract, as determined by the original employer.
6. (10) The department is not responsible for exceptions to or interpretations of these policies which have occurred without the written approval of the director of the department or his/her designee.
7. (11) The department is not responsible for any practice arrangements or contractual obligations entered into by the physician prior to approval of a J-1 Visa Waiver request.

AUTHORITY: section 191.411.1, RSMo 2016.* This rule was previously filed as 19 CSR 50-4.020. Emergency rule filed April 17, 1995, effective April 27, 1995, expired Aug. 24, 1995. Original rule filed April 17, 1995, effective Oct. 30, 1995. Changed to 19 CSR 10-4.020 July 30, 1998. Emergency amendment filed Sept. 19, 2000, effective Sept. 29, 2000, expired March 27, 2001. Amended: Filed Sept. 19, 2000, effective Feb. 28, 2001. Emergency amendment filed Dec. 16, 2002, effective Dec. 26, 2002, expired June 23, 2003. Amended: Filed Dec. 16, 2002, effective May 30, 2003. Emergency recission and rule filed Sept. 17, 2019, effective Oct. 1, 2019, expired March 27, 2020. Rescinded and readopted: Filed Sept. 17, 2019, effective April 30, 2020. Amended: Filed April 1, 2020, effective Sept. 30, 2020.

*Original authority: 191.411, RSMo 1993, amended 2001, 2007.