PURPOSE: This rule establishes the procedure for requesting an attestation from the Department of Health that an alien physician’s work in an area or areas of the United States that have been designated as having a shortage of health care providers by the Secretary of Health and Human Services is in the public interest for the purpose of applying for a National Interest Waiver from the Immigration and Naturalization Service.

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

   1. (A) Department means the Missouri Department of Health;
   2. (B) Director means the director of the Missouri Department of Health;
   3. (C) Board means the Board of Registration for the Healing Arts, Missouri Department of Economic Development;
   4. (D) Physician means an individual licensed and registered pursuant to Chapter 334, RSMo;
   5. (E) Hospital means a facility licensed in the state of Missouri pursuant to Chapter 197, RSMo;
   6. (F) Health Professional Shortage Area (HPSA) means an area or facility designated by the Secretary of Health and Human Services as having inadequate health care providers; and
   7. (G) Approved practice site means the practice location for which the department has issued the attestation of public interest.

2. (2) The department may provide attestations in support of a National Interest Waiver request for waiver to the job offer requirement that applies to alien second preference employment-based immigrant visa petitions.

   1. (A) The request must contain all of the following information and documentation and must be submitted in a single package with the documents presented in the order they are listed in paragraphs (2)(A)1.–9. Waiver requests which do not comply with these requirements will not be considered. Each request shall contain:

      1. 1. A written request from the physician

that the department provide a letter that the physician’s work in such an area, areas or facility is in the public interest;

1. 2. A detailed written description of the

service area, facility or population in which the physician will be working, including documentation of its designation as a Health Professional Shortage Area and the services currently being provided;

1. 3. A letter from the board stating that

the physician is licensed in good standing in Missouri;

1. 4. A letter from the medical director of

all hospitals at which the physician has privileges delineating the status of the privileges that were granted, when the privileges began and how the privileges may have changed over time along with an explanation for any changes;

1. 5. A written statement from the physi-

cian’s malpractice insurance carrier stating the claims made against the physician and the disposition of those claims;

1. 6. A written statement from the city

council or county commission, whose jurisdiction includes the physician’s practice site, that the physician’s services are required by and are in the interest of the community;

1. 7. A written statement from the local

public health agency, whose jurisdiction includes the physician’s practice site, that the physician’s services are required by and are in the interest of the community;

1. 8. A copy of the physician’s employment

contract for the practice site for a period of no less than five (5) years; and

1. 9. A written statement as to how the

denial of the waiver will affect the provision of medical services in that community.

1. (3) No attestation shall be granted to any physician who fails to provide any of the information in paragraphs (2)(A)1.–9.
2. (4) No attestation shall be granted to any physician who does not have privileges at any hospital in Missouri.
3. (5) A physician must work at the approved practice site for a minimum of five (5) years. If the physician fails to comply with this section, the department shall report the physician to the Immigration and Naturalization Service and other agencies as necessary.

4. (6) A physician with a National Interest Waiver from Missouri, who wishes to transfer to another qualifying practice site in Missouri, may do so under the following circumstances:

   1. (A) The physician must notify the department at least sixty (60) days prior to the proposed change. The notice must contain, at minimum the following:

      1. 1. All the information and documenta-

tion required in subsection (1)(A) of this rule; and

1. 2. A detailed explanation as to the rea-

son for the change; and

1. (B) The physician retains sole responsibility for financial liabilities caused by the change in approved practice site. 19 CSR 10-4

1. (7) Physicians for whom the department provides public attestations shall supply the following to the department by February 1 of each year:

   1. (A) Name;
   2. (B) Address of the physician’s present practice site(s);

   3. (C) The number and characteristics of the patients served including:

      1. 1. Gender;
      2. 2. Age distributions; and
      3. 3. Payor source (Medicaid, Medicare,

commercial insurance or self-pay);

1. (D) Letters of continued support from the medical director of all hospitals at which said physician has privileges;
2. (E) Letters of continued support from the local public health agency; and
3. (F) Letter from the board stating that the physician is licensed in good standing in Missouri.

AUTHORITY: section 191.411, RSMo 2000.* Emergency rule filed March 27, 2001, effective April 9, 2001, expired Jan. 17, 2002. Original rule filed March 27, 2001, effective Sept. 30, 2001. *Original authority: 191.411, RSMo 1993.