Effective Date of Rule: Immediately.

     Purpose: The emergency amendments to WAC 246-562-020 and 246-562-075 will allow the department to exceed and approve the current number of primary care physician applications to practice in designated health professional shortage areas in Washington state for the 2009 program year. These amendments are necessary to continue access to primary health care within designated health professional shortage areas in Washington state.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-562-020 and 246-562-075.

     Statutory Authority for Adoption: Chapter 70.185 RCW and Public Law 110-362.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

     Reasons for this Finding: Without the amendments to the rule, physicians who have signed employment contracts with Washington state employers will look to other states for employment. Current rules are a barrier to primary care physicians. The amendments will allow for the immediate acceptance of the primary care physician's waiver applications to secure their employment in underserved areas with focus on access to care.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 1, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 2, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

     Date Adopted: February 18, 2009.

Mary C. Selecky

Secretary

OTS-2181.1

AMENDATORY SECTION(Amending WSR 06-07-035, filed 3/8/06, effective 4/8/06)

WAC 246-562-020   Authority to sponsor visa waivers.   (1) The department of health may assist communities to recruit and retain physicians, or other health care professionals, as directed in chapter 70.185 RCW, by exercising an option provided in federal law, 8 U.S.C. Sec. 1184(l) as amended by Public Law ((108-441)) 110-362 and 22 C.F.R. 514.44(e). This option allows the department of health to sponsor a limited number of visa waivers each federal fiscal year if certain conditions are met.

     (2) The department may acknowledge sponsorship proposed by federal agencies, including the United States Department of Health and Human Services.

     (3) The department may carry out a visa waiver program, or, in the event of resource limitations or other considerations, may discontinue the program. Purposes of the program are:

     (a) To increase the availability of physician services in existing federally designated shortage areas for health care facilities that have long standing vacancies;

     (b) To improve access to physician services for communities and specific underserved populations that are having difficulty finding physician services;

     (c) To serve Washington communities which have identified a physician currently holding a J-1 visa as an ideal candidate to meet the community's need for primary health care services or specialist services as allowed by WAC 246-562-080.

     (4) The department may only sponsor a visa waiver request when:

     (a) The application contains all of the required information and documentation;

     (b) The application meets the criteria contained in chapter 246-562 WAC.

     (5) The department will limit its activities:

     (a) Prior to submission of an application, the department may provide information on preparing a complete application;

     (b) For applicants that have benefited from department sponsorship previously, the applicant's history of compliance will be a consideration in future sponsorship decisions;

     (c) Because the number of sponsorships the department may provide is limited, and because the number of shortage areas is great, sponsorship will be limited. In any single program year, a health care facility in any one designated health professional shortage area or medically underserved area:

     (i) Will not be allotted more than two sponsorships;

     (ii) Will not be allotted more than one specialist sponsorship as allowed by WAC 246-562-080(4); and

     (iii) Will not be allotted more than one hospitalist sponsorship per hospital;

     (d) In any given program year no less than twenty of the federally allocated sponsorships will be allotted for primary care physicians and up to ten of the federally allocated sponsorships will be allotted for specialists through March 31. Any waiver sponsorships that remain unfilled on April 1 of each program year will be available to:

     (i) Both primary care and specialist physicians consistent with the provisions of this chapter; and

     (ii) Physicians intending to practice in nondesignated shortage areas in health care facilities that meet the criteria in WAC 246-562-075.

[Statutory Authority: Chapter 70.185 RCW and Public Law 108-441. 06-07-035, § 246-562-020, filed 3/8/06, effective 4/8/06. Statutory Authority: Chapter 70.185 RCW. 03-19-054, § 246-562-020, filed 9/11/03, effective 10/12/03; 00-15-082, § 246-562-020, filed 7/19/00, effective 8/19/00; 98-20-067, § 246-562-020, filed 10/2/98, effective 11/2/98.]

     (1) Provide care to patients who reside in designated shortage areas.

     (a) Describe the facility's service area.

     (b) Provide a patient visit report that identifies total patient visits in last six months of service by patient origin zip code.

     (2) Describe who will benefit from the physician's services.

     (a) Identify the percentage of medicaid and medicare patients who will have access to this physician.

     (b) Describe how the facility will assure access to this physician for low-income or uninsured patients.

     (c) Explain if the physician has language skills that will benefit patients at this facility.

     (3) Provide a detailed report of the extensive recruitment efforts made to recruit a U.S. physician for the specific position that the J-1 physician will fill.

     (a) Explain why this physician is necessary at this location.

     (b) Explain why it is difficult to recruit a U.S. physician for this location.

     (c) Provide the number of physicians interviewed for this position.

     (d) Provide the number of physicians offered this position.

[Statutory Authority: Chapter 70.185 RCW and Public Law 108-441. 06-07-035, § 246-562-075, filed 3/8/06, effective 4/8/06.]

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