Original Notice.

     Preproposal statement of inquiry was filed as WSR 02-12-100.

     Title of Rule: J-1 Physician Visa Waiver regulations, WAC 246-562-080 Physician eligibility requirements and 246-562-160 Implementation.

     Purpose: The amendments to WAC 246-562-080 is intended to allow physicians with training in geriatric medicine to apply for primary care waivers, and also to allow physicians to be eligible to apply for a waiver during the last six months of the their residency or fellowship training. The amendments to WAC 246-562-160 are intended to clean up outdated implementation language from 2000.

     Statutory Authority for Adoption: Chapter 70.185 RCW.

     Statute Being Implemented: RCW 70.185.030 and 70.185.040.

     Summary: The proposed amendment to WAC 246-562-080 will move physicians practicing geriatric medicine from the "specialist" classification to "primary care" classification. This will allow geriatric physicians to be considered for a primary care visa waiver. The other proposed amendment will allow physicians to apply for a visa waiver during the last six months of their residency or fellowship training. This will allow physicians to be employable upon completion of training pending the approval of their visa waiver. The amendment to WAC 246-562-160 is housekeeping for implementation language addressing the rule change in 2000. The current amendments reflect implementation of this rule change.

     Reasons Supporting Proposal: The proposed amendments are in response to constituent requests to consider geriatric physicians as a primary care physician and to allow J-1 physicians to apply for a waiver prior to completion of their residency or fellowship training.

     Name of Agency Personnel Responsible for Drafting and Implementation: Jennell Prentice, 2725 Harrison Avenue N.W., Olympia, WA, (360) 705-6666; and Enforcement: Kristina Sparks, Director, 2725 Harrison Avenue N.W., Olympia, WA, (360) 705-6762.

     Name of Proponent: Department of Health, governmental.

     Rule is not necessitated by federal law, federal or state court decision.

     Explanation of Rule, its Purpose, and Anticipated Effects: Geriatrics is a subspecialty of internal medicine and is considered a "specialist" under the current rule language. Due to the nature of the services provided, the aging demographics, and a number of requests to consider geriatrics as primary care, the proposed amendment would identify geriatrics in rule as a primary care physician. This would allow geriatric physicians to apply for a primary care waiver instead of a "specialist" waiver. The anticipated effect is that the state will have more opportunities to get primary care physicians into practice.

     Current language for physician eligibility criteria is vague and does not allow a physician to be eligible for a waiver until they have completed their residency or fellowship program. The proposed amendment to the rules would enable J-1 physicians to be eligible to apply for a waiver during their final year of training. This would permit J-1 physicians with waiver approvals to begin practicing immediately after they complete their training rather than just beginning the waiver process at that time.

     WAC 246-562-160 Implementation, was originally adopted in 2000 to address the addition of physicians with subspecialty training during a current program year. This section only addresses the 2000 program year. The language is being amended to reflect current rules.

     Proposal Changes the Following Existing Rules: The proposed amendment will list geriatric physicians as an eligible primary care category. The amendment will also exempt geriatric physicians from having any subspecialty training and from being included in the specialist category.

     The other amendments will allow physicians to apply during the last six months of their residency or fellowship program with submission of a letter from their program that identifies the date the physician will complete the residency or fellowship program and confirming that the physician is in good program standing.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The amendments to this rule do not add any additional requirements or costs to the regulated parties. The amendments ease existing requirements and adjust the application submission timeline.

     A cost benefit analysis was prepared and can be obtained by writing to Jennell Prentice, Office of Community and Rural Health, P.O. Box 47834, Olympia, WA 98504-7834, phone (360) 705-6666, or fax (360) 664-9273.

     RCW 34.05.328 applies to this rule adoption. The amendments to WAC 246-562-080 alter the eligibility requirements for the application process for J-1 visa waiver sponsorships by the state of Washington. A significant analysis was prepared on the proposed amendments.

     Hearing Location: Department of Health, Target Plaza, Hearing Room, 2725 Harrison Avenue N.W., Suite 500, Olympia, WA 9850 [98502], on August 27, 2002, at 10:00 a.m.

     Assistance for Persons with Disabilities: Contact Earl Meyer by August 13, 2002, at (360) 705-6770, or TDD (800) 833-6388.

     Submit Written Comments to: Jennell Prentice, J-1 Physician Visa Waiver Program, P.O. Box 47834, Olympia, WA 98504-7834, e-mail J1rules@doh.wa.gov, fax (360) 664-9273, by August 26, 2002.

     Date of Intended Adoption: August 28, 2002.

July 19, 2002

M. C. Selecky

Secretary

OTS-5803.2

AMENDATORY SECTION(Amending WSR 00-15-082, filed 7/19/00, effective 8/19/00)

WAC 246-562-080   Criteria for the physician.   (1) The physician must not have a J-1 visa waiver pending for any other employment offer.

     (2) Physicians must have the qualifications described in recruitment efforts for a specific vacancy.

     (3) Physicians are considered eligible to apply for a waiver when they are:

     (a) Complete with their residency or fellowship program; or

     (b) In the last six months of a residency or fellowship program, and the physician provides a letter from their program that:

     (i) Identifies the date the physician will complete the residency or fellowship program; and

     (ii) Confirms the physician is in good standing with the program.

     (4) Physicians applying as primary care physicians must:

     (a) Provide direct patient care; and

     (b) Be trained in:

     (i) Family practice; or

     (ii) General internal medicine; or

     (iii) Pediatrics; or

     (iv) Geriatric medicine; or

     (v) Obstetrics and gynecology; or

     (((v))) (vi) Psychiatry and its subspecialties; and

     (c) Except for geriatric medicine and psychiatrists, not have any additional specialty training. Continuing medical education (CME) will not be considered specialty training for the purposes of this rule.

     (((4))) (5) Physicians applying as specialists must:

     (a) Provide direct patient care;

     (b) Be trained in a subspecialty as defined by the Accreditation Council for Graduate Medical Education and published in the 1999-2000 Graduate Medical Education Directory, which is hereby incorporated by reference of:

     (i) Internal medicine, except for geriatric medicine; or

     (ii) Family practice, except for geriatric medicine; or a specialty as defined by the Accreditation Council for Graduate Medical Education and published in the 1999-2000 Graduate Medical Education Directory, which is hereby incorporated by reference of

     (iii) General surgery; or

     (iv) Radiology-diagnostic((; and

     (v) Be an active candidate for board certification on or before the start date of employment)).

     (((c))) (6) Copies of the 1999-2000 Graduate Medical Education Directory are available from the American Medical Association or can be viewed at the Washington State Department of Health, Office of Community and Rural Health, 2725 Harrison NW, Olympia WA 98504.

     (((5))) (7) Physicians must have an active Washington state medical license, unless unusual circumstances delay licensing. If the application for a Washington state medical license has been received by the Washington state medical quality assurance commission four or more weeks prior to submission of the visa waiver application, the applicant may substitute a copy of the license application and request an exception.

     (((6))) (8) Physicians must be an active candidate for board certification on or before the start date of employment.

     (9) Physicians must have at least one recommendation from their residency program if applying as a primary care physician or from their fellowship program if applying as a specialist that:

     (a) Addresses the physician's interpersonal and professional ability to effectively care for diverse and low-income people in the United States; and

     (b) Describes an ability to work well with supervisory and subordinate medical staff, and adapt to the culture of United States health care facilities; and

     (c) Documents level of specialty training, if any; and

     (d) Is prepared on residency program letterhead and is signed by residency program staff or faculty; and

     (e) Includes name, title, relationship to physician, address and telephone number of signatory.

     (((7))) (10) The physician must comply with all provisions of the employment contract.

     (((8))) (11) Physician must:

     (a) Accept Medicaid assignment; and

     (b) Post and implement a sliding fee discount schedule; and

     (c) Serve the low-income population; and

     (d) Serve the uninsured population; and

     (e) Serve the shortage designation population; or

     (f) Serve the population of a local, state, or federal governmental institution or corrections facility as an employee of the institution.

[Statutory Authority: Chapter 70.185 RCW. 00-15-082, § 246-562-080, filed 7/19/00, effective 8/19/00; 98-20-067, § 246-562-080, filed 10/2/98, effective 11/2/98.]

     (2) ((Ten working days after the effective date of this rule, the department will determine:

     (a) The number of J-1 visa waiver sponsorships already approved during the federal fiscal year which ends September 30, 2000;

     (b) The number of pending primary care applications which the department has determined to be complete.

     The department will subtract the sum of these two numbers from twenty which is the total number of J-1 visa waiver sponsorships the federal government has allocated to the state of Washington for the federal fiscal year ending September 30, 2000. The department will multiply the difference between these two numbers by .25. In the event the product of this operation is a whole number, the department will allocate that number of J-1 visa waiver sponsorships to specialists for the federal fiscal year ending September 30, 2000. In the event the product of this operation is not a whole number, the department will determine the larger of the two whole numbers between which the product falls, and will allocate that number of J-1 visa waiver sponsorships to specialists for the federal fiscal year ending September 30, 2000. All other J-1 visa waiver sponsorships available during the federal fiscal year ending September 30, 2000, will be allocated to primary care physicians.

     (3))) The department will not ((accept)) process J-1 visa waiver sponsorship applications ((from specialists)) until ((ten days after)) the effective date of the amendments ((of which this rule is a part)) to WAC 246-562-080, but may advise ((specialists)) applicants with respect to any proposed application.

     (((4) The department will prioritize among specialists applying for J-1 visa waiver sponsorships for the federal fiscal year ending September 30, 2000, using criteria generally applicable to the selection of specialists under this chapter.)) (3) Applications received between October 1, 2002, and the effective date of the amendments to WAC 246-562-080 will be date and time stamped, and will be processed on the effective date of the rule in the order received.

[Statutory Authority: Chapter 70.185 RCW. 00-15-082, § 246-562-160, filed 7/19/00, effective 8/19/00.]

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