These rules amend the requirements for foreign physicians to apply to the Florida Department of Health for sponsorship. These amendments clarify issues that have caused many applications to be submitted incorrectly.

 

DEPARTMENT OF HEALTH

Division of Public Health Statistics and Performance Management

RULE NOS.:RULE TITLES:

64W-1.002Definitions

64W-1.003Eligibility

64W-1.004Application Requirements

64W-1.006Application Processing

64W-1.008Modification, Termination, or Violation

PURPOSE AND EFFECT: These rules amend the requirements for foreign physicians to apply to the Florida Department of Health for sponsorship. These amendments clarify issues that have caused many applications to be submitted incorrectly.

SUMMARY: These changes clarify specialty definitions, physician licensure, employment contract eligibility, application requirements, application processing, and change of employer notification requirements. It also adds a provision to allow deficiencies to be corrected under specific circumstances.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on the SERC checklist, this rulemaking will not have an adverse impact on regulatory costs in excess of $1 million within five years as established in s.120.541(2)(a), F.S.

Any person who wishes to provide information regarding the statement of estimated regulatory costs, or to provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 381.4018(3) FS

LAW IMPLEMENTED: 381.4018 FS

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jeffrey Johnson at 850-617-1471 or [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64W-1.002 Definitions.

For the purpose of this chapter, the words and phrases below are defined as follows:

(1) through (5) No Change

(6) “Primary Care Physicians” – Physicians providing at least 80% of the required 40 hours per week of direct patient care in an outpatient ambulatory care site in the following practices: Family Medicine; general Internal Medicine; general Pediatrics; general Obstetrics/Gynecology; and Psychiatry.

(7) “Specialists” – Physicians who do not provide primary care as defined in subsection (6) above., including Hospitalistshospitalists, intensivists, and laborists are considered specialists. Any primary care physician who provides less than 80% of the required 40 hours per week of direct patient care in an outpatient ambulatory care site is also considered a specialist.

Rulemaking Authority 381.4018(3) FS. Law Implemented 381.4018 FS. History–New 8-12-21, Amended.

 

64W-1.003 Eligibility.

(1) No Change

(2) Physician Eligibility.

(a) through (c) No change

(d) Applicants must have a clear, activecurrent Florida medical license that is effective on or before the last date of the application period as defined in Rule 64W-1.006(1) F.A.C or have submitted a complete medical license application prior to requesting sponsorship.

(3) Employment Contract Eligibility. For an employment contract to be considered eligible, it must include:

(a) No Change

(b) The dDate the document was signed, either next to the signature or under it;

(c) All practice locations must be clearly delineated, including the physical address. Any language that states the practice location can be changed to any location not listed or locations added at a future date, without prior notification to the Department as required by Rule 64W-1.008, F.A.C., will make the contract ineligibleContact name, physical address, mailing address, phone number, and contact’s email address for each practice location;

(d) A statement that the physician will practice direct patient care for a minimum of 40 hours per week. Any language that alters the weekly 40 hours of direct patient care will make the contract ineligible. Any mention of shift work will require a detailed explanation on how the 40 hours of direct patient care will be provided;

(e) No Change

(f) TheA statement that “full-time employment shall commence within 90 days after the waiver is approved by U.S. Citizenship and Immigration Services (USCIS).” Any language that adds caveats to this statement will shall make the contract ineligible;

(g) No Change

(h) A clause stating that the applicant shall notify the Department Primary Care Office will be notified in writing at least 60 days prior to the termination of the contract by either party or immediately upon termination, if an immediate termination occurs;

(i) There shall not be any non-compete clauses/provisions; and

(j) Termination of employment provisions shall provide that termination is only for cause;.

(k) If the Offer of Employment letter includes provisions that are legally binding, it is part of the contract, and must be included with any contract and addendums. It must not be used as the Practice Facility Cover Letter; and

(l) Any addendum or attachment that alters the original terms of the contract must also be signed and dated by both the physician and the employer as described in paragraphs (a) and (b) above.

Rulemaking Authority 381.4018(3) FS. Law Implemented 381.4018 FS. History–New 8-12-21, Amended.

 

64W-1.004 Application Requirements.

(1) The following Conrad 30 Waiver Program documents must be completed and submitted to the Department to be evaluated for sponsorship:

(a) A completed Florida DOH Sponsorship Application (DH8006-PHSPM-07/20222021), incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX https://www.flrules.org/Gateway/reference.asp?No=Ref-13374;

(b) A Physician Agreement (DH8007-PHSPM-07/2021), incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-13375;

(c) A Physician Attestation of Exclusivity (DH8008-PHSPM-07/2021), incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-13376;

(d) Employer Practice Location Attestation(s) (DH8009-PHSPM-07/20222021), incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX https://www.flrules.org/Gateway/reference.asp?No=Ref-13377;

(e) A Specialist Addendum (DH8010-PHSPM-07/2021), incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-13378, is required if the physician is not a Primary Care Physician, as defined in Rule 64W-1.002(6) F.A.C.;

(f) A Flex Addendum (DH8011-PHSPM-07/2021), incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-13379, is required for every if any practice site that is not located in a designated HPSA;

(g) through (i) No Change

(j) A copy of the applicant’s clear, active Florida medical license or evidence of a submitted, complete medical license application;

(k) through (o) No Change

(2) No Change

(3) Application packets must:

(a) include the applicant’s USDOS case number on the bottom right corner of each page in the submission packet, excluding the Florida DOH Sponsorship Application, to assure accurate review and processing at the USDOS and the USCIS;

(b) include a table of contents and 8½” x 11” colored section dividers to assure accurate review and processing at the USDOS and the USCIS.  The application packet must not have tabs that exceed the 8½” x 11” size;

(c) not use staples or two-prong fasteners.  Binder clips and rubber bands are acceptable; and

(d) only include one copy of the application packet materials. Additional copies will be shredded.

Rulemaking Authority 381.4018(3) FS. Law Implemented 381.4018 FS. History–New 8-12-21, Amended.

 

64W-1.006 Application Processing.

(1) Application packages, as outlined in Rule 64W-1.004, F.A.C., will only be accepted beginning at 8:00 a.m. (EDTEST) on the first Monday of October and must be received no later than 5:00 p.m. (EDTEST) 10 business days, excluding state holidays or office closures, thereafter. Applications must be mailed to: Florida Department of Health, Division of Public Health Statistics and Performance Management, State Primary Care Office, 4052 Bald Cypress Way, Bin A‑05, Tallahassee, Florida 32399-1720.

(2) At the close of the application cycle, Department staff will conduct an initial review of the information contained in the application packet. Any application deemed ineligible during the initial reviewincomplete by the Department based on any failure outlined in paragraphs (a) through (d) below will not be recommended shall not be eligible for recommendation to the State Surgeon General (or designee) for sponsorship. An application package will be deemed ineligible if:

(a) it does not meet the eligibility requirements in Rule 64W-1.003, F.A.C.

(b) it does not include all application requirements in Rule 64W-1.004, F.A.C.,

(c) it is submitted by any method other than mail as specified in subsection (1) above,

(d) is not received within the timeframes stipulated in subsection (1) above, or

(3) Correspondence and/or communication between employers, physicians, or attorneys with Department staff will not take place during the initial review and prioritization of applications.

(4) After final approval by the State Surgeon General (or designee), Department staff will notify each applicant on his or her sponsorship status by email. This shall occur on or before December 31 of each year, unless the condition in subsection (5) below occurs. The Department willis responsible for sending sponsorship application packets to the USDOS, on or before December 31 of each year, unless the condition in subsection (5) below occurs.

(5) In the event the total number of applications deemed eligible by the Department during the initial review is fewer than 30 for sponsorship, applications received during the application cycle, as outlined in subsection (1) above, that were deemed ineligible will be notified by email of the deficits in their application package.

(a) All additional documentation must be received on or before 15 business days, excluding state holidays or office closures, from the date of the Department’s deficiency notice. All updated applications will be evaluated based on the scoring priorities provided in Rule 64W-1.005, F.A.C. in order to bring the total number sponsored to 30.

(b) All applicants whose application was deemed eligible during the initial review will be notified of sponsorship status on the same day that the deficiency notices are sent.

Rulemaking Authority 381.4018(3) FS. Law Implemented 381.4018 FS. History–New 8-12-21, Amended.

 

64W-1.008 Modification, Termination, or Violation.

(1) through (3) No Change

(4) Contract changes that result in the transfer of the physician to a different employer must be presented in writing to the Department at least 10 business days prior to the change. This includes physicians transferring from one Florida provider to another Florida provider, from an out-of-state provider to a Florida provider, or from a Florida provider to an out-of-state provider. Transfer requests must include:

(a) through (c) No Change

(d) A Physician Agreement (DH8007-PHSPM-07/2021) as incorporated in Ruleparagraph 64W-1.004(4)(b), F.A.C.;

(e) A Physician Attestation of Exclusivity (DH8008-PHSPM-07/2021) as incorporated in Ruleparagraph 64W-1.004(4)(c), F.A.C.;

(f) Employer Practice Location Attestation(s) (DH8009-PHSPM-07/20222021) as incorporated in Ruleparagraph 64W-1.004(4)(d), F.A.C., with one form for each practice location;

(g) A Specialist Addendum (DH8010-PHSPM-07/2021), as incorporated in Ruleparagraph 64W-1.004(4)(e), F.A.C., is required if the physician is not a Primary Care Physician, as defined in Rule 64W-1.002(6) F.A.C.if physician is not a Primary Care Physician;

(h) A Flex Addendum (DH8011-PHSPM-07/2021), as incorporated in Ruleparagraph 64W-1.004(4)(f), F.A.C., is required for every practice site that is not located in a designated HPSA if any practice site is not located in a HPSA;

(i) through (j) No Change

(k) A clear, active Florida medical license or evidence of a submitted, complete medical license application if physician is relocating into Florida.

(5) No Change

Rulemaking Authority 381.4018(3) FS. Law Implemented 381.4018 FS. History–New 8-12-21, Amended.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jeffrey Johnson

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Joseph A. Ladapo, MD, PhD, Surgeon General and Secretary

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 08/10/22

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 3/24/22