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Arizona National Interest Waiver Program
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The United States Citizenship and Immigration Services (USCIS) of the Department of Homeland Security is the federal agency that grants national interest waivers. The federal National Interest Waiver (NIW) program allows certain foreign workers with advanced degrees, including foreign physicians (MDs), or exceptional abilities to work in the United States. A national interest waiver granted to a foreign physician by the USCIS the exempts the foreign physician from the labor certification process administered by the United States Department of Labor.
Under the federal NIW program, a state health department may support with an attestation letter a request for a national interest waiver for a foreign physician. The foreign physician must agree to provide medical services full time in a federally designated primary care health professional shortage area (HPSA), medically underserved area (MUA), medically underserved population (MUP), or mental health professional shortage area (MHPSA) for an aggregate of five years.
A state public health department's participation in the NIW program is discretionary. The Arizona Department of Health Services (ADHS) has determined that participation in the NIW program will promote the effective use of health manpower and facilities in this state as required by A.R.S. § 36-104(16). The ADHS' participation in the NIW program will increase access to health care for the underserved residents of this state.
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Click on the questions below to find what you are looking for:
Am I eligible?
The following criteria must be met in order to be considered for the Arizona National Interest Waiver (NIW) Program:
- J-1 physicians who have obtained a J-1 visa waiver from the USCIS based on waiver recommendation from the Arizona Department of Health Services (ADHS).
- Have practiced as an Arizona J-1 physician for at least 1 year immediately preceding the request for an ADHS NIW attestation letter.
- Provide full time medical services at a qualifying site located within a federally designated primary care health professional shortage area (HPSA), medically underserved area (MUA), medically underserved population (MUP), or mental health professional shortage area (MHPSA) for an aggregate five (5) years of service including the three year J-1 waiver service obligation.
- Must serve the uninsured and under-insured, regardless of ability to pay.
- Must accept Medicaid (AHCCCS), Medicare assignment, and other public health insurance options.
- Must implement a Sliding Fee Schedule based on current Federal Poverty Level Guidelines.
Foreign physicians in research positions or those who will practice in long-term care, chronic care, inpatient care, or rehabilitation facilities are NOT eligible. Foreign physicians who received their J-1 waiver from another State are NOT eligible.
Is my current or potential employer/service site eligible?
A service site must:
- Be an approved service site located in a federally designated primary care health professional shortage area (HPSA), medically underserved area (MUA), medically underserved population (MUP), or mental health professional shortage area (MHPSA).
- Accept all patients regardless of their ability to pay.
- Accept State Medicaid (AHCCCS) and Medicare assignments, and other public health insurance options.
- Charge patients at the usual and prevailing rates in the area.
- Use a sliding fee schedule for all patients at the facility who are uninsured and at or below 200% of Federal Poverty Guidelines. The sliding-fee schedule must be based on current Federal Poverty Guidelines.
- Post a notice of Sliding Fee Scale discount in a clearly visible location such as a patient waiting room. If a service site does not meet all the requirements listed above, the site is not eligible, and the application will not be processed.
Examples of service sites that may qualify for NIW:
- Federally Qualified Health Center (FQHC) or FQHC Look-A-Likes
- Rural Health Clinic
- Federal or State correctional facility
- Community Outpatient Facility
- Community Mental Health Facility
How many national interest waivers are available each year?
There is no limit to the number of NIW attestation letters that can be issued by the Arizona Department of Health Services (ADHS) each year as long as those applications meet program eligibility requirements.
Are hospitalists or specialists eligible to apply?
The Arizona National Interest Waiver (NIW) Program supports primary care physicians in the specialties of family or general medicine, pediatrics, general internal medicine, obstetrics and gynecology; and psychiatry, as well as hospitalists and specialists who are practicing or will practice in federally designated medically underserved or shortage areas of the State and are currently participating in the ADHS J01 Visa Waiver Program.
The ADHS NIW Program will not issue NIW attestation letters for foreign physicians in research positions or those who will practice in long-term care, chronic care, inpatient care, or rehabilitation facilities.
The ADHS NIW Program will not issue NIW attestation letters for foreign physician who received their J-1 waiver from another State.
How can I apply?
A foreign physician who is seeking for a national interest waiver recommendation from the Arizona Department of Health Services must submit an application packet and supporting documents included in the National Interest Waiver Program Checklist.
Applications and supporting documentation should be sent to:[an error occurred while processing this directive]
Note: The documentation submitted for the support of a National Interest Waiver is site specific and non-transferable. Any changes to the original approved service site must be communicated to ADHS and appropriate documentation for any transfer must be filed for documentation.
When can I apply?
There is no specific application period for the Arizona National Interest Waiver Program. A J-1 physician interested in obtaining national interest waiver through recommendation from the Arizona Department of Health Services (ADHS) may submit his/her application anytime as long as he/she meets the following requirement:
- Has worked full time as an Arizona J-1 Visa Waiver physician for at least one year at a qualified service site located within a federally designated HPSA, MUA/P or MHPSA immediately preceding the request for a national interest waiver.
- Has complied with the Arizona J-1 Visa Program requirements, including submission of copies of the physician's J-1 visa waiver issued by the USCIS, valid employment authorization document (EAD) or H1B visa, and Arizona medical license and is in good program standing overall as of the date of the waiver application.
How long does the ADHS application review process takes?
A decision for a National Interest Waiver (NIW) attestation letter from ADHS typically takes about three to four weeks from receipt of the application. To ensure that an NIW request will be considered, all required documents must be received by ADHS. ADHS reserves the right to only consider complete applications.
ADHS reviews each received application for completeness, inclusion of all documents, physician and service site eligibility, including the physician's adherence to the Arizona J-1 Visa Waiver Program requirements. The documentation submitted for an ADHS NIW attestation letter is site specific. For all required documents, check out the Arizona National Interest Waiver Program Checklist.
ADHS will not issue an NIW attestation letter when circumstances indicate that a foreign physician with a J-1 visa waiver based on an ADHS J-1 visa waiver letter of support transferred to a site other than the original placement without prior notification to ADHS.
The ADHS will review Arizona Medical Board records and ADHS records for each foreign physician meeting the NIW eligibility requirements. At its discretion, the ADHS may determine that it is not in the public interest to issue a NIW attestation letter for a foreign physician who has been the subject of a complaint made to the Arizona Medical Board or to ADHS.
At its discretion, the ADHS may determine that it is not in the public interest to issue a NIW attestation letter for a foreign physician practicing at a service site that is not in compliance with the ADHS J-1 Visa Waiver Program's policies or that has been the subject of a complaint made to ADHS or to other regulatory agencies.
ADHS will notify the physician and the legal representative regarding the status of the application once decision has been made.
How do I know if ADHS grants an NIW letter of support on my behalf?
ADHS will notify the physician and the legal representative regarding the status of the application once decision has been made.
ADHS reserves the right to approve or deny support of a National Interest Waiver (NIW) application. If ADHS decides to support a physician, a letter of support for the waiver signed by the ADHS Deputy Director will be issued.
ADHS does not bear any liability for the denial of support of a NIW application, including but not limited to the consequences arising from any practice arrangements or contracts entered into by the physician or proposed employer before or after requesting an NIW recommendation.
How long does the USCIS NIW process and approval takes?
The United States Bureau of Citizenship and Immigration Services (USCIS) processing time for NIW applications generally takes 3 to 9 months from the time it is filed. Processing times vary depending on the USCIS service center that has jurisdiction over the NIW application and the person who is handling the case.
To check the processing times, visit the USCIS website.
What are the requirements for a physician who receives an NIW based on ADHS' recommendation?
If a foreign physician obtains a national interest waiver from the USCIS based on ADHS NIW attestation letter, ADHS must receive documentation of the national interest waiver approval within seven (7) business days after the physician receives the national interest waiver.
ADHS will track the physician's J-1/NIW service obligation through the physician's submission of the required notarized quarterly encounter report that must be received in ADHS on or before the 10th business day following the end of each calendar quarter. The report documents that the foreign physician is practicing in the approved service site on a full time basis and confirms sliding fee schedule use for the foreign physician's patients.
Failure to submit the required quarterly encounter report within the timeframe specified will result to further compliance monitoring by the program. If ADHS determines that the physician has ongoing compliance issues with program requirements, ADHS may at its discretion report this issue to the USCIS. The NIW provider may not be eligible for a completion letter if non-compliance issues remain unresolved.
What if I want to transfer to a different service site after USCIS granted an NIW for the original approved site?
NIW physicians who wish to transfer to another eligible service site or add a site to an existing approved site must immediately notify the Arizona National Interest Waiver Program Manager in writing. A Service Site Transfer Packet must be submitted for documentation that the new service meets program requirements. ADHS will inform the NIW physician or the legal representative of additional supporting documents needed to ensure that the new service site meets program requirements. ADHS will confirm in writing with the NIW physician or the legal representative that the new service site meets the program's service site eligibility requirement.
The NIW physician or the legal representative must file a petition to amend his/her NIW status directly with the United Citizens Bureau of Citizenship and Immigration Services (USCIS). Once this petition is approved, the NIW provider must submit a copy of the approval notice to ADHS for documentation.
What are my responsibilities to obtain a letter of completion?
An NIW letter of completion may be requested directly from the ADHS NIW Program Manager within 60 days prior to the end of the five year service obligation. A NIW physician will be eligible for a completion letter only upon ADHS' verification of service completion that will be based upon complete documentation of services rendered at the USCIS approved site(s) and verified compliance to all program requirements.
Any observed discrepancy with the service site listed on the encounter report forms will require further investigation and may cause delay in the issuance of the completion letter. If it is determined that the NIW provider transferred to a different service site or worked at a service site that was not previously included in the original NIW application without notifying ADHS, the NIW provider may anticipate delay in receiving a completion letter or may anticipate not receiving a completion letter at all.
Any verified gaps in service due to site transfers, or other reasons resulting to a gap in service, will result in an extension of the NIW service obligation.
Only NIW physicians deemed to have completely satisfied the requirements of the program will receive a completion letter from the Arizona National Interest Waiver Program.
Who can I contact in ADHS if I have a question about NIW?
The contact person for any issues related to National Interest Waivers:
Ana Lyn Roscetti, MPH
Workforce Section Manager
Bureau of Health Systems Development
150 N. 18th Avenue, Suite 300
Phoenix, AZ 85007
(602) 542-2011 (fax)