39-6114A. REQUIRED APPLICATION FORMS AND DOCUMENTS FOR A NATIONAL INTEREST WAIVER REQUEST. (1) Applications for the national interest waiver program must include, but not be limited to, the following:

(a) Evidence of recruiting efforts over a minimum of six (6) months prior to when the petitioning physician applied for the vacancy. This evidence must include regional and national electronic or print advertising stating the position available and the practice site location. Copies of advertisements submitted must show the publication date. Advertisements run at the time of or after preparation of the employment contract are unusable. Online advertisements must show dates the advertisements were online. Contracts with recruitment firms are allowable as evidence in lieu of electronic or print advertisements if the activities described in this paragraph are provided under contract. Recruitment firm contracts must be included, if applicable. The provision of evidence for recruitment efforts over a six (6) month period is not necessary for national interest waiver petitioning physicians who receive a J-1 visa waiver at the request of the state of Idaho;

(b) Evidence that the physician selected for the position visited the practice site;

(c) A mailing list of physicians who applied for the position and the reason they were not selected;

(d) Evidence that the applicant has been providing medical or mental health care in Idaho for at least twelve (12) months or meets the requirements for a new start as defined in section 39-6105, Idaho Code. This includes, but may not be limited to, the Idaho taxpayer identification number, facility address, fax and telephone numbers and staffing list;

(e) A copy of an employment contract between the physician and the applicant;

(f) Evidence that the employment site is in a federally determined area of underservice;

(g) The request must be submitted by the applicant or applicant’s representative. The letter must be written on the applicant’s letterhead stationery, which includes address, telephone and fax numbers, if any. Letters, contracts and forms must contain original signatures;

(h) A copy of the sliding fee scale which the health care facility must agree to implement and post;

(i) A copy of the physician’s license to practice medicine in the state of Idaho, or eligibility to apply for an Idaho license;

(j) Legible copies of any DS 2019 forms (formerly IAP-66), and other United States immigration documentation attesting to the physician’s current legal status and history of stay in the United States;

(k) The physician’s curriculum vitae; and

(l) Payment of the department’s administrative application processing fee.

(2) The state of Idaho may require any other documentation or information for the support and approval process in the waiver application on the part of the physician or the applicant.

(3) These requirements are subject to change without notice.

History:

[39-6114A, added 2009, ch. 106, sec. 17, p. 336; am. 2017, ch. 72, sec. 13, p. 181.]