Conrad 30

Physician Eligibility

1. Physicians must currently reside in the U.S. and agree to reside in Florida and only treat patients in Florida for the duration of their approved Conrad 30 employment.
2. Physicians must have a U.S. Department of State (USDOS) case number at the time of application. Do not send any money to the Department. Any funds due to the U.S. Department of State for the J-1 Visa Waiver must be sent to them directly.
3. Physicians must have only applied for a Conrad 30 Program sponsorship from the Florida Department of Health.
4.  Physicians must have a current, unrestricted Florida medical license (MD/DO), that is effective on or before the last date of the application period. License should be in clear active status. Registrations are not considered medical licenses.

Employer Eligibility

1. The sponsoring facility/employer and all practice site locations must accept Florida Medicaid clients and be actively billing Florida Medicaid, whether through Fee-for-Service or as a Medicaid Managed Care plan provider.
2. All physicians at the practice site location must accept Medicaid. The applicant physician cannot be the only physician in the practice accepting Medicaid.
3. All employers, facilities, and practice locations must be physically located in Florida.

Employment Contract Eligibility

The following are required for an employment contract to be considered eligible:

1. Signatures of both the physician and employer.
2. Date the document was signed, either next to the signature or under it.
3. All practice locations must be clearly delineated, including the physical address. Any language that states the practice location can be changed or locations added at a future date shall make the contract ineligible
4. A statement that the physician will practice a minimum of 40 hours per week of direct patient care (in-person, face-to-face care with patients). Any language that alters the weekly 40 hours of direct patient care shall 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. Administrative duties, telemedicine, and being “available to provide direct patient care” may not be included in the 40 hours.
5. A minimum three-year term of full-time employment, including the specific start and end dates.
6. The 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 shall make the contract ineligible.
7. A description of the geographic area served by the facility.
8. A clause stating that the Florida Department of Health's 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.
9. There shall not be any non-compete clauses/provisions. Any language that looks to limit a physician’s ability to practice medicine after leaving the employer constitutes a non-compete provision, regardless of how the contract lists the restriction.
10. Termination of employment provisions shall provide that termination is only for cause. This is for both the employer and physician employee.
11. 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 if there are conflicting statements between them, an addendum should be done to clarify which language takes precedence; and
12. 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 (1) and (2) above.

An example of how contract eligibility criteria #5 and #6 may be combined that still meets the requirements would be: “Full-time employment shall commence within 90 days after the waiver is approved by U.S. Citizenship and Immigration Services (USCIS), or July 1, 2023, whichever comes first, Employment will be for three years, ending on June 30, 2026.”

If the submitted employment contract is missing any of these requirements, a contract addendum will be required that adds the missing elements.

If the submitted contract includes non-compete provisions and/or termination without cause provisions, an addendum will be required that removes those provisions from the contract. The addendum can cover both additions and deletions – one addendum for each is not required.

Application packages, as outlined in Rule 64W-1.004, F.A.C., will only be accepted beginning at 8 a.m. (EDT) on the first Monday of October and must be received no later than 5 p.m. (EDT) 10 business days, excluding state holidays or office closures, thereafter.

Process to Apply

Application packets must be mailed to:

The Florida Department of Health
Division of Public Health Statistics and Performance Management
State Primary Care Office
4052 Bald Cypress Way Bin #A05
Tallahassee, Florida 32399-1720

The following documents must be submitted to the department to be evaluated for sponsorship:

1. Completed Conrad 30 Waiver Program Florida DOH Sponsorship Application (DH8006-PHSPM-07/2022)
2. Physician Agreement (DH8007-PHSPM-07/2021)
3. Physician Attestation of Exclusivity (DH8008-PHSPM-07/2021)
4. Employer Practice Location Attestation – one attestation for each practice location (DH8009-PHSPM-07/2022)
5. Specialist Addendum - required if the physician is a specialist as defined in Rule 64W-1.002(7). Be sure to read and answer the questions. Failure to answer the questions correctly will make the application ineligible. (DH8010-PHSPM-07/2021)
6. Flex Addendum - required if any practice site is not located in a HPSA. Be sure to read and answer the questions. Failure to answer the questions correctly will make the application ineligible. (DH8011-PHSPM-07/2021)
7. Practice facility cover letter. This is a letter from the facility to the PCO/USDOS/USCIS explaining why the applicant physician is needed.
8. Copy of the Employment Contract and all addenda
9. Evidence of Shortage Designation Status: copy of the Health Resources and Health Administration (HRSA) “Find Shortage Areas by Address” query result for each practice site location.
10. Copy of a valid Florida medical license that was approved prior to requesting sponsorship. Training registrations are not considered medical licenses.
11. Physician curriculum vitae
12. Copy of USDOS Form DS-3035 - You must include all bar code pages, supplemental pages, and the statement of reason as received back from the submission to USDOS.
13. Copy of all applicable USDOS Form DS-2019/IAP-66 received from the USDOS
14. Copy of USDOS Form G28 as submitted with USDOS Form DS-3035

Additional Documentation Requirements

• Every field of the Florida Conrad 30 Waiver Program Application must be completed. The Department will only accept applications submitted on the current application form.
• The applicant’s USDOS case number should be on the bottom right corner of each document in the packet, excluding the DOH application, to assure accurate review and processing at the USDOS and the USCIS.
• Each application should include a table of contents and 8½” x 11” colored section dividers/pages to assure accurate review and processing at the USDOS and the USCIS.  The application packet shall not have tabs that exceed the 8½” x 11” size.
• Applications may not use staples or two-prong fasteners. Binder clips and rubber bands are preferred.
• Only one copy of the application packet is needed. Additional copies will be shredded.

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 review by the Department based on any failure in paragraphs (a) through (d) below will not be recommended to the State Surgeon General (or designee) for sponsorship.

An application package will be deemed ineligible if:

1. it does not meet the eligibility requirements in rule.
2. it does not include all application requirements in rule
3. it is submitted by any method other than mail.
4. is not received within the timeframes stipulated in rule.

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

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 conditions below occurs. The Department will send sponsorship application packets to the USDOS, on or before December 31, of each year, unless the conditions below occurs.

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 that were deemed ineligible will be notified by email of the deficits in their application package.

• 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 stipulated in 64W-1.005, F.A.C. in order to bring the total number sponsored to 30.
• All applicants whose application was deemed eligible during the initial review will be notified of their sponsorship on the same day that the deficiency notices are sent. A copy of the sponsorship letter will not be sent until after the deficient applications have been reviewed and the remaining slots have been filled.

The Department will sponsor applicants based on these priorities.

1. The state’s highest priority for sponsorship is primary care physicians practicing in Health Professional Shortage Areas (HPSAs) at outpatient ambulatory care sites in rural communities, as defined in section 381.0406, F.S., and serving a Medicaid patient volume of 30% or greater.
2. Applicants not practicing in the highest priority will be prioritized according to specialty (primary care over specialists), HPSA score, practice location (rural over urban), percent of patients served by Medicaid and sliding fee scale, and practice type (ambulatory outpatient care practices over safety-net hospitals and critical access hospitals, followed by all other types of inpatient care facilities)
3. If there are applications that have equal priorities for the last available slot(s), the application(s) will be re-evaluated based on the aforementioned priorities. If there are still applications that are equal, the State Surgeon General, or designee, will select the final applicant(s).
4. If the State Surgeon General determines that there is a critical shortage, Department staff will forward to the State Surgeon General (or their designee) all applications deemed complete for the specified specialty and/or in the specified geographic location, for the State Surgeon General’s (or designee’s) determination of sponsorship. These applications will take precedent, superseding all other priority criteria, with the remainder of the available slots being filled based on the priority criteria listed in (1).

The physician and employer may complete and submit to the Department the Conrad 30 Waiver Program Practice Status Report on or before June 30, of each year during the three-year waiver service period.

If the physician and employer choose not to submit the form annually, they must submit the form at the end of the 3-year employment period in order to receive a completion letter from the PCO Director.

Contract changes that result in a change of practice scope, location, or employer must be presented in writing to the Department at least 10 business days prior to the change.

The change in scope must be clearly explained in a cover letter and follow all eligibility criteria in Rule 64W-1.003, F.A.C.

Contract changes that result in a change of practice scope, location, or employer must be presented in writing to the Department at least ten business days prior to the change.

When there are contract changes that result in the relocation of the physician from the employer’s current approved site(s) to a new site(s) or adding practice locations, the employer must notify the PCO in writing and must include:

• Name and address of the additional/new location(s)
• Reason for the change
• Verification that the new site(s) are located within a designated shortage area. If the new site(s) are not located in a designated shortage area, then a Flex Addendum is required to be submitted to the PCO director.

Contract changes that result in a change of practice scope, location, or employer must be presented in writing to the Department at least 10 business days prior to the change.

• Transfer request must be made when a physician transfers from:

  • One Florida provider to another Florida provider
  • Out-of-state provider to a Florida provider
  • Florida provider to an out-of-state provider

Transfer requests must include

• Cover letter from the physician indicating the intent to transfer, reasons for the transfer, proof of the extenuating circumstance(s), intended date of transfer, and intent to continue upholding all requirements of Rule 64W-1 F.A.C.
• Letter from the current employer indicating the release of the physician and reasons for termination of employment. If the physician is unable to obtain a letter from the current employer due to the extenuating circumstance(s), the physician shall clearly state this in their letter and provide a detailed explanation as to why the letter cannot be obtained.
• Letter from the new employer stating their desire to hire the physician.
• Physician Agreement (DH8007-PHSPM-07/2021).
• Physician Attestation of Exclusivity (DH8008-PHSPM-07/2021).
• Employer Practice Location Attestation – one per practice location (DH8009-PHSPM-07/2022).
• Specialist addendum (DH8010-PHSPM-07/2021), if the physician is not a primary care physician as defined in the rule.
• FLEX Addendum (DH8011-PHSPM-07/2021), if any practice site is not located in a HPSA.
• Employment Contract from the new employer that incorporates all eligibility requirements in Rule 64W-1.003(3) [see Employment Contract Eligibility section above].
• Evidence of Shortage Designation Status: A copy of the HRSA “Find Shortage Areas by Address” query result for each practice site location, and

If the physician is moving into Florida with an approved J-1 Visa Waiver, the following should also be submitted:

• Proof of a Florida medical license in clear, active status,
• Completed Conrad 30 Waiver Program Florida DOH Sponsorship Application (DH8006-PHSPM-07/2022), and
• Written documentation (letter or email) from the primary care office the physician is transferring from, acknowledging that the physician is relocating.

In the event the current employer’s business changes ownership and the Conrad 30 physician’s practice location does not change, a modified list of transfer documents is required, and include:

• Letter from the current employer acknowledging the change in ownership and the anticipated date of change.
• Letter from the new owner stating their desire to continue the employment of the physician.
• Employer Practice Location Attestation – one per practice location (DH8009-PHSPM-07/2022).
• Employment Contract from the new employer that incorporates all eligibility requirements in Rule 64W-1.003(3) [see Employment Contract Eligibility section above].

 If the change in ownership also changes the Conrad 30 physician’s practice locations, the letter from the new owner should include:

• the name and address of the additional/new location(s),
• the reason for the change, and
• verification that the new site(s) are located within a designated shortage area. If the new site(s) are not located in a designated shortage area, then a Flex Addendum is required to be submitted to the PCO director.