WAC 246-562-085   Eligibility for primary care and specialist waivers.  (1) Primary care waivers.

     (a) Primary care waivers are available to the following physician specialties:

     (i) Family medicine;

     (ii) General internal medicine;

     (iii) Pediatrics;

     (iv) Geriatric medicine;

     (v) Obstetrics and gynecology; or

     (vi) Psychiatry and its subspecialties.

     (b) Physicians who have completed any additional subspecialty training are not eligible for a primary care waiver, with the exception of geriatric medicine and psychiatry. Continuing medical education (CME) will not be considered subspecialty training for the purposes of this rule.

     (2) Specialist waivers. Specialist waivers are available to nonprimary care physician specialties. Applicants submitting an application for a specialist physician must:

     (a) Demonstrate a need for the nonprimary care specialty by addressing one of the following need criteria:

     (i) The physician specialty is needed to meet state or federal health care facility regulations, for example to maintain the hospital trauma designation level.

     (A) Identify the regulation; and

     (B) Address how the facility is currently meeting this regulation.

     (ii) The physician specialty is needed to address a major health problem in the facility service area.

     (A) Identify the health problem and how this specialty will address it;

     (B) Provide incident rates of the pathology and tie diagnosis codes to payer mix (i.e., how many patients are affected and how many are low-income or uninsured?); and

     (C) If this specialty is not available in the community, identify the nearest location where this specialty service can be obtained.

     (iii) The physician specialty is needed to address population-to-physician ratio because the current ratio does not meet national standards.

     (A) Provide the population-to-physician ratio for the specialty, include source for data provided;

     (B) Provide the number of physicians (FTE) practicing this specialty in the same health professional shortage area/facility service area;

     (C) Provide the distance to the nearest physician practicing the same specialty; and

     (D) Describe how the demand for the specialty has been handled in the past.

     (b) Describe the referral system that includes:

     (i) On-call sharing;

     (ii) Affiliation agreements with other health care entities in the service area, specifically with publicly funded employers, such as public hospital districts, community health centers, local, state, or federal governmental institutions or correctional facilities, who have an obligation to provide care to underserved populations.

     (c) Provide at least one letter of support for this type of physician specialty from a primary care provider practicing with publicly funded employers, such as public hospital districts, community health centers, local, state, or federal governmental institutions or correctional facilities, who have an obligation to provide care to underserved populations outside of the applicant's organization.

     (d) Provide written notice to the department and all publicly funded providers in the health care facility's HPSA or MUA designated area within thirty days of the physician's start-date of employment. The notice must include:

     (i) The physician's name, employment start date and practice location;

     (ii) Services to be provided; and

     (iii) Identification of accepted patients, such as medicaid, medicare, or basic health plan.



[Statutory Authority: Chapter 70.185 RCW and Public Law 108-441. 06-07-035, § 246-562-085, filed 3/8/06, effective 4/8/06.]