Florida Administrative Code › 64 - DEPARTMENT OF HEALTH › 64W - Division of Public Health Statistics and Performance Management › Chapter 64W-1 - CONRAD 30 WAIVER PROGRAM › Section 64W-1.008 - Modification, Termination, or Violation

Current through Reg. 50, No. 138; July 16, 2024
(1)
				In the event of a termination of employment, the employer must notify the
				Department in writing within 5 business days of the termination.
(2) Contract changes which result in a change
				in practice scope 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 and follow all eligibility criteria in Rule
				 64W-1.003, F.A.C.
(3) Contract changes which result in the
				relocation of the physician from the employer's current approved site(s) to a
				new site(s) must be presented in writing to the Department at least 10 business
				days prior to the change. The employer notification must include the name and
				address of the new location(s), the reason for the change, and verification
				that the new site(s) is located within a designated shortage area. If the new
				site(s) is not located in a designated shortage area, then a Flex Addendum
				(DH8011-PHSPM-07/2021), incorporated in paragraph
				 64W-1.004(4)(f),
				F.A.C., is required.
(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) A cover letter
				from the physician indicating the intent to transfer, reasons for the transfer
				and proof of the extenuating circumstance(s), intended date of transfer, and
				intent to continue upholding all requirements of Chapter 64W-1,
				F.A.C.;
(b) A 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 detailed explanation as to
				why the letter cannot be obtained;
(c) A letter from the new employer stating
				their desire to hire physician;
(d)
				A Physician Agreement (DH8007-PHSPM-07/2021) as incorporated in Rule
				 64W-1.004(4)(b),
				F.A.C.;
(e) A Physician Attestation
				of Exclusivity (DH8008-PHSPM-07/2021) as incorporated in Rule
				 64W-1.004(4)(c),
				F.A.C.;
(f) Employer Practice
				Location Attestation(s) (DH8009-PHSPM-07/2022) as incorporated in Rule
				 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 Rule
				 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;
(h) A Flex Addendum
				(DH8011-PHSPM-07/2021), as incorporated in Rule
				 64W-1.004(4)(f),
				F.A.C., is required for every practice site that is not located in a designated
				HPSA;
(i) Employment Contract from
				new employer that incorporates all eligibility requirements in subsection
				 64W-1.003(3),
				F.A.C.;
(j) Evidence of Shortage
				Designation Status: A copy of the HRSA "Find Shortage Areas by Address" query
				result for each practice site location; and
(k) A clear, active Florida medical
				license.