(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 Fl. Admin. Code R. 64W-1.003
    (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 Fl. Admin. Code R. 64W-1.004(4)(f), 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 Fl. Admin. Code Chapter 64W-1;
    (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.
    (5) Violation of any of the employer eligibility criteria in Fl. Admin. Code R. 64W-1.003, may result in denial of future requests for visa waivers.
Rulemaking Authority Florida Statutes § 381.4018(3). Law Implemented Florida Statutes § 381.4018. History-New 8-12-21, Amended 10-24-22.