Shortage Designation Update

State Office of Rural Health Orientation Meeting

Rockville, Maryland September 11, 2013

Become familiar Shortage Designation Branch

Gain an understanding of Shortage Designation Types

Gain an understanding of Shortage Partners and Stakeholders

Objectives

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Organizational Structure October 2012, Shortage Designation Function Transferred to BCRS

Increased alignment with National Health Service Corps and NURSE Corps Scholarship and Loan Repayment Programs

Office of the Associate Administrator

Associate AdministratorDeputy Associate Administrator

Administrative Management Services

Office of Legal and

Compliance

Division of National Health Service Corps

Division of Nursing and

Public Health

Division of External Affairs

Division of Policy and Shortage

Designation

Division of Program

Operations

Division of Regional

Operations

Office of Business

Operations

Improve access to health care services for individuals and communities that are underserved by designating and addressing health professional shortages areas (HPSAs) and Medically Underserved Areas and Populations (MUA/Ps)

State Primary Care Offices

Public Health Service Act, Title III, Sections 330 and 333

Division of Policy and Shortage Designation

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Health Professional Shortage Area (HPSA) designations are used to identify areas and population groups within the United States that are experiencing a shortage of health professionals

There are three categories of HPSAs based on health discipline:1. primary medical care2. dental3. mental health

For each discipline category, there are three types of HPSAs1. geographic area2. population group3. facility

The primary factor used to determine a HPSA designation is the number of health professionals relative to the population with consideration of high need.

These HPSA Designations are required to be updated on a regular basis

HPSA Designations:Health Discipline Shortages

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Legislation in 2002 created a separate type of HPSA designation, not based on geographic or population data but based on status as a certain type of facility

This legislation created “Automatic Facility (Auto) HPSAs”

Auto HPSAs are automatically designated by statute

Auto HPSAs are manually scored by the BCRS Shortage Designation Branch

Automatic Health Professional Shortage Area (HPSA) Statute

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Federal Indian Health Service Clinics

Tribally-run Health Clinics

Urban Indian Health Clinics

Dual-funded Community Health Centers/Tribal Health Clinics

Entities Covered under Auto HPSA Statute

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Certified Rural Health Clinics (RHCs) meeting NHSC-Site Requirement

Federally Qualified Health Centers/Community Health Centers

FQHC Look-A-Likes (LALs)

Primary Care Medical Geographic HPSA

Primary Care Medical Population-Group HPSA

Medically Underserved Area

Governor-designated and Secretary-certified shortage area

Shortage Designations and Medicare Certification as a Rural Health Clinic

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What is as HPSA Score?

HPSA Scores are developed for use by the National Health Service Corps in determining priorities for assignment of clinicians.

Scores range from 1 to 25 for primary care and mental health, 1 to 26 for dental.

The higher the score, the greater the chance of obtaining a provider.

A score of “0” can mean two different things:• Data was provided and

calculated score is “0”• Or, the site has not been

scored, that is no data has been presented and thus not scored

• “0” means “null” in the latter case

Auto HPSA Scores are not required to be updated and only updated on request

Auto HPSA Scores

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MUAs may be a whole county, a group of contiguous counties, a group of county or civil divisions, or a group of urban census tracts in which residents have a shortage of personal health services

MUPs may include groups of persons who face economic, cultural or linguistic barriers leading to a shortage of personal health services

MUA/Ps use an Index of Medical Underservice (IMU) with a scale of 0 to 100

The IMU involves four variables which are summed and weighted to obtain an area’s score:• ratio of primary medical care physicians per 1,000 population• infant mortality rate• percentage of the population with incomes below the poverty level• percentage of the population age 65 or over

An IMU of 62.0 or less qualifies for designation as an MUA/P

MUAs/PsHealth Services Shortages

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HPSA Find Website

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HPSA Find Website

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HPSA Find Website

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HPSA Find Website

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HRSA-PCO Cooperative Agreement addresses the needs of underserved areas and populations

Coordinate and oversee HPSA and MUA/P needs assessment and application process

Pending FY 14 Competing Continuation Funding Opportunity Announcement

Retain its historic focus to support states and territories in:1. their statewide primary care needs assessments2. shortage designation coordination3. technical assistance and collaborations that seek expand access to primary care

FOA will strongly encourage needs assessments be based on pre-defined Rational Service Area plans or Primary Care Service Areas (PCSAs) and serve as the basis for shortage designation applications

Discussion of past and/or future plans to coordinate the collection of provider data with all licensing boards for health professionals in the state or other appropriate organizations

State Primary Care Offices: PCOs

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How Shortage Designations are used

Shortage Designation Option National Health Service Corps

Federally Qualified Health Center Program

CMS Medicare Incentive Payment

CMS Rural Health Clinic

ProgramJ-1 Visa Waiver

Primary Care HPSA X X X X

Dental Care HPSA X

Mental Health HPSA X X X

Geographic HPSA X X X X

Population HPSA X X X

Facility HPSA X X

Exceptional MUP X X

Medically Underserved Area X X XMedically Underserved

Population X XState Governor's Certified

Shortage Area X

Division of Policy and Shortage Designation

CAPT Phil Budashewitz, Director: pbudashewitz@hrsa.gov301-443-1372

Q&A