Shortage Designation Update

1. Shortage Designation Update State Office of Rural Health Orientation Meeting Rockville, Maryland September 11, 2013

2. Objectives • Become familiar Shortage Designation Branch • Gain an understanding of Shortage Designation Types • Gain an understanding of Shortage Partners and Stakeholders

3. 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

4. Division of Policy and Shortage Designation • 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

5. HPSA Designations:Health Discipline Shortages • 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: • primary medical care • dental • mental health • For each discipline category, there are three types of HPSAs • geographic area • population group • 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

6. Automatic Health Professional Shortage Area (HPSA) Statute • 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

7. Entities Covered under Auto HPSA Statute • Federal Indian Health Service Clinics • Tribally-run Health Clinics • Urban Indian Health Clinics • Dual-funded Community Health Centers/Tribal Health Clinics • Certified Rural Health Clinics (RHCs) meeting NHSC-Site Requirement • Federally Qualified Health Centers/Community Health Centers • FQHC Look-A-Likes (LALs)

8. Shortage Designations and Medicare Certification as a Rural Health Clinic • Primary Care Medical Geographic HPSA • Primary Care Medical Population-Group HPSA • Medically Underserved Area • Governor-designated and Secretary-certified shortage area

9. 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.

10. Auto HPSA Scores • 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

11. MUAs/PsHealth Services Shortages • 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

12. HPSA Find Website

13. HPSA Find Website

14. HPSA Find Website

15. HPSA Find Website

16. State Primary Care Offices: PCOs • 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: • their statewide primary care needs assessments • shortage designation coordination • 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

17. How Shortage Designations are used

18. Division of Policy and Shortage Designation CAPT Phil Budashewitz, Director: pbudashewitz@hrsa.gov 301-443-1372

19. Q&A