I. Introduction & Overview I-1

To identify areas of greatest need so limited resources can be prioritized and directed to the people in those areas. Purpose of Designations I-2

Training Objectives  To increase the understanding of the HPSA and MUA/MUP criteria and application process  To increase the quality and completeness of applications submitted for designations, and therefore reduce the time period from submission to final determination I-3  To foster collaboration among community participants

Shortage Designations Shortage designations are based on the evaluation of criteria established through regulation to identify geographic areas or population groups with a shortage of primary health care services. There are two types of shortage designations, each linked to the federal Bureau of Clinician Recruitment Services (BCRS) activity or function. The shortage designations are:  Health Professional Shortage Area (HPSA) designation, which is a prerequisite to apply for National Health Service Corps (NHSC) recruitment assistance. The HPSA designation disciplines are primary medical care, mental health, and dental care.  Medically Underserved Area/Medically Underserved Population (MUA/MUP) designation, which is a prerequisite to requesting grant awards to plan, develop, and operate a community health center under Section 330 of the Public Health Service Act. I-4

Shortage Designation Branch MISSION The federal Shortage Designation Branch (SDB) is responsible for developing and implementing criteria and procedures for designating areas and populations having a shortage of primary health care services. ACTIVITIES  Criteria Development for Designations  Review and process requests for designation of HPSAs and MUA/MUPs, including the annual review of HPSAs  Maintain and disseminate the database of existing HPSAs and MUA/MUPs I-5

Shortage Designation Branch (continued)  Maintain and disseminate quarterly statistics on the number of HPSAs, the number of people residing in HPSAs, and the number of practitioners needed to remove the designation  Manage and serve as Project Officers for State Primary Care Office Cooperative Agreements  Provide information about designations for review to each State's Primary Care Office and to other interested parties  Publish an annual list of designated HPSAs in the Federal Register I-6

SDB - Regional Assignments I-7 States Included are: Region IX – Arizona, California, Hawaii, Nevada, American Samoa, CNMI/FSM/Guam, Republic of Palau, Republic of Marshall Islands Melvin Whitfield Public Health Analyst Phone: (301)

I-8

Primary Care Office’s (PCO) Role In Designation Process Development  Identify areas with underserved populations, limited access to health professionals, or health disparities  Assist applicants in developing designation applications Technical Assistance  Provide technical assistance to entities within the State preparing designation applications  Provide information within State on types of designations Oversight  Validate information contained in applications  Review and comment on applications submitted by entities within State I-9

PCO Role In Designation Process (continued)  Assure that all appropriate entities receive copies of designation applications such as County officials, Primary Care Association, Medical, Dental, and Mental Societies, etc.  Submit updated information (annual review process) by the SDB due dates Database Development  Coordinate with other State offices to obtain State databases for designation purposes, e.g. licensure lists, state population estimates, physician database, and Geographic Information System (GIS) database development I-10

Designation Interest Group (DIG) DIG is a working group open to interested participants from State PCOs and the SDB. A conference call is held once a month to discuss any designation issues related to the current method. DIG is a learning forum for participants to discuss issues, questions, and concerns related to the current designation process. It assists SDB in the development of policies and procedures to implement the designation criteria as fairly and efficiently as possible. It is also an opportunity to share ideas on how to access data, prepare cases, and address SDB review concerns. I-11

HRSA Website Select Health Professional Shortage Areas to view guidelines, criteria, HPSA database, MUA/MUP list, and Automatic HPSA Facility scores. PCO Number Call for information on current designations, copies of guidelines, criteria, HPSA or MUA/MUP list, etc. Additional Information I-12 OSHPD Website

SDB 2014 HPSA Annual Review Schedule I January 2014The renewal cycle is open for all 2011 HPSA renewals. February 2014State PCOs s original applicants requesting updates of HPSAs designated or last updated in 2011 with copies to county officials and State PCA. July 2014PCO sends reminder notices to applicants of deadline for submitting 2011 HPSA updates. September HPSA updates due to PCO. December HPSA updates due to SDB on December 31, 2014 January HPSAs for which no update was received will be proposed for withdrawal. July 2014Publish new list of designated HPSAs in the Federal Register

Legislation  Original legislation enacted by Congress in 1970's, Sections 330 (MUA/P) and 332 (HPSA) of the U.S. Public Health Service Act (as amended); Health Care Safety Net Amendments authorized automatic facility HPSA process for FQHCs and RHCs  Authorizes the Secretary of U.S. Department of Health and Human Services (DHHS) to designate shortage areas; delegated to HRSA Criteria  Developed to implement legislation; required to publish in Federal Register; required Secretary of DHHS and Office of Management Budget approval  First issued 1970's; periodic revisions - last revision 1992 (mental health) Guidelines  Administrative policies and procedures to implement program  Issued by HRSA I-14 Authority

Designation Requirements for Selected Federal Programs I-15 Shortage Designation Option National Health Service Corps FQHCs/CHCs/ FQHC Look-Alikes/ New Start/Expansion Medicare Incentive Payment Rural Health Clinic Program J-1 Visa Waiver Primary Care HPSA (Area only)XXXX Primary Care HPSA (Population only)X XX Dental Care HPSA (Area & Population)X Mental Health HPSA (Area only) XXX Mental Health HPSA (Population only) XX Facility HPSAXX Medically Underserved AreaXX X Medically Underserved Population XX State Governor’s Certified Eligible Area (for RHC purposes only) X (Not in CA)

Designation Requirements for State Programs  HPSA Required: NHSC/State Loan Repayment Program (OSHPD)  HPSA, MUA, or MUP Required: J-1 Visa Waiver Program (DHCS) Medicare Rural Hospital Flexibility Program Small Rural Hospital Improvement Program Rural Health Services Development Program (DHCS)* Seasonal Agricultural & Migratory Workers Program (DHCS)* *These programs are not funded by the State for Fiscal Year I-16

Designation Requirements for State Programs (continued)  HPSA, MUA or MUP Required: Health Professions Education Foundation (HPEF) Programs (  Allied Healthcare Scholarship Program  Associate Degree Nursing Scholarship Program  Bachelor of Science Nursing Scholarship & Loan Repayment Programs  Health Professions Education Scholarship & Loan Repayment Programs for Dentistry, Dental Hygienist, Nurse Practitioner, Certified Nurse Midwife, and Physician Assistant  Licensed Mental Health Service Provider Education Program  Steven M. Thompson Physician Corps Loan Repayment Program  Vocational Nursing Scholarship & Loan Repayment Programs I-17

Initial Contact Applicant contacts SDP for technical assistance (TA) and information. SDP provides:  TA on appropriate designation  Maps  Population and demographic data  Survey samples  Application worksheets 1 st Step – Application Received  Log application on tracking database  Assign case number  acknowledgment letter 2 nd Step – 30-day Comment Notice to:  County Health Officer/ Department/Medical Society  Primary Care, Dental, or Mental Health Association  HRSA/SDB copied  Case assigned to SDP staff 3 rd Step – Application Analysis (complete within 90 days, depending on caseload) Primary Care & Dental HPSAs and MUAs/MUPs (ASAPS Process)  Validate application information before entering data into ASAPS (use on-line tools: maps, data tables, MSSA data)  Verify provider data  Calculate population to provider ratio  Conduct contiguous area analysis in mapping interface (does not apply to MUAs/MUPs)  If application is “incomplete”, request additional data and allow applicant 15 days for resubmission.  Verify and enter all additional data needed  Prepare notification letter to applicant  Prepare ASAPS packet for Manager’s review and approval  Upon completion, Manager submits recommendation via ASAPS  ASAPS packet to applicant and others  Update tracking database 4 th Step - HRSA Review  Hold all recommendations for 30-day waiting period  Perform primary and secondary reviews  Upon approval or denial, post designation on HRSA on-line database  Send designation letter to SDP and applicant NOTE: HPSA designations are valid for 3 years. To maintain the HPSA status, designees must reapply every 3 years. MUA/MUP designations are permanent, unless there is a change in the MSSA boundary then designees must reapply for the updated boundary. 5 th Step – SDP Tracking Update  Update SDP tracking database  File designation letter in program file  Create monthly dynamic maps HPSA and MUA/MUP Application Process Shortage Designation Program (SDP) III-18

AcronymMeaning ALOSAverage Length of Stay AMAAmerican Medical Association ASAPSApplication Submission and Processing System BCRSBureau of Clinician Recruitment Services BHCDANETBureau of Health Care Delivery and Assistance (NET) BPHCBureau of Primary Health Care BOPBureau of Prisons CACooperative Agreement CCDCounty Census Division CFR Code of Federal Register CHCCommunity Health Center CHMPCCalifornia Healthcare Workforce Policy Commission CDPHCalifornia Department of Public Health CMHPCore Mental Health Providers/Professionals CMSCenter for Medicaid/Medicare Services (formerly HCFA) CPCACalifornia Primary Care Association CTCensus Tract DHHSDepartment of Health and Human Services I-19

AcronymMeaning (continued) DHCSDepartment of Health Care Services DTDental FQHCFederally Qualified Health Center FTEFull-Time Equivalent GISGeographic Information System HMOHealth Maintenance Organization HPSAHealth Professional Shortage Areas HRSA Health Resources and Services Administration IHPIndian Health Program IHSIndian Health Services IMRInfant Mortality Rate IMUIndex of Medical Underservice MCDMinor Civil Division MFWMigrant Farmworker MSFWMigrant Seasonal Farmworker MHMental Health MSSA Medical Service Study Areas MUAMedically Underserved Areas MUPMedically Underserved Populations I-20

NCHWANational Center for Health Workforce Analysis NHSCNational Health Service Corps NSCNearest Source of Care OMB Office of Management and Budget SDBShortage Designation Branch OSHPDOffice of Statewide Health Planning and Development OWEQAOffice of Workforce Evaluation and Quality Assurance PCPrimary Care PCAPrimary Care Association PCOPrimary Care Office PHSPublic Health Services RHCRural Health Clinic RSARational Service Area SFSSliding Fee Scale SLRPState Loan Repayment Program TATechnical Assistance AcronymMeaning (continued) I-21