1. Shortage Designation Modernization Project: Auto-HPSAs
Janelle D. McCutchen DHEd, MPH, CHES
Chief, Shortage Designation Branch
Division of Policy and Shortage Designation
Bureau of Health Workforce

2. Shortage Designations* Help Target Resources**
Shortage Designation Option
National Health Service Corps (NHSC)
NURSE Corps
Health Center Program
IHS Loan Repayment Program
CMS HPSA Bonus Payment Program
CMS Rural Health Clinic Program
J-1 Visa Waiver
Primary Care
Geographic HPSA X
Population HPSA
Facility HPSA
Dental Care
Mental Health
Medically Underserved Area (MUA)
Medically Underserved Population (MUP)
Exceptional MUP
State Governor's Certified Shortage Area
*42 USC §254e(d)(1): “The Secretary shall determine health professional shortage areas in the States, publish a descriptive list of the areas, population groups, medical facilities, and other public facilities so designated, and at least annually review and, as necessary, revise such designations.”
**List of programs is not exhaustive.

3. Current Auto-HPSA Scores
Current Participants and Those Awarded in 2019
No changes to Auto-HPSAs have occurred
May be used for 2019 National Health Service Corps (NHSC) and Nurse Corps (NC) application cycles
Will not be impacted by national update of HPSA scores
May complete their service obligations-even if scores change.
If eligible for a continuation-may be awarded as long as participants are working in a HPSA

4. National Health Service Corps: Substance Use Disorder (SUD) Investments
$225 million may be used to strengthen the substance use disorder workforce, of that some will be dedicated to:
Rural Communities Opioid Response
$45 million in loan repayment awards to rural communities with high opioid mortality rates
American Indian/Alaska Native
$15 million for SUD or traditional NHSC LRP awards to IHS, Tribal, and Urban Indian health care delivery sites

5. Automatically Designated Facility HPSAs
Using the statute and regulations, HRSA has deemed the following facility types as eligible for automatic HPSA designation:
Health Centers (funded under Sec. 330)
Health Center Look-Alikes
Tribally-Run Clinics
Urban Indian Organizations
Dual-Funded Tribal Health Centers
Federally-Run Indian Health Service Clinics
CMS-Certified Rural Health Clinics meeting NHSC site requirements

6. Automatic Facility (Auto-HPSAs)
Auto-HPSAs compared to other HPSAs
Similar but not the same
Other HPSAs
Automatic Facility (Auto-HPSAs)
Designation & scoring done online
Criteria used to first designate as HPSA
Criteria used to determine HPSA score
Scores range from 0-25 (26 for dental)
Designations are required to be reviewed and updated as necessary annually
Score of “0” is rare
Designation & scoring currently done manually
No application process necessary
Same criteria used to determine HPSA score as other HPSAs
Same scoring range used
HRSA has not historically required Auto-HPSA scores to be reviewed regularly; updates are requested by facility
Score of “0” more frequent and means low shortage or no data was available for scoring

7. Shortage Designation Modernization Project Core Principles
PARITY
TRANSPARENCY
ACCOUNTABILITY
The Shortage Designation Modernization Project utilizes the existing HPSA scoring criteria. No changes to the criteria have been made.

8. HPSA Scoring Criteria Primary Care Mental Health Dental Health
HPSA scores are based on a variety of criteria and range from 0 to 25 in the case of Primary Care and Mental Health, and 0 to 26 in the case of Dental Health.
Primary Care
0-25
Infant Health Index Point Value (Based on IMR or LBW Rate)
Travel Time to Nearest Source of Care Point Values
% of Population at 100% Federal Poverty Level Point Value
Population-to-Provider Ratio Point Value
Double Weighted
HPSA Score (out of 25)
Mental Health
0-25
Youth Ratio Point Value
Elderly Ratio Point Value
Substance Abuse Prevalence Point Value
Alcohol Abuse Prevalence Point Value
Travel Time to Nearest Source of Care Point Values
% of Population at 100% Federal Poverty Level Point Value
Population-to-Provider Ratio Point Value
HPSA Score (out of 25)
Dental Health
0-26
Water Fluoridation Status Point Value
Travel Time to Nearest Source of Care Point Values
% of Population at 100% Federal Poverty Level Point Value Double Weighted
Population-to-Provider Ratio Point Value
Double Weighted
HPSA Score (out of 26)

9. National Update of Auto-HPSAs
Tentatively planned for this Spring/Summer (no sooner than April, no later than August)
Series of Auto-HPSA preview reports in advance
Raise awareness of Auto-HPSAs
Provide scoring transparency
Enable HRSA to provide technical assistance
Submit supplemental data to change Auto-HPSA scores
facility-specific data
fluoridation status, alcohol misuse rate and substance misuse rate data
Work with State Primary Care Offices (PCOs) to ensure provider data are correct

10. Auto-HPSA Working Group: Data Proposals
Thank you to the Auto-HPSA Working Group:
Nathan Baugh (National Association of Rural Health Clinics)
Jennifer Harrison (Eastern Aleutian Tribes)
Debra Jahnke (Minnesota Department of Health)
Aleksandr Kladnitsky (Wisconsin Primary Health Care Association)
Maine Primary Care Association
Jyl Marden (California Consortium for Urban Indian Health)
Colleen Meiman (National Association of Community Health Centers)
Alan Morgan (National Rural Health Association)
Greg Nycz (Family Health Center of Marshfield)
Shelly Phillips (Association for Utah Community Health)
Thomas Rauner (Nebraska Division of Public Health)
Data Availability
Reporting Processes
CHCs
ITUs
RHCs
The Shortage Designation Modernization Project utilizes the existing HPSA scoring criteria. No changes to the criteria have been made.

11. *Scoring will be at the organizational level.
Population: Provider Ratio
Primary
Care
Dental
Health
Mental Health
HPSA Scoring Criteria
Max Pts Awarded
Multiplier
Total Points Possible 5
x 2
= 10 7
Community Health Centers*
Service area
Defined by zip codes in which 75% of a Auto-HPSA facility’s patients reside to create a Zip Code Tabulation Area (ZCTA)-based service area. (Source: 2017 UDS)
DEFINITION
Population defined as low income population at or below 200% FPL in the service area. (Source: Census)
Providers defined as the count of eligible FTEs that serve Medicaid patients AND/OR provide services on a sliding fee scale in the service area. (Source: SDMS)
Rural Health Clinics**
Service area
Defined by census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: SDMS)
DEFINITION
Population defined as low income population at or below 200% FPL in the service area. (Source: Census)
Providers defined as the count of eligible FTEs that serve Medicaid patients AND/OR provide services on a sliding fee scale in the service area. (Source: SDMS)
I/T/Us**
Service area
Defined by census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: SDMS)
DEFINITION
Population defined as total population of American Indian and Alaska Native alone or in combination with one or more races (when available) in the service area. (Source: Census)
Providers defined as the count of eligible FTEs that serve the American Indian and Alaska Native populations within the service area. (Source: SDMS)
*Scoring will be at the organizational level.
**Following the National Update, RHCs and ITUs may provide facility-level data to be rescored.

12. Dual-Eligible Organizations
Being scored as FQHCs with their UDS data.
In part, why the supplemental data for ITUs is critical.

13. Determining the Default Service Area
Site is geocoded
30 or 40 min travel polygon is drawn around the site
Census tracts (CT) that overlap the travel polygon are identified and saved as the service area
All usable providers located in the CT service area are identified
NOTE: A provider used in the population to provider ratio can be more than 30 or 40 minutes away from the site.
*Default Service Area is used for ITUs, RHCs and FQHCs/LALs that have not reported UDS data.

14. Ratio of Population to Providers Which Providers Count?
Primary Care
Mental Health
Dental Health
Includes Doctors of Medicine (MD) and Doctors of Osteopathy (DO) who provide services in the following specialties:
Family Practice
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Includes:
Psychiatrists, and may include other Core Mental Health (CMH) providers, such as:
Clinical Psychologists
Clinical Social Workers
Psychiatric Nurse Specialists
Marriage & Family Therapists
Includes:
Dentists, and takes into account
Dental Auxiliaries
Dental auxiliaries are defined as any non-dentist staff employed by the dentist to assist in the operation of the practice.
Note: Providers solely engaged in administration, research or training are excluded.

15. Providers Used for Population to Provider Ratios
Service Area Approach
Includes all eligible providers in your organization’s service area
Not just your organization
If service area crosses state lines, providers may be from another state
A provider can be more than 30 or 40 minutes away from the site.
State Primary Care Office (PCO) is responsible for the provider data

16. If there are no providers in the population to provider spreadsheet how is the subscore being calculated?
Primary Care
Dental Health
Score for Pop: FTE Ratio
Points
Ratio > 10,000:1
or no PCP and a population over 2,500
5 points
10,000:1 > Ratio ≥ 5,000:1
or no PCP and a population ≥ 2,000 and < 2,500
4 points
5,000:1 > Ratio ≥ 4,000:1
or no PCP and a population ≥ 1,500 and < 2,000
3 points
4,000:1 > Ratio ≥ 3,500:1
or no PCP and a population ≥ 1,000 and < 1,500
2 points
3,500:1 > Ratio ≥ 3,000:1
or no PCP and a population ≥ 500 and < 1,000
1 point
Score for Pop: FTE Ratio
Points
Ratio ≥ 10,000 : 1
or no dentists and population ≥ 3,000
5 points
Ratio < 10,000:1 but ≥ 8,000:1
or no dentists and population ≥ 2,500 and <3,000
4 points
Ratio < 8,000:1 but ≥ 6,000:1
or no dentists and population ≥ 2,000 and <2,500
3 points
Ratio < 6,000:1 but ≥ 5,000:1
or no dentists and population ≥ 1,500 and <2,000
2 points
Ratio < 5,000:1 but ≥ 4,000:1
or no dentists and population ≥ 1,000 and <1,500
1 point

17. If there are no providers in the population to provider spreadsheet how is the subscore being calculated? (continued)
Mental Health

18. % of Population Below FPL
Primary
Care
Dental
Health
Mental Health
HPSA Scoring Criteria
Max Pts Awarded
Multiplier
Total Points Possible
% of Population below FPL 5
x 1
= 5
x 2
= 10
Community Health Centers
Service area
Not used
DEFINITION
The percent of population of patients served with known income at or below 100% FPL (Source: 2017 UDS)
Rural Health Clinics*
Service area
Defined by census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: SDMS)
DEFINITION
Out of the population in the service area, the count of individuals at or below 100% FPL divided by the total population for whom poverty is determined. (Source: Census)
I/T/Us*
Service area
Defined by census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: SDMS)
DEFINITION
Out of the population in the service area, the count of individuals at or below 100% FPL divided by the total population for whom poverty is determined. (Source: Census)
*Following the National Update, RHCs and ITUs may provide facility-level data to be rescored.

19. How is the 100% Federal Poverty Level scored?
Score for % Population with Income at or Below 100% FPL
P ≥ 50%
5 points
50% > P ≥ 40%
4 points
40% > P ≥ 30%
3 points
30% > P ≥ 20%
2 points
20% > P ≥ 15%
1 point
P < 15%
0 points

20. Travel Distance/Time to Nearest Source of Care (NSC)
Primary
Care
Dental
Health
Mental Health
HPSA Scoring Criteria
Max Pts Awarded
Multiplier
Total Points Possible
Travel distance/time to nearest source of care (NSC) 5
x 1
= 5
Community Health Centers
DEFINITION
The nearest provider that serves Medicaid patients AND provides services on a sliding fee scale who is not in an over utilized* area. (Source: SDMS)
Rural Health Clinics
DEFINITION
The nearest provider that serves Medicaid patients AND provides services on a sliding fee scale who is not in an over utilized* area. (Source: SDMS)
I/T/Us
DEFINITION
The nearest provider that serves American Indian/Alaska Native populations who is not in an over utilized* area. (Source: SDMS)
*To determine overutilization: a minute travel polygon will be drawn around each provider based on private
transportation to create an area from which the population and provider data will be pulled. (Source: SDMS)
A provider will be considered over-utilized if the population to provider ratio is greater than:
Primary Care: 2,000:1
Dental Health: 3,000:1
Mental Health
Providers will be considered over-utilized if the population-to-provider ratio for psychiatrists ≥ 10,000:1 and the population-to-provider ratio for Core Mental Health providers is ≥ 3,000:1;
If there is no data on Core Mental Health providers other than psychiatrists or the Core Mental Health other than psychiatrists FTE = 0, providers will be
considered over utilized if the population-to-provider ratio for psychiatrists is ≥ 20,000:1.x
Note: Following the national update, State Primary Care Offices will be able to change NSCs

21. Infant Mortality Rate or Low Birth Rate
Primary
Care
Dental
Health
Mental Health
HPSA Scoring Criteria
Max Pts Awarded
Multiplier
Total Points Possible
Low Birth Weight 5
x 1
= 5
Community Health Centers
DEFINITION
IMR: Out of the total population, the count of infant deaths divided by the total number of infant births for the county/counties in which the Auto-HPSA ‘s service area intersects. Scaled by 1,000. (Source: CDC)
LBW: Out of the total population, the count of low birth weight births divided by the total number of infant births for the county/counties in which the Auto-HPSA’s service area intersects. Scaled by 100. (Source: CDC)
Rural Health Clinics
DEFINITION
IMR: Out of the total population, the count of infant deaths divided by the total number of infant births for the county/counties in which the Auto-HPSA ‘s service area intersects. Scaled by 1,000. (Source: CDC)
LBW: Out of the total population, the count of low birth weight births divided by the total number of infant births for the county/counties in which the Auto-HPSA’s service area intersects. Scaled by 100. (Source: CDC)
I/T/Us
DEFINITION
IMR: Out of the total population, the count of infant deaths divided by the total number of infant births for the county/counties in which the Auto-HPSA ‘s service area intersects. Scaled by 1,000. (Source: CDC)
LBW: Out of the total population, the count of low birth weight births divided by the total number of infant births for the county/counties in which the Auto-HPSA’s service area intersects. Scaled by 100. (Source: CDC)

22. Community Health Centers Rural Health Clinics I/T/Us
Water Fluoridation
Primary
Care
Dental
Health
Mental Health
HPSA Scoring Criteria
Max Pts Awarded
Multiplier
Total Points Possible 1
x 1
= 1
Community Health Centers
DEFINITION
Score default to “0”.
Rural Health Clinics
DEFINITION
Score default to “0”.
I/T/Us
DEFINITION
Score default to “0”.
Following the National Update tentatively scheduled for spring/summer 2019, all Auto-HPSA facilities may provide supplemental information for a point to be awarded, where warranted.
To receive a score of 1, must provide data showing that less than 50% of the population has access to fluoridated water

23. Community Health Centers Rural Health Clinics* I/T/Us*
Ratio of Children &
Ratio of Adults
Primary
Care
Dental
Health
Mental Health
HPSA Scoring Criteria
Max Pts Awarded
Multiplier
Total Points Possible
Ratio of children under 18 to adults 18-64 3
Ratio of adults 65 and older to adults 18-64
Community Health Centers
DEFINITION
Out of the total unduplicated patient population, the count of individuals younger than 18, or 65 and older, divided by the count of adults age (Source: 2017 UDS)
Rural Health Clinics*
DEFINITION
The count of individuals younger than 18, or 65 and older, divided by the count of adults age (Source: Census)
I/T/Us*
DEFINITION
The count of individuals younger than 18, or 65 and older, divided by the count of adults age (Source: Census)
*Following the National Update, RHCs and ITUs may provide facility-level data.

24. Substance Misuse & Alcohol Misuse Rates
Primary
Care
Dental
Health
Mental Health
HPSA Scoring Criteria
Max Pts Awarded
Multiplier
Total Points Possible
Substance misuse rate 1
Alcohol misuse rate
Community Health Centers
DEFINITION
Score default to “0”.
Rural Health Clinics
DEFINITION
Score default to “0”.
I/T/Us
DEFINITION
Score default to “0”.
Following the National Update tentatively scheduled for spring/summer 2019, all Auto-HPSA facilities may provide supplemental information for a point to be awarded, where warranted.
To receive a score of 1, must provide data showing that the alcohol misuse rate is in the worst quartile for the nation, region or state
To receive a score of 1, must provide data showing that the substance misuse rate is in the worst quartile for the nation, region or state

25. Supplemental Data: Following the National Update*
ITUs/RHCs
FQHCs and FQHC LALs
State Primary Care Offices
Zip codes in which 75% of the Auto-HPSA facility’s patients reside
The percent of population of patients served with known income at or below 100% FPL
Out of the total unduplicated patient population, the count of individuals younger than 18, or 65 and older, divided by the count of adults age 18-64
Water Fluoridation
Alcohol Misuse Rate
Substance Misuse Rate
Water Fluoridation
Alcohol Misuse Rate
Substance Misuse Rate
Nearest Source of Care
Water Fluoridation
Alcohol Misuse Rate
Substance Misuse Rate
Facility-specific Data
Reporting period: calendar year
January 1, 2017-December 31, 2017
January 1, 2018-December 31, 2018 (Preferable)
The fluoridation, alcohol misuse and substance misuse data do not need to mirror the HRSA-created service area.
However, the information submitted should reflect the service area (i.e., be based on the organization’s address and sites) and represent a minimum 12 month reporting period.
*Data will be submitted via online portal. Data will be accepted on a continual basis.

26. What Organizations Can Do Now
Focus on supplemental data
Assist PCOs with provider data
Make sure contact information is correct in EHBs or BHW Portal/BMISS system

27. To Whom to Direct Questions
Project itself (purpose, timeline, etc.):
Data shown on Update Preview Report: State PCO
Provider data: State PCO
Update preview scores: State PCO
Supplemental data: State PCO
Score or rescore* before the national update:
State Primary Care Offices:
Project Website:
*Tentative last day SDB will receive requests: April 1, 2019.

28. Shortage Designation Modernization Project Summary
No changes to HPSA scores have occurred at this time.
Current participants will not be impacted.
National update is tentatively planned for spring/summer 2019.
There are things that organizations can do to change their scores.
Before the update takes place:
Collect facility-specific
Collect supplemental data
Work with State Primary Care Offices on the provider data
Following the national update
Submit facility-specific and supplemental data
Note: 2018 UDS data will be added to the system so FQHCs and FQHCs LAL may request rescores, but the date on which the data will be available in our system has not yet been determined.
Contact with questions.

29. To learn more about our agency, visit
Connect with HRSA
To learn more about our agency, visit
Sign up for the HRSA eNews
FOLLOW US: