1. Service Areas That Are Rational for the Delivery of Care Current Framework

2. Terms Rational Service Area (RSA) – A description and rationale for the boundaries of the proposed designation Contiguous Area (CA) – A description of like service areas adjacent to the RSA, which are distinct from the RSA based on one or more characteristics

3. Boundaries The boundaries must be “rational” in that they describe a distinctive area or population, which meets or exceeds shortage designation criteria Census tracts are the basic unit

4. Acceptable Constructions whole county

5. Acceptable Constructions multiple counties (states)

6. Acceptable Constructions sub-county

7. Acceptable Constructions parts of adjacent counties

8. Construction All census tract components must be contiguous with one another No interior portions may be carved out Cannot overlap with another service area Ideally should match the service area of other designation types, though not a requirement

9. Rational Rationale Strongest, when multiple reasons can be cited population with similar – demographic – health status – socioeconomic characteristics is distinctive from contiguous areas by the same criteria used to describe the population

10. Rational Rationale isolated from health resources because of – poverty – racial or ethnic composition – language significant physical barriers to travel to contiguous areas such as – bodies of water – mountain ranges – large military bases – national parks – large industrial areas – rail yards

11. Rational Rationale It is a strongly cohesive, homogenous, and interdependent neighborhood like those formed by a shared language, culture, and/or national origin.

13. Contiguous Area Analysis The purpose is to distinguish the RSA population from the surrounding populations and describe why the population of the RSA is unable to reasonably acquire care in adjacent service areas

14. Contiguous Area Analysis CA may be ruled out as a source of care if – excessively distant – over utilized – otherwise inaccessible to the population of the service area

16. Units of Geography Census Tracts Zip Codes

17. Discussion