1. 1 Shortage Designation Update State Office of Rural Health Orientation Meeting Rockville, Maryland September 10, 2014

2. 2 Objectives Become familiar Shortage Designation Branch Gain an understanding of Shortage Designation Types Gain an understanding of Shortage Partners and Stakeholders Shortage Designation Management System 2.0

3. 3 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

4. 4 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: 1.primary medical care 2.dental 3.mental health For each discipline category, there are three types of HPSAs 1.geographic area 2.population group 3.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

5. 5 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

6. 6 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)

7. 7 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.

8. 8 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

9. 9 MUAs/Ps Health Services Shortages MUAs may be a whole county or 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 Governor’s Exceptional MUP/Designation

10. 10 MUAs/Ps Health Services Shortages MUAs may be a whole county, group of contiguous counties, civil divisions or 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

11. 11 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

12. 12 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 Retain its historic focus to support states and territories in: 1.their statewide primary care needs assessments 2.shortage designation coordination 3.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

13. 13 HPSA Find Website

14. 14 HPSA Find Website

15. 15 Shortage Designation Option National Health Service Corps Federally Qualified Health Center Program CMS Medicare Incentive Payment CMS Rural Health Clinic Program J-1 Visa Waiver Primary Care HPSAX XXX Dental Care HPSAX Mental Health HPSAX X X Geographic HPSAX XXX Population HPSAX XX Facility HPSAX X Exceptional MUP X X Medically Underserved Area X XX Medically Underserved Population X X State Governor's Certified Shortage Area X How Shortage Designations are used

16. 16 History of Shortage Designation 1970 - 197519901998 2001 2008 -The National Health Service Corps (NHSC) enacted - Health Professional Shortage Area (HPSA) methodology developed The National Health Service Corps Revitalization Act to Prioritized on HPSAs ASAPS Built on Manual Business Process & HPSA Methodology Defined in 1970s Shortage Designation 2.0 HRSA Proposed New Rules for Designation, No Modifications to Methodology Implemented Paper Processing 2014 ASAPS & Paper Processing

17. 17 New Shortage Designation Transformation Shortage Designation 2.0 bridges people, process, and data. Shortage Designation 2.0 Annual Updates Automated Recalculations of Scores via Standard Data Use of Predefined Rational Service Areas Standard Data Sets Auditable & Traceable Projections Based on Standard Data Impact Analysis & Trending Defined Roles & Responsibilities New Business Process & Functions Single, Automated System for all Processing & Scoring

18. 18 Shortage Designation 2.0: Phased Implementation Shortage Designation 2.0 will have releases in 2014 and 2015; leading to a decision for recalculation of scores. September 2014 Release ASAPS archival / decommission in August, data migrated as-is and no changes to scores Designations will not be submitted from September to December Current process for auto-HPSA manual request and processing will continue to May 2015 PCOs provide additional data attributes for provider data to National Provider Identifier (NPI) file starting in September December 2014 Release HPSA & MUA/P designations can be submitted and processed; interface to data warehouse restarts PCOs / stakeholders can use automated data submission for non-standard data Ability for PCOs and SDB analysts to communicate via system (inquiries) Current process for auto-HPSA manual request and processing will continue to May 2015 Initial impact analysis of scoring recalculation begins PCSA integrated in the system as a support tool Facility, including Auto HPSA, designations can be requested and processed Continued impact analysis of score recalculations PCOs continue to complete provider data to NPI file May 2015 Release

19. 19 Division of Policy and Shortage Designation Dr. Kae Brickerd, Branch Chief kbrickerd@hrsa.gov CAPT Phil Budashewitz, Director pbudashewitz@hrsa.gov pbudashewitz@hrsa.gov

20. 20 Q&A