Health Professional Shortage Area (HPSA)

Health Professional Shortage Area (HPSA)
Join the HPSA Tour Shortage Designation Program (SDP) Introduces Health Professional Shortage Area (HPSA) W E L C O M E

Topics to be Covered Introduction & Overview RSA & MSSA
Similarites between all 3 Disciplines Differences between all 3 Disciplines MUA & MUP Designations HPSA Scores Auto HPSAs Acronyms & Resources

Purpose and Training Objectives
Purpose of Designations To identify areas of greatest need so limited resources can be prioritized and directed to the people in those areas. 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 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 Health Workforce (BHW) activity or function. 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. Other Federal and State programs also use these shortage designations.

Primary Care Office’s (PCO) Role
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 the State on types of designations. Oversight Validate information contained in applications. 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. 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.

Primary Care Office’s (PCO) Staff
Liz Martin, Chief Access to Care Section Telephone: (916) Carol Petuela, Program Analyst Shortage Designation Program Telephone: (916) Hovik Khosrovian, Manager Shortage Designation Program Telephone: (916) Kyra van den Bogert, Program Analyst Proactive Shortage Designations Telephone: (916) Primary Care Office Bally Nagra, Program Analyst Proactive Shortage Designations Telephone: (916) Richard Creer, Program Analyst Mental Health Shortage Designations Telephone: (916) PCO Number Call for information on current designations, copies of guidelines, criteria, HPSA or MUA/MUP list, etc.

Authority Primary Care Office Development Criteria Guidelines
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. Primary Care Office 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.

Selected Federal Programs
Shortage Designation Option NHSC RHC J-1 Visa Waiver Medicare Incentive FQHCs & LALs/CHCs/ New Start /Expansion Primary Care (area only) X Primary Care (pop only) Dental Health (area & pop) Mental Health (area only) Mental Health (pop only) Facility MUA MUP State Governor’s Certified Eligible Area (for RHC purposes only) (Not in CA) Rational Service Area

Designation Requirements
Federal Programs State Programs HPSA required HPSA required NHSC (BHPr) NHSC/State Loan Repayment Program (OSHPD) 10% Medicare Incentive Payment (CMS) J-1 Visa Waiver Program (DHCS) HPSA, MUA or MUP required MUA or MUP required Medicare Rural Hospital Flexibility Program CHCs (BPHC) Small Rural Hospital Improvement Program New Start/Expansion (BPHC) Rural Health Services Development Program (DHCS)* FQHCs Look-Alike (BPHC) Seasonal Agricultural & Migratory Workers Program (DHCS)* MUA or MUP required Health Professions Education Foundation (HPEF) Programs ( J-1 Visa Waiver Program (HRSA) HPSA or MUA required Rural Health Clinic Certification (CMS) * These programs are no longer funded by the State of California

Types of Rational Service Areas
Types of RSAs Applies to all types HPSA and MUA/MUP designations Medical Service Study Areas (MSSAs) – recognized by HRSA’s Office of Shortage Designation (OSD) as rational services areas Whole County MSSA Types of RSAs Sub-County MSSA RSAs Cannot Overlap Have interior portions carved out Be smaller than a census tract Have more than one HPSA designation per discipline (e.g., geographic and low- income population) Exceed travel time between population centers

What is an MSSA? MSSA Definitions Rural MSSA: Urban MSSA:
Each MSSA is composed of one or more complete census tracts. MSSAs will not cross county lines. All population centers within the MSSA are within 30 minutes travel time to the largest population center. Rural MSSA: Urban MSSA: Population density of less than 250 persons per square mile Population range 75,000 to 125,000 Reflect recognized community and neighborhood boundaries No population center exceed 50,000 Frontier MSSA: Similar demographic and socio-economic characteristics Population density of less than 11 persons per square mile Adopted by the California Healthcare Workforce Policy Commission on May 29, 2013 11

Major Uses of MSSAs Types of MSSAs Major Uses of MSSAs:
Whole County MSSA U.S. Public Health Service recognizes MSSAs as “rational service areas” for purposes of determining Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas/Medically Underserved Populations (MUAs/MUPs). MSSAs are a principal component for display of large databases through OSHPD’s Geographic Information System (GIS). Sub-County MSSA MSSAs have the potential for assisting in needs assessment, health planning, and health policy development.

Rational Service Areas (HPSAs – RSAs)
Objective The characteristics of a HPSA/RSA The criteria used to determine if a service area is rational Health Professional Shortage Area Origin: National Health Service Corps (NHSC) (Measures the shortage of health professionals in an area) Components Disciplines a. Rational Service Area (RSA) b. Population to Provider Ratio c. Contiguous Area Analysis a. Primary Medical Care b. Dental Health Care c. Mental Health Care HPSAs & RSAs Type of Designations a. Geographic Area b. Population Group c. Facility

Primary Care - Humboldt County
14

Dental Health - Humboldt County
15

Mental Health - Humboldt County
16

Three Disciplines – Similarites & Differences
Primary Care Dental Health Mental Health Similarities & Differences 17

Three Disciplines – The Similarities
MFW, Tourists, Seasonal Residents & Homeless Geographic Designations & Population Designations Contiguous Area Analysis the Similarities Identify the boundaries & Determine the available resources The Nearest Source of Care Geographic Designation: Can be in a Low-Income HPSA Population Designation: Cannot be a HPSA of any type Cannot have a Disparity Can be Excessively Distant Can be Overutilized Non-Responder Calculation What FTE to include/exclude in your survey

Geographic Designations
Exclude MFW, Tourists, Seasonal Residents & Homeless Can Add Inmates or individuals in institutions (e.g. nursing homes, prisons, college dormitories, military installations, Native Americans on reservations, etc.) Migrant Farmworkers Data from the 2000 Migrant and Seasonal Farmworker Enumeration Profiles Study, or other approved source (must include methodology) Resident Civilian Population = Total permanent population in the service area (non-institutionalized population) Tourists Formula: 0.25 X [fraction of year present] X [average daily number of tourists] (Use local data, which must include methodology and length of stay.) Seasonal Residents Those who maintain a residence in the area, but inhabit it for only 2-8 month year (Use census or local data, which must include methodology.) Source: U.S. Census and 5-year American Community Survey Population Estimates. Homeless Local data (must include methodology) Source: U.S. Census and 5-year American Community Survey Population Estimates. Note: cannot add MFW, Tourists, Seasonal Residents or Homeless to Mental Health.

Population Designations
Low-Income Population MFW, Tourists, Seasonal Residents & Homeless Number of individuals in the service area that are at or below 200% of the Federal poverty level. Must be > 30% of the population in the service area. Source: year ACS Population estimates Can Add Migrant Farmworkers Data from the 2000 Migrant and Seasonal Farmworker Enumeration Profiles Study, or other approved source (must include methodology) Migrant Farmworker Population Number of individuals in the service area who are migrant farmworkers adjusted for the fraction of the year they are in the service area. Source: State/local data & 2000 Migrant & Seasonal Farmworker Enumeration Profiles Study Homeless Local data (must include methodology) : Native American/Alaskan Population Number of individuals in the service area that are Native Americans or Native Alaskans Source: census data Note: adding any of the above will increase the Pop to Provider Ratio of the proposed area. Must be of the population in the service area > 30%

California All Agricultural Workers Estimates
County Adjusted MSFW Farmworker Estimates Migrant Farmworkers Seasonal Farmworkers Non-Farmworkers In Migrant Households Non-Farmworkers In Seasonal Households MSFW Farmworkers And Non-Farmworkers Alameda 1,148 531 616 195 699 2,043 Alpine Amador 737 341 396 125 449 1,311 Butte 7,263 3,363 3,900 1,236 4,426 12,925 Calaveras 135 63 73 23 83 241 Colusa 13,932 6,450 7,481 2,371 8,490 24,792 Contra Costa 2,470 1,144 1,326 420 1,505 4,395 Del Norte 604 280 325 103 368 1,076 El Dorado 960 444 515 163 585 1,708 Fresno 145,919 67,561 78,359 24,828 88,917 259,665 Glenn 3,747 1,735 2,012 638 2,283 6,668 Humboldt 935 433 502 159 570 1,664 Imperial 29,312 13,572 15,741 4,988 17,862 52,162 Inyo 71 33 38 12 43 126 Kern 92,142 42,662 49,480 15,678 56,148 163,968 Kings 16,592 7,682 8,910 2,823 10,111 29,526 Lake 2,911 1,348 1,563 495 1,774 5,181 Lassen 544 252 292 93 331 968 Los Angeles 14,180 6,566 7,615 2,413 8,641 25,234

Migrant Farmworkers (MFW)
MFW calculation for proposed area MSSA 7.1 in Butte County 200% Poverty MFW MFW for Butte county from enumeration study 3363 200% poverty for proposed area MSSA 7.1 38376 200% poverty for entire Butte county 84764 Calculation Divide the 200% poverty for proposed area by the 200% poverty for the entire county 38376 / = 45.27% Multiply the MFW for county by percentage above 3363 * 45.27% = 1523 Divide the number of months the MFW works per year by the total months in the year (if less than 12) 11 / 12 = 91.66% Multiply the MFW by the percentage above 1523 * 91.66% = 1396 Add 1396 MFW to 100% civilian population

Contiguous Area Analysis
Objective & Purpose: Participants will understand how to identify the contiguous areas, determine if they have resources, and if the resources are inaccessible to the population of the area proposed for designation. The Steps (determine the available resources): Is the contiguous area a HPSA? The next slide will explain more about what HPSAs to rule out. Are there significant socio-economic/demographic disparities or physical barriers. If the contiguous area cannot be ruled-out by one of these methods, the proposed area cannot be designated. Determine if the resources in the contiguous area exceed the population-to-provider ratio and therefore are overutilized . Determine if the contiguous area’s providers are located > 30/40 minutes away from the population center of the proposed area and therefore are excessively distant.

Is the Contiguous Area a HPSA?
Check the HPSA status of each contiguous area to determine if this type of HPSA is inaccessible to the proposed area Contiguous Areas If the proposed service area is: Geographic without high needs Then the contiguous area is inaccessible if it is a Geographic HPSA Geographic with high needs Then the contiguous area is inaccessible if it is a Geographic HPSA (this is a significant change) Low-Income HPSA Then the contiguous area is inaccessible if it is a Geographic HPSA or Low-Income HPSA

Calculating Disparities for Percentages > 15%
Significant demographic disparities between the population in the service area and the population in the contiguous area result in the population being isolated from nearby resources Use (2 * N) to determine a disparity between the population in the service area and the population in the contiguous area MSSA 35b/Clovis West/Fresno East in Fresno County Proposed Area: Civilian Pop White Black Native American Asian Pacific Islander Hispanic 100% 200% Compare each contiguous area to the proposed area in the same category If the highest number is greater Than 2* the lowest number, then a disparity exist 93336 60.21 53.74 1.20 12.43 0.57 32.21 15.94 32.42 Contiguous Area Desig Pop MSSA 35d/Fresno E 65008 39.78 26.14 1.43 16.98 0.07 58.69 34.11 65.00 The lowest # = * 2 = 52.28 Is the higher # 53.74 greater than 52.28 if yes = Disparity Exist MSSA 35e/Fresno S 52848 45.22 10.49 1.05 11.64 0.13 60.31 31.14 The lowest # = * 2 = 31.88 Is the higher # 31.14 greater than 31.88 If no = Disparity does not Exist MSSA 35a/Fresno NW 29861 27.91 4.31 0.45 11.54 0.03 22.47 5.99 18.89 The lowest # = * 2 = 55.82 Is the higher # 60.21 greater than If yes = Disparity Exist Black 100% White Note: Using the lower number between proposed area and contiguous area for calculating disparity is suggested.

Calculating Disparities for Percentages < 15%
Significant demographic disparities between the population in the service area and the population in the contiguous area result in the population being isolated from nearby resources Plus 15 to determine a disparity between the population in the service area and the population in the contiguous area MSSA 35b/Clovis West/Fresno East in Fresno County Proposed Area: Civilian Pop White Black Native American Asian Pacific Islander Hispanic 100% 200% Compare each contiguous area to the proposed area in the same category If the highest number is greater Than the lowest number plus 15, then a disparity exist 93336 60.21 53.74 1.20 12.43 0.57 32.21 12.94 32.42 Contiguous Area Desig Pop MSSA 35d/Fresno E 65008 39.78 14.85 1.43 16.98 0.07 58.69 34.11 65.00 The lowest # = = 29.85 Is the higher # 53.74 greater than 29.85 if yes = Disparity Exist MSSA 35e/Fresno S 52848 45.22 10.49 1.05 11.64 0.13 60.31 21.14 The lowest # = = 27.94 Is the higher # 21.14 greater than 27.94 If no = Disparity does not Exist MSSA 35a/Fresno NW 29861 6.71 4.31 0.45 11.54 0.03 22.47 5.99 18.89 The lowest # = = 21.71 Is the higher # 60.21 greater than If yes = Disparity Exist Black 100% White Note: Using the lower number between proposed area and contiguous area for calculating disparity is suggested.

Are Providers Excessively Distant?
Primary Care Road Type Miles Min Interstate Roads 25 x 1.2 = 30 Primary Roads 20 x 1.5 = Secondary Roads 15 x 2.0 = Determine the closest provider Providers are excessively distant if they are > 30 minutes from the population center. Determine the closest provider in each contiguous area. Map their office locations Map the office location for the provider in the contiguous area to the population center in the proposed area. Dental / Mental Health Road Type Miles Min Interstate Roads 30 x 1.33 = 40 Primary Roads 25 x 1.60 = Secondary Roads 20 x 2.00 = Providers are excessively distant if they are > 40 minutes from the population center. Use the same starting point The Contiguous area will be measured from the same starting point (which is the population center of the proposed area). Providers > 30/40 minutes, depending on discipline, from the population center are excessively distant

Excessively Distant (cont)
Public Transportation Distance is based on time using public transportation during non-rush hour (either 10am or 2pm). Contiguous Area Bus routes and schedules must be described (provide narrative description and include bus schedule if possible). If the MSSA doesn’t meet this requirement the next step is to show that there is a 30% or greater public transportation ridership in the MSSA (provide documentation to back up the claim). Public Transportation can be used only in Inner City/Metro areas for Geographic designations, where the 100% poverty rate is ≥ 20%, or for Population designations regardless of the 100% poverty rate.

Is the Contiguous Area Overutilized?
Calculate FTE using same method as used for the proposed service area. If needed, survey providers and determine FTE serving the population. Use same surveying method as used for the proposed service area. If applying for low-income designation, gather Medi-Cal and Sliding Fee Scale percentages to calculate low-income FTE. Explain how the information was obtained and calculated, and include population, total FTE, and population to provider ratio. Calculate the population to provider ratio counting each provider as 1.0 FTE. If area meets ratio of Primary Care > 2,000:1 Dental Health > 3,000:1 Mental Health > 20,000:1 psychiatrists or 3,000:1 CMHP including psychiatrists and > 10,000:1 psychiatrists. do not survey (Applies to Geographic only) Low-Income will need to be surveyed to obtain the Medi-cal & Sliding Fee Scale percentages.

Nearest Source of Non-Designated Care
Geographic Designation: Can be in a Low-Income HPSA Provide a road map with the proposed service area and contiguous areas outlined. On the map, indicate the population center of the proposed service area, the nearest source of care, and the route between these points. Provide the name and address of the nearest source of care, route, miles, and minutes. Population Designation: Cannot be a HPSA of any type Cannot have significant socio-economic/demographic differences or physical barriers Can be excessively distant Can be overutilized For inner portions of Metropolitan Areas, include: Bus route information from the population center of the proposed area to the nearest source of care. Provide miles & minutes of travel time.

Non-Responder Calculation
Survey all physicians in service area. Must attempt to contact the provider at least three (3) times. Minimum two-thirds response rate required. Average response rate applied to non-responders. The Calculation: Responders Non-Responders Response Rate Responder FTE Avg Responder FTE Non-Responder FTE 15 5 15/20=.75 9.5 .63 12.7 Response rate (Responders/Total Responders = Response Rate [15/20 = 75%]) Divide FTE of responders from the survey (9.5) by the number of responders (15) for the average FTE of responders (.63) Multiply number of non-responders (5) by the average FTE of responders (5 x .63 = 3.16=3.2) Add FTE of responders (9.5) and non-responders (3.2) for total FTE = 12.7

What FTE to include/exclude in survey
Include in survey but reduce FTE to zero Physicians who serve under a J-1 or H-1B waiver. All providers who provide direct patient care in the service area, including those who: Providers engaged solely in administration, research or teaching Locum tenens serving less than 1 year on contract. Serve in State Scholarship or Loan Repayment Programs Providers who are planning on retiring within six months, but are still seeing patients Serve at Indian Health Clinics and are not Federal providers Hospital staff physicians involved exclusively in inpatient or emergency room care. Count FTE Do not count FTE Providers who serve in the NHSC Scholarship or Federal Loan Repayment Programs Plan on retiring, from 6 months to 1 year, but are still seeing patients Providers who are Federal providers (e.g., Commissioned Officers at Indian Health Services or Bureau of Prisons) Physicians who are suspended under provisions of the Medicaid-Medicare Anti-Fraud and Abuse Act for a period of 18 months or more and Mid-levels.

What are the Differences
Health Professional Shortage Area (HPSA) Primary Care What are the Differences unique to Primary Care (M.D. & D.O.)

Population to Provider Ratios
Determine the population to provider ratios for geographic and population designations Geographic Area > 3,500:1 A rational service area: county or sub-county (MSSA) Geographic Area w/Unusually High Needs > 3,000:1 A rational service area plus one of the following: More than 20% of the population has incomes at or below 100% of the Federal poverty level; or More than 100 births per year per 1,000 women ages 15-44; or More than 20 infant deaths per 1,000 live births1; or Meets insufficient capacity criteria Population Groups > 3,000:1 A rational service area plus meets the requirements of the specific designation category (e.g. low-income, homeless, etc.) Contiguous Areas are Overutilized if > 2,000:1

Geographic Designation FTE
Physician Name SP Location of Practice/CT Census Track Hrs of Direct Patient Care/Wk Hosp Hours FTE L. McCoy, D.O. GP 19 Main Street City, CA 90001 531 48 Incld 1.0 (48/40=1.2=1.0) D. Scully, MD 1 Ped 11 Park Place City, CA 90001 540 30 0.8 (30/40=.75=.8) B Spock, M.D. 2 IM 6 Muldar Ave City, CA 90002 538 15 0.4 (15/40=.375=.4) M. Welby, M.D.3 OBG 3306 Russia Blvd City, CA 90002 543 25 Not Incld .625 (25/40=.625=.6) Y. Zhivago, D.O. 4 FP 99 Bones Drive City, CA 90003 539 --- 0.0 (0/40=.0) Primary Care Survey 1 – Dr. Scully spends 10 hours a week doing research. 2 – Dr. Spock chooses to work only 15 hours/week. 3 – Dr. Welby – chooses to work to work 25 hours. 4 – Dr. Zhivago spends full-time in administration. Total Physicians: 5 Total FTE: = 3.0

Low-Income Designation FTE Hours of Direct Pt. Care/Wk
Physician Name Hours of Direct Pt. Care/Wk Hosp. Hours FTE % Medi -Cal SFS % of Low-Income Total Low- Income L. McCoy, D.O. 48 Incld 48/40 =1.2=1.0 64% 15% 79% (64%+15%=79%) 0.79 (.79 x 1.0 = .79 ) D. Scully, MD 1 30 30/40 = 0.75 35% 8% 43% (35%+8%=43%) 0.32 (.43 x .75 = .322) B Spock, M.D. 2 15 15/40=0.375 60% 40% 100% (60%+40%=100%) .375 (1 x .375 = .375) M. Welby, M.D. 3 25 Not Incld 25/40=.625 13% 0% 0.08 (.13 x .625=.08) Y. Zhivago, D.O. 4 0.0 0.00 1 – Dr. Scully spends 10 hours a week doing research 2 – Dr. Spock chooses to work only 15 hours a week 3 – Dr. Welby chooses to work 25 hours a week. 4 – Dr. Zhivago spends full-time in administration Total Physicians: Total Low-Inc FTE: = 1.6

F T E FTE Calculation Primary Care
For each provider, include the number of hours of direct patient care provided, office and hospital inpatient, in the service area: The FTE for low-income 40 hours = 1.0 FTE Primary Care population designations is F 40+ hours = 1.0 FTE based on the average Every 4 hours (1/2 day) = 0.1 FTE T number of hours Interns & residents = 0.1 FTE per week Only the total FTE is rounded to the nearest tenth of a percent E spent Rounding Examples: 0.875 = = 0.8 0.83 = = 0.9 with Medicaid and Sliding Fee Scale (SFS) patients

Health Professional Shortage Area (HPSA) Dental Health What are the Differences unique to Dental Health (D.D.S & D.M.D.)

Geographic Area > 5,000:1 A rational service area: county or sub-county (MSSA) Geographic Area w/High Needs > 4,000:1 A rational service area plus: More than 20% of the population has incomes at or below 100% of the Federal poverty level; or More than 50% of the population has no fluoridated water; or Meets insufficient capacity criteria Population Groups > 4,000:1 A rational service area plus meets the requirements of the specific designation category (e.g. low-income, homeless, etc.) Contiguous Areas are overutilized if > 3,000:1

Geographic Dental Survey Hours of Direct Pt. Care/Wk
Dentist Name Age Location of Practice # of Aux Hours of Direct Pt. Care/Wk FTE Based on Hours Total FTE M. Incisor, D.D.S. 29 789 Crown St. Tooth Fairy, CA 99864 1 =1 45 1.0 (45/40= 1.1=1) (1.0 x 1=1.0) R. Wisdom, D.D.S.1 78 Tooth Fairy, CA 99864 =.7 15 .375 (15/40= .375) 0.26 (.375 x .7= .26) A. Canine, D.D.S.2 40 33 Halitosis Rd. Smile City, CA 99918 3 =1.4 37 .925 (37/40= .925) 1.29 (.925 x 1.4=1.29) B. Crown, D.D.S.3 39 103 Molar Lane Chompers, CA 99918 2 =1.2 25 .625 (25/40=.625) 0.75 (.625 x 1.2= .75) C. Buck, D.D.S.4 32 66 Cavity Place Mouthtown, CA 99918 (25/40= .625) (.625 x 1.2 =.75) Dental Health 1 – Dr. Wisdom works 25 hours/week in another location 2 – Dr. Canine spends 3 hours/week in administrative activities 3 – Dr. Crown chooses to work 25 hours/week 4 – Dr. Buck spends 15 hours/week in childcare activities Total FTEs: 4.05 = 4.1

Low-Income Dental Survey Hours of Direct Pt. Care/Week
Dentist Name Hours of Direct Pt. Care/Week FTE Based on Hours Total FTE % Medi-Cal* % SFS % of Low- Income Total Low-Income FTE M. Incisor, D.D.S. 45 (45/40= 1.1=1) 1.0 (1x1= 1) 10% 2% 12% (10%+02%=12%) 0.12 (.12 x 1 = .12) R. Wisdom, D.D.S. 15 (15/40=.375) .375 0.262 (.375x.0.7= .262) 0.0% 0% 0.0 (0 x .262 = 0) A. Canine, D.D.S. 37 (37/40= .925) .925 1.29 (.925x1.4=1.29) 50% 60% (50%+10%=60%) 0.774 (.6 x 1.29 = .774) B. Crown, D.D.S. 25 (25/40=.625) .625 0.75 (.625x1.2= .75) 20% 40% (20%+20%=40%) 0.3 (.4 x .75 = .3) C. Buck, D.D.S. (25/40= .625) (.625x1.2 =.75) 15% 75% (60%+15%=75%) 0.5625 (.75 x .75 = .5625) 1 – Dr. Wisdom works 25 hours a week in another location 2 – Dr. Canine spends 3 hours a week in administrative activities 3 – Dr. Crown chooses to work 25 hours a week 4 – Dr. Buck spends 15 hours a week in childcare activities Total FTEs: = 1.8

Auxiliaries & Age Dental Health
Auxiliaries are non-dentists assisting in dental care, such as, dental assistants, hygienists, etc. Auxiliaries < 55 55 – 59 60 – 64 65+ 0.8 0.7 0.6 0.5 1 1.0 0.9 2 1.2 3 1.4 >4 1.5 1.3 Dental Health If an auxiliary is less than full-time, round to the nearest whole number (0.4 = = 1) If more than one auxiliary works less than full time, add total hours, divide by 40, and round if not a whole number ([16+20] + [32/40]) = 1.7 = 2 If # of auxiliaries is not available: Use weight: <55 = 1.2, = 0.9, = 0.8 and > 65= 0.6 If dentist’s age and the number of auxiliaries are not available: Use weight of 1.2

Travel Time and Max FTE Travel Time Calculating the Maximum FTE
Miles Minutes Interstate Roads 30 x 1.33 = 40 Primary Roads 25 x 1.60 = Secondary Roads 20 x 2.00 = To determine the maximum allowable FTE divide the Civilian Population by the Ratio. Geographic Designation: Civilian Population = 70,000 Population to Provider Ratio: 5000:1 Maximum FTE (70,000/5000) = 14.0 Geographic Designation (High Needs) : Civilian Population = 80,000 Population to Provider Ratio: 4000:1 Maximum FTE (80,000/4000) = 20.0 Contiguous Area: Civilian Population = 75,000 Population to Provider Ratio: 3000:1 Maximum FTE (75,000/3000) = 25.0 Providers > 40 minutes from the population center are excessively distant

Health Professional Shortage Area (HPSA) Mental Health What are the Differences Unique to Mental Health (Psychiatrists & CMHP)

Geographic Area > 30,000:1 A rational service area: can combine 1 or more MSSAs, or whole county > 30,000:1 psychiatrists, or > 9,000:1 CMHP including psychiatrists, or > 6,000:1 CMHP including psychiatrists and > 20,000 psychiatrists Determine the population to provider ratios for geographic and population designations Geographic Area w/High Needs > 20,000:1 A rational service area plus one of the following: 20% or more population is < 100% of the poverty level, or The youth ratio (# of persons < 18 to the # of adults ages ) is greater than 0.6, or The elderly ratio (# of persons > 65 to the # of adults ages ) is greater than 0.25, or Alcohol or substance abuse prevalence data showing the area to be in the worst quartile of the region > 20,000:1 psychiatrists, or > 6,000:1 CMHP including psychiatrists, or > 4,500:1 CMHP including psychiatrists and > 15,000:1 psychiatrists

Low-Income Population > 20,000:1 Number of individuals in the service area that are at or below 200% of the Federal poverty level Mental Health Must be >30% of the population in the service area > 20,000:1 psychiatrists, or > 6,000:1 CMHP including psychiatrists, or > 4,500:1 CMHP including psychiatrists and > 15,000:1 psychiatrists Contiguous Areas are Overutilized if: 20,000:1 psychiatrists, or > 3,000:1 CMHP including psychiatrists and > 10,000:1 psychiatrists

Mental Health Designations
Psychiatrists Only, or Core Mental Health Providers (CMHP), including: Psychiatrists Clinical Psychologists Clinical Social Workers Psychiatric Nurse Specialists Marriage and Family Therapists Note: must include all of the disciplines for this type of designation Exclusions from Survey Mental health providers engaged solely in administration, research or teaching Mental health hospital staff physicians involved exclusively in inpatient or emergency room care Mental health providers who are suspended under provisions of the Medicaid-Medicare Anti-Fraud and Abuse Act for a period of 18 months or more Mental health providers with full-time staff positions in correctional institutions, youth detention facilities, residential treatment centers for children with emotional or developmental disabilities, and inpatient units of State or County mental hospitals.

Include in Survey but Exclude FTE:
Travel Times & Survey Travel Times Include in Survey but Exclude FTE: Road Type Miles Minutes Interstate Roads 30 x 1.33 = 40 Primary Roads 25 x 1.6 = Secondary Roads 20 x 2.0 = Mental health providers who serve in the NHSC Scholarship or Loan Repayment Programs (FTEs will include State Loan Repayment Program recipients) Physicians who are graduates of foreign medical school who are not citizens or lawful permanent residents (including those with J-1or H-1B visas) Mental health providers who are Federal providers All providers who meet these qualifications should be listed, even if their FTE will be zero. Mental health providers who are planning on retiring, after 6 months, but are still seeing patients

Geographic Mental Health Survey
Provider Name Specialty Location of Practice Hrs of Direct Pt. Care/Wk1 FTE Based on Hours Total FTE S. Freud, M.D. Psychiatry 5 Oedipal Lane City, CA 90001 20 0.5 (20/40=.5) C. Jung, M.D.1 11 Dream Drive 40 (40/40=1.0 1.0/.5=.5) H. Lecter, Ph.D. Clinical Psychology 6 Can Street City, CA 90021 26 .65 (26/40=.65) 0.65 M. Houlihan, R.N. Psychiatric Nursing 1400 Captain Ave City, CA 90003 55 1.375 (55/40=1.375=1.0) 1.0 R. Weisheimer, M.F.T. Marriage Fam Counseling 69 Shex Street City, CA 90009 10 .25 (10/40=.25) 0.25 L. Schlessinger, M.S.W. Clinical Social Work 1 Radio Road City, CA 90006 6 0.15 (6/40=.15) Total Psychiatrists: Total Psychiatrist FTE = 1.0 Total Core Mental Health Providers: 6 Total Core Mental Health FTE: 3.05= 3.1 1 - Dr. Jung is in his last year of residency and is therefore counted as 0.5

Low-Income Mental Health Survey
Provider Name Specialty Location of Practice Hours of Direct Patient Care/Wk FTE Based on Hours % Medi-Cal SFS % of L-I Total L-I FTE S. Freud, MD Psychiatry 5 Oedipal Lane City, CA 90001 20 0.5 0% 0.0 C. Jung, M.D. 11 Dream Drive 40 30% 15% 45% .225 (.5 x .45 = .225) H. Lecter,Ph.D. Clinical Psychology 6 Can Street City, CA 90021 26 .65 85% .55 (.65 x .85 = .5525) M. Houlihan, R.N. Psychiatric Nursing 1400 Captain Avenue City, CA 90003 55 1.0 50% 10% 60% .6 (1.0 x .6 = .6) R. Weisheimer,M.S. Marriage/Fam. Counseling 69 Shex Street City, CA 90009 10 .25 25% 5% 0.075 (.25 x .3 = .075) L. Schlessinger, M.S.W. Clinical Social Work 1 Radio Road City, CA 90006 6 0.15 .015 (.15 x .1 = .015) Total Psychiatrists: 2 Total L-I Psychiatrist FTE: = .2 Total Core Mental Health Providers: 6 Total L-I Core Mental Health FTE: =1.5

Alcohol and Drug Use Los Angeles County
The table for Key Indicators of Community Alcohol and Drug Use can be used to determine if the MSSA is located in a county that is in the lowest quartile in the state. There are 7 key indicators. The county must have 4 out of 7 indicators to qualify for a Geographic HPSA with high needs. The web site is located at: Key Indicators of Community Alcohol and Drug Use This is unique to Mental HPSAs. Located to the right of each indicator, under the last (or only) year the data was compiled is the “State Rank” for that indicator (third number down). (Note: Do not use the Three Year Average.) Los Angeles County The “# of Counties” participating in gathering the data is located directly underneath the Indicator Number, third line down. Indicator State Rank # of Counties Result Qualifies 1 34 44 34 / 44 = 77% 77% > 75% = Yes 2 30 49 30 / 49 = 61% 61% < 75% = No 3 25 58 25 / 58 = 43% 43% < 75% = No 4 57 57 / 58 = 98% 98% > 75% = Yes 5 48 48 / 58 = 83% 83% > 75% = Yes 6 15 50 15/58 = 2% 2% < 75% = No 7 45 45/58 = 78% 78% > 75% = Yes Does the county have 4 out of 7 indicators Yes Formula: State Rank / # of Counties = State Rank % If the State Rank % is > 75% = Qualifies

MUA & MUP Designations Objective MUA & MUP Criteria
Measures the degree of underservice of an area (MUA) or a population (MUP) Participants will understand: The difference between MUAs & MUPs Determine the Rational Service Area (RSA) (use MSSA) Determine the Criteria & Weighted Values of The information required for a complete submission Percent of Population at 100% Poverty Percent of Population > 65 Infant Mortality Rate (IMR) How each factor is weighted and scored to determine a final Index of Medical Underservice (IMU) Score Primary Care Physicians per 1,000 Population MUP Only – Primary Care Physicians serving the low-income population at 200% poverty level per 1,000 low-income population Compute the Index of Medical Underservice Score: MUA = Medically Underserved Area Value must be < 62.0 MUP = Medically Underserved Pop

Percent Population at 100% Poverty
Determine the % of the population in the area at the 100% poverty level Percent Below Poverty Weighted Value 25.1 14.9 2.1 24.6 13.6 1.3 23.7 12.2 1.0 22.8 10.9 0.7 21.9 9.3 0.4 21.0 7.8 0.1 20.0 6.6 50 + 18.7 5.6 17.4 4.7 16.2 3.4 Calculate 100% Poverty: Number at 100% Federal Poverty Level Civilian Population Divided By Determine the weighed value Note: The weighted value is the same for MUAs & MUPs See table Use latest available data (2012 ACS Population Estimates)

Percentage of Population > 65
Determine the percentage of the % in the area > 65 years old % of Pop > 65 Weighted Value 0 –7.0 20.2 16.1 4.0 20.1 14.4 2.8 19.9 12.8 1.7 19.8 11.1 0.6 19.6 9.8 30 + 19.4 8.9 19.1 8.0 18.9 7.0 18.7 6.1 17.8 5.1 Calculate percent for >65 years old: Number > 65 yrs old Civilian Population Divided By Determine the weighed value Note: The weighted value is the same for MUAs & MUPs See table Use the latest available data (2012 ACS Population Estimates)

Infant Mortality Rate (IMR) Use the IMR for the county
Use the OSD available data (5-year avg) or Infant Mortality Rate Weighted Value 0-8 26.0 17.5 6.1 2.0 25.6 16.4 5.4 1.4 24.8 15.3 5.0 0.8 24.0 14.2 4.7 0.2 23.2 13.1 4.3 45.1+ 22.4 11.9 4.0 21.5 10.8 3.6 20.5 9.6 3.3 19.5 8.5 3.0 18.5 7.3 2.6 OSD-approved State Department of Health data Calculation for >65 years old # of Infant Death # of Live Births X 1,000 Divided By Determine the weighed value Use the IMR for the county Note: The weighted value is the same for MUAs & MUPs See table Department of Public Health’s Center for Health Statistics website:

Providers per 1,000 Population
Determine the FTE Calculation MUA – All primary care physicians are counted MUA Total FTE Civilian Population x 1,000 MUP – All primary care physicians servicing the population group are counted MUP Total FTE Pop to be designated x 1,000 Must collect inpatient and outpatient hours of the outpatient Doctors (not hospitalists) Determine the Weighted Value (see table) Determine the Population MUA = civilian population All physicians must be counted (including J-1 Visa physicians, NHSC physicians, etc.) MUP = number in that population group (e.g., low-income pop = pop at or below the 200% poverty) For MUA designations, the HPSA adjustment factor for the FTE is not used.

Geographic Designation - FTEs
Provider Name Specialty Location of Practice Hours of Direct Pt. Care/Wk FTE Based on Hours A. Liver, MD1 General Practice 86 N. Onion Street City, State, Zip 48 (48/40=1.2=1.0) 1.0 B. Spleen MD2 Pediatrics 103 Sanfgroid Dr City, State, Zip 30 (30/40=.75) 0.75 C. Heart, MD Internal Medicine 777 Stopper Ave City, State, Zip 40 D. Kidney, DO OB-GYN 3306 Stone Drive City, State, Zip E. Lung, DO3 Family Practice 99 Airborne Blvd City, State, Zip 25 (25/40=.625) 0.625 Total Physicians = 5 Total FTE = = 4.4 1 Dr. Liver is an NHSC loan repayment recipient , counted as 1.0 FTE 2 Dr. Spleen spends 10 hours/week doing research 3 Dr. Lung spends 15 hours/ week in administration

Low-Income Population Designation - FTEs
Provider Name Specialty Location of Practice Hours of Direct Pt. Care/Wk FTE Based on Hours % Medi-Cal Sliding Fee % of Low Income Total Low Income FTE A. Liver, MD GP 86 N. Onion St City, State, Zip 48 1.0 64% 15% 79% 0.79 B. Spleen MD PED 103 Sanfgroid Dr City, State, Zip 30 0.75 35% 8% 43% 0.3225 C. Heart, MD IM 777 Stopper Ave City, State, Zip 40 60% 40% 100% D. Kidney, DO OB/ GYN 3306 Stone Drive City, State, Zip 13% 0% 0.13 E. Lung, DO FP 99 Airborne Blvd City, State, Zip 25 0.625 7% Total Physicians: 5 Total Low-Income FTE: = 2.3

Providers per 1,000 Population
Left Column Prov per 1,000 pop Weighted Value 0-.05 10.7 24.3 0.5 12.6 25.3 1.5 14.8 25.9 2.8 16.9 26.6 4.1 19.1 27.2 5.7 20.7 27.7 7.3 21.9 28.0 9.0 23.1 28.3 28.6 Over 1.250 28.7 find the range which includes the ratio of primary care physicians per 1,000 population for the area being examined. See table Note: The weighted value is the same for MUAs & MUPs

Index of Medical Underserved Score
The IMU Score IMU < 62.0 The IMU Score is determined by adding the values of each of the four factors Qualifies for designation as an MUA/MUP IMU > 62.0 Percent of Population at 100% Poverty Does not qualify for designation as an MUA/MUP + Time Saving Tips Percent of Population > 65 Before surveying providers, check the IMU score of the first 3 variables + If V1 + V2 + V3 are > 62.0, the area will not designate as an MUA or MUP Infant Mortality Rate (IMU) If the IMU > 62, then review rational service area to determine if other boundaries would be appropriate + Primary Care Physicians per 1,000 Population If not an MUA, check if area would designate as an MUP

MUA/MUP Designation Worksheet

MUA/MUP Designation Map
MUA/MUP Map The orange area is a designated MUA, and part of the designation is in MSSA 66a and part is in MSSA 63. Because of this the whole designation can be thrown out.

HPSA Scores Disciplines
HPSA scores are critical for U.S. HRSA administered programs, such as: J1-Visa Waiver National Health Service Corps (NHSC) Scholar Placements and Loan Repayment Ready Responders These programs rely on HPSA scores to prioritize resource allocation and level of assistance. Disciplines Primary Medical Care HPSA (4 factors = 25 points) Dental Care HPSA (4 factors = 26 points) Mental Health HPSA ( 7 factors = 26 points) Note: There is nothing in writing from the Feds on Mental Health

Primary Care HPSA Scores
For Primary Care there are Factors for a total of 25 Points Factor 1 Factor 2 Population to Provider Ratio 100% Poverty Rate Factor 1 – Population to Provider Ratio Score (x2) >10,000:1 and the de-designation threshold is >0 or there is no physicians and a population >2,500 5 <10,000:1 but >5,000:1 and the de-designation threshold is >0 or there is no physicians and a population >2,000 4 <5,000:1 but >4,000:1 and the de-designation threshold is >0 or there is no physicians and a population >1,500 3 <4,000:1 but >3,500:1 and the de-designation threshold is >0 or there is no physicians and a population >1,000 2 <3,500:1 but >3,000:1 and the de-designation threshold is >0 or there is no physicians and a population >500 1 Factor 2 – 100% Poverty Rate Score >50% 5 <50% but >40% 4 <40% but >30% 3 <30% but >20% 2 <20% but >15% 1

Primary Care HPSA Scores (cont)
Factor 3 Factor 4 Infant Health Index (choose largest) Average Travel Time or Distance to Nearest Source of Non-Designated Accessible Care (choose largest) Infant Mortality Rate Low Birth Weight Rate Score >20.0 or >13% 5 <20 but >18 or <13 but >11% 4 <18 but >15 or <11 but >10% 3 <15 but >12 or <10 but >9% 2 <12 but >10 or <9 but >7% 1 Time Distance Score >60 minutes >50 miles 5 <60 but >50 minutes <50 but >40 miles 4 <50 but >40 minutes <40 but >30 miles 3 <40 but >30 minutes <30 but >20 miles 2 <30 but >20 minutes <20 but >10 miles 1

Dental Health HPSA Scores
For Dental Health there are Factors for a total of 26 Points Factor 1 Population to Dentist Ratio Factor 2 100% Poverty Rate Factor 1 – Population to Provider Ratio Score (x2) >10,000:1 and a de-designation threshold of >0 or there is no dentists and a population >3,000 5 <10,000:1 but >8,000:1 and a de-designation threshold of >0 or there is no dentists and a population >2,500 4 <8,000:1 but >6,000:1 and a de-designation threshold of >0 or there is no dentists and a population >2,000 3 <6,000:1 but >5,000:1 and a de-designation threshold of >0 or there is no dentists and a population >1,500 2 <5,000:1 but >4,000:1 and a de-designation threshold of >0 or there is no dentists and a population >1,000 1 Factor 2 – 100% Poverty Rate Score (x2) >50% 5 <50% but > 40% 4 <40 but >30% 3 <30% but >20% 2 <20% but >15% 1

Dental Health HPSA Scores (cont)
Factor 3 Factor 4 Fluoridated Water Average Travel Time or Distance to Nearest Source of Non-Designated Accessible Care (choose largest) Water Not Fluoridated = Score of 1 point Time Distance Score >90 minutes >60 miles 5 <90 but >75 minutes <60 but >50 miles 4 <75 but >60 minutes <50 but >40 miles 3 <60 but >45 minutes <40 but >30 miles 2 <45 but >30 minutes <30 but >20 miles 1

Mental Health HPSA Scores
For Mental Health there are Factors for a total of 26 Points Factor 1 Population to Mental Provider Ratio Factor 2 Factor 1 – Population to Mental Provider Ratio Score Psychiatrists Ratio Core Mental Health Ratio > 45,000:0 AND > 4,500:0 8 > 4500:1 and < 6000:1 7 < 20,000:1 and > 15,000:1 AND > 6000:1 and < 9,000:1 6 < 30,000:1 and > 15,000:1 OR > 4,500:1 and LT 6,000:1 5 < 45,000:1 and > 20,000:1 AND > 4,500:0 and LT 6,000:0 4 > 20,000:1 AND > 6,000:1 3 > 30,000:1 2 > 9,000:1 1 100% Poverty Rate Factor 2 – 100% Poverty Rate Score P(%) GE 50% 5 50% > P(%) GE 40% 4 40% > P(%) GE 30% 3 30% > P(%) GE 20% 2 20% > P(%) GE 15% 1 P(%) < 15%

Mental Health HPSA Scores (cont)
Factor 3 Factor 5 Score >25% 3 <25 and >15 2 <15 and >10 1 Avg Travel Time or Distance to the Nearest Source of Non-Designated Accessible Care (choose largest) Elderly Ratio: Ratio of Adults over 65 to Adults 18-64 Time Score Time GE 60 minutes 5 < 60 min and >50 minutes 4 <50 minutes and > 40 minutes 3 <40 minutes and >30 minutes 2 <30 minutes and >20 minutes 1 Factor 6 Substance Abuse prevalence: Area’s rate is in worst quartile for nation, region, or state Score Yes 1 No Factor 4 Factor 7 Youth Ratio: Ratio of Children under 18 to Adults 18-64 Time Score >60% 3 <60 and >40 2 <40 and >20 1 Score Yes 1 No Alcohol Abuse prevalence: Area’s rate is in worst quartile for nation, region, or state

IF THE SITE IS NOT ONE OF THESE, IT DOES NOT QUALIFY FOR AUTO HPSA!
Automatic HPSA Statute Legislation in 2002 created a new class of HPSAs, not based on data but based on status as a certain type of facility. Federally Qualified Health Centers (FQHCs) that weren’t located in HPSAs still wanted access to NHSC Clinicians. Who is Covered Federally Qualified Health Centers (FQHC)/Community Health Centers FQHC Look-A-Likes Rural Health Clinics (RHCs) who submit the required application Indian Health Service (IHS) and IHS Contract/Compact Sites –Tribal and Urban Indian Sites IF THE SITE IS NOT ONE OF THESE, IT DOES NOT QUALIFY FOR AUTO HPSA!

Automatic HPSA Scores Important Note No data, no score
Developed as a way to estimate using the national data. Results were often no score or very low scores. Option to increase scores with alternative data available-posted on the website. Changes in the loan repayment program with graduated payments and tiered funding has led to increased requests for score changes. We caution people that a high score is no guarantee given the small number of clinicians available, so don’t waste too much energy! Important Note The HPSA applies to all sites that are a part of the FQHC or Look-A-Like. They have the same UDS#, but a different ALPHA code at the end; now they have the BCHMIS#. They are only listed under the “MOTHER SITE” name and location, which may be in a different county from a satellite site. This information is listed on HPSAFIND website. Recently, HRSA’s Office of Information Technology (OIT) created a tool that allows you to identify FQHCs and their Satellite sites. See URL listed on “Resource” slide. Rural Health Clinics have to apply for each individual site.

Automatic HPSA Data Used to Compute Scores Partial Scores
The current scoring methodology for primary care includes four factors: Population-to-Primary Care Physician Ratio; Percent of the Population with incomes below 100% of the Poverty Level; Infant Mortality Rate or Low Birth Weight (whichever score is higher); and Travel Time or Distance to the nearest available source of care (whichever score is higher). Partial Scores There is a transformation scale that allows computation of partial scores for the four factors. The sum of these partial scores form the total HPSA score, except that the partial score for Population-to-Primary Care Physician Ratio is double weighted because HPSA designations are primarily intended to measure the shortage of primary care providers within the HPSA. For Dental HPSAs, the poverty factor is also doubled.

Automatic HPSA Population to Primary Care Physician Ratio
For the FQHC grantees, FQHC Look-a-Likes and RHCs, these ratios were calculated for the following: Defined Primary Care Service Area (PCSA) which included the location of the facility; As an approximation to the service area of the facility; and Resident civilian population data from the census were used, and primary care physician data were taken from the combined AMA/AOA files used by the Office of Shortage Designation. For the IHS Service Units and the Alaska Native facilities, Native American or Alaska Native population: Figures from the IHS or the Alaska Native Health System were used; and Physician data represent the non-federal providers in the area as reported by the IHS or the Alaska Native Health System.

Automatic HPSA Percent of the population with incomes below 100% of the poverty level For FQHC grantees: Initially 2002 Uniform Data System (UDS)-reported data on percent of users with incomes below 100% of poverty were used; more recent UDS data used subsequently For FQHC Look-a-likes and Rural Health Clinics (RHCs): The 2000 census poverty data for the county of location were used. We now have UDS Data for FQHC Look-a-Likes. For the IHS and Alaska Native areas: The census poverty data for Native American populations within those areas were used or data supplied by the IHS

Automatic HPSA Infant Mortality Rate or Low Birth Weight (IMR/LBW)
For FQHC grantees, FQHC Look-a-Likes and RHCs: IMR/LBW rates for the PCSAs including the FQHC or RHC were used. For IHS and Alaska Native scoring: Service unit data for the appropriate populations were used. Travel Time or Distance to the Nearest Available Source of Care For FQHC grantees, FQHC Look-a-Likes, and RHCs: Travel time and distance were calculated from the population-weighted center of the PCSA in which the entity was located to the population-weighted center of the nearest PCSA with a population-to-primary care physician ratio of at least 2000:1, using average road speeds and travel time for each road segment involved. For IHS and Alaska Natives: Data reported by the IHS or the Alaska Native Health System were used.

Acronyms Acronym and Meaning ALOS Average Length of Stay CHMPC
California Healthcare Workforce Policy Commission AMA American Medical Association CDPH California Department of Public Health ASAPS Application Submission and Processing System CMHP Core Mental Health Providers/Professionals BHCDANET Bureau of Health Care Delivery and Assistance (NET) CMS Center for Medicaid/Medicare Services (formerly HCFA) BHW Bureau of Health Workforce CPCA California Primary Care Association BPHC Bureau of Primary Health Care CT Census Tract BOP Bureau of Prisons DHHS Department of Health and Human Services CA Cooperative Agreement DHCS Department of Health Care Services CCD County Census Division DT Dental CFR Code of Federal Register FQHC Federally Qualified Health Center CHC Community Health Center FTE Full-Time Equivalent

Acronyms (cont) Acronym and Meaning PCA Primary Care Association GIS
Geographic Information System MSSA Medical Service Study Areas HMO Health Maintenance Organization MUA Medically Underserved Areas HPSA Health Professional Shortage Areas MUP Medically Underserved Populations HRSA Health Resources and Services Administration NHSC National Health Service Corps IHP Indian Health Program PC Primary Care IHS Indian Health Services PCA Primary Care Association IMR Infant Mortality Rate PCO Primary Care Office IMU Index of Medical Underservice RHC Rural Health Clinic MCD Minor Civil Division RSA Rational Service Area MFW Migrant Farmworker SFS Sliding Fee Scale MSFW Migrant Seasonal Farmworker SLRP State Loan Repayment Program MH Mental Health TA Technical Assistance

Other Resources SLRP http://oshpd.ca.gov/HWDD/SLRP.html OSHPD
NHSC Address Lookup CalHealth Twitter J1-Visa Waiver Program HPSA Find HRSA Data Warehouse Shortage Designation Program Geographic Information Systems (GIS) MSFW Enumeration Profiles Estimates

Health Professional Shortage Area (HPSA)
Join the HPSA Tour Shortage Designation Program (SDP) Concludes Health Professional Shortage Area (HPSA) Hope to see you again

Health Professional Shortage Area (HPSA)

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