1. HPSAs MUAs What are they? How can they benefit my practice/my health center? Patrick J. Durkin, M.A. Primary Care Office Manager Indiana State Department of Health 2 N. Meridian St. 8B, Indianapolis, IN 46204 317-233-7846, 317-233-7761 fax pdurkin@isdh.state.in.us

2. Shortage Designations HPSA Health Professional Shortage Area MUA/P Medically Underserved Area/Population What are they: A way to identify areas of greatest health needs so limited resources can be prioritized and given to those most in need of primary health services

3. When you think HPSA Think Health Professions: Primary Care HPSA Dental HPSA Mental Health HPSA Subtypes under all of these Geographic HPSA Population HPSA Facility HPSA

4. When you think MUA Think Federally Qualified Health Centers (FQHC). At least 37 federal programs use MUA/Ps and HPSA designations. Other types of health institutions and professions benefit from HPSA/MUAs but the general focus is primary care rather than specialties.

5. Legislation Original legislation enacted by Congress in 1970s, Sections 330 MUA/MUP and 332 (HPSA) of Public Health Service Act as amended. Most recently, Health Care Safety Net Amendments authorized automatic facility HPSA designation process for Federally Qualified Health Centers and a simple HPSA application process for Rural Health Clinics.

6. How a HPSA/MUA is Designated The US Department of Health & Human Services (HHS) contracts with a State Health Department to analyze a local area to determine whether there is a shortage of primary care physicians, dentists or mental health professional. The rules for this are very specific in law and regulation. If it appears the area meets the requirements, the information is submitted for final determination to HHS. The federal section doing designations is taking from 3 to 6 months or more to make a determination. The rules are being more strictly interpreted than they were a few years ago.

7. Primary Benefits If you are in a HPSA: You can apply for National Health Service Corps (NHSC) loan repayment or a NHSC scholar. You can apply for State Loan Repayment Program – a health professional loan repayment program. You can apply to be Rural Health Clinic. You can seek a J1 Visa Physician.

8. More Benefits If you are in a Geographic HPSA : There are 10% Medicare Incentive Benefits. Psychiatrists can receive the same incentive benefits beginning July 1, 2004 in a Mental Health Geographic HPSA that is not in a Primary Care HPSA.

9. Primary Benefits If you are in a MUA/P : You can apply to be Federally Qualified Health Center. (FQHC) or a FQHC look alike. who are both Automatic HPSAs. You can apply to be Rural Health Clinic (RHC) who can obtain a Automatic HPSA. You can seek a J1 Visa Physician.

10. Designation Needed for Selected Federal Programs Shortage Designations Options National Health Service Corps State Loan Repayment Program Federally Qualified Health Center Programs CMS Medicare Incentive Payment CMS Rural Health Clinic Program J-1Visa Waiver Primary Care HPSA XXX Geographic HPSA only XX Dental Care HPSAXX Mental Health HPSA XX 7/1/04 Geographic only, ask CMS X HPSA Subtypes Geographic HPSAXXXXX Population HPSAXXXX Facility HPSAXXX Medically Underserved Area (MUA) XXX Medically Underserved Population (MUP) XX Governor’s Exceptional MUP XX

11. Primary Care HPSA

12. Dental HPSA

13. Mental Health HPSA

14. Many of the MUA are from the 1990ties. So they use the 1990 census tracts. MUA