I. Introduction & Overview

I-1

To identify areas of greatest need so limited resources can be prioritized and directed to the people in those areas.

Purpose of Designations

I-2

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

I-3

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 Clinician Recruitment Services (BCRS) activity or function. The shortage designations are:

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.

I-4

Shortage Designation BranchMISSION

The federal Shortage Designation Branch (SDB) is responsible for developing and implementing criteria and procedures for designating areas and populations having a shortage of primary health care services.

ACTIVITIES Criteria Development for Designations

Review and process requests for designation of HPSAs and MUA/MUPs, including the annual review of HPSAs

Maintain and disseminate the database of existing HPSAs and MUA/MUPs

I-5

Shortage Designation Branch (continued)

Maintain and disseminate quarterly statistics on the number of HPSAs, the number of people residing in HPSAs, and the number of practitioners needed to remove the designation

Manage and serve as Project Officers for State Primary Care Office Cooperative Agreements

Provide information about designations for review to each State's Primary Care Office and to other interested parties

Publish an annual list of designated HPSAs in the Federal Register

I-6

SDB - Regional Assignments

I-7

States Included are:

Region IX – Arizona, California, Hawaii, Nevada, American Samoa, CNMI/FSM/Guam, Republic of Palau, Republic of Marshall Islands

Melvin Whitfield

Public Health Analyst

Phone: (301) 594-4454

E-mail: mwhitfield@hrsa.gov

I-8

Primary Care Office’s (PCO) Role In Designation Process

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 State on types of designations

Oversight

Validate information contained in applications

Review and comment on applications submitted by entities within State

I-9

PCO Role In Designation Process (continued)

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

Database Development

Coordinate with other State offices to obtain State databases for

designation purposes, e.g. licensure lists, state populationestimates, physician database, and Geographic Information

System (GIS) database development

I-10

Designation Interest Group (DIG)

DIG is a working group open to interested participants from State PCOs and the SDB. A conference call is held once a month to discuss any designation issues related to the current method.

DIG is a learning forum for participants to discuss issues, questions, and concerns related to the current designation process. It assists SDB in the development of policies and procedures to implement the designation criteria as fairly and efficiently as possible. It is also an opportunity to share ideas on how to access data, prepare cases, and address SDB review concerns.

I-11

HRSA Websitehttp://www.hrsa.gov/shortage/

Select Health Professional Shortage Areas to view guidelines, criteria, HPSA database, MUA/MUP list, and Automatic HPSA Facility scores.

PCO Number916-326-3700

Call for information on current designations, copies of guidelines, criteria, HPSA or MUA/MUP list, etc.

Additional Information

I-12

OSHPD Websitehttp://www.oshpd.ca.gov/HWDD/CalPCO.html

SDB 2014 HPSA Annual Review Schedule

I-13

2013-2014

January 2014 The renewal cycle is open for all 2011 HPSA renewals.

February 2014 State PCOs e-mails original applicants requesting updates of HPSAs designated or last updated in 2011 with copies to county officials and State PCA.

July 2014 PCO sends reminder notices to applicants of deadline forsubmitting 2011 HPSA updates.

September 2013 2011 HPSA updates due to PCO.

December 2013 2011 HPSA updates due to SDB on December 31, 2014

January 2014 2011 HPSAs for which no update was received will be proposed for withdrawal.

July 2014 Publish new list of designated HPSAs in the Federal Register

Legislation

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

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

I-14

Authority

Designation Requirements for Selected Federal Programs

I-15

Shortage Designation Option

National Health Service Corps

FQHCs/CHCs/

FQHC Look-Alikes/

New Start/Expansion

Medicare Incentive Payment

Rural Health Clinic

Program

J-1 Visa Waiver

Primary Care HPSA (Area only) X X X X

Primary Care HPSA (Population only) X X X

Dental Care HPSA (Area & Population) X

Mental Health HPSA (Area only) X X X

Mental Health HPSA (Population only)

X X

Facility HPSA X X

Medically Underserved Area X X X

Medically Underserved Population

X X

State Governor’s Certified Eligible Area (for RHC purposes only)

X

(Not in CA)

Designation Requirements for State Programs

HPSA Required:

• NHSC/State Loan Repayment Program (OSHPD)

HPSA, MUA, or MUP Required:• J-1 Visa Waiver Program (DHCS)

• Medicare Rural Hospital Flexibility Program

• Small Rural Hospital Improvement Program

• Rural Health Services Development Program (DHCS)*

• Seasonal Agricultural & Migratory Workers Program (DHCS)*

*These programs are not funded by the State for Fiscal Year 13-14

I-16

Designation Requirements for State Programs (continued)

HPSA, MUA or MUP Required:Health Professions Education Foundation (HPEF) Programs (www.oshpd.ca.gov/hpef)

Allied Healthcare Scholarship Program

Associate Degree Nursing Scholarship Program

Bachelor of Science Nursing Scholarship & Loan Repayment Programs

Health Professions Education Scholarship & Loan Repayment Programs for Dentistry, Dental Hygienist, Nurse Practitioner, Certified Nurse Midwife, and Physician Assistant

Licensed Mental Health Service Provider Education Program

Steven M. Thompson Physician Corps Loan Repayment Program

Vocational Nursing Scholarship & Loan Repayment Programs

I-17

Initial Contact

Applicant contacts SDP for technical assistance (TA) and information. SDP provides: TA on appropriate designation Maps Population and demographic data Survey samples Application worksheets

1st Step – Application Received Log application on tracking database Assign case number E-mail acknowledgment letter

2nd Step – 30-day Comment Notice to: County Health Officer/ Department/Medical Society Primary Care, Dental, or Mental Health Association HRSA/SDB copied Case assigned to SDP staff

3rd Step – Application Analysis (complete within 90 days, depending on caseload)

Primary Care & Dental HPSAs and MUAs/MUPs (ASAPS Process) Validate application information before entering data into ASAPS (use on-line tools: maps, data tables, MSSA data) Verify provider data Calculate population to provider ratio Conduct contiguous area analysis in mapping interface (does not apply to MUAs/MUPs) If application is “incomplete”, request

additional data and allow applicant 15 days for resubmission. Verify and enter all additional data needed Prepare notification letter to applicant Prepare ASAPS packet for Manager’s review and approvalUpon completion, Manager submits recommendation via ASAPS E-mail ASAPS packet to applicant and others Update tracking database

4th Step - HRSA Review Hold all recommendations for 30-day waiting period Perform primary and secondary reviews Upon approval or denial, post designation on HRSA on-line database Send designation letter to SDP and applicant

NOTE:

HPSA designations are valid for 3 years. To maintain the HPSA status, designees must reapply every 3 years. MUA/MUP designations are permanent, unless there is a change in the MSSA boundary then designees must reapply for the updated boundary.

5th Step – SDP Tracking Update Update SDP tracking database File designation letter in program file Create monthly dynamic maps

HPSA and MUA/MUP Application ProcessShortage Designation Program (SDP)

III-18

Acronym Meaning

ALOS Average Length of StayAMA American Medical AssociationASAPS Application Submission and Processing SystemBCRS Bureau of Clinician Recruitment ServicesBHCDANET Bureau of Health Care Delivery and Assistance (NET)BPHC Bureau of Primary Health CareBOP Bureau of PrisonsCA Cooperative AgreementCCD County Census DivisionCFR Code of Federal RegisterCHC Community Health CenterCHMPC California Healthcare Workforce Policy CommissionCDPH California Department of Public HealthCMHP Core Mental Health Providers/ProfessionalsCMS Center for Medicaid/Medicare Services (formerly HCFA)CPCA California Primary Care AssociationCT Census TractDHHS Department of Health and Human Services

I-19

Acronym Meaning (continued)

DHCS Department of Health Care ServicesDT DentalFQHC Federally Qualified Health CenterFTE Full-Time EquivalentGIS Geographic Information SystemHMO Health Maintenance OrganizationHPSA Health Professional Shortage AreasHRSA Health Resources and Services AdministrationIHP Indian Health ProgramIHS Indian Health ServicesIMR Infant Mortality RateIMU Index of Medical UnderserviceMCD Minor Civil DivisionMFW Migrant FarmworkerMSFW Migrant Seasonal FarmworkerMH Mental HealthMSSA Medical Service Study AreasMUA Medically Underserved AreasMUP Medically Underserved Populations

I-20

NCHWA National Center for Health Workforce AnalysisNHSC National Health Service CorpsNSC Nearest Source of CareOMB Office of Management and BudgetSDB Shortage Designation BranchOSHPD Office of Statewide Health Planning and DevelopmentOWEQA Office of Workforce Evaluation and Quality AssurancePC Primary CarePCA Primary Care AssociationPCO Primary Care OfficePHS Public Health ServicesRHC Rural Health ClinicRSA Rational Service AreaSFS Sliding Fee ScaleSLRP State Loan Repayment ProgramTA Technical Assistance

Acronym Meaning (continued)

I-21