1. Shortage Designations Terri Lang, Project Coordinator UND Center for Rural Health October 12, 2011

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. 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.

4. When you think… HPSA Think three health professions –Primary Care –Dental –Mental Health Think three sub-types –Geographic –Population –Facility

5. Primary Care HPSAs

6. Mental Health HPSAs

7. Dental Care HPSAs

8. When you think… MUA Think Federally Qualified Health Centers (FQHC) or Community Health Centers and FQHC look-a-likes

9. Medically Underserved Areas/Populations

10. Who uses the designations ***Approximately 40 federal programs use MUA/P and HPSA designations as eligibility requirements

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

12. 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 to be Rural Health Clinic You can seek a J1 Visa Physician If you are in a Geographic HPSA There are 10% Medicare Incentive Benefits o Psychiatrists can receive same incentive benefits beginning 7-1-2004 in a Mental Health Geographic HPSA

13. 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.

14. How a HPSA/MUA is Designated DHHS contracts with State Health Department to analyze local areas to determine shortages. The rules are very specific in law and regulation. If it appears the area meets criteria, application is submitted to Shortage Designation Branch. Currently taking approximately 3 months or more to make a determination. The rules are being more strictly interpreted than they were a few years ago.