1. 11 HPSA and MUA/P NEGOTIATED RULEMAKING A DRAFT ROAD MAP HOW DO WE GET FROM HERE TO WHERE WE NEED TO BE? November 17, 2010 Edward Salsberg, HHS Representative

2. 22 STATUTORY REQUIREMENTS Ratio of health “professionals” to the number or individuals in an area/population group (HPSA) The Availability of health professionals to residents of an area/population group (MUA) Indicators of need, notwithstanding the supply (HPSA) Factors indicative of the health status of a population group or residents of an area (MUA) Ability to pay for services and their accessibiIity (MUA)

3. 33 PRELIMINARY COMPONENTS FOR DEVELOPING A MODEL OF UNDERSERVICE Need/Demand/Supply Quantify population-based need (people, visits, etc.) Quantify supply of providers Accessibility / Factors notwithstanding supply Identify Key Health Disparities linked to access Identify other measurable factors indicative of underservice Identify Sub-populations and related methods Implementation Steps Determine if/how to combine these components Define rational service areas Define thresholds of underservice Test models and methodology Consideration of alternatives based on results of testinn

4. 44 CONCEPTUAL FRAMEWORK FOR EACH COMPONENT Meeting 1 Present an overview of topic and possible approaches Discussion of alternatives and informational needs Meeting 2 Provision of additional information in response to Committee data requests and suggested alternatives Further discussion and development of alternatives Preliminary vote to assess potential consensus Meeting 3 Further discussion Take vote on consensus Future meeting Review impact testing results; modify as needed.

5. 55 COMMITTEE’S PRIORITIES FROM MEETING 1 NEED MEASUREMENT HPSA/MUA DISTINCTION UNDERSERVICE ACCESS SUBPOPULATIONS CAPACITY/SUPPLY SERVICE AREA DEFINITION BARRIERS HIGH NEED/INDIRECT/NON-PROVIDER OPTIONS FACILITIES THRESHOLDS IMPACT TESTING SHORTAGE EXCEPTIONS RENEWAL DO NO HARM Items in BLUE already under discussion/consideration

6. 66 POSSIBLE TIMEFRAMES NOVEMBER –FURTHER CONSIDERATION OF BASIC APPROACH TO NEED/DEMAND –DISCUSS HEALTH STATUS COMPONENT OF NEED/DEMAND- PRESENTATION ON HEALTH STATUS AS MODIFIER OF NEED/DEMAND SUBCOMMITTEE REPORT AND RECOMMENDATIONS –INITIAL PRESENTATION/DISCUSSION ON SUBPOPULATION APPROACHES –INITIAL PRESENTATION/DISCUSSION OF ISSUES RELATED TO PROVIDER SUPPLY

7. 7 POSSIBLE TIMEFRAMES DECEMBER (via Conference call) –ANALYSIS CONDUCTED BASED ON NOVEMBER RECOMMENDATIONS –DISCUSSION OF SUBPOPULATIONS AND/OR STATUS/OUTCOMES, POSSIBLY FORM SUBCOMMITTEE 7

8. 88 POSSIBLE TIMEFRAMES JANUARY –PRESENTATION ON HEALTH STATUS/OUTCOMES ANALYSIS AND OPTIONS –DISCUSSION ON INCORPORATING HEALTH STATUS/OUTCOMES INTO A MODEL –CHARGE FOR ANALYSIS OF THE MODEL WITH STATUS/OUTCOMES INCORPORATED –CONSENSUS ON NEED/DEMAND COMPONENT –SECOND DISUCUSSION ON PROVIDER SUPPLY AND INCORPORATION INTO MODEL –SECOND DISCUSSION ON SUBPOPULATIONS –FIRST PRESENTATION/DISCUSSION ON OF RATIONAL SERVICE AREAS –FIRST PRESENTATION ON THRESHOLDS

9. 9 POSSIBLE TIMEFRAMES FEBRUARY –PRESENTATION OF ANALYSIS FROM PREVIOUS MEETING: DECISIONS ON HEALTH STATUS/OUTCOME COMPONENT –FINAL DECISION ON SUPPLY –FINAL DECISION ON SUBPOPULATIONS –SECOND DISCUSSION OF RATIONAL SERVICE AREAS –DISCUSSION OF THRESHOLDS OF UNDERSERVICE-WHERE TO DRAW A LINE –DIFFERENCES BETWEEN HPSAS AND MUAS DEFINED FOR TESTING –IMPACT TESTING ANALYSIS PLAN PROPOSED AND APPROVED 9

10. 10 MARCH –INITIAL IMPACT TESTING RESULTS PRESENTED –CONCENSUS DECISION ON RATIONAL SERVICE AREAS –CONSENSUS DECISIONS ON THRESHOLDS –REVISIONS DISCUSSED ON VARIOUS COMPONENTS –REVISED TESTING PLAN PROPOSED –DRAFT REPORT TO SECRETARY ON PROGRESS POSSIBLE TIMEFRAMES

11. 11 POSSIBLE TIMEFRAMES APRIL –REVIEW OF REVISED TESTING –DISCUSSION OF IMPLEMENTATION ISSUES; TIMING, EXPECTATIONS, ETC. 11

12. 12 POSSIBLE TIMEFRAMES MAY –FINAL DECISION ON METHODOLOGY COMPONENTS –REMAINING ANALYSIS QUESTIONS RAISED FOR FURTHER CONSIDERATION 12

13. 13 POSSIBLE TIMEFRAMES JUNE –FINAL CONSENSUS ON METHODOLGY AND IMPLEMENTATION PLAN –INITIAL DRAFTING OF PROPOSED RULE –REVIEW OF RULE LANGUAGE BY COMMITTEE

14. 14 POSSIBLE TIMEFRAMES JULY –FINAL DRAFTING OF PROPOSED RULE PARAMETERS AND KEY ELEMENTS 14