1. --------------------------------------------------
I. Introduction & Overview
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2. Purpose of Designations
To identify areas of greatest need so limited resources can be prioritized and directed to the people in those areas.
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3. --------------------------------------------------
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
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4. 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.
Changed MUA/MUPs to MUA/MUP
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5. Shortage Designation Branch
MISSION
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
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6. 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
2nd bullet is confusing
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7. SDB - Regional Assignments
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)
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8. I-8

9. --------------------------------------------------
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
Reword the 2nd bullet under development
Oversight
Validate information contained in applications
Review and comment on applications submitted by entities within State
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10. --------------------------------------------------
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 population estimates, physician database, and Geographic Information System (GIS) database development
Database Development
Claritas Data
MSSA maps
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11. 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.
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12. OSHPD Website http://www.oshpd.ca.gov/HWDD/CalPCO.html
Additional Information
PCO Number
Call for information on current designations, copies of guidelines, criteria, HPSA or MUA/MUP list, etc.
HRSA Website
Select Health Professional Shortage Areas to view guidelines, criteria, HPSA database, MUA/MUP list, and Automatic HPSA Facility scores.
OSHPD Website
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13. --------------------------------------------------
SDB 2014 HPSA Annual Review Schedule
January 2014 The renewal cycle is open for all 2011 HPSA renewals.
February 2014 State PCOs s 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 for submitting 2011 HPSA updates.
September HPSA updates due to PCO.
December HPSA updates due to SDB on December 31, 2014
January HPSAs for which no update was received will be proposed for withdrawal.
July 2014 Publish new list of designated HPSAs in the Federal Register
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14. --------------------------------------------------
Authority
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)
1st & 2nd bullets under criteria needs to be reworded
Guidelines
Administrative policies and procedures to implement program
Issued by HRSA
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15. Designation Requirements for Selected Federal Programs
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
Primary Care HPSA (Population only)
Dental Care HPSA (Area & Population)
Mental Health HPSA (Area only)
Mental Health HPSA (Population only)
Facility HPSA
Medically Underserved Area
Medically Underserved Population
State Governor’s Certified Eligible Area (for RHC purposes only)
(Not in CA)
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16. 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
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17. --------------------------------------------------
Designation Requirements for State Programs (continued)
HPSA, MUA or MUP Required:
Health Professions Education Foundation (HPEF) Programs (
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
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18. HPSA and MUA/MUP Application Process Shortage Designation Program (SDP)
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
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)
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
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 days for resubmission.
Verify and enter all additional data needed
Prepare notification letter to applicant
Prepare ASAPS packet for Manager’s review and approval
Upon completion, Manager submits recommendation via ASAPS
ASAPS packet to applicant and others
Update tracking database
5th Step – SDP Tracking Update
Update SDP tracking database
File designation letter in program file
Create monthly dynamic maps
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.
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19. Acronym Meaning ALOS Average Length of Stay
AMA American Medical Association
ASAPS Application Submission and Processing System
BCRS Bureau of Clinician Recruitment Services
BHCDANET Bureau of Health Care Delivery and Assistance (NET)
BPHC Bureau of Primary Health Care
BOP Bureau of Prisons
CA Cooperative Agreement
CCD County Census Division
CFR Code of Federal Register
CHC Community Health Center
CHMPC California Healthcare Workforce Policy Commission
CDPH California Department of Public Health
CMHP Core Mental Health Providers/Professionals
CMS Center for Medicaid/Medicare Services (formerly HCFA)
CPCA California Primary Care Association
CT Census Tract
DHHS Department of Health and Human Services
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20. Acronym Meaning (continued)
DHCS Department of Health Care Services
DT Dental
FQHC Federally Qualified Health Center
FTE Full-Time Equivalent
GIS Geographic Information System
HMO Health Maintenance Organization
HPSA Health Professional Shortage Areas
HRSA Health Resources and Services Administration
IHP Indian Health Program
IHS Indian Health Services
IMR Infant Mortality Rate
IMU Index of Medical Underservice
MCD Minor Civil Division
MFW Migrant Farmworker
MSFW Migrant Seasonal Farmworker
MH Mental Health
MSSA Medical Service Study Areas
MUA Medically Underserved Areas
MUP Medically Underserved Populations
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21. Acronym Meaning (continued)
NCHWA National Center for Health Workforce Analysis
NHSC National Health Service Corps
NSC Nearest Source of Care
OMB Office of Management and Budget
SDB Shortage Designation Branch
OSHPD Office of Statewide Health Planning and Development
OWEQA Office of Workforce Evaluation and Quality Assurance
PC Primary Care
PCA Primary Care Association
PCO Primary Care Office
PHS Public Health Services
RHC Rural Health Clinic
RSA Rational Service Area
SFS Sliding Fee Scale
SLRP State Loan Repayment Program
TA Technical Assistance
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