27th Annual HPSA & MUA/MUP workshop

27th Annual HPSA & MUA/MUP workshop
“Access to Safe, Quality Healthcare Environments that Meet California’s Dynamic and Diverse Needs.” October 3 & 4, 2019 Anaheim, CA Presented by: California Primary Care Office Office of Statewide Health Planning and Development

Workshop Objectives Role of the Primary Care Office
Purpose of Designations Benefits of Shortage Designation Data Elements of Shortage Designation Understanding the Shortage Designation Process Methodology & Purpose of Automatic Facility Shortage Designations Discussion on Recruitment and Retention Efforts Technical Assistance on the Shortage Designation Process and Scoring

Primary Care Office Staff
Hovik Khosrovian PCO Director (916) Elyssa Urias Program Administrator (916) Richard Creer Program Administrator (916) Steffi Wong Program Analyst (916) Bally Nagra Program Analyst (916) Jalaunda Granville Program Manager (916)

Role of Primary Care Office
Development: Identify areas with underserved populations, limited access to health professionals, or health disparities. Develop designation applications. Conduct statewide analysis of unmet need, disparities, and health workforce issues. Technical Assistance: Provide technical assistance. Provide guidance regarding the National Health Service Corps (NHSC) site application process and Nurse Corps program. In a nutshell… Assist in developing designation applications by identifying areas of need & conducting statewide analysis of disparities Provide technical assistance and guidance Collaborate with various entities and organizations to improve and expand access to health care Provide oversight of HPSA designations and ensure compliance with federal criteria

Role of Primary Care Office
Collaboration: Collaborate with statewide organizations, county health offices, community organizations, and other HRSA partners to expand access to primary care. Collaborate with HRSA partner organizations to maintain and strengthen the growth, support, and role of health centers. Oversight: Review and submit applications to HRSA. Review NHSC site applications for compliance of federal criteria.

Purpose of Designations
There are two types of shortage designations: Health Professional Shortage Area (HPSA): designations that indicate health care provider shortages in Primary Care, Dental Health, and/or Mental Health. Medically Underserved Area/Medically Underserved Population (MUA/MUP): designations that identify geographic areas and populations with a lack of access to primary care services. Improve healthcare service delivery and workforce availability to meet the needs of underserved populations. Identify geographic areas or population groups with a shortage of primary care, dental care, and/or mental healthcare services.

Benefits of Shortage Designation
Recruitment and Retention Benefits NHSC Loan Repayment and Scholar Placement State Loan Repayment Program (SLRP) Nurse Corps & Nurse Scholar Health Professions Education Foundation (HPEF) Loan Repayment and Scholarship Programs J-1 Visa Waiver Expedited Medical Licensure - Medical Board of California Financial Benefits Rural Health Clinic (RHC) Certification New Access Point (NAP) and Service Area Competition (SAC) Grants Federally Qualified Health Center (FQHC) Look-Alike Program 10% Medicare Bonus Payment – Does not apply to FQHCs or RHCs Registered Dental Hygienist in Alternative Practice (RDHAP) – Dental Board of California

Benefits of Shortage Designation
Designation Type NHSC/SLRP NAP/SAC Grants/ Look-Alike Medicare Incentive Payment Rural Health Clinic Certification J-1 Visa Waiver HPEF Priority Licensure RDHAP Primary Care HPSA (Area) x Primary Care HPSA (Population) Dental Care HPSA (All) Mental Health HPSA (Area) Mental Health HPSA (Population) Facility HPSA MUA MUP Auto-Facility HPSA (FQHCs, RHCs, Tribal)

HPSA DESIGNATIONS Components Disciplines (Direct Outpatient Care Only)
MSSA or County Population to Provider Ratio Population Data: year American Community Survey (ACS) Estimates Provider Data: National Provider Identifier (NPI) Contiguous Area Analysis Disciplines (Direct Outpatient Care Only) Primary Medical Care Family Practitioners, Gerontologists, Internal Medicine, Obstetrician/Gynecologist, and Pediatricians Dental Health Care Doctor of Dental Surgery (DDS) and Doctor of Medicine in Dentistry (DMD) Registered Dental Hygienists and Dental Assistants are also counted Mental Health Care Psychiatrists, Clinical Psychologists, Licensed Clinical Social Workers, Psychiatric Nurse Specialists, Licensed Marriage and Family Therapists

Service Areas Medical Service Study Areas (MSSA):
Recognized by HRSA’s Shortage Designation Branch (SDB) as Rational Service Areas (RSA) Census Tract based Cannot cross county boundaries Must be whole areas, no carved out portions Defined cities, neighborhoods, or recognized communities that are socio-economically or demographically similar Uses for MSSAs: HPSAs and MUA/MUP designations Health workforce planning and development Policy development Used in OSHPD Geographic Information Systems development

service areas Types of MSSAs: Urban Population range 75,000 to 125,000
Reflect recognized community and neighborhood boundaries Similar demographic and socio-economic characteristics Rural Population density of less than 250 persons per square mile No population center exceed 50,000 Frontier Population density of less than 11 persons per square mile

Example of Whole County MSSA

Example of Sub-county MSSA

3rnet National Rural recruitment and retention Network
Healthcare Jobs Across the Nation

3rnet 3RNet is a national nonprofit network of members committed to matching healthcare professionals with rural and underserved jobs. Finding a job on 3RNet is as easy as: 1) Search Jobs 2) Register 3) Get Answers

For Healthcare Professionals
3rnet 3RNet Website: the OSHPD Shortage Inbox: For Healthcare Professionals For Employers Search jobs in dozens of professions and specialties Jobs in rural and underserved areas across the country Registration is free – access to full job details and notifications on new jobs that meet your needs Additional information on loan repayment programs, J1 Visa Waivers, and unbiased job information Complete an Employer Registration Form, once approved you can post jobs immediately Access to over 46,000 candidates Recruitment and retention resources, education on J1 Visa Waiver process

3rnet In fiscal year 2017-18, there were:
8,693 Views of Posted Positions in California 17 New Facilities Registered 98 New Positions Posted 1271 Active Health Professionals Registered Top 5 Health Professional Types Registered: Physicians Nurse Practitioners Registered Nurses Dentists Physician Assistants

Recruitment and retention
Current Efforts: Bi-Annual Workshops Quarterly Mini-Workshops Technical Assistance Collaborate with other government partners, communities, and stakeholders 3RNet Suggestions?

HPSA Designations Rules and Policies of HPSA Designations

HPSA designation The applicant must demonstrate a shortage of providers within a service area including an analysis of resources surrounding the service area to determine if the population is isolated from it’s neighboring communities Step 1: Service Area Determine your area of interest for the HPSA designation Utilize the OSHPD website to find your MSSA, Step 2: Type of Designation Determine the type of designation Primary Care, Dental Care, or Mental Health and sub category, e.g., Area, Population, or Facility

HPSA Basics Step 3: Contiguous Area Analysis
Review maps of contiguous areas Determine which areas can be ruled out to demonstrate access to care inaccessibility Step 4: Provider Survey and Analysis Conduct provider survey Calculate the Full Time Equivalent to determine if it meets criteria for shortage area If necessary survey the contiguous areas that were not inaccessible to determine if they are over utilized Step 5: Nearest Source of Care (NSC) Determine the nearest provider outside of the MSSA that is accessible The provider distance is determined using either private transportation or public depending on the location and size of the MSSA

Service Area Must Use MSSAs.
MSSA Maps can be found on the OSHPD website, or by contacting the PCO. MSSAs can be combined for designations if, The MSSA population centers are within 30 minutes of each other for Primary Care HPSAs, or 40 minutes of each other for Dental and Mental Health Or, there are no services available to one or more of the MSSAs, and the population must travel to a neighboring MSSA to seek care The MSSAs whether combined or not cannot exceed the population maximum of: 250,000 people for Primary Care 250,000 people for Dental Care 250,000 people for a County Mental Health HPSA or 999,999 for a MSSA based Mental Health HPSA

Service Area

Service Area Criteria Population Data Mental Health Quartile Rankings
ACS Data, found on your Workshop flash drive Farmworker Enumeration Profile Data and calculation worksheet can be found on your Workshop flash drive, Worksheet section Seasonal Residents and Tourist data can be obtained by contacting the counties or tourism boards, the calculations can be found on the Workshop flash drive, Worksheet section Homeless count is obtained by contacting the county or reaching out to the homeless shelters in the MSSAs to get an estimate Mental Health Quartile Rankings Substance Abuse and Mental Health Service Administration (SAMHSA) data is used The SAMHSA quartile rankings are available on the Workshop flash drive

Types of DESIGNATIONS A shortage of: providers in a: Primary Care
Mental Health Dental Health providers in a: Geographic Area Population Group Facility

Types of DESIGNATIONS Geographic Area
Geographic Area based on MSSA and the Resident Civilian Population. Can add Homeless Populations, Migrant Farmworkers, Seasonal Residents, Tourists for Primary Care and Dental Health Geographic Area with High Needs Primary Care: More than 20% of population must be at or below 100% Federal Poverty Level (FPL); or More than 100 births per year per 1,000 women ages 15-44; or More than 20 infant deaths per 1,000 live births; or Meets insufficient capacity criteria Dental Health: More than 20% of the population must be at or below 100% FPL; or More than 50% of the population has no fluoridated water; or Mental Health: More than 20% of the population must be at or below 100 % FPL; or The youth ratio (# of persons < 18 to the # of adults ages ) is greater than 0.6; or The elderly ratio (# of persons > 65 to the # of adults ages ) is greater than 0.25; or Alcohol or substance abuse prevalence data showing the area to be in the worst quartile nationally, state, region.

Types of Designations Population Group
Low-Income Population: 30% of the population must be at or below the 200% FPL Medicaid Eligible Count Medicaid Visits (5,000 visits = 1 Full Time Equivalent (FTE)) Can add Homeless and Migrant Farmworker counts to all three disciplines Facility A facility that is either designated as a HPSA based on a request to the PCO using specific facility data or by statute or through regulation without having to apply for a designation. Other Facility (OFAC) Correctional Facility State Mental Hospitals Automatic Facility HPSAs (Auto HPSAs)

Population to provider criteria primary care
Area (Geographic) Primary Care HPSA Population to Provider Ratio Requirements: ≥3,500:1 Area (Geographic with High Needs) Primary Care HPSA Population to Provider Ratio Requirements: ≥3,000:1 Population (Low-Income) Primary Care HPSA Population to Provider Ratio Requirements: Population (Medicaid Eligible) Primary Care HPSA Population to Provider Ratio Requirements:

Population to provider criteria dental care
Area (Geographic) Dental Care HPSA Population to Provider Ratio Requirements: ≥5,000:1 Area (Geographic with High Needs) Dental Care HPSA Population to Provider Ratio Requirements: ≥4,000:1 Population (Low-Income) Dental Care HPSA Population to Provider Ratio Requirements: Population (Medicaid Eligible) Dental Care HPSA Population to Provider Ratio Requirements:

Population to provider criteria mental health
Area (Geographic) Mental Health HPSA Population to Provider Ratio Requirements: ≥30,000:1 Area (Geographic with High Needs) Mental Health HPSA Population to Provider Ratio Requirements: ≥20,000:1 Population (Low-Income) Mental Health HPSA Population to Provider Ratio Requirements: Population (Medicaid Eligible) Mental Health HPSA Population to Provider Ratio Requirements:

Contiguous area analysis

Contiguous Area Analysis
Contiguous Area Determination: A polygon is created based on the population center of a MSSA The polygon is based on public or private transportation rules for 30 minutes of travel Public Transit: MSSA must be an Inner City/Metro area Public Transportation can be used if the 100% FPL is ≥20%; or Ridership Rate is greater than 30% in the MSSA or region Private Transportation: Primary Care HPSA is a 30 minute travel polygon: Mental Health and Dental Care HPSA is a 40 minute travel polygon: Any MSSA the polygon is touching is considered a contiguous area

Determination of Access to Care Contiguous Areas must meet one of the following to be ruled out as inaccessible: The Contiguous Area is currently a HPSA. There are significant socio-economic/demographic disparities or physical barriers. The Contiguous Area’s providers are excessively distant from the population center. >30 minutes travel time for Primary Care >40 minutes travel time for Dental and Mental Health The resources in the Contiguous Area exceed the population-to-provider ratio and are therefore over utilized.

Determine if the Contiguous Areas are Over Utilized: Conduct survey of providers for the discipline you are designating Follow methods to survey as shown in the following survey methodology presentation For Population HPSA designations, the survey for Over Utilization must collect the percentages of Medicaid and Sliding Fee Scale as well as the provider’s outpatient hours The population to provider ratio must meet the federal criteria to be considered over utilized for the contiguous area: Primary Care - ≥2,000:1 Dental Care - ≥3,000:1 Mental Health - ≥20,000:1

Provider Survey Process

Primary Care Provider Survey
Use NPI list provided by PCO Family Practitioner General Internal Medicine Pediatrician Obstetrician/Gynecologist Contact providers listed in the MSSA proposed for HPSA designation If necessary, survey providers in the Contiguous Area to determine overutilization Do not count providers that are: Engaged solely in admin, research, or teaching Hospitalists/In-patient Care/Urgent Care Locum Tenens less than one year on contract Suspended on Medicaid/Medicare Fraud or Abuse Serving in NHSC, J-1, or H-1B waiver Federal Providers (e.g., Commissioned Officers or Bureau of Prisons) Are planning on retiring within six months

Primary Care Provider Survey
What Information is Needed? Geographic and Geographic with High Needs HPSA: # of Hours Worked in direct patient care in an Outpatient Setting 40 hours = 1.0 Full Time Equivalent (FTE) Provider cannot exceed 1.0 FTE Interns and Residents are counted as 0.1 FTE Verify Address Population (Low-Income) HPSA: Percentage of Patients seen that are Medicaid or Sliding Fee Scale 40 hours = 1 Full Time Equivalent Medicaid Eligible HPSA: Medicaid Eligible Designations require the Medicaid eligible population count and annual Medicaid claims visits

Primary Care Provider Survey Geographic/Geographic w/ Hi Needs/Population (low-Income)

Dental Care Provider Survey
Use NPI list provided by PCO DDS and/or DMD Contact providers listed in the MSSA proposed for HPSA designation If necessary, survey providers in the Contiguous Area to determine overutilization Do not count providers that are: Engaged solely in admin, research, or teaching Locum Tenens less than one year on contract Serving in NHSC Suspended on Medicaid/Medicare Fraud or Abuse Federal Providers (e.g., Commissioned Officers or Bureau of Prisons) Are planning on retiring within six months

Dental Care Provider Survey
What Information is Needed? Geographic and Geographic with High Needs HPSA: # of Hours Worked in direct patient care in general dentistry or pediatric dentistry 40 hours = 1.0 Full Time Equivalent (FTE) Provider can exceed 1.0 FTE by utilizing auxiliaries Verify Address Population (Low-Income) HPSA: Percentage of Patients seen that are Medicaid or Sliding Fee Scale 40 hours = 1 Full Time Equivalent

Dental Care Provider Survey (cont.)
Calculations: Dental Auxiliaries and Age are factored into the FTE Equation Auxiliaries are non-dentists assisting in dental care such as dental assistants, hygienists, etc. Auxiliaries < > If an auxiliary is less than full-time, round to nearest whole number (0.4 = 0, 0.5 = 1). If more than one auxiliary works less than full time, add total hours, divide by 40, and round if not a whole number [( /40) = 1.7 = 2]. If number of auxiliaries is not available, use these weights: <55 = 1.2 = 0.9 = 0.8 > 65 = 0.6 If dentist’s age and the number of auxiliaries are not available: Use weight of 1.2

dental Care Provider Survey Geographic/Geographic w/Hi Needs/Population (low-income)

Mental health Provider Survey
Use NPI list provided by PCO Psychiatrists only Contact providers listed in the MSSA proposed for HPSA designation and If necessary survey providers in the Contiguous Area to determine overutilization Do not count providers that are: Engaged solely in admin, research, or teaching Hospitalists Locum Tenens less than one year on contract Serving in NHSC, J-1, or H-1B waiver Suspended on Medicaid/Medicare Fraud or Abuse Federal Providers (e.g., Commissioned Officers or Bureau of Prisons) Are planning on retiring within six months

Mental health Provider Survey
What Information is Needed? Geographic and Geographic with High Needs HPSA: # of Hours Worked in direct patient care in an Outpatient Setting 40 hours = 1.0 Full Time Equivalent (FTE) Provider cannot exceed 1.0 FTE Interns and Residents are counted as 0.5 FTE Verify Address Population (Low-Income) HPSA: Percentage of Patients seen that are Medicaid or Sliding Fee Scale 40 hours = 1 Full Time Equivalent

Mental health Provider Survey geographic/geographic w/ hi needs/Population (low income)

Nearest Source of Care

Nearest Source of Care Requirements
Nearest Source of Care (NSC) is the final step to a designation: The NSC is the provider closest to the population in the proposed HPSA that is accessible. Needed to determine the HPSA score. Shows the distance the population in the proposed HPSA would have to travel outside of their MSSA to seek care. NSC has the following requirements for all HPSA designations: The NSC cannot be in a HPSA of any type; The NSC cannot be in an area that is overutilized; The NSC can be excessively distant to the proposed HPSA; The NSC can be in an area with significant socio-economic or demographic disparities; For a proposed Population HPSA, the NSC must accept both Medicaid and have a Sliding Fee Scale; For a proposed Geographic with High Needs HPSA, the NSC must accept Medicaid; To determine travel time: Use private transportation to measure NSC if your polygon is based on car travel; or If your polygon is based on public transit, use the public transportation feature on Google Maps to determine travel time to NSC.

Facility Designations
Rules and Policies of Facility HPSA Designations

Facility HPSA Designations
Facility HPSAs are special designations for facilities that fall outside the regulations of standard HPSA designations, but have workforce issues. There are three types of Facility HPSA designations Federal and State Correctional Institutions and Youth Detention Facilities Public or Non-Profit Private Facilities State and County Mental Hospitals This presentation will address the requirements of the Public or Non-Profit Facilities, as Correctional Facilities and State Hospitals are only requested by the departments that govern those facilities.

Facility HPSA Designations
Automatic Facility HPSAs and standard HPSAs are similar, but not the same. Other HPSAs Automatic Facility HPSAs Designation & scoring done online Criteria used to first designate as HPSA Criteria used to determine HPSA score Scores range from 0-25 (26 for dental) Designations are required to be reviewed and updated as necessary annually Score of “0” is rare Designation & scoring currently done manually No application process necessary Same criteria used to determine HPSA score as other HPSAs Same scoring range used HRSA has not historically required Auto-HPSA scores to be reviewed regularly; updates are requested by facility Score of “0” more frequent and means low shortage or no data was available for scoring

Public or Non-Profit Private Facility HPSAs
The Facility HPSAs are designed for clinics that serve residents of a HPSA but do not reside in a HPSA. If the clinic’s MSSA does not meet the HPSA criteria, the Facility HPSA is intended to assist the clinic in recruitment and retention of providers to help with the influx of patients from a HPSA. Steps to Designate a Facility HPSA: Confirm Provision of Services to a HPSA Demonstrate Insufficient Capacity Conduct Provider Survey

Confirm Provision of Services to a HPSA Must meet one of the following: >50% of the facility’s primary care, dental, or mental health services are provided to residents of a designated HPSA, or Travel time for residents of a HPSA to the facility is < 30 minutes for primary health care, < 40 minutes for dental or mental health, or For mental health, the facility has been given responsibility for providing or coordinating mental health services for area or population group.1 1 – Federal or State statute or administrative action via a State plan that charges the facility as the sole provider of mental health services to the area or population group

1.a. To establish that >50% of the facility’s primary care, dental, or mental health services are provided to residents of a designated HPSA, the facility must: Identify the HPSA or HPSAs being served. Review records over a recent period of time (e.g. within the past year) long enough to accurately reflect patient utilization (this will be a shorter time for a large facility and a longer time for a small facility). Determine the residence of the patients during the time period established. Determine the percentage of total patients of the facility that reside in the designated HPSA or HPSAs. Describe the methodology and results in the application. If >50% of the facility’s services are provided to residents of a designated HPSA, then provision of services to a HPSA is established.

1.b. To establish travel time for residents of a HPSA to the facility: Provide a road map showing the facility location and HPSA location. Provide Google Maps printout showing mileage from HPSA to facility. Travel times are calculated the same as standard HPSAs. Primary Health Care (30 minutes). Dental and Mental Health Care (40 minutes) If travel time for residents of the HPSA to the facility is <30 minutes for primary health care or <40 minutes for dental or mental health, then provision of services to a HPSA is established.

Public or Non-Profit Private Facility HPSAs (cont.)
Demonstrate Insufficient Capacity Primary Care Dental Care Mental Health

2.a. Primary Care: Demonstrate Insufficient Capacity Must meet two of the following: >8,000 outpatient visits per year per FTE physician on staff at facility, or Excessive (> 35%) use of emergency room facilities (all ERs within the MSSA) for routine primary care, or Waiting time for routine appointments is > 7 days for established patients, or waiting time for routine appointments is >14 days for new patients, or Waiting time at facility is >1 hour for patients with appointments, or Waiting time at facility is >2 hours for patients on first-come, first-served basis.

2.b. Dental Care: Demonstrate Insufficient Capacity Must meet one of the following: >5,000 outpatient visits per year per FTE dentist on staff at facility, or Waiting time for routine appointments is > 6 weeks 2.c. Mental Health: Demonstrate Insufficient Capacity >1,000 patient visits per year per FTE core mental health professional on staff of the facility, or >3,000 patient visits per year per FTE psychiatrist on staff of facility, or No psychiatrists on staff and this is the only facility providing mental health services to the HPSA.

MUA/MUP Designations Rules and Policies of Facility HPSA Designations

MUA/MUP Designation Criteria
Measures the degree of underservice of an area (MUA) or a population (MUP) Component: MSSA Criteria and Weighted Values: [V1] Percent of Population at 100% Poverty [V2] Percent of Population > 65 [V3] Infant Mortality Rate (IMR) MUA: [V4] Primary Care Physicians per 1,000 Population for a MUA MUP: [V4] Primary Care Physicians serving the low-income pop (200% poverty level) per 1,000 low-income population Index of Medical Underservice (IMU): Value must be < 62.0

MUA/MUP Designation Criteria (cont.)
Data Sources for MUA/MUP Designations [V1] Percent of Population at 100% FPL – ACS 2016 Data on Workshop flash drive [V2] Percent of Population ≥65 – ACS 2016 Data file on Workshop flash drive [V3] Infant Mortality Rate (IMR) – available on the California Public Health website, or through the PCO Formula for IMR: Number of Infant Death Number of Live Births x 1,000= IMR

[V4] MUA Survey - Primary Care Physicians per 1,000 Population: Survey using the NPI list for Primary Care Physicians provided by PCO upon request The survey is similar to that of the Primary Care Geographic HPSA with the exception that J-1 Visa, and NHSC/SLRP clinicians’ FTEs are counted [V4] MUP Survey – Primary Care Physician Survey using NPI list The survey is similar to the Primary Care Population HPSA with the exception that J-1 Visa, and NHSC/SLRP clinicians’ FTEs are counted

MUA Qualifying Score: IMU Score=V1 + V2 + V3 + V4 IMU Score ≤62.0 – the MSSA qualifies as an MUA/MUP IMU Score >62.0 – the MSSA does not qualify as an MUA/MUP Quick Tips on MUA/MUP designations: V1, V2, and V3 data points can be added up prior to conducting the survey If the first three variables are greater than 62.0 then the MSSA will not pass and no further inquiry is needed for the MUA/MUP request If the first three variable are less than 62.0, contact the PCO to gauge the likely hood of a designation prior to conducting the survey The MUA/MUP Worksheet is on the Workshop flash drive with the weighted values pre-loaded

MUA/MUP Weighted Values
[V1] Percent of Population at 100% FPL Percent Below Poverty Weighted Value 25.1 24.6 23.7 22.8 21.9 21.0 20.0 18.7 17.4 16.2 Percent Below Poverty Weighted Value 14.9 13.6 12.2 10.9 9.3 7.8 6.6 5.6 4.7 3.4 Percent Below Poverty Weighted Value 2.1 1.3 1.0 0.7 0.4 0.1 50 +

MUA/MUP Weighted Values (cont.)
[V2] Percent of Population at ≥65 Percent of Pop >65 Weighted Value 0 –7.0 20.2 20.1 19.9 19.8 19.6 19.4 19.1 18.9 18.7 17.8 Percent of Pop >65 Weighted Value 16.1 14.4 12.8 11.1 9.8 8.9 8.0 7.0 6.1 5.1 Percent of Pop >65 Weighted Value 4.0 2.8 1.7 0.6 30 +

[V3] Infant Mortality Rate: Nearly every MSSA receives the maximum point of 26.0 Infant Mortality Rate Weighted Value 0-8 26.0 25.6 24.8 24.0 23.2 22.4 21.5 20.5 19.5 18.5

[V4] Providers per 1,000 Population PC Physicians per 1,000 pop Weighted Value 0-.05 0.5 1.5 2.8 4.1 5.7 7.3 9.0 PC Physicians per 1,000 pop Weighted Value 10.7 12.6 14.8 16.9 19.1 20.7 21.9 23.1 Providers per 1,000 pop Weighted Value 24.3 25.3 25.9 26.6 27.2 27.7 28.0 28.3 28.6 Over 1.250 28.7

Example of MUA/MUP MUA/MUP Designations are lifetime designations
Many MUA/MUP Designations are from the 1980’s and 1990’s and did not use MSSAs prior to 1994 Many MUAs and MUPs are incomplete MSSAs and have holes within the MSSAs Many would not qualify as whole MSSAs with current census data An example of the difficulties acquiring a MUA/MUP is shown in the following map

MUA/MUP Map

Useful Links www.hrsa.gov
HPSA search HRSA data Resources and Updates to HPSAs Maps, Census Data verify your HPSA status Substance Abuse and Alcohol Abuse Data useful tool for determining RHC status NPI search engine

27th Annual HPSA & MUA/MUP workshop

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