1. Overview of Impact Testing Plan

2. 2 Purpose and Concept Goal: Model the likely result of a revised rule and examine the implications for the population and existing safety net system Primarily based on nationally available data Assessed using prescribed Service Areas: –Existing designation boundaries –Uniform baseline service area geography covering all areas…. Potential/Mix of: PCSAs Counties Statewide RSAs New geographical groupings based on rule parameters

3. 3 Impact Testing Process 1.Committee first makes decisions about the factors, scales, and thresholds for designation –Data/maps provided at this phase don’t assess ‘impact’ 2.JSI will describe how we will capture those decisions using available nationally available data and any estimates used to fill gaps in information 3.Data will be used to score ‘potential’ service areas to determine if they would be designated based on the new rule 4.Statistics/maps will be produced estimating the ‘impact’ of the new rule (see definition of impact on following slide) 5.Sensitivity Analyses can be run (need to keep limited) –Factor Estimates (up/down) –Factors in out –Variation in any weights applied –Variation in thresholds

4. 4 Impact Testing Outputs Reported by designation category –HPSA/MUA –Geographic vs. Population (to the extent possible for pop.) Overall Impact: –% Population & Service Areas covered Total and Change from Current (Newly Designated, Preserved, Lost –Potential programmatic impact HRSA: Existing program sites/organizations covered –RHC, FQHC, LAL, NHSC, etc. CMS: Eligible $ by program Relative Impact: –State, region –Rural/Urban (definition t.b.d.) –Demographic Mix –Others?

5. 5 Impact Testing Utility No objective measure of need/underservice is likely to exist outside of factors in the rule Impact likely to be assessed based on: –Level of acceptable change from current population/program coverage –Individual examination of known communities Areas felt to be erroneously included or excluded can be examined for insight into needed changes Assessment of utility as a means of awarding ‘baseline’ national designations to areas that designate using national data

6. 6 Caveats Valid but imperfect process –Will use best uniform data currently available –Will need to accept some degree of imperfection and uncertainty: Use ‘standardized’ service area boundaries Combine factors that describe incongruent geographic layers and different timeframes Apply attributes of geographic populations to sub- groups or use small-area estimates Make estimates when data will come from local/primary sources