I' Introduction

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I. Introduction Overview
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Purpose of Designations
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To identify areas of greatest need so limited
resources can be prioritized and directed to the
people in those areas.
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Training Objectives
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• 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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Shortage Designations
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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 a
BPHC/BHPr activity or function. The shortage
designations are

• Health professional shortage area (HPSA)
  designation, which is a
• prerequisite to apply for National Health
  Service Corps 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.
• Other Federal and State programs also use
  these shortage designations.

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Shortage Designation Branch
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MISSION The 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 data base of
  existing HPSAs and MUA/MUPs.

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Shortage Designation Branch (Continued)
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• 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 Cooperation
  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.

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SDB - Regional Assignments
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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
[phone] E-mail mwhitfield_at_hrsa.gov
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Primary Care Offices (PCO) Role In Designation
Process
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• Development
• Identify areas with underserved populations,
  limited access to health
• professionals, or health disparities
• Assist applicants to develop designation
  applications

• Technical Assistance
• Provide technical assistance to entities
  within the State preparing designation
  applications
• Provide information within State on types of
  designations

• Oversight
• Validate information contained in
  applications
• Review and comment on applications submitted
  by entities within State

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PCO Role In Designation Process (continued)
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• Assure that all appropriate entities receive
  copies of designation applications such as
  Governors Office, 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.

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Primary Care Association (PCA) Role in
Designation Process
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• Annual Review Process
• Review annual HPSA list with community health
  centers (CHCs)
• and identify designation for updating or
  for planned projects

• Assist PCOs, CHCs, and communities to assure
  timely updating
• of HPSAs

• Technical Assistance
• Assist PCO and communities with new or
  existing CHCs in the
• identification of potential HPSAs and the
  preparation of designation
• applications
• Provide information or referral sources to
  CHCs and others on designations and
  programs that use designations

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Designation Issues Group (DIG)
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DIG is a working group open to interested
participants from State Primary Care Offices
(PCOs) and the Health Resources and Services
Administrations Shortage Designation Branch
(SDB). A conference call is held the first
Thursday of every month from 1100 a.m. 1230
p.m. (PST) time 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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Additional Information
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SDB Toll-Free Number 1-800-400-2742 Call for
information on current designations, copies of
guidelines, criteria, HPSA or MUA/MUP list, etc.
HRSA Website www.bhpr.hrsa.gov/shortage Select
Health Professional Shortage Areas to view
guidelines, criteria, HPSA database, MUA/MUP
list, and Automatic HPSA Facility scores.
OSHPD Websitewww.oshpd.ca.gov/HWCDD/cooperative/i
ndex.htm
To obtain HPSA/MUA/MUP criteria, application
worksheets, etc.
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Shortage Designation Branch (SDB) 2007 HPSA
Annual Review Schedule
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2007-2008 March 2007 SDB mails Annual Review
letter to State PCOs requesting updates of
HPSAs designated or last updated in 2003 with
copies to Governors Offices and State PCAs. (In
May 2007, OSHPD sent certified notices to
original applicants and copies to the PCA and
county health officials informing them of the
Annual Review process.) June 2007 SDB sends
reminder notice to PCOs/PCAs of deadline
for submitting 2003 HPSA updates. Nov
2007 2003 HPSA updates due in SDB. (Updates due
to PCO in October 2007.) May 2008 2003 HPSAs
for which no update received will be proposed
for withdrawal. Nov 2008 Publish new list of
designated HPSAs in the Federal Register.
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Authority
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• 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/BHPr/OWEQA/SDB

• Criteria
• Developed to implement legislation
  required 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)

• Guidelines
• Administrative policies and procedures to
  implement program
• Issued by HRSA/BHPr/OWEQA/SDB

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37 Federal Programs (require designations)
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• HPSA Required
• NHSC (BHPr)
• 10 Medicare Incentive Payment (CMS)
• MUA or MUP Required
• CHCs (BPHC)
• New Start/Expansion (BPHC)
• FQHCs Look-Alike (BPHC)
• HPSA, MUA or MUP Required
• J-1 Visa Waiver Program (HRSA)
• HPSA or MUA Required
• Rural Health Clinic Certification (CMS)

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Designation Requirements for Selected Federal
Programs
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Designation Requirements for State Programs
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• HPSA Required
• NHSC/State Loan Repayment Program (OSHPD)
• HPSA, MUA, or MUP Required
• J-1 Visa Waiver Program (DHCS)
• Expanded Access to Primary Care Program (DHCS)
• Rural Health Services Development Program
  (DHCS)
• Seasonal Agricultural Migratory Workers
  Program (DHCS)

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Designation Requirements for State Programs
(continued)
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• HPSA, MUA or MUP Required
• Pre-Nursing Scholarship Program (HPEF)
• Associate Degree Nursing Scholarship Program
  (HPEF)
• Bachelor of Science Nursing Scholarship Program
  (HPEF)
• Bachelor of Science Nursing Loan Repayment
  Program (HPEF)
• Health Professions Education Scholarship
  Program (HPEF)
• Health Professions Education Loan Repayment
  Program for Dentist, Dental Hygienist, Nurse
  Practitioner, Certified Nurse Midwife, and
  Physician Assistant (HPEF)
• Steven M. Thompson Physician Corps Loan
  Repayment Program (HPEF)

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Acronym Meaning ALOS Average Length of
Stay AMA American Medical Association ASAPS Ap
plication Submission and Processing
System BHCDANET Bureau of Health Care Delivery
and Assistance (NET) BPHC Bureau of Primary
Health Care BHPr Bureau of Health
Professions BOP Bureau of Prisons CA Cooperativ
e 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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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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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 OSHPD Office of
Statewide Health Planning and Development PC Prim
ary Care PCA Primary Care Association PCO Primar
y Care Office PHS Public Health
Services RHC Rural Health Clinic RSA Rational
Service Area SDB Shortage Designation
Branch SFS Sliding Fee Scale SLRP State Loan
Repayment Program TA Technical Assistance
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