Bonser Bishop and Associates has conducted MORE Health Professional
Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P)
http://nhsc.bhpr.hrsa.gov/ surveys and designations THAN ANYBODY in the
State of California. We are THE national expert in increasing Facility HPSA
scores. Some of our clients have consistently found that they can contract
with a hard-to-find dentist or psychiatrist within days after our assistance.
On 2/29/08, the Federal Register published proposed regulation changes
which we currently are analyzing to understand the impact on rural
healthcare providers in the West.
Contact us for help with understanding the effect these
proposed changes will have upon your community or to find out
how Bonser Bishop and Associates can work with your facility
and community to recruit National Health Service Corps
providers or get a 10% Medicare Bonus Payment.
Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P)
http://nhsc.bhpr.hrsa.gov/ surveys and designations THAN ANYBODY in the
State of California. We are THE national expert in increasing Facility HPSA
scores. Some of our clients have consistently found that they can contract
with a hard-to-find dentist or psychiatrist within days after our assistance.
On 2/29/08, the Federal Register published proposed regulation changes
which we currently are analyzing to understand the impact on rural
healthcare providers in the West.
Contact us for help with understanding the effect these
proposed changes will have upon your community or to find out
how Bonser Bishop and Associates can work with your facility
and community to recruit National Health Service Corps
providers or get a 10% Medicare Bonus Payment.
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| Our HPSA/MUA/P clients include: - Central Valley Health Network - Sequoia Community Health Center - Family Health Care Network - George Koortbojian - Golden Valley Health Center - Inland Health and Behavioral Services - Ravenswood Family Health Center - United Indian Health Services - Mad River Community Hospitals - Rural Health Clinics (RHCs) in Fortuna and McKinleyville, California - North Coast Clinics Network - Mountain Health and Community Services - Southern Trinity Health Services - Open Door Community Health Centers |
Introduction
Community health center patients experience many barriers to accessing health care services including
financial, geographic and linguistic challenges. Designations like Medically Underserved Area (MUA), Medically
Underserved Population (MUP) and Primary Care, Dental and Mental Health Professional Shortage Area (HPSA)
provide recognition of overutilization of available services and qualify areas with those designations for some
state and federal programs.
Many areas of the Central Valley are federally recognized as provider shortage areas. Having a shortage
designation has helped clinics in those regions increase grant funds and recruit physicians and dentists.
Maintaining area shortage designations fits in with the Central Valley Health Network’s larger Workforce
Initiative and is joined by emphases in reimbursement advocacy, provider recruitment and establishment of a
loan repayment program. These activities, together, will help alleviate the current and future provider
shortage in the Central Valley.
Types of Shortages and Benefits
Primary Care, Mental and Dental Health Professional Shortage Areas (HPSAs) are federally designated areas
where the population-to-provider ratio indicates relative degree of access to services for a special population
(like the Low Income) or for the community as a whole. Federally Qualified Health Centers (FQHCs) are
automatically deemed as Facility HPSAs. Some other organizations serving the low income, such as County
Health Departments or Correctional Institutes, may also be eligible for a Facility designation.
FQHCs are not the only ones benefiting from HPSA designations. The most common use of a HPSA
designation is to qualify a clinic or community to receive placement of a National Health Service Corps
physician, psychiatrist, dentist or other provider. California State loan repayment programs tend to only
require that a placement site be located in a HPSA, but do not specify a particular score. Private practice
physicians in a Geographic HPSA (as opposed to a Population-Based HPSA) can receive a 10% Medicare bonus.
And Rural Health Centers must be located in a HPSA to qualify for that enhanced reimbursement program.
A clinic must serve a Medically Underserved Area (MUA) or Medically Underserved Population (MUP) to qualify
as an FQHC.
Physician Scarcity Areas (PSAs) are determined by the federal Centers for Medicaid Services (CMS) using
American Medical Association data, which is often prone to errors. Private practice physicians in PSAs
receive a 5% Medicare bonus. All other designations are deemed by the Health Resources and Services
Administration.
How to Get a Shortage Designation
In California, the Office of Statewide Health Planning and Development responds to community-submitted
HPSA, MUA or MUP applications. After a 1-2 month long state review process, the State submits the
application to the Federal Shortage Designation Branch for final approval. All designations are then publicly
listed at www.hpsafind.hrsa.gov.
The application process can be lengthy, depending on the size and ease of surveying a community. Different
designations require surveying different providers:
Communities may choose to include Migrant Farmworker and tourism/seasonal resident statistics to provide a
clearer population-to-provider ratio. Application guidelines also require researching area poverty rates,
infant mortality rates and low birth weights using State and US Census data and determining access to care in
contiguous areas.
Scoring
Each type of shortage designation has a score computed using a formula published in the Federal Register.
Score elements are listed below.
Facility HPSA scores are based on the clinic’s patient population instead of that of the community and are
usually higher than community scores. Only high scoring HPSAs qualify for National Health Service Corps
providers. MUA/MUPs also scores but they are not commonly used to determine program eligibility or
preference.
More information
On February 29, 2008, the federal Health Resources and Services Administration proposed to merge the
Primary Care HPSA and MUA designations into one using a new formula. Public comment for that proposal is
scheduled to close on April 29th, 2008. At this point we do not know the potential effect of the proposed
changes on the communities we are privileged to serve.
More information on shortage designations is available at
• Bureau of Primary Health Care's Shortage Designation Branch
• National Health Service Corps
• The California Office of Statewide Health Planning and Development Shortage Designation Program and
• The Federal Register, listing the proposed changes
Community health center patients experience many barriers to accessing health care services including
financial, geographic and linguistic challenges. Designations like Medically Underserved Area (MUA), Medically
Underserved Population (MUP) and Primary Care, Dental and Mental Health Professional Shortage Area (HPSA)
provide recognition of overutilization of available services and qualify areas with those designations for some
state and federal programs.
Many areas of the Central Valley are federally recognized as provider shortage areas. Having a shortage
designation has helped clinics in those regions increase grant funds and recruit physicians and dentists.
Maintaining area shortage designations fits in with the Central Valley Health Network’s larger Workforce
Initiative and is joined by emphases in reimbursement advocacy, provider recruitment and establishment of a
loan repayment program. These activities, together, will help alleviate the current and future provider
shortage in the Central Valley.
Types of Shortages and Benefits
Primary Care, Mental and Dental Health Professional Shortage Areas (HPSAs) are federally designated areas
where the population-to-provider ratio indicates relative degree of access to services for a special population
(like the Low Income) or for the community as a whole. Federally Qualified Health Centers (FQHCs) are
automatically deemed as Facility HPSAs. Some other organizations serving the low income, such as County
Health Departments or Correctional Institutes, may also be eligible for a Facility designation.
FQHCs are not the only ones benefiting from HPSA designations. The most common use of a HPSA
designation is to qualify a clinic or community to receive placement of a National Health Service Corps
physician, psychiatrist, dentist or other provider. California State loan repayment programs tend to only
require that a placement site be located in a HPSA, but do not specify a particular score. Private practice
physicians in a Geographic HPSA (as opposed to a Population-Based HPSA) can receive a 10% Medicare bonus.
And Rural Health Centers must be located in a HPSA to qualify for that enhanced reimbursement program.
A clinic must serve a Medically Underserved Area (MUA) or Medically Underserved Population (MUP) to qualify
as an FQHC.
Physician Scarcity Areas (PSAs) are determined by the federal Centers for Medicaid Services (CMS) using
American Medical Association data, which is often prone to errors. Private practice physicians in PSAs
receive a 5% Medicare bonus. All other designations are deemed by the Health Resources and Services
Administration.
How to Get a Shortage Designation
In California, the Office of Statewide Health Planning and Development responds to community-submitted
HPSA, MUA or MUP applications. After a 1-2 month long state review process, the State submits the
application to the Federal Shortage Designation Branch for final approval. All designations are then publicly
listed at www.hpsafind.hrsa.gov.
The application process can be lengthy, depending on the size and ease of surveying a community. Different
designations require surveying different providers:
Communities may choose to include Migrant Farmworker and tourism/seasonal resident statistics to provide a
clearer population-to-provider ratio. Application guidelines also require researching area poverty rates,
infant mortality rates and low birth weights using State and US Census data and determining access to care in
contiguous areas.
Scoring
Each type of shortage designation has a score computed using a formula published in the Federal Register.
Score elements are listed below.
Facility HPSA scores are based on the clinic’s patient population instead of that of the community and are
usually higher than community scores. Only high scoring HPSAs qualify for National Health Service Corps
providers. MUA/MUPs also scores but they are not commonly used to determine program eligibility or
preference.
More information
On February 29, 2008, the federal Health Resources and Services Administration proposed to merge the
Primary Care HPSA and MUA designations into one using a new formula. Public comment for that proposal is
scheduled to close on April 29th, 2008. At this point we do not know the potential effect of the proposed
changes on the communities we are privileged to serve.
More information on shortage designations is available at
• Bureau of Primary Health Care's Shortage Designation Branch
• National Health Service Corps
• The California Office of Statewide Health Planning and Development Shortage Designation Program and
• The Federal Register, listing the proposed changes
Below is a document we wrote for the Central Valley Health Network about HPSAs that might be useful in
understanding them. Please feel free to share this work but attribute it accordingly.
understanding them. Please feel free to share this work but attribute it accordingly.
| Shortage Designations: Why They Are Important and How to Get them |
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| Shortage Designation Links What's my HPSA status? What's my MUA status? Why are HPSAs important? |