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Panel Presentation

Panel Presentation. Shortage Area Designations Larry Allen, Center for Rural Health Elizabeth Cobb, KY Hospital Association Steve Salt, KY Department for Public Health. ORIGIN OF SHORTAGE DESIGNATIONS. Health Professional Shortage Area

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Panel Presentation

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  1. Panel Presentation Shortage Area Designations Larry Allen, Center for Rural Health Elizabeth Cobb, KY Hospital Association Steve Salt, KY Department for Public Health

  2. ORIGIN OF SHORTAGE DESIGNATIONS • Health Professional Shortage Area • National Health Service Corps (NHSC) was created in 1971 • NHSC need determination process was expanded in 1978 to include poverty, infant mortality rate or birthrate and access barrier measures • This expanded methodology is the current HPSA designation methodology • Required to be reviewed every three years

  3. ORIGIN OF SHORTAGE DESIGNATIONS • Medically Underserved Areas or Populations (MUA/P) • MUA/P process was developed in 1975 to create grant opportunities for Community Health Centers (CHCs) • MUA/P process uses similar measures as the HPSA but also includes % 65 years and older • MUA/Ps have no review requirement – DESIGNATION FOR LIFE!

  4. DESIGNATION REQUIREMENTS FOR CERTAIN FEDERAL PROGRAMS

  5. HPSA DESIGNATION PROCESS • Calculate the population to provider ratio • Must meet threshold of 3500:1 • Consider contiguous areas • Identify on the map the boundaries and population center of the proposed service area • Evaluate each area to determine the availability of resources • If area meets ratio requirement AND you can rule out service availability in all contiguous areas, a recommendation is made to HRSA for designation

  6. Recent Policy Changes HRSA Policy

  7. Recent Changes • HRSA Proposed Changes in 1998 and 2008 – Never made final • ACA 0f 2010 requires changes to the shortage area designation methodology • Negotiated Rule Making Process (June 2011) • If no consensus, Secretary to publish an Interim Final Rule for new methodology (June 2012)

  8. “Negotiated Rulemaking” • What is it? • Statutory basis: Negotiated Rulemaking Act of 1996 encouraged the use of negotiation to determine complicated regulations and directed agencies and negotiated rulemaking committees to “use consensus to the maximum extent possible consistent with law.”

  9. “Negotiated Rulemaking” • Who was involved? • Secretary Kathleen Sebelius made appointments summer 2010 • Criteria for selection : 28 experts representing • Community Health Centers, rural health clinics and health care practitioners, • Representatives of special populations with unique health care needs, • Technical experts in the area of research in health care access and statistical methods • State Offices of Rural Health and Primary Care • Role of DHHS/HRSA: One representative on the NRMC – Ed Salsberg, support staff in regular attendance

  10. Timeline and Progress of the Negotiated Rulemaking • Secretary Sebelius appointed members July 2010 • First meeting – September 2010 • Completion by July 1 and then… • Extension granted • Final meeting – October 2011 (14 month process) • Final Report to Secretary October 31, 2011

  11. Sub-committees and Work Groups Tackling the content areas: • Measuring “underservice” • Population and providers for “P2P” – Population to Provider Ratios • Counting providers, deciding on “back outs” • Population counts and age/sex adjustments, other issues • Health Status • Barriers • Ability to Pay • Updating “rational service area” definition • Considering Data Sources and Validity

  12. Notable Concern: “Yo-Yo Effect” • Need to exclude federally supported providers from the provider to population count: • NHSC • SLRP • FQHC • RCH

  13. Next Steps • Report submitted to the Secretary 10/31/2011 • “Interim Final Rule” to be posted…. • Comments – will be accepted -- but HRSA does not have to change the Interim Final Rule • Those organizations and entities represented by Committee members will not comment adversely on sections on which there was consensus, but may comment on areas on which there was not consensus

  14. Concerns and Advocacy Efforts • Concerned future changes will be similar to previous proposal by HRSA which would have adversely impacted Kentucky • Need a more pro-active effort to influence the process • Need to educate lawmakers and others on the impact to Kentucky

  15. PCO Designation Role • Designated by HRSA to evaluate at state level • HPSAs required to be reviewed every 3 years • Methodology and data sources required by HRSA • Activities to ensure accuracy • Work with stakeholders to exhaust all efforts

  16. Policy On Publication in FR • Proposed for withdrawal, not published in Federal Register • Some availability of designation benefits • November 2011, began publishing regularly

  17. Published Withdrawal in Nov. 3, 2011 Federal Register • Anderson • Barren • Breathitt • Clark • Cumberland • Daviess • Fayette • Fleming • Greenup • Johnson • Laurel • Lawrence • Marion • Perry • Shelby • Trimble • Warren • Webster • Whitley • Hickman

  18. (1) On (or about) Sept., 25, the PCO will send an e-mail recommending a County HPSA be withdrawn because the Population to Provider Criteria was not met. • (2) In mid-October HRSA will prepare the list of P’s (Proposed for Withdrawals) and N’s (No information forthcoming from the PCO =Proposed for Withdrawal). This list will be shared with the PCO’s to double check the information is correct. • (3) In November, HRSA will check the list of HPSAs Proposed for Withdrawal against the list of NHSC individual and site applications. (HRSA will not impact pending NHSC matches-vacancies by a change in HPSA status). • (4) In November, the HPSAFIND (HRSA website) status will be changed to Proposed Withdrawal.

  19. HPSA Federal Register Notice Update Schedule

  20. Data Sources • American Community Survey – • large national survey • uses continuous measurement methods to produce detailed population estimates each year • Current survey information from period 2006-2010

  21. 2011-2012 HPSA Activity Adair 2012-5 Bath 2012-12 Nicholas -Withdrawn Bracken ???? Breckinridge 2012-15 Ohio 2012-9 Caldwell – PW Carter 2011-6 Robertson 2011-14 Clay 2011-13 Crittenden 2012-11 Russell 2012-5 Elliott 2011-9 Estill – PW Todd 2012-13 Green – PW Harlan (partial) 2012-16 Washington 2011-11 Hart – PW Jackson 2012-14 Wayne 2012-11 Jefferson 2011-8 Knox 2012-11 Wolfe - PW Larue 2011-11 Leslie 2012-14 Lewis 2012-8 Livingston – Withdrawn Logan 2012-11 Lyon 2012-6 Madison – PW Magoffin 2011-11 Marion 2011-10 McLean 2012-10 Meade ???? Menifee 2011-13 Metcalfe 2012-16 Muhlenberg - PW

  22. Recent Trends • Overview of gains and losses for 2011-2012 • Sample designation profiles

  23. HPSA Determination: Hart

  24. HPSA Determination – Hart 2

  25. HPSA Determination – Hart 3 Contiguous Areas

  26. HPSA Determination: Wolfe County

  27. Panel Questions?

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