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II. Rational Service Areas

II. Rational Service Areas. --------------------------------------------------. (HPSA - RSAs). II-1. HPSA - Rational Service Areas (HPSA - RSAs). --------------------------------------------------. Objective : Participants will understand:

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II. Rational Service Areas

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  1. II. Rational Service Areas -------------------------------------------------- (HPSA - RSAs) II-1

  2. HPSA - Rational Service Areas (HPSA - RSAs) -------------------------------------------------- Objective: Participants will understand: 1)The characteristics of a health professional shortage area/rational service area 2) The criteria used to determine if a service area is rational. II-2

  3. Health Professional Shortage Area (HPSA) -------------------------------------------------- Origin: National Health Service Corps (NHSC) (Measures the shortage of health professionals in an area) • Componentsa) Rational Service Area (RSA)b) Population to Provider Ratioc) Contiguous Area Analysis • Disciplinesa) Primary Medical Careb) Dental Health Carec) Mental Health Care • Type of Designationsa) Areab) Population Groupc) Facility II-3

  4. Types of Rational Service Areas(Applies to all types HPSA and MUA/MUP designations) -------------------------------------------------- • Medical Service Study Areas (MSSAs) – recognized byHRSA’s Shortage Designation Branch (SDB) as rational services areas • Whole County • Sub-County • Catchment Areas • (mental health only) II-4

  5. Rational Service Areas -------------------------------------------------- • Cannot: • 1)  Overlap • 2) Have more than one HPSA designation per discipline (e.g., geographic and low-income population) • 3) Be smaller than a census tract • Exceed travel time between population centers • Have interior portions carved out II-5

  6. “What is an MSSA?” II-6

  7. A. MSSA Definitions -------------------------------------------------- Adopted by the California Healthcare Workforce Policy Commission on May 15, 2002 • Each MSSA is composed of one or more complete census tracts. • MSSAs will not cross county lines. • 3) All population centers within the MSSA are within 30 minutes travel time to the largest population center. II-7

  8. A. MSSA Definitions (Continued) -------------------------------------------------- Urban MSSA: • Population range 75,000 to 125,000 • Reflect recognized community and neighborhood boundaries • Similar demographic and socio-economic characteristics Rural MSSA: • Population density of less than 250 persons per square mile • No population center exceed 50,000 Frontier MSSA: • Population density of less than 11 persons per square mile II-8

  9. “Why MSSA?” II-9

  10. Problem MSSAs Address -------------------------------------------------- California has 58 counties with wide ranging differences in size and population • U.S. Census Bureau recognizes whole counties as rural or urban. • Rural portions of counties such as San Bernardino, Riverside, Los Angeles, and Butte are declared as urban. • California’s cities have wide disparities in income and health status. II-10

  11. Rationale for MSSAs -------------------------------------------------- Advantages of sub-county / sub-city areas • Better means of determining rural and urban areas in California • Better means of determining demographic/socio-economic differences and recognizing health disparities • Better means of identifying healthcare access in medically underserved communities II-11

  12. Major Uses of MSSAs -------------------------------------------------- • U.S. Public Health Service recognizes MSSAs as “rational service areas” for purposes of determining Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas/Medically Underserved Population (MUAs/MUPs). • MSSAs are a principal component for display of large databases through OSHPD’s Geographic Information System (GIS). • MSSAs have the potential for assisting in needs assessment, health planning, and health policy development. II-12

  13. Types of MSSA -------------------------------------------------- • Whole County MSSA • Sub-County MSSA II-13

  14. Whole County -------------------------------------------------- II-14

  15. Sub-County -------------------------------------------------- II-15

  16. Service Area Travel Calculation -------------------------------------------------- Primary Health CareInterstate Roads: 25 miles X 1.2 = 30 minutes Primary Roads (include surface streets): 20 miles X 1.5 = 30 minutes Secondary Roads (mountainous terrain or unpaved road): 15 miles X 2.0 = 30 minutes Dental and Mental Health CareInterstate Roads: 30 miles X 1.33 = 40 minutes Primary Roads (include surface streets): 25 miles X 1.6 = 40 minutesSecondary Roads (mountainous terrain or unpaved road) 20 miles X 2.0 = 40 minutes Mapping Sources Used By SDB: Rand McNally Road Atlas, Maps On Us (www.mapsonus.com) II-16

  17. Mapping Sources -------------------------------------------------- Rand McNally Road Atlas or Rand McNally on-line: www.randmcnally.com or Maps on Us on-line: www.mapsonus.com II-17

  18. (Use travel calculation from Pages II-16) Primary Care 17 miles x 1.5 min = 26 minutes Dental & Mental 17 miles x 1.6 min = 27 minutes II-18

  19. B. Mental Health Catchment Area -------------------------------------------------- Since California does not have mental health catchment areas, MSSAs are used for purposes of designating mental health HPSAs. Service areas can be: 1)   An MSSA 2) One or more MSSAs combined – travel time between each MSSA must be within 40 minutes and population no more than 475,000 3) Whole county - maximum population no more than 475,000. II-19

  20. Completion of the “Census 2000” MSSA Reconfiguration in Record Time II-20

  21. Before • “Census 1990”: - ~5,000 census tracts - 29.7 million population • It took 2 years Rural MSSAs = 213 Urban MSSAs = 274 Total MSSAs = 487 -------------------------------------------------- After • “Census 2000”: - 7,049 census tracts - 33.8 million population • It took 9 months with the GIS Redistricting Tool Frontier MSSAs = 56 Rural MSSAs = 186 Urban MSSAs = 299 Total MSSAs = 541 II-21

  22. II-22

  23. MSSA Reconfiguration: Step-by-Step -------------------------------------------------- 1) Organized selected 2000 census data in 1990’s MSSA configuration 2) Examined total population, square miles, income information, and demographic data 3) Noted areas defined as “rural” and as “urban”   a) The MSSA was “rural” if any census defined place within the MSSA has a population of 50,000 or more   b) The MSSA was “rural” if the density exceeds 250 person per square mile II-23

  24. MSSA Reconfiguration: Step-by-Step -------------------------------------------------- • 4) Determined if there were contiguous census tracts within a defined “urban MSSA” that, if separated from the urban MSSA, would stand alone as a “rural MSSA”. Determined if community stakeholders supported creating a new rural MSSA. • 5) Determined the population and area (in square miles) of urban MSSAs within the county. • Ascertained whether the urban MSSA was greater than five square miles. If it was not, then one or more adjacent census tracts was added to increase the area to five square miles or greater. II-24

  25. MSSA Reconfiguration: Step-by-Step -------------------------------------------------- • If the total population of the urban MSSA exceeded 200,000 it was divided into at least two “urban MSSA subdivisions” that had a population range no less than 75,000 and no more than 125,000. • Ascertained that each urban MSSA subdivision was within at least five square miles in area. If not, then one or more adjacent census tracts was added to increase the area to five square miles or greater, even if the resulting population of the urban MSSA exceeded 125,000 II-25

  26. MSSA Reconfiguration: Step-by-Step -------------------------------------------------- 7) Once consensus (or substantial agreement) among the stakeholders was reached on MSSA reconfiguration, OSHPD prepared a draft motion for the California Healthcare Workforce Policy Commission (CHMPC), which was circulated among the stakeholders in the county. II-26

  27. MSSA Reconfiguration Adoption Process -------------------------------------------------- • Changes to the boundaries of MSSAs can only be made through motions adopted by the California Healthcare Workforce Policy Commission (CHMPC). • Any such motions will be agenda items of CHMPC and should be accompanied support letters from community officials and stakeholders. II-27

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