AN OVERVIEW OF SHORTAGE DESIGNATIONS IN MICHIGAN &

THEIR SIGNIFICANCE IN PROGRAMS BENEFITTING RHCS AND

PROVIDERS

Presented By: Amber Myers, MPH & Miguelina Z. Carela-Garcia, MPH

Workforce/Access & Grants Management

Office of Policy, Planning & Legislative Services

Michigan Department of Health and Human Services (MDHHS)

May 3, 2018

TODAY’S OBJECTIVES

• Background of the shortage designations in MichiganBackground

• Describe the components of the designation processDescribe

• Explain the different types of shortage designations and their scoring criteriaExplain

• Illustrate where are located the shortage designations in MichiganIllustrate

• Provide examples of the use of these designations in federal and state programs.Provide

STATE PRIMARY

CARE OFFICES

(PCO)

• State level offices that facilitate and participate in activities to improve access to health care services for residents of their state, through a Cooperative Agreement managed by the federal agency of Health Resources and Services Administration (HRSA):

• There are currently 54 PCOs nationwide in both states and U.S. territories.

• Funding authority for the PCO cooperative agreement is authorized under Title 3, Sections 330 and 333, of the Public Health Service Act, as amended.

PRIMARY CARE OFFICE (PCO)

ORGANIZATIONAL CHART

MDHHS

Director

Chief Medical Executive

Senior Chief Deputy Director

Policy, Planning & Legislative Services

Office of Planning

Workforce/Access Section

Office of Recipient Rights

Office of Inspector General

PRIMARY CARE OFFICE (PCO)

FOUR KEY PROGRAM AREAS

Shortage

Designation

Coordination

Provider

Recruitment

& Retention

Access to

Primary

Care

Services

PCO

• HPSA/MUA Designation Process

• Statewide Primary Care Needs

Assessment

• Coordination of NHSC Program

• MSLRP

• Foreign Born Medical Graduate

Programs

• J-1 Visa Waiver Program

• National Interest Waiver

• Health Center Planning &

Development

• Collaborates With Other

Statewide Entities

• Supports the Free Clinics Program

• Rural Health InitiativesHealth

Planning

SHORTAGE DESIGNATIONS

Definition,

Types,

Components

of the

Designation

Process and

Scoring

Criteria

DEFINITION

Identification of an area, population group, or facility experiencing a

shortage of health services and providers.

There are two main types of shortage designations, each

linked to several federal and state programs.

TYPES OF SHORTAGE DES IGNATIONS

HPSA (Health Professional Shortage Area)

MUA/P (Medically Underserved Area/Population)

A shortage of: Limited access to:

Providers in a: Services in a:

HPSA DESIGNATION CRITERIA

While each type of HPSA designation has its own distinct rules, there are several cross-cutting factors that go into any designation application.

To achieve a HPSA designation, the area under consideration must:

• Be a Rational Service Area (RSA)

• Have a certain population to providers ratio

• Demonstrate that health professionals in contiguous areas are excessively distant, over-utilized, or inaccessible to the population under consideration.

RATIONAL SERVICE

AREA

A state-identified geographic area within which most area residents could or do seek and obtain most

of their health care services.

RSAs can be:

• A whole county;

• Multiple counties;

• Sub-counties (but not smaller than a census tract);

• Statewide Rational Service Areas (SRSA); or

• Catchment areas (for mental health only).

RATIO OF POPULATION TO PROVIDERS

HPSA Primary

Care

Dental

Health

Mental Health

Geographic 3,500:1 5,000;1 6,000:1 & 20,000:1 (CMH and Psych)

9,000:1 (CMH only)

30,000:1(Psych only)

Geographic “High

Needs”Certain high-need indicators are

present

3,000:1 4,000:1 20,000:1 (CMH and Psych)

6,000:1 (CMH only)

Population 3,000:1 4,000:1 4,500:1 & 15,000:1 (CMH and Psych)

6,000:1 (CMH only)

20,000:1 (Psych only)

Facility 1,000:1 1,500:1 2,000:1 (Psych only) 6,000:1 (CMH only)

If there are NO eligible

providers in the RSA, certain

minimum population

requirements

Min Pop 500 Min Pop 1,000 Min Pop 3,000

CMH= Core Mental Health Providers & Psych= Psychiatrists

ANALYS IS OF CONTIGUOUS

AREA (C A) AND NEAREST SOURCE

OF C ARE (NSC)

CA= All whole counties, multiple counties, or sub-

counties that border the RSA under

consideration for designation.

Excessively distant providers?

Over-utilized?

Inaccessible providers?

Demographic disparity?

Economic barriers?

NSC is used to determine the time and distance the population of the RSA must travel to seek care outside of

the RSA.

FACILITY HPSA DESIGNATIONS

• PCOs are able to submit applications for

some Facility HPSA designations, such as:

• State Correctional Institutions (medium or

maximum security)

• State and County Mental Health Hospitals

• Public or Non-Profit Private Medical Facility

(OFACS) or other public facility which HRSA

determines has shortage of primary health

care providers.

AUTOMATIC FACILITY HPSA

• Using the statute and regulations,

HRSA has deemed the following facility

types as eligible for automatic HPSAs:

• Health Center (funded under Sec. 330,

e.g. FQHC)

• Health Center Look-Alikes

• Tribally-Run Clinics

• Urban Indian Organizations

• Tribal Health Centers (Dual-Funded)

• Federally-run Indian Health Service

Clinics

• CMS-Certified Rural Health Clinics

(RHCs)-Meeting NHSC* site

requirements

*National Health Service Corps

AUTO HPSAS VS. OTHER HPSAS

Other HPSAs Auto-Facility HPSAs

Designation & Scoring done online in

SDMS (Shortage Designation System)

Designation & Scoring done manually by

HRSA

Criteria used to first designate as HPSA No application process necessary

Criteria used to determine HPSA score Same criteria used to determine HPSA

score as other HPSAs

Score range from 0-25 (26 for dental) Same scoring range used

Designations are reviewed and updated

as necessary annually

HRSA has not historically required Auto-

HPSA scores to be reviewed; current

updates must be requested by the facility

or PCO

Score of “0” is rare Score of “0” more frequent and means low

shortage or no available data for scoring

MUA/P DESIGNATION CRITERIA

• To achieve this designation, the area under consideration must:

• Be a rational service area (following same guidance as for HPSA RSAs).

• Contain information on the following four criteria:

• Primary care physicians per 1,000 population;

• Percent of population at or below the 100% Federal Poverty Level (FPL);

• Percent of the population > 65 years; and

• The Infant Mortality Rate (IMR) of the area.

• Receive an Index of Medical Underservice (IMU) composite score of ≤ 62.0.

• IMU ≤62.0: Qualifies for designation

• IMU >62.0: Does NOT qualify for designation

GOVERNOR’S EXCEPTIONAL MUA/P

• Areas with an IMU score of greater than 62.0 may still qualify as a special type of MUA/P if:

• there’s an unusual, documented local conditions that prevent access to, or demonstrate the lack of, personal health services.

• A state governor can recommend, and a PCO can then request, an exceptional MUP for a population that demonstrates need but does not meet the regular criteria for designation.

• Such requests must also include a written recommendation for designation from the governor or other chief executive officer of the state (or state-equivalent) and local health official, as well as any supporting data.

SCORING PROCESS

Once designated, HRSA scores HPSAs on a scale of 0-25 for primary medical care and mental health disciplines, and 0-26 for dental health, with higher scores indicating greater need.

MUA/P designations has a different scoring process with a scale from 0-100, where 0 represents completely underserved and 100 represents best served or least underserved area or population group.

HPSA SCORING CRITERIA

• HPSAs scores are based on a variety of factors, and it differs within

each discipline and designation type. These are the main factors:

HPSA SCORING CALCULATIONS

MUA/P SCORING CRITERIA

• Based on an Index of Medical Underservice (IMU) composite score of ≤ 62.0.

• IMU ≤62.0: Qualifies for designation

• IMU >62.0: Does NOT qualify for designation

DATA SOURCES & PROVIDER UPDATES FOR DESIGNATION

• Most of the data utilized for the designation process is federally provided

data in the system, from the: CDC, U.S. Census and SDMS-ESRI data

• State level data is required for some special population designations – for

the population to provider ratios, certain facilities designations and for

some health indicators: water fluoridation, substance and alcohol abuse

prevalence, among others

• What You Can Do

• Provider data are critical to designations and their scores (Data source originates

from the National Provider Identifier (NPI) file maintained by the CMS).

• These provider records need to be validated/updated throughout the

designation process through surveys, online resources and community

collaborations.

SHORTAGE DESIGNATIONS IN MICHIGAN

• As of January 1st, 2018,

there was a total of 1,027

shortage designations in

Michigan:

• 913 designated Health

Professional Shortage Areas

(HPSAs), and

• 114 designated Medically

Underserved

Areas/Populations (MUAs/Ps).

MICHIGAN’S HPSA & MUA/P

HPSAs Total

Designations

Geographic

Area

Population

Group

Facility

Primary Care 361 27 51 283

Dental Health 283 1 60 222

Mental Health 269 51 3 215

Total 913 79 114 720Data Source: HRSA Data Warehouse, as of 01/01/2018. Available at:

https://datawarehouse.hrsa.gov/topics/shortageAreas.aspx

State Total

Designations

MUAs MUPs Governor

Michigan 114 89 11 14

Data Source: HRSA Data Warehouse, as of 01/01/2018. Available at:

https://datawarehouse.hrsa.gov/topics/shortageAreas.aspx

Shortage Designations: State and Federal Programs Using HPSAs and MUAs/PsShortage Designation

Type

National

Health

Service Corps

(NHSC)

NURSE

Corps

State Loan

Repayment

Program

Health

Center

Program

CMS

Medicare

Incentive

Payment

CMS Rural

Health

Clinic

Program

J-1 Visa

Waiver

Program

Primary Care

Geographic HPSA X X X X X X

Population HPSA X X X X X

Facility HPSA X X X X

Dental Care

Geographic HPSA X X

Population HPSA X X

Facility HPSA X X

Mental Health

Geographic HPSA X X X X X

Population HPSA X X X X

Facility HPSA X X X X

Medically Underserved

Area (MUA)

X X X

Medically Underserved

Population (MUP)

X X

“Governor’s”

Exceptional MUP

(Unique Local

Conditions)

X X

State Governor’s

Certified Shortage Area

X

More information is available at: https://bhw.hrsa.gov/shortage-designation/types

Michigan Primary Care Office (PCO)

RESOURCES FOR RECRUITMENT AND RETENTION IN RURAL AREAS

• Conrad State 30 Program

• Medical Opportunities in Michigan

• Michigan’s Rural Recruitment and Retention Network (3RNet)

• Michigan State Loan Repayment Program

• National Health Service Corps Loan Repayment Program

• National Health Service Corps Scholarship Program

• National Interest Waiver Program

• Rural Health Clinic Certification

Bhw.hrsa.gov. (2018). Shortage Designation | Bureau of Health Workforce. [online] Available at: https://bhw.hrsa.gov/shortage-designation [Accessed 15 Mar. 2018].

Shortage Designation Management System (SDMS): Manual for Policies and Procedures. (2017). Health

Resources & Services Administration (HRSA), pp.1-75. Shortage Designation Management System (SDMS): Mapping Tool User Guide. (2017) . Health Resources

& Services Administration (HRSA), pp.1-87. Shortage Designation Management System (SDMS): Facility Form User Guide. (2016). Health Resources &

Services Administration (HRSA), pp.1-50. Primary Care Office (PCO) Portal: Shortage Designation Management. (2017). Health Resources & Services

Administration (HRSA), pp.1-79. Auto-HPSA Scoring: A Review Webinar. (2018). Health Resources & Services Administration (HRSA)

REFERENCES/RESOURCES USED TO PREPARE THIS PRESENTATION

CONTACT INFORMATION

• If you are interested in applying for a new designation or updating a current designation, please contact the state Primary Care Office (PCO) for assistance.

• PCO Director: Amber Myers, myersa1@michigan.gov, 517-284-4981HPSA Contact: Miguelina Carela-Garcia, CarelaGarciaM@michigan.gov, 517-284-4982

• Auto-HPSAs: To request a score or rescore, email SDB@hrsa.gov

• For more contact information, including loan repayment programs, visit: https://bhw.hrsa.gov/shortage-designation/hpsa/primary-care-offices

• To find HPSA information by address or county please visit the HPSA find website at -https://datawarehouse.hrsa.gov/tools/analyzers/HpsaFind.aspx