INDIANA SHORTAGE DESIGNATIONS Raymond J. Guest, M.P.H

1

INDIANA SHORTAGE

DESIGNATIONSRaymond J. Guest, M.P.H.

Primary Care Office Manager

Indiana State Department of Health

2

Definitions

PCO PCA OSD HRSA NHSC CMS

National Health Service Corps

Centers for Medicare & Medicaid Services

Health Resources & Services Administration

Primary Care Office (ISDH)

Primary Care Association (IPHCA)

Agencies

Office of Shortage Designation

3

Definitions

HPSA

MUA

MUP

Health Professional Shortage Area

Medically Underserved Area

Medically Underserved Population

Types of Designations

4

NHSC SLRP FQHC Program

CMS Medicare Incentive

Payment Program

CMS Rural Health Clinic

Program

J-1 Visa Waiver

Program

Primary Care HPSA X X

Geographic

onlyX X

Dental HPSA X X

Mental HPSA

X X

Geographic

only,

ask CMS

X

HPSA Subtypes

Geographic HPSA X X X X X

Population HPSA X X X X

Facility HPSA X X X

MUA X X X

MUP X X

Governor’s Exception MUP

X X

Designations Needed for Selected Federal Programs

5

Application Process

Determine Rational Service Area (RSA)

Determine Contiguous Service Areas

Identify providers (Local Help Needed)

Collect data.

6

Application Process

Determine Rational Service Area (RSA)

Single County

Multi-county or Catchment Area

Partial County

Census Tracts

Townships

7

Application Process

Facility Designations HPSA Designation of Facilities Prisons Medical Facilities (i.e. Community Health Centers)

Automatic HPSA Designation of Facilities Federally Qualified Health Centers (FQHC) Rural Health Centers (RHC)

8

Application ProcessDesignation of a geographic area or population?

Geographic areaPopulation

9

Application ProcessDesignation of a geographic area or population?

Populations that can be designated:Low-income/poor

Migrant farm workers

Homeless

Medicaid eligible

et al.

10

Application Process

Preliminary Analysis Determine Contiguous Service Areas

20 mile polygon for Primary Care HPSAs

25 mile polygon for Dental & Mental HPSAs

No contiguous analysis for MUA/Ps

11

12

Application ProcessIdentify Providers

Primary Care Physicians

Family/General Practice

General Internal Medicine

General Pediatric Medicine

OB/GYN

Geriatric Medicine

Immediate care physicians

13

Application Process

Identify Providers

Dentists who provide direct patient care

General Dentistry

Pediatric Dentistry

14

Application Process

Identify Providers

Core Mental Health Providers (CMHP)

Psychiatrists

Clinical Psychologists

Clinical Social Workers

Psychiatric Nurse Specialists

Marriage and Family Therapists

15

Application Process

Collect demographic data

Race

Poverty

Infant Mortality Rate

Age (65+)

Low-Income

16

Application Process

Survey providers

In RSA

In Contiguous Service Areas

17

Application Process

Analysis

Are all the qualifications met?

18

Application Process

Analysis - Qualifications for RSAs PC-HPSA – Geographic

3500:1 pop to provider ratio PC-HPSA – Population

3000:1 pop to provider ratio 30% of population must be at or below 200% of

poverty

19

Application Process

Analysis - Qualifications for RSAs Dent-HPSA – Geographic

5000:1 pop to provider ratio Dent-HPSA – Population

4000:1 pop to provider ratio 30% of population must be at or below 200% of

poverty

20

Application Process

Analysis - Qualifications for RSAs

Ment-HPSA Geographic 30,000:1 psychiatrists only 9,000:1 CMHP including psychiatrists 6,000:1 CMHP and = or > 20,000:1 psychiatrists

21

Application Process

Analysis – Qualifications for RSAs Ment-HPSA Population

20,000:1 psychiatrists only 6,000:1 CMHP including psychiatrists 4,500:1 CMHP and > 15,000:1 psychiatrists 30% of population must be at or below 200% of

poverty

22

Application Process

Analysis - Qualifications for Contiguous Areas Barriers to access

Distance Physical barriers Socio-Economic disparities Contig Area has = or > designation Self Identified neighborhood Overutilization

23

Application Process

Analysis – Qualifications for Contiguous Areas For Primary Care HPSAs,

no resources within 30 min For Dental & Mental HPSA’s

no resources within 40 min.

24

25

Application Process

Analysis - Qualifications for Contiguous Areas Overutilization Population to provider ratios

PC > 2,000:1 Dent > 3,000:1 Ment > 20,000:1 (psychiatrists) or Ment > 3,000:1 (CMHP) + >10,000:1 (psychiatrists)

26

Application Process

Analysis – Qualifications for MUA/Ps MUA & MUP– Score of 62 or less

Variables % of Population in Poverty % of Population 65 & over Infant Mortality Rate Providers per 1000 population

27

Medically Underserved Area (MUA)

Variable Value WV

V1. Poverty 10.5% 20.0

V2. >65 pop 12.2% 19.1

V3. IMR 13.1 21.5

V4. Prov/1000 pop .151 .5

Total Score 61.1

28

Application Process

Review Identify RSA & Contig Areas Identify providers Survey providers Analysis Submission to OSD Designation

29

Resources

ISDH web site

http://www.in.gov/isdh/publications/llo/shortages/shortage.htm

Official Designation Database

http://hpsafind.hrsa.gov/

Nat’l Health Service Corps

http://nhsc.bhpr.hrsa.gov

30

ContactNatalie Brown, MPH

Shortage Designations and National Health Service Corps Program

Director

Indiana Primary Health Care Assoc.

nbrown@indianapca.org

(317) 630-0845

31

ContactRaymond J. Guest, MPHPrimary Care Office Manager

Indiana State Department of Health

rguest@isdh.in.gov

(317) 233-7846