V' CALCULATING POPULATION TO PROVIDER RATIOS

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V. CALCULATING POPULATION TO PROVIDER RATIOS
--------------------------------------------------
Mental Health Care
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CALCULATING POPULATION TO PROVIDER RATIOS
(MENTAL HEALTH CARE)
--------------------------------------------------
Objective Participants will understand how
to 1) Identify mental health providers 2)
Calculate full-time-equivalency rates, and 3)
Determine the population to provider ratios for
mental health geographic and population
designations
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Mental Health Designations
--------------------------------------------------

• 1) Psychiatrists Only, or
• 2) Core Mental Health Providers (CMHP)1,
  including
• Psychiatrists
• Clinical Psychologists
• Clinical Social Workers
• Psychiatric Nurse Specialists
• Marriage and Family Therapists
• ¹ - Must include all of these for this type of
  designation

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Population to Provider Ratios Needed for
Designation (MENTAL HEALTH CARE)

• Geographic Area
• A rational service area - MSSA, combine 1
  or more MSSAs, or whole county
• gt 30,0001 psychiatrists, or
• gt 9,0001 CMHP including psychiatrists, or
• gt 6,0001 CMHP including psychiatrists and gt
  20,0001 psychiatrists

--------------------------------------------------
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Population to Provider Ratios Needed for
Designation (Continued)
--------------------------------------------------
Geographic Area w/Unusually High Needs
A rational service area plus one of the following
a) 20 or more of the population is lt 100 of
the poverty level, or b) The youth ratio (
of persons lt 18 to the of adults ages 18 - 64)
is greater than 0.6, or c) The elderly
ratio ( of persons gt 65 to the of adults ages
18- 64) is greater than 0.25, or d)
Alcohol or substance abuse prevalence data
showing the area to be in the worst quartile
of the nation, state, or region

• gt 20,0001 psychiatrists, or
• gt 6,0001 CMHP including psychiatrists, or
• gt 4,5001 CMHP including psychiatrists and
  gt 15,0001 psychiatrists

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Low-Income Population
--------------------------------------------------

• Number of individuals in the service area that
  are at or below 200 of the Federal poverty level
  
• Must be gt30 of the population in the service
  area
• Source 2005 Claritas Population Estimates

gt 20,0001 psychiatrists, or gt 6,0001
CMHP including psychiatrists, or gt 4,5001
CMHP including psychiatrists and gt 15,0001
psychiatrists
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Contiguous Areas areOver-utilized if
--------------------------------------------------
gt 20,0001 psychiatrists, or gt
3,0001 CMHP including psychiatrists and gt
10,0001 psychiatrists
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POPULATION SIDE OF THE RATIO
--------------------------------------------------
(SAME AS PRIMARY HEALTH CARE)

________________

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PROVIDER SIDE OF THE RATIO
--------------------------------------------------

____

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STEPS
--------------------------------------------------

• 1) Identify all mental health providers for the
  type of designation being sought in the area to
  be designated
• 2) Determine the number of hours each provider
  works inpatient care (office and follow-up
  hospital inpatientcare) serving the population
  to be designated
• 3) Calculate the FTE for each mental health
  providerserving the population to be designated
• 4) Calculate the population to provider ratio

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STEP 1
--------------------------------------------------
Identify all mental health providers for the
type of designation being sought in the area to
be designated.
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Core Mental Health Providers(CMHP)
--------------------------------------------------
Includes I. Psychiatrists II. Clinical
Psychologists III. Clinical Social Workers IV.
Psychiatric Nurse Specialists V. Marriage and
Family Therapists
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I. Psychiatrist
--------------------------------------------------
A doctor of medicine (M.D.) or doctor of
osteopathy (D.O.) who
a) is certified as a psychiatrist or child
psychiatrist by the American Medical Specialties
Board of Psychiatry and Neurology or by the
American Osteopathic Board of Neurology and
Psychiatry or, if not certified, is board
eligible (i.e. has successfully completed an
accredited program of graduate medical or
osteopathic education in psychiatry or child
psychiatry) and
b) practices patient care psychiatry or child
psychiatry, and is licensed to do so if required
by the State of practice.
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II. Clinical Psychologist
--------------------------------------------------
a) An individual with a doctorate in psychology
who is practicing as a clinical or counseling
psychologist and is licensed or certified to do
so by their State of practice or
b) if licensure or certification is not State
required, the individual must have a doctorate in
psychology and two years of supervised clinical
training or counseling experience (excluding
school psychologists).
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III. Clinical Social Worker (CSW)
--------------------------------------------------
a) Is certified as a CSW by the American Board of
Examiners in Clinical Social Work or is listed
on the National Association of Social Workers
Clinical Register, or has a masters degree in
social work and two years of supervised clinical
experience and
b) is licensed to practice as a social worker if
required by the State of practice.
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IV. Psychiatric Nurse Specialist
--------------------------------------------------
A registered nurse who
a) Is certified by the American Nurses
Association as a psychiatric and mental health
clinical nurse specialist, or has a masters
degree in nursing with a specialization in
psychiatric/mental health and two years of
supervised clinical training and
b) is licensed to practice as a psychiatric or
mental health nurse specialist if required by the
State of practice.
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V. Marriage and Family Therapist (MFT)
--------------------------------------------------
a) An individual with a masters or doctoral
degree in marriage and family therapy and at
least two years of supervised clinical experience
who is practicing as a MFT and is licensed to do
so if required by the State of practice or
b) if licensure or certification is not State
required, is eligible for clinical membership in
the American Association for Marriage and Family
Therapy.
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List all Psychiatrists or CMHPs who
--------------------------------------------------

• Provide mental health care in the service area
• Provide direct care or consultation and
  supervision
• Practice in ambulatory or other short term
  care settings2
• 2 Usually defined as lt 2 weeks average length of
  stay.

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Include
--------------------------------------------------

• All psychiatrists or CMHP (including
  psychiatrists) who provide patient care in the
  service area, including those who
• 1) Serve in State Scholarship or Loan Repayment
  Programs
• 2) Serve at Indian Health Clinics and are not
  Federal providers
• 3) Plan on retiring but are still seeing
  patients

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FTE Exclusions from Survey
--------------------------------------------------

• Mental health providers engaged solely in
  research, administration, or teaching
• Mental health hospital staff involved
  exclusively in inpatient or
• emergency room care
• Mental health providers with full-time staff
  positions in correctional institutions, youth
  detention facilities, residential treatment
  centers for children with emotional or
  developmental disabilities, and inpatient units
  of State or County mental hospitals
• Psychiatrists who are suspended under provisions
  of the Medicaid- Medicare Anti-Fraud and Abuse
  Act for 18 months or more

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Include in Survey, but Exclude in FTE
--------------------------------------------------

• Mental health providers who serve in the NHSC
  Scholarship or Loan Repayment Programs (FTEs will
  include State Loan Repayment Program recipients)
  
• Physicians who are graduates of foreign medical
  schoolwho are not citizens or lawful permanent
  residents(including those with J-1or H-1B visas)
• Mental health providers who are Federal providers
  (e.g. Commissioned Officers at Indian Health
  Services or Bureau of Prisons)

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Include in Survey, but Exclude in FTE (cont)
--------------------------------------------------

• Mental health providers who are planning on
  retiring but are still seeing patients
• Note All providers who meet these
  qualifications should be listed, even
  if their FTE will be 0.

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Sources of Provider Data
--------------------------------------------------

• State Licensure Lists
• National, State, and Local Professional
  Association Directories
• Medicare and Medicaid Practitioner
• Lists
• Local Telephone Directory Yellow Pages
• Commercially Developed Listings

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STEP 2
--------------------------------------------------
Determine the number of hours eachprovider
works in out-patient care (this includes office
visits and follow-up hospital in-patient care)
serving the population to be designated.
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Designation Types and Whom To Include in the
Provider Count
--------------------------------------------------

• Designation Type Count all psychiatrists or
  other CMHP (inc.
• Psychiatrists) who serve all persons
• Geographic in the service area
• Low-Income in the service area that have
  incomes
• Population lt 200 of the Federal poverty level
  (Medicaid and Sliding Fee)
• Medicaid-Eligible in the service area that are
  
• Population Medicaid-eligible
• Migrant Farmworker in the service area that are
  migrant
• Population farmworkers
• Native American/ in the service area that are
  Native
• Native Alaskan American or Native Alaskan
• For each provider, include the number
  of hours of patient care provided

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Providers
--------------------------------------------------

• Location of Hours of Direct
• Provider Name Specialty Practice/CT Pt.
  Care/Week3
• 1) S. Freud, M.D. Psychiatry 5 Oedipal
  Lane 20
• City, CA 90001
• 2) C. Jung, M.D. Psychiatry 11 Dream
  Drive 40 City, CA 90001
  
• 3) H. Lecter, Ph.D. Clinical 6 Can Street
  26
• Psychology City, CA 90021
• 4) M. Houlihan, R.N. Psychiatric 1400
  Captain Avenue 55
• Nursing City, CA 90003
• 5) R. Weisheimer, M.S. Marriage Fam. 69
  Shex Street 10
• Counseling City, CA. 90009
• 6) L. Schlessinger, M.S.W. Clinical Social 1
  Radio Road 6

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STEP 3
--------------------------------------------------

• Calculate the FTE for each mental health
• provider serving the population to be
• designated.

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FTE Calculation
--------------------------------------------------

• 40 hours 1.0 FTE
• Every 4 hours (½ day) is counted as 0.1 FTE
• A provider serving more than 40 hours a week is
  counted as 1.0 FTE
• A provider whose hospital hours are unknown is
  counted as a 1.0 (no adjustment factor)
• Each providers FTE is rounded to the nearest
  tenth of a percent prior to totaling
• Examples 0.875 0.9 0.817 0.8
• 0.83 0.8 0.85 0.9
• Psychiatric interns and residents are counted as
  0.5 FTE (40 hours 0.5 FTE)

Note The FTE for low-income population
designations is based on the average number of
hours per week spent with Medicaid and SFS
patients. It is not based on whether the
provider is accepting new Medicaid patients.
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All appropriate providers providing mental
health services in the service area 40
hours 1.0 FTE)? Adjust FTE based on number
of hours of direct patient care? Hours may be
less than full time due to administrative duties,
research, teaching, semi-retirement, or
infirmity? If less than full time due to
provision of services in another location,
calculate based on the number of hours of direct
care provided in the service area ?
Providers in facilities or institutions that
provide both inpatient and outpatient
services will only be counted for the number of
hours in outpatient units or other
short-term care units. ? Psychiatric interns
and residents - count as 0.5 FTE (40 hours 0.5
FTE)? Physicians who are graduates of foreign
schools who are citizens or lawful permanent
residents but have restricted medical licenses
are counted as 0.5 FTE (40 hours 0.5 FTE)
INCLUDE IN THE FTE COUNT
--------------------------------------------------
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Providers under contract with the NHSC Federal
Scholarship or Loan Repayment Programs (This
does not apply to providers in State loan
repayment or scholarship programs.)? Other
Federal providers (e.g. Commissioned Officers at
IHS or BOP sites, etc.)? Physicians who
are graduates of foreign schools who are not
citizens or lawful permanent residents (including
those with J-I or H1-B visas.)
INCLUDE IN APPLICATION BUT EXCLUDE FROM FTE
COUNT
--------------------------------------------------
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DO NOT INCLUDE IN APPLICATION OR FTE COUNT

• Providers engaged solely in administration,
  research, or teaching? Hospital staff
  physicians involved exclusively in in-patient or
  emergency room care? Providers with
  full-time staff positions in correctional
  institutions,
• youth detention facilities, residential
  treatment centers for children with
  emotional or developmental disabilities, and
  in-patient
• units of State or County mental hospitals?
  Providers who are suspended under provisions of
  the Medicaid-
• Medicare-Anti-Fraud and Abuse Act for a
  period of 18 months or
• more

--------------------------------------------------
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FTEs Geographic Designation
--------------------------------------------------
Total Psychiatrists 2 Total Psychiatrist FTE
1.0 Total Core Mental Health Providers 6 Total
Core Mental Health FTE 3.2 ¹ - Must include
hospital hours (for psychiatrist only) ² - Dr.
Jung is in his last year of residency and is
therefore counted as 0.5
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FTEs Low-Income Designation
--------------------------------------------------
(20/40.5)
(301545)
(40/401.5)
(.45x.5.2250.2)
(26/40.65)
(.85x.65.550.6)
(501060)
(.60x1.0.60.6)
(55/401.371)
(10/40.25)
(.30x.25.075.1)
(25530)
(6/40.15)
(.10x.15.0150.020)
Total Psychiatrists 2 Total L-I Psychiatrist
FTE 0.2 Total Core Mental Health Providers
6 Total L-I Core Mental Health FTE 1.5
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Survey Providers
--------------------------------------------------
Survey all mental health providers in the
service area for the type of designation being
sought (psychiatrists only or all CMHP)

• Must include hospital hours (psychiatrist)
• Minimum two-thirds response rate required

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Calculate Non-Responders
--------------------------------------------------
Use survey average (minimum two-thirds response
rate required) Example Sacramento, California
- 80 providers 60 - respond to survey 20 - no
response after repeated telephone calls
(Response rate 60/80 75) Total FTE for
the 60 responders 28 FTEs 1) Divide FTE of
responders (28) by the number of responders (60)
for the average FTE of responders (.46) 2)
Multiply number of non-responders (20) by the
average FTE of responders (.46) for FTE of
non-responders (9.3) 3) Add FTE of responders
(28) and non-responders (9.3) for total FTE
38.0
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STEP 4
Calculate the population to provider ratio.
--------------------------------------------------
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Population to Provider Ratio
--------------------------------------------------
2 Possible Ratios Psychiatrists
Core Mental Health Providers Step 1
Determine if area has high need Youth ratio
5,881/11,483 .51 (min. gt .6) Elderly ratio
3,681/11,483 .32 (min. gt .25) Indicates
High Need
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Population to Provider Ratio
--------------------------------------------------
Geographic Mental HPSA Resident/Civilian
Population Ratio Resident/Civilian Population
20,900 Psychiatrist FTE 1 (20,900 / 1
20,9001) Psychiatrist Ratio 20,9001 CMHP
FTE 3.2 (20,900 / 3.2 6,5311) CMHP Ratio
6,5311
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Population to Provider Ratio
--------------------------------------------------
Geographic Mental HPSA with High
Needs Resident/Civilian Population (High Needs)
Ratio Resident/Civilian Population 20,900
Psychiatrist FTE 1 (20,900 / 1
20,9001) Psychiatrist Ratio 20,9001 CMHP
FTE 3.2 (20,900 / 3.2 6,5311) CMHP Ratio
6,5311
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Population to Provider Ratio
--------------------------------------------------
Low-Income Mental HPSA Low-Income Population
(200 Poverty) Ratio Low-Income Population
10,137 (49.47) Psychiatrist FTE 0.2 (10,137
/ 0.2 50,6851) Psychiatrist Ratio
50,6851 CMHP FTE 1.5 (10,137 / 0.2
6,7581) CMHP Ratio 6,7581
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What to Include In the Population Provider Ratio
Mental Health Care Section of Your Application
--------------------------------------------------

• Population
• Total adjusted population
• Source of data
• List of Providers
• Include the Following for Each Provider
• Name
• Location
• Non-metro areas - name of town
• Metro areas complete address with zip code,
  and CT if available
• Degree (M.D., MFT, R.N., M.S.W., etc.)
• Average of hours/week of patient care in area
• Verification that hospital hours are included
• of practice Medicaid (for low-income and
  Medicaid-eligible designations)
• of practice Sliding Fee Scale (for low-income
  designations)
• FTE total for each provider rounded to the
  nearest tenth of a percent
• Description of how information was obtained
  (source, method)

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What to Include In the Population Provider Ratio
Mental Health Care Section of Your Application
(continued)
--------------------------------------------------

• Totals and Ratio
• Total number of providers
• Total FTE
• Explanation of any high need indicators
• Population to provider ratio

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What Not To Include In Your Application
--------------------------------------------------

• Information on the weather or climate
• Information on road conditions, construction, or
  number of avalanches
• Personal statements of driving time
• Average number of funerals
• History of the early settlers of the area
• Newspaper articles
• Pictures of the mayor
• General information on access issues that is not
  specific to the area or population
• Copies of old applications

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Contiguous Area Resources
--------------------------------------------------
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Contiguous Area Resources
--------------------------------------------------
Objective Participants will understand how to
identify contiguous areas, determine if they
have resources, and if the resources are
excessively distant, over-utilized, or
inaccessible to the population of the area
proposed for designation
Purpose of Contiguous Area Analysis To
identify nearby sources of care and determine if
they are inaccessible to the population in
the proposed service area
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STEPS
--------------------------------------------------

• 1) Identify the boundaries of eachcontiguous
  area.
• 2) Evaluate each area to determine
  availability of resources.

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Identify the boundaries of each contiguous area
--------------------------------------------------
A. Identify on a map the boundaries and
population center of the proposed servicearea B.
Determine the contiguous areas in all
directions within 40 minutes from the
proposed areas population center C. Map the
boundaries of each contiguous area in all
directions (North, East, South, West)
Boundaries The boundaries of each contiguous area
may be based on

• Travel time (40 minutes)
• Socio-economic/demographic characteristics
• Established neighborhoods
• Physical barriers
• Designated HPSA

The boundaries of contiguous areas are often (not
always) based on the same census delineation as
the proposed area Proposed service area whole
county Contiguous areas whole
counties Proposed service area census tracts
(MSSA) Contiguous areas census tracts (MSSA)
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PROCESS OF EVALUATING AVAILABILITY OF RESOURCES
--------------------------------------------------

• A) Check the HPSA list to determine if any of
  the contiguous areas are designated as
• HPSA and therefore considered
  inaccessible.
• If it is not a HPSA, then
• Determine if there are significant
  socio-economic/demographic disparities or
  physical
• barriers
• If there are no significant socio-economic/demogr
  aphic disparities orphysical barriers, then
• C) Determine if the contiguous areas providers
  are located gt 40 minutes away from the population
  center of the proposed area and are therefore
  inaccessible due to excessive distance
• If they are not excessively distant, then
• D) Determine if the resources in the contiguous
  area exceed the population-to-provider ratio and
  are therefore over-utilized
• If they are not over-utilized, this area cannot
  be designated.
• (Consider a different kind of designation)

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A) Check the HPSA status of the contiguous
areas and determine if this type of HPSA
is inaccessible to the proposed area
--------------------------------------------------
If the proposed service area is Then the
contiguous area is inaccessible if it
is a
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B) Determine if Significant Socio-economic/Demog
raphic Disparities or Physical Barriers
Exist
Significant demographic disparities between the
population in the service area and the population
in the contiguous area which result in the
population being isolated from nearby
resources (A 30 or more disparity between the
population in the service area and the population
in the contiguous area)
--------------------------------------------------
Significant socio-economic disparities 100
poverty rate or 200 poverty rate (A 30 or more
disparity between the population in the service
area and the population in the contiguous area)
Significant physical barrier mountains, large
parks, bodiesof water, highways, railway yards,
industrial areas, etc. which result in the
population being isolated from nearby resources
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C) Determine If Providers Are Excessively
Distant
--------------------------------------------------

• Develop a list of providers in the contiguous
  area,
• Map their office locations
• Determine the travel time from the proposed
  areas population center to the contiguous area
• Providers gt 40 minutes from the population
• center are excessively distant

Mental Health Care gt 40 minutes Interstate Roads
- 30 miles X 1.33 40 minutes Primary Roads - 25
miles X 1.6 40 minutes Secondary Roads - 20
miles X 2.0 40 minutes
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C) Determine If Providers Are Excessively
Distant (continued)
--------------------------------------------------
Inner Portions of Metropolitan Areas Distance
is based on time using public transportationdurin
g non-rush hour. Bus routes and schedules must
be described (provide narrative description and
include bus schedule if possible).
(Use only if the service area has
population greater than 20 _at_ 100
poverty)
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• D) Determine if Contiguous Areas Are
  Overutilized
• Calculate FTE - use the same method as used for
  the proposed service area.
• If needed, survey providers and determine FTE
  serving the population. Use the same surveying
  method as used for the proposed service area.
• Explain how the information was obtained and
  calculated, and
• include population, total FTE, and
  population to provider ratio

--------------------------------------------------
Population to Provider Ratios MENTAL HEALTH
CARE gt 20,0001 psychiatrist orgt 3,0001 CMHP
and gt 10,0001 psychiatrist
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Example
--------------------------------------------------
Whole County Map Analysis 55-63
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Whole County Identify on a map the
boundaries and population center of the proposed
service area.
--------------------------------------------------
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Whole County
--------------------------------------------------
Proposed Area Lassen County (Susanville)
  Summary Total Pop 34,708 White Pop
81.52 Black Pop 8.91 Hispanic
Pop 14.80 Below 200 Pov 25.12 Below
100 Pov 10.30 65 year or older Pop
8.02 Elderly Ratio Youth Ratio
Based on Total Population (Not Civilian
Pop.)
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Whole County A) Identify the contiguous areas
in all directions within 40 minutes from the
proposed areas population center B) Map the
boundaries of each contiguous area in all
directions (N, E, S, W)
--------------------------------------------------
Area 1 (N) Modoc County Area 2 (E) Washoe
County, NV Area 3 (S) Plumas County Area 4
(S) Sierra County Area 5 (W) Shasta County
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Whole County Identify the boundaries and
population center of the proposed service area.
--------------------------------------------------
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Whole County (Contiguous Areas)
--------------------------------------------------
Area 1 (N) Modoc County (Alturas) (Excessively
Distant 103.7 miles/166 minutes) Summary
Res./Civ. Pop 8,890 White Pop
90.74 Black Pop
0.63 Hispanic Pop 12.01 Below 200 Pov
45.64 Below 100 Pov 21.64 Elderly Ratio
0.28 Youth Ratio
0.37 HPSA No Travel Time 103.7
miles/166 min.  
Proposed Area Lassen County (Susanville)   Summa
ry Total Pop 34,708 White
Pop 81.52 Black Pop
8.91 Hispanic Pop
14.80 Below 200 Pov 25.12 Below
100 Pov 10.30 Elderly Ratio
0.11 Youth Ratio
0.27 Based on Total Population (Not Civilian
Pop.)
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Whole County (Contiguous Areas)
--------------------------------------------------
Area 2 (E) Washoe County, Nevada State
(Reno) (Excessively Distant 85.9 miles/137
minutes) Summary Res./Civ. Pop
382,256 White Pop
81.06 Black Pop 2.40 Hispanic
Pop 20.06 Below 200 Pov
28.42 Below 100 Pov
7.51 Elderly
Ratio 0.16 Youth Ratio 0.39 HPSA
No Travel Time 85.9 miles/137 min.  
Proposed Area Lassen County (Susanville)   Summa
ry Total Pop 34,708 White
Pop 81.52 Black Pop
8.91 Hispanic Pop
14.80 Below 200 Pov 25.12 Below
100 Pov 10.30 Elderly Ratio
0.11 Youth Ratio
0.27 Based on Total Population (Not Civilian
Pop.)
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Whole County (Contiguous Areas)
--------------------------------------------------
Area 3 (S) Plumas County (Quincy) (Excessively
Distant 69.2 miles/111 minutes) Summary
Res./Civ. Pop 20,781 White Pop
92.81 Black Pop .68 Hispanic Pop 6.09
Below 200 Pov 31.21 Below 100 Pov
12.98 Elderly Ratio
0.27 Youth Ratio
0.31 HPSA No Travel Time 69.2 miles/111
min.  
Proposed Area Lassen County (Susanville)   Summa
ry Total Pop 34,708 White
Pop 81.52 Black Pop
8.91 Hispanic Pop
14.80 Below 200 Pov 25.12 Below
100 Pov 10.30 Elderly Ratio
0.11 Youth Ratio
0.27 Based on Total Population (Not Civilian
Pop.)
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Whole County (Contiguous Areas)
--------------------------------------------------
Area 4 (S) Sierra County (Loyalton) (Excessivel
y Distant 79 miles/126 minutes) Summary
Res./Civ. Pop 3,430 White Pop
94.99 Black Pop 0.20 Hispanic
Pop 8.78 Below 200 Pov 31.02 Below 100
Pov 11.31 Elderly Ratio
0.23 Youth Ratio
0.30 HPSA No   Travel Time 79 miles/126
min.    
Proposed Area Lassen County (Susanville)   Summa
ry Total Pop 34,708 White
Pop 81.52 Black Pop
8.91 Hispanic Pop
14.80 Below 200 Pov 25.12 Below
100 Pov 10.30 Elderly Ratio
0.11 Youth Ratio
0.27 Based on Total Population (Not Civilian
Pop.)
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Whole County (Contiguous Areas)
--------------------------------------------------
Area 5 (W) Shasta County (Redding) (Excessively
Distant 112 miles/179 minutes) (Inaccessible
Designated Mental HPSA) Summary Res./Civ. Pop
175,026 White Pop 89.82 Black Pop
0.94 Hispanic Pop 7.14 Below 200 Pov
36.60 Below 100 Pov 15.42 Elderly Ratio
0.22 Youth Ratio
0.38 HPSA Low-Income Mental
HPSA Travel Time 112 miles/179 min.  
Proposed Area Lassen County (Susanville)   Summa
ry Total Pop 34,708 White
Pop 81.52 Black Pop
8.91 Hispanic Pop
14.80 Below 200 Pov 25.12 Below
100 Pov 10.30 Elderly Ratio
0.11 Youth Ratio
0.27 Based on Total Population (Not Civilian
Pop.)
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Sample HPSA Worksheets
--------------------------------------------------
Whole County
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Determine the Nearest Source of Non-Designated
Care
--------------------------------------------------

• Needed for HPSA score
• Cannot be a HPSA (of any type)
• Cannot have significant socio-economic/demograph
  ic differences or physical barriers
• Can be excessively distant
• Can be overutilized
• For all applications
• Provide a road map with the proposed service
  area and contiguous areas outlined
• On the map, indicate the population center of
  the proposed service area, the nearest
• source of care, and the route between these
  points
• Provide the name and address of the nearest
  source of care, route, miles, and minutes
• For inner portions of metropolitan areas,
  include
• Bus route information from the population
  center of the proposed area to the nearest
• source of care
• Miles and minutes of travel time

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Time Saving Tips Survey providers only if
necessary
--------------------------------------------------

• In contiguous areas, calculate the population
  to provider ratio
• counting each provider as 1.0 FTE. If area
  meets ratio of
• gt 20,0001, dont survey.
• Collect all possible information in one survey
  (e.g. Medicaid and
• sliding fee scale even for an area
  designation).
• Work with State licensing department to obtain
  information on
• providers.
• Use claims data for Medicaid FTE (works only in
  fee-for-service
• Medicaid).

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What To Include In The Contiguous Area Resources
Section of Your Application
--------------------------------------------------

• Map with Census Delineations
• Name and boundaries of proposed service area
• Name and boundaries of contiguous areas
• Population center for the proposed service area
• Helpful current designation status of each of
  the contiguous areas

• Road Map
• Outline of proposed area boundaries
• Location of nearest source of non-designated
  care
• For automobile transportation - start, end, and
  route
• For public transportation - start and end
  points of route

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--------------------------------------------------
For Contiguous Areas that are not Excluded with
Current Designations and Whose Providers are
Excessively Distant

• Travel time to closest provider from
  population center of service area, including
  miles,
• route, and type of road or public
  transportation information, including bus routes,
  
• start/end points, miles, minutes, and
  source include bus schedule if available.

For Contiguous Areas that are not Excluded with
Current Designations and have Access Barriers

• Description of any significant
  socio-economic/demographic disparities (e.g.
  demographic data on racial/ethnic composition
  or income levels comparing proposed
  service area population to population in the
  contiguous area, and source of data), or
• Description of any significant physical barrier

For Contiguous Areas that are not Excluded with
Current Designations and are Overutilized

• Population to provider ratios
• Description of how information was obtained

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--------------------------------------------------

• For All Designation Requests
• Address of nearest source of non-designated,
  accessible care, including address, miles
  and minutes via public transportation if
  metropolitan area
• Location of nearest source on road map (see
  above)

• For Public Transportation Routes
• Travel time, based on non-rush hour bus
  schedules
• Start/End point of route
• Include time waiting for transfers while in
  route
• Map showing proposed area boundaries, start
  and end points of bus route
• Bus schedules, if available
• Cite source of information

(Public transportation can be used for service
areas with a 100 poverty population at or
greater than 20 of the civilian population.)
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75
Websites
--------------------------------------------------
Bay Area Public Transit (San Francisco) http//tr
ansit.511.org/index.asp Southern California
Public Transit (San Diego) http//www.sdcommute.c
om/ Los Angeles County Metropolitan
Transportation Authority http//www.metro.net/defa
ult.asp 2000 CT Locator http//www.ffiec.gov/Geo
code/default.aspx U.S. Census Bureau American
Factfinder http//factfinder.census.gov/home/saff/
main.html?_langen
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Process Model for Mental Health Professional
Shortage Area Designation
To Use Follow arrows. Numbers are reference
citations only. Refer to correspondingly
numbered pages following for additional
information on steps in numbered
boxes
Define Rational Service Area
1
CHMP Core Mental Health Professional Psych
Psychiatrist
Determine Service Area Population
2
POPCMHP gt 60001 and POPPsych gt 200001
Determine Core Mental Health Profession (CMHP)
FTEs
POPCMHP gt 45001 and POPPsych gt 150001
or
or
3
Evaluate Contiguous Area
Evaluate Service Area for High-Need Indicators
POPCMHP gt 90001
POPCMHP gt 60001
5
6
or
Calculate Population-to- CMHP
Population-to-Psych Ratio
or
POPPsych gt 200001
POPPsych gt 300001
4
1 or more High Need Indicators Present
NO High-Need Indicators Present
POPCMHP gt 45001 and POPPsych gt 150001
1 or more High Need Indicators Present
No contiguous area conditions met
or
POPCMHP gt 60001
Evaluate Contiguous Area
or
POPPsych gt 200001
5
APPLY FOR DESIGNATION
STOP Area Not Qualified For Designation
1 or more contiguous area conditions met
No contiguous area conditions met
STOP Area Not Qualified For Designation
7
8
8
STOP Area Not Qualified For Designation
APPLY FOR DESIGNATION
8
7
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77
HPSA and MUA/MUP Application ProcessShortage
Designation Program (SDP)

• Initial Contact
• Applicant contacts SDP for technical assistance
  (TA) and information. SDP provides
• TA on appropriate designation
• Maps
• Population and demographic data
• Survey samples
• Application worksheets

• 1st Step Application Received (Lal)
• Log application on tracking database
• Assign case number
• Mail acknowledgment letter

3rd Step Application Analysis (complete within
90 days, depending on caseload)

• 2nd Step 30-day Comment Notice to (Oakes)
• County Health Officer/ Department/Medical
  Society
• Primary Care, Dental, or Mental Health
  Association
• HRSA/SDB copied
• Case assigned to SDP staff (Chung)

or

• Dental Mental HPSA
• (Manual Process)
• Define rational service area (MSSA)
• Verify population, poverty, demographic
  data
• Geo-code and verify provider data
• Calculate population to provider ratio
• Verify contiguous area resources
• Develop proposed and contiguous area maps
• Determine data is accurate, current, and
  consistent with all HPSA criteria
• If application is incomplete, request
  additional data and allow applicant 15 days
  for re- submission.
• Prepare recommendation packet to Federal
  Shortage Designation Branch (SDB)
• Submit packet for peer review
• Submit packet for Manager review and approval
  (Chung)
• Mail recommendation packet to SDB and copies
  to applicant others (Oakes)
• Update tracking database (Lal)

• 4th Step - HRSA Review (SDB)
• Hold all recommendations for 30-day waiting
  period
• Perform primary and secondary reviews
• Upon approval or denial, post designation on
  HRSA on-line database
• Send designation letter to SDP and applicant

• Primary Care HPSA and MUA/MUP (ASAPS Process)
• Validate application information before
  entering data into ASAPS (use on-line tools
  maps, data tables, MSSA data)
• Verify provider data
• Calculate population to provider ratio
• Conduct contiguous area analysis in mapping
  interface (does not apply to MUA/MUP)
• If application is incomplete, request
• additional data and allow applicant 15 days
  for resubmission.
• Verify and enter all additional data needed
• Prepare notification letter to applicant
• Prepare ASAPS packet for Managers review
  and approval (Chung)
• Upon completion, Manager submits
  recommendation via ASAPS
• Mail ASAPS packet to applicant and others
  (Oakes)
• Update tracking database (Lal)

• 5th Step SDP Tracking Update
• Update SDP tracking database (Lal)
• File designation letter in program file (Lal)
• Create monthly dynamic maps (Dixon/Pham)

NOTE HPSA designations are valid for 4 years. To
maintain the HPSA status, designees must reapply
every 4 years. MUA/MUP designations are
permanent, unless there is a change in the MSSA
boundary then designees must be reapply for the
updated boundary.
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