INDIANA SHORTAGE DESIGNATIONS

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INDIANA SHORTAGE DESIGNATIONS

• Raymond J. Guest, M.P.H.
• Primary Care Office Manager
• Indiana State Department of Health

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Definitions
Agencies

• PCO
• PCA
• OSD
• HRSA
• NHSC
• CMS

Primary Care Office (ISDH)
Primary Care Association (IPHCA)
Office of Shortage Designation
Health Resources Services Administration
National Health Service Corps
Centers for Medicare Medicaid Services
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Definitions
Types of Designations

• HPSA
• MUA
• MUP

Health Professional Shortage Area
Medically Underserved Area
Medically Underserved Population
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Designations Needed for Selected Federal Programs
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 only X 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
Governors Exception MUP X X
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Application Process

• Determine Rational Service Area (RSA)
• Determine Contiguous Service Areas
• Identify providers (Local Help Needed)
• Collect data.

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Application Process

• Determine Rational Service Area (RSA)
• Single County
• Multi-county or Catchment Area
• Partial County
• Census Tracts
• Townships

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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)

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Application Process

• Designation of a geographic area or population?
• Geographic area
• Population

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Application Process

• Designation of a geographic area or population?
• Populations that can be designated
• Low-income/poor
• Migrant farm workers
• Homeless
• Medicaid eligible
• et al.

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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

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Application Process

• Identify Providers
• Primary Care Physicians
• Family/General Practice
• General Internal Medicine
• General Pediatric Medicine
• OB/GYN
• Geriatric Medicine
• Immediate care physicians

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Application Process

• Identify Providers
• Dentists who provide direct patient care
• General Dentistry
• Pediatric Dentistry

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Application Process

• Identify Providers
• Core Mental Health Providers (CMHP)
• Psychiatrists
• Clinical Psychologists
• Clinical Social Workers
• Psychiatric Nurse Specialists
• Marriage and Family Therapists

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Application Process

• Collect demographic data
• Race
• Poverty
• Infant Mortality Rate
• Age (65)
• Low-Income

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Application Process

• Survey providers
• In RSA
• In Contiguous Service Areas

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Application Process

• Analysis
• Are all the qualifications met?

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Application Process

• Analysis - Qualifications for RSAs
• PC-HPSA Geographic
• 35001 pop to provider ratio
• PC-HPSA Population
• 30001 pop to provider ratio
• 30 of population must be at or below 200 of
  poverty

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Application Process

• Analysis - Qualifications for RSAs
• Dent-HPSA Geographic
• 50001 pop to provider ratio
• Dent-HPSA Population
• 40001 pop to provider ratio
• 30 of population must be at or below 200 of
  poverty

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Application Process

• Analysis - Qualifications for RSAs
• Ment-HPSA Geographic
• 30,0001 psychiatrists only
• 9,0001 CMHP including psychiatrists
• 6,0001 CMHP and or gt 20,0001 psychiatrists

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Application Process

• Analysis Qualifications for RSAs
• Ment-HPSA Population
• 20,0001 psychiatrists only
• 6,0001 CMHP including psychiatrists
• 4,5001 CMHP and gt 15,0001 psychiatrists
• 30 of population must be at or below 200 of
  poverty

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Application Process

• Analysis - Qualifications for Contiguous Areas
• Barriers to access
• Distance
• Physical barriers
• Socio-Economic disparities
• Contig Area has or gt designation
• Self Identified neighborhood
• Overutilization

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Application Process

• Analysis Qualifications for Contiguous Areas
• For Primary Care HPSAs,
• no resources within 30 min
• For Dental Mental HPSAs
• no resources within 40 min.

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Application Process

• Analysis - Qualifications for Contiguous Areas
  Overutilization
• Population to provider ratios
• PC gt 2,0001
• Dent gt 3,0001
• Ment gt 20,0001 (psychiatrists) or
• Ment gt 3,0001 (CMHP) gt10,0001
  (psychiatrists)

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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

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Medically Underserved Area (MUA)
Variable Value WV
V1. Poverty 10.5 20.0
V2. gt65 pop 12.2 19.1
V3. IMR 13.1 21.5
V4. Prov/1000 pop .151 .5
Total Score 61.1
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Application Process

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

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Resources

• ISDH web site
• http//www.in.gov/isdh/publications/llo/shortages
  /shortage.htm
• Official Designation Database
• http//hpsafind.hrsa.gov/
• Natl Health Service Corps
• http//nhsc.bhpr.hrsa.gov

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Contact

• Natalie Brown, MPH
• Shortage Designations and National Health Service
  Corps Program Director
• Indiana Primary Health Care Assoc.
• nbrown_at_indianapca.org
• [phone]

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Contact

• Raymond J. Guest, MPH
• Primary Care Office Manager
• Indiana State Department of Health
• rguest_at_isdh.in.gov
• [phone]