VII. MUA/MUP

1
VII. MUA/MUP
--------------------------------------------------
VII-1
2
Medically Underserved Areas (MUA) Medically
Underserved Populations (MUP)
--------------------------------------------------

• Objective
• Participants will understand
• 1) The difference between MUAs MUPs
• 2) The information required for a complete
  submission
• 3) How each factor is weighted and scored to
  determine
• a final Index of Medical
  Underservice (IMU) Score

VII-2
3
Designation Requirements for Selected Federal
Programs
Shortage Designation Option National Health Service Corps Federally Qualified Health Center Program Medicare Incentive Payment Rural Health Clinic Program J-1 Visa Waiver
Primary Care HPSA (Area only) X X X X
Primary Care HPSA (Population Only) X X X
Dental Care HPSA (Area Population) X
Mental Health HPSA (Area only) X X X
Mental Health HPSA (Population only) X X
Facility HPSA X X
Medically Underserved Area X X X
Medically Underserved Population X X
State Governors Certified Eligible Area (for RHC purposes only) X (Not in CA)
VII-3
4
MUA Criteria
--------------------------------------------------

• Origin HMO program and Community/Migrant Health
  Centers (C/MHC)
• Measures the degree of underservice of an area
  (MUA) or a population (MUP)
•  
• 1. Component
•   Rational Service Area (RSA)
•  
• 2. Criteria and Weighted Values
•   a) V1 Percent of Population at 100 Poverty
• b) V2 Percent of Population gt 65
• c) V3 Infant Mortality Rate (IMR)
• d) V4 Primary Care Physicians per 1,000
  Population
•  
• 3) Index of Medical Underservice
•   Value must be lt 62.0

VII-4
5
MUP Criteria
--------------------------------------------------

•  
• 1. Component
•   Rational Service Area (RSA)
•  
• 2. Criteria and Weighted Values
•   a) V1 Percent of Population at 100 Poverty
• b) V2 Percent Population gt 65
• c) V3 Infant Mortality Rate
• d) V4 Primary Care Physician serving the
  low-income pop (200 poverty level) per 1,000
  low-income population
•  
• 3. Index of Medical Underservice
•   Value must be lt 62.0

VII-5
6
STEPS
--------------------------------------------------

• 1. Determine the Rational Service Area (use MSSA)
• 2. Assemble data
• a) Percent of the population at the 100 poverty
  level
• b) Percent of the population gt 65
• c) Infant mortality rate
• d) Primary care physicians per 1,000 population
• 3. Determine weighted values
• 4. Compute the Index of Medical Underservice
  Score

VII-6
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STEP 1
--------------------------------------------------
Determine the Rational Service Area (use MSSA).
VII-7
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Types of MSSAs
--------------------------------------------------

• Medical Service Study Areas (MSSAs)
• Whole County MSSA
• Sub-County MSSA

VII-8
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STEP 2
--------------------------------------------------

• Assemble data on
• a) Percent of the population at the 100 poverty
  level
• b) Percent of the population gt 65
• c) Infant mortality rate (IMR)
• d) Primary care physicians per 1,000 population

VII-9
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STEP 3

• Determine weighted values of

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

• Percent of the population at the 100
• poverty level
• Percent of the population gt 65
• Infant mortality rate (IMR)
• Primary care physicians per 1,000
• population

VII-10
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Step 3a(V1) Percentage Population at 100
Poverty
--------------------------------------------------

• Determine the percentage of the population in
  the area at the 100 poverty level
• Use latest available data (2007 Claritas
  Population Estimates)
• Calculate 100 Poverty
• Number at 100 Federal Poverty Level
• Civilian Population
• Determine the weighed value (see table)1
• 1 This value is the same for both MUAs and
  MUPs

VII-11
12
2007 Claritas Population Estimates (Dashboard)
VII-11
Source HWDD - Access Database
13
Step 3a (V1) Percent Population at 100 Poverty
--------------------------------------------------
Percent Below Poverty Weighted Value
0 25.1
0.1-2.0 24.6
2.1-4.0 23.7
4.1-6.0 22.8
6.1-8.0 21.9
8.1-10.0 21.0
10.1-12.0 20.0
12.1-14.0 18.7
14.1-16.0 17.4
16.1-18.0 16.2
Percent Below Poverty Weighted Value
18.1-20.0 14.9
20.1-22.0 13.6
22.1-24.0 12.2
24.1-26.0 10.9
26.1-28.0 9.3
28.1-30.0 7.8
30.1-32.0 6.6
32.1-34.0 5.6
34.1-36.0 4.7
36.1-38.0 3.4
VII-13
14
Step 3a (V1) Percent Population at 100 Poverty
(continued)
--------------------------------------------------
Percent Below Poverty Weighted Value
38.1-40.0 2.1
40.1-42.0 1.3
42.1-44.0 1.0
44.1-46.0 0.7
46.1-48.0 0.4
48.1-50.0 0.1
50 0
VII-14
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Step 3b (V2) Percentage of Population gt 65
--------------------------------------------------

• Determine the percentage of the population in
  the area gt 65 years old
• Use the latest available data (2007 Claritas
  Population Estimates)
• Calculate percent gt 65 years old
• Number gt 65 years old
• Civilian Population
• Determine the weighted value (see table on next
  page)1
• 1 This value is the same for both MUAs and MUPs

VII-15
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Step 3b (V2) Percent Population gt 65
(continued)
--------------------------------------------------
Percent of Pop gt65 Weighted Value
0 7.0 20.2
7.1-8.0 20.1
8.1-9.0 19.9
9.1-10.0 19.8
10.1-11.0 19.6
11.1-12.0 19.4
12.1-13.0 19.1
13.1-14.0 18.9
14.1-15.0 18.7
15.1-16.0 17.8
Percent of Pop gt65 Weighted Value
16.1-17.0 16.1
17.1-18.0 14.4
18.1-19.0 12.8
19.1-20.0 11.1
21.1-21.0 9.8
22.1-22.0 8.9
22.1-23.0 8.0
23.1-24.0 7.0
24.1-25.0 6.1
25.1-26.0 5.1
VII-16
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Step 3b (V2) Percent Population gt 65
(continued)
--------------------------------------------------
Percent of Pop gt65 Weighted Value
26.1-27.0 4.0
27.1-28.0 2.8
28.1-29.0 1.7
29.1-30.0 0.6
30 0
VII-17
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Step 3c (V3) Infant Mortality Rate (IMR)
--------------------------------------------------

• Use the OSD available data (5-year average) or
  OSD-approved State Department of Health data
• Department of Public Healths Center for
  Health Statistics website http//www.cdph.ca.go
  v/certlic/birthdeathmar/Pages/default.aspx
• Use the IMR for the service area (MSSA) or
  countywide
• Calculate Infant Mortality Rate
• Number of Infant Death
• Number of Live Births
• Determine the weighted value (see table on next
  page)1

x 1,000
1 This value is the same for both MUAs and MUPs
VII-18
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Step 3c (V3) Infant Mortality Rate (IMR)
(continued)
--------------------------------------------------
Infant Mortality Rate Weighted Value
0-8 26.0
8.1-9.0 25.6
9.1-10.0 24.8
10.1-11.0 24.0
11.1-12.0 23.2
12.1-13.0 22.4
13.1-14.0 21.5
14.1-15.0 20.5
15.1-16.0 19.5
16.1-17.0 18.5
Infant Mortality Rate Weighted Value
17.1-18.0 17.5
18.1-19.0 16.4
19.1-20.0 15.3
20.1-21.0 14.2
21.1-22.0 13.1
22.1-23.0 11.9
23.1-24.0 10.8
24.1-25.0 89.6
25.1-26.0 8.5
26.1-27.0 7.3
VII-19
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Step 3c (V3) Infant Mortality Rate
(continued)
--------------------------------------------------
Infant Mortality Rate Weighted Value
27.1-28.0 6.1
28.1-29.0 5.4
29.1-30.0 5.0
30.1-31.0 4.7
31.1-32.0 4.3
32.1-33.0 4.0
33.1-34.0 3.6
34.1-35.0 3.3
35.1-36.0 3.0
36.1-37.0 2.6
Infant Mortality Rate Weighted Value
37.1-39.0 2.0
39.1-41.0 1.4
41.1-43.0 0.8
43.1-45.0 0.2
45.1 0





VII-20
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Step 3d (V4) Providers per 1,000 Population
--------------------------------------------------

• Determine the FTE
• MUA All primary care physicians are counted
• MUP All primary care physicians servicing the
  population group are counted
• Must collect inpatient and outpatient hours
• Determine the population
• MUA civilian population
• MUP number in that population group (e.g.,
  low-income pop pop at or below the
  200 poverty)
• Calculate Providers per 1,000 population
• MUA Total FTE1 MUP Total FTE
  
• Civilian Pop Pop to be
  designated
• Determine the weighted value (see table)

X 1,000
X 1,000
1 All physician must be counted (including J-1
Visa physicians, NHSC physicians, etc.). For
MUA designations, the HPSA adjustment factor for
the FTE is not used.
VII-21
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FTEs - Geographic Designation
--------------------------------------------------
Physician Name Specialty Location of Practice/CT Hours of Direct Patient Care/Week FTE
A. Liver, MD1 General Practice 86 N. Onion StreetCity, State, Zip 48(48/401.21.0) 1.0
B. Spleen MD2 Pediatrics 103 Sanfgroid Dr City, State, Zip 30(30/40.75) 0.75
C. Heart, MD Internal Medicine 777 Stopper AveCity, State, Zip 40 1.0
D. Kidney, DO OB-GYN 3306 Stone DriveCity, State, Zip 40 1.0
E. Lung, DO3 Family Practice 99 Airborne BlvdCity, State, Zip 25(25/40.625) 0.625
Total Physicians 5 Total FTE 4.3754.4
1 Dr. Liver is an NHSC loan repayment recipient
, counted as 1.0 FTE 2 Dr. Spleen spends 10
hours/week doing research 3 Dr. Lung spends 15
hours/ week in administration
VII-22
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FTEs Low-Income Population Designation
--------------------------------------------------
Physician Name Spec. Practice Location Direct Pat. Care Hrs/Wk FTE of Medi-Cal of Sliding Fee of Low-Income Total Low-Inc FTE
A. Liver, MD GP 86 N. Onion StCity, State, Zip 48 1.0 64 15 79 0.79
B. Spleen MD PED 103 Sanfgroid Dr City, State, Zip 30 0.75 35 8 43 0.3225
C. Heart, MD IM 777 Stopper AveCity, State, Zip 40 1.0 60 40 100 1.0
D. Kidney, DO OB/ GYN 3306 Stone DriveCity, State, Zip 40 1.0 13 0 13 0.13
E. Lung, DO FP 99 Airborne BlvdCity, State, Zip 25 0.625 7 0 7 0.04375
Total Physicians 5 Total L- I FTE 2.286252.3
VII-23
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Step 3d (V4) Providers per 1,000 Population
--------------------------------------------------
Left Column find the range which includes the
ratio of primary care physicians per 1,000
population for the area being examined.
PC Physicians per 1,000 pop Weighted Value
0-.05 0
.051-.100 0.5
.101-.150 1.5
.151-.200 2.8
.201-.250 4.1
.251-.300 5.7
.301-.350 7.3
.351-.400 9.0
PC Physicians per 1,000 pop Weighted Value
.401-.450 10.7
.451-.500 12.6
.501-.550 14.8
.551--.600 16.9
.601-.650 19.1
.651-.700 20.7
.701-.750 21.9
.751-.800 23.1
VII-24
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Step 3d (V4) Providers per 1,000 Population
(continued)
--------------------------------------------------
Providers per 1,000 pop Weighted Value
.801-.850 24.3
.851-.900 25.3
.901-.950 25.9
.951-1.000 26.6
1.001-1.050 27.2
1.051-1.100 27.7
1.101-1.150 28.0
1.151-1.200 28.3
1.201-1.250 28.6
Over 1.250 28.7
VII-25
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STEP 4
--------------------------------------------------
Compute the Index of Medical Underservice Score
(IMU).
VII-26
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Compute the Index of Medical Underservice Score
--------------------------------------------------

• The IMU Score is determined by adding the values
  of each of the four factors.
• V1 V2 V3 V4 IMU Score
• IMU lt 62.0
• Qualifies for designation as an MUA/MUP
• IMU gt 62.0
• Does not qualify for designation as an MUA/MUP

VII-27
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Time Saving Tips
--------------------------------------------------

• Before surveying providers, check the IMU score
  of the first 3 variables
• If V1 V2 V3 are gt 62.0, the area will not
  designate as an MUA or MUP
• If the IMU gt 62, then review rational service
  area to determine if other boundaries would be
  appropriate
• If not an MUA, check if area would designate as
  an MUP

VII-28
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MUA/MUP Exercise
--------------------------------------------------
(Example)
VII-29
30
VII-30
31

Source HWDD - Access Database
Percent Population at 100 Poverty Percent Population at 100 Poverty
Percent Below Poverty Weighted Value
0 25.1
0.1 - 2.0 24.6
2.1 - 4.0 23.7
4.1 - 6.0 22.8
6.1 - 8.0 21.9
8.1 - 10.0 21.0
10.1 - 12.0 20.0
12.1 - 14.0 18.7
14.1 - 16.0 17.4
16.1 - 18.0 16.2

Percent Population gt 65 Percent Population gt 65
Percent of Pop gt65 Weighted Value
16.1 - 17.0 16.1
17.1 - 18.0 14.4
18.1 - 19.0 12.8
19.1 - 20.0 11.1
21.1 - 21.0 9.8
22.1 - 22.0 8.9
22.1 - 23.0 8.0
23.1 - 24.0 7.0
24.1 - 25.0 6.1
25.1 - 26.0 5.1
Infant Mortality Rate (IMR) Infant Mortality Rate (IMR)
Infant Mortality Rate Weighted Value
0.0 - 8.0 26.0
8.1 - 9.0 25.6
9.1 - 10.0 24.8
10.1 - 11.0 24.0
11.1 - 12.0 23.2
12.1 - 13.0 22.4
13.1 - 14.0 21.5
14.1 - 15.0 20.5
15.1 - 16.0 19.5
16.1 - 17.0 18.5
Providers per 1,000 Population Providers per 1,000 Population
PC Physicians per 1,000 pop Weighted Value
.000 - .05 0.0
.051 - .100 0.5
.101 - .150 1.5
.151 - .200 2.8
.201 - .250 4.1
.251 - .300 5.7
.301 - .350 7.3
.351 - .400 9.0
VII-31
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1 23
VII-32
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What to Include in the MUA/MUP Application
--------------------------------------------------
VII-33
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What to Include in the MUA/MUP Application
(continued)
--------------------------------------------------
List of Primary Care Physicians

• Name
• Location Non-Metro areas name of
  town Metro area address with zip
  code, CT if available
• Degree (MD or DO)
• Specialty
• Average hours/week of patient care in area
• of practice Medicaid (for low-income,
  Medicaid-eligible, and poverty population
  designations)
• of practice Sliding Fee Scale (for
  low-income, poverty pop designation)
• Inpatient care hours
• FTE total for each provider rounded to the
  nearest tenth of a percent
• Description of how information obtained
  (source, method)

VII-34
35
What to Include in the MUA/MUP Application
(continued)
--------------------------------------------------

• Primary Care Physician per 1,000 Population
• Total FTE
• Primary Care Physician per 1,000 Population
• Calculation

• Other Variables
• Percent at 100 Poverty
• Infant Mortality Rate
• Percent gt 65
• Source of Data

• IMU Score
• Show weighted values for 4 variables
• Show IMU Score
• Do not submit applications for IMU gt 62.0

VII-35
36
Proposed MSSA is 66a
VII-36
37
The orange area is a designated MUA, and part of
the designation is in MSSA 66a and part MSSA 63-
because of this the whole designation can be
thrown out
VII-37
38
Process Model for MUA Designation
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
Determine Service Area Population
2
Calculate Percentage of Population with Income
below the Poverty Level
3
Calculate the Percentage of Population Age 65 or
Over
4
Calculate the Infant Mortality Rate
5
Determine Physician FTE
6
Calculate the Ratio of Population to Primary
Care Physician
7
APPLY FOR DESIGNATION
STOP Area Will Not Qualify
Calculate the IMU Score
62.1 or Above
9
62.0 or Below
8
10
VII-38
39
Process Model for MUP Designation
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
Determine Service Area Population
2
Calculate Percentage of Population with Income
below the Poverty Level
3
Calculate the Percentage of Population Age 65 or
Over
4
Calculate the Infant Mortality Rate
5
Determine Physician FTE
6
Calculate the Ratio of Low Income Population to
Primary Care Physician Serving that Population
7
STOP Area Will Not Qualify
Calculate the IMU Score
APPLY FOR DESIGNATION
62.1 or Above
62.0 or Below
9
8
10
VII-39