an overview of shortage designations in michigan …
TRANSCRIPT
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
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:
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, [email protected], 517-284-4981HPSA Contact: Miguelina Carela-Garcia, [email protected], 517-284-4982
• Auto-HPSAs: To request a score or rescore, email [email protected]
• 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