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Slide 1: RURAL HEALTH
CLINICS AND SHORTAGE AREAS
WHAT YOU NEED TO KNOW
Andy
Jordan
Shortage Designation Branch
NATIONAL ASSOCIATION OF
RURAL HEALTH
CLINICS
OCTOBER 29, 2004
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Slide 2: TYPES OF SHORTAGE DESIGNATIONS
- HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA)
AND POPULATIONS
- MEDICALLY UNDERSERVED AREAS (MUA)
- GOVERNOR'S CERTIFIED SHORTAGE AREAS
- AUTOMATIC FACILITY HPSAS
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Slide 3: HOW ARE THEY USED?
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Shortage Designation Option
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National Health Service Corps
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Federally Qualified Health Ctr Program
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CMS Medicare Incentive Payment
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CMS Rural Health Clinic Program
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J-1 Visa Waiver
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Primary
Care HPSA
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X
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X
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X
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X
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Dental
Care HPSA
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X
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Mental
Health HPSA
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X
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X
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Geographic
HPSA
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X
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X
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X
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X
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Population
HPSA
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X
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X
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X
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Facility
HPSA
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X
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X
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Automatic
Facility HPSA
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X
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X
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Exceptional
MUP
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X
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X
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Medically
Underserved Area
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X
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X
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X
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Medically
Underserved Population
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X
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X
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State
Governor’s Certified Shortage Area
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X
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Slide 4: Current Primary Care HPSA Criteria
- Rational Service Area
- Population-to-Provider Ratio
- PC Physicians 3,500:1
- 3,000: 1 if High Need
- Poverty > 20%
- Infant Mortality Rate >20 per 1,000
live births
- Fertility Rate > 100 per 1,000 women
aged 15-44
- Contiguous Area Resources not available
- overutilized, excessively distant,
inaccessible
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Slide 5: Medically Underserved Areas (MUA)
- Rational Service Area (RSA)
- Criteria and Weighted Values
- Percent of Population at 100% Poverty
- Percent Population > 65
- Infant Mortality Rate
- Primary care physicians per 1,000 Population
- Index of Medical Underservice
- Value must be < 62.0
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Slide 6: Governor’s Certified Shortage
Area
- Governor or designee establishes State
criteria for designating "Governor's certified shortage
areas for Rural Health Clinic purposes"
- Governor submits criteria to Shortage
Designation Branch (SDB) for review and approval
- SDB reviews, modifies as necessary, then
approves criteria
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Slide 7: Governor’s Certified Shortage
Area (cont.)
- State then submits
Governor-designated areas that meet criteria to SDB for
certification as RHC eligible areas.
- SDB reviews data
and sends certification letter to Governor or designee
- Copy of certification
letter goes to CMS (formerly HCFA), Center for Medicaid
and State Operations, Survey and Certification Group
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Slide 8: IMPORTANT REMINDER!!!
- New CMS regulations require that the
shortages areas used for RHC eligibility must be "UPDATED
WITHIN THE CURRENT YEAR OR THE PREVIOUS 3 YEARS".
- Sites need to be aware of the most recent
date of their designation; this can be found on our web
site www.bhpr.hrsa.gov/shortage
- Office of Rural Health Policy is supporting
assistance for designations through NARHC
- Assistance can also be obtained from
the Primary Care Offices in each state; check www.bphc.hrsa.gov/osnp/PCODirectory.htm
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Slide 9: AUTOMATIC FACILITY HPSAS
- Health Care Safety Amendments of 2002
allow for the automatic designation as HPSAs of Rural Health
Clinics which met certain requirements. Key elements include:
- Services cannot be denied to individuals
unable to pay for services or those covered by Medicaid,
Medicare, or the State Children's Health Insurance Program
(SCHIP)
- Site must have a schedule of fees and
corresponding discounts adjusting for ability to pay
- Sites must accept Medicare assignment
and assure coverage for Medicaid and SCHIP beneficiaries
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Slide 10: HOW DO YOU GET AUTOMATIC HPSA
STATUS?
- Initial letter and Certification form
mailed to RHCs in August 2003
- As of 9/30/04, 512 sites have returned
the forms and been designated as Automatic HPSAs
- Automatic HPSAs are being entered into
the data base and will appear on the SDB Web Site
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Slide 11: HOW DO YOU GET AUTOMATIC HPSA
STATUS? (cont.)
- Scoring of automatic HPSA, for purposes
of NHSC placement priorities, has been completed and scores
are available on the HPSA Web Site; periodic updates are
posted as new sites are identified
- HRSA is working with CMS to discuss how
to incorporate these requirements into the periodic site
reviews conducted by the Survey and Certification staff
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Slide 12: WHY WOULD YOU WANT AUTOMATIC
HPSA STATUS?
- If you are not currently in a HPSA, it
can make you potentially eligible for NHSC recruitment assistance
and J1 Visa Waiver placements
- It CANNOT be used for initial or continued
eligibility for RHC status
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Slide 13: Additional Information
Shortage Designation Branch
1-301-594-0816
To request a copy of the letter and certification form
SDB Toll-Free Number
1-888-275-4772
Call for information on current designations, copies of guidelines,
criteria, HPSA or MUP list, etc.
HRSA Website
www.bhpr.hrsa.gov/shortage
Select Health Professional Shortage Areas to view guidelines,
criteria, HPSA database, MUA/P list, automatic HPSA scores
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