Shortage Designation Modernization Project

Auto-HPSA Update Preview Technical Assistance Webinars

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HRSA began distributing update previews in November 2018. Contact your organization's shortage designation point-of-contact for your latest report.

The Shortage Designation Modernization Project (SDMP) modernizes the shortage designation and scoring processes.

The SDMP initiative gives greater transparency, accountability, and parity to the HPSA designation and scoring process. The project also aims to reduce the burden of data collection on state Primary Care Offices (PCOs) by using standardized data sets.

Note: No changes will be made to the criteria or methodology for designating or scoring HPSAs.

Timeline | Data & Scoring | NHSC/NURSE Corps

Timeline

When did the project begin?

SDMP began in 2013 with the development and implementation of the Shortage Designation Management System (SDMS). The SDMS uses standardized data from several trusted sources and streamlines the data submitted by state Primary Care Offices (PCOs).

What is the National Shortage Designation Update?

The National Shortage Designation Update is another component of the SDMP, which updates existing automatically-designated HPSA (Auto-HPSA) designations.

SDMP Working Groups
HRSA’s Bureau of Primary Health Care, Federal Office of Rural Health Policy, the Indian Health Service, and other stakeholders identified data sources to use for the planned update.

We have engaged partners in this effort via ad hoc working groups, conferences, individual discussions, and other regular communications.

These organizations and individuals have provided substantive input into key project decisions. For example, HRSA initially planned for the update to occur in 2017, but revised the timeline and data sources in response to stakeholders concerns.

What updates will occur in the future?

Late spring/early summer 2019 (tentative): We plan to implement the National Shortage Designation Update of Auto-HPSAs. We will include all Auto-HPSA facilities in this update.

We limit Auto-HPSA facilities to the following:

  • Health Centers (funded under Sec. 330)
  • Health Center Look-Alikes
  • Tribally-Run Clinics
  • Urban Indian Organizations
  • Dual-Funded Tribal Health
  • Federally-Run Indian Health Service Clinics
  • Rural Health Clinics that meet National Health Service Corps (NHSC) site requirements

Note: Auto-HPSAs will not lose their designations due to the national update.

What updates have been made?

November 2017: National Shortage Designation Update of existing Geographic, Population, and Other Facility HPSA designations based on standardized and PCO-provided data, using SDMS.

Note: We plan to update these HPSAs again in 2020, but PCOs may update HPSAs at any time.

What is an update preview?

In the months leading up to the 2019 national update, stakeholders will receive a series of reports from us, previewing their projected Auto-HPSA scores and the data used to generate them. The preview scores are informative only and subject to change as state PCOs continue to review and revise their provider data. We do not use preview scores to make federal program decisions.

Auto-HPSA facilities will receive a number of update preview reports from HRSA.

Each preview:

  • Shows the data used to calculate the HPSA score
  • Is informational only
  • Is sent to Auto-HPSA facilities electronically
  • Is NOT used to make program decisions

We expect to provide update preview reports to Auto-HPSA organizations every month between November 2018 and April 2019.

Once the National Shortage Designation Update takes place, we will make the national results available on this site and updated scores will be available on the HRSA Data Warehouse.

After the national update of Auto-HPSAs occurs, we will establish a timeline for future updates.

How do you change your organization’s contact information?

For Community Health Centers and Look-Alikes: contact Health Center Program Support at 877-464-4772 or use the BPHC Contact Form.

For Rural Health Centers and Indian, Tribal, and Urban Indian Health facilities: Site points-of-contact (POCs) should follow instructions on the POC portal account page under the Quick Links.

Who should you contact with questions?

For questions related to the provider data used for the update preview, contact your Primary Care Office.

For general questions about the Shortage Designation Modernization Project, email us at SDMP@hrsa.gov.

Data & Scoring

What scoring data will we use when the national update takes place?

We use national, standardized data sets along with data provided by Auto-HPSA facilities and PCOs.

  • We use data from the following sources:
    • The Centers for Medicare and Medicaid Services
    • The Centers for Disease Control and Prevention
    • The Census Bureau
    • The Environment Systems Research Institute
    • The Health Resources and Services Administration’s Uniform Data System
    • State and Territory PCOs
  • Auto-HPSA facilities will be able to provide supplemental data when data from these sources are unavailable.

For information about the current scoring process visit the HPSA Application and Scoring Process.

What is the population-to-provider ratio?

HRSA is using a service area approach to determine the population-to-provider ratio.

The chart below defines the service area, population and providers each Auto-HPSA facility type uses.

COMMUNITY HEALTH CENTERS (CHCs)* RURAL HEALTH CLINICS (RHCs)** INDIAN HEALTH SERVICE FACILITIES, TRIBALLY OPERATED 638 AND URBAN INDIAN HEALTH PROGRAMS (ITUs)**
SERVICE AREA
  • Defined by zip codes in which 75% of an Auto-HPSA facility’s patients reside to create a Zip Code Tabulation Area (ZCTA)-based service area. (Source: Uniform Data System (UDS))
  • Defined by census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: Shortage Designation Management System (SDMS))
  • Defined by census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: SDMS)
DEFINITION
  • Population defined as low income population at or below 200% federal poverty level (FPL) in the service area. (Source: Census)
  • Population defined as low income population at or below 200% FPL in the service area. (Source: Census)
  • Population defined as total population of American Indian and Alaska Native alone or in combination with one or more races (when available) in the service area. (Source: Census)
  • Providers defined as the count of eligible FTEs that serve Medicaid patients AND/OR provide services on a sliding fee scale in the service area. (Source: SDMS)
  • Providers defined as the count of eligible FTEs that serve Medicaid patients AND/OR provide services on a sliding fee scale in the service area. (Source: SDMS)
  • Providers defined as the count of eligible FTEs that serve the American Indian and Alaska Native populations within the service area. (Source: SDMS)

*Scoring will be at the organizational level.

**Following the National Update, RHCs and ITUs may provide facility-level data to be rescored.

What should you know about the providers in the population-to-provider ratio?

  • HRSA includes all eligible providers in your organization’s service area, NOT just the eligible providers in your organization.
  • If the service area crosses state lines, providers may be from another state.
  • For RHCs and ITUs, a provider can be more than 30 or 40 minutes away from the site.

For additional guidance on reading your data, contact your PCO or email us at SDMP@hrsa.gov.

How do we determine the default service area for RHCs and ITUs?

The image shows a geocoded site with 30 or 40 min travel polygon that is drawn around the site. With census tracts (CT) that overlap the travel polygon are identified and saved as the service area, and all usable providers located in the CT service area.We:

  1. Geocode the site.
  2. Draw a polygon around the site that encompasses a region within 30 or 40 minutes travel time from the site.
  3. Identify census tracts that overlap the travel polygon. These tracts are the service area.
  4. Identify all usable providers located in the service area.

Note: Because the census tracts may extend outside the travel polygon, some providers used in the population to provider ratio may be more than 30 or 40 minutes away from the site.

How can you change your score?

Following the National Shortage Designation Update, HRSA will accept supplemental data on a rolling basis through an online portal for Auto-HPSA organizations and state Primary Care Offices.

Auto-HPSA facilities that do not report or have not yet reported Uniform Data System data may submit the following facility-specific data:

  • The zip codes in which 75% of the organization’s patients reside;
  • The percent of the patient population with known income at or below 100 percent of the federal poverty level (FPL); and
  • The count of individuals younger than 18 and 65 or older than 65, divided by the count of adults age 18-64 (of total unduplicated patient population).

All Auto-HPSA facilities may submit:

  • Water fluoridation data;
  • Substance misuse rate data; and
  • Alcohol misuse rate data.

The following chart details the additional data each type of facility or organization can provide after the national update takes place.

FQHCs and LALs RHCs, ITUs and FQHCs and LALs* PCOs
  • Water Fluoridation
  • Alcohol Misuse Rate
  • Substance Misuse Rate
  • Zip codes in which 75% of the Auto-HPSA facility’s patients reside
  • The percent of population of patients served with known income at or below 100% of the federal poverty level (FPL)
  • The count of individuals younger than 18, or 65 and older than 65, divided by the count of adults age 18-64 (of the total unduplicated patient population)
  • Water Fluoridation
  • Alcohol Misuse Rate
  • Substance Misuse Rate
  • Nearest Source of Care
  • Water Fluoridation
  • Alcohol Misuse Rate
  • Substance Misuse Rate
*Only FQHCs and LALs that have not yet reported UDS data.

What will change for Auto-HPSAs?

When the National Shortage Designation Update occurs, the updated scores will replace all current scores. Auto-HPSA scores may increase, stay the same, or decrease.

Until the National Shortage Designation Update occurs, Auto-HPSA facilities may continue to request scores or rescores by emailing us.

NHSC/NURSE Corps

How does the SDMP affect National Health Service Corps and NURSE Corps?

Changes in HPSA scores may impact a facility’s competitive status for the National Health Service Corps (NHSC) and NURSE Corps programs. The National Shortage Designation Update will not affect CMS HPSA Bonus Payments or rural health clinics’ enrollment/certification.

If a facility’s score decreases, NHSC and NURSE Corps participants at the facility will be able to fulfill their service commitment without contract changes. Following their commitment, NHSC and NURSE Corps participants may apply for a continuation award if they remain in a HPSA.

If NHSC and NURSE Corps participants want to transfer to another approved site, they must identify a site in the same tier. If NHSC participants are eligible for a continuation, they may continue to serve at any eligible site with a HPSA.

Date Last Reviewed:  December 2018


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Modernization Project Technical Assistance

Update Preview TA Session Exit Disclaimer
(Recorded November 15, 2018)

Update Preview TA Session Exit Disclaimer
(Recorded November 6, 2018)

Community Health Centers Exit Disclaimer
(Recorded August 6, 2018)

General Webinar Exit Disclaimer
(Recorded August 6, 2018)

Indian, Tribal, & Urban Clinics Exit Disclaimer
(Recorded June 28, 2018)

Primary Care Associations Exit Disclaimer
(Recorded April 20, 2018)

Rural Health Clinics Exit Disclaimer
(Recorded April 10, 2018)

Primary Care Offices Exit Disclaimer
(Recorded February 28, 2018)