Shortage Designation Application and Review Process

State Primary Care Offices (PCOs) conduct a needs assessment in their states, determine what areas are eligible for designations, and submit designation applications to HRSA.

We then review the shortage designation applications. If they meet the designation eligibility criteria, we approve the designation.

What is the application process?

State Primary Care Offices (PCO) submit applications for geographic, population, and certain facility HPSAs in the Shortage Designation Management System (SDMS) for primary care, dental, and mental health.

Certain Automatic Facility Health Professional Shortage Areas (Auto-HPSA) do not require an application based on statue and regulation.

How do we review applications?

Health Professional Shortage Areas (HPSA) & Medically Underserved Areas/Populations (MUA/P)

  • A State PCO submits an application to us for review.
  • All interested parties have 30 days to comment on the request.
  • HRSA reviews and makes a final decision on each designation request within 90 days of the initial PCO submission date, where possible.
  • We email the PCO and all interested parties within 24 hours of the final decision.
  • We also post new designation scores to data.hrsa.gov within 24 hours of the final decision.

Automatic Facility HPSA (Auto- HPSA)

Neither HRSA, nor the State PCO, reviews a system data rescore request. The system automatically processes these requests within 24-72 hours.

  • The State PCO reviews supplemental data rescores first. They have the ability to re-geocode a site or modify the nearest source of care.
  • Once the PCO completes any changes, they submit the designation to us.
  • We review and make a final decision on each designation request within 90 days of the initial PCO submission date, where possible.
  • We email the PCO and all interested parties within 24 hours of the final decision.
  • We also post new designation scores to data.hrsa.gov within 24 hours of the final decision.

What is the Shortage Designation Management System (SDMS)?

The Shortage Designation Management System (SDMS) is an online system used by both State Primary Care Offices (PCOs) and HRSA.

State PCOs use SDMS to:

  • Manage health workforce data for their states
  • Apply for HPSAs and MUAs/Ps
  • Request Auto-HPSA re-scores

HRSA uses SDMS to:

  • Review shortage designation applications
  • Communicate with the PCOs on specific applications
  • Make final shortage designation determinations
  • Review Auto-HPSAs rescore request

We base SDMS business rules on National Health Service Corps governing statutes and regulations, and Shortage Designation policies and procedures.

What data does SDMS use for scoring?

The SDMS uses standard national data sets and if applicable, supplemental data provided by the State PCO or Auto HPSA Facility via the Auto-HPSA portal.

We use data from the following sources:

Depending on the type of designation requested, PCOs may also need to provide additional health and demographic data for which standard national data sets with the sensitivity and specificity required for shortage designation do not currently exist.

We rely on PCOs Auto-HPSA organizations to provide facility-specific data where national data are not available.

Learn more about the Shortage Designation Scoring Criteria.

Data & Scoring

What is the population-to-provider ratio?

The chart below defines the service area, population, and providers used to generate population-to-provider ratios for each Auto-HPSA facility type.

Facililty Type Service Area Population Provider
Federally Qualified Health Centers (FQHCs)/Look-A-Likes (FQHC LAL) 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)) Low income population at or below 200% federal poverty level (FPL) in the service area. (Source: Census) Number of eligible FTEs who serve Medicaid patients AND/OR provide services on a sliding fee scale in the service area. (Source: SDMS)
Rural Health Clinics (RHCs)** Census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: Shortage Designation Management System (SDMS)) Low income population at or below 200% FPL in the service area. (Source: Census) Number of eligible FTEs who serve Medicaid patients AND/OR provide services on a sliding fee scale in the service area. (Source: SDMS)
Indian Health Service Facilities, Tribally Operated 638, and Urban Indian Health Programs (ITUs)** Census tracts intersecting with a 30 or 40 minute travel polygon to create service area. (Source: SDMS) 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) Number of eligible FTEs that serve the American Indian and Alaska Native populations within the service area. (Source: SDMS)

*Scoring is at the organizational level.
** RHCs and ITUs may provide facility-level data to be rescored through the online Auto-HPSA portal.

What providers do we count in the population-to-provider ratio?

HRSA includes all eligible providers in your organization’s service area that accept payments via Sliding Fee Scale or Medicaid, NOT just the eligible providers in your organization.

What provider types do we consider eligible?

Primary Care

Doctors of Medicine (MD) or Doctors of Osteopathy (DO) who provide services in the following specialties:

  • General or family practice,
  • General internal medicine,
  • Pediatrics, or;
  • Obstetrics and gynecology

Dental Health

  • Dentists, and;
  • Dental Auxiliaries (any non-dentist staff employed by the dentist to assist in the operation of the practice)

Mental Health

  • Only Psychiatrists, or;
  • Psychiatrists AND all:
    • Clinical Social Psychologists
    • Clinical Social Workers
    • Psychiatric Nurse Specialists
    • Marriage & Family Therapists

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

  1. Geocode the site.
  2. System draws a polygon around the site that encompasses a region within 30 or 40 minutes travel time from the site (dependent on discipline).
  3. Identify census tracts that overlap the travel polygon and label as the service area.
  4. Identify eligible providers and population located within the service area.

Note: The census tracts may extend outside the travel polygon. Some providers in the population-to-provider ratio may be more than 30 or 40 minutes away from the site.

How do you request a rescore?

We accept supplemental data on a rolling basis through the online Auto-HPSA portal.

Auto-HPSA organizations that do not report or have not yet reported HRSA Uniform Data System (UDS) data may submit the following facility-specific data:

  • The zip codes in which 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 list details the additional data each type of facility or organization can provide after the national update takes place:

  • FQHCs and LALs
    • Water Fluoridation
    • Alcohol Misuse Rate
    • Substance Misuse Rate
  • RHCs, ITUs and FQHCs and LALs*
    • Zip codes in which 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
  • PCOs
    • Nearest Source of Care
    • Water Fluoridation
    • Alcohol Misuse Rate
    • Substance Misuse Rate

*Only FQHCs and LALs that have not yet reported UDS data.

Are you reviewing my rescore request?

Supplemental data rescore requests require HRSA’s review. Navigate to the “Organization Profile” page in the BHW Customer Service Portal and select “Rescore Progress” to determine the status of your rescore request.

Which site(s) did you use to generate my Auto-HPSA Score?

We identify the sites used to generate your Auto- HPSA score in the “Sites” section of the “Organization Profile” page.

What is your organization score?

You can find discipline specific Auto-HPSA scores in the “Score” section of each discipline within the “Organization Profile” page.

Date Last Reviewed:  September 2019


Contact Us

Shortage designation questions?
Email us, or call 301-594-5168

Shortage Designation Modernization Project questions?
Email us

Questions about providers in your Auto-HPSA update preview?
Contact your State PCO

NHSC or Nurse Corps questions?
Email us or call 1-800-221-9393

CMS Bonus Payment questions?
Contact your Medicare Administrative Contractor (MAC)

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