Health Professional Shortage Area (HPSA) Application and Scoring Process


Shortage Designation Modernization Project
We are modernizing the shortage designation process with automated procedures and standardized data sets.

A Health Professional Shortage Area (HPSA) is a geographic area, population, or facility with a shortage of primary care, dental, or mental health providers and services.

The Health Resources and Services Administration (HRSA) and State Primary Care Offices (PCOs) work together using public, private, and state-provided data to determine when such a shortage qualifies for designation as a HPSA.

How the application process works

State PCOs submit applications for geographic, population, and certain facility HPSAs1 in the Shortage Designation Management System (SDMS) for primary care, dental, and mental health.

For geographic and population designations, the PCOs must identify a geographic area for designation.

Depending on the type of designation, they may need to provide additional health or demographic data.


  • Fluoridation rates for an area proposed for dental designations
  • Alcohol and substance abuse rates for mental health designations
  • Medicaid eligible, homeless, migrant worker, and other special population data

How the review process works

Once a PCO submits an application for review, all interested parties are given 30 days to comment on the request.

We make every effort to review and make a final decision on each designation request within 90 days of the date the PCO submits it.

How the scoring process works

For most designated HPSAs, we calculate a score based on discipline-specific methodology.2 We use this score to identify areas of greatest need. We also use it for the National Health Service Corps and Nurse Corps when determining awards.

What are the scoring criteria?

Three scoring criteria are common across all HPSA disciplines:

  • Population to provider ratio
  • Percentage of the population below 100% of the Federal Poverty Level (FPL)
  • Travel time to the nearest source of care (NSC) outside the HPSA designation

You can review the HPSA scoring methodology, differentiated by discipline, below:

Primary Care HPSA Scoring

Primary Care HPSAs can receive a score between 0-25.

This is broad overview of the four components we use in Primary Care HPSA scoring:

Population-to-Provider Ratio [10 points max] + Percent of Population below 100% FPL [5 points max] + Infant Health Index (Based on IMR or LBW Rate) [5 points max] + Travel Time to NSC [5 points max] = HPSA Score Out of 25


The Infant Health Index looks at both Infant Mortality Rate (IMR) and the rate of low birth weight (LBW). It awards points based on whichever of these indicators provide the higher score.

Dental Health HPSA Scoring

We calculate a score between 0-26 for Dental Health HPSAs.

This is a broad overview of the four components used in Dental HPSA scoring:

Population-to-Provider Ratio [10 points max] + Percent of Population below 100% FPL [10 points max] + Water Fluoridation Status [1 point max] + Travel Time to NSC = HPSA Score Out of 26


Mental Health Scoring

We calculate a score between 0-25 for Mental Health HPSAs.

This is a broad overview of the seven components used in Mental Health HPSA scoring:

Population-to-Provider Ratio [7 points max] + Percent of Population below 100% FPL [5 points max] + Elderly Ratio [3 points max] + Youth Ratio [3 points max] + Alcohol Abuse Prevalence [1 point max] + Substance Abuse Prevalence [1 point max] + Travel Time to NSC [5 points max] = HPSA Score Out of 25

How we automatically designate HPSAs

Based on the statutes and regulations governing shortage designation, we automatically designate certain facilities as HPSAs.

These Auto-HPSAs do not need to submit an application for designation, but may need to submit data to us to calculate their facility’s HPSA score.

How do we score Auto-HPSAs?

While we calculate scores for other HPSAs in SDMS as part of the application process; we currently score Auto-HPSAs manually using the scoring criteria described above.

To request an initial score or re-score of an Auto-HPSA, email our Shortage Designation Branch. We may request data to assist with scoring Auto-HPSA facilities.

A score of “0” for any Auto-HPSA can mean that data was provided and resulted in a score of “0,” or that we have not received the data necessary to score the site.

For the purposes of the National Health Service Corps, any Auto-HPSA-designated facility physically located in a geographic or population-HPSA can use either their facility Auto-HPSA score or the geographic or population HPSA score.

Federally Qualified Health Centers (FQHCs) and Health Center Look-Alikes

FQHCs and Health Center Look-Alikes have multiple sites under one organization have a unique scoring structure.

We calculate a score for each site in the organization using the criteria above and then we calculate the average of all these scores. The average becomes the Auto-HPSA score for all of the sites within the organization.

Indian Health Service Clinics, Tribally-Run Clinics, Dual-Funded Tribal Health Centers, or Urban Indian Organizations

Any request asking us to score or re-score any of these facilities should include site data on the Indian Health Service Scoring Form (PDF - 98 KB). Learn more about IHS site scores.

Centers for Medicare & Medicaid Services-certified Rural Health Clinics (RHCs)

Submit a completed Certificate of Eligibility Form (PDF - 103 KB). This form certifies that the RHC meets all NHSC site requirements, including that the RHC:

  • Cannot deny requested health care services, or discriminate in the provision of services to an individual whose services are paid by Medicare, Medicaid, or Children’s Health Insurance Program (CHIP);
  • Has a schedule of fees or payments consistent with locally prevailing rates or charges;
  • Has a corresponding schedule of discounts (including waivers) to be applied to such fee or payments, with adjustments made on the basis of the patient’s ability to pay; and,
  • Accepts assignment for Medicare beneficiaries, and enters into agreements with state agencies that administer Medicaid and CHIP to assure coverage of beneficiaries of these programs.

1PCOs may submit HPSA applications for state correctional facilities, state mental hospitals, and other public or non-profit facilities that serve the population of a geographic or population HPSA (OFACs).

However, based on statutes and regulations, we automatically designate a number of facilities as HPSAs without an application from the State PCO.

2 Correctional facilities have their own scoring criteria while OFACs are given the same score as the geographic or population HPSA they serve.

Date Last Reviewed:  June 2019

Sign Up

Get email updates about the Shortage Designation Modernization Project

Contact Us

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

Shortage Designation Modernization Project questions?
Email us

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

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

Modernization Project Technical Assistance