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HPSA Proposed Negotiated Rulemaking
Written by: Heather Bonser-Bishop

In May, the Health Resources and Services Administration (HRSA) published a proposal to engage in a Negotiated Rulemaking process for the purposes of revising the methodology for creating Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs).  The proposal is online at and can be viewed by clicking here. Any change to the current system has the potential to impact the rural health care system of California because: 

  • Rural Health Clinics must be located in (or serve) HPSAs and/or MUAs
  • Physicians in Geographic HPSAs qualify for a 10% Medicare bonus
  • Federally Qualified Health Centers (FQHCs) must be located in (or serve) MUAs or MUPs and
  • National and State Health Service Corps providers must serve in a HPSA.

In response to concern about the age and relevancy of the current methodology, HRSA attempted shortage designation methodology changes in 1998 and 2008 but the proposals met with significant resistance each time.  Therefore Congress directed HRSA to engage in a process of negotiated rulemaking so that all affected parties could have a voice in updating a regulation that affects them.

The published proposal says that negotiated rulemaking is a facilitated, committee-based process “with members chosen to represent the various interests that will be significantly affected by the rule…The goal of the committee is to reach consensus on the treatment of the major issues involved in the rule, including key issues of language.” Committee meetings are expected to be held monthly, in the Washington, DC area, through the end of 2010.  The groups identified for committee involvement include representatives from:

  • State Primary Care Offices (PCOs)
  • The National Organization of State Offices of Rural Health (NOSOHR)
  • The Association of State and Territorial Health Officers (ASTHO) or the National Academy for State Health Policy (NASHP)
  • State Primary Care Associations (PCAs) from different types of States
  • The National Association of Community Health Centers (NACHC)
  • The National Association of Rural Health Clinics (NARHC)
  • The National Rural Health Association
  • The Native American community
  • Research/data analysis institutions
  • Representatives of primary care providers and training programs with expertise on supply and demand
  • And organizations representing State, territorial and local government elected officials

During the public comment period (which ends June 10th), other organizations had an opportunity to petition for involvement.  The public comments section of the proposal indicated that Gay/Lesbian/Transgender health organizations and disability advocate groups also desired involvement with the committee.  Konder Chung, manager of California’s Policy & Planning Healthcare Workforce Development Division in the Office of Statewide Health Planning and Development, has been nominated for inclusion on the committee.

At this point in the process, we do not know if the final rule change (if any) will consider the time of Physician Assistants and Family Nurse Practitioners (it currently does not), whether additional factors will play into shortage designation score, whether MUAs/MUPs will be combined with HPSAs, whether existing organizations will be “grandfathered” in to their program and how any changes will be implemented and in what timeframe.  In 2008, when we last revisited this topic, many saw a methodology change as an opportunity to improve a flawed process but that, until it is known how the FQHC, RHC and NHSC programs would use the new scoring and designations, total impact could not be calculated. 

If you have concerns about the impact of HPSA/MUA/MUP methodology changes or ideas about how to improve the current process, you can share your thoughts with CSRHA at advocate@csrha.org or communicate with the groups listed above.

About the Author:
Heather Bonser-Bishop, MBA, is a consultant specializing in shortage designations, needs assessments and 330 grantwriting.  She has also served as a community health center consortium director, FQHC lookalike board member and RHC administrator.  She works out of Trinidad, California and Gold Beach, Oregon. You may contact her at heather@bonserbishop.com

 

Comments or feedback? Email us at advocate@csrha.org.


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