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# Calculating Population to Provider Ratios: Dental Health Care

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### Calculating Population to Provider Ratios: Dental Health Care

1. 1. IV. CALCULATING POPULATION TO PROVIDER RATIOS Dental Health Care IV-1 --------------------------------------------------
2. 2. CALCULATING POPULATION TO PROVIDER RATIOS (DENTAL HEALTH CARE) Objective: Participants will understand how to: 1) Identify all dental health providers, 2) Calculate full-time-equivalency rates, and 3) Determine the population to provider ratios for dental health geographic and population designations IV-2 --------------------------------------------------
3. 3. Population to Provider Ratios Needed for Designation (DENTAL HEALTH CARE) Geographic Area : > 5,000:1 A rational service area - sub-county (MSSA) Geographic Area w/Unusually High Needs: > 4,000:1 A rational service area plus: a) At or more than 20% of the population has incomes at or below 100% of the Federal poverty level; or b) More than 50% of the population has no fluoridated water; or c) Meets insufficient capacity criteria Population Groups: > 4,000:1 A rational service area plus meets the requirements of the specific designation category (e.g. low-income, homeless, etc.) Contiguous Areas are overutilized if : > 3,000:1 IV-3 --------------------------------------------------
4. 4. POPULATION SIDE OF THE RATIO (Same as Primary Health Care) IV-4 -------------------------------------------------- ________________ :
5. 5. PROVIDER SIDE OF THE RATIO : ____ IV-5 --------------------------------------------------
6. 6. STEPS 1) Identify all general practice dentists in the area to be designated 2) Determine the number of hours each dentist works in direct patient care (office and hospital inpatient) serving the population to be designated 3) Calculate the FTE for each dentist serving the population to be designated 4) Calculate the population to provider ratio -------------------------------------------------- IV-6
7. 7. STEP 1 Identify all general practice dentists in the area to be designated. IV-7 --------------------------------------------------
8. 8. List all dentists (D.D.S. or D.M.D.) who: 1) Provide direct patient care in the service area, and 2) Practice principally in general dentistry or pedodontics (pediatric dentistry) Do not include: <ul><li>Oral surgeons, orthodontist, or other specialists </li></ul><ul><li>Dentists engaged solely in administration, research, or teaching </li></ul><ul><li>Locum tenens serving less than 1 year </li></ul><ul><li>Include: </li></ul><ul><li>Dentists who serve in the NHSC Scholarship or Loan Repayment Programs (exclude their FTEs) </li></ul><ul><li>Dentists who serve in State Loan Repayment Program </li></ul><ul><li>Dentists who are Federal providers (e.g. Commissioned Officers at IHS or BOP) </li></ul><ul><li>Dentists who are planning on retiring but are still seeing patients </li></ul>Note: All providers who meet these qualifications should be listed, even if their FTE will be 0. IV-8 --------------------------------------------------
9. 9. <ul><li>Sources of Provider Data </li></ul><ul><ul><ul><li>State Licensure Lists </li></ul></ul></ul><ul><ul><ul><li>National, State, and Local Dental Association Directories </li></ul></ul></ul><ul><ul><ul><li>Local Telephone Directory/Yellow Pages </li></ul></ul></ul><ul><ul><ul><li>Commercially Developed Listings </li></ul></ul></ul>IV-9 --------------------------------------------------
10. 10. STEP 2 Determine each dentist’s age, number of auxiliaries 1 , and number of hours serving the population to be designated. IV-10 1 Auxiliaries are non-dentists assisting in dental care such as dental assistants, hygienists, etc. They do not include receptionist and other support staff. --------------------------------------------------
11. 11. Designation Types and Whom To Include In the Provider Count <ul><ul><ul><li> Designation Type: Count all dentists who </li></ul></ul></ul><ul><ul><ul><li>serve all persons: </li></ul></ul></ul><ul><li>Geographic in the service area </li></ul><ul><li>Low-Income in the service area that have incomes </li></ul><ul><li>Population < 200% of the Federal poverty level (Medicaid and Sliding Fee) </li></ul><ul><li>Medicaid-Eligible in the service area that are </li></ul><ul><li>Population Medicaid-eligible </li></ul><ul><li>Migrant Farmworker in the service area that are </li></ul><ul><li>Population migrant farmworkers </li></ul><ul><li>Native American/ in the service area that are </li></ul><ul><li>Native Alaskan Native American or Native Alaskan </li></ul>IV-11 --------------------------------------------------
12. 12. For each dentist, include the number of hours of direct patient care provided in the service area <ul><ul><li>Dentists under contract with the NHSC Federal Scholarship or Loan Repayment Programs (This does not apply to dentists in the State Loan Repayment Program.) </li></ul></ul><ul><ul><li>Other Federal providers (e.g. Commissioned Officers at IHS or BOP sites, etc.) </li></ul></ul>Note: List these dentists in the application but do not include their hours. Include: All dentists who provide direct patient care in the service area, including those who: <ul><li>Serve in State Loan Repayment Program </li></ul><ul><li>Serve at Indian Health Clinics and are not Federal providers </li></ul><ul><li>Plan on retiring but are still seeing patients </li></ul>IV-12 -------------------------------------------------- Except:
13. 13. Providers Total Dentists: 5 IV-13 -------------------------------------------------- 25 2 66 Cavity Place Mouthtown, CA 99918 32 C. Buck, D.D.S. 24 2 103 Molar Lane Chompers, CA 99918 39 B. Crown, D.D.S. 37 3 33 Halitosis Road Smile City, CA 99918 40 A. Canine, D.D.S. 15 1 789 Crown Street Tooth Fairy, CA 99864 78 R. Wisdom, D.D.S. 45 1 789 Crown Street Tooth Fairy, CA 99864 29 M. Incisor, D.D.S. Hours of Direct Pt. Care/Week # of Auxiliaries Location of Practice Age Dentist Name
14. 14. STEP 3 Calculate the FTE for each dentist serving the population to be designated. IV-14 --------------------------------------------------
15. 15. Equivalency Weights by Number of Auxiliaries and Age Auxiliaries are non-dentists assisting in dental care such as dental assistants, hygienists, etc. Auxiliaries <55 55-59 60-64 65+ 0 0.8 0.7 0.6 0.5 1 1.0 0.9 0.8 0.7 2 1.2 1.0 1.0 0.8 3 1.4 1.2 1.0 1.0 > 4 1.5 1.5 1.3 1.2 If an auxiliary is less than full-time, round to nearest whole number (0.4 = 0, 0.5 = 1) If more than one auxiliary works less than full time, add total hours, divide by 40, and round if not a whole number (0.4 +0.5 + 0.8 = 1.7 = 2) <ul><li>If number of auxiliaries is not available, use these weights: </li></ul><ul><li> < 55 = 1.2 </li></ul><ul><li> 55 - 59 = 0.9 </li></ul><ul><li> 60 - 64 = 0.8 </li></ul><ul><ul><ul><li> > 65 = 0.6 </li></ul></ul></ul>If dentist’s age and the number of auxiliaries are not available: Use weight of 1.2 IV-15 --------------------------------------------------
16. 16. FTE Calculation 40 hours = 1.0 FTE (There are no provisions to reduce the FTE of a dentist in residency.) Every 4 hours (½ day) is counted as 0.1 FTE Adjust FTE based on actual hours, age, and auxiliaries A dentist’s FTE can exceed 1.0 due to auxiliaries Each dentist’s FTE is rounded to the nearest tenth of a percent prior to totaling: <ul><ul><ul><li>Examples: 0.875= 0.9 0.817= 0.8 </li></ul></ul></ul><ul><li>0.83 = 0.8 0.85 = 0.9 </li></ul>Note: The FTE for low-income population designations is based on the average number of hours per week spent with Medicaid and SFS patients. It is not based on whether the provider is accepting new Medicaid patients. IV-16 --------------------------------------------------
17. 17. FTEs - Geographic Designation Total Dentists: 5 Total FTEs: 4.1 9 – Dr. Wisdom works 25 hours/week in another location 10 – Dr. Canine spends 2 hours/week in administrative activities 11 – Dr. Crown chooses to work 25 hours/week 12 – Dr. Buck spends 15 hours/week in childcare activities IV-17 -------------------------------------------------- 25 25 37 15 45 Hours of Direct Pt. Care/Week 2 2 3 1 1 # of Auxiliaries 66 Cavity Place Mouthtown, CA 99918 103 Molar Lane Chompers, CA 99918 33 Halitosis Rd. Smile City, CA 99918 789 Crown St. Tooth Fairy, CA 99864 789 Crown St. Tooth Fairy, CA 99864 Location of Practice 32 39 40 78 29 Age C. Buck, D.D.S. 12 B. Crown, D.D.S. 11 A. Canine, D.D.S. 10 R. Wisdom, D.D.S. 9 M. Incisor, D.D.S. Dentist Name 0.8 (.625x 1.2 =.75) .625 (25/40= .625) 0.7 (.6x 1.2 = .72) .6 (25/40=.6) 1.3 (.925x 1.4 =1.29) .925 (37/40= .925) 0.3 (.375x .7 = .26) .375 (15/40= .375) 1.0 (1.0x 1.0 =1.0) 1.0 (45/40= 1.1=1) Total Rounded FTE FTE Based on Hours
18. 18. FTEs - Low-Income Designation Total Low-Inc FTEs: 1.8 IV-18 -------------------------------------------------- 25 (25/40= .625) 24 (24/40=.6) 37 (37/40= .925) 15 (15/40=.375) 45 (45/40= 1.1=1) Hours of Direct Pt. Care/Week .625 .6 .925 .375 1.0 Hourly FTE 0.75 (.625x1.2 =.75) 0.72 (.6x1.2= .72) 1.33 (.925x1.4=1.33) 0.262 (.375x.7= .262) 1.0 (1x1= 1) Adjusted FTE C. Buck, D.D.S. B. Crown, D.D.S. A. Canine, D.D.S. R. Wisdom, D.D.S. M. Incisor, D.D.S. Dentist Name 0.6 0.562 (.75 x .75 = .562) 75% (60%+15%=75%) 15% 60% 0.3 0.288 (.4 x .72 = .288) 40% (20%+20%=40%) 20% 20% 0.8 0.798 (.6 x 1.33 = .798) 60% (50%+10%=60%) 10% 50% 0.0 0.0 (0 x .262 = 0) 0% 0% 0.0% 0.1 0.12 (.12 x 1 = .12) 12% (10%+02%=12%) 2% 10% Total Rounded L-I FTE Total Low-Income FTE % of Low- Income % SFS % Medi-Cal
19. 19. Survey Dentists to Determine Their FTE <ul><li>Survey all dentists in service area </li></ul><ul><li>Minimum two-thirds response rate required </li></ul>Calculation of Non-Responders <ul><li>Use survey average </li></ul><ul><ul><ul><li>Ex: Galt, California - 6 providers </li></ul></ul></ul><ul><ul><ul><li>4 - respond to survey </li></ul></ul></ul><ul><ul><ul><li>2 - no response after repeated telephone calls </li></ul></ul></ul><ul><ul><ul><li>Response rate: 4/6 = 66.6% </li></ul></ul></ul><ul><ul><ul><li>Total FTE for the 4 responders= 3.5 </li></ul></ul></ul><ul><li>Divide FTE of responders (3.5) by the number of responders (4) for the average FTE of responders (.87) </li></ul><ul><li>Multiply number of non-responders (2) by the average FTE of responders (.87) for FTE of non-responders (1.75) </li></ul><ul><li>3) Add FTE of responders (3.5) and non-responders (1.75) for total FTE = 5.3 </li></ul>IV-19 --------------------------------------------------
20. 20. STEP 4 Calculate the population to provider ratio. IV-20 --------------------------------------------------
21. 21. Population to Provider Ratios Resident-Civilian Population Ratio: Resident Civilian Population = 20,900 Dentist FTE = 4.1 (20,900/4.1 = 5,098:1 ) Resident-Civilian Population (High Needs) Ratio: Resident Civilian Population = 20,900 Dentist FTE = 5.2 (20,900/5.2 = 4,019:1 ) (100% Federal poverty level at 18.9%) Low-Income Population (200% Poverty): Low-Income Population = 10,137 (49.47%) FTE of Dentists Serving that Population = 1.8 (10,137/1.8 = 5,632:1 ) IV-21 --------------------------------------------------
22. 22. What To Include In The Population to Provider Ratio Dental Health Care Section of Your Application <ul><li>Population </li></ul><ul><li>Total adjusted population </li></ul><ul><li>Source of data </li></ul><ul><li>List of Dentists </li></ul><ul><li>Include the Following for Each Dentist: </li></ul><ul><li>Name </li></ul><ul><li>Age </li></ul><ul><li>Location: </li></ul><ul><li>Non-metro areas - name of town </li></ul><ul><li>Metro areas – complete address with zip code, and CT if available </li></ul><ul><li>Specialty (general dentistry and pedodontics) </li></ul><ul><li>Number of auxiliaries </li></ul><ul><li>Equivalent weights </li></ul><ul><li>Number of hours/week of patient care in area </li></ul><ul><li>Percentage of practice Medicaid (for low-income and Medicaid-eligible designations) </li></ul><ul><li>Percentage of practice Sliding Fee Scale (for low-income designations) </li></ul><ul><li>FTE total for each provider rounded to the nearest tenth of a percent </li></ul><ul><li>Description of how information was obtained (sources, methods of gathering data) </li></ul><ul><li>Totals and Ratio </li></ul><ul><li>Total number of providers </li></ul><ul><li>Total FTE </li></ul><ul><li>Population to provider ratio </li></ul><ul><li>Explanation of any high need indicators </li></ul>IV-22 --------------------------------------------------
23. 23. What Not To Include In Your Application <ul><li>Information on the weather or climate </li></ul><ul><li>Information on road conditions, construction, or number of avalanches </li></ul><ul><li>Personal statements of driving time </li></ul><ul><li>Average number of funerals </li></ul><ul><li>History of the early settlers of the area </li></ul><ul><li>Newspaper articles </li></ul><ul><li>Pictures of the mayor </li></ul><ul><li>General information on access issues that is not specific to the area or population </li></ul><ul><li>Copies of old applications </li></ul>-------------------------------------------------- IV-23
24. 24. Contiguous Area Resources -------------------------------------------------- IV-24
25. 25. Contiguous Area Resources <ul><li>Objective: </li></ul><ul><ul><ul><li>Participants will understand how to identify contiguous areas, determine if they have resources, and if the resources are excessively distant, over-utilized, or inaccessible to the population of the area proposed for designation </li></ul></ul></ul><ul><li>Purpose of Contiguous Area Analysis: </li></ul><ul><ul><ul><li>To identify nearby sources of care and determine if they are inaccessible to the population in the proposed service area </li></ul></ul></ul>-------------------------------------------------- IV-25
26. 26. STEPS 1) Identify the boundaries of each contiguous area 2) Evaluate each area to determine availability of resources -------------------------------------------------- IV-26
27. 27. Identify the boundaries of each contiguous area A. Identify on a map the boundaries and population center of the proposed service area B. Determine the contiguous areas in all directions within 40 minutes from the proposed area’s population center <ul><li>Map the boundaries of each contiguous area in all directions (North, </li></ul><ul><li>East, South, and West) </li></ul> Boundaries The boundaries of each contiguous area may be based on: <ul><li>Travel time (40 minutes) </li></ul><ul><li>Socio-economic/demographic characteristics </li></ul><ul><li>Established neighborhoods </li></ul><ul><li>Physical barriers </li></ul><ul><li>Designated HPSA </li></ul><ul><li>The boundaries of contiguous areas are often (not always) based on the same census delineation as the proposed area </li></ul><ul><ul><ul><li>Proposed service area = whole county </li></ul></ul></ul><ul><ul><ul><li>Contiguous areas = whole counties </li></ul></ul></ul><ul><li>Proposed service area = census tracts (MSSA) </li></ul><ul><li>Contiguous areas = census tracts (MSSA) </li></ul>-------------------------------------------------- IV-27
28. 28. PROCESS OF EVALUATING AVAILABILITY OF RESOURCES <ul><li>Check the HPSA list to determine if any of the contiguous areas are designated as </li></ul><ul><li>HPSA and therefore considered inaccessible. </li></ul>If it is not inaccessible HPSA, then B) Determine if there are significant socio-economic/demographic disparities or physical barriers If there are not significant socio-economic/ demographic disparities or physical barriers, then <ul><li>Determine if the contiguous area’s providers are located > 40 minutes away </li></ul><ul><li>from the population center of the proposed area and are therefore inaccessible due to excessive distance </li></ul>If they are not excessively distant, then D) Determine if the resources in the contiguous area exceed the population-to- provider ratio and are therefore over-utilized If they are not over-utilized, this area cannot be designated. ( Consider a different kind of designation) -------------------------------------------------- IV-28
29. 29. A) Check the HPSA status of the contiguous areas and determine if this type of HPSA is inaccessible to the proposed area <ul><ul><ul><li>If the proposed service area is: Then the contiguous area is inaccessible </li></ul></ul></ul><ul><ul><ul><li> if it is a: </li></ul></ul></ul>-------------------------------------------------- IV-29 Geographic, Low-Income, Medicaid Eligible or Poverty HPSA Poverty Population HPSA Geographic, Low-Income, or Medicaid Eligible Medicaid Eligible HPSA Geographic HPSA, Low-Income HPSA Low-Income HPSA Geographic HPSA, Low-Income HPSA Geographic with high needs (based on 100% poverty indicator) Geographic HPSA Geographic without high needs
30. 30. <ul><li>Determine if Significant Socio-economic/Demographic Disparities or Physical Barriers Exist </li></ul><ul><li>Significant demographic disparities between the population in the service area and the population in the contiguous area which result in the population being isolated from nearby resources </li></ul><ul><li>(A 30% or more disparity between the population in the service area and the population in the contiguous area) </li></ul>Significant socio-economic disparities: 100% poverty rate or 200% poverty rate (A 30% or more disparity between the population in the service area and the population in the contiguous area) Significant physical barrier: mountains, large parks, bodies of water, highways, railway yards, industrial areas, etc. which result in the population being isolated from nearby resources -------------------------------------------------- IV-30
31. 31. <ul><li>C) Determine If Providers Are Excessively Distant </li></ul><ul><ul><ul><li>Develop a list of providers in the contiguous area </li></ul></ul></ul><ul><ul><ul><li>Map their office locations </li></ul></ul></ul><ul><ul><ul><li>Determine the travel time from the proposed area’s population center to the contiguous area </li></ul></ul></ul><ul><ul><ul><li>Providers > 40 minutes from the population center are excessively distant </li></ul></ul></ul>-------------------------------------------------- Dental Health Care: > 40 minutes Interstate Roads - 30 miles X 1.33 = 40 minutes Primary Roads - 25 miles X 1.6 = 40 minutes Secondary Roads - 20 miles X 2.0 = 40 minutes IV-31
32. 32. C) Determine If Providers Are Excessively Distant (continued) Inner Portions of Metropolitan Areas: Distance is based on time using public transportation during non-rush hour. Bus routes and schedules must be described (provide narrative description and include bus schedule if possible) (Use only if the service area has population greater than 20% @ 100% poverty) -------------------------------------------------- IV-32
33. 33. D) Determine if Contiguous Areas Are Overutilized <ul><ul><ul><li>Calculate FTE - use same method as used for the proposed service area </li></ul></ul></ul><ul><ul><ul><li>If needed, survey providers and determine FTE serving the population. Use same surveying method as used for the proposed service area. </li></ul></ul></ul><ul><ul><ul><li>Explain how the information was obtained and calculated, and include population, total FTE, and population to provider ratio </li></ul></ul></ul><ul><li>Population to Provider Ratios: </li></ul><ul><li>DENTAL HEALTH CARE: > 3,000:1 dentist </li></ul>-------------------------------------------------- IV-33
34. 34. Example Sub-County Map Analysis: 35-43 -------------------------------------------------- IV-34
35. 35. Sub-County Identify the boundaries of the proposed service area MSSA 161c – Downtown (MSSAs) in San Diego Largest population center C.T. 41.00 -------------------------------------------------- IV-35
36. 36. Sub-County (Dental HPSA) Proposed Area: MSSA 161c – Golden Hill/Logan Heights, San Diego County: Summary: Res./Civ. Pop: 75,852 White Pop: 61.04% Black Pop: 10.80% Hispanic Pop: 73.11% Below 200% Pov: 70.60% * Below 100% Pov: 35.69% Age 65 & + Pop: 7.74% * Fluoridated Water: No   *High Need Indicator: (CT 41.00 is the pop center)   1) 100% of Poverty Rate > 20%   2) No fluoridated water   -------------------------------------------------- IV-36
37. 37. Sub-County A) Determine the contiguous areas in all directions within 40 minutes from the proposed area’s population center Area 1 (N) MSSA 161e - Kensington (C.T. 16.00) Area 2 (NE) MSSA 161d - East San Diego (C.T. 27.08) Area 3 (SE) MSSA 161g - National City (C.T. 33.02) Area 4 (S) MSSA 161k - Chula Vista (C.T. 125) Area 5 (W) MSSA 161n - Coronado (C.T. 74) -------------------------------------------------- B) Map the boundaries of each contiguous area IV-37
38. 38. Sub-County Identify the boundaries and population center of the proposed service area -------------------------------------------------- IV-38
39. 39. Sub-County (Contiguous Area) Proposed Area: MSSA 161c – Golden Hill/ Logan Heights, San Diego County  Summary: Res./Civ. Pop: 75,852 White Pop: 61.04% Black Pop: 10.80% Hispanic Pop: 73.11% Below 200% Pov: 70.60% Below 100% Pov: 35.69% 65 year or older Pop: 7.74% Fluoridated Water: No Area 1 (N) – MSSA 161e – College Heights/Hillcrest Southeast/Kensington/Rolando North/University Heights (Significant Demographic Difference : Hispanic @ 44.46% Disparity)   Summary: Res./Civ. Pop: 89,963 White Pop: 64.86% Black Pop: 11.22% Hispanic Pop: 28.65% Below 200% Pov: 44.83% Below 100% Pov: 21.22% 65 year or older Pop: 8.81% Fluoridated Water: No HPSA: No Travel Time: 57 minutes   IV-39
40. 40. Sub-County (Contiguous Area) Proposed Area: MSSA 161c – Golden Hill/ Logan Heights, San Diego County  Summary: Res./Civ. Pop: 75,852 White Pop: 61.04% Black Pop: 10.80% Hispanic Pop: 73.11% Below 200% Pov: 70.60% Below 100% Pov: 35.69% 65 year or older Pop: 7.74% Fluoridated Water: No Area 2 (NE) – MSSA 161d – Chollas Creek/City Heights/East San Diego/North Park/Oak Park/South Park Survey Required – 14 providers 10 FTE – pop to provider ratio is 10,345:1   Summary: Res./Civ. Pop: 103,453 White Pop: 39.10% Black Pop: 11.36% Hispanic Pop: 52.29% Below 200% Pov: 60.48% Below 100% Pov: 31.28% 65 year or older Pop: 5.66% Fluoridated Water: No HPSA: No Civilian population 103,453/14FTE=10,345:1 Travel Time: 30 minutes IV-40
41. 41. Sub-County (Contiguous Area) Area 3 (SE) – MSSA 161g – Encanto/Lincoln Acres/ National City E./Paradise Hills SW.: (Excessively Distant : 55 minutes by public transportation from CT 41.00 St (29 th St & F St) to CT 33.02 ( 49 th St & Imperial Ave) Summary: Res./Civ. Pop: 94,751 White Pop: 30.09% Black Pop: 19.96% Hispanic Pop: 50.40% Below 200% Pov: 49.28% Below 100% Pov: 20.96% 65 year or older Pop: 8.84% Fluoridated Water: No HPSA: No Travel Time: 55 minutes Proposed Area: MSSA 161c – Golden Hill/ Logan Heights, San Diego County  Summary: Res./Civ. Pop: 75,852 White Pop: 61.04% Black Pop: 10.80% Hispanic Pop: 73.11% Below 200% Pov: 70.60% Below 100% Pov: 35.69% 65 year or older Pop: 7.74% Fluoridated Water: No IV-41
42. 42. Sub-County (Contiguous Area) Proposed Area: MSSA 161c – Golden Hill/ Logan Heights, San Diego County  Summary: Res./Civ. Pop: 75,852 White Pop: 61.04% Black Pop: 10.80% Hispanic Pop: 73.11% Below 200% Pov: 70.60% Below 100% Pov: 35.69% 65 year or older Pop: 7.74% Fluoridated Water: No Area 4 (S) – MSSA 161k – Chula Vista Central and Northwest/National City West SW.: ( Excessively Distant : 60 minutes by public transportation from CT 41 [29 th St & F St) to CT 125.00 (Chula Vista/Oaklawn ST ) Summary: Res./Civ. Pop: 80,991 White Pop: 45.09% Black Pop: 5.02% Hispanic Pop: 68.82% Below 200% Pov: 52.18% Below 100% Pov: 22.16% 65 year or older Pop: 9.74% Fluoridated Water: No HPSA: No Travel Time: 60 minutes IV-42
43. 43. Sub-County (Contiguous Area) Proposed Area: MSSA 161c – Golden Hill/ Logan Heights, San Diego County  Summary: Res./Civ. Pop: 75,852 White Pop: 61.04% Black Pop: 10.80% Hispanic Pop: 73.11% Below 200% Pov: 70.60% Below 100% Pov: 35.69% 65 year or older Pop: 7.74% Fluoridated Water: No Area 5 (W) – MSSA 161n – Coronado/Ocean Beach/ Point Loma: (Significant Demographic Difference : White Pop @ 35.64% and Hispanic Pop @ 54.72% Disparity)   Summary: Res./Civ. Pop: 80,679 White Pop: 96.68% Black Pop: 3.79% Hispanic Pop: 18.39% Below 200% Pov: 24.01% Below 100% Pov: 9.49% 65 year or older Pop: 12.80% Fluoridated Water: No HPSA: No   IV-43
44. 44. Examples Worksheets -------------------------------------------------- IV-44
45. 45. Sample HPSA Worksheets -------------------------------------------------- IV-45 Sub-County
46. 46. IV-46
47. 47. IV-47 IV-47 3 30
48. 48. IV-28 IV-48
49. 49. IV-49 IV-49
50. 50. IV-50
51. 51. Determine the Nearest Source of Non-Designated Care <ul><li>Needed for HPSA score: </li></ul><ul><li>Cannot be a HPSA (of any type) </li></ul><ul><li>Cannot have significant socio-economic/demographic differences or physical barrier </li></ul><ul><li>Can be excessively distant </li></ul><ul><li>Can be overutilized </li></ul><ul><li>For all applications: </li></ul><ul><li>Provide a road map with the proposed service area and contiguous areas </li></ul><ul><li>outlined </li></ul><ul><li>On the map, indicate the population center of the proposed service area, the </li></ul><ul><li>nearest source of care, and the route between these points </li></ul><ul><li>Provide the name and address of the nearest source of care, route, miles, and </li></ul><ul><li>minutes </li></ul><ul><li>For inner portions of metropolitan areas, include: </li></ul><ul><li>Bus route information from the population center of the proposed area to the nearest source of care </li></ul><ul><li>Miles and minutes of travel time </li></ul>-------------------------------------------------- IV-51
52. 52. Time Saving Tips Survey providers only if necessary: <ul><li>In contiguous areas, calculate the population to provider ratio counting each </li></ul><ul><li>provider as 1.0 FTE. If area meets ratio of > 3,000:1, don’t survey </li></ul><ul><li>Collect all possible information in one survey (e.g. Medicaid and </li></ul><ul><li>sliding fee scale even for an area designation) </li></ul><ul><li>Work with State licensing department to obtain information on </li></ul><ul><li>providers </li></ul><ul><li>Use claims data for Medicaid FTE (works only in fee-for-service </li></ul><ul><li>Medicaid) </li></ul>-------------------------------------------------- IV-52
53. 53. What To Include In The Contiguous Area Resources Section of Your Application <ul><li>Map with Census Delineations </li></ul><ul><li>Name and boundaries of proposed service area </li></ul><ul><li>Name and boundaries of contiguous areas </li></ul><ul><li>Population center for the proposed service area </li></ul><ul><li>Helpful: current designation status of each of the contiguous areas </li></ul><ul><li>Road Map </li></ul><ul><li>Outline of proposed area boundaries </li></ul><ul><li>Location of nearest source of non-designated care </li></ul><ul><li>For automobile transportation - start, end, and route </li></ul><ul><li>For public transportation - start and end points of route </li></ul>-------------------------------------------------- IV-53
54. 54. For Contiguous Areas that are not Excluded with Current Designations, and Whose Providers are Excessively Distant <ul><li>Travel time to closest provider from population center of service area, </li></ul><ul><li>including miles, route, and type of road; or public transportation information, </li></ul><ul><li>including bus routes, start/end points, miles, minutes, and source; include </li></ul><ul><li>bus schedule if available </li></ul><ul><li>For Contiguous Areas that are not Excluded with Current Designations, </li></ul><ul><li>and have Access Barriers </li></ul><ul><li>Description of any significant socio-economic/demographic disparities (e.g. demographic data on racial/ethnic composition or income levels comparing proposed service area population to population in the contiguous area, and source of data), or </li></ul><ul><li>Description of any significant physical barrier </li></ul><ul><li>For Contiguous Areas that are not Excluded with Current Designations, </li></ul><ul><li>and are Overutilized </li></ul><ul><li>Population to provider ratios </li></ul><ul><li>Description of how information was obtained </li></ul>-------------------------------------------------- IV-54
55. 55. <ul><li>Address of nearest source of non-designated, accessible care, including address, miles, and minutes via public transportation if metropolitan area </li></ul><ul><li>Location of nearest source on road map (see above) </li></ul>For All Designation Requests: <ul><li>For Public Transportation Routes: </li></ul><ul><li>Travel time, based on non-rush hour bus schedules </li></ul><ul><li>Start/End point of route </li></ul><ul><li>Include time waiting for transfers while in route </li></ul><ul><li>Map showing proposed area boundaries, start and end points of bus route </li></ul><ul><li>Bus schedules, if available </li></ul><ul><li>Cite source of information </li></ul>(Public transportation can be used for service areas with a 100% poverty population at or greater than 20% of the civilian population.) -------------------------------------------------- IV-55
56. 56. Websites Bay Area Public Transit (San Francisco) : http://www.transitinfo.org Southern California Public Transit (San Diego) : http://www.sdcommute.com/ Los Angeles County Metropolitan Transportation Authority http://www.metro.net/default.asp 2000 CT Locator : http://ffiec.gov/geocode/default.htm U.S. Census Bureau – American Factfinder http://factfinder.census.gov/home/saff/main.html?_lang=en -------------------------------------------------- IV-56
57. 57. APPLY FOR DESIGNATION No Contiguous Area Conditions Met 1or more Contiguous Area Conditions Met for EACH Contiguous Area Evaluate Contiguous Area STOP : Area Not Qualified For Designation Calculate Population-to- Dentist Ratio Define Rational Service Area Determine Dental FTEs Determine Service Area Population Evaluate Service Area for High- Need Indicators STOP: Area Not Qualified For Designation STOP : Area Not Qualified For Designation No High Need Indicators Present 1 or more High- Need Indicators Present Process Model for Geographic Dental Health Professional Shortage Area Designation To Use : Follow arrows. Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes 2 3 4 6 9 1 5 9 8 IV-57 Ratio < 3999 9 Ratio 4000-4999 Evaluate Contiguous Area 5 1 or less Insufficient Capacity Indicators Present 2 or more Insufficient Capacity Indicators Present 1 or more Contiguous Area Conditions Met for EACH Contiguous Area No Contiguous Area Conditions Met STOP : Area Not Qualified For Designation 9 APPLY FOR DESIGNATION 8 Ratio > 5000 Evaluate for Insufficient Capacity 7
58. 58. HPSA and MUA/MUP Application Process Shortage Designation Program (SDP) <ul><li>Initial Contact </li></ul><ul><li>Applicant contacts SDP for technical assistance (TA) and information. SDP provides: </li></ul><ul><li>TA on appropriate designation </li></ul><ul><li>Maps </li></ul><ul><li>Population and demographic data </li></ul><ul><li>Survey samples </li></ul><ul><li>Application worksheets </li></ul><ul><li>1 st Step – Application Received (Lal) </li></ul><ul><li>Log application on tracking database </li></ul><ul><li>Assign case number </li></ul><ul><li>Mail acknowledgment letter </li></ul><ul><li>2 nd Step – 30-day Comment Notice to: (Oakes) </li></ul><ul><li>County Health Officer/ Department/Medical Society </li></ul><ul><li>Primary Care, Dental, or Mental Health Association </li></ul><ul><li>HRSA/SDB copied </li></ul><ul><li>Case assigned to SDP staff (Chung) </li></ul>3 rd Step – Application Analysis (complete within 90 days, depending on caseload) <ul><li>Primary Care HPSA and MUA/MUP ( ASAPS Process ) </li></ul><ul><li>Validate application information before entering data into ASAPS (use on-line tools: maps, data tables, MSSA data) </li></ul><ul><li>Verify provider data </li></ul><ul><li>Calculate population to provider ratio </li></ul><ul><li>Conduct contiguous area analysis in mapping interface (does not apply to MUA/MUP) </li></ul><ul><li>If application is “incomplete”, request </li></ul><ul><li>additional data and allow applicant 15 days for resubmission. </li></ul><ul><li>Verify and enter all additional data needed </li></ul><ul><li>Prepare notification letter to applicant </li></ul><ul><li>Prepare ASAPS packet for Manager’s review and approval (Chung) </li></ul><ul><li>Upon completion, Manager submits recommendation via ASAPS </li></ul><ul><li>Mail ASAPS packet to applicant and others (Oakes) </li></ul><ul><li>Update tracking database (Lal) </li></ul><ul><li>4 th Step - HRSA Review (SDB) </li></ul><ul><li>Hold all recommendations for 30-day waiting period </li></ul><ul><li>Perform primary and secondary reviews </li></ul><ul><li>Upon approval or denial, post designation on HRSA on-line database </li></ul><ul><li>Send designation letter to SDP and applicant </li></ul>NOTE: HPSA designations are valid for 4 years. To maintain the HPSA status, designees must reapply every 4 years. MUA/MUP designations are permanent, unless there is a change in the MSSA boundary then designees must be reapply for the updated boundary. or <ul><li>5 th Step – SDP Tracking Update </li></ul><ul><li>Update SDP tracking database (Lal) </li></ul><ul><li>File designation letter in program file (Lal) </li></ul><ul><li>Create monthly dynamic maps (Dixon/Pham) </li></ul><ul><li>Dental & Mental HPSA </li></ul><ul><li>(M anual Process ): </li></ul><ul><li>Define rational service area (MSSA) </li></ul><ul><li>Verify population, poverty, & demographic data </li></ul><ul><li>Geo-code and verify provider data </li></ul><ul><li>Calculate population to provider ratio </li></ul><ul><li>Verify contiguous area resources </li></ul><ul><li>Develop proposed and contiguous area maps </li></ul><ul><li>Determine data is accurate, current, and consistent with all HPSA criteria </li></ul><ul><li>If application is “incomplete”, request additional data and allow applicant 15 days for re- submission. </li></ul><ul><li>Prepare recommendation packet to Federal Shortage Designation Branch (SDB) </li></ul><ul><li>Submit packet for peer review </li></ul><ul><li>Submit packet for Manager review and approval (Chung) </li></ul><ul><li>Mail recommendation packet to SDB and copies to applicant & others (Oakes) </li></ul><ul><li>Update tracking database (Lal) </li></ul>IV-58