INDIANA SHORTAGE DESIGNATIONS Raymond J. Guest, M.P.H. Primary Care Office Manager Indiana State Department of Health
Definitions <ul><li>PCO </li></ul><ul><li>PCA </li></ul><ul><li>OSD </li></ul><ul><li>HRSA </li></ul><ul><li>NHSC </li></u...
Definitions <ul><li>HPSA   </li></ul><ul><li>MUA </li></ul><ul><li>MUP </li></ul>Health Professional Shortage Area Medical...
Designations Needed for Selected Federal Programs X X Governor’s Exception MUP X X MUP X X X MUA X X X Facility HPSA X X X...
Application Process <ul><li>Determine Rational Service Area (RSA) </li></ul><ul><li>Determine Contiguous Service Areas </l...
Application Process <ul><li>Determine Rational Service Area (RSA) </li></ul><ul><li>Single County </li></ul><ul><li>Multi-...
Application Process <ul><li>Facility Designations  </li></ul><ul><li>HPSA Designation of Facilities </li></ul><ul><li>Pris...
Application Process <ul><li>Designation of a geographic area or population? </li></ul><ul><li>Geographic area </li></ul><u...
Application Process <ul><li>Designation of a geographic area or population? </li></ul><ul><li>Populations that can be desi...
Application Process <ul><li>Preliminary Analysis  </li></ul><ul><li>Determine Contiguous Service Areas </li></ul><ul><li>2...
 
Application Process <ul><li>Identify Providers   </li></ul><ul><li>Primary Care Physicians </li></ul><ul><li>Family/Genera...
Application Process <ul><li>Identify Providers </li></ul><ul><li>Dentists who provide direct patient care </li></ul><ul><l...
Application Process <ul><li>Identify Providers   </li></ul><ul><li>Core Mental Health Providers (CMHP) </li></ul><ul><li> ...
Application Process <ul><li>Collect demographic data </li></ul><ul><li>Race </li></ul><ul><li>Poverty </li></ul><ul><li>In...
Application Process <ul><li>Survey providers   </li></ul><ul><li>In RSA </li></ul><ul><li>In Contiguous Service Areas </li...
Application Process <ul><li>Analysis </li></ul><ul><li>Are all the qualifications met? </li></ul>
Application Process <ul><li>Analysis -  Qualifications for RSAs </li></ul><ul><li>PC-HPSA – Geographic </li></ul><ul><ul><...
Application Process <ul><li>Analysis -  Qualifications for RSAs </li></ul><ul><li>Dent-HPSA – Geographic </li></ul><ul><ul...
Application Process <ul><li>Analysis -  Qualifications for RSAs </li></ul><ul><li>Ment-HPSA Geographic </li></ul><ul><ul><...
Application Process <ul><li>Analysis –  Qualifications for RSAs </li></ul><ul><li>Ment-HPSA Population </li></ul><ul><ul><...
Application Process <ul><li>Analysis -  Qualifications for Contiguous Areas </li></ul><ul><li>Barriers to access </li></ul...
Application Process <ul><li>Analysis –  Qualifications for Contiguous Areas </li></ul><ul><li>For Primary Care HPSAs,  </l...
 
Application Process <ul><li>Analysis -  Qualifications for Contiguous Areas  Overutilization </li></ul><ul><ul><li>Populat...
Application Process <ul><li>Analysis –  Qualifications for MUA/Ps </li></ul><ul><li>MUA & MUP– Score of 62 or less </li></...
Medically Underserved Area (MUA) .151 13.1 12.2% 10.5% Value 61.1 Total Score .5 V4. Prov/1000 pop 21.5 V3. IMR 19.1 V2.  ...
Application Process <ul><li>Review </li></ul><ul><li>Identify RSA & Contig Areas  </li></ul><ul><li>Identify providers </l...
Resources <ul><li>ISDH web site </li></ul><ul><li>http://www.in.gov/isdh/publications/llo/shortages/shortage.htm </li></ul...
Contact <ul><li>Natalie Brown, MPH </li></ul><ul><li>Shortage Designations and National Health Service Corps Program Direc...
Contact <ul><li>Raymond J. Guest, MPH </li></ul><ul><li>Primary Care Office Manager </li></ul><ul><li>Indiana State Depart...
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INDIANA SHORTAGE DESIGNATIONS Raymond J. Guest, M.P.H.

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INDIANA SHORTAGE DESIGNATIONS Raymond J. Guest, M.P.H.

  1. 1. INDIANA SHORTAGE DESIGNATIONS Raymond J. Guest, M.P.H. Primary Care Office Manager Indiana State Department of Health
  2. 2. Definitions <ul><li>PCO </li></ul><ul><li>PCA </li></ul><ul><li>OSD </li></ul><ul><li>HRSA </li></ul><ul><li>NHSC </li></ul><ul><li>CMS </li></ul>National Health Service Corps Centers for Medicare & Medicaid Services Health Resources & Services Administration Primary Care Office (ISDH) Primary Care Association (IPHCA) Agencies Office of Shortage Designation
  3. 3. Definitions <ul><li>HPSA </li></ul><ul><li>MUA </li></ul><ul><li>MUP </li></ul>Health Professional Shortage Area Medically Underserved Area Medically Underserved Population Types of Designations
  4. 4. Designations Needed for Selected Federal Programs X X Governor’s Exception MUP X X MUP X X X MUA X X X Facility HPSA X X X X Population HPSA X X X X X Geographic HPSA HPSA Subtypes X Geographic only, ask CMS X X Mental HPSA X X Dental HPSA X X Geographic only X X Primary Care HPSA J-1 Visa Waiver Program CMS Rural Health Clinic Program CMS Medicare Incentive Payment Program FQHC Program SLRP NHSC
  5. 5. Application Process <ul><li>Determine Rational Service Area (RSA) </li></ul><ul><li>Determine Contiguous Service Areas </li></ul><ul><li>Identify providers ( Local Help Needed ) </li></ul><ul><li>Collect data. </li></ul>
  6. 6. Application Process <ul><li>Determine Rational Service Area (RSA) </li></ul><ul><li>Single County </li></ul><ul><li>Multi-county or Catchment Area </li></ul><ul><li>Partial County </li></ul><ul><li>Census Tracts </li></ul><ul><li>Townships </li></ul>
  7. 7. Application Process <ul><li>Facility Designations </li></ul><ul><li>HPSA Designation of Facilities </li></ul><ul><li>Prisons </li></ul><ul><li>Medical Facilities ( i.e. Community Health Centers) </li></ul><ul><li>Automatic HPSA Designation of Facilities </li></ul><ul><li>Federally Qualified Health Centers (FQHC) </li></ul><ul><li>Rural Health Centers (RHC) </li></ul>
  8. 8. Application Process <ul><li>Designation of a geographic area or population? </li></ul><ul><li>Geographic area </li></ul><ul><li>Population </li></ul>
  9. 9. Application Process <ul><li>Designation of a geographic area or population? </li></ul><ul><li>Populations that can be designated: </li></ul><ul><li>Low-income/poor </li></ul><ul><li>Migrant farm workers </li></ul><ul><li>Homeless </li></ul><ul><li>Medicaid eligible </li></ul><ul><li>et al. </li></ul>
  10. 10. Application Process <ul><li>Preliminary Analysis </li></ul><ul><li>Determine Contiguous Service Areas </li></ul><ul><li>20 mile polygon for Primary Care HPSAs </li></ul><ul><li>25 mile polygon for Dental & Mental HPSAs </li></ul><ul><li>No contiguous analysis for MUA/Ps </li></ul>
  11. 12. Application Process <ul><li>Identify Providers </li></ul><ul><li>Primary Care Physicians </li></ul><ul><li>Family/General Practice </li></ul><ul><li>General Internal Medicine </li></ul><ul><li>General Pediatric Medicine </li></ul><ul><li>OB/GYN </li></ul><ul><li> Geriatric Medicine </li></ul><ul><li>Immediate care physicians </li></ul>
  12. 13. Application Process <ul><li>Identify Providers </li></ul><ul><li>Dentists who provide direct patient care </li></ul><ul><li>General Dentistry </li></ul><ul><li> Pediatric Dentistry </li></ul>
  13. 14. Application Process <ul><li>Identify Providers </li></ul><ul><li>Core Mental Health Providers (CMHP) </li></ul><ul><li> Psychiatrists </li></ul><ul><li> Clinical Psychologists </li></ul><ul><li> Clinical Social Workers </li></ul><ul><li> Psychiatric Nurse Specialists </li></ul><ul><li> Marriage and Family Therapists </li></ul>
  14. 15. Application Process <ul><li>Collect demographic data </li></ul><ul><li>Race </li></ul><ul><li>Poverty </li></ul><ul><li>Infant Mortality Rate </li></ul><ul><li>Age (65+) </li></ul><ul><li>Low-Income </li></ul>
  15. 16. Application Process <ul><li>Survey providers </li></ul><ul><li>In RSA </li></ul><ul><li>In Contiguous Service Areas </li></ul>
  16. 17. Application Process <ul><li>Analysis </li></ul><ul><li>Are all the qualifications met? </li></ul>
  17. 18. Application Process <ul><li>Analysis - Qualifications for RSAs </li></ul><ul><li>PC-HPSA – Geographic </li></ul><ul><ul><li>3500:1 pop to provider ratio </li></ul></ul><ul><li>PC-HPSA – Population </li></ul><ul><ul><li>3000:1 pop to provider ratio </li></ul></ul><ul><ul><li>30% of population must be at or below 200% of poverty </li></ul></ul>
  18. 19. Application Process <ul><li>Analysis - Qualifications for RSAs </li></ul><ul><li>Dent-HPSA – Geographic </li></ul><ul><ul><li>5000:1 pop to provider ratio </li></ul></ul><ul><li>Dent-HPSA – Population </li></ul><ul><ul><li>4000:1 pop to provider ratio </li></ul></ul><ul><ul><li>30% of population must be at or below 200% of poverty </li></ul></ul>
  19. 20. Application Process <ul><li>Analysis - Qualifications for RSAs </li></ul><ul><li>Ment-HPSA Geographic </li></ul><ul><ul><li>30,000:1 psychiatrists only </li></ul></ul><ul><ul><li>9,000:1 CMHP including psychiatrists </li></ul></ul><ul><ul><li>6,000:1 CMHP and = or > 20,000:1 psychiatrists </li></ul></ul>
  20. 21. Application Process <ul><li>Analysis – Qualifications for RSAs </li></ul><ul><li>Ment-HPSA Population </li></ul><ul><ul><li>20,000:1 psychiatrists only </li></ul></ul><ul><ul><li>6,000:1 CMHP including psychiatrists </li></ul></ul><ul><ul><li>4,500:1 CMHP and > 15,000:1 psychiatrists </li></ul></ul><ul><ul><li>30% of population must be at or below 200% of poverty </li></ul></ul>
  21. 22. Application Process <ul><li>Analysis - Qualifications for Contiguous Areas </li></ul><ul><li>Barriers to access </li></ul><ul><ul><li>Distance </li></ul></ul><ul><ul><li>Physical barriers </li></ul></ul><ul><ul><li>Socio-Economic disparities </li></ul></ul><ul><ul><li>Contig Area has = or > designation </li></ul></ul><ul><ul><li>Self Identified neighborhood </li></ul></ul><ul><ul><li>Overutilization </li></ul></ul>
  22. 23. Application Process <ul><li>Analysis – Qualifications for Contiguous Areas </li></ul><ul><li>For Primary Care HPSAs, </li></ul><ul><ul><li>no resources within 30 min </li></ul></ul><ul><li>For Dental & Mental HPSA’s </li></ul><ul><ul><li>no resources within 40 min. </li></ul></ul>
  23. 25. Application Process <ul><li>Analysis - Qualifications for Contiguous Areas Overutilization </li></ul><ul><ul><li>Population to provider ratios </li></ul></ul><ul><ul><ul><li>PC > 2,000:1 </li></ul></ul></ul><ul><ul><ul><li>Dent > 3,000:1 </li></ul></ul></ul><ul><ul><ul><li>Ment > 20,000:1 (psychiatrists) or </li></ul></ul></ul><ul><ul><ul><li>Ment > 3,000:1 (CMHP) + > 10,000:1 (psychiatrists) </li></ul></ul></ul>
  24. 26. Application Process <ul><li>Analysis – Qualifications for MUA/Ps </li></ul><ul><li>MUA & MUP– Score of 62 or less </li></ul><ul><ul><li>Variables </li></ul></ul><ul><ul><ul><li>% of Population in Poverty </li></ul></ul></ul><ul><ul><ul><li>% of Population 65 & over </li></ul></ul></ul><ul><ul><ul><li>Infant Mortality Rate </li></ul></ul></ul><ul><ul><ul><li>Providers per 1000 population </li></ul></ul></ul>
  25. 27. Medically Underserved Area (MUA) .151 13.1 12.2% 10.5% Value 61.1 Total Score .5 V4. Prov/1000 pop 21.5 V3. IMR 19.1 V2. > 65 pop 20.0 V1. Poverty WV Variable
  26. 28. Application Process <ul><li>Review </li></ul><ul><li>Identify RSA & Contig Areas </li></ul><ul><li>Identify providers </li></ul><ul><li>Survey providers </li></ul><ul><li>Analysis </li></ul><ul><li>Submission to OSD </li></ul><ul><li>Designation </li></ul>
  27. 29. Resources <ul><li>ISDH web site </li></ul><ul><li>http://www.in.gov/isdh/publications/llo/shortages/shortage.htm </li></ul><ul><li>Official Designation Database </li></ul><ul><li>http://hpsafind.hrsa.gov/ </li></ul><ul><li>Nat’l Health Service Corps </li></ul><ul><li>http://nhsc.bhpr.hrsa.gov </li></ul>
  28. 30. Contact <ul><li>Natalie Brown, MPH </li></ul><ul><li>Shortage Designations and National Health Service Corps Program Director </li></ul><ul><li>Indiana Primary Health Care Assoc. </li></ul><ul><li> [email_address] </li></ul><ul><li>(317) 630-0845 </li></ul>
  29. 31. Contact <ul><li>Raymond J. Guest, MPH </li></ul><ul><li>Primary Care Office Manager </li></ul><ul><li>Indiana State Department of Health </li></ul><ul><li>[email_address] </li></ul><ul><li>(317) 233-7846 </li></ul>

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