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Health Professional Shortage Area (HPSA) Designation
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The information found on this webpage is also found on the Health Resources and Services Administration website.

 

Health Professional Shortage Area (HPSA) designations are determined by the Secretary of the U.S. Department of Health and Human Services (HHS) to have a shortage of either primary, dental, and/or mental health care professionals. These designations afford Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and other entities the ability to recruit physicians from the National Health Service Corps (NHSC), hire physicians holding a J-1 visa, and improve the score of their FQHC grant application.

 

 

Federal Programs that Use HPSA Designations

  • National Health Service Corps (Section 333 of the Public Health Service Act): Provides for assignment of federally-employed and/or service-obligated physicians, dentists, and other health professionals to designated HPSAs
  • National Health Service Corps Scholarship Programs (Section 338A): Provides scholarships for training health professionals who agree to serve in designated HPSAs through the NHSC or the private practice option
  • National Health Service Corps Loan Repayment Program (Section 338B): Provides loan repayment to health professionals who agree to serve in the NHSC in HPSAs selected by the HHS Secretary
  • Rural Health Clinics Act (Public Law 95-210): Provides Medicare and Medicaid reimbursement for services provided by physician assistants and nurse-practitioners in clinics in rural HPSAs
  • Medicare Incentive Payments for Physician's Services Furnished in HPSAs (Public Law 100-203, Section 4043, as amended): The Centers for Medicare & Medicaid Services (CMS, formerly HCFA) gives a 10% bonus payment for Medicare-reimbursable physician services provided within geographic HPSAs; this payment does not apply to population group HPSAs.
  • Higher "Customary Charges" for New Physicians in HPSAs (Public Law 100-203, Section 4047): CMS exempts new physicians opening practices in non-metropolitan geographic HPSAs from new Medicare limitations on "customary charges"
  • Area Health Education Center Program (Section 781(a)(1)): Gives special consideration to centers that would serve HPSAs with higher percentages of underserved minorities; gives funding priority to centers providing substantial training experience in HPSAs
  • Federal Employees Health Benefits Programs: Provides reimbursement for non-physician services in states with high percentages of their population residing in HPSAs

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Designation Process

HPSAs expire every three years and must be resubmitted for redesignation or withdrawal. The Michigan Department of Health and Human Services Primary Care Office (PCO) is responsible for this process and contract with Michigan Primary Care Association (MPCA) to collect the data needed for redesignation. MPCA also carries out designation feasibility analyses in conjunction with the PCO and independently.

  • HPSA Areas: There are three types of areas that can become a HPSA—an urban or rural area (geographic), a population group, or a public or nonprofit private medical facility
  • HPSA Type: There are three categories that HPSAs can fall under—primary care, dental, or mental health—and each category has its own conditions in which to qualify

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Primary Care HPSAs

Primary Care: Geographic

  • Must be a rational service area for the delivery of primary medical care services
  • Must meet ONE of the following conditions:
    • Have a population to full-time-equivalent primary care physician (FTE PCP) ratio of at least 3500:1
    • Have a population to full-time-equivalent primary care physician ratio of less than 3500:1 but greater than 3000:1 AND have unusually high needs for primary care services or insufficient capacity of existing primary care providers
  • Demonstrate that primary medical professionals in contiguous areas are overutilized, excessively distant, or inaccessible to the population under consideration. A contiguous area is automatically inaccessible if it is a similarly designated HPSA. Population group HPSAs are not considered inaccessible for a geographic HPSA.

Primary Care: Population Group

  • Must reside in a rational service area for the delivery of primary medical care services
  • Have access barriers that prevent the population group from use of the area's primary medical care providers (e.g. economic, linguistic, cultural, architectural barriers; or could involve refusal of some providers to accept certain types of patients or Medicaid reimbursement)
  • Have a ratio of persons in the population group to full-time-equivalent primary care physician serving the specific population ratio of at least 3000:1
  • Members of federally recognized Native American tribes are automatically designated
  • Demonstrate that primary medical professionals in contiguous areas are overutilized, excessively distant, or inaccessible to the population under consideration. A contiguous area is automatically inaccessible if it is a similarly designated HPSA. Population group HPSAs are not considered inaccessible for a geographic HPSA.

Primary Care: Facility

  • Medium to maximum security federal and state correctional institutions and youth detention facilities if they have at least 250 inmates and the ratio of the number of internees/year to the number of FTE primary care physicians serving the institution must be at least 1000:1
  • Public and/or non-profit facilities must provide primary medical care to an area or population group already designated as a primary care HPSA (the majority of the facilities' patients are from a HPSA or the HPSA population has reasonable access to facility) and must have insufficient capacity to meet the primary care needs of that area or population group

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Dental Care HPSAs

Dental: Geographic

  • Must be a rational service area for the delivery of dental services
  • Must meet ONE of the following conditions:
    • Have a population to FTE dental professionals ratio of at least 5000:1
    • Have a population to FTE dental professional ratio of less than 5000:1 but greater than 4000:1 and unusually high needs for dental services
  • Demonstrate that dental professionals in contiguous areas are overutilized, excessively distant, or inaccessible to the population under consideration. A contiguous area is automatically inaccessible if it is a similarly designated HPSA. Population group HPSAs are not considered inaccessible for a geographic HPSA.

Dental: Population Group

  • Exist in a rational service area for delivery of dental care services
  • Have access barriers that prevent the population group from use of the area's dental professionals (e.g. economic, linguistic, cultural, architectural barriers; or could involve refusal of some providers to accept certain types of patients or Medicaid reimbursement)
  • Have a ratio of persons in the population group to FTE dental professionals serving the specific population ratio of at least 4000:1
  • Groups of members of Indian tribes are automatically designated
  • Demonstrate that dental professionals in contiguous areas are overutilized, excessively distant, or inaccessible to the population under consideration. A contiguous area is automatically inaccessible if it is a similarly designated HPSA. Population group HPSAs are not considered inaccessible for a geographic HPSA.

Dental: Facility

  • Medium to maximum security federal and state correctional institutions and youth detention facilities if they have at least 250 inmates and the ratio of the number of internees/year to the number of FTE dental professionals serving the institution must be at least 1500:1
  • Public and/or non-profit facilities must provide dental care to an area or population group already designated as a dental HPSA (the majority of the facilities' patients are from a HPSA or the HPSA population has reasonable access to facility) and must have insufficient capacity to meet the dental care needs of that area or population group

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Mental Health Care HPSAs

Mental Health: Geographic

  • Be in a rational service area for the delivery of mental health services
  • Must meet ONE of the following conditions:
    • A population-to-core-mental-health-professional ratio greater than or equal to 6,000:1 and a population-to-psychiatrist ratio greater than or equal to 20,000:1
    • A population-to-core professional ratio greater than or equal to 9,000:1
    • A population-to-psychiatrist ratio greater than or equal to 30,000:1
  • Have unusually high needs for mental health services, and
    • A population-to core-mental-health-providers ratio greater than or equal to 4,500:1 and a population-to-psychiatrist ratio greater than or equal to 15,000:1, or
    • A population-to-core-professional ratio greater than or equal to 6,000:1, or
    • A population-to-psychiatrist ratio greater than or equal to 20,000:1
  • Mental health professionals in contiguous areas are overutilized, excessively distant, or inaccessible to residents of the area under consideration

Mental Health: Population Group

  • Face access barriers that prevent the population group from use of the area's mental health providers.
  • Must meet ONE of the following conditions:
    • Have a ratio of the number of persons in the population group to the number of FTE core mental health professionals serving the population group greater than or equal to 4,500:1 and the ratio of the number of persons in the population group to the number of FTE psychiatrists serving the population group greater than or equal to 15,000:1
    • Have a ratio of the number of persons in the population group to the number of FTE core mental health professionals serving the population group greater than or equal to 6,000:1
    • Have a ratio of the number of persons in the population group to the number of FTE psychiatrists serving the population group are greater than or equal to 20,000:1

Mental Health: Facility

  • Be either federal and/or state correctional institutions, state/county mental hospitals, or public and/or non-profit mental health facilities
  • Federal or state correctional facilities must:
    • Have at least 250 inmates
    • Have a ratio of the number of internees per year to the number of FTE psychiatrists serving the institution of at least 2,000:1
  • State and county mental health hospitals must:
    • Have an average daily inpatient amount of at least 100
    • The number of workload units per FTE psychiatrists available at the hospital exceeds 300, where workload units are calculated using the following formula: total workload units = average daily inpatient census + 2 x (number of inpatient admissions per year) + 0.5 x (number of admissions to day care and outpatient services per year)
  • Community mental health centers and other public and non-profit facilities must:
    • Be providing (or responsible for providing) mental health services to an area or population group designated as having a shortage of mental health professionals
    • Have insufficient capacity to meet the psychiatric needs of the area or population group

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Automatic Facility HPSA Scoring

More information about Automatic Facility HPSA Scoring, the Scoring Process, and Possible Score Appeals

See Criteria for Determining Primary Care HPSAs of Greatest Shortage if considering an appeal.

 

Current Designations in Michigan

Primary Care Health Professional Shortage Area

Statewide Map of HPSAs
List by County

Mental Health Professional Shortage Area

Statewide Map of HPSAs
List by County

Dental Health Professional Shortage Area

Statewide Map of HPSAs
List by County

Medically Underserved Area/Population

Map of MUA/MUP
List by County

Detroit Medically Underserved Area/Population

Map of Detroit's MUA/Ps

Governor’s Certified Shortage Area for RHC

Statewide Map of RHCs
List by County

More Information & Designation Inquiries

Joe Tran

Program Specialist, Health Center Operations
jtran@mpca.net
517.827.0472

 

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