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Proposed Rule: Designation of Medically Underserved Populations & Health Professional Shortage Areas

About the Proposed Rule

Instead of issuing a final regulation as the next step, the U.S. Department of Health and Human Services will issue a new Notice of Proposed Rulemaking for further review and public comment prior to issuing a final rule. (Federal Register Notice, 7-23-2008)

The Notice of Proposed Rulemaking, Designation of Medically Underserved Populations and Health Professional Shortage Areas, was originally published on February 29, 2008.

The proposed rule revised and consolidated the criteria and processes for designating Medically Underserved Populations (MUPs) and Health Professional Shortage Areas (HPSAs).

The 60-day comment period was extended twice: an additional 30 days on April 21 (to May 31); and another 30 days on June 2 (to June 30). The Health Resources and Services Administration received many substantive comments on the proposed rule and will consider these comments carefully.

The proposed rule was intended to improve the way underserved areas and populations are designated, by

  • incorporating up-to-date measures of health status and access barriers,
  • eliminating inconsistencies and duplication of effort between the two existing processes, and
  • reducing the effort and data burden on States and communities by simplifying and automating the designation process as much as possible while maximizing the use of technology.

No changes were proposed with respect to the criteria for designating dental and mental health HPSAs. Podiatric, vision care, pharmacy, and veterinary care HPSAs, which are no longer in use, would be abolished.

Impact of the Proposed Rule

HRSA estimated that more than 90 percent of designations would be retained and a number of new designations would be added.

The proposed methodology, using only nationally available data, would retain a much higher percentage (91 percent) of the current HPSAs than would an update using the current HPSA method (50 percent). The new method, using the expanded need factors, designates many more areas, even without local data, than does the current method. With the inclusion of local data, which the new method also allows, this number would go even higher.

Twenty-three States conducted their own analyses, using local and state data sources. The consensus is that a large majority of their areas would be retained, including areas that have lost or are losing their designations under the current method. In addition, states report that the proposed method captured new areas of need better than the current method, and the proposed method provides greater flexibility for identifying rational service areas.

Contact your State's Primary Care Office representative to discuss their findings on the impact of the proposed rule using national, State and local data.