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Shortage Designations

What are they? |  Why Important?  |  How to Request?

What are Shortage Designations?

Federal shortage designations:

• Document a severe shortage of primary care, dental, or mental health providers in a rural or urban service area; 
• Are specific to a service area that can be a county, group of towns, group of census tracts in a city, a state or federal correctional facility, a rural health clinic or a community health center; and
• Are associated with difficulty or delays in getting basic health care (e.g., long travel distances to providers, long wait times for appointments, or no providers who can serve uninsured or underinsured patients).

Two basic categories of shortage designations:

• Health Professional Shortage Area (HPSA)
  There are three different types of HPSAs, and each type indicates a shortage of primary care, dental, or mental health providers.  HPSA service areas can be based on geographic areas, a population or a facility.  Each HPSA must be reviewed for re-designation every 3 years.
• Medically Underserved Area/population (MUA/P)
  Documents shortages of primary care providers and also reflects high needs of the target population.  MUA/Ps currently do not need to be re-designated.

Federal and State Partnership:

• Federal Shortage Designation Bureau in DHHS/HRSA is responsible for reviewing and making final decisions on shortage designation applications per federal regulations, and maintaining a web-searchable database of designation:  http://bhpr.hrsa.gov/shortage/
• State health departments are responsible for:  coordinating with clinics that request shortage designations, collecting and analyzing provider FTE and other designation data, and submitting state applications for federal designation of shortage areas.  The Wisconsin Primary Care Program is responsible for shortage designation applications in Wisconsin.

Shortage Designations in Wisconsin:

• HPSAs in Wisconsin (2007) = 101 primary care, 56 dental, & 88 mental health 
• HPSA searchable database (exit DHS) -- Select state, then select county and specialty, and select "show me the HPSAs"
  
  
• MUA/Ps in Wisconsin (2007) = 73
• MUA/P searchable database (exit DHS) --  Select state, then select county and "show me the MUA/Ps"

Why are Shortage Designations Important?

There are a number of federal and state benefits that are linked with Health Professional Shortage Area designations (HPSAs) and/or Medically Underserved Area/Population designations (MUA/Ps). These benefits are designed to encourage health professionals to work in rural and inner-city shortage areas and increase access to primary care, dental care and mental health services. 

Provider Payment Incentives Linked with HPSAs

• Medicare HPSA bonus  (exit DHS): 10% reimbursement for covered physician or psychiatrist services in geographic HPSAs (primary care and mental health HPSAs respectively)  
• Wisconsin Medicaid HPSA bonus: 20% reimbursement bonus for covered services by primary care physicians, advanced practice nurses and physician assistants located in a HPSA or serving recipients living in a HPSA (includes a 50% bonus for certain Obstetric services).  
• Rural Health Clinic Certification: Certified RHCs are eligible for Medicare  (exit DHS) and Medicaid cost-based reimbursement for outpatient services in rural HPSAs or rural MUAs. 

Provider Recruitment Resources Linked with HPSAs or MUA/Ps

• National Health Service Corps recruitment assistance (exit DHS): Student loan repayment for clinicians and placement of scholarship recipients at sites in high-scoring primary care, dental and mental health HPSAs. 
• Wisconsin Loan Repayment program (exit DHS): Student loan repayment for clinicians at sites in high-need primary care, dental and mental health HPSAs. 
• J-1 Visa Waivers for Foreign Physician Recruitment: State recommendations for J-1 visa waivers to recruit foreign physicians into HPSAs or MUA/Ps. 

Federal Community Health Center Funding Linked with MUA/Ps

Non-profit community organizations located in MUA/Ps are eligible to apply for federal grants under the Community Health Centers Program (exit DHS) (community health center, migrant health center, health care for the homeless, public housing health center). 

Federally funded community health centers are then eligible for cost-based reimbursement from Medicare and Medicaid as federally qualified health centers (FQHCs).

Health Professions Training Resources Linked with HPSAs & MUA/Ps

Health professions academic training programs who apply for many of the education and training grants from the federal Bureau of Health Professions (exit DHS) are given a funding preference if they can demonstrate that they recruit students from and if their graduates serve populations in designated HPSAs and MUA/Ps.

How do I Request a Shortage Designation?

To initiate a request for a shortage designation for a community, please send a written request (e-mail, fax or letter) specifying the service area for which a shortage designation is desired.  Also explain why the community wants a shortage designation--which shortage designation benefit is most desired by the community.

Send the request to the Wisconsin Primary Care Program at:  

Last Revised: June 24, 2008