What is a HPSA? - Ohio Association of Community Health Centers

Loan Repayment
Options and
HPSA 101
OACHC Annual Spring
Conference
March 6, 2013
HPSA 101 Overview
Part I
– What is a HPSA?
– What are the types of HPSAs?
Part II
– HPSA scoring
What is a HPSA?
Health Professional Shortage Areas (HPSAs) are defined
service areas that demonstrate a critical shortage of primary
care, dental or mental health providers.
A HPSA can be:
•
•
•
A distinct geographic area (such as a county or grouping of
census tracts or townships),
A specific population group within a defined geographic
area (such as the low-income population below 200% of
the federal poverty level), or
A specific facility (such as a community health center).
Why be designated?
The HPSA is the foundation for many
recruitment/retention programs, including:
• National Health Service Corps (NHSC)
• State Loan Repayment Programs
• J-1 Visa Waiver Program (except for a limited
number of slots)
HPSAs are a federal designation
• All requests for designation of a HPSA are
evaluated and approved or disapproved by the
federal Division of Policy and Shortage Designation
in the Health Resources and Services
Administration (HRSA) based on criteria
established by regulation.
• HPSAs must generally be updated at least every
four years.
Types of HPSAs
1. Geographic HPSAs - entire population
2. Special population HPSAs - such as the low-income
and Medicaid-eligible populations
3. Facility HPSAs - include:
•
•
•
•
Public or non-profit facilities that serve residents of a
designated HPSA
State and federal correctional facilities
State and county psychiatric hospitals
Automatic HPSAs: Rural Health Clinics that meet specific
requirements and all FQHCs and FQHC Look-Alikes
Key HPSA Components – Geographic and
Special Population HPSAs
• Rational service area - The area must be rational for the
delivery of services. May be full county, sub-county, or
parts of adjacent counties. For mental health, could be a
catchment area.
• Population-to-provider ratio - Minimum ratios vary with
the discipline and type of HPSA being requested, as well as
with the demographics of the area.
• Contiguous area analysis - Services in neighboring areas
must be unavailable to the HPSA based on overutilization,
excessive distance or socioeconomic barriers.
Map of Ohio’s Primary Care HPSAs
= Geographic HPSA
= Special Population HPSA
C
Ohio Department of Health Primary Care
Office, Feb. 22, 2013
= Correctional Facility HPSA
= Facility HPSA*
*includes only main automatic HPSA
sites listed on www.hpsafind.hrsa.gov
HPSA Scoring
.
HPSA Scoring
• Geographic and population HPSA scores are calculated from data
included in the HPSA application.
• Automatic FQHC/FQHC Look-ALike HPSA scores can be adjusted if
better data is available.
Data used to Compute HPSA Scores
The current scoring methodology for primary care includes four factors:
• Population-to-Primary Care Physician Ratio;
• Percent of the Population with incomes below 100% of the
Poverty Level;
• Infant Mortality Rate or Low Birth Weight (whichever score is
higher); and
• Travel Time or Distance to the nearest available source of care
(whichever score is higher).
Population-to-PC Physician Ratios
Population Side of the Ratio: Primary Care
Service Areas (PCSAs) are used as a
proxy for the Rational Service Area
PC Physician Side of the Ratio: Combined
AMA/AOA files were used
12
Percent of the Population with incomes
below 100% of the Poverty Level
For FQHC and FQHC Look-a-like grantees:
• Initially 2002 Uniform Data System (UDS)-reported data on
percent of users with incomes below 100% of poverty were used;
more recent UDS data used subsequently
Infant Health Index
Uses the Infant Mortality Rates and Low
Birth Weight Rates for the PCSA where
the site is located
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Travel Time/Distance
Travel Time and Distance are calculated from
the population-weighted center of the PCSA
in which the entity is located to the
population-weighted center of the nearest
PCSA with a population-to-primary care
physician ratio of 2,000:1 or under, using
average road speeds and travel time for each
road segment involved
Submitting Alternative Data for Use in
the AUTOHPSA Scoring Process
Provider data:
• All non-federal providers without NHSC obligations or J-1 visa
waiver obligations must be counted under the current
designation and HPSA scoring method;
• May substitute the ratio from a “Regular HPSA”;
• Data collected from the UDS Mapper may be used.
Submitting Alternative Data for Use in
the AUTOHPSA Scoring Process
Population Data and Poverty Data:
• US Census data on these variables should be used for any service area
considered;
• Data on these variables may be calculated for the actual service area
rather than the whole county or PCSA of the entity’s location, if a more
accurate definition of the actual service area is available;
• Updated UDS poverty data may be used if significantly different (Please
note that the majority of the FQHC and FQHC Look-Aike grantee sites
already get the maximum points allowed for the poverty variable, based
on UDS user poverty rates greater than 50%.)
Submitting Alternative Data for Use in the
AUTOHPSA Scoring Process
Infant Mortality Rate/Low Birth Weight:
• In most cases, county-level data are the only data are used.
• The use of 5-year averages at the census tract level may be used.
• In order to use such census tract data, the service area must have
more than 4,000 births over 5 years. (Please note, it is unlikely
that any facility will get more than 1 or 2 points maximum with
new data.)
Submitting Alternative Data for Use in the
AUTOHPSA Scoring Process
Travel Time/Distance:
• These estimates were based on use of PCSA data and GIS road
classification data.
• In some cases, they may not accurately reflect the actual
time/distance to nearest source of care for the population being
reviewed.
• Local data could be submitted in accordance with the existing
HPSA criteria.
Loan Repayment Programs
Part I
National Health Service Corps
Part II
State Loan Repayment Programs
NHSC LRP Site Eligibility
 All FQHC’s and FQHC Look-Alikes are
automatically NHSC Approved Sites
 FQHC’s and FQHC Look-alikes do not need
to submit applications to add new sites
through the Customer Service Portal
NHSC Site Administrator Portal
 Allows sites to create their site
profile in the NHSC Jobs Center
 Effective January 1, 2013, sites
must have at least a basic site
profile to continue to list job
opportunities in the Jobs Center
 Sites also complete the 6month In-Service Verification
(ISV) for NHSC participants
through the Customer Service
Portal
NHSC Loan Repayment Program Provider Eligibility
 U.S. citizen or national
 Have unpaid government or commercial loans for school tuition,
reasonable educational expenses, and reasonable living expenses,
segregated from all other debts
 Licensed to practice in state where employer site is located
 Currently working at an NHSC-approved service site or have
accepted an offer of employment at an NHSC-approved service
site and will begin employment at that site by July 15, 2013.
2013 NHSC LRP Application Cycle
Approximately 1,535 New LRP Awards
and 3,000 Continuations for 2013
Application Cycle - 2013
Application Cycle Opened
Application Deadline
All 2013 Awards Made
Important Dates
February 7, 2013
April 16, 2013
September 30, 2013
Service Requirements
 Full-time clinical practice is defined as no less than 40 hours per week, for
a minimum of 45 weeks per year.
•
At least 32 hours/week are spent providing direct patient care or teaching at the
approved service site(s).
 Half-time clinical practice is defined as a minimum of 20 hours per week
(not to exceed 39 hours per week), for a minimum of 45 weeks per year.
•
At least 16 hours/week are spent providing direct patient care or teaching at the
approved service site(s).
 For OB/Gyn’s, Certified Nurse-Midwives, Mental and Behavioral Health
providers, Pediatric Dentists and Geriatric Service providers: 21
hours/week providing care at an NHSC-approved site; 19 hours/week
providing patient care at an alternate site.
NHSC Loan Repayment Initial Awards
The NHSC Loan Repayment Program offers two levels of funding,
based upon the need of the community in which a provider works,
as defined by Health Professional Shortage Area (HPSA) score
HPSA Score
2-Year Full-time
Up to
4-Year Half-time
Up to
2-Year Half-time
Up to
14+
$60,000
$60,000
$30,000
0-13
$40,000
$40,000
$20,000
LRP Contract Continuations
With continued service, NHSC providers may be able
to pay off all of their student loans.
Years of Continued Service
Full-Time
Status
Half-Time
Status
3rd year of NHSC Service
$30,000
$15,000
4th year of NHSC Service
$30,000
$15,000
5th year of NHSC Service
$20,000
$10,000
6th year of NHSC Service
$20,000
$10,000
 If a participant’s outstanding balance of qualifying educational loans is less than
the stated amount, the NHSC LRP will pay the remaining balance of the total
qualifying educational loans.
State Loan Repayment Programs
1. Ohio Physician Loan Repayment Program
2. Ohio Dentist Loan Repayment Program
3. State Loan Repayment Program
These programs do not use HPSA Scores!
Ohio Physician Loan Repayment Program
 Funded by physician license renewal fees
 Application submitted by physician includes
one-page site information
 Applications were due February 15th
 23 applications under review including 9 from
FQHC’s
 Awards to be made by Summer
Ohio Physician Loan Repayment Program
Eligible primary care specialties are Family Medicine; General Internal Medicine;
General Pediatrics; OB/Gyn; Geriatrics; Med/Ped; Adolescent Medicine; and
General, Child and Adolescent, or Geriatric Psychiatry
Years of Service
Annual Amount
1st two-year contract
$25,000
2nd and 3rd years
$35,000
 Applicants must be in current practice or in final year of training
 Physicians must work full time (40 hrs./week) at an approved site
 Sites must be located in a HPSA or Health Resource Shortage Area
Ohio Dentist Loan Repayment Program
(ODLRP)
• General and pediatric dentists are
eligible (hygienists are not)
• Must work full-time (can work at
multiple sites)
ODLRP Applications
Applications will be accepted until
Monday, April 8, 2013 (postmarked)
ODLRP Applications
Visit the ODH Oral Health Web page
to download an application
http://www.odh.ohio.gov/odhprograms/ohs/oral/oral1.aspx
Contact Information
Mona.Taylor@odh.ohio.gov
Oral Health Access Program Coordinator
614.466.4180
Sandy.Brado@odh.ohio.gov
Oral Health Consultant
330.643.1322
State Loan Repayment Program
Years of Service




Annual Amount
1st two-year contract
$25,000
2nd and 3rd years
$35,000
HRSA Grant to Primary Care Office
Eligible disciplines same as NHSC LRP plus Pharmacists!
Applicants must work in designated HPSA
Requires non-federal matching funds
Questions
36
Contact information
Shane Ford, Researcher
shane.ford@odh.ohio.gov
614-466-7475
Jennifer Jones, Rural Health Coordinator
jennifer.jones@odh.ohio.gov
614-466-5333
Contact information
Vicki Marie, SEARCH Coordinator
vicki.marie@odh.ohio.gov
614-752-4787
Coleen Schwartz, Primary Care Administrator
coleen.schwartz@odh.ohio.gov
614-728-3700