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pdfShortage Designation Management System (SDMS): MPPs
November 2015
November 2013
Shortage Designation Management
System (SDMS):
Manual for Policies and Procedures
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Shortage Designation Management System (SDMS): MPPs
November 2015
Shortage Designation Management System (SDMS): MPPs Outline
Shortage Designation Management System (SDMS): Manual for Policies and Procedures (MPPs)
The SDMS MPPs document includes information about the policies and procedures for creating and
maintaining designations for shortage areas. The content provides a single document for use by internal
and external stakeholders for Division of Policy and Shortage Designation (DPSD), with clear and concise
definitions of terms used in the regulations and policies regarding shortage designations.
The policies and practical applications are identified for each shortage designation type. Procedures for
carrying out the process of creating and managing shortage designations are set by the DPSD. The
procedures for applying for a designation, updating data, and carrying out other functions overseen by
the Shortage Designation Branch (SDB) of the DPSD are outlined in this document.
This document should be updated annually to reflect any new policy and procedure decisions.
Table of Contents
Section I: Overview of Designation Types ..................................................................................... 3
Section II: Descriptions of Data Sources Used .............................................................................. 6
Section III: Statistical Methodology for Health and Demographic Data .................................... 11
Section IV: Provider Management and Provider Data................................................................ 15
Section V: HPSA and MUA/P Designation Components ............................................................ 24
Section VI: HPSA Scoring .............................................................................................................. 40
Section VII: MUA/P Scoring ......................................................................................................... 54
Section VIII: OFAC Requirements and Scoring ............................................................................ 59
Section IX: State/County Mental Hospital Requirements and Scoring ...................................... 67
Section X: Correctional Facility Requirements and Scoring........................................................ 69
Appendix I: Future Updates ......................................................................................................... 75
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Shortage Designation Management System (SDMS): MPPs
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Section I: Overview of Designation Types
I.
Introduction
The U.S. Department of Health and Human Services (HHS) established regulations to determine if certain
geographic areas, population groups, or medical facilities are qualified as Health Professional Shortage
Areas (HPSAs) or Medically Unserved Areas or Populations (MUAs/Ps). Federal shortage designations
document need for additional health care professionals and resources in order to prioritize and focus
limited federal resources on areas of highest need.
II.
HPSA: Health Professional Shortage Area
According to the Public Health Service Act (Authority: Sec. 215,58 Stat. 690 (42 U.S.C. 216); sec. 332, 90
Stat. 2270 - 2272 (42 U.S.C. 254ea) a HPSA is defined as any of the following which the Secretary
determines has a shortage of health professionals: (1) an urban or rural area (which need not conform
to the geographic boundaries of a public subdivision and which is a rational area for the delivery of
health services): (2) a population group; or (3) a public or nonprofit private medical facility.
HPSAs can be for Primary Care, Dental, and Mental Health provider shortages. There are three different
types of HPSAs:
1. Geographic Area (an urban or rural area)
o Demonstrates a shortage for the total resident civilian population of an area.
2. Population Groups
o Demonstrates a shortage of providers for a specific population group(s) within a defined
geographic area.
o Population HPSAs include the following options but are not limited to:
Low Income Population HPSA
• Defined as all resident civilians at or below 200% Federal Poverty Level.
Medicaid Eligible Population HPSA
• Qualification is based on at least 30% of population at or below 200%
Federal Poverty Level.
Migrant Farmworker Population HPSA
• Defined as all migrant farmworker population.
Migrant Seasonal Worker Population HPSA
• Defined as all migrant seasonal worker population.
Native American Population HPSA
• Defined as all Native American population of the total resident civilian
population.
Low Income Homeless Population HPSA
• Defined as all resident civilians at or below 200% Federal Poverty Level
plus the homeless population.
• This will be provided by the user.
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Shortage Designation Management System (SDMS): MPPs
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Low Income Migrant Farmworker Population HPSA
• Defined as all the resident civilians at or below 200% Federal Poverty
Level plus Migrant Farmworker population.
• This will be provided by the user.
Low Income Homeless Migrant Farmworker Population HPSA
• Defined as all the resident civilians at or below 200% Federal Poverty
Level plus Homeless Population plus Migrant Farmworker Population.
• This will be provided by the user.
Low Income Migrant Seasonal Worker Population HPSA
• Defined as all the resident civilians at or below 200% Federal Poverty
Level plus Migrant Seasonal Worker population.
• This will be provided by the user.
Low Income Migrant Seasonal Worker Homeless Population HPSA
• Defined as all the resident civilians at or below 200% Federal Poverty
Level plus Migrant Seasonal Worker population plus Homeless
Population.
• This will be provided by the user.
Migrant Farmworker Homeless
• Defined as all Migrant Farmworker Population plus Homeless
Population.
• This will be provided by the user.
Migrant Seasonal Worker Homeless
• Defined as all Migrant Seasonal Worker plus Homeless Population.
• This will be provided by the user.
Population Other
• Defined as any other indicated special population group.
3. Facilities (a public or nonprofit private medical facility)
o Other Facility (OFAC)
Public or non-profit private medical facilities serving a population or geographic
area designated as a HPSA with a shortage of health providers.
o Correctional Facilities
Medium to maximum security Federal and State correctional institutions and
youth detention facilities with a shortage of health providers.
o State Mental Hospitals
State or County hospital with a shortage of psychiatric professionals.
o Auto-HPSA
By statute, Auto-HPSA facilities are automatically designated as having a
shortage. The types of Auto-HPSAs include:
• Indian Health Facilities.
• Federally Qualified Health Centers (FQHC).
• Section 330 Health Center Program grantees.
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Shortage Designation Management System (SDMS): MPPs
•
•
III.
November 2015
FQHC Look-A-Likes (LALs).
Certified Rural Health Clinics (RHCs) meeting NHSC Site Requirements.
MUA: Medically Underserved Areas
MUAs are represented by a whole county, group of contiguous counties, a group of urban census
tracts, or a group of county or civil divisions in which residents have a shortage of Primary Care
professional health services. MUA designations use the Index of Medical Underservice (IMU) to
obtain a score for the area being proposed for designation. Each proposed service area must have
an IMU of 62.0 or less to qualify as an MUA designation. MUAs require the same method of
establishing the Rational Service Area as used by HPSAs.
IV.
MUP: Medically Underserved Populations
MUPs may include groups of persons who face economic, cultural, or linguistic barriers to health
care. It may be a population of an urban or rural area designated as an area with a shortage of
professional health services or a population group designated as having a shortage of service.
MUPs only apply to the Primary Care discipline and include the following types:
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
MUP Low Income
MUP Medicaid
MUP Medicaid Eligible
MUP Migrant Farmworker
MUP Migrant Seasonal Worker
MUP Native American
MUP Homeless
MUP Low Income Homeless
MUP Low Income Migrant Farmworker
MUP Low Income Homeless Migrant Farmworker
MUP Low Income Migrant Seasonal Worker
MUP Low Income Migrant Seasonal Worker Homeless
MUP Migrant Farmworker Homeless
MUP Migrant Seasonal Worker Homeless
MUP Other Population
MUA/Ps may also apply with a Governor’s Exception, which supersedes the requirements of MUA/Ps in
the case of high need situations.
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Section II: Descriptions of Data Sources Used
I.
Introduction
The Health (Infant Health Index Measures) and Demographic (Age, Sex, Race/Ethnicity, Poverty) data
used for designations is derived from federal and state data sources as of September 2014. The federal
sources include the American Community Survey (ACS) 2012 5-year estimate and the 2010 Census data.
Infant Health index data is sourced from the Center for Disease Control (CDC) 5-year aggregate 20022006.
II.
Federally Provided Data Sets
The following table displays all data points that are sourced by the Census and ACS 2012 5-year estimate
and their respecting source format. All data points displayed below can be sourced at the Census Tract
(CT), Minor Civil Division (MCD), or County level.
Applicable
Discipline
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
MH
MH
MH
6
Data Point
Total Population
Total Resident Civilian
Population
African-American
Population
Native American/ Alaska
Native Population
Asian Population
Caucasian Population
Hispanic Population
Native Hawaiian/Pacific
Islander Population
Population at 100% of
Federal Poverty Level
Population at 200% of
Federal Poverty Level
Population that is Low
Income
Population that is
Medicaid Eligible
Age 18 and Under
Population
Population Age18-64
Number of Youth
(Population under 18)
Source
Primary Source
Census
CT
X
MCD
X
County
X
ACS_12_5YR_S0101
X
X
X
ACS_12_5YR_DP05
X
X
X
ACS_12_5YR_DP05
X
X
X
ACS_12_5YR_DP05
ACS_12_5YR_DP05
ACS_12_5YR_DP05
X
X
X
X
X
X
X
X
X
ACS_12_5YR_DP05
X
X
X
ACS_12_5YR_C17002
X
X
X
X
X
X
X
X
X
X
X
X
ACS_12_5YR_DP05
X
X
X
ACS_12_5YR_DP05
X
X
X
ACS_12_5YR_S0101
X
X
X
ACS_12_5YR_C17002
ACS_12_5YR_C17002
ACS_12_5YR_C17002
Shortage Designation Management System (SDMS): MPPs
Applicable
Discipline
Number of Elderly
(Population 65 and Over)
Age 65 and Over
Population
Female 15 to 44 Years
Number of Infant Deaths
Number of Infant Births
Number of Low Birth
Weights
MH
MH/PC
PC
PC
PC
PC
III.
Data Point
November 2015
Source
Primary Source
CT
MCD
County
ACS_12_5YR_S0101
X
X
X
ACS_12_5YR_DP05
X
X
X
ACS_12_5YR_B01001
CDC
CDC
X
N/A
N/A
X
N/A
N/A
X
X
X
CDC
N/A
N/A
X
State Provided Data Sets
The table below lists all data points sourced from the state. These points are not federally sourced but
are supported in SDMS. State provided data points should be provided with the application at the RSA
level.
Applicable
Discipline
ALL
ALL
ALL
PC
PC, DH
PC, DH
PC
DT
MH
MH
Data Point
Homeless Population
Migrant Farmworker
Population
Migrant Seasonal Worker
Population
Tourist Population
Migrant Worker Population
Seasonal Resident
Population
Age-Sex Adjusted Population
Number of Population
without Fluoridated Water
Substance Abuse Prevalence
Alcohol Abuse Prevalence
Source
Primary Source
State
CT
N/A
MCD
N/A
County
N/A
RSA
X
State
N/A
N/A
N/A
X
State
N/A
N/A
N/A
X
State
State
N/A
N/A
N/A
N/A
N/A
N/A
X
X
State
N/A
N/A
N/A
X
State
N/A
N/A
N/A
X
State
N/A
N/A
N/A
X
State
State
N/A
N/A
N/A
N/A
N/A
N/A
X
X
Primary Care Adjusted Populations
Users may enter an Adjusted Population for a Primary Care Geographic or Geographic High Needs HPSA.
This Adjusted Population can include the Resident Civilian Population with the Age-Sex Adjustment, and
any combination of the following population types added to the Resident Civilian or Age-Sex Adjusted
population: Tourist, Migrant Worker, and Seasonal Resident.
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Shortage Designation Management System (SDMS): MPPs
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Dental Health Adjusted Populations
Users may enter an Adjusted Population for a Dental Geographic or Geographic High Needs HPSA. This
Adjusted Population can include the Resident Civilian Population and any combination of the following
population types added to the Resident Civilian Population: Migrant Worker and Seasonal Resident.
IV.
System Calculated Data Points
The following table displays all data points that are derived through a system calculation. These data
points cannot be edited by the user, as they are calculated to provide a consistent set of demographic
data for all states and regions to be used during the application process.
All demographic population percentages use Resident Civilian Population to determine the percentage.
Applicable
Discipline
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
MH
MH
MH
MH
PC
PC
8
Data Point
% African-American
Population
% Native American/
Alaska Native Population
% Asian Population
% Caucasian Population
% Hispanic Population
% Native Hawaiian/
Pacific Islander
Population
% Population at 100%
Federal Poverty Level
% Poverty at 200%
Federal Poverty Level
% Population that is Low
Income
% Population that is
Medicaid Eligible
Youth Ratio
Elderly Ratio
Elderly Population
Fertility Rate
Infant Mortality Rate
Low Birth Weight Rate
Source
Primary Source
System Calculation
CT
X
MCD
X
County
X
System Calculation
X
X
X
System Calculation
System Calculation
System Calculation
System Calculation
X
X
X
X
X
X
X
X
X
X
X
X
System Calculation
X
X
X
System Calculation
X
X
X
System Calculation
X
X
X
System Calculation
X
X
X
System Calculation
System Calculation
System Calculation
System Calculation
System Calculation
System Calculation
X
X
X
N/A
N/A
N/A
X
X
X
N/A
N/A
N/A
X
X
X
X
X
X
Shortage Designation Management System (SDMS): MPPs
V.
November 2015
User Provided Health and Demographic Data
SDMS will import updated data as the latest federally provided data sets are published and publically
available for use within the SDMS application map. Notably, the following data points are not being
sourced and will only be captured within the map application cycles by the PCOs:
Percentage of Population without access to Fluoridated Water
Substance Abuse Prevalence
Alcohol Abuse Prevalence
Migrant Farmworker Population
Migrant Seasonal Worker Population
Seasonal Resident Population
Tourist Population
Migrant Worker Population
Homeless Population
Age Sex Adjusted Population
The user enters the Fluoridation Rate and Substance and /or Alcohol Abuse prevalence in the RSA
creation step of the application.
The populations listed above are entered during the creation of the RSA. The user will be required to
enter a source and methodology used for determining the population for these groups on the
Supplemental Information Form.
The following tables should be used by the user to calculate the Age-Sex Adjusted, Tourist, Seasonal
Resident, and Migrant Worker Populations for the RSA. These adjustments may be entered for
Geographic HPSAs in the Adjusted Population box for the RSA. Please note that the Adjusted Population
for Primary Care may include Age-Sex Adjusted Population, Tourists, Seasonal Residents, and Migrant
Workers added to the Resident Civilian Population. Dental Health Geographic HPSAs may only add
Seasonal Residents and Migrant Workers to the Resident Civilian Population. Mental Health does not
allow an Adjusted Population for Geographic HPSAs; it uses only the Total Resident Civilian Population.
The Age-Sex Adjusted Population replaces the original Resident Civilian Population for the RSA.
After calculating the effective population for Seasonal Residents, Tourists, and Migrant Workers, these
populations may be added to the Resident Civilian Population total, depending on the HPSA discipline
being applied for.
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November 2015
Age-Sex Adjustments
Multiply the population within each Age-Sex group against the weight provided in the table below. Add
all of the groups with the appropriate weight together and divide by 5.1 to obtain the Age-Sex Adjusted
Population.
Sex
Male
Female
Age groups
Under 5
5-15
7.3
3.6
6.4
3.2
15-24
3.3
5.5
25-44
3.6
6.4
45-64
4.7
6.5
65 and over
6.4
6.8
Seasonal Residents
Seasonal Residents are defined as those who maintain a residence in the area but inhabit it for only 2 to
8 months per year. These residents may be added to the Resident Civilian Population but must be
weighted in proportion to the fraction of the year that they are present in the area.
Tourists
Tourists that are not residents of the area may be included in the population, but the Tourist Population
must have the following weighted calculation first applied:
Effective tourist contribution to population = 0.25 * (fraction of year tourists are present in area)
* (average daily number of tourists during portion of year that tourists are present)
Migrant Workers
Migrant Workers and their families may be included in the area’s population using the following
formula:
Effective migrant contribution to population = (fraction of year migrants are present in area)
*(average daily number of migrants during portion of year that migrants are present)
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Shortage Designation Management System (SDMS): MPPs
November 2015
Section III: Statistical Methodology for Health and Demographic Data
I.
Background
The health and demographic data used for designations is derived from federal and state data sources.
The federal sources include:
• Demographic (Age, Sex, Race/Ethnicity, Poverty Data): American Community Survey (ACS) 2012
5-year estimate.
• Health (Infant Health Index Measures): Census and Center for Disease Control and Prevention
(CDC). The data sourced through the CDC adheres to the CDC methodology for reporting health
statistics. For Infant Health Index data the 5-year aggregate data set is used to adhere to
statistical significance standards.
The following table displays all of the federally sourced data points in SDMS and the population
surveyed for the data point.
Applicable
Discipline
ALL
MH/PC
MH
PC
MH
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
II.
Data Point
Total Resident Civilian Population
Age 65 and Over Population
Population Under Age 18
Females 15 to 44 Years
Population Age 18-64
African-American Population
Native America / Native Alaskan Population
Asian Population
Caucasian Population
Hispanic Population
Pacific Islanders Population
Population at 100% of Federal Poverty Level
Population at 200% of Federal Poverty Level
Population that is Low Income
Population that is Medicaid Eligible
Population Surveyed
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Converting County Level Statistic to the Census Tract Level
Certain health and demographic statistics are reported through the primary source only at the county
level. A formula is used to determine the hard numbers weighted by population for each census tract
and MCD. Standardization in how the data for a RSA is reported is enabled by having all the data tied to
a census tract.
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Shortage Designation Management System (SDMS): MPPs
November 2015
The following formula displays the process by which the county level statistics are distributed by
population weight to the census tracts/MCDs that are entirely contained within the county.
𝐶𝐶𝐶𝐶𝐶𝐶 𝐿𝐿𝐿𝐿𝐿 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆
𝐶𝐶𝐶𝐶𝐶𝐶 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆
× 𝐶. 𝑇. 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆 = 𝐶. 𝑇. 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆
The following table represents all data points that are reported through the primary source at the
county level. The county population surveyed denominator that is used to distribute the county statistic
among the census tracts/MCDs is included on the right side.
Applicable
Discipline
PC
PC
III.
Data Point
County Population
Surveyed Denominator
Number of Infant Deaths
Number of Infant Births
Females 15-44
Females 15-44
Converting Census Tract data to the RSA Level
Data points are summed up to the RSA level from the CT level for scoring purposes. The formula below is
used to calculate RSA level health and demographic statistics:
∑ 𝐶𝐶𝐶𝐶𝐶𝐶 𝑇𝑇𝑇𝑇𝑇 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆 𝑓𝑓𝑓 𝑎𝑙𝑙 𝐶𝐶𝐶 𝑖𝑖 𝑅𝑅𝑅 = 𝑇𝑇𝑇𝑇𝑇 𝑅𝑅𝑅 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆
If the statistic is a percentage then the data point and denominator will be summed in the method
above. The two totals will then be divided to obtain the percentage for the RSA. The following table
shows all data points that will be calculated by the system. For purposes of determining HPSAs and
MUA/Ps these data points are calculated at the RSA level.
Applicable
Discipline
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
MH
MH
MH
12
Data Point
% African-American Population
% Native American / Native Alaskan Population
% Asian Population
% Caucasian Population
% Hispanic Population
% Pacific Islander Population
% Population at 100% Federal Poverty Level
% Poverty at 200% Federal Poverty Level
% Population that is Low Income
% Population that is Medicaid Eligible
% Elderly
Elderly Ratio
Youth Ratio
Calculation Denominator
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Total Resident Civilian
Population 18-64
Population 18-64
Shortage Designation Management System (SDMS): MPPs
IV.
November 2015
Infant Health Index Statistical Approach
Number of infant births, number of infant deaths, and number of low birth weight instances are sourced
from the CDC. Infant birth statistics are aggregated over a 5-year period. The population from which the
CDC obtains these figures is the female age 15-44 population, currently accepted as women of child
bearing-age.
The following formulas are used to calculate the Infant Health Index for scoring via two measures, Infant
Mortality Rate and Low Birth Weight. The definitions for the sourced data points at the county level
used in the scoring formula are as follows:
•
•
•
# of Infant Births = Number of infants born to population of females 15-44
# of Infant Deaths = Number of infant deaths to population of females 15-44
# LBW Instances = Number of instances of LBW born to population of females 15-44
IMR =
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖 𝑑𝑑𝑑𝑑ℎ𝑠
LBW =
V.
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝑙𝑙𝑙𝑙 𝑏𝑏𝑏𝑏ℎ𝑠
# 𝐿𝐿𝐿 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼
# 𝐼𝐼𝐼𝐼𝐼𝐼 𝐵𝐵𝐵𝐵ℎ𝑠
𝑥 1000 𝑙𝑙𝑙𝑙 𝑏𝑏𝑏𝑏ℎ𝑠
𝑥 100 𝑏𝑏𝑏𝑏ℎ𝑠
Populations Used for Population-to-Provider Ratios
Calculating Population-to-Provider Ratios
The Population-to-Provider Ratio is a measure of the number of providers that serve either a total
population in a specific geographic area (Geographic HPSA) or a specific population within a specific
geographic area (Population HPSA).
The Population-to-Provider ratio is determined by the system as:
(Total Population of Area or Total Specific Population): Total FTE of Providers Serving Area
or Specific Population)
Geographic HPSAs and Population HPSAs require different Population-to-Provider ratio information.
The table below provides an overview of the providers associated with each HPSA type. If populations
are combined for a population designation, for example “Low-Income Homeless Population,” the FTE
includes providers that serve the Low-Income Population, the Homeless Population, or both. These
guidelines apply to all HPSA discipline Population-to-Provider ratio calculations.
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Shortage Designation Management System (SDMS): MPPs
Type of HPSA
Primary Care Geographic
Dental Geographic
Mental Health Geographic
Low Income Population
Medicaid-Eligible Population
Homeless Population*
Migrant Farmworker Population*
Native American/ Native Alaskan
Population
Migrant Seasonal Workers
Population*
November 2015
Population counted in Population-to-Provider ratio:
The Resident Civilian Population of the Rational Service Area
or
the Resident Civilian Population of the Rational Service Area with
Age-Sex Adjustment + Migrant Worker Population + Tourist
Population + Seasonal Resident Population*
The Resident Civilian Population of the Rational Service Area
or
the Resident Civilian Population + Seasonal Residents + Migrant
Workers of the Rational Service Area
the resident civilian population of the rational service area
The population in the Rational Service Area that have incomes at
or below 200% of the Federal Poverty Level
Residents in the Rational Service Area who are eligible for
Medicaid
The Homeless Population within the Rational Service Area
The Migrant Farmworker Population within the Rational Service
Area
The Native American/Native Alaskan Population within the
Rational Service Area
The Migrant Seasonal Worker Population with the Rational
Service Area
*These populations must be provided by the user via the data exception process. Prior to entry into the system, the
user is required to perform a calculation (provided by the regulations) to determine the weight of these populations
on the total resident civilian population based on the amount of time the population is in the area. Migrant
Farmworker and Migrant Seasonal Worker Populations are applicable to all disciplines. The Resident Civilian plus
Other populations for Geographic HPSAs is restricted only to Primary Care and Dental Health HPSAs. The system
will calculate the compound Geographic population type with the available, optional populations such as the AgeSex Adjustment, Tourist, Migrant Worker, and Seasonal Resident Population. The user is not required to provide all
of these types to receive the Adjusted Population count.
More details on the individual scoring threshold requirements for Population-to-Provider ratios per
discipline and HPSA type follow in the respective sections.
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Shortage Designation Management System (SDMS): MPPs
November 2015
Section IV: Provider Management and Provider Data
I.
Introduction
Provider Data used for designations is maintained and updated through the Provider Management
functionality in SDMS. The full description of the business rules and how to use this functionality is
available through the Provider Management User Guide. This section provides a high level overview of
how the data is used for designations.
National Provider Identifier
The provider data set used in SDMS originates from the National Provider Identifier (NPI) file maintained
by the Center for Medicaid and Medicare Services (CMS). This data set provides a comprehensive file
with all providers covered by HIPAA actively billing insurance in the United States.
The NPI file will import the provider address, among other location attributes.
Provider Records
All providers will receive a default FTE for Geographic and Geographic High Needs use. This default is 1
FTE, and can be updated by surveying the provider and changing the hours from 40 to the number of
hours worked at that location by the provider indicated in the survey response.
The provider can have a different FTE for each HPSA and MUA/P type based on which populations the
provider serves and how much time the provider spends serving that population. This information is
gathered through the provider’s profile, and is then used in the mapping application to calculate FTEs
for the RSA and the Contiguous Areas (CAs), and determining if the NND serves the population of the
RSA.
Provider FTE Overview
All providers are represented by a Full Time Equivalent (FTE) number for each of the population types
that the providers serve, including the general population. Each provider has a set of hours that they
spend devoted to patient care, which is gathered through surveys administered by the State PCOs;
unless set as a default for use for Geographic HPSAs.
Obtaining the number of patient hours that a provider dedicates to serving at a location is paramount to
the calculation of obtaining the FTE measure. This measure crosses the provider’s patient care hours
with the standard U.S. 40 hour work week to determine the proportion of the standard work week that
the provider is available to serve patients.
The standard FTE calculation is then weighted by any special populations served by the provider, as
indicated on the survey. The percentage of time that the provider dedicates to serving special
populations is applied as the weight. As a result, a single provider in SDMS will always have a general
population FTE for each address at which they serve, plus additional special population FTEs as
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Shortage Designation Management System (SDMS): MPPs
November 2015
appropriate. Calculating the FTE for each provider is a key initial step for the system to be able to
determine the Population-to-Provider ratio, used for qualification and scoring purposes.
Additional characteristics about the employment status of the provider are crucial in determining the
FTE and can affect the final number. The FTE should be multiplied by the weight for all disciplines for the
following characteristics:
Primary Care and Mental Health: Federal Provider, Foreign Medical School Graduates
who are not U.S. citizens or lawful permanent residents (including J1 Visa Waiver
Holders) FTE = 0
Primary Care and Mental Health: Foreign Medical School Graduates who are U.S.
citizens or lawful permanent residences but do not have an unrestricted license to
practice medicine FTE = 0.5
Primary Care Resident/Intern FTE = 0.1
Mental Health Resident/Intern FTE = 0.5
Calculating Primary Care FTEs When Only Office Hours Are Known
SDMS does not calculate primary care FTEs when only office hours are known. It is the responsibility of
the user to enter the correct tour hours (adjusted or otherwise) into SDMS.
To determine primary medical care FTEs in cases where only a physician's office hours are known, and
information is not available on a physician's hours spent in other patient care activities, an upward
adjustment must normally be made from the number of office hours per week to obtain the total
estimated number of hours spent in direct patient care per week. The adjustment factors provided in
the table below are designed to take into consideration the hours of direct patient care provided in both
office and inpatient settings.
To obtain a full-time-equivalency for a given physician, his/her total office hours per week should be
multiplied by the appropriate factor for his/her specialty. In the event that the primary care specialty is
unspecified, the factor shown for "all primary care" should be used. If this calculation yields a number
greater than 40, the physician should be considered as 1.0 FTE; otherwise, this number of hours should
be divided by 40 to obtain the physician's FTE.
The adjustment factors provided in the table below are designed to take into consideration the hours of
direct patient care provided in both office and inpatient settings:
Primary Care Specialty
FP: Family Practice
IM: Internal Medicine
OBG: Obstetrics and Gynecology
PD: Pediatrics
All Primary Care
Provider Completeness for RSA and CA
16
FTE Adjustment
Direct Tour Hours * 1.4
Direct Tour Hours * 1.8
Direct Tour Hours * 1.9
Direct Tour Hours * 1.4
Direct Tour Hours* 1.6
Shortage Designation Management System (SDMS): MPPs
November 2015
Any given RSA or CA must have at least 2/3 of the providers in the area in a usable state. This is defined
by DPSD as completing the required fields in Provider Management to indicate if the provider serves the
specific population mapping to the designation being created. It is possible that providers do not serve
the population, in which case this should be indicated so that the provider is counted in the 2/3
examination of having providers completed. Providers are by default in a usable state for Geographic
HPSAs.
If at least 2/3 of the providers do not have the required data fields completed in SDMS the user will not
be able to continue with the RSA or CA until this requirement is met.
II.
FTE Calculations
The table below outlines all the types of FTE and their calculations for each discipline and Designation
Type. When a user is looking to designate an area the Designation type and option selected affects
which FTE calculation is used for a provider. Certain special population types, indicated below in the
table, use additional data to calculate the FTE, such as Medicaid claims, and therefore have more than
one possible approach for calculating the FTE. In the table below, ‘percent’ refers to the percent of time
spent by the provider serving the specific population.
Primary Care Provider FTE Calculations
Calculation #1
Calculation #2
Geographic Area
Provider FTE
FTE = (# Tour Hours/40)
N/A
Geographic Area High
Needs Provider FTE
FTE = (# Tour Hours/40)
N/A
Low Income Population
Provider FTE
Medicaid Claims Available FTE=(#
Medicaid Claims/5000) + [# Tour
Hours/40)*(Sliding Fee Scale
Percent)]
Medicaid Claims Unavailable FTE=
(# Tour Hours/40)*(Sliding Fee
Scale Percent + Medicaid Percent)
Medicaid Population
Provider FTE
Medicaid Claims Available FTE=(#
Medicaid Claims/5000)
FTE= (# Tour
Hours/40)*(Medicaid Percent)
Migrant Farmworker
Population Provider FTE
FTE =(# Tour Hours/40)*(Migrant
Farmworker Percent)
N/A
Native American/Native
Alaskan Population
Provider FTE
FTE =(# Tour Hours/40)*Native
American/Native Alaskan Percent
N/A
Migrant Farmworker and
Homeless Population
Provider FTE
FTE =[(# Tour Hours/40)*Migrant
Farmworker Percent] + [(# Tour
Hours/40)*Homeless Percent]
N/A
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Shortage Designation Management System (SDMS): MPPs
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Migrant Seasonal Worker
and Homeless Population
Provider FTE
FTE =[(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent] + [(#
Tour Hours/40)*Homeless Percent]
Low Income Homeless
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/5000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent]
Medicaid Claims Unavailable FTE
=[(# Tour Hours/40)*Sliding Fee
Scale Percent] + [(# Tour
Hours/40)*Homeless Percent] +
[(# Tour Hours/40)*Medicaid
Percent]
Low Income Migrant
Farmworker Population
Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/5000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Migrant
Farmworker Percent]
Medicaid Claims Unavailable FTE
=[(# Tour Hours/40)*Sliding Fee
Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Farmworker Percent]
N/A
Primary Care Provider FTE Calculations
Calculation #1
Calculation #2
Low Income Homeless
Migrant Farmworker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/5000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Farmworker
Percent]
Medicaid Claims Unavailable FTE
=[(# Tour Hours/40)*Sliding Fee
Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Farmworker
Percent]
Low Income Migrant
Seasonal Worker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/5000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent]
Medicaid Claims Unavailable FTE
=[(# Tour Hours/40)*Sliding Fee
Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent]
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Shortage Designation Management System (SDMS): MPPs
Low Income Homeless
Migrant Seasonal Worker
Population Provider FTE
November 2015
Medicaid Claims Unavailable FTE
=[(# Tour Hours/40)*Sliding Fee
Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +[(#
Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Seasonal
Farmworker Percent]
Medicaid Claims Available FTE = (#
Medicaid Claims/5000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Seasonal
Farmworker Percent]
Additional data is required to calculate the FTE for a dentist beyond the number of hours dedicated to
patient care. Both the number of dental auxiliaries employed at a dentist’s work location, and the
dentist’s age are required; the dentist’s age is calculated using the dentist’s birthdate. An auxiliary is
defined as any non-dentist staff employed by the dentist to assist in the operation of the practice (42
CRF Part 5, Appendix B, 3(b)). The dentist’s age and the number of auxiliaries are used to determine
what is known as the Equivalency Weight, represented in the following table.
Dentist Age
Aux #
Unknown
< 55
55 to 59
60 to 64
<65
Unknown
1.2
1.2
0.9
0.8
0.6
0
0.8
0.8
0.7
0.6
0.5
1
1
1
0.9
0.8
0.7
2
1.2
1.2
1
1
0.8
3
1.4
1.4
1.2
1
1
≥4
1.5
1.5
1.5
1.3
1.2
*42 CFR Part 5, Appendix B, Part I, 3(b)
If an auxiliary is less than full time, the user should divide the hours worked by 40 and round the
result to the nearest whole number.
If more than one auxiliary works less than full time, the user should add their total hours, divide
by 40 and round to the nearest whole number.
Dental Provider FTE Calculations
Calculation #1
Calculation #2
Geographic Area
Provider FTE
FTE = (# Tour Hours/40)
N/A
Geographic Area High
Needs Provider FTE
FTE = (# Tour Hours/40)
N/A
19
Shortage Designation Management System (SDMS): MPPs
November 2015
Low Income Population
Provider FTE
Medicaid Claims Available FTE=(#
Medicaid Claims/4000) + [# Tour
Hours/40)*Sliding Fee Scale Percent]
Medicaid Claims Unavailable
FTE= (# Tour Hours/40)*(Sliding
Fee Scale Percent + Medicaid
Percent)
Medicaid Population
Provider FTE
Medicaid Claims Available FTE=(#
Medicaid Claims/4000)
Medicaid Claims Unavailable
FTE= (# Tour
Hours/40)*(Medicaid Percent)
Migrant Farmworker
Population Provider FTE
FTE =(# Tour Hours/40)*Migrant
Farmworker Percent
N/A
Native American/Native
Alaskan Population
Provider FTE
FTE =(# Tour Hours/40)*Native
American/Native Alaskan Percent
N/A
Migrant Farmworker and
Homeless Population
Provider FTE
FTE =[(# Tour Hours/40)*(Migrant
Farmworker Percent)] + [(# Tour
Hours/40)*Homeless Percent]
N/A
Migrant Seasonal Worker
and Homeless Population
Provider FTE
FTE =[(# Tour Hours/40)*(Migrant
Seasonal Farmworker Percent)] + [(#
Tour Hours/40)*Homeless Percent]
N/A
Dental Provider FTE Calculations
Calculation #1
Calculation #2
Low Income Homeless
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Homeless Percent]+
[(# Tour Hours/40)*Medicaid
Percent]
Low Income Migrant
Farmworker Population
Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Migrant
Farmworker Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Farmworker Percent]
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Shortage Designation Management System (SDMS): MPPs
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Low Income Homeless
Migrant Farmworker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Farmworker
Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Farmworker
Percent]
Low Income Migrant
Seasonal Worker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent]
Low Income Homeless
Migrant Seasonal Worker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Seasonal
Farmworker Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent]
+[(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Seasonal
Farmworker Percent]
For Mental Health designations the provider FTE is very similar to Primary Care and Dental Health.
Mental health providers can be classified by type to determine if they fall into the Core Mental Health or
Psychiatrist class. The Core Mental Health classification includes psychiatrists, clinical psychologists,
clinical social workers, psychiatric nurse specialists, and marriage and family therapists. The psychiatrist
classification only includes psychiatrists. The FTE calculations for each of these classes follow the same
approach. When calculating the Population-to-Provider ratio for a given area having accurate data on
the class of provider ensures that the correct provider group is being measured for qualification and
scoring purposes. The FTE calculations in the table below are used for both Core Mental Health and
Psychiatrists.
Mental Provider FTE Calculations
Calculation #1
Calculation #2
Geographic Area
Provider FTE
FTE = (# Tour Hours/40)
N/A
Geographic Area High
Needs Provider FTE
FTE = (# Tour Hours/40)
N/A
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Shortage Designation Management System (SDMS): MPPs
November 2015
Low Income Population
Provider FTE
Medicaid Claims Available FTE=(#
Medicaid Claims/4000) + [# Tour
Hours/40)*Sliding Fee Scale Percent]
Medicaid Claims Unavailable
FTE= (# Tour Hours/40)*(Sliding
Fee Scale Percent + Medicaid
Percent)
Medicaid Population
Provider FTE
Medicaid Claims Available FTE=(#
Medicaid Claims/4000)
Medicaid Claims Unavailable
FTE= (# Tour
Hours/40)*Medicaid Percent
Migrant Farmworker
Population Provider FTE
FTE =(# Tour Hours/40)*Migrant
Farmworker Percent
N/A
Native American/Native
Alaskan Population
Provider FTE
FTE =(# Tour Hours/40)*Native
American/Native Alaskan Percent
N/A
Migrant Farmworker and
Homeless Population
Provider FTE
FTE =[(# Tour Hours/40)*Migrant
Farmworker Percent] + [(# Tour
Hours/40)*Homeless Percent]
N/A
Migrant Seasonal Worker
and Homeless Population
Provider FTE
FTE =[(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent] + [(#
Tour Hours/40)*Homeless Percent]
N/A
Low Income Homeless
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Homeless Percent]+
[(# Tour Hours/40)*Medicaid
Percent]
Mental Provider FTE Calculations
Low Income Migrant
Farmworker Population
Provider FTE
22
Calculation #1
Calculation #2
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Migrant
Farmworker Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Farmworker Percent]
Shortage Designation Management System (SDMS): MPPs
November 2015
Low Income Homeless
Migrant Farmworker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Farmworker
Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Farmworker
Percent]
Low Income Migrant
Seasonal Worker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent]
Low Income Homeless
Migrant Seasonal Worker
Population Provider FTE
Medicaid Claims Available FTE = (#
Medicaid Claims/4000) + [(# Tour
Hours/40)*Sliding Fee Scale Percent]
+ [(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Seasonal
Farmworker Percent]
Medicaid Claims Unavailable
FTE =[(# Tour Hours/40)*Sliding
Fee Scale Percent] + [(# Tour
Hours/40)*Medicaid Percent]
+[(# Tour Hours/40)*Homeless
Percent] + [(# Tour
Hours/40)*Migrant Seasonal
Farmworker Percent]
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Shortage Designation Management System (SDMS): MPPs
November 2015
Section V: HPSA and MUA/P Designation Components
I.
Definition of Rational Service Area
Identifying a Rational Service Area is the first step in creating a designation. The area will become the
designated area for the HPSA or MUA/P. In the case of geographic HPSAs or MUAs the entire population
of the area is designated, for population HPSAs or MUPs the specific subset of the population of the area
is designated.
Primary Care HPSA and MUA/P RSA Qualifications
24
A group of Census Tracts, Minor Civil Divisions, Whole County, or Multiple Whole Counties can
be selected to create a service area.
A Whole County is considered rational for a RSA.
o The Whole County Resident Civilian Population must not exceed 250,000.
Multiple Whole Counties with centroids within 30 minutes of each other are considered rational
for a RSA.
o The centroid is the geographic center of the most populous CT or MCD within the RSA. If
the RSA is a whole county, then the Geographic center of the county will be used.
A Sub-County RSA, meaning a group of census tracts or MCDs, can be rational if the following is
true:
o RSA cannot be smaller than a single CT or MCD.
o RSA components must be adjacent to each other.
o RSA cannot include components that are already designated.
User must also provide an explanation of why a Sub-County RSA is valid based on the following
reasons:
o Distinctive travel patterns.
o Physical barriers.
o Strong self-identity of a neighborhood that has a minimum population of 20,000.
o Similar socio-economic characteristics.
At least 2/3 of the providers in the RSA must be usable for the designation type.
o Please refer to the Provider Management User Guide for more details on this
functionality.
The Population-to-Provider ratio minimums must be met.
o Geographic: If there is an FTE greater than zero then the ratio of 3,500:1 must be met. If
the FTE is zero then the population must be at least 500.
o Geographic High Needs and Population: If there is an FTE greater than zero then the
ratio of 3,000:1 must be met. If the FTE is zero then the population must be at least 500.
Shortage Designation Management System (SDMS): MPPs
November 2015
The system will analyze the population within the RSA depending on the HPSA or MUA/P type to
determine if the qualifications for designation are met.
HPSA Type
Additional Population Qualifications
Geographic
All Resident Civilian Population + Tourist
Population + Migrant Worker Population +
Seasonal Resident Population
Geographic High Needs
Geographic Population must meet one of the
following:
At least 20% of the population has income
at or below 100% FPL
More than 100 births per year per 1,000
women ages 15-44
More than 20 infant deaths per 1,000 live
births
At least 30% of the population has income at or
below 200% FPL
Population Low Income
Population Low Income plus Special Populations
At least 30% of the population has income at or
below 200% FPL plus Special Population is > 0
Population Medicaid
At least 30% of the population has income at or
below 200% FPL and/or is eligible for Medicaid
Migrant Farmworker Population
User entered Migrant Farmworker Population,
Population > 0
Migrant Seasonal Worker Population
User entered Migrant Seasonal Worker
Population, Population > 0
Homeless Population
User entered Homeless population, Population > 0
Native American Population
All Native American population, Population > 0
25
Shortage Designation Management System (SDMS): MPPs
November 2015
Dental Health HPSA RSA Qualifications
26
A group of Census tracts, Minor Civil Divisions, Whole County, or Multiple Whole Counties can
be selected to create a service area.
A Whole County is considered rational for a RSA.
o The Whole County resident civilian population must not exceed 250,000.
Multiple Whole Counties with centroids within 30 minutes of each other are considered rational
for a RSA.
o The centroid is the geographic center of the most populous CT or MCD within the RSA. If
the RSA is a whole county, then the Geographic center of the County will be used.
A Sub-County RSA, meaning a group of census tracts or MCDs, can be rational if the following is
true:
o RSA cannot be smaller than a single CT or MCD.
o RSA components must be adjacent to each other.
o RSA cannot include components that are already designated.
User must also provide an explanation of why a Sub-County RSA is valid based on the following
reasons:
o Distinctive travel patterns.
o Physical barriers.
o Strong Self-Identity of a neighborhood with a minimum population of 20,000.
o Similar socio-economic characteristics.
At least 2/3 of the providers in the RSA must be usable for the designation type.
o Please refer to the Provider Management User Guide for more details on this
functionality.
The Population-to-Provider ratio minimums must be met.
o Geographic: If there is an FTE greater than zero then the ratio of 5,000:1 must be met. If
the FTE is zero then the population must be at least 1,000.
o Geographic High Needs and Population: If there is an FTE greater than zero then the
ratio of 4,000:1 must be met. If the FTE is zero then the population must be at least
1,000.
Shortage Designation Management System (SDMS): MPPs
November 2015
The system will analyze the population within the RSA depending on the HPSA type to determine if the
qualifications for designation are met.
HPSA Type
Additional Population Qualifications
Geographic
All Resident Civilian Population + Tourist
Population + Migrant Worker Population +
Seasonal Resident Population
Geographic High Needs
Geographic Population must meet one of the
following:
At least 20% of the population has income
at or below 100% FPL
More than 50% of the population has no
access to fluoridated water
At least 30% of the population has income at or
below 200% FPL
Population Low Income
Population Low Income plus Special Populations
At least 30% of the population has income at or
below 200% FPL plus Special Population is > 0
Population Medicaid
At least 30% of the population has income at or
below 200% FPL and/or is eligible for Medicaid
Migrant Farmworker Population
User entered Migrant Farmworker Population,
Population > 0
Migrant Seasonal Worker Population
User entered Migrant Seasonal Worker
Population, Population > 0
Homeless Population
User entered Homeless Population, Population > 0
Mental Health HPSA RSA Qualifications
27
A group of Census tracts, Minor Civil Divisions, Whole County, or Multiple Whole Counties can
be selected to create a service area.
A Whole County is considered rational for a RSA.
o The Whole County must not exceed 999,999 for the resident civilian population.
Multiple Whole Counties with centroids within 30 minutes of each other are considered rational
for a RSA.
o The centroid is the geographic center of the most populous CT or MCD within the RSA. If
the RSA is a whole county then the Geographic center of the County will be used.
Shortage Designation Management System (SDMS): MPPs
28
November 2015
A Sub-County RSA, meaning a group of census tracts or MCDs, can be rational if the following is
true:
o RSA cannot be smaller than a single CT or MCD.
o RSA components must be adjacent to each other.
o RSA cannot include components that are already designated.
User must also provide an explanation of why a Sub-County RSA is valid based on the following
reasons:
o Distinctive travel patterns.
o Physical barriers.
o Strong self-identity of neighborhood with a minimum population of 20,000.
o Similar socio-economic characteristics.
At least 2/3 of the providers in the RSA must be usable for the designation type.
o Please refer to the Provider Management User Guide for more details on this
functionality.
The Population-to-Provider ratio minimums must be met.
o Geographic, Psychiatrists Only: If there is an FTE greater than zero then the ratio of
30,000:1 must be met.
o Geographic, Core Mental Health Only: If there is an FTE greater than zero then the ratio
of 9,000:1 must be met.
o Geographic, Core Mental Health and Psychiatrists: If the FTE is greater than zero for
both Core Mental Health providers and Psychiatrists then the Core Mental Health ratio
must meet 6,000:1 and the Psychiatrist ratio must meet 20,000:1.
o Geographic, No Providers: If the FTE is zero then the population must be at least 3,000.
o Geographic High Needs and Population, Psychiatrists Only: If there is an FTE greater
than zero then the ratio of 20,000:1 must be met.
o Geographic High Needs and Population, Core Mental Health Only: If there is an FTE
greater than zero then the ratio of 6,000:1 must be met.
o Geographic High Needs and Population, Core Mental Health and Psychiatrists: If the FTE
is greater than zero for both Core Mental Health providers and Psychiatrists, then the
Core Mental Health ratio must meet 4,500:1 and the Psychiatrist ratio must meet
15,000:1.
o Geographic High Needs and Population, No Providers: If the FTE is zero then the
population must be at least 1,500.
Shortage Designation Management System (SDMS): MPPs
November 2015
The system will analyze the population within the RSA depending on the HPSA type to determine if the
requirements for designation are met.
HPSA Type
Additional Population Qualifications
Geographic
All Resident Civilian Population
Geographic High Needs
Population must meet one of the following:
At least 20% of the population has income
at or below 100% FPL
Youth Ratio (age under 18/age 18-64)
exceeds 0.6
Elderly Ratio (age 65 and over/ages 18-64)
exceeds 0.25
Alcohol Abuse Prevalence is in the worst
quartile of the nation, region or state
Substance Abuse Prevalence is the worst
quartile of the nation, region or state
At least 30% of the population has income at or
below 200% FPL
Population Low Income
Population Low Income plus Special Populations
At least 30% of the population has income at or
below 200% FPL plus Special Population is > 0
Population Medicaid
At least 30% of the population has income at or
below 200% FPL and/or is eligible for Medicaid
Migrant Farmworker Population
User entered Migrant Farmworker Population,
Population > 0
Migrant Seasonal Worker Population
User entered Migrant Seasonal Worker
Population, Population > 0
Homeless Population
User entered Homeless Population, Population > 0
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Shortage Designation Management System (SDMS): MPPs
II.
November 2015
Definition of Centroid and Population Center
Centroid Definition
The centroid is the geographic center of the most populous CT or MCD within the RSA. If the RSA
is a whole county then the Geographic center of the county will be used.
The travel time and travel polygon calculations will originate at the centroid.
Population Center
The centroid is automatically identified by the system as the population center. However, users
may choose to move it to a new point within the boundaries of the RSA, with sufficient
supporting evidence provided on the Supplemental Information Form.
The travel time and travel polygon would now originate from the population center in SDMS.
PCO Procedure for selecting Population Center in SDMS
III.
The centroid is created after the RSA identification is complete. The user has the ability to move
the pin on the map to a new population center.
If a user moves the pin to select a new population center SDMS will check to make sure the
newly selected population center is valid by determining if it is within the boundary of the RSA.
If the user chooses to select a new population center, and not use the system generated
centroid in SDMS, the user must provide an explanation to justify the population center
placement on the Supplemental Information Form.
This is true for all types and disciplines. If the RSA is a Multiple Whole County then the user must
provide explanation on the Supplemental Information Form to confirm that the centroids or
population centers are within 30 minutes of each other.
Travel Polygon Generation
DPSD Travel Time Business Process
SDMS will be using ESRI transportation data. The road speed limits are provided in the road data set.
The roads, and respective speed limits, data will be used in all distance and time calculations for private
and public travel. Public transportation road networks are not available in SDMS, however.
Private Transportation Travel Polygon
30
If the user selects Private Transportation for the travel polygon step SDMS will complete the
following steps:
o The travel polygon will measure the distance from the centroid or population center,
depending on the user’s selection.
o SDMS will use the shortest path analysis to determine the boundaries of the travel
polygon in all directions.
Shortage Designation Management System (SDMS): MPPs
o
November 2015
The travel polygon signifies the travel distance that can be covered in 30 minutes for
Primary Care and 40 minutes for Dental and Mental Health originating at the
Centroid/Population center and stemming out in all directions based on the roads that
cover that area.
Public Transportation Travel Polygon
IV.
If the user selects Public Transportation one of the following must be demonstrated for the
area:
o At least 20% of the population has income below 100% of the Federal Poverty Level.
OR
o Dependency on public transportation in the area is greater than 30%. The user will
provide this information on the Supplemental Information Form.
If the user selects Public Transportation for the travel polygon step SDMS will complete the
following steps:
o The travel polygon will measure the distance from the centroid or population center,
depending on the user’s selection.
o SDMS will use the shortest path analysis to determine the boundaries of the travel
polygon.
o The travel polygon signifies the boundaries that are 5 miles away for Primary Care and 7
miles away from Dental and Mental Health originating at the Centroid/Population
center and stemming out in all directions.
Definition of Contiguous Areas
Contiguous Areas (CAs) are defined as those Whole Counties, Multiple Counties, or Sub-Counties (which
are groups of rational Census Tracts and Minor Civil Divisions) that border the RSA for the proposed
designation. The availability and accessibility of health providers in areas contiguous to an area being
considered for a designation are also considered in determining whether an RSA can be designated. In
SDMS the user will select all Contiguous Area groups while the system will perform various checks to
make sure each Contiguous Area is valid and inaccessible to the population of the RSA proposed for
designation. Contiguous Areas must completely cover the travel polygon and must all pass the analysis,
either through system or user analysis, in order for the Contiguous Area section to be completed.
In the rare circumstance that the travel polygon is entirely contained within the RSA the user is not
required to analyze surrounding areas.
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Shortage Designation Management System (SDMS): MPPs
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User Creation of Contiguous Areas
Components used to create contiguous areas include:
o MCDs
o CTs
o Counties
Contiguous area groups cannot overlap with one another or be part of the RSA.
A single contiguous area cannot be made of different component types.
For Whole and Multiple counties the contiguous area population if the designation is Primary
Care or Dental Health cannot exceed 250,000. The population cannot exceed 999,999 if the
designation is Mental Health.
Contiguous Area Analysis
The table below represents all the checks ran for the contiguous area analysis. SDMS will run a majority
of the contiguous area analysis checks. If a CA does not pass a check the system will continue running
the subsequent checks.
Contiguous Area System Checks
Passing Qualifications
System Check?
Is it an Inaccessible HPSA?
If a contiguous area is an inaccessible HPSA based
on the type of designation proposed
Yes
Refer to Inaccessible HPSA table below
Is it Over-utilized?
Ratio of CA population type, using same
population type as relevant for RSA to Usable
Providers within CA boundary. These ratios must
meet or exceed the following thresholds for the
three disciplines:
Yes
Primary Care
Dental
Mental
Yes
2000:1
3000:1
≥ 10,000:1 for
Psychiatrist
≥ 3,000:1 for
Core Mental
Health
If the Core FTE
= 0 or null; ≥
20,000:1 for
psychiatrists
(See Appendix
I for more
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Shortage Designation Management System (SDMS): MPPs
November 2015
information)
Contiguous Area System Checks
Passing Qualifications
System Check?
Are the providers Excessively
Distant?
System searches travel time for all providers in
the contiguous area. Contiguous area is
considered excessively distant if providers are
more than the following travel time for each
discipline:
Yes
Is there a Lack of Economic
Access?
Only calculated if RSA is a Low
Income HPSA
Is there a Demographic
Disparity?
Are there Other Access Barriers
that make it inaccessible?
33
Primary Care
Dental
Mental
30 minutes
40 minutes
40 minutes
System calculates the percent of the total
population in the RSA that is below 100% of the
FPL. System checks the number of providers in
the contiguous area that accepts Medicaid.
Contiguous area is considered to have a lack of
economic access if more than 20% of the RSA
population is below 100% FPL and there are no
providers in the contiguous area that accept
Medicaid.
Yes
Please reference Demographic Disparity
Calculation below.
Yes
User must provide an explanation for any
contiguous area that failed the system analysis
based on physical barriers (mountains, lakes,
rivers, airports, military bases), Linguistic barriers
and Other Access Barriers
No
Shortage Designation Management System (SDMS): MPPs
November 2015
The following table reflects the type of proposed RSA and the corresponding Contiguous Area types that
are inaccessible:
34
Proposed Rational Service Area Is:
Inaccessible HPSA for Contiguous Area:
Geographic
Geographic HPSA
Geographic High Needs
Geographic HPSA
Population Low Income
Geographic HPSA, Low Income Population HPSA,
Medicaid Eligible Population HPSA, Low Income
Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless
Migrant Farmworker HPSA, Low Income Migrant
Seasonal Worker HPSA, Low Income Migrant Seasonal
Worker Homeless HPSA
Population Medicaid Eligible
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA
Population Migrant Farmworker
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA, Population Native American,
Population Other
Population Migrant Seasonal Worker
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA, Population Native American,
Population Other
Shortage Designation Management System (SDMS): MPPs
Proposed Rational Service Area Is:
November 2015
Inaccessible HPSA for Contiguous Area:
Population Native American
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA, Population Native American HPSA,
Population Other HPSA
Low Income Homeless
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA
Low Income Migrant Farmworker
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA
Low Income Homeless Migrant Farmworker
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA
Low Income Migrant Seasonal Worker
35
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless
Migrant Farmworker HPSA, Low Income Migrant Seasonal
Worker HPSA, Low Income Migrant Seasonal Worker
Homeless HPSA, Medicaid Eligible Population HPSA,
Migrant Seasonal Worker and Homeless Population HPSA
Shortage Designation Management System (SDMS): MPPs
Proposed Rational Service Area Is:
November 2015
Inaccessible HPSA for Contiguous Area:
Low Income Homeless Migrant
Seasonal Worker
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA, Migrant Seasonal Worker and
Homeless Population HPSA, Population Native
American HPSA, Population Other HPSA
Migrant Seasonal Worker and Homeless
Geographic HPSA, Low Income Population HPSA, Low
Income Homeless Population HPSA, Low Income
Migrant Farmworker Population HPSA, Low Income
Homeless Migrant Farmworker HPSA, Low Income
Migrant Seasonal Worker HPSA, Low Income Migrant
Seasonal Worker Homeless HPSA, Medicaid Eligible
Population HPSA, Migrant Seasonal Worker and
Homeless Population HPSA, Population Native
American HPSA, Population Other HPSA
Demographic Disparity Calculation
SDMS will look for one point where there is a demographic disparity. The system will calculate
demographic disparity in the following order:
36
% of Population at 100% of the Federal Poverty Level
% of Population at 200% of the Federal Poverty Level
% of Population that is African American
% of Population that is American Indian / Eskimo / Alaska Native
% of Population that is Asian
% of Population that is Caucasian
% of Population that is Hispanic
% of Population that is Pacific Islander
% of Population that is Homeless
% of Population that is Migrant Farmworker
% of Population that is Migrant Seasonal Worker
Shortage Designation Management System (SDMS): MPPs
November 2015
If the first data comparison does not pass the demographic disparity calculation the system will go to
the next data point. Once a disparity is uncovered, based on the calculation, the system does not
continue with the remaining statistics.
The demographic disparity calculations steps are as follows:
Step
Determining the
Base
System Determination
System will identify which
statistic is larger between
the RSA and Contiguous
Area
Outcome
a. If the RSA statistic is greater than the Contiguous
Area statistic, the Contiguous Area is used as the
base
b. If the RSA statistic is less than the Contiguous Area
statistic, the RSA is used as the base
c. If the RSA statistic equals the Contiguous Area
statistic, there is no demographic disparity and the
system moves onto the next statistic
RSA as the base
1. The system will identify
the RSA statistic
2. The system will identify
the same statistic for the
Contiguous Area
3. The system will compare
the two statistics using the
RSA figure as the starting
point
a. If the RSA statistic is 15% or less, the system will
add 15% to the RSA percentage to be compared to
the Contiguous Area
i. If the Contiguous Area has a statistics
percentage greater than or equal to the RSA + 15%,
the system will confirm the demographic disparity
ii. If the Contiguous Area has a statistics
percentage less than the RSA + 15%, then there is no
demographic disparity for this factor
b. If the RSA statistic is greater than or equal to 15%,
the system will double the RSA % (2*RSA%) to be
compared to the Contiguous Area
i. If the Contiguous Area has a statistic percentage
greater than or equal to 2*RSA%, then the system
will confirm the demographic disparity for this factor
ii. If the Contiguous Area has a statistic percentage
less than 2*RSA%, then there is not a demographic
disparity for this factor
37
Shortage Designation Management System (SDMS): MPPs
Step
System Determination
Contiguous Area
as the base
1. The system will identify
the Contiguous Area statistic
Contiguous Area
as the base
(continued)
2. The system will identify
the same statistic for the
RSA
3. The system will compare
the two statistics using the
Contiguous Area figure as
the starting point
November 2015
Outcome
a. If the Contiguous Area figure is 15% or less, the
system will add 15% to the Contiguous Area
percentage to be compared to the RSA
i. If the RSA has a statistics percentage greater
than or equal to the Contiguous Area + 15% the
system will confirm the demographic disparity for
this factor
ii. If the RSA has a statistics percentage less than
the Contiguous Area + 15% then there is no
demographic disparity for this factor
b. If the Contiguous Area statistic is greater than or
equal to 15% the system will double the Contiguous
Area % (2*CA%) to be compared to the RSA
i. If the RSA has a statistic percentage greater than
or equal to 2*CA% then the system will confirm the
demographic disparity for this factor
ii. If the RSA has a statistic percentage less than
2*CA% then there is not a demographic disparity for
this factor
V.
Nearest Non-Designated Provider (NND)
Purpose of Identifying the NND
The main purpose of identifying the NND is to determine the time and distance that the population of
the RSA must travel for care outside of the RSA. There are different rules for each discipline that
determine how many points a designation receives based on the time and distance to travel to the NND.
The system will determine the NND provider by determining the qualifying NND with the shortest path
originating from the Centroid/Population Center to the geographic coordinates of the provider. The
NND must practice in the discipline of the designation, must not be tied to another designation
determined as Inaccessible (see above) or an inaccessible contiguous area (please reference Contiguous
Area Analysis section), and must serve the population of the designation.
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Shortage Designation Management System (SDMS): MPPs
November 2015
The system will identify the NND in the following radius for each discipline:
•
•
•
Primary Care: 50 miles or 60 minutes
Dental Health: 60 miles or 90 minutes
Mental Health: 60 minutes
If the system cannot locate a qualifying NND in the radiuses above the user will be prompted to identify
the NND. The system will then calculate the travel time and distance for that provider using the ESRI
road network.
The user may also select an alternate NND, manually enter miles and minutes for a provider or continue
without and NND from the system identified provider. The user will be required to provide an
explanation on the Supplemental Information Form if these 3 alternate options are taken.
The user also has the option to edit the system’s suggestion of distance and time for the NND or select
another NND other than the system generated one. If the user selects a different NND or changes the
distance or time an explanation must be provided.
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Shortage Designation Management System (SDMS): MPPs
November 2015
Section VI: HPSA Scoring
Once all of the RSA components of a designation have been identified, the Contiguous Area analysis
completed, the application deemed eligible for designation, and NND identified, the designation is able
to be scored. For each HPSA the system calculates a score based on the following criteria and formulas,
differentiated by discipline. This score is used to prioritize areas of greatest need.
I.
Primary Care HPSA Scoring
The Division of Policy and Shortage Designation calculates a score between 0-25 for Primary Care HPSAs.
Primary Care
Population-toProvider Ratio
% of Population
at 100% FPL
Infant Health
Index
Travel Time to
NND
HPSA Score
Out of 25
• Population-to-Provider ratio*
• Percent of individuals below 100% of the Federal Poverty Level
• Infant Health Index (Infant Mortality Rate or Low Birth Weight Rate)
• Travel time or distance to nearest source of non-designated accessible care
*Double weighted scoring factor
Population-to- Provider Ratio for Primary Care
The Population-to-Provider ratio for Primary Care Geographic, Geographic High Needs/Insufficient
Capacity, and Population HPSAs is scored according to the values in the table below.
Score for Pop: FTE Ratio
Points
Ratio > 10,000:1
or no PCP and a population over 2,500
10,000:1 > Ratio ≥ 5,000:1
or no PCP and a population ≥ 2,000 and < 2,500
5,000:1 > Ratio ≥ 4,000:1
or no PCP and a population ≥ 1,500 and < 2,000
4,000:1 > Ratio ≥ 3,500:1
or no PCP and a population ≥ 1,000 and < 1,500
3,500:1 > Ratio ≥ 3,000:1
or no PCP and a population ≥ 500 and < 1,000
5 points
4 points
3 points
2 points
1 points
Please note that Primary Care Geographic, Geographic High Needs/Insufficient Capacity, and Population
HPSAs have different eligibility thresholds for being designated as a HPSA as described below.
Primary Care Geographic: Primary Care Geographic HPSAs must meet a minimum Population-toProvider Ratio of 3,500:1.
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Shortage Designation Management System (SDMS): MPPs
November 2015
Primary Care Geographic High Needs/Insufficient Capacity: Primary Care Geographic High
Needs/Insufficient Capacity HPSAs must meet a minimum Population-to-Provider Ratio of 3,000:1. To
qualify as a High Needs/Insufficient Capacity the RSA must meet at least one of the following four
criteria:
1.
2.
3.
4.
More than 20% of the population has incomes at or below 100% FPL.
More than 100 births per year per 1,000 women ages 15-44.
More than 20 infant deaths per 1,000 live births.
Meets two criteria for insufficient capacity:
a. More than 8,000 office or outpatient visits per year per FTE primary care physician
serving the area.
b. Unusually long waits for appointments for routine medical services (that is, more than 7
days for established patients and 14 days for new patients).
c. Excessive average waiting time at primary care providers (longer than one hour where
patients have appointments or two hours where patients are treated on a first-come,
first-served basis).
d. Evidence of excessive use of emergency room facilities for routine primary care.
e. A substantial proportion (two-thirds or more) of the area's physicians do not accept new
patients.
f. Abnormally low utilization of health services, as indicated by an average of two or fewer
office visits per year on the part of the area's population.
Primary Care Population: Primary Care Population HPSAs must meet a minimum Population-toProvider Ratio of 3,000:1. The population used for the Primary Care Population HPSA population
calculations is the population specified in the designation. The providers that serve these populations
are the sole providers included in the FTE calculation for the Population-to-Provider ratio.
Percent of Population with Incomes At or Below Federal Poverty Level
The HPSA scoring thresholds are consistent across all disciplines for the percent of the population at or
below Federal Poverty Level. The system will assign a point value according to the table below for this
portion of the HPSA score calculation. This value is based on sourced data for the population at 100%
Federal Poverty Level for each census tract within the designation.
41
Score for % Population with Income at
or Below 100% FPL
Points
P ≥ 50%
5 points
50% > P ≥ 40%
4 points
40% > P ≥ 30%
3 points
30% > P ≥ 20%
2 points
20% > P ≥ 15%
1 points
P < 15%
0 points
Shortage Designation Management System (SDMS): MPPs
November 2015
Infant Health Index
Across all Primary Care HPSA score calculations a measure of infant health is utilized, commonly referred
to as the Infant Health Index. These measures include Infant Mortality Rate (IMR) and Low Birth Weight
(LBW), as defined by the CDC. The system calculates both data points for the proposed designation
area* and uses the index measure which provides the higher point value according to the following
thresholds:
Infant Health Index
Points
IMR ≥ 20 or LBW ≥ 13
5 points
20 > IMR ≥ 18 or 13 > LBW ≥ 11
4 points
18 > IMR ≥ 15 or 11 > LBW ≥ 10
3 points
15 > IMR ≥ 12 or 10 > LBW ≥ 9
2 points
12 > IMR ≥ 10 or 9 > LBW ≥ 7
1 points
IMR < 10 or LBW < 7
0 points
*There is a special condition regarding which value for the IMR is used when the number of births in a
Sub-County designation is less than 4,000. To ensure statistical significance in the sample size for this
metric anything less than 4,000 is considered a sample size that is insufficient to make the assumptions.
If the sub-county RSA’s number of infant births is ≥ 4,000 then the IMR will be calculated in the following
way:
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖 𝑑𝑑𝑑𝑑ℎ𝑠
𝑥 1000 𝑙𝑙𝑙𝑙 𝑏𝑏𝑏𝑏ℎ𝑠
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝑙𝑙𝑙𝑙 𝑏𝑏𝑏𝑏ℎ𝑠
If the sub-county RSA’s number of infant births is < 4,000 SDMS must identify the IMR for the
county/counties which are covered by the sub-county.
o
o
o
o
SDMS will calculate a weighted average of the IMRs based on the proportion of the
service area's population that resides in the county/counties to establish the sub-county
RSA's IMR rate for scoring.
If the sub-county area covers parts of two different counties SDMS will sum the Resident
Civilian Population for all RSA components falling in County A and the Resident Civilian
Population for all RSA components falling into County B. The IMR for each county should
be multiplied by the Resident Civilian Population for the components in the respective
counties.
The results should be added together and then divided by the sum of the Resident
Civilian Population residing in the components to be included in the RSA.
The result of this will be the IMR for the sub-county RSA with # infant births < 4000.
∑ 𝑹𝑹𝑹 𝑪𝑪𝑪 𝒇𝒇𝒇 𝒂𝒂𝒂 𝑹𝑹𝑹 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 𝒊𝒊 𝑪𝑪𝑪𝑪𝑪𝑪 𝑨 ∗ (𝑪𝑪𝑪𝑪𝑪𝑪 𝑨′𝒔 𝑰𝑰𝑰 ) + ∑ 𝑹𝑹𝑹 𝑪𝑪𝑪 𝒇𝒇𝒇 𝒂𝒂𝒂 𝑹𝑹𝑹 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 𝒊𝒊 𝑪𝑪𝑪𝑪𝑪𝑪 𝑩 ∗ (𝑪𝑪𝑪𝑪𝑪𝑪 𝑩′𝒔 𝑰𝑰𝑰)
(𝑪𝑪𝑪𝑪𝑪𝑪 𝑨 𝑹𝑹𝑹 𝑪𝑪𝑪 𝑹𝑹𝑹 𝑪𝑪𝑪𝑪𝑪𝑪𝑪𝑪𝑪) + (𝑪𝑪𝑪𝑪𝑪𝑪 𝑩 𝑹𝑹𝑹𝑹 𝑪𝑪𝑪 𝑹𝑹𝑹 𝑪𝑪𝑪𝑪𝑪𝑪𝑪𝑪𝑪)
o
42
If the sub-county RSA is entirely contained within a single county with infant births
< 4,000, or if the RSA is a whole county with infant births < 4,000, the system will use
the number reported by the CDC for the calculations without using a weighted average
approach.
Shortage Designation Management System (SDMS): MPPs
November 2015
Primary Care Nearest Non-Designated Provider (NND)
The system will calculate the time and distance to the nearest source of care by using the shortest path
analysis discussed above in the travel time and NND section. Primary care NND travel time and distance
is then generated. The following table displays the scoring thresholds for Primary Care NND Travel Time
and Distance:
II.
Score for Travel Time or Distance to NND
Points
Time ≥ 60 minutes
or Distance ≥ 50 miles
60 min > Time ≥ 50 min
or 50 mi > Distance ≥ 40 mi
50 min > Time ≥ 40 min
or 40 mi > Distance ≥ 30 mi
40 min > Time ≥ 30 min
or 30 mi > Distance ≥ 20 mi
30 min > Time ≥ 20 min
or 20 mi > Distance ≥ 10 mi
Time < 20 min
or Distance < 10 mi
5 points
4 points
3 points
2 points
1 points
0 points
Dental Health HPSA Scoring
The Division of Policy and Shortage Designation calculates a score between 0-26 for Dental Health
HPSAs.
Population-toProvider Ratio*
% of Population
at 100% FPL*
Water
Fluoridation
Travel Time to
NND
• Population-to-Provider ratio*
• Percent of individuals below 100% of the Federal Poverty Level*
• Water fluoridation status
• Travel time or distance to nearest source of non-designated accessible care
*Double weighted scoring factor
43
HPSA Score
Out of 26
Shortage Designation Management System (SDMS): MPPs
November 2015
Dental Health Population-to-Provider Ratio
The Population-to-Provider Ratio for Dental HPSAs is scored according to the values in the table below.
Score for Pop: FTE Ratio
Points
Ratio ≥ 10,000 : 1
or no dentists and population ≥ 3,000
Ratio < 10,000:1 but ≥ 8,000:1
or no dentists and population ≥ 2,500 and <3,000
Ratio < 8,000:1 but ≥ 6,000:1
or no dentists and population ≥ 2,000 and <2,500
Ratio < 6,000:1 but ≥ 5,000:1
or no dentists and population ≥ 1,500 and <2,000
Ratio < 5,000:1 but ≥ 4,000:1
or no dentists and population ≥ 1,000 and <1,500
5 points
4 points
3 points
2 points
1 points
Please note that Dental Geographic, Geographic High Needs/Insufficient Capacity, and Population HPSAs
have different eligibility thresholds for being designated as a HPSA as described below.
Dental Geographic: Dental Geographic HPSAs must meet a minimum Population-to-Provider Ratio of
5,000:1.
Dental Geographic High Needs/Insufficient Capacity: Dental Geographic High Needs/Insufficient
Capacity HPSAs must meet a minimum Population-to-Provider Ratio of 4,000:1. To qualify as a Dental
Geographic High Needs/Insufficient Capacity HPSA a RSA must meet at least one of the following three
criteria. (See Appendix I for Future Updates pertaining to this section)
1. More than 20% of the population has incomes at or below 100% FPL.
2. More than 50% of the population has no fluoridated water.
3. Meets one criteria for insufficient capacity:
a. More than 5,000 visits per year per FTE dentist serving the area.
b. Unusually long waits for appointments for routine dental services (that is, more than six
weeks).
c. A substantial proportion (two-thirds or more) of the area’s dentists do not accept new
patients.
Dental Population: The population used for the Dental Population HPSA population calculations is the
population specified in the designation. The providers that serve these populations are the sole
providers included in the FTE calculation for the Population-to-Provider ratio. Dental Population HPSAs
must meet a minimum Population-to-Provider Ratio of 4,000:1.
44
Shortage Designation Management System (SDMS): MPPs
November 2015
Percent of Population with Incomes At or Below Federal Poverty Level
The HPSA scoring thresholds are consistent across all disciplines for the percent of the population at or
below Federal Poverty Level. The system will assign a point value according to the table below for this
portion of the HPSA score calculation. This value is based on sourced data for the population at 100%
Federal Poverty Level for each census tract within the designation.
Score for % Population with Income at
or Below 100% FPL
Points
P ≥ 50%
5 points
50% > P ≥ 40%
4 points
40% > P ≥ 30%
3 points
30% > P ≥ 20%
2 points
20% > P ≥ 15%
1 points
P < 15%
0 points
Fluoridation Rate
Across all Dental HPSA score calculations a measure of fluoridation rate is factored into the HPSA score.
This data is provided by the user on the Supplemental Information Form of the application by entering in
the percent of the population without fluoridated water supply or indicating that the information is
unknown. Points are assigned as follows:
Fluoridated Water Available
Points
Fluoridated Water Available for ≥ 50% of Population
1 point
Fluoridated Water Available for < 50% of Population
0 points
Nearest Non-Designated Provider
The system will calculate the time and distance to the nearest source of care by using the shortest path
analysis discussed above in the travel time and NND section. Dental NND travel time and distance is
then generated. The following table displays the scoring thresholds based on Dental NND Travel Time
and Distance:
Score for Travel Time or Distance to NND
Points
Time ≥ 90 min or Distance ≥ 60 mi
5 points
90 min > Time ≥ 75 min or 60 mi > Distance ≥ 50 mi
4 points
75 min > Time ≥ 60 min or 50 mi > Distance ≥ 40 mi
3 points
60 min > Time ≥ 45 min or 40 mi > Distance ≥ 30
2 points
45 min > Time ≥ 30 min or 30 mi > Distance ≥ 20 mi
1 points
Time < 30 min or Distance < 20 mi
0 points
45
Shortage Designation Management System (SDMS): MPPs
III.
November 2015
Mental Health Scoring
The Division of Policy and Shortage Designation calculates a score between 0-25 for Mental Health
HPSAs.
Population-toProvider Ratio
•
•
•
•
•
•
•
% of Population
at 100% FPL
Alcohol Abuse
Prevalence
Substance Abuse
Prevalence
Elderly Ratio
Youth Ratio
Travel Time to
NND
HPSA Score
Out of 25
Population-to-Provider ratio
Percent of individuals below 100% of the Federal Poverty Level
Youth ratio (ratio of children under 18 to adults ages 18-64)
Elderly ratio (ratio of adults age 65 and over to adults ages 18-64)
Substance abuse prevalence
Alcohol abuse prevalence
Travel time or distance to nearest source of non-designated accessible care
Mental Health Population-to-Provider Ratio
For all Mental Health HPSAs, the providers counted in the Population-to-Provider ratio may consist of
Psychiatrists only, Core Mental Health providers only, or both Psychiatrists and Core Mental Health
providers. The Population-to-Provider Ratio scoring thresholds are represented in a matrix when both
Core Mental Health and Psychiatrists are used. The system will make the determination of which
scoring table to use based on the available data.
Geographic: The Population-to-Provider Ratio for a Geographic Mental Health HPSA is scored according
to the values in the following tables, depending on which providers are included.
46
Shortage Designation Management System (SDMS): MPPs
November 2015
Core Mental Health and Psychiatrists
Psychiatrists
Geographic (NonHigh Need)
Core Mental Health
≥6,000:1
and
<7,500:1
≥7,500:1
and
<9,000:1
≥9,000:1
and
<12,000:1
≥12000:1
and
<15,000:1
≥15,000:1
and
<18,000:1
≥18,000:1
and
<24,000:1
≥24,000:1
≥20,000:1 and
<25,000:1
1
2
3
4
5
6
7
≥25,000:1 and
<30,000:1
2
3
4
5
6
7
7
≥30,000:1 and
<35,000:1
3
4
5
6
7
7
7
≥35,000:1 and
<40,000:1
4
5
6
7
7
7
7
5
6
7
7
7
7
7
6
7
7
7
7
7
7
7
7
7
7
7
7
7
≥40,000:1 and
<45,000:1
≥45,000:1 and
<50,000:1
≥50,000:1 or 0
psychiatrists
as verified by
HRSA
Psychiatrists Only and Core Mental Health Only
Psychiatrists Only Geographic
(Non High Need)
Ratio
47
Score
Core Mental Health
Geographic (Non High
Need)
Ratio
Score
≥30,000:1 and <35,000:1
1
≥9,000:1 and <12,000:1
1
≥35,000:1 and <40,000:1
2
≥12,000:1 and <15,000:1
2
≥40,000:1 and <45,000:1
3
≥15,000:1 and <18,000:1
3
≥45,000:1 and <50,000:1
4
≥18,000:1 and <24,000:1
4
≥50,000:1 and <55,000:1
5
≥24,000:1 and <30,000:1
5
≥55,000:1 and <60,000:1
6
≥30,000:1 and <36,000:1
6
≥60,000:1
7
≥36,000:1
7
Shortage Designation Management System (SDMS): MPPs
November 2015
No Psychiatrists or Core Mental Health Providers Available in Service Area
No Providers Geographic (Non High
Need)
Ratio
Score
≥3,000:0 and <4,500:0
1
≥4,500:0 and <6,000:0
2
≥6,000:0 and <7,500:0
3
≥7,500:0 and <9,000:0
4
≥9,000:0 and <12,000:0
5
≥12,000:0 and <15,000:0
6
≥15,000:0 and <18,000:0
7
Geographic High Needs: To qualify as a Mental Health Geographic High Need HPSA a RSA must meet at
least one of following criteria.
1. More than 20% of the population has incomes at or below 100% FPL.
2. The Youth Ratio (# of persons under 18 divided by the number of adults 18-64) is greater than
0.6.
3. The Elderly Ratio (# of persons age 65 and older divided by the total # of adults 18-64) is greater
than 0.25.
4. Alcohol or substance abuse prevalence data shows the area to be among the worst quartile in
the nation, state, or region.
The Population-to-Provider Ratio for a Geographic Mental Health HPSAs is scored according to the
values in the following tables, depending on which providers are included.
48
Shortage Designation Management System (SDMS): MPPs
November 2015
Core Mental Health
≥4,500:1
and
<6,000:1
≥6,000:1
and
<7,500:1
≥7,500:1
and
<9,000:1
≥9,000:1
and
<12,000:1
≥15,000:1
and
<18,000:1
≥18,000:1
≥15,000:1 and
<20,000:1
1
2
3
4
5
6
7
≥20,000:1 and
<25,000:1
2
3
4
5
6
7
7
≥25,000:1 and
<30,000:1
3
4
5
6
7
7
7
≥30,000:1 and
<35,000:1
4
5
6
7
7
7
7
≥35,000:1 and
<40,000:1
5
6
7
7
7
7
7
≥40,000:1 and
<45,000:1
6
7
7
7
7
7
7
≥45,000:1 or 0
psychiatrists
as verified by
HRSA
7
7
7
7
7
7
7
Psychiatrists
High Needs
≥12,000:1
and
<15,000:1
Only and Core Mental Health Only
Psychiatrists Only (High
Need)
Ratio
Score
Core Mental Health (High
Need)
Ratio
Score
≥20,000:1 and <25,000:1
1
≥6,000:1 and <7,500:1
1
≥25,000:1 and <30,000:1
2
≥7,500:1 and <9,000:1
2
≥30,000:1 and <35,000:1
3
≥9,000:1 and <12,000:1
3
≥35,000:1 and <40,000:1
4
≥12,000:1 and <15,000:1
4
≥40,000:1 and <45,000:1
5
≥15,000:1 and <18,000:1
5
≥45,000:1 and <50,000:1
6
≥18,000:1 and <24,000:1
6
≥50,000:1
7
≥24,000:1
7
No Psychiatrists or Core Mental Health Providers Available in Service Area
49
Shortage Designation Management System (SDMS): MPPs
November 2015
No Psych or CMH Providers (High
Need)
Ratio
Score
≥1,500:0 and <3,000:0
1
≥3,000:0 and <4,500:0
2
≥4,500:0 and <6,000:0
3
≥6,000:0 and <7,500:0
4
≥7,500:0 and <9,000:0
5
≥9,000:0 and <12,000:0
6
≥12,000:0 and <15,000:0
7
Population: The population used for the Mental Health Population HPSA population calculations is the
population specified in the designation. The providers that serve these populations are the sole
providers included in the FTE calculation for the population to provider ratio. The Population-toProvider Ratio for a Mental Health population HPSAs is scored according to the values in the tables
below, depending on which providers are included.
Core Mental Health
≥4,500:1
and
<6,000:1
≥6,000:1
and
<7,500:1
≥7,500:1
and
<9,000:1
≥9,000:1
and
<12,000:1
≥12,000:1
and
<15,000:1
≥15,000:1
and
<18,000:1
≥18,000:1
≥15,000:1 and
<20,000:1
1
2
3
4
5
6
7
≥20,000:1 and
<25,000:1
2
3
4
5
6
7
7
≥25,000:1 and
<30,000:1
3
4
5
6
7
7
7
≥30,000:1 and
<35,000:1
4
5
6
7
7
7
7
≥35,000:1 and
<40,000:1
5
6
7
7
7
7
7
≥40,000:1 and
<45,000:1
6
7
7
7
7
7
7
≥45,000:1 or 0
psychiatrists
as verified by
HRSA
7
7
7
7
7
7
7
Psychiatrists
Population
Psychiatrists Only and Core Mental Health Only
50
Shortage Designation Management System (SDMS): MPPs
Psychiatrists Only
(Population)
Ratio
November 2015
Core Mental Health
(Population)
Score
Ratio
Score
≥20,000:1 and <25,000:1
1
≥6,000:1 and <7,500:1
1
≥25,000:1 and <30,000:1
2
≥7,500:1 and <9,000:1
2
≥30,000:1 and <35,000:1
3
≥9,000:1 and <12,000:1
3
≥35,000:1 and <40,000:1
4
≥12,000:1 and <15,000:1
4
≥40,000:1 and <45,000:1
5
≥15,000:1 and <18,000:1
5
≥45,000:1 and <50,000:1
6
≥18,000:1 and <24,000:1
6
≥50,000:1
7
≥24,000:1
7
No Psychiatrists or Core Mental Health Providers Available in Service Area that serve Population
No Psych or CMH Providers
(Population)
Ratio
Score
≥1,500:0 and <3,000:0
1
≥3,000:0 and <4,500:0
2
≥4,500:0 and <6,000:0
3
≥6,000:0 and <7,500:0
4
≥7,500:0 and <9,000:0
5
≥9,000:0 and <12,000:0
6
≥12,000:0 and <15,000:0
7
Percent of Population with Incomes At or Below Federal Poverty Level
51
Shortage Designation Management System (SDMS): MPPs
November 2015
The HPSA scoring thresholds are consistent across all disciplines for the percent of the population at or
below the Federal Poverty Level. The system will assign a point value according to the table below for
this portion of the HPSA score calculation. This value is based on sourced data for the population at
100% Federal Poverty Level for each census tract within the designation.
Score for % Population with Income at
or Below 100% FPL
Points
P ≥ 50%
5 points
50% > P ≥ 40%
4 points
40% > P ≥ 30%
3 points
30% > P ≥ 20%
2 points
20% > P ≥ 15%
1 points
P < 15%
0 points
Youth and Elderly Ratios
Across all Mental Health HPSA score calculations a scoring factor for both the elderly and youth ratio in
the designation area is used. The ratios are defined as follows:
𝐸𝐸𝐸𝐸𝐸𝐸𝐸 𝑅𝑅𝑅𝑅𝑅 =
𝑌𝑌𝑌𝑌ℎ 𝑅𝑅𝑅𝑅𝑅 =
Points are assigned as follows:
# 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴 18 𝑎𝑎𝑎 𝑢𝑢𝑢𝑢𝑢
𝑇𝑇𝑇𝑇𝑇 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴 18 − 64
Elderly Ratio
Points
R ≥ 0.25:1
0.25:1 > R ≥ 0.15:1
0.15:1 > R ≥ 0.10:1
3 points
2 points
1 points
Youth Ratio
Points
R ≥ 0.6:1
0.6:1 > R ≥ 0.4:1
0.4:1 > R ≥ 0.2:1
3 points
2 points
1 points
Alcohol and Substance Abuse Prevalence
52
# 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴 65 𝑎𝑎𝑎 𝑜𝑜𝑜𝑜
𝑇𝑇𝑇𝑇𝑇 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴 18 − 64
Shortage Designation Management System (SDMS): MPPs
November 2015
Across all Mental Health HPSA score calculations, a measure of substance and alcohol abuse is factored
into the HPSA score. This optional data is provided by the user on the Supplemental Information Form
of the application by indicating that the proposed designation’s substance or alcohol abuse rate is in the
worst quartile of the nation, state, or regional level. The proposed designation HPSA score is affected as
follows:
Alcohol Abuse Prevalence
Points
Area’s rate is in worst quartile for nation, region, or state
1 point
Substance Abuse Prevalence
Points
Area’s rate is in worst quartile for nation, region, or state
1 point
Nearest Non Designated Provider
The system will calculate the time and distance to the nearest source of care by using the shortest path
analysis discussed above in the travel time and NND section. The system will look for the nearest
provider regardless if the RSA’s scoring is based on Core Mental Health or Psychiatrists. Mental Health
NND travel time is then generated. The following table displays the scoring thresholds based on Mental
Health NND Travel Time:
Score for Travel Time or Distance to NND Points
53
≥ 60 minutes
5 points
< 60 minutes and ≥50 minutes
4 points
< 50 minutes and ≥ 40 minutes
3 points
< 40 minutes and ≥ 30 minutes
2 points
< 30 minutes and > 20 minutes
1 points
Shortage Designation Management System (SDMS): MPPs
November 2015
Section VII: MUA/P Scoring
I.
MUA/P Common Requirements
Rational Service Area
II.
Defined in terms of:
o Whole County.
o Minor Civil Divisions (MCDs) with population centers within 30 minutes time of each
other.
o Census Tracts.
RSA Population for a whole county cannot exceed 250,000.
For RSAs the following must be true in order for the RSA boundaries to be valid:
o RSA cannot be smaller than a single census tract or MCD.
o RSA components must be adjacent to each other.
o RSA cannot include components that are already designated for the same discipline.
An explanation must be entered on the Supplemental Information Form in SDMS as to why the
Sub-County RSA is considered Rational.
MUA/P Scoring
MUA/P designations are scored by summing the values listed in the following illustration. The total IMU
score must be 62.0 or less in order for the service area to qualify for a MUA/P designation.
Population-toProvider Ratio
Weighted Score
54
% of Population
at 100% FPL
Weighted Score
% Population Age
65 and Over
Weighted Score
Infant Mortality
Rate
Weighted Score
IMU Score
0-100
Population-to-Provider ratio
o The ratio of the total Primary Care Provider FTE per 1,000 population for the service
area using the Total Resident Civilian Population.
% Population at 100% of the Federal Poverty Level
o Total Resident Civilian Population is used as the denominator.
% Population age 65 and over
o Total Resident Civilian Population is used as the denominator.
Infant Mortality Rate
o Please refer to the Infant Health Index section under the HPSA Scoring section for the
same Sub-County RSA methodology.
Shortage Designation Management System (SDMS): MPPs
November 2015
Index of Medical Underservice (IMU)
IMU scale is between 0 and 100
o 0 represents completely underserved.
o 100 represents least underserved or best served.
o To qualify as an MUA designation the service area must have an IMU of 62.0 or less.
IMU involves four weighted variables
o Ratio of primary medical care physicians per 1,000 population.
o Infant Mortality Rate.
o Percentage of the population with incomes at or below 100% Federal Poverty Level.
o Percentage of population age 65 and over.
The IMU involves four variables which are converted to a weighted value, per the established criteria in
the tables below.
Population-to-Provider Weighted Values
Population-toProvider Ratio
0 - .050
.051 - .100
.101 - .150
.151 - .200
.201 - .250
.251 - .300
.301 - .350
.351 - .400
.401 - .450
.451 - .500
.501 - .550
.551 - .600
.601 - .650
.651 - .700
.701 - .750
.751 - .800
.801 - .850
.851 - .900
.901 - .950
.951 - 1.000
1.001 - 1.050
1.051 - 1.100
1.101 - 1.150
1.151 - 1.200
1.201 - 1.250
over 1.250
55
Weighted Value
0
0.5
1.5
2.8
4.1
5.7
7.3
9.0
10.7
12.6
14.8
16.9
19.1
20.7
21.9
23.1
24.3
25.3
25.9
26.6
27.2
27.7
28.0
28.3
28.6
28.7
Shortage Designation Management System (SDMS): MPPs
November 2015
Infant Mortality Weighted Values
56
Infant Mortality Rate
Weighted Value
0-8
8.1 - 9.0
9.1 - 10.0
10.1 - 11.0
11.1 - 12.0
12.1 - 13.0
13.1 - 14.0
14.1 - 15.0
15.1 - 16.0
16.1 - 17.0
17.1 - 18.0
18.1 - 19.0
19.1 - 20.0
20.1 - 21.0
21.1 - 22.0
22.1 - 23.0
23.1 - 24.0
24.1 - 25.0
25.1 - 26.0
26.1 - 27.0
27.1 - 28.0
28.1 - 29.0
29.1 - 30.0
30.1 - 31.0
31.1 - 32.0
32.1 - 33.0
33.1 - 34.0
34.1 - 35.0
35.1 - 36.0
36.1 - 37.0
37.1 - 39.0
39.1 - 41.0
41.1 - 43.0
43.1 - 45.0
45.1 +
26.0
25.6
24.8
24.0
23.2
22.4
21.5
20.5
19.5
18.5
17.5
16.4
15.3
14.2
13.1
11.9
10.8
9.6
8.5
7.3
6.1
5.4
5.0
4.7
4.3
4.0
3.6
3.3
3.0
2.6
2.0
1.4
0.8
0.2
0
Shortage Designation Management System (SDMS): MPPs
November 2015
% Population at 100% Poverty Weighted Values
Percent Below
Poverty
0
0.1 - 2.0
2.1 - 4.0
4.1 - 6.0
6.1 - 8.0
8.1 - 10.0
10.1 - 12.0
12.1 - 14.0
14.1 - 16.0
16.1 - 18.0
18.1 - 20.0
20.1 - 22.0
22.1 - 24.0
24.1 - 26.0
26.1 - 28.0
28.1 - 30.0
30.1 - 32.0
32.1 - 34.0
34.1 - 36.0
36.1 - 38.0
38.1 - 40.0
40.1 - 42.0
42.1 - 44.0
44.1 - 46.0
46.1 - 48.0
48.1 - 50.0
50+
57
Weighted Value
25.1
24.6
23.7
22.8
21.9
21.0
20.0
18.7
17.4
16.2
14.9
13.6
12.2
10.9
9.3
7.8
6.6
5.6
4.7
3.4
2.1
1.3
1.0
0.7
0.4
0.1
0
Shortage Designation Management System (SDMS): MPPs
November 2015
% Population age 65 and Over
58
Percent Age 65
and Over
Weighted Value
0-7.0
20.2
7.1 - 8.0
8.1 - 9.0
9.1 - 10.0
10.1 - 11.0
11.1 - 12.0
12.1 - 13.0
13.1 - 14.0
14.1 - 15.0
15.1 - 16.0
16.1 - 17.0
17.1 - 18.0
18.1 - 19.0
19.1 - 20.0
20.1 - 21.0
21.1 - 22.0
22.1 - 23.0
23.1 - 24.0
24.1 - 25.0
25.1 - 26.0
26.1 - 27.0
27.1 - 28.0
28.1 - 29.0
29.1 - 30.0
30+
20.1
19.9
19.8
19.6
19.4
19.1
18.9
18.7
17.8
16.1
14.4
12.8
11.1
9.8
8.9
8.0
7.0
6.1
5.1
4.0
2.8
1.7
0.6
0
Shortage Designation Management System (SDMS): MPPs
November 2015
Section VIII: OFAC Requirements and Scoring
I.
Primary Care OFAC Common Requirements
Criteria
The facility must be a public or non-profit medical facility.
The facility is providing primary medical care services to an area or population group designated
as having a primary care professional shortage.
The facility cannot fall within a current HPSA or MUA/P of the same discipline.
Provisions of Services
The facility must meet one of the following provisions of services criteria:
o The facility is within 30 minutes of a HPSA and the facility is accessible to residents of
the HPSA (i.e no socioeconomic difference).
o More than 50% of the facility’s health care services are provided to residents of a HPSA.
Insufficient Capacity
The facility must meet at least two of the following insufficient capacity:
o More than 8,000 outpatient visits per year per FTE of primary care physicians.
o Excessive use (greater than 35%) of emergency room facilities for routine primary care.
o Waiting time for appointments is more than 7 days for established patients or more
than 14 days for new patients for routine health services.
o Facility waiting time is greater than 1 hour for patients with appointments or 2 hours for
walk-in patients.
Suggested Supporting Documents
Document
Type Name
When
Required?
Suggested Document
Evidence that
facility is
public or
non-profit
Evidence that
more than
50% of the
facility's
health care
services are
provided to
Always
Letter establishing non-profit status with IRS
Scan of website page that documents type of facility
If used as a
criteria on
the
Provision of
Services
page
Patient origin by zip code or other data provided by facility
59
Shortage Designation Management System (SDMS): MPPs
residents of a
HPSA
Evidence of
Travel Time
Evidence of
Public
Transportati
on
Evidence of
% Population
using Public
Transportati
on is greater
than 30%
Evidence that
facility has
more than
8000
outpatient
visits per
year per
primary care
physician
FTE
Evidence of
excessive use
(greater than
35%) of
emergency
room
facilities for
routine
60
November 2015
If automated
travel time
for Private
transportati
on is edited
or the user
selects
public
transportati
on
If the user
selects
public
transportati
on
If user
selects this
to pass as a
criteria for
public
transportati
on selection
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of Google Maps (or other internet mapping tool) results for
private transit; scan of public transit schedule to show travel time
(SDMS should measure from the population center; if there is not one,
then measure from the centroid of the most populous component in
the RSA).
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by ER
Scan of public transit schedule to show travel time
Scan of local, state, or federal data used; Census data available at
http://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?
refresh=t
This is using the Advanced Search under People: Employment:
Commuting (Journey to Work)
Scan of documentation provided by facility
Shortage Designation Management System (SDMS): MPPs
primary care
Evidence that
waiting time
for
appointment
s is greater
than 7 days
for
established
patients
Evidence that
waiting time
for
appointment
s is greater
than 14 days
for new
patients for
routine
health
services
Evidence that
the facility
waiting time
is greater
than 1 hour
for patients
with
appointment
s
Evidence that
the facility
waiting time
is greater
than 2 hours
for walk-in
patients
61
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by facility
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by facility
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by facility
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by facility
November 2015
Shortage Designation Management System (SDMS): MPPs
II.
November 2015
Dental Health OFAC Common Requirements
Criteria
The facility must be a public or non-profit medical facility.
The facility is providing general dental care services to an area or population group designated
as having a dental professional shortage.
The facility cannot fall within a current HPSA of the same discipline.
Provisions of Services
The facility must meet one of the following provisions of services criteria:
o The facility is within 40 minutes of a HPSA and the facility is accessible to residents of
the HPSA (i.e no socioeconomic difference).
o More than 50% of the facility’s dental care services are provided to residents of a HPSA.
Insufficient Capacity
The facility must meet one of the following insufficient capacity:
o More than 5,000 outpatient visits per year per FTE of dentist
o Facility waiting time for appointments is greater than 6 weeks for routine dental
services.
Suggested Supporting Documents
Document
Type Name
When
Required?
Suggested Document
Evidence that
facility is
public or
non-profit
Evidence that
more than
50% of the
facility's
health care
services are
provided to
residents of a
HPSA
Evidence of
Travel Time
Always
Letter establishing non-profit status with IRS
Scan of website page that documents type of facility
If used as a
criteria on
the
Provision of
Services
page
Patient origin by zip code or other data provided by facility
62
If automated Scan of Google Maps (or other internet mapping tool) results for
travel time
private transit; scan of public transit schedule to show travel time
for Private
(SDMS should measure from the population center; if there is not one,
Shortage Designation Management System (SDMS): MPPs
Evidence of
Public
Transportati
on
Evidence of
% Population
using Public
Transportati
on is greater
than 30%
Evidence that
facility has
more than
5000
outpatient
visits per
year per
dentist FTE
Evidence that
waiting time
for
appointment
s for routine
dental health
services is
greater than
6 weeks
63
November 2015
transportati
on is edited
or the user
selects
public
transportati
on
If the user
selects
public
transportati
on
If user
selects this
to pass as a
criteria for
public
transportati
on selection
If user
selects this
criteria on
the
Insufficient
capacity
page
then measure from the centroid of the most populous component in
the RSA).
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by facility
Scan of public transit schedule to show travel time
Scan of local, state, or federal data used; Census data available at
http://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?
refresh=t
This is using the Advanced Search under People: Employment:
Commuting (Journey to Work)
Scan of documentation provided by facility
Shortage Designation Management System (SDMS): MPPs
III.
November 2015
Mental Health OFAC Common Requirements
Criteria
The facility must be a public or non-profit medical facility or a Community Mental Health Center
(CMHC) authorized by L. 94-63.
The facility is providing mental health services to an area or population group designated as
having a mental health professional shortage.
The facility cannot fall within a current HPSA of the same discipline.
Provisions of Services
The facility must meet one of the following provisions of services criteria:
o The facility is within 40 minutes of a HPSA and the facility is accessible to residents of
the HPSA (i.e no socioeconomic differences).
o More than 50 % of the facility’s mental health care services are provided to residents of
a HPSA.
o The facility will be considered to be providing services to a designated area or
population group if the facility, by Federal or State statue, administrative action, or
contractual agreement, has been given responsibility for providing and/or coordinating
mental health services for the area or population group consistent with applicable state
plans.
Insufficient Capacity
The facility must meet one of the following insufficient capacity:
o More than 1,000 outpatient visits per year per FTE of mental health care providers.
o More than 3,000 outpatient visits per year per FTE of psychiatrist.
o No psychiatrists are on staff and this facility is only providing mental health services to
the designated area or population.
Suggested Supporting Documents
Document
Type Name
When
Required?
Suggested Document
Evidence that
facility is
public or
non-profit
Evidence that
more than
50% of the
facility's
Always
Letter establishing non-profit status with IRS
Scan of website page that documents type of facility
If used as a
criteria on
the
Provision of
Patient origin by zip code or other data provided by facility
64
Shortage Designation Management System (SDMS): MPPs
health care
services are
provided to
residents of a
HPSA
Evidence of
Travel Time
Evidence of
Public
Transportati
on
Evidence of
% Population
using Public
Transportati
on is greater
than 30%
Evidence that
facility has
more than
1000
outpatient
visits per
year per
mental
health care
provider FTE
Evidence that
facility has
more than
3000
outpatient
65
November 2015
Services
page
If automated
travel time
for Private
transportati
on is edited
or the user
selects
public
transportati
on
If the user
selects
public
transportati
on
If user
selects this
to pass as a
criteria for
public
transportati
on selection
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of Google Maps (or other mapping tool) results for private transit;
scan of public transit schedule to show travel time (SDMS should
measure from the population center; if there is not one, then measure
from the centroid of the most populous component in the RSA).
If user
selects this
criteria on
the
Insufficient
Scan of documentation provided by facility
Scan of public transit schedule to show travel time
Scan of local, state, or federal data used; Census data available at
http://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?
refresh=t
This is using the Advanced Search under People: Employment:
Commuting (Journey to Work)
Scan of documentation provided by facility
Shortage Designation Management System (SDMS): MPPs
visits per
year per
psychiatrist
FTE
Evidence that
no
psychiatrists
are on staff
and this
facility is the
only facility
providing
mental
health
services to
the
designated
area or
population
Evidence that
the facility
has been
given
responsibilit
y for
providing
and/or
coordinating
mental
health
services to an
area or
population
group,
consistent
with
applicable
State plans.
IV.
November 2015
capacity
page
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by facility and/or other local or state
source
If user
selects this
criteria on
the
Insufficient
capacity
page
Scan of documentation provided by facility and/or other local or state
source
OFAC Scoring
The facility score and the degree of shortage is the same as the HPSA or MUA/P score and degree of
shortage of the designated area or population group which it serves.
66
Shortage Designation Management System (SDMS): MPPs
November 2015
Section IX: State/County Mental Hospital Requirements and Scoring
I.
State/ County Mental Hospital Common Requirements
Criteria
The state or county mental hospital must have an average daily inpatient census of at least 100.
The number of workload units per FTE psychiatrist available at the hospital must be greater than
or equal to 300.
Total Workload Units Calculation
The total workload units is calculated in the following way:
𝑇𝑇𝑇𝑇𝑇 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊 𝑈𝑈𝑈𝑈𝑈
= 𝐴𝐴𝑒𝑟𝑟𝑟𝑟 𝑑𝑑𝑑𝑑𝑑 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑐𝑐𝑐𝑐𝑐𝑐 𝑛𝑛𝑛𝑛𝑛𝑛 + 2
∗ (𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎 𝑝𝑝𝑝 𝑦𝑦𝑦𝑦) + 0.5
∗ (𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎 𝑡𝑡 𝑑𝑑𝑑 𝑐𝑐𝑐𝑐 𝑎𝑎𝑎 𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜 𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠 𝑝𝑝𝑟 𝑦𝑦𝑦𝑦
II.
State/County Mental Hospital Scoring
The state and county mental hospital scoring is equivalent to the hospital’s degree of shortage.
Degree of Shortage
The following table demonstrates the criteria based on the Total Workload Units/Psychiatrist
FTE Ratio (R) that is used to determine the hospital’s Degree of Shortage:
Group Number
1
2
3
4
Criteria
No psychiatrists or R > 1,800
1,800 > R > 1,200
1,200 > R > 600
600 > R > 300
Degree of Shortage Points
20
16
12
8
Psychiatrists Shortage
The psychiatrists short is defined as the number of psychiatrists needed to meet the Total
Workload Units: PSY FTE ratio. The following calculation determines the Psychiatrists Shortage.
(𝑇𝑇𝑇𝑇𝑇 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊 𝑈𝑈𝑈𝑈𝑈)/300 − 𝑃𝑃𝑃𝑃ℎ𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝐹𝐹𝐹
67
Shortage Designation Management System (SDMS): MPPs
November 2015
Suggested Supporting Documents
Document Type Name
When Required?
Acceptable Document
Evidence of Mean Daily Inpatient
Census
Always
Evidence of Inpatient
Admissions/year
Always
Evidence of Admissions to Day Care
and Outpatient Services/year
Always
Scan of documentation
provided by facility
Scan of documentation
provided by facility
Scan of documentation
provided by facility
68
Shortage Designation Management System (SDMS): MPPs
November 2015
Section X: Correctional Facility Requirements and Scoring
I.
Primary Care Correctional Facility Common Requirements
Criteria
Federal and State correctional facilities must be medium or maximum security.
The institution must have at least 250 inmates.
The ratio of the number of internees per year to the number of FTE primary care physicians
serving the institution must be at least 1000:1.
Number of Internees Calculation
The number of internees is calculated in the following way:
o If the number of new inmates per year and the mean length-of-stay are not specified, or
if the information provided does not indicate that intake medical examinations are
routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦
o
If the mean length- of- stay is specified as one year or more, and intake medical
examinations are routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼
= 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦 + 0.3 ∗ (𝑀𝑀𝑀𝑀 𝑁𝑁𝑁 𝐼𝐼𝐼𝐼𝐼𝐼𝐼/𝑦𝑦𝑦𝑦)
o
If the mean length- of- stay is specified as less than one year, and intake medical
examinations are routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦 + 0.2 ∗ (1 + 𝑀𝑀𝑀𝑀/2) ∗
(𝑀𝑀𝑀𝑀 𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦) where MLOS is in a fraction of a year
II.
Primary Care Correctional Facility Scoring
The correctional facility scoring is equivalent to the institution’s degree of shortage plus point for the
intersecting geographic and geographic high needs HPSA
Degree of Shortage
69
The following table demonstrates the criteria based on the number of inmates and/or the ratio
of Internees to Primary Care physicians Ratio (R) that is used to determine the institutions
Degree of Shortage:
Shortage Designation Management System (SDMS): MPPs
Group Number
1
2
3
Criteria
Institutions with 500 or more
inmates and no physicians
Other institutions with no
physicians and institutions with
R greater than or equal to
2000:1
Institutions with a ratio greater
than or equal to 1,000:1 but less
than 2,000: 1
November 2015
Degree of Shortage Points
12
6
3
Intersecting HPSA Points
The intersecting HPSA points are determined in the following way:
o Geographic HPSA score between 20-25; Points = 12
o Geographic HPSA score between 14-19; Points = 9
o Geographic HPSA score between 8-13; Points = 6
o Geographic HPSA score between 1-7; Points = 3
o Not located in a geographic HPSA; Points = 0
Physician Short
The physician short is defined as the number of physicians needed to meet the Internee/
Provider FTE ratio. The following calculation determines the physicians short.
𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼/1000 − 𝐹𝐹𝐹
70
Shortage Designation Management System (SDMS): MPPs
III.
November 2015
Dental Health Correctional Facility Common Requirements
Criteria
Federal and State correctional facilities must be medium or maximum security.
The institution must have at least 250 inmates.
The ratio of the number of internees per year to the number of FTE dentists serving the
institution must be at least 1500:1.
Number of Internees Calculation
The number of internees is calculated in the following way:
o If the number of new inmates per year and the mean length-of-stay are not specified, or
if the information provided does not indicate that intake dental examinations are
routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑢𝑢𝑢𝑢𝑢 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦
o
If the mean length- of- stay is specified as one year or more, and intake dental
examinations are routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦 + 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦
o
If the mean length- of- stay is specified as less than one year, and intake dental
examinations are routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦 + (1/3) ∗ [1 + (2 ∗
𝑀𝑀𝑀𝑀)] ∗ (𝑀𝑀𝑀𝑀 𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦) where MLOS is in a fraction of a year
IV.
Dental Health Correctional Facility Scoring
The correctional facility scoring is equivalent to the institution’s degree of shortage plus point for the
intersecting geographic and geographic high needs HPSA
Degree of Shortage
The following table demonstrates the criteria based on the number of inmates and/or the ratio
of Internees to dentists Ratio (R) that is used to determine the institutions Degree of Shortage:
Group Number
1
71
Criteria
Institutions with 500 or more
inmates and no dentists
Degree of Shortage Points
12
Shortage Designation Management System (SDMS): MPPs
2
3
Other institutions with no
dentists and institutions with R
greater than or equal to 3000: 1
Institutions R greater than or
equal to 1500:1 but less than
3000: 1
November 2015
6
3
Intersecting HPSA Points
The intersecting HPSA points are determined in the following way:
o Geographic HPSA score between 20-26; Points = 12
o Geographic HPSA score between 14-19; Points = 9
o Geographic HPSA score between 8-13; Points = 6
o Geographic HPSA score between 1-7; Points = 3
o Not located in a geographic HPSA; Points = 0
Physicians Short
The physician short is defined as the number of dentists needed to meet the Internee/ Provider
FTE ratio. The following calculation determines the physicians short.
𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼/1500 − 𝐹𝐹𝐹
72
Shortage Designation Management System (SDMS): MPPs
V.
November 2015
Mental Health Correctional Facility Common Requirements
Criteria
Federal and State correctional facilities must be medium or maximum security.
The institution must have at least 250 inmates.
The ratio of the number of internees per year to the number of FTE psychiatrists serving the
institution must be at least 2000:1.
Number of Internees Calculation
The number of internees is calculated in the following way:
o If the number of new inmates per year and the mean length-of-stay are not specified, or
if the information provided does not indicate that intake psychiatric examinations are
routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦
o
If the mean length- of- stay is specified as one year or more, and intake psychiatric
examinations are routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦 + 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦
o
If the mean length- of- stay is specified as less than one year, and intake psychiatric
examinations are routinely performed upon entry, then
𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦 + (1/3) ∗ [1 + (2 ∗
𝑀𝑀𝑀𝑀)] ∗ (𝑀𝑀𝑀𝑀 𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦) where MLOS is in a fraction of a year
VI.
Mental Health Correctional Facility Scoring
The correctional facility scoring is equivalent to the institution’s degree of shortage plus point for the
intersecting geographic and geographic high needs HPSA
Degree of Shortage
The following table demonstrates the criteria based on the number of inmates and/or the ratio
of Internees to psychiatrist Ratio (R) that is used to determine the institutions Degree of
Shortage:
Group Number
1
73
Criteria
Facilities with 500 or more
Degree of Shortage Points
12
Shortage Designation Management System (SDMS): MPPs
2
3
November 2015
inmates or residents and no
psychiatrists
Other institutions with no
psychiatrists and institutions
with R greater than or equal to
3000:1;
Institutions with R greater than
or equal to 2000:1 but less than
3000:1
6
3
Intersecting HPSA Points
The intersecting HPSA points are determined in the following way:
o Geographic HPSA score between 20-26; Points = 12
o Geographic HPSA score between 14-19; Points = 9
o Geographic HPSA score between 8-13; Points = 6
o Geographic HPSA score between 1-7; Points = 3
o Not located in a geographic HPSA; Points = 0
Psychiatrist Short
The psychiatrists short is defined as the number of psychiatrists needed to meet the Internee/
psychiatrist FTE ratio. The following calculation determines the Psychiatrists Short.
𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼/2000 − 𝐹𝐹𝐹
Suggested Supporting Documents- All Disciplines
Document Type Name
When Required?
Acceptable Document
Evidence of Mean Inmates/year
Always
Evidence of Routine Intake Exams
performed
If user enters information
on the Facility Criteria page
If user enters information
on the Facility Criteria page
If user enters information
on the Facility Criteria page
Scan of documentation
provided by facility
Scan of documentation
provided by facility
Scan of documentation
provided by facility
Scan of documentation
provided by facility
Evidence of Mean New
Inmates/year
Evidence of Mean Length of Stay for
inmates
74
Shortage Designation Management System (SDMS): MPPs
November 2015
Appendix I: Future Updates
Appendix I contains future updates to specific areas that are currently being tracked by DPSD. Updates
to the system will be available in a future release, and any related content will be updated within the
MPPS document and User Guides.
1. Contiguous Area Analysis Over-Utilized Measure for Mental Health
SDMS will be updated to reflect these measures:
•
•
Providers in CAs will be considered over-utilized if the population-to-provider ratio for
psychiatrists ≥ 10,000:1 and the population-to-provider ratio for Core Mental Health
providers is ≥ 3,000:1
If there is no data on Core Mental Health providers other than psychiatrists or the Core
Mental Health other than psychiatrists FTE = 0, CA providers will be considered overutilized if the population-to-provider ratio for psychiatrists is ≥ 20,000:1
2. Dental Geographic High Needs/Insufficient Capacity Qualification
SDMS will be updated to reflect these measures:
1. More than 20% of the population has incomes at or below 100% FPL.
2. More than 50% of the population has no fluoridated water.
3. Meets two criteria for insufficient capacity:
a. More than 5,000 visits per year per FTE dentist serving the area.
b. Unusually long waits for appointments for routine dental services (that is, more than six
weeks).
c. A substantial proportion (two-thirds or more) of the area’s dentists do not accept new
patients.
75
| File Type | application/pdf |
| Author | WIN764BIT |
| File Modified | 2015-12-18 |
| File Created | 2015-11-13 |