G Manual for Policies and Procedures - Attachment G

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Shortage Designation Management
System (SDMS):
Manual for Policies and Procedures
April 4, 2020

The information collected via the Shortage Designation Management System is used to determine which areas,
populations, and facilities have qualifying as Health Professional Shortage Areas for the distribution of NHSC
resources. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this information
collection is 0906-0029 and it is valid until 5/31/2020. This information collection is required to obtain or retain a
benefit (Section 332 and Section 330(b)(3) of the Public Health Service (PHS) Act). Public reporting burden for this
collection of information is estimated to average xx hours per response, including the time for reviewing instructions,
searching existing data sources, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville,
Maryland, 20857 or [email protected].

1

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Shortage Designation Management System (SDMS): MPP Outline

Shortage Designation Management System (SDMS): Manual for Policies and Procedures (MPP)
The SDMS MPP 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 at least 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 Demographic and Health Data .................................... 12
Section IV: Provider Management and Provider Data................................................................ 17
Section V: HPSA and MUA/P Designation Components ............................................................ 27
Section VI: HPSA Scoring .............................................................................................................. 46
Section VII: MUA/P Scoring ......................................................................................................... 59
Section VIII: OFAC Requirements and Scoring ............................................................................ 64
Section IX: State/County Mental Hospital Requirements and Scoring ...................................... 72
Section X: Correctional Facility Requirements and Scoring........................................................ 74
Appendix A: Future Updates........................................................................................................ 80
Appendix B: Auto-HPSAs.............................................................................................................. 81
Appendix C: Active Taxonomies .................................................................................................. 84

2

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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 qualify as Health Professional Shortage Areas
(HPSAs) or Medically Unserved Areas or Populations (MUA/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 of HHS
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 designated 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 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 the Population at or below 200% Federal Poverty Level.
 Medicaid Eligible Population HPSA
• Qualification is based on at least 30% of the Population at or below
200% Federal Poverty Level
• User can provider alternate population.
 Migrant Farmworker Population HPSA
• Defined as all migrant farmworker population.
• This will be provided by the user.
 Migrant Seasonal Worker Population HPSA
• Defined as all migrant seasonal worker population
• This will be provided by the user.
 Native American Population HPSA
• Defined as the American Indian/Alaska Native(single race) Population.
 Low Income Homeless Population HPSA

3

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Defined as the Population at or below 200% Federal Poverty Level plus
the homeless population.
• This will be provided by the user.
 Low Income Migrant Farmworker Population HPSA
• Defined as the Population 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 the Population 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 the Population 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 the Population 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
• This will be provided by the user.
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/County 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:
•

4

Shortage Designation Management System (SDMS): MPP

•
•
•
•
•

III.

April 4, 2020

Indian Health Facilities
Federally Qualified Health Centers (FQHC)
Section 330 Health Center Program grantees
FQHC Look-A-Likes (LALs)
CMS-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

MUP Low Income
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.

5

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Section II: Descriptions of Data Sources Used
I.

Introduction

The demographic (age, sex, race/ethnicity, poverty) and infant health (birth and death events) data used
for designations is derived from federal and state data sources. Demographic data are sourced from the
U.S. Census American Community Survey (ACS) 2014-2018 5-year estimates. Infant health data are
sourced from the Centers for Disease Control (CDC) Mortality and Natality Files from 2014-2018.

II.

Federally Provided Data Sets

The following table displays all federally-sourced data points. Data points displayed below can be
sourced at the ZIP Code Tabulation Area (ZCTA), Census Tract (CT), County Subdivision (CSD), or County
level. CDC counts are aggregated and averaged over 5 years at the US county or county-equivalent of
maternal residence.
Applicable
Discipline
ALL
ALL
ALL

ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
MH

6

Data Point
Total Population
African-American Population
American Indian/ Alaska Native
Population
(single race)
American Indian/ Alaska Native
Population
(alone or in combination with other
races)
Asian Population
Caucasian Population
Hispanic Population
Native Hawaiian/Pacific Islander
Population
Population at 100% of Federal Poverty
Level
American Indian/Alaska Native (single
race) 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 Under 18 Population

Source File Name

Geography level

ACSST5Y2018.S1701
ACSST5Y2018.S1701

ZCTA



CT



CSD



County



ACSST5Y2018.S1701









ACSDT5Y2018.B02010





-

-

ACSST5Y2018.S1701
ACSST5Y2018.S1701
ACSST5Y2018.S1701
























ACSST5Y2018.S1701









ACSST5Y2018.S1701









ACSST5Y2018.S1701









ACSST5Y2018.S1701
ACSST5Y2018.S1701
ACSST5Y2018.S1701
















ACSST5Y2018.S1701

Shortage Designation Management System (SDMS): MPP
Applicable
Discipline
MH
MH
MH
MH,PC
MH
PC
PC

Data Point
American Indian/ Alaska Native
Population (single race) Age Under 18
Population
Age 18 to 64 Population
American Indian/ Alaska Native
Population (single race) Age 18 to 64
Population
Age 65 and Over Population
American Indian/ Alaska Native
Population (single race) Age 65 and Over
Population
Female Age 15 to 44 Population
American Indian/ Alaska Native
Population (single race) Female Age 15
to 44 Population

PC

Number of Infant Deaths

PC

Number of Live Births

PC

Number of Low Birthweight Births

April 4, 2020

Source File Name

Geography level

ACSDT5Y2018.B17001C





-

-

ACSST5Y2018.S1701









ACSDT5Y2018.B17001C





-

-

ACSST5Y2018.S1701









ACSDT5Y2018.B17001C





-

-

ACSST5Y2018.S1701









ACSDT5Y2018.B17001C





-

-

-







-







-







CDC Mortality File :
2014-2018
CDC Natality File :
2014 -2018
CDC Natality File :
2014 -2018

Data from HRSA Bureau of Primary Healthcare (BPHC) Uniform Data System (UDS) is used in the AutoHPSA scoring process but is not maintained in the system. The following data points are sourced from
the most recently available UDS Performance Report data submitted by FQHC and FQHC LAL
organizations at organizational level:
•
•
•
•
•

III.

Service Areas (Patients Served by ZIP Code)
% of Patients Served With Known Income At or Below 100% of the Federal Poverty Level
Number of Patients Under Age 18
Number of Patients Age 18 to 64
Number of Patients Age 65 or Older

State/Organization Provided Data Sets

The table below lists all data points in SDMS sourced from US states/territories (State) or Auto-HPSA
eligible healthcare organizations (Org). The data points listed below are entered during the creation of
the service area in an application or for Auto-HPSAs, and are submitted as part of a rescore request. The
user will be required to enter a source and cite the methodology used for determining the population
for these groups on the Supplemental Information Form. See Appendix B for information on the
submission of patients served data in the Auto-HPSA scoring process.

7

Shortage Designation Management System (SDMS): MPP

Applicable
Discipline

ALL
ALL
ALL
ALL
PC
PC, DH
PC, DH
PC
DH
MH
MH
MH
MH
MH

Data Point

Homeless Population
Migrant Farmworker
Population
Migrant Seasonal Worker
Population
Population at 100% of
Federal Poverty Level
Tourist Population
Migrant Worker Population
Seasonal Resident
Population
Age-Sex Adjusted
Population
Number/Percent of
Population without
Fluoridated Water Indicator
Substance Misuse
Prevalence Indicator
Alcohol Misuse Prevalence
Indicator
Age Under 18 Population
Age 18 to 64 Population
Age 65 and Over Population

April 4, 2020

Source

Primary Source
ZCTA

CT

CSD

County

State

-

-

-

-

Service
Area


State

-

-

-

-



State

-

-

-

-



State

-

-

-

-



State
State

-

-

-

-




State

-

-

-

-



State

-

-

-

-



State/Org

-

-

-

-



State/Org

-

-

-

-



State/Org

-

-

-

-



Org
Org
Org

-

-

-

-





Any FQHC organization that does not have BPHC-submitted UDS Performance Report data that is
available to DPSD, as well as RHCs and ITUs, may submit the following data points:
•
•
•
•
•

Service Areas (Patients Served by ZIP Code)
% of Patients Served With Known Income At or Below 100% of the Federal Poverty Level
Number of Patients Under Age 18
Number of Patients Age 18 to 64
Number of Patients Age 65 or Older

See the PCO Portal User Guide for information on the data submission process.
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 Populations for whom Poverty Status is Determined with the
Age-Sex Adjustment, and any combination of the following population types added to Population for
whom Poverty Status is Determined or Age-Sex Adjusted population: Tourist, Migrant Worker, and

8

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Seasonal Resident. Users may also enter an adjusted population for the Medicaid Eligible HPSA
population.
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 Total Population and any combination of the following population
types added to the Population for Whom Poverty Status is Determined: Migrant Worker and Seasonal
Resident. Users may also enter an adjusted population for the Medicaid Eligible HPSA population.
Mental Health Adjusted Populations
Users may not enter an adjusted population for a Mental Geographic or Geographic High Needs HPSA as
there are no adjustments to the population count in the regulation for mental health designations. User
may enter an adjusted population that can include the Total Population and any combination of the
following population types added to the Population for Whom Poverty Status is Determined: Migrant
Worker and Seasonal Resident. Users may also enter an adjusted population for the Medicaid Eligible
HPSA population.

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 Population for whom Poverty Status is Determined. Dental Health Geographic
HPSAs may only add Seasonal Residents and Migrant Workers to the Population for whom Poverty
Status is Determined. Mental Health does not allow an Adjusted Population for Geographic HPSAs; it
uses only the Population for whom Poverty Status is Determined.
After calculating the effective population for Seasonal Residents, Tourists, and Migrant Workers, these
populations may be added to the Population for whom Poverty Status is Determined total, depending
on the HPSA discipline being applied for.
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. The Age-Sex Adjusted Population replaces the original Population for whom Poverty Status
is Determined for the RSA.

9

Shortage Designation Management System (SDMS): MPP

Sex
Male
Female

Under 5
7.3
6.4

5-14
3.6
3.2

15-24
3.3
5.5

April 4, 2020

Age groups
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 Population for whom Poverty Status is
Determined 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)

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 the universe of the Population for whom Poverty Status is
Determined to determine the percentage. The process by which Fertilty Rate, Infant Mortality Rate, and
Low Birthweight Rate are estimated at the level of the service area is described in Section III.
Applicable
Discipline
ALL

10

Data Point

% African-American
Population

Source

System
Calculation

Primary Source
ZCTA

CT

CSD

County









Shortage Designation Management System (SDMS): MPP

ALL
ALL
ALL

Applicable
Discipline

Data Point
% American Indian/
Alaska Native
Population
% Asian Population

MH

% 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

MH

Elderly Ratio

MH

Elderly Population

MH

Fertility Rate

PC

Infant Mortality Rate

PC

Low Birthweight Rate

ALL
ALL
ALL
ALL
ALL
ALL

11

April 4, 2020

Source
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation
System
Calculation

Primary Source









































































































-







-







Shortage Designation Management System (SDMS): MPP

April 4, 2020

Section III: Statistical Methodology for Demographic and Health Data
I.

Background

The demographic and health data used for designations is derived from federal and state data sources.
The federal sources include:
Demographic (Age, Sex, Race/Ethnicity, and Poverty Data): American Community Survey (ACS)
2014-2018 5-year estimates.
• Infant Health (Birth and Death events): Centers for Disease Control and Prevention (CDC) Period
Linked Birth/Infant Death File 2014-2018. The data sourced through the CDC adheres to the
CDC methodology for reporting health statistics. Infant health measures are aggregated over 5
years in order to increase precision and circumvent CDC suppression rules intended to protect
personal privacy.
The following table displays all of the data points sourced in SDMS from the ACS and the universe
surveyed for the data point.
•

Applicable
Discipline
ALL
MH/PC
MH

Data Point

Universe
Surveyed
PPD
PPD
PPD

Total Population
Age 65 and Over Population
American Indian/ Alaska Native (single race) Age 65 and
Over Population
MH
Age Under 18 Population
PPD
MH
American Indian/ Alaska Native (single race) Under 18
PPD
Population
PC
Females Age 15 to 44 Years Population
PPD
PC
American Indian/ Alaska Native (single race) Females Age 15
PPD
to 44 Years Population
MH
Age 18 to 64 Population
PPD
MH
American Indian/ Alaska Native (single race) 18 to 64
PPD
Population
ALL
African-American Population
PPD
ALL
American Indian / Alaska Native Population (single race)
PPD
ALL
American Indian / Alaska Native Population (alone or in
AIAN
combination with other races)
ALL
Asian Population
PPD
ALL
Caucasian Population
PPD
ALL
Hispanic Population
PPD
ALL
Pacific Islanders Population
PPD
ALL
Population at 100% of Federal Poverty Level
PPD
ALL
Population at 200% of Federal Poverty Level
PPD
ALL
Population that is Low Income
PPD
ALL
Population that is Medicaid Eligible
PPD
PPD: Persons for whom poverty has been determined
AIAN: People who are American Indian or Alaska Native alone or in combination with one or more races

12

Shortage Designation Management System (SDMS): MPP

II.

April 4, 2020

Estimating Statistics for Sub-county Areas using County Data

Certain demographic and health data are only reported through the primary source at the county level.
In the designation process, a formula is used to apportion county data to sub-county areas comprised of
census tracts or county subdivisions. This method allows for sub-county estimates which may be used to
generate statistics necessary for a designation at the RSA level.
The following formula is used to generate sub-county estimates through weighting county data by the
proportion of a relevant population of the sub-county areas in that of the whole county.

𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 𝐿𝐿𝐿𝐿𝐿𝐿𝐿𝐿𝐿𝐿 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆 ×

𝐶𝐶𝐶𝐶 𝑜𝑜𝑜𝑜 𝑀𝑀𝑀𝑀𝑀𝑀 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸

= 𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸 𝐶𝐶𝐶𝐶 𝑜𝑜𝑜𝑜 𝑀𝑀𝑀𝑀𝑀𝑀 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆

The following table represents all data points that are reported through the primary source at the
county level and the relevant population used in sub-county estimation. The population of females age
15 to 44 is used apportion infant mortality and natality data, with the assumption that these events
occur at a rate for any area within a given county that is proportional to its population of women of
child-bearing age.
Applicable
Discipline
PC
PC
PC

III.

Data Point

Population Weighting
Factor

Number of Infant Deaths
Number of Live Births
Number of Infants Born LBW

Females 15-44
Females 15-44
Females 15-44

Calculating RSA-level Values using Sub-county Data

Data points are summed up to the RSA level from the CT or CSD level for designation purposes. The
formula below is used to calculate RSA level health and demographic statistics:
∑ 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆 𝑓𝑓𝑓𝑓𝑓𝑓 𝑎𝑎𝑎𝑎𝑎𝑎 𝐶𝐶𝐶𝐶𝐶𝐶/𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑖𝑖𝑖𝑖 𝑅𝑅𝑅𝑅𝑅𝑅 = 𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇 𝑅𝑅𝑅𝑅𝑅𝑅 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆

If the statistic is a percentage or ratio then the numerator 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

13

Data Point
% African-American Population
% American Indian/ Alaska Native Population

Calculation
Denominator
Total Population
Total Population

Shortage Designation Management System (SDMS): MPP

Applicable
Discipline
ALL
ALL
ALL
ALL
ALL
ALL
ALL
ALL
MH
MH
MH

IV.

Data Point
% 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

April 4, 2020

Calculation
Denominator
Total Population
Total Population
Total Population
Total Population
Total Population
Total Population
Total Population
Total Population
Total Population
Age 18 to 64 Population
Age 18 to 64 Population

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 the total
population in a specific geographic area (Geographic HPSA), a subpopulation within a specific geographic
area (Population HPSA, Auto-HPSAs) or the population receiving care at a specific facility (e.g.
correctional facility, state/county mental hospital, other public or non-profit facility).
The Population-to-Provider ratio is defined as the following, normalized to the form n:1 when the FTE is
greater than zero to enable comparison across designations:

[Relevant Population] : [Total FTE of Providers Serving Relevant Population]

Geographic HPSAs, Population HPSAs, and Auto-HPSAs require data on different populations in order to
calculate thePopulation-to-Provider ratio. 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.

14

Shortage Designation Management System (SDMS): MPP

Type of HPSA
Primary Care Geographic

April 4, 2020

Population counted in Population-to-Provider ratio:
The total Population for whom Poverty Status is Determined of the
service area
or

Dental Geographic

The total Population for whom Poverty Status is Determined of the
service area with Age-Sex Adjustment + Migrant Worker
Population + Tourist Population + Seasonal Resident Population*
The total Population for whom Poverty Status is Determined of the
service area
or

Mental Health Geographic
Low Income Population
Medicaid-Eligible Population
Homeless Population*
Migrant Farmworker
Population*
American Indian/ Alaska Native
Population
Migrant Seasonal Workers
Population*
FQHC, FQHC LAL, and RHC
Auto-HPSA
ITU Auto-HPSA

The total Population for whom Poverty Status is Determined +
Seasonal Residents + Migrant Workers of the service area
The total Population for whom Poverty Status is Determined of the
service area
The population in the service area that have incomes at or below
200% of the Federal Poverty Level
The population in the service area that have incomes at or below
200% of the Federal Poverty Level and/or is eligible for Medicaid
The Homeless Population within the service area
The Migrant Farmworker Population within the service area
The American Indian/ Alaska Native Population (single race) within
the service area
The Migrant Seasonal Worker Population with the Rational Service
Area
The population in the service area that have incomes at or below
200% of the Federal Poverty Level
The American Indian/ Alaska Native Population (Alone or in
Combination with One or More races) within the 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 Population for whom Poverty Status is Determined 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
Population for whom Poverty Status is Determined 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 Age-Sex 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.

15

Shortage Designation Management System (SDMS): MPP

V.

April 4, 2020

Infant Health and Fertility Rates

Number of live births, number of infant deaths, and number of infants born with low birthweight are
sourced from the CDC. Infant birth statistics are aggregated and averaged over a 5-year period in order
to increase precision while increasing privacy of individuals. Female Population Age 15-44 from the ACS
is used in to standardize fertility rate estimates across populations that may vary in the distribution of
women of child-bearing age.
The following formulas are used to calculate Infant Mortality Rate (IMR), Low Birthweight Rate, (LBW)
and Fertility Rate:

IMR =

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑ℎ𝑠𝑠

LBW =

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙 𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏ℎ𝑠𝑠

𝑥𝑥 1000

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏 𝑙𝑙𝑙𝑙𝑙𝑙 𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏ℎ𝑤𝑤𝑤𝑤𝑤𝑤𝑤𝑤ℎ𝑡𝑡

Fertility Rate =

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙 𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏ℎ𝑠𝑠

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏ℎ𝑠𝑠

𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴𝐴𝐴𝐴 15−44

𝑥𝑥 100

𝑥𝑥 1000

Some Auto-HPSA service areas are comprised of ZCTAs. For the purpose of calculating IMR and LBW,
any ZCTA that falls entirely within a county inherits the IMR and LBW of that county. If a ZCTA crosses
county borders, then the ZCTA’s IMR and LBW will equal a simple, unweighted average of the counties’
IMR and LBW. If a ZCTA crosses state borders, the same rules apply. The ZCTA inherits the average of
the counties in which it overlaps. The IMR and LBW of the Auto-HPSA service area is calculated as an
average of each ZCTA rate, weighted by the female age 15-44 population in each ZCTA.

16

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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 are used for designations.
National Provider Identifier
The provider data set used in SDMS originates from the National Provider Identifier (NPI) file maintained
by the Centers 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 per week 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 the populations the
provider serves and how much time the provider spends serving these populations. 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 NSC 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 specific 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

17

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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. The following FTE are assigned by default per regulation and cannot be overwritten in the system
by any user.







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

Office Hour Adjustment

FP: Family Practice

Office hours per week * 1.4

IM: Internal Medicine

Office hours per week * 1.8

OBG: Obstetrics and Gynecology

Office hours per week * 1.9

PD: Pediatrics

Office hours per week * 1.4

All Primary Care

Office hours per week * 1.6

18

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Provider Completeness for RSA and CA
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
Default Calculation

Alternate Calculation

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)

Medicaid Claims Unavailable:
FTE= (# Tour Hours/40)
*(Medicaid Percent)

Migrant Farmworker
Population Provider FTE

FTE =(# Tour Hours/40)*(Migrant
Farmworker Percent)

N/A

American Indian/Alaska
native Population
Provider FTE

FTE =(# Tour Hours/40)*American
Indian/Alaska Native Percent

N/A

19

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Primary Care Provider FTE Calculations
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/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]

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]

Low Income Homeless
Migrant Seasonal Worker
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 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]

20

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Primary Care Provider FTE Calculations

FQHC, FQHC LAL, and
RHC Auto-HPSA

Medicaid Claims Available:
FTE=(# Medicaid Claims/5000) + [(#
Tour Hours/40)*(Sliding Fee Scale
Percent)]

ITU Auto-HPSA

FTE =(# Tour Hours/40)*American
Indian/Alaska Native Percent

Medicaid Claims Unavailable:
FTE= (# Tour Hours/40)*(Sliding
Fee Scale Percent + Medicaid
Percent)

N/A

Additional data are required for components of dentist FTE calculations that utilize 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, with the dentist’s age 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)



21

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.

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Dental Provider FTE Calculations
Default Calculation

Alternate Calculation

Geographic Area
Provider FTE

FTE = (# Tour Hours/40)*Aux weight

N/A

Geographic Area High
Needs Provider FTE

FTE = (# Tour Hours/40) *Aux weight

N/A

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) *Aux weight

Medicaid Population
Provider FTE

Medicaid Claims Available:
FTE=(# Medicaid Claims/4000)

Medicaid Claims Unavailable:
FTE= (# Tour Hours/40)*
(Medicaid Percent) *Aux weight

Migrant Farmworker
Population Provider FTE

FTE =(# Tour Hours/40)*Migrant
Farmworker Percent*Aux weight

Native American/Native
Alaskan Population
Provider FTE

FTE =(# Tour Hours/40)*American
Indian/Alaska Native Percent*Aux
weight
FTE =[[(# Tour Hours/40)*(Migrant
Farmworker Percent)] + [(# Tour
Hours/40)*Homeless Percent]] *Aux
weight
FTE =[[(# Tour Hours/40)*(Migrant
Seasonal Farmworker Percent)] + [(#
Tour Hours/40)*Homeless Percent]]
*Aux weight

Migrant Farmworker and
Homeless Population
Provider FTE
Migrant Seasonal Worker
and Homeless Population
Provider FTE

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]

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]

22

N/A
N/A

N/A

N/A
Medicaid Claims Unavailable:
FTE =[[(# Tour
Hours/40)*Sliding Fee Scale
Percent] + [(# Tour
Hours/40)*Homeless Percent]+
[(# Tour Hours/40)*Medicaid
Percent]] *Aux weight
Medicaid Claims Unavailable:
FTE =[[(# Tour
Hours/40)*Sliding Fee Scale
Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Farmworker Percent]]
*Aux weight

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Dental Provider FTE Calculations

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]

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]

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]

FQHC, FQHC LAL, and
RHC Auto-HPSA

Medicaid Claims Available:
FTE = (# Medicaid Claims/4000) + [(#
Tour Hours/40)*Sliding Fee Scale
Percent] + [(# Tour
Hours/40)*Homeless Percent]

ITU Auto-HPSA

FTE =(# Tour Hours/40)*American
Indian/Alaska Native Percent*Aux
weight

23

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]]
*Aux weight
Medicaid Claims Unavailable:
FTE =[[(# Tour
Hours/40)*Sliding Fee Scale
Percent] + [(# Tour
Hours/40)*Medicaid Percent] +
[(# Tour Hours/40)*Migrant
Seasonal Farmworker Percent]]
*Aux weight
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]] * Aux weight
Medicaid Claims Unavailable:
FTE =[[(# Tour
Hours/40)*Sliding Fee Scale
Percent] + [(# Tour
Hours/40)*Homeless Percent]+
[(# Tour Hours/40)*Medicaid
Percent]] *Aux weight

N/A

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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
Default Calculation

Alternate Calculation

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/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

American Indian/Alaska
Native Population
Provider FTE

FTE =(# Tour Hours/40)*American
Indian/Alaska Native 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

24

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Mental Provider FTE Calculations

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]

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]

25

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Mental Provider FTE Calculations

FQHC, FQHC LAL, and
RHC Auto-HPSA

Medicaid Claims Available:
FTE=(# Medicaid Claims/4000) + [(#
Tour Hours/40)*Sliding Fee Scale
Percent]

ITU Auto-HPSA

FTE =(# Tour Hours/40)*Native
American/Native Alaskan Percent

26

Medicaid Claims Unavailable:
FTE= (# Tour Hours/40)*(Sliding
Fee Scale Percent + Medicaid
Percent)

N/A

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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. Please note that for any population limit stated below, the user will be permitted to
submit an application where limits are not met (in the case of minimum population sizes) or are
exceeded (in the case of maximum population sizes). In these cases the user will have to supply
justification for why the limit should not be observed. Auto-HPSA service areas are not required to be
RSAs, and are developed only for the purposes of scoring. See Appendix B for more information.
Primary Care Geographic HPSA, Population HPSA and MUA/P RSA Qualifications











27

A group of census tracts, a group of county subdivisions, a whole county, or multiple whole
counties can be selected to create a service area.
The population designated in the RSA should not ideally exceed 250,000.
A whole county, or multiple whole counties with centroids within 30 minutes of each other are
considered rational for an RSA.
A Sub-County RSA, meaning a group of census tracts or CSDs, can be rational if the following is
true:
o RSA cannot be smaller than a single CT or CSD.
o RSA components must physically connect without a break and may not contain interior
gaps (i.e. donut holes).
o RSA cannot include components that are already designated.
User must also provide an explanation, with evidence, of why a Sub-County RSA is valid using
based on at least one of the following:
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.
For HPSAs, the Population-to-Provider ratio minimums should be met.
o Geographic: If there is an FTE greater than zero then the ratio of 3,500:1 should be met.
If the FTE is zero then the population should be at least 500.
o Geographic High Needs and HPSA Population: If there is an FTE greater than zero then
the ratio of 3,000:1 must be exceeded. If the FTE is zero then the population should be
at least 500.

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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. DPSD staff will review all primary care
applications to ensure compliance with policies and regulations.
HPSA Type

Additional Population Qualifications

Geographic

Total Population for whom Poverty Status is Determined + Tourist
Population + Migrant Worker Population + Seasonal Resident
Population

Geographic High Needs

Geographic Population must meet one of the following:
 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:
o More than (greater than) 8,000 office or outpatient visits
per year per FTE per primary care physician serving in the
area
Unusually long waits for appointments for routine medical
services (that is, more than 7 days for established patients
and 14 days for new patients).
o 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, firstserved basis).
o Evidence of excessive use of emergency room facilities for
routine primary care.
o A substantial proportion (two-thirds or more) of the area's
physicians do not accept new patients.
o Abnormally low utilization of health services, as indicated by
an average of two or fewer (less than or equal to) office
visits per year on the part of the area's population.

Population Low Income

At least 30% of the population has income at or below 200% FPL

Population Low Income plus
Special Populations
Population Medicaid
Migrant Farmworker Population
Migrant Seasonal Worker
Population

At least 30% of the population has income at or below 200% FPL
plus Special Population is > 0
User entered Population Medicaid, Population > 0
User entered Migrant Farmworker Population, Population > 0
User entered Migrant Seasonal Worker Population, Population > 0

28

Shortage Designation Management System (SDMS): MPP

HPSA Type
Homeless Population
Native American Population

April 4, 2020

Additional Population Qualifications
User entered Homeless population, Population > 0
All Native American population, Population > 0

Dental Health Geographic and Population HPSA RSA Qualifications











A group of census tracts, a group of county subdivisions, a whole county, or multiple whole
counties can be selected to create a service area.
The population designated in the RSA should not ideally exceed 250,000.
A whole county, or multiple whole counties with centroids within 30 minutes of each other are
considered rational for a RSA.
A Sub-County RSA, meaning a group of census tracts or CSDs, can be rational if the following is
true:
o RSA cannot be smaller than a single CT or CSD.
o RSA components must physically connect without a break and may not contain interior
gaps (i.e. donut holes).
o RSA cannot include components that are already designated.
User must also provide an explanation, with evidence, of why a Sub-County RSA is valid using
based on at least one of the following:
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 should be met.
o Geographic: If there is an FTE greater than zero then the ratio of 5,000:1 should be met.
If the FTE is zero then the population should 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 exceeded. If the FTE is zero then the population should be at
least 1,000.

The system will analyze the population within the RSA depending on the HPSA type to determine if the
qualifications for designation are met. DPSD staff will review all dental health applications to ensure
compliance with policies and regulations.

29

Shortage Designation Management System (SDMS): MPP

HPSA Type
Geographic

Geographic High Needs

Population Low Income
Population Low Income plus Special Populations
Population Medicaid
Migrant Farmworker Population
Migrant Seasonal Worker Population
Homeless Population

April 4, 2020

Additional Population Qualifications
Total Population for whom Poverty Status is
Determined + Tourist Population + Migrant
Worker Population + Seasonal Resident
Population
Geographic Population must meet one of the
following:
 More than 20% of the population has incomes
at or below 100% FPL.
 More than 50% of the population has no
fluoridated water.
Or
 Meets two criteria for insufficient capacity:
o More than (greater than) 5,000 visits per
year per FTE dentist serving the area.
o Unusually long waits for appointments for
routine dental services (that is, more than
six weeks).
o A substantial proportion (two-thirds or
more) of the area’s dentists do not accept
new patients.
At least 30% of the population has income at or
below 200% FPL
At least 30% of the population has income at or
below 200% FPL plus Special Population is > 0
User entered Population Medicaid, Population >
0
User entered Migrant Farmworker Population,
Population > 0
User entered Migrant Seasonal Worker
Population, Population > 0
User entered Homeless Population, Population >
0

Mental Health Geographic and Population HPSA Non-Catchment Area RSA Qualifications


30

A group of census tracts, a group of county subdivisions, a whole county, or multiple whole
counties can be selected to create a service area.

Shortage Designation Management System (SDMS): MPP










31

April 4, 2020

The population designated in non-catchment area RSAs should not ideally exceed 250,000,
whether the RSA is composed of a whole county, multiple counties, county subdivisions, or
census tracts.
A whole county or multiple whole counties with centroids within 30 minutes of each other are
considered rational for a RSA.
A Sub-County RSA, meaning a group of census tracts or CSDs, can be rational if the following is
true:
o RSA cannot be smaller than a single CT or CSD.
o RSA components must physically connect without a break and may not contain interior
gaps (i.e. donut holes).
o RSA cannot include components that are already designated.
User must also provide an explanation, with evidence, of why a Sub-County RSA is valid using
based on at least one of the following:
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 should be met.
o Geographic, Psychiatrists Only: If there is an FTE greater than zero then the ratio of
30,000:1 should be met.
o Geographic, Core Mental Health Only: If there is an FTE greater than zero then the ratio
of 9,000:1 should 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
should meet 6,000:1 and the Psychiatrist ratio should meet 20,000:1.
o Geographic, No Providers: If the FTE is zero then the population should 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 should 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 should 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 should meet 4,500:1 and the Psychiatrist ratio must should
15,000:1.
o Geographic High Needs and Population, No Providers: If the FTE is zero then the
population should be at least 1,500.

Shortage Designation Management System (SDMS): MPP

April 4, 2020

The system will analyze the population within the RSA depending on the HPSA type to determine if the
requirements for designation are met. DPSD staff will review all mental health applications to ensure
compliance with policies and regulations.
HPSA Type
Geographic
Geographic High Needs

Population Low Income
Population Low Income
plus Special Populations
Population Medicaid
Migrant Farmworker
Population
Migrant Seasonal Worker
Population
Homeless Population

Additional Population Qualifications
Total Population for whom Poverty Status is Determined
Population must meet one of the following:
 More than 20% of the population has incomes at or below
100% FPL.
 The Youth Ratio (# of persons under 18 divided by the number
of adults 18-64) is greater than 0.6:1.
 The Elderly Ratio (# of persons age 65 and older divided by the
total # of adults 18-64) is greater than 0.25:1.
 Alcohol or substance abuse prevalence data shows the area to
be among the worst quartile in the nation, state, or region.
At least 30% of the population has income at or below 200% FPL
At least 30% of the population has income at or below 200% FPL plus
Special Population is > 0
User entered Population Medicaid, Population > 0
User entered Migrant Farmworker Population, Population > 0
User entered Migrant Seasonal Worker Population, Population > 0
User entered Homeless Population, Population > 0

Mental Health Geographic and Population HPSA Catchment Area RSA Qualifications








32

A group of census tracts, a group of county subdivisions, a whole county, or multiple whole
counties can be selected to create a service area.
The population designated in the catchment area RSA must not exceed 999,999.
A whole county is considered rational for an RSA.
The criteria for population low income, population low income plus special populations and
population Medicaid (listed in the table above) do not apply for these types of catchment areas.
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 should be met.
o Geographic, Psychiatrists Only: If there is an FTE greater than zero then the ratio of
30,000:1 should be met.
o Geographic, Core Mental Health Only: If there is an FTE greater than zero then the ratio
of 9,000:1 should be met.

Shortage Designation Management System (SDMS): MPP

o

o
o
o
o

o

II.

April 4, 2020

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
should meet 6,000:1 and the Psychiatrist ratio should meet 20,000:1.
Geographic, No Providers: If the FTE is zero then the population should be at least
3,000.
Geographic High Needs and Population, Psychiatrists Only: If there is an FTE greater
than zero then the ratio of 20,000:1 should be met.
Geographic High Needs and Population, Core Mental Health Only: If there is an FTE
greater than zero then the ratio of 6,000:1 should be met.
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 should meet 4,500:1 and the Psychiatrist ratio should meet
15,000:1.
Geographic High Needs and Population, No Providers: If the FTE is zero then the
population should be at least 1,500.

Definition of Centroid and Population Center

Centroid Definition


The centroid of an RSA is the weighted geographic center of all sub-county components within
the RSA to account for each components population and size. If the RSA is a whole county, then
the geographic center of the county will be used.

Population Center





The RSA 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 originate from the population center in SDMS.
The population used to define the population center varies based on the designation type being
created.

HPSA Type
Geographic
Geographic High Needs
Population Low Income
Population Low Income
plus Special Populations
Population Medicaid

33

Population Used for Pop Center
Total Population for whom Poverty Status is Determined
Total Population for whom Poverty Status is Determined
Population at 200% FPL
Population at 200% FPL
Population at 200% FPL

Shortage Designation Management System (SDMS): MPP

HPSA Type
Population Migrant
Farmworker
Population Migrant
Seasonal Worker
Population Homeless
Population Native
American
Population Other

April 4, 2020

Population Used for Pop Center
Population at 200% FPL
Population at 200% FPL
Population at 200% FPL
Native American Population
Total Population for whom Poverty Status is Determined

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 uses transportation data provided by Esri. Street network and speed limit data are 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


34

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.
o 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

Shortage Designation Management System (SDMS): MPP



April 4, 2020

Centroid/Population center and stemming out in all directions based on the roads that
cover that area.
A 30- or 40- minute travel polygon is used in the Auto-HPSA scoring process. See Appendix B.

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 County Subdivisions) 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. Users will be permitted to submit applications when the CAs are
outside of the preferred population thresholds delineated below.
User Creation of Contiguous Areas


35

Components used to create contiguous areas include:
o CSDs
o CTs
o Counties

Shortage Designation Management System (SDMS): MPP







April 4, 2020

A single contiguous area must be rational (i.e. based on travel patterns, socio-economic
similarities, etc.).
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 any non-catchment contiguous area, the population ideally should not exceed 250,000.
For catchment area designations that are contiguous, the population ideally should not exceed
999,999.

Contiguous Area Analysis
The table below represents all the checks run 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 there a Demographic
Disparity?

Please reference Demographic Disparity Calculation below.

Yes

Are the providers
Excessively Distant?

System searches travel time for all providers in the contiguous
area. A contiguous area is considered excessively distant if there
are no usable providers or the providers are more than the
following travel time for each discipline:

Yes

Is there a Lack of
Economic Access?

Is it Over-utilized?

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.
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:
Primary Care

36

Dental

Mental

Yes

Yes

Shortage Designation Management System (SDMS): MPP

Contiguous Area
System Checks

April 4, 2020

Passing Qualifications
2000:1

3000:1

System
Check?

≥ 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 AI for more
information)

For any contiguous area that failed the system analysis based on physical barriers (mountains, lakes,
rivers, airports, military bases), linguistic barriers and/or other access barriers, the user can force pass
the analysis but must provide an explanation in the supplemental information form.
The following table reflects the type of proposed RSA and the corresponding Contiguous Area types that
are inaccessible:
Proposed Rational
Service Area Is:

Inaccessible HPSA for Contiguous Area deemed inaccessible if currently
designated as a:

Geographic

Geographic HPSA, Geographic High Needs HPSA

Geographic High Needs
(PC):

Geographic HPSA, Geographic High Needs HPSA

- Births per 1,000
women aged 15-44
years >100
OR
- Infant deaths per 1,000
live births >20
OR
- Justified Insufficient
capacity information

37

Shortage Designation Management System (SDMS): MPP

Proposed Rational
Service Area Is:
Geographic High Needs
(DH):

April 4, 2020

Inaccessible HPSA for Contiguous Area deemed inaccessible if currently
designated as a:
Geographic HPSA, Geographic High Needs HPSA

- More than 50% of the
population has no
fluoridated water
OR
- Justified Insufficient
capacity information
Geographic High Needs
(MH):

Geographic HPSA, Geographic High Needs HPSA

- The Youth Ratio is
greater than 0.6
OR
- The Elderly Ratio is
greater than 0.25:1
OR
- Alcohol or substance
abuse prevalence data
shows the area to be
among the worst
quartile in the nation,
state, or region
Geographic High Needs
(all disciplines)
Pov 100% >20%

38

Geographic HPSA, Geographic High Needs 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 Population HPSA, Low Income
Migrant Seasonal Worker Population HPSA, Low Income Migrant Seasonal
Worker Homeless Population HPSA

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Proposed Rational
Service Area Is:

Inaccessible HPSA for Contiguous Area deemed inaccessible if currently
designated as a:

Population Low Income

Geographic HPSA, Geographic High Needs 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 Population HPSA, Low Income
Migrant Seasonal Worker Population HPSA, Low Income Migrant Seasonal
Worker Homeless Population HPSA

Population Medicaid
Eligible

Geographic HPSA, Geographic High Needs HPSA, Low Income Population
HPSA, Low Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Medicaid Eligible Population HPSA

Population Migrant
Farmworker

Geographic HPSA, Geographic High Needs HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Migrant Farmworker Population HPSA, Migrant
Farmworker and Homeless Population HPSA, Migrant Seasonal Worker
Population HPSA, Migrant Seasonal Worker and Homeless Population
HPSA

Population Migrant
Seasonal Worker

Geographic HPSA, Geographic High Needs HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Migrant Farmworker Population HPSA, Migrant
Farmworker and Homeless Population HPSA, Migrant Seasonal Worker
Population HPSA, Migrant Seasonal Worker and Homeless Population
HPSA

Population Native
American

39

Geographic HPSA, Geographic High Needs HPSA, Native American
Population HPSA

Shortage Designation Management System (SDMS): MPP

Proposed Rational
Service Area Is:
Population Low Income
Homeless

Population Low Income
Migrant Farmworker

Population Low Income
Homeless Migrant
Farmworker

Population Low Income
Migrant Seasonal
Worker

40

April 4, 2020

Inaccessible HPSA for Contiguous Area deemed inaccessible if currently
designated as a:
Geographic HPSA, Geographic High Needs HPSA, Low Income Population
HPSA, Low Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Medicaid Eligible Population HPSA, Homeless
Population HPSA, Migrant Farmworker and Homeless Population HPSA,
Migrant Seasonal Worker and Homeless Population HPSA
Geographic HPSA, Geographic High Needs HPSA, Low Income Population
HPSA, Low Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Medicaid Eligible Population HPSA, Migrant
Farmworker and Homeless Population HPSA, Migrant Seasonal Worker
and Homeless Population HPSA, Migrant Farmworker Population HPSA,
Migrant Seasonal Worker Population HPSA
Geographic HPSA, Geographic High Needs HPSA, Low Income Population
HPSA, Low Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Medicaid Eligible Population HPSA, Migrant
Farmworker and Homeless Population HPSA, Migrant Seasonal Worker
and Homeless Population HPSA, Migrant Farmworker Population HPSA,
Migrant Seasonal Worker Population HPSA, Homeless Population HPSA
Geographic HPSA, Geographic High Needs HPSA, Low Income Population
HPSA, Low Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Medicaid Eligible Population HPSA, Migrant
Farmworker and Homeless Population HPSA, Migrant Seasonal Worker
and Homeless Population HPSA, Migrant Farmworker Population HPSA,
Migrant Seasonal Worker Population HPSA

Shortage Designation Management System (SDMS): MPP

Proposed Rational
Service Area Is:

April 4, 2020

Inaccessible HPSA for Contiguous Area deemed inaccessible if currently
designated as a:

Population Low Income
Homeless Migrant
Seasonal Worker

Geographic HPSA, Geographic High Needs HPSA, Low Income Population
HPSA, Low Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Medicaid Eligible Population HPSA, Migrant
Farmworker and Homeless Population HPSA, Migrant Seasonal Worker
and Homeless Population HPSA, Migrant Farmworker Population HPSA,
Migrant Seasonal Worker Population HPSA, Homeless Population HPSA

Population Migrant
Farmworker and
Homeless

Geographic HPSA, Geographic High Needs HPSA, Low Income Homeless
Population HPSA, Low Income Migrant Farmworker Population HPSA, Low
Income Homeless Migrant Farmworker Population HPSA, Low Income
Migrant Seasonal Worker Population HPSA, Low Income Migrant Seasonal
Worker Homeless Population HPSA, Migrant Farmworker and Homeless
Population HPSA, Migrant Seasonal Worker and Homeless Population
HPSA, Migrant Farmworker Population HPSA, Migrant Seasonal Worker
Population HPSA, Homeless Population HPSA

Population Migrant
Seasonal Worker and
Homeless

Geographic HPSA, Geographic High Needs HPSA, Low Income Homeless
Population HPSA, Low Income Migrant Farmworker Population HPSA, Low
Income Homeless Migrant Farmworker Population HPSA, Low Income
Migrant Seasonal Worker Population HPSA, Low Income Migrant Seasonal
Worker Homeless Population HPSA, Migrant Farmworker and Homeless
Population HPSA, Migrant Seasonal Worker and Homeless Population
HPSA, Migrant Farmworker Population HPSA, Migrant Seasonal Worker
Population HPSA, Homeless Population HPSA

Population Homeless

Geographic HPSA, Geographic High Needs HPSA, Low Income Population
HPSA, Low Income Homeless Population HPSA, Low Income Migrant
Farmworker Population HPSA, Low Income Homeless Migrant
Farmworker Population HPSA, Low Income Migrant Seasonal Worker
Population HPSA, Low Income Migrant Seasonal Worker Homeless
Population HPSA, Medicaid Eligible Population HPSA, Migrant
Farmworker and Homeless Population HPSA, Migrant Seasonal Worker
and Homeless Population HPSA, Homeless Population HPSA

Population Other

41

Geographic HPSA, Geographic High Needs HPSA

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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:












% 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/Alaska Native (single race)
% 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

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

Outcome

System will identify which
statistic is larger between
the RSA and Contiguous
Area

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

42

a. If the RSA statistic is less than 15%, the system will
add 15% to the RSA percentage to be compared to the
Contiguous Area

Shortage Designation Management System (SDMS): MPP

Step

System Determination
3. The system will
compare the two
statistics using the RSA
figure as the starting
point

April 4, 2020

Outcome
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

Contiguous
Area as the
base

1. The system will identify
the Contiguous Area
statistic

a. If the Contiguous Area figure is less than 15%, the
system will add 15% to the Contiguous Area
percentage to be compared to the RSA

2. The system will identify
the same statistic for 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

3. The system will
compare the two
statistics using the
Contiguous Area figure as
the starting point

ii. If the RSA has a statistics percentage less than the
Contiguous Area + 15% then there is no demographic
disparity for this factor

2. The system will identify
the same statistic for the
RSA

43

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

Shortage Designation Management System (SDMS): MPP

Step

System Determination
3. The system will
compare the two
statistics using the
Contiguous Area figure as
the starting point

V.

April 4, 2020

Outcome
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

Nearest Source of Non-Designated Accessible Care (NSC)

Purpose of Identifying the NSC
The main purpose of identifying the NSC 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 NSC.
The system will determine the NSC by determining the qualifying provider with the shortest path
originating from the Centroid/Population Center to the geographic coordinates of the provider. For the
purposes of the HPSA designation, the NSC must practice in the discipline of the designation and cannot
do any of the following, as described in Section IV on Contiguous Area Analysis:
•
•
•

Serve in a geographic or like population HPSA;
Serve in an over-utilized area;
Serve in an area that is inaccessible due to a physical barrier.

Selection of the NSC
The system will identify the NSC 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 NSC in the radiuses above the user will be prompted to identify
the NSC. The system will then calculate the travel time and distance for that provider using the ESRI road
network.
The user may also manually select an alternate NSC by entering the miles and minutes for a provider or
continue without a NSC from the system-identified provider. The user will be required to provide an
explanation on the Supplemental Information Form if they chose to continue with a NSC that is not the
system-identified default.

44

Shortage Designation Management System (SDMS): MPP

April 4, 2020

The user also has the option to edit the system’s suggestion of distance and time for the NSC or select
another NSC other than the system generated one. If the user selects a different NSC or changes the
distance or time an explanation must be provided.
SDMS determines over-utilization by calculating the population to provider ratio of a service area
unique to each provider for NSC purposes. The data used to calculate over-utilization reflects the
residents relevant to the designation type located within a provider travel polygon. The size of the
travel polygon depends on the application discipline: 30 minutes for primary care, 40 minutes for dental
and mental health designations. A potential NSC is considered over-utilized If the population-toprovider ratio exceeds the thresholds for each discipline as described earlier in this section in the table
under Contiguous Area Analysis
For Geographic and Population HPSA designations, the NSC selected by default must have an FTE > 0 for
that designation type. In the Auto-HPSA scoring process, the NSC selected by default for FQHCs, FQHC
LALs, and RHCs must serve Medicaid patients and provide services on a sliding fee scale. ITU Auto-HPSA
NSCs must serve the Native America/Alaska Native population.

45

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Section VI: HPSA Scoring
Once all of the RSA components of a designation have been identified, the Contiguous Area analysis
completed, the NSC identified, and the application is deemed eligible for submission, the designation
can be scored. For each HPSA, the system calculates a score based on the following criteria and
formulas. Listed below is the HPSA scoring methodology, differentiated by discipline.

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-to-Provider ratio*
Percent of individuals below 100% of the Federal Poverty Level
Infant Health Index (Based on Infant Mortality Rate or Low Birthweight 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, Population HPSAs, and Auto-HPSAs is scored according to the values in the table below. Only
Auto-HPSAs are capable of scoring zero points.

46

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
Ratio < 3,000:1

5 points
4 points
3 points
2 points
1 points
0 points

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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.
Primary Care Geographic High Needs/Insufficient Capacity: Primary Care Geographic High
Needs/Insufficient Capacity HPSAs must exceed a Population-to-Provider Ratio of 3,000:1 if the provider
FTE is greater than zero. 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 (greater than) 8,000 office or outpatient visits per year per FTE per primary
care physician serving in 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.

47

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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

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 Birthweight
Rate (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

Primary Care Nearest Source of Non-Designated Accessible Care (NSC)
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 NSC section. Primary care NSC travel time and distance
is then generated. The following table displays the scoring thresholds for Primary Care NSC Travel Time
and Distance:

48

Score for Travel Time or Distance to NSC

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

5 points
4 points
3 points
2 points

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Score for Travel Time or Distance to NSC
30 min > Time ≥ 20 min
or 20 mi > Distance ≥ 10 mi
Time < 20 min
or Distance < 10 mi

II.

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-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
Dental Health Population-to-Provider Ratio
The Population-to-Provider Ratio for Dental HPSAs is scored according to the values in the table below.
Only Auto-HPSAs are capable of scoring zero points.
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
Ratio < 4,000:1

5 points
4 points
3 points
2 points
1 points
0 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.

49

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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 exceed a Population-to-Provider Ratio of 4,000:1 if the provider FTE is greater
than zero. 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 A 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 two criteria for insufficient capacity:
a. More than (greater 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.
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

Water Fluoridation Status
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

50

Shortage Designation Management System (SDMS): MPP

April 4, 2020

the percent of the population without fluoridated water supply or indicating that the information is
unknown. Points are assigned as follows:
Score for Water Fluoridation Status

Points

Fluoridated Water Available for ≤ 50% of Population

1 point

Fluoridated Water Available for > 50% of Population

0 points

Nearest Source of Non-designated Accessible Care (NSC)
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 NSC section. Dental NSC travel time and distance is then
generated. The following table displays the scoring thresholds based on Dental NSC Travel Time and
Distance:

III.

Score for Travel Time or Distance to NSC

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

Mental Health Scoring

The Division of Policy and Shortage Designation calculates a score between 0-25 for Mental Health
HPSAs.

•
•
•
•
•
•
•

51

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

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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. Only Auto-HPSAs are capable of scoring zero points.
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.
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

52

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

Shortage Designation Management System (SDMS): MPP

Psychiatrists Only Geographic
(Non High Need)

April 4, 2020

Core Mental Health Geographic
(Non High Need)

≥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

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
0.6:1.
3. The Elderly Ratio (# of persons age 65 and older divided by the total # of adults 18-64) is greater
than 0.25:1.
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.

53

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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

High Needs

Only and Core Mental Health Only

Psychiatrists Only (High Need)
Ratio

Score

Core Mental Health (High
Need)
Ratio

≥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

54

Score

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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 and Auto-HPSAs: The population used for the Mental Health Population HPSA and AutoHPSA population-to-provider calculations is the population of the service area. The providers that serve
these populations are the sole providers included in the FTE calculation for the population-to-provider
ratio. The population-to-provider 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

Psychiatrists

Population

≥45,000:1 or 0
psychiatrists
7
7
7
7
7
7
as verified by
HRSA
*Auto-HPSA service areas with ratios below the minimum values in the above matrix receive zero points

55

7

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Psychiatrists Only and Core Mental Health Only

Psychiatrists Only
(Population/Auto)
Ratio

Core Mental Health
(Population/Auto)
Score

Ratio

Score

<20,000:1

0

<6,000:1

0

≥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

56

Score
<1,500:0

0

≥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

Shortage Designation Management System (SDMS): MPP

April 4, 2020

No Psych or CMH Providers
(Population)
≥12,000:0 and <15,000:0

7

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 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:

𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸𝐸 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 =

𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴𝐴𝐴𝐴 65 𝑎𝑎𝑎𝑎𝑎𝑎 𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜
𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴𝐴𝐴𝐴 18 − 64

𝑌𝑌𝑌𝑌𝑌𝑌𝑌𝑌ℎ 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 =
Points are assigned as follows:

57

𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴𝐴𝐴𝐴 𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢 18
𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 𝐴𝐴𝐴𝐴𝐴𝐴 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

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Alcohol and Substance Abuse Prevalence
Across all Mental Health HPSA score calculations, a measure of substance and alcohol abuse is factored
into the HPSA score. This optional data are 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 Source of Non-designated Accessible Care (NSC)
The system will calculate the time and distance to the nearest source of non-designated accessible care
by using the shortest path analysis discussed above in the travel time and NSC 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 NSC travel time is then generated. The following table displays the scoring
thresholds based on Mental Health NSC Travel Time:

58

Score for Travel Time or Distance to NSC

Points

≥ 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): MPP

April 4, 2020

Section VII: MUA/P Scoring
I.

MUA/P Common Requirements

Rational Service Area







II.

Defined in terms of:
o Whole County.
o County Subdivisions (CSDs) with population centers within 30 minutes time of each
other.
o Census Tracts.
RSA Population for whom Poverty Status is Determined 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 CSD.
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.







59

Provider per 1,000 population ratio
o The ratio of the total Primary Care Provider FTE per 1,000 population for the service
area using the Population for whom Poverty Status is Determined.
% Population at 100% of the Federal Poverty Level
o Total population for whom Poverty Status is Determined is used as the denominator.
% Population age 65 and over
o Total population for whom Poverty Status is Determined is used as the denominator.
Infant Mortality Rate (IMR)
o Please refer to the Infant Health Index section under the Section III for details on the
methodology used to calculate IMR.

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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 point value, per the established criteria in the
tables below.
Provider per 1,000 population ratio Point Values
Provider per 1,000
population 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

60

Points
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

Shortage Designation Management System (SDMS): MPP

Provider per 1,000
population ratio
over 1.250

April 4, 2020

Points
28.7

Infant Mortality Rate Point Values

61

Infant Mortality Rate

Points

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): MPP

April 4, 2020

% Population at 100% Poverty Point 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+

62

Points
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): MPP

April 4, 2020

% Population age 65 and Over Point Values

63

Percent Age 65
and Over

Points

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): MPP

April 4, 2020

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 provides 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 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.

Evidence of Insufficient Capacity


Evidence must be given that the facility meets at least two of the following indicators of
insufficient capacity:
o There are more than 8,000 outpatient visits per year per FTE of primary care physicians.
o There is excessive use (greater than 35% of patient visits) 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

Always

Letter establishing non-profit status with IRS
Scan of website page that documents type of facility

64

Shortage Designation Management System (SDMS): MPP

Document Type
Name
Evidence that
more than 50%
of the facility's
health care
services are
provided to
residents of a
HPSA
Evidence of
Travel Time

Evidence of
Public
Transportation
Evidence that %
of Population
using Public
Transportation
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
primary care

65

April 4, 2020

When
Required?
If used as
criterion on
the Provision
of Services
page

Suggested Document

If automated
travel time for
Private
transportation
is edited or
the user
selects public
transportation
If the user
selects public
transportation
If user selects
this to pass as
a criteria for
public
transportation
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 a
population center was not calculated, 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

Patient origin statistics by zip code or other data provided by
facility

Scan of public transit schedule to show travel time

Scan of local, state, or federal data concerning % of the
population using public transportation; Census data can also be
used if appropriate

Scan of documentation concerning outpatient visits per year per
primary care physician FTE, provided by facility

Shortage Designation Management System (SDMS): MPP

Document Type
Name
Evidence that
waiting time for
appointments is
greater than 7
days for
established
patients
Evidence that
waiting time for
appointments 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
appointments
Evidence that
the facility
waiting time is
greater than 2
hours for walkin patients

II.

April 4, 2020

When
Required?
If user selects
this criteria on
the
Insufficient
capacity page

Suggested Document

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

Scan of documentation provided by facility

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


66

The facility must meet one of the following provisions of services criteria:

Shortage Designation Management System (SDMS): MPP

o
o

April 4, 2020

The facility is within 40 minutes of a HPSA and the facility is accessible to residents of
the HPSA (i.e., no socioeconomic difference).
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
criterion on
the Provision
of Services
page

Patient origin by zip code statistics or other data provided by
facility

If automated
travel time for
Private
transportation
is edited or the
user selects
public
transportation
If the user
selects public
transportation

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 a
population center was not calculated, then measure from the
centroid of the most populous component in the RSA)

Evidence of
Public
Transportation

67

Scan of public transit schedule to show travel time

Shortage Designation Management System (SDMS): MPP

Document Type
Name
Evidence of % of
Population
using Public
Transportation
is greater than
30%
Evidence that
facility has more
than 5000
outpatient visits
per year per
dentist FTE
Evidence that
waiting time for
appointments
for routine
dental health
services is
greater than 6
weeks

III.

April 4, 2020

When
Required?
If user selects
this to pass as
a criteria for
public
transportation
selection
If user selects
this criteria on
the Insufficient
capacity page

Suggested Document

If user selects
this criteria on
the Insufficient
capacity page

Scan of documentation provided by facility

Scan of local, state, or federal data concerning% of the
population using public transportation; Census data can also be
used if appropriate

Scan of documentation concerning outpatient visits per year per
dentist FTE, provided by facility

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


68

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

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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
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
criterion on
the Provision
of Services
page

Patient origin by zip code statistics or other data provided by facility

If automated
travel time for
Private
transportation
is edited or the
user selects
public
transportation
If the user
selects public
transportation

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 a population
center was not calculated, then measure from the centroid of the
most populous component in the RSA)

Evidence of
Public
Transportation

69

Scan of public transit schedule to show travel time

Shortage Designation Management System (SDMS): MPP

Document Type
Name
Evidence of %
of Population
using Public
Transportation
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
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

70

April 4, 2020

When
Required?
If user selects
this to pass as
a criteria for
public
transportation
selection
If user selects
this criteria on
the Insufficient
capacity page

Suggested Document

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 and/or other local or
state source

Scan of local, state, or federal data concerning % of the population
using public transportation; Census data can also be used if
appropriate

Scan of documentation concerning outpatient visits per year per
mental health care provider FTE, provided by facility

Shortage Designation Management System (SDMS): MPP

Document Type
Name
Evidence that
the facility has
been given
responsibility
for providing
and/or
coordinating
mental health
services to an
area or
population
group,
consistent with
applicable
State plans.

IV.

When
Required?
If user selects
this criteria on
the Insufficient
capacity page

April 4, 2020

Suggested Document
Scan of documentation provided by facility and/or other local or
state source

OFAC Scoring

The facility score is the same as the HPSA score of the designated area or population group for which it
serves.

71

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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:
𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊 𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈
= 𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴 𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 + 2
∗ (𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎 𝑝𝑝𝑝𝑝𝑝𝑝 𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦) + 0.5
∗ (𝑁𝑁𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢 𝑜𝑜𝑜𝑜 𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎 𝑡𝑡𝑡𝑡 𝑑𝑑𝑑𝑑𝑑𝑑 𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐 𝑎𝑎𝑎𝑎𝑎𝑎 𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜 𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠 𝑝𝑝𝑝𝑝𝑝𝑝 𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦

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.
(𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊 𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈)/300 − 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃ℎ𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝐹𝐹𝐹𝐹𝐹𝐹

72

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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

73

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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
𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦
o

If the mean length- of- stay is specified as one year or more, and intake medical
examinations are routinely performed upon entry, then

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛
= 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦 + 0.3 ∗ (𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑁𝑁𝑁𝑁𝑁𝑁 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦)
o

If the mean length- of- stay is specified as less than one year, and intake medical
examinations are routinely performed upon entry, then

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦 + 0.2 ∗ (1 + 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀/2) ∗
(𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦) 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


74

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): MPP

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

April 4, 2020

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.
𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼/1000 − 𝐹𝐹𝐹𝐹𝐹𝐹

75

Shortage Designation Management System (SDMS): MPP

III.

April 4, 2020

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
𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦
o

If the mean length- of- stay is specified as one year or more, and intake dental
examinations are routinely performed upon entry, then

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦 + 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑠𝑠/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦
o

If the mean length- of- stay is specified as less than one year, and intake dental
examinations are routinely performed upon entry, then

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦 + (1/3) ∗ [1 + (2 ∗
𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀)] ∗ (𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦) 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


76

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:

Shortage Designation Management System (SDMS): MPP

Group Number
1
2
3

Criteria
Institutions with 500 or more
inmates and no dentists
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

April 4, 2020

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 20-26; 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.



V.

𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼/1500 − 𝐹𝐹𝐹𝐹𝐹𝐹

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
𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦

77

Shortage Designation Management System (SDMS): MPP

o

April 4, 2020

If the mean length- of- stay is specified as one year or more, and intake psychiatric
examinations are routinely performed upon entry, then

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦 + 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦
o

If the mean length- of- stay is specified as less than one year, and intake psychiatric
examinations are routinely performed upon entry, then

𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑁𝑒𝑒𝑒𝑒 𝑜𝑜𝑜𝑜 𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼 = 𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦 + (1/3) ∗ [1 + (2 ∗
𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀)] ∗ (𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀 𝑛𝑛𝑛𝑛𝑛𝑛 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖/𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦) 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
2

3

Criteria
Facilities with 500 or more
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

Degree of Shortage Points
12

Intersecting HPSA Points


78

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

6

3

Shortage Designation Management System (SDMS): MPP

April 4, 2020

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.
𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼/2000 − 𝐹𝐹𝐹𝐹𝐹𝐹

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

79

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Appendix A: Future Updates
Appendix A 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
MPP 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.

80

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Appendix B: Auto-HPSAs
This appendix is intended to outline policies and procedures unique to the Auto-HPSA scoring process.
For information on processes concerning submission of data and Auto-HPSA rescore requests, the
reader should consult the Designation Management User Guide.

I. Re-scoring an Auto-HPSA
System Data Rescore
Either the Organizational Point of Contact (POC) or State Primary Care Office (PCO) may submit a system
data rescore request. These requests can be made for an organization’s Primary Care, Dental Health
and/or Mental Health scores. No supplemental data can be submitted. The purpose of these requests
is to recalculate scores using the most current Federal, State, and Provider data in the system. No
review is required.
Supplemental Data Rescore
Either the Organizational Point of Contact (POC) or State Primary Care Office (PCO) may submit a
supplemental data rescore request. The system will determine which designations to update based on
the supplemental data entered.The data that may be submitted depends on the requestor type As
described previously, FQHC and FQHC LALs are not permitted to submit supplemental data that has
already been added to the system from UDS.
The next three tables show the detailed list of data that may be submitted by the POC or PCO and the
susbscores that are recalculated upon submission and approval across each discipline. The system will
check for user-entered data. For those indicated with an * below, if present, the system will use userentered data in scoring. Otherwise, it will use the standard system data in SDMS.

81

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Average NSC

X

NSC Site C

X*

NSC Site B

IMR or LBWR

X

NSC Site A

%Population at 100% FPL

X

X
X
X

X
X
X

X
X
X

X

X

X

X

X

X

X
X
X
X
X
X
X
X
X

Average NSC

X

NSC Site C

Facility Data Submitted by PCO/POC
Service Areas (Patients Served by Zipcode)
% of Patients Served With Known Income At Or
Below 100% FPL
Site A geolocation (when service area is ZCTAs)
Site B geolocation (when service area is ZCTAs)
Site C geolocation (when service area is ZCTAs)
Site A geolocation (when service area is CTs)
Site B geolocation (when service area is CTs)
Site C geolocation (when service area is CTs)
Site A Primary Care NSC
Site B Primary Care NSC
Site C Primary Care NSC

Pop:Provider Ratio

PRIMARY CARE SUBSCORES

X

X

82

X*

NSC Site B

NSC Site A

Fluoridated Water

Pop:Provider Ratio

Facility Data Submitted by PCO/POC
Service Areas (Patients Served by Zipcode)
X
Fluoridated water
% of Patients Served With Known Income At Or
Below 100% FPL
Site A geolocation (when service area is ZCTAs)
Site B geolocation (when service area is ZCTAs)
Site C geolocation (when service area is ZCTAs)
Site A geolocation (when service area is CTs)
Site B geolocation (when service area is CTs)
Site C geolocation (when service area is CTs)
Site A Dental Health NSC
Site B Dental Health NSC
Site C Dental Health NSC

%Population at 100% FPL

DENTAL HEALTH SUBSCORES

X

X
X

X
X
X

X
X
X

X
X
X

X

X

X

X

X

X

X

X

X
X
X
X
X
X
X
X
X

Shortage Designation Management System (SDMS): MPP

April 4, 2020

X
X

X
X
X

Average NSC

X

X

X
X
X

NSC Site C

X*

NSC Site B

X*

NSC Site A

Youth Ratio

X

Elderly Ratio

X*

Alcohol Misuse Prev.

X

Substabce Misuse Prev.

%Population at 100% FPL

Facility Data Submitted by PCO/POC
Service Areas (Patients Served by Zipcode)
Substance misuse prevalence
Alcohol misuse prevalence
% of Patients Served With Known Income At Or
Below 100% FPL
Patients <18
Patients 18-64
Patients 65+
Site A geolocation (when service area is ZCTAs)
Site B geolocation (when service area is ZCTAs)
Site C geolocation (when service area is ZCTAs)
Site A geolocation (when service area is CTs)
Site B geolocation (when service area is CTs)
Site C geolocation (when service area is CTs)
Site A Mental Health NSC
Site B Mental Health NSC
Site C Mental Health NSC

Pop:Provider Ratio

MENTAL HEALTH SUBSCORES

X
X
X

X
X
X

X
X
X

X

X

X

X

X

X

X

X

X
X
X
X
X
X
X
X
X

II. Auto-HPSA Service Areas
Auto-HPSA scoring is similar to Population HPSA scoring in that the data points derived to calculate the
score are generally for a service area and specific subpopulation. The service areas for any FQHC or
FQHC LAL which has UDS data will be the 75% Core Service Area (as described below) calculated by
BPHC. These service areas cannot be replaced or updated by submission of supplemental data.
The service areas for RHCs, ITU, and any FQHC or FQHC LAL without UDS data will by default based on all
census tracts that intersect with a 30-minute (for Primary Care) or 40-minute (for Dental and Mental
Health) travel polygon around each site within the organization. As described in the previous section,
POCs may submit supplemental data consisting of the most recently available total annual patient
counts by residential zip codes. This analysis mimics that peformed by BPHC with UDS-submitted zip
codes and patient counts and is described below:
1. Zip codes are converted to ZCTAs through a crosswalk. Any patient counts associated with zip
codes not represented in this crosswalk are discarded from the remining steps
2. The list of ZCTAs is ordered in descending order by patient count
3. The patient counts are summed starting at the top of the list until at least 75% of the total
patient counts reported have been reached. This list of ZCTAs is the 75% Core Service Area and
is used to generate HPSA scores in a supplemental data rescore
4. Zip codes with 10 or fewer patients are not reported individually but grouped together and
reported as “Other Zip Codes” in the supporting documentation provided. These counts are not
used in the Core Service Area analysis.

83

Shortage Designation Management System (SDMS): MPP

April 4, 2020

Appendix C: Active Taxonomies
This appendix provides a list of active taxonomies.
TAXONOMY
CODE

TAXONOMY TYPE

CLASSIFICATION

SPECIALIZATION

PROVIDER
DISCIPLINE
TYPE
DH
DH
DH
MH

PROVIDER
SPECIALTY
TYPE
CPSY
CPSY
CPSY
CPSY

122300000X
1223G0001X
1223P0221X
103T00000X

Dental Providers
Dental Providers
Dental Providers
Behavioral Health & Social Service
Providers

Dentist
Dentist
Dentist
Psychologist

Dentist
General Practice
Pediatric Dentistry
Psychologist

103TA0400X

Behavioral Health & Social Service
Providers

Psychologist

Addiction (Substance Use
Disorder)

MH

CPSY

103TA0700X

Behavioral Health & Social Service
Providers

Psychologist

Adult Development & Aging

MH

CPSY

103TB0200X

Behavioral Health & Social Service
Providers

Psychologist

Cognitive & Behavioral

MH

CPSY

103TC0700X

Behavioral Health & Social Service
Providers

Psychologist

Clinical

MH

CPSY

103TC1900X

Behavioral Health & Social Service
Providers

Psychologist

Counseling

MH

CPSY

103TC2200X

Behavioral Health & Social Service
Providers

Psychologist

Clinical Child & Adolescent

MH

CPSY

103TE1000X

Behavioral Health & Social Service
Providers

Psychologist

Educational

MH

CPSY

103TF0000X

Behavioral Health & Social Service
Providers

Psychologist

Family

MH

CPSY

84

Shortage Designation Management System (SDMS): MPP

TAXONOMY
CODE
103TH0004X

Behavioral Health & Social Service
Providers

Psychologist

Health

PROVIDER
DISCIPLINE
TYPE
MH

103TH0100X

Behavioral Health & Social Service
Providers

Psychologist

Health Service

MH

CPSY

103TP0016X

Behavioral Health & Social Service
Providers

Psychologist

Prescribing (Medical)

MH

CPSY

103TP0814X

Behavioral Health & Social Service
Providers

Psychologist

Psychoanalysis

MH

CSW

103TP2700X

Behavioral Health & Social Service
Providers

Psychologist

Psychotherapy

MH

CSW

103TS0200X

Behavioral Health & Social Service
Providers

Psychologist

School

MH

CSW

104100000X

Behavioral Health & Social Service
Providers

Social Worker

Social Worker

MH

MFT

1041C0700X

Behavioral Health & Social Service
Providers

Social Worker

Clinical

MH

GDT

1041S0200X

Behavioral Health & Social Service
Providers

Social Worker

School

MH

GDT

106H00000X

Behavioral Health & Social Service
Providers

Marriage & Family
Therapist

Marriage & Family Therapist

MH

GDT

2084A0401X

Allopathic & Osteopathic Physicians

Psychiatry &
Neurology

Addiction Medicine

MH

FP

2084P0800X

Allopathic & Osteopathic Physicians

Psychiatry &
Neurology

Psychiatry

MH

FP

2084P0802X

Allopathic & Osteopathic Physicians

Psychiatry &
Neurology

Addiction Psychiatry

MH

FP

85

TAXONOMY TYPE

April 4, 2020

CLASSIFICATION

SPECIALIZATION

PROVIDER
SPECIALTY
TYPE
CPSY

Shortage Designation Management System (SDMS): MPP

TAXONOMY
CODE
2084P0804X

Allopathic & Osteopathic Physicians

Psychiatry &
Neurology

Child & Adolescent Psychiatry

PROVIDER
DISCIPLINE
TYPE
MH

2084P0805X

Allopathic & Osteopathic Physicians

Psychiatry &
Neurology

Geriatric Psychiatry

MH

IM

363LP0808X

Physician Assistants & Advanced
Practice Nursing Providers

Nurse Practitioner

Psych/Mental Health

MH

IM

364SP0807X

Physician Assistants & Advanced
Practice Nursing Providers

Clinical Nurse
Specialist

Psych/Mental Health, Child &
Adolescent

MH

IM

364SP0808X

Physician Assistants & Advanced
Practice Nursing Providers

Clinical Nurse
Specialist

Psych/Mental Health

MH

OBG

364SP0809X

Physician Assistants & Advanced
Practice Nursing Providers

Clinical Nurse
Specialist

Psych/Mental Health, Adult

MH

OBG

207Q00000X

Allopathic & Osteopathic Physicians

Family Medicine

Family Medicine

PC

OBG

207QA0000X

Allopathic & Osteopathic Physicians

Family Medicine

Adolescent Medicine

PC

PD

207QA0505X

Allopathic & Osteopathic Physicians

Family Medicine

Adult Medicine

PC

PD

207QG0300X

Allopathic & Osteopathic Physicians

Family Medicine

Geriatric Medicine

PC

PSY

207R00000X

Allopathic & Osteopathic Physicians

Internal Medicine

Internal Medicine

PC

PSY

207RA0000X

Allopathic & Osteopathic Physicians

Internal Medicine

Adolescent Medicine

PC

PSY

207RG0300X

Allopathic & Osteopathic Physicians

Internal Medicine

Geriatric Medicine

PC

PSY

86

TAXONOMY TYPE

April 4, 2020

CLASSIFICATION

SPECIALIZATION

PROVIDER
SPECIALTY
TYPE
FP

Shortage Designation Management System (SDMS): MPP

TAXONOMY
CODE
207V00000X

Allopathic & Osteopathic Physicians

Obstetrics &
Gynecology

Obstetrics & Gynecology

PROVIDER
DISCIPLINE
TYPE
PC

207VG0400X

Allopathic & Osteopathic Physicians

Obstetrics &
Gynecology

Gynecology

PC

GP

207VX0000X

Allopathic & Osteopathic Physicians

Obstetrics &
Gynecology

Obstetrics

PC

PNS

208000000X

Allopathic & Osteopathic Physicians

Pediatrics

Pediatrics

PC

PNS

2080A0000X

Allopathic & Osteopathic Physicians

Pediatrics

Adolescent Medicine

PC

PNS

208D00000X

Allopathic & Osteopathic Physicians

General Practice

General Practice

PC

PNS

87

TAXONOMY TYPE

April 4, 2020

CLASSIFICATION

SPECIALIZATION

PROVIDER
SPECIALTY
TYPE
PSY