Revision of the Federal Rules for HPSA/MUA/P Designation

Dates: 2008-2011

Geographic Scope: Nationwide

Client(s): HRSA

Services: Health Care & Public Health Planning, Health Information Technology, Applied Research & Evaluation, Health Systems Transformation

Technical Expertise: Health Disparities, Health Care Reform, Health Information Technology, Population Health, Primary Care, Rural Health, Safety Net, State and Local Public Health


Nearly every component of the federal health care safety net system now rests, to some degree, on designation of communities as Health Professional Shortage Areas (HPSAs) and/or Medically Underserved Areas /Populations (MUA/Ps). In the decades since they were created, the rules governing these designations have become significantly outdated, though efforts to change them have met with strong resistance from current stakeholders.

HRSA's Bureau of Health Professions engaged JSI to analyze the factors used to identify communities that are facing medical underservice and provider shortages, and to assist in updating the designation rules and model the likely impact of changes on the existing safety net infrastructure nationwide. A provision in the Affordable Care Act mandated that this regulation be developed through a formal Negotiated Rulemaking committee process with the stakeholders and national topic experts - a first for the agency.

JSI worked integrally with the agency and committee throughout these deliberations and the development of their report to the Secretary of HHS. This included developing presentations to frame the issues under consideration, and to present the results of extensive analyses perfomred in support of the factors being considered for inclusion and approaches to scoring and combining them, settign thresholds, and ultimately for evaluating the likely impact of the changes adopted on the nation overall, and on the existing safety net infrastructure. The JSI team was an integral part of every step in the process, and contributed to nearly all Committee/Sub-Committee discussions. Analysis involved a wide array of statistical, database, and GIS techniques combining data fom a wide range of sources. Results were produced in a range of formats to facilitate Committee review, including custom reports and a web-based interactive mapping system created specifically for this project, to show the location, data, and scoring for over 6000 service areas developed nationally for impact testing.

A separate follow-on contract has since been awarded to JSI under which JSI is assisting HRSA in completing the post-committee process of finishing the regulation development, supporting internal governmental review, and ultimately working with states as the rule is published and implemented nationally.