[Federal Register Volume 76, Number 213 (Thursday, November 3, 2011)]
[Notices]
[Pages 68198-68199]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-28318]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Lists of Designated Primary Medical Care, Mental Health, and 
Dental Health Professional Shortage Areas

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice advises the public of the published lists of all 
geographic areas, population groups, and facilities designated as 
primary medical care, mental health, and dental health professional 
shortage areas (HPSAs) as of September 1, 2011, available on the Health 
Resources and Services Administration (HRSA) Web site at http://bhpr.hrsa.gov/shortage/index.html. HPSAs are designated or withdrawn by 
the Secretary of Health and Human Services (HHS) under the authority of 
section 332 of the Public Health Service (PHS) Act and 42 CFR part 5.

FOR FURTHER INFORMATION CONTACT: Requests for further information on 
the HPSA designations listed below and requests for additional 
designations, withdrawals, or reapplication for designation should be 
submitted to Andy Jordan, Office of Shortage Designation, Bureau of 
Health Professions, Health Resources and Services Administration, Room 
9A-18, Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857, 
(301) 594-0816), http://bhpr.hrsa.gov/shortage/index.html.

SUPPLEMENTARY INFORMATION:

Background

    Section 332 of the PHS Act, 42 U.S.C. 254e, provides that the 
Secretary of HHS shall designate HPSAs based on criteria established by 
regulation. HPSAs are defined in section 332 to include (1) urban and 
rural geographic areas with shortages of health professionals, (2) 
population groups with such shortages, and (3) facilities with such 
shortages. Section 332 further requires that the Secretary annually 
publish a list of the designated geographic areas, population groups, 
and facilities. The lists of HPSAs are to be reviewed at least annually 
and revised as necessary. HRSA's Bureau of Health Professions (BHPr) 
has the responsibility for designating and updating HPSAs.
    Public or private nonprofit entities are eligible to apply for 
assignment of National Health Service Corps (NHSC) personnel to provide 
primary health services in or to these HPSAs. NHSC health professionals 
with a service obligation may serve only in federally designated HPSAs. 
Entities with clinical training sites located in HPSAs are eligible to 
receive priority for certain training program grants administered by 
BHPr. Many other Federal programs also utilize HPSA designations. For 
example, under authorities administered by the Centers for Medicare and 
Medicaid Services, certain qualified providers in HPSAs are eligible 
for increased levels of Medicare reimbursement.

Development of the Designation and Withdrawal Lists

    Criteria for designating HPSAs were published as final regulations 
(42 CFR part 5) in 1980. Criteria then were defined for each of seven 
health professional types (primary medical care, dental, psychiatric, 
vision care, podiatric, pharmacy, and veterinary care). The criteria 
for correctional facility HPSAs were revised and published on March 2, 
1989, in the Federal Register (54 FR 8735). The criteria for 
psychiatric HPSAs were expanded to mental health HPSAs on January 22, 
1992 (57 FR 2473). Currently funded PHS Act programs use only the 
primary medical care, mental health, or dental HPSA designations.
    Individual requests for designation or withdrawal of a particular 
geographic area, population group, or a facility as a HPSA are received 
and reviewed continuously by BHPr. The majority of the requests come 
from the Primary Care Offices (PCOs) in the State Health Departments, 
who have access to the on-line application and review system. Requests 
that come from other sources are referred to the PCOs for their review 
and concurrence. In addition, applicants are expected to share copies 
of the requests with other interested parties, including the Governor, 
the State Primary Care Association and state professional associations 
for their comments and recommendations.
    Annually, lists of designated HPSAs are provided to all PCOs, state 
medical and dental societies and others, with a request to review and 
update the data on which the designations are based. Emphasis is placed 
on updating those designations that are more than 3 years old or where 
significant changes relevant to the designation criteria have occurred.
    Recommendations for possible additions, continuations, revisions or 
withdrawals from a HPSA list are reviewed by BHPr, and the review 
findings are provided by letter to the agency or individual requesting 
action or providing data, with copies to other interested organizations 
and individuals. These letters constitute the official notice of 
designation as a HPSA, rejection of recommendations for HPSA 
designation, revision of a HPSA designation, and/or advance notice of 
pending withdrawals from the HPSA list. Designations (or revisions of 
designations) are effective as of the date of the notification letter 
from BHPr. Proposed withdrawals become effective only after interested 
parties in the area affected have been afforded the opportunity to 
submit additional information to BHPr in support of its continued or 
revised designation. If no new data are submitted, or if BHPr review 
confirms the proposed withdrawal, it becomes effective upon publication 
in the Federal Register of the lists of HPSAs that do not include

[[Page 68199]]

the proposed withdrawals. In addition, lists of HPSAs are continuously 
available on the HRSA Web site, http://bhpr.hrsa.gov/shortage/index.html, so that interested parties can access the most accurate and 
timely information.

Publication and Format of Lists

    Due to the volume of designations, this notice informs the public 
of the availability on the HRSA Web site of the published lists of 
designated shortage areas. The three lists of designated HPSAs are 
available at a link on the Office of Shortage Designation Web site at 
http://bhpr.hrsa.gov/shortage/index.html. Each list (primary medical 
care, mental health, and dental) includes all those geographic areas, 
population groups, and facilities that were designated HPSAs as of 
September 1, 2011. This notice incorporates the most recent annual 
reviews of designated HPSAs and supersedes the HPSA lists published in 
the Federal Register on February 20, 2002 (67 FR 7740). The lists 
include those automatic facility HPSAs that have been entered into the 
HPSA data base. Automatic facility HPSAs, designated as a result of the 
Health Care Safety Net Amendments of 2002 (Pub. L. 107-251), are not 
subject to the updating requirements. The lists are constantly changing 
based on the identification of new sites that meet the eligibility 
criteria or current sites that lose their eligibility and need to be 
removed. Each list of designated HPSAs (primary medical care, mental 
health, and dental) is arranged by state. Within each state, the list 
is presented by county. If only a portion (or portions) of a county is 
(are) designated, or if the county is part of a larger designated 
service area, or if a population group residing in the county or a 
facility located in the county has been designated, the name of the 
service area, population group, or facility involved is listed under 
the county name. Counties that have a whole county geographic HPSA are 
indicated by the ``Entire county HPSA'' notation following the county 
name. Further details for the HPSAs listed can be found on the HRSA Web 
site: http://bhpr.hrsa.gov/shortage/index.html.
    In addition to the specific listings included in this notice, all 
Indian Tribes that meet the definition of such Tribes in the Indian 
Health Care Improvement Act of 1976, 25 U.S.C. 1603(d), are 
automatically designated as population groups with primary medical care 
and dental health professional shortages. The Health Care Safety Net 
Amendments of 2002 also made the following entities eligible for 
automatic facility HPSA designations: all federally qualified health 
centers (FQHCs) and rural health clinics that offer services regardless 
of ability to pay. These entities include: FQHCs funded under section 
330 of the PHS Act, FQHC Look-Alikes, and Tribal and urban Indian 
clinics operating under the Indian Self-Determination and Education Act 
of 1975 (25 U.S.C. 450) or the Indian Health Care Improvement Act. 
Many, but not all, of these entities are included on this listing. 
Exclusion from this list does not exclude them from the list of HPSAs; 
all will be included in the data base as they are identified.

Future Updates of Lists of Designated HPSAs

    The lists of HPSAs below consist of all those that were designated 
as of September 1, 2011. It should be noted that additional HPSAs may 
have been designated by letter since that date. The appropriate 
agencies and individuals have been or will be notified of these actions 
by letter. These newly designated HPSAs will be included in the next 
publication of the HPSA list.
    Any designated HPSA listed on the HRSA Web site below is subject to 
withdrawal from designation if new information received and confirmed 
by HRSA indicates that the relevant data for the area involved have 
significantly changed since its designation. The effective date of the 
withdrawal will be the next publication of a notice regarding this list 
in the Federal Register.
    All requests for new designations, updates, or withdrawals should 
be based on the relevant criteria in regulations published at 42 CFR 
part 5.

Electronic Access Address

    The complete lists of HPSAs designated as of September 1, 2011, are 
available on the HRSA Web site at http://bhpr.hrsa.gov/shortage/index.html. Frequently updated information on HPSAs is also available 
at http://datawarehouse.hrsa.gov.

    Dated: October 25, 2011.
Mary K. Wakefield,
Administrator.
[FR Doc. 2011-28318 Filed 11-1-11; 11:15 am]
BILLING CODE 4165-15-P