[Federal Register Volume 78, Number 124 (Thursday, June 27, 2013)]
[Notices]
[Pages 38718-38720]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-15380]


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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.

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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 May 11, 2013, available on the Health 
Resources and Services Administration (HRSA) Web site at http://www.hrsa.gov/shortage/. HPSAs are designated or withdrawn by the 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 on the HRSA Web site below and requests 
for additional designations, withdrawals, or reapplication for 
designation should be submitted to Victoria Hux, Chief, Shortage 
Designation Branch, Bureau of Clinician Recruitment and Service, Health 
Resources and Services Administration, Room 9A-55, Parklawn Building, 
5600 Fishers Lane, Rockville, Maryland 20857, (301) 594-0816, http://www.hrsa.gov/shortage/.

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 Clinician Recruitment and 
Service (BCRS) 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 care,

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dental, or mental health services in or to these HPSAs. NHSC health 
professionals with a service obligation may enter into service 
agreements to serve only in federally designated HPSAs. Entities with 
clinical training sites located in HPSAs are eligible to receive 
priority for certain residency training program grants administered by 
the Bureau of Health Professions. 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 geographic area 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 (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 BCRS. The majority of the requests come 
from the Primary Care Offices (PCO) 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, interested parties, including the 
Governor, the State Primary Care Association and state professional 
associations are notified of each request submitted for their comments 
and recommendations.
    Annually, lists of designated HPSAs are made available 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 three 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 BCRS, 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 on the notification letter 
from BCRS. Proposed withdrawals become effective only after interested 
parties in the area affected have been afforded the opportunity to 
submit additional information to BCRS in support of its continued or 
revised designation. If no new data are submitted, or if BCRS review 
confirms the proposed withdrawal, the withdrawal becomes effective upon 
publication of the lists of designated HPSAs in the Federal Register. 
In addition, lists of HPSAs are updated daily on the HRSA Web site, 
http://www.hrsa.gov/shortage/, so that interested parties can access 
the most accurate and timely information.

Publication and Format of Lists

    Due to the large volume of designations, a printed version of the 
list is no longer distributed. This notice serves to inform the public 
of the availability of the complete listings of designated HPSA on the 
HRSA Web site. The three lists (primary medical care, mental health, 
and dental) of designated HPSAs are available at a link on the HRSA Web 
site at http://www.hrsa.gov/shortage/ and include a snapshot of all 
geographic areas, population groups, and facilities that were 
designated HPSAs as of May 11, 2013. This notice incorporates the most 
recent annual reviews of designated HPSAs and supersedes the HPSA lists 
published in the Federal Register on June 29, 2012 (77 FR 38838). The 
lists also include automatic facility HPSAs, designated as a result of 
the Health Care Safety Net Amendments of 2002 (Pub. L. 107-251), not 
subject to update requirements. 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 on the snapshot of HPSAs 
listed can be found on the HRSA Web site: http://www.hrsa.gov/shortage/.
    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 HPSA designation; 
any facilities eligible for automatic designation will be included in 
the database as they are identified.

Future Updates of Lists of Designated HPSAs

    The lists of HPSAs on the HRSA Web site below consist of all those 
that were designated as of May 11, 2013. It should be noted that HPSAs 
are currently updated on an ongoing basis based on the identification 
of new areas, population groups, and facilities and sites that meet the 
eligibility criteria or that no longer meet eligibility criteria and/or 
are being replaced by another type of designation. As such, 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 and are currently included in 
the daily updates posted on the HRSA Web site at http://www.hrsa.gov/shortage/find.html.
    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 such 
a withdrawal will be the next publication of a notice regarding this 
list in the Federal Register.

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    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 list of HPSAs designated as of May 11, 2013, are 
available on the HRSA Web site at http://www.hrsa.gov/shortage/. 
Frequently updated information on HPSAs is also available at http://datawarehouse.hrsa.gov.

    Dated: June 21, 2013.
Mary K. Wakefield,
Administrator.
[FR Doc. 2013-15380 Filed 6-26-13; 8:45 am]
BILLING CODE 4165-15-P