[Federal Register Volume 79, Number 86 (Monday, May 5, 2014)]
[Notices]
[Pages 25599-25603]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-10193]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Methodology for Designation of Frontier and Remote Areas

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Final response.

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SUMMARY: The Office of Rural Health Policy (ORHP) in the Health 
Resources and Services Administration (HRSA) published a 60-day public 
notice in the Federal Register on November 5, 2012 (Federal Register 
volume 77, number 214, 66471-66476) describing a methodology for 
designating U.S. frontier areas. The Frontier and Remote Area (FAR) 
Codes methodology was developed in a collaborative project between ORHP 
and the Economic Research Service (ERS) in the U.S. Department of 
Agriculture (USDA). This notice responds to the comments received 
during this 60-day public notice.

ADDRESSES: Further information on the Frontier and Remote Area (FAR) 
Codes is available at http://www.ers.usda.gov/data-products/frontier-and-remote-area-codes.aspx.

FOR FURTHER INFORMATION CONTACT: Questions can be directed to Steven 
Hirsch via phone at (301) 443-7322; email to [email protected]; or 
mailed to Office of Rural Health Policy, Health Resources and Services 
Administration, 5600 Fishers Lane, Parklawn Building, 17-W-55 
Rockville, Maryland 20857; or fax to (301) 443-2803.

Background

    This project was intended to create a definition of frontier based 
on easily explained concepts of remoteness and population sparseness. 
The goal was to create a statistical delineation that will be useful in 
a wide variety of research and policy contexts and adjustable to the 
circumstances in which it is applied. FAR areas are defined in relation 
to the time it takes to travel by car to the edges of nearby Urban 
Areas. Four levels are necessary because rural areas experience degrees 
of remoteness at higher or lower population levels that affect access 
to different types of goods and services.
    The four FAR Levels are defined as follows (travel times are 
calculated one-way by the fastest paved road route):
    (1) Frontier Level 1 areas are 60 minutes or greater from Census 
Bureau defined Urban Areas of 50,000 or more population;
    (2) Frontier Level 2 areas are 60 minutes or greater from Urban 
Areas of 50,000 or more people and 45 minutes or greater from Urban 
Areas of 25,000-49,999;
    (3) Frontier Level 3 areas are 60 minutes or greater from Urban 
Areas of 50,000 or more people; 45 minutes or greater from Urban Areas 
of 25,000-49,999; and 30 minutes or greater from Urban Areas of 10,000-
24,999; and
    (4) Frontier Level 4 areas are 60 minutes or greater from Urban 
Areas of 50,000 or more people; 45 minutes or greater from Urban Areas 
of 25,000-49,999; 30 minutes or greater from Urban Areas of 10,000-
24,999; and 15 minutes or greater from Urban Areas of 2,500-9,999.

Comments on the FAR Codes and HRSA Response

    The ORHP received twenty-six responses to the request for comments. 
Many of the comments received dealt with similar concerns over either 
the details of the proposed methodology or the potential use of the FAR 
codes in directing resources.
    Several commenters noted that the data used to assign FAR codes 
were from the 2000 Census rather than the more recent 2010 Census. When 
ORHP and USDA began the process of developing the methodology in 2008, 
only Census 2000 data were available. As stated in the initial Federal 
Register notice, the FAR codes will be updated for all 50 states using 
Census 2010 data. There were also commenters who believed that 
decennial updates to FAR codes would be too infrequent to be current. 
ORHP will examine the possibility of using American Community Survey 
data to update FAR codes in the future.
    In particular, HRSA sought public comments on:
    1. The use of a population threshold of 50,000 as the central place 
from which to measure in defining FAR areas;
    2. The use of 60 minutes travel time from the central place;
    3. Whether the 50 percent population threshold for assigning 
frontier status to a ZIP code/census tract is the appropriate level for 
the four standard provided levels;
    4. Other ways of representing urban and rural areas;
    5. Alternatives to using grid cells for measuring remoteness;
    6. Applicability of the FAR methodology to island populations; and
    7. Need for a Census tract and county version of the FAR.
    Comment: On the use of a population threshold of 50,000 as the 
central place from which to measure, there was no consensus of views 
expressed and many commenters did not address the issue. Comments 
received correctly pointed out that there are some states (such as 
Alaska, Wyoming, or New Mexico) which have few urban areas with 
populations of over 50,000.
    One commenter noted that, ``Population size is not necessarily a 
reliable measure of the goods and services that will be available or 
other important factors.'' Another commenter also believed that there 
are great differences between urban areas of only 50,000 people and 
urban areas with hundreds of thousands or millions of inhabitants. 
There were also comments received that concurred with the use of the 
population threshold of 50,000 as appropriate for the purpose.
    Response: No comment received suggested a threshold other than 
50,000. The population threshold of 50,000 also forms the core for both 
the Urbanized

[[Page 25600]]

Areas of the Census Bureau and Metropolitan Areas as defined by the 
Office of Management and Budget. ORHP believes urban areas of 50,000 or 
more have a sufficient population base to support necessary services, 
including advanced medical services, and that there is no need to 
change the threshold.
    Comment: ORHP received comments not only on the use of the 60-
minute travel time, but also on what was the correct point from which 
to measure travel time. Many comments were received from the State of 
Alaska all of which made the point that being a 60-minute drive from an 
urban area is considerably different than having to travel 60 or more 
minutes by air or boat to reach an urban area, both of which are more 
subject to being limited by weather conditions. Commenters also noted 
that travel time might not be directly related to distance. Traveling 
60 minutes by air means that the originating location is much further 
from the central area than a 60-minute trip by automobile. Even the 
distance traveled by car in 60 minutes can be significantly different 
depending on roads and speed. One commenter noted, ``Physical distance 
is important too. If I can typically travel 70 miles in one hour vs. 40 
miles in one hour, even though the travel time models make this 
``equivalent,'' there may be different consequences in terms of 
availability of local resources, costs in accessing and utilizing 
services, providing services, etc.''
    Problems with the increase or diminution of travel time due to 
weather conditions were also mentioned more than once. One commenter 
wrote, ``While the 60 minute framework is a useful benchmark, there 
would be areas affected seasonally where the distance alone would not 
accurately reflect the driving time. Winter snow in passes is one 
example, and high density seasonal traffic in vacation or tourist areas 
is another. If it is possible to incorporate these seasonal shifts into 
the determination, this would more accurately reflect the barriers 
faced by our citizens.''
    Response: ORHP recognizes that commenters are correct that the 60-
minute travel time represents different distances depending on 
circumstances, such as available roads or highways, and depending on 
the mode of transportation used, such as cars, boats, or aircraft. The 
60-minute travel time is a minimum by default. The commenters were also 
correct to note that travel times can be much greater than 60 minutes.
    At the same time, for those who live in areas accessible only by 
water or air, travel time is assumed to be at least 60 minutes even 
though it may actually be less. This is done in an effort to recognize 
the barriers created by lack of ground transport and the frequent 
limitations on availability of transport by water or air. Therefore, we 
believe that the current model addresses concerns stated in regards to 
remote areas with limited road infrastructure or that are reliant on 
non-road transport.
    Comments that weather can affect the distance that can be traveled 
in 60 minutes, or even prevent travel, were also correct. However, 
there is no data source we know of that will allow the FAR codes to be 
adjusted for weather conditions.
    While we recognize the various problems with the assumptions 
inherent in the use of a 60-minute minimum travel time, ORHP believes 
that the 60-minute travel time represents an appropriate minimum. 
Programmatic users of the FAR codes could choose to incorporate weather 
and seasonal variations in access in their criteria if such information 
is available.
    Comment: Several commenters also believed that 60 minutes travel 
did not represent a great barrier to access to the urban area and that 
there should be another level of designation for extremely remote 
Frontier Areas.
    Response: ORHP agrees with the comments received that there can be 
significantly greater travel time than 60 minutes and that communities 
would then face greater barriers to services than those at 60-minutes 
travel time from an Urbanized Area. ORHP will examine the possibility 
of designating another, more remote level that will be 2 or more hours 
travel time from the nearest Urbanized Area in future versions of the 
FAR Codes. This will require additional data analysis and testing 
before another level could be added to the Codes.
    Comment: Comments on the use of travel to the nearest edge of the 
urban area raised concerns about the kinds of services that are 
available at the edge of urban areas, the possible size of the urban 
area itself, and whether the centroid of the area would not be a better 
point from which to measure from. Over a third of commenters felt that 
measuring to the center of the urban area had advantages over measuring 
to the edge.
    Response: While in many cases the commenters' observations on 
services available at the edge of urban areas are accurate, the 
principal reason for using the edge rather than the center of an urban 
area is that the edge is the same for all urban areas; it represents 
the point where population density falls below 500 people per square 
mile. While the edge is a consistent point to measure from, the center 
is not. The center may be one mile from an edge or it may be many miles 
from the edge in the case of large population areas. Neither is it 
self-evident what the ``center'' is. Large urban areas may contain 
several agglomerations of population, none of which may be considered 
the geographic or population ``center.''
    Measuring travel from a centroid would increase the areas 
qualifying as frontier and remote, even though those areas could be 
located close to the edge of the urban area. In addition, many urban 
areas have resources readily available in suburbs and using the 
centroid would discount access to those resources. ORHP does not 
believe that using the centroid would lead to greater accuracy 
designating Frontier and Remote areas and will continue to use travel 
time from the edge of the urban area.
    Comment: The 50 percent population threshold for the ZIP code or 
Census Tract versions of the FAR codes received few comments. One 
comment suggested use of a gradated level to indicate the percentage of 
the population that is FAR instead of simply designating a ZIP or tract 
once the percentage reaches 50 percent. One commenter noted, 
``Aggregation works well when population is evenly dispersed in a 
candidate area, but can lead to inaccuracy if the population of an area 
is concentrated in a single location.'' Commenters from Alaska pointed 
out that Census tracts there can be extremely large, which may lead to 
a problem.
    There were commenters who concurred with the use of the 50 percent 
threshold. ``We recognize there are scenarios in which a ZIP code may 
be designated as urban based on a commuting population being 
concentrated in a small percentage of the land area of a very large ZIP 
code (most like to occur in Western states). Those anomalies can be 
resolved by adjusting the percentage of the population downward, which 
is possible given the public availability of the data.''
    Response: No other threshold was suggested by commenters that could 
replace the 50 percent threshold for designation of Frontier ZIPs or 
Census Tracts. ORHP believes that the 50 percent threshold is a 
reasonable criterion for designating ZIP areas or Census Tracts as FAR 
regions. When the data analysis with Census 2010 is completed, users 
will have access to variables that show, for each ZIP code,

[[Page 25601]]

the percentage of the population that is designated frontier, and 
therefore can set their own thresholds if the need arises to use some 
level other than 50 percent.
    Comment: Other ways of representing urban and rural areas were 
suggested by a few commenters. One commenter wrote, ``States have 
identified a number of distinct areas and communities, currently 
categorized as frontier under other designations discussed in Section 
2.2, which do not appear in the dataset resulting from the FAR 
methodology. The designation of these areas and communities as non-
frontier is problematic if they are to be given consideration for 
federal programs depending on the FAR methodology.'' Another commenter 
mentioned several methods used in other countries.
    Response: While ORHP recognizes that states can and should set 
standards for their own programmatic use, for the purpose of setting a 
national standard, allowing use across the entire United States, it is 
important to use consistent measures. ORHP believes that the Census 
Bureau's designation of Urbanized Areas is a uniform national standard 
and cannot be replaced by standards that would change from state to 
state. While the information on other countries' use of other methods 
is informative, the Census Bureau's standards work best for a national 
standard.
    Comment: Several comments were received on use of the one kilometer 
grid cells that are used to overlay the whole country. One commenter 
noted, ``The use of one by one kilometer grid cells has the potential 
to be a very powerful tool, especially if local organizations are 
provided with a means to access and manipulate that data . . . However, 
even such fine-grained data cannot capture every variation impacting 
the remoteness of an area. Local input can complement the use of the 
FAR methodology to determine remoteness.''
    A State Department of Health commented ``The methodology provides 
more precision by using . . . a 1 x 1 kilometer grid level.''
    However, other commenters were concerned with use of the grid 
system. ``The first component of the method we take issue with is the 
assignment of the 1 square kilometer cells . . . Population assignments 
across these cells could vary greatly across even thinly settled areas, 
unless there was a fixed way to determine the assigned placement of 
these cells from east to west, and from north to south. It was unclear 
how grid assignment was determined.''
    Response: The FAR Codes did use a fixed method to determine the 
assigned placement of the cells. The initial web data product based on 
2000 Census data did not provide detailed, grid-level maps of each 
state, a situation that will change with future updates. In the 
revision of the FAR methodology, the use of a 1 x 1 kilometer grid will 
be replaced with a \1/2\ x \1/2\ kilometer grid, which will increase 
accuracy, and further functionality will be added to the Web site 
allowing users to drill down and examine small areas. ORHP believes 
that this level of analysis obviates the need to overlay other sources 
of data, while still allowing users to include other data appropriate 
to their use of the FAR codes.
    Comment: Many comments were received on the applicability of the 
FAR methodology to island populations, with several stating that 
without more detailed information on which islands were classified 
under which codes it was impossible to evaluate their effect.
    One commenter from Hawaii noted, ``With the information provided, 
it is fairly easy to determine if our small, populated islands would 
qualify, but it is more difficult to evaluate the impact of this 
methodology on remote areas on the islands of Maui and Hawaii.''
    Response: ORHP believes travel time on any island would be treated 
the same way as travel time on the mainland and would produce similar 
results. Islands with small populations would be classified as remote, 
while islands with large populations could have areas that are 
classified as FAR depending on their distance from the population 
center.
    Comment: A comment received from a clinic located on an island in 
the State of Maine pointed out that their ZIP code was not classified 
as FAR even though they are located on an island.
    Response: This may be due to a mismatch between ZIP code areas and 
the FAR grid analysis. In cases where an error is either discovered or 
suspected, ORHP will examine the issue and make corrections where data 
have not been listed correctly.
    Comment: Multiple commenters noted, ``The proposed FAR methodology 
references the need for designation of island and coastal locations 
without road access, but makes only a limited specification of how 
these situations should be handled--the addition of 60 minutes travel 
time to these locations. While this will lead to the designation of 
many island or coastal locations in their own ZCTAs [ZIP Code 
Tabulation Areas], it is not entirely clear how this will impact 
island/coastal communities combined into larger ZCTAs. There are 
multiple island/coastal locations where actual travel time on scheduled 
ferries is less than 60 minutes. A more robust approach is needed for 
dealing with the variety of different island/coastal locations in the 
nation.''
    While there were several examples involving islands given in the 
Federal Register notice, there were also concerns on whether bush 
communities in Alaska, although not technically islands, were just as 
isolated as though they were surrounded by water. At the same time, 
islands that are part of a major Metropolitan Area could qualify as FAR 
Level 4 even though they might have far easier access to services 
available in large population areas than would a community in the 
Alaskan frontier.
    Response: ORHP believes that those who commented on island 
populations and residents of isolated areas, such as the Alaskan bush, 
have legitimate concerns. The update of the FAR codes based on 2010 
Census data should clarify the status of island populations.
    ORHP notes that the 60-minute travel time is a minimum and is not 
intended to be exact. Travel times on land, as well as by air or water, 
could be far greater than 60 minutes. In the case of islands or areas 
where only air or water transport is available, the default to 60 
minutes is not meant to accurately reflect travel under all conditions. 
Travel time will frequently exceed 60 minutes or may be less, but the 
use of the default is meant to reflect the difficulty in assuring 
access to areas where air or water travel is required. As mentioned 
above, ORHP will examine the possibility of designating another, more 
remote level that will be 2 or more hours travel time from the nearest 
Urbanized Area, which would allow a more accurate designation of the 
Alaskan populations mentioned by commenters. There will be an analysis 
of 2010 Census data to determine whether it is feasible to designate 
islands as FAR Level 4, when the actual travel time is less than 60 
minutes travel time from a large population center.
    Comment: Multiple comments were received from Alaska which pointed 
out that the Bethel Urban area comprises a large land area and includes 
multiple communities.
    Response: The commenters are understandably concerned about the 
distances between population centers in Alaska. ORHP will examine the 
issue when data from Alaska are added to the FAR codes through use of 
the Census 2010 data, to determine whether the use of the grid layer 
will allow an accurate representation of the Frontier status of the 
communities that make up the Bethel Census area.

[[Page 25602]]

    Comment: The final question ORHP presented involved issuing Census 
Tract or county versions of the FAR codes. One group wrote, ``The Panel 
recognizes value in having data available in geographic metrics other 
than ZIP code, particularly for integration across data sources. 
However, given current ability to measure areas using RUCA codes or 
Urban Influence Codes, making the data available for designating FARs 
by those areas is not a priority for completing the process of FAR 
designation. The value of the new classification system is its ability 
to be more refined in identifying FARs, which is best accomplished with 
analysis based on ZIP codes.''
    Another group supported census tract and county versions of FAR to 
aid in comparative analysis. Several organizations wrote, ``If the 
methodology is going to begin at the 1 x 1 kilometer grid level and is 
intended to be used flexibly by policymakers, then, of course, it 
should be organized so that aggregation at a variety of geographic and 
political levels should be possible. We suggest that the grid data 
should be organized in a data base in which it can be aggregated at a 
variety of levels, including, each town, county, Indian reservation (or 
other land designation), school district, county, census block, census 
tract, etc. But, most importantly, each aggregation should be 
accompanied by clear definition of how it was developed.''
    Response: As future refinements or revisions are made to the 
methodology, details will be made public at the FAR Codes Web site: 
www.ers.usda.gov/data-products/frontier-and-remote-area-codes.aspx. 
ORHP will examine making different levels of aggregation based on 
geographic units available at the Web site.
    Comment: A large number of commenters were not satisfied with the 
use of ZIP code areas. Especially in rural areas, ZIP codes can cover 
large areas of land including a large population center, which may 
conceal the isolation of areas far from the populated place.
    Response: ORHP agrees with commenters that when attempting to 
compare populations with geographic boundaries that do not match, 
inaccurate classifications are inevitable. Future web access to FAR 
data not based on ZIP code areas but using the grid cells will allow 
greater specificity in analysis, which ORHP believes will deal with the 
commenters concerns.
    Comment: Eight organizations involved in Tribal health care 
commented that the FAR codes were developed without Tribal input.
    Response: While ORHP did sponsor five regional stakeholder meetings 
across the United States which were all announced in the Federal 
Register in order to allow public input, ORHP has also sought input 
through the comment process and welcomes further input in future 
revisions of the FAR codes from tribal organizations and others.
    Comment: Several commenters believed that it was difficult to 
impossible to assess FAR codes without any indication of how they will 
be applied to analysis or used programmatically.
    Response: As was mentioned in the original Federal Register notice, 
ORHP has not used FAR codes to determine programmatic eligibility nor 
has any other agency indicated any intention to use them to direct 
resources. The codes are available and can be used with additional 
sources of data, including demographic data, depending on the purpose. 
However, neither ORHP nor USDA can anticipate how the codes may be used 
in the future. In the event FAR codes are put to programmatic use, 
comments could be directed to the relevant organizations that chose 
their use.
    Comment: Several commenters requested a comparison showing whether 
areas that are classified as ``frontier'' using other methodologies are 
also classified as frontier using FAR codes and whether areas are 
classified as FAR even though they are not ``frontier'' under other 
methodologies.
    Response: ORHP understands the concerns expressed by the 
commenters. While such an analysis is possible, it would not be very 
instructive since FAR is not simply an attempt to designate the same 
areas as frontier using a different methodology. ORHP believes that the 
FAR codes are a new, data-driven methodology and they are offered for 
use or for analysis. Other methods may be better suited for particular 
applications and the FAR codes are not intended to supplant or replace 
other definitions.
    Comment: Several comments were received such as this one saying 
that ``The FAR levels are based on distance only and do not include a 
density consideration.''
    Response: Population density is a key part of this methodology. 
Density is captured much more accurately on the 1x1 km level rather 
than being measured based on entire counties of vastly different areas. 
Use of counties as a unit is problematic because of the lack of 
uniformity. Use of counties would allow too much low-density area to be 
classified as non-Frontier due to the counties overall population 
density concealing the reality of remote, low-density areas.
    Urbanized Areas have population density of over 500 per square 
mile. Distance from Urbanized Areas determines density to a very 
significant extent. The larger the population of the Urbanized Area, 
the greater the distance that must be travelled to get to a low 
threshold population density. On average, rural densities drop to ten 
people per square mile at the following travel times: 50 minutes for 
Urbanized Areas of 2,500 to 10,000 people; 70 minutes for Urbanized 
Areas of 10,000 to 25,000; 95 minutes for Urbanized Areas of 25,000 to 
50,000; and 150 minutes for Urbanized Areas above 50,000.
    The FAR codes measurement from the edge of Urbanized Areas, where 
population density falls below 500 people per square mile, assures that 
density is a primary consideration.
    Comment: Several comments also requested that an appeals process be 
added to the FAR methodology. As one commenter noted, ``Participants at 
every meeting raised the critical importance of providing a process to 
allow local entities (state, tribes, etc.) to provide additional 
information specific to local conditions and to request designation.'' 
Another comment received stated, ``It is recommended that the issuing 
agencies establish a mechanism for submission and review of state, 
tribal and local requests for designation of frontier areas consistent 
with established language for HPSA and MUA/P language.''
    Response: While ORHP realizes that no designation, either for rural 
areas or for Frontier areas, can be perfect, ORHP currently uses a 
data-driven definition of rurality to determine program eligibility. 
ORHP also sought a statistically based, nationally consistent 
definition of frontier territory; one that is adjustable within a 
reasonable range, and applicable in different research and policy 
contexts. In both cases, delineations of rural or frontier areas, 
opening a process to allow individuals or organizations to appeal to 
change a specific area's designation based on criteria other than the 
defined data could cause more problems than it would fix. The advantage 
of having set criteria would be lost as more individual exceptions were 
added. Neither OMB, the Census Bureau, nor the USDA have appeals 
processes regarding their designations. If changes need to be made, the 
criteria are changed which results in a uniform, national standard that 
is clearly understandable even though there are always grey areas that 
can be considered misclassified.
    The FAR codes can be used programmatically, but ORHP and USDA

[[Page 25603]]

believe that it is best to leave individual program decisions on how to 
use FAR codes and what additional criteria to use, if any, to 
programmatic staff. Therefore, neither ORHP nor USDA will undertake 
reviews except in cases where erroneous classifications may have been 
made.

Conclusion

    There are many different definitions of what constitutes both rural 
and frontier areas. The FAR codes are not offered as a replacement for 
other definitions but as one alternative that may be useful in research 
or for programmatic use.
    ORHP considers many of the comments received to be useful in future 
revisions of the FAR codes and appreciates the interest and passion of 
the commenters who are concerned with the population of the United 
States who reside in remote and isolated areas. Further comments and 
suggestions on the FAR codes are welcome.

    Dated: April 25, 2014.
Mary K. Wakefield,
Administrator.
[FR Doc. 2014-10193 Filed 5-2-14; 8:45 am]
BILLING CODE 4165-15-P