[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]
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