[Federal Register Volume 79, Number 122 (Wednesday, June 25, 2014)]
[Notices]
[Pages 36075-36076]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-14806]


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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 23, 2014, 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    HPSAs are designated or withdrawn by the Secretary of Health and 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.

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 Workforce (BHW) 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, mental, or dental 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 BHW. 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 BHW. 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 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 BHW, 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 BHW. Proposed withdrawals become effective only after interested 
parties in the area affected have been afforded the opportunity to 
submit additional information to BHW in support of its continued or 
revised designation. If no new data are submitted, or if BHW 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 HPSAs 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

[[Page 36076]]

include a snapshot of all geographic areas, population groups, and 
facilities that were designated HPSAs as of May 23, 2014. This notice 
incorporates the most recent annual reviews of designated HPSAs and 
supersedes the HPSA lists published in the Federal Register on June 27, 
2013 (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 23, 2014. It should be noted that HPSAs are currently updated on an 
ongoing basis based on the identification of new areas, population 
groups, 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. 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 23, 2014, 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.

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 Melissa Ryan, Operations Director, 
Division of Policy and Shortage Designation, Bureau of Health 
Workforce, Health Resources and Services Administration, Room 9A-55, 
Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857, (301) 
594-0816, http://www.hrsa.gov/shortage/.

    Dated: June 18, 2014.
Mary K. Wakefield,
Administrator.
[FR Doc. 2014-14806 Filed 6-24-14; 8:45 am]
BILLING CODE 4165-15-P