[Federal Register Volume 89, Number 1 (Tuesday, January 2, 2024)]
[Notices]
[Pages 82-83]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-28844]


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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 (HRSA), Department 
of Health and Human Services.

ACTION: Notice.

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SUMMARY: This is the second of two planned notices informing the public 
of the availability of the complete lists of all geographic areas, 
population groups, and facilities designated as primary medical care, 
dental health, and mental health professional shortage areas (HPSA). 
This notice includes the lists of HPSAs in a designated status as of 
December 2, 2023. The lists are available on the shortage area topic 
page on HRSA's data.hrsa.gov website. The first Federal Register notice 
was published on July 3, 2023, and included HPSAs in a designated 
status and those proposed for withdrawal, while extending the 
transition time communicated in the prior notice published on July 7, 
2022. State primary care offices had additional time to submit HPSA 
data that was re-evaluated in preparation for the publication of this 
notice. This second Federal Register notice includes the lists of HPSAs 
in a designated status and withdraws designations proposed for 
withdrawal not meeting the requirements for designation as of the data 
pull on December 2, 2023.

ADDRESSES: Complete lists of HPSAs designated as of December 2, 2023, 
are available on the website at https://data.hrsa.gov/tools/health-workforce/shortage-areas/frn. Frequently updated information on HPSAs 
is available at https://data.hrsa.gov/topics/health-workforce/health-workforce-shortage-areas. Information on shortage designations is 
available at https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation.

FOR FURTHER INFORMATION CONTACT: For further information on the HPSA 
designations listed on the website or to request additional 
designation, withdrawal, or reapplication for designation, please 
contact Anthony Estelle, Chief, Shortage Designation Branch, Division 
of Policy and Shortage Designation, Bureau of Health Workforce (BHW), 
HRSA, 5600 Fishers Lane, Room 11W16, Rockville, Maryland 20857, 
[email protected].

SUPPLEMENTARY INFORMATION: 

Background

    Section 332 of the Public Health Service (PHS) Act, 42 U.S.C. 254e, 
provides that the Secretary 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 lists of the designated geographic areas, 
population groups, and facilities. The lists of HPSAs are to be 
reviewed at least annually and revised as necessary.
    Final regulations (42 CFR part 5) were published in 1980 that 
include the criteria for designating HPSAs. Criteria were defined for 
seven health professional types: primary medical care, dental, 
psychiatric, vision care, podiatric, pharmacy, and veterinary care. The 
criteria for correctional facility

[[Page 83]]

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 or 
relevant sub-score designations such as Maternity Care Target Areas.
    HPSA designation offers access to potential federal assistance. 
Public or private nonprofit entities are eligible to apply for 
assignment of National Health Service Corps personnel to provide 
primary medical care, mental health, or dental health services in or to 
these HPSAs. National Health Service Corps health professionals enter 
into service agreements to serve 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 HRSA's BHW. Other federal programs also utilize HPSA 
designations. For example, under authorities administered by the 
Centers for Medicare & Medicaid Services, certain qualified providers 
in geographic area HPSAs are eligible for increased levels of Medicare 
reimbursement.

Content and Format of Lists

    The three lists of designated HPSAs are available on the HRSA Data 
Warehouse shortage area topic web page and include a snapshot of all 
geographic areas, population groups, and facilities that were 
designated HPSAs as of December 2, 2023. This notice incorporates the 
most recent annual reviews of designated HPSAs, which can be located on 
HRSA's data.hrsa.gov website, and supersedes the HPSA lists published 
in the Federal Register on July 3, 2023 (88 FR 42725).
    In addition, all Indian Tribes that meet the definition of such 
Tribes in the Indian Health Care Improvement Act of 1976, 25 U.S.C. 
1603, are automatically designated as population groups with primary 
medical care and dental health professional shortages. Further, the 
Health Care Safety Net Amendments of 2002 provides eligibility for 
automatic facility HPSA designations for all federally qualified health 
centers (FQHC) and rural health clinics that offer services regardless 
of ability to pay. Specifically, 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. Since they are automatically designated by statute, 
absence from this list does not exclude them from HPSA designation; 
facilities eligible for automatic designation are included in the 
database when they are identified.
    Each list of designated HPSAs 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, a county is part of a larger 
designated service area, or a population group residing in a 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. A county that has a whole county geographic or 
population group HPSA is indicated by the phrase ``County'' following 
the county name.

Development of the Designation and Withdrawal Lists

    Requests for designation or withdrawal of a particular geographic 
area, population group, or facility as a HPSA are received continuously 
by BHW. Under a Cooperative Agreement between HRSA and the 54 state and 
territorial Primary Care Offices (PCO), PCOs conduct needs assessments 
and submit applications to HRSA to designate HPSAs. BHW also receives 
other requests for designation from other sources and refers them to 
PCOs for review. As part of the HPSA designation process, interested 
parties, including Governors, state Primary Care Associations, and 
state professional associations, are notified of requests so that they 
may submit their comments and recommendations.
    BHW reviews each recommendation for possible addition, 
continuation, revision, or withdrawal. Following review, BHW notifies 
the appropriate agency, individuals, and interested organizations of 
each designation of a HPSA, rejection of recommendation 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 from BHW 
and are updated daily on the HRSA Data Warehouse website. While this 
list is a snapshot of HPSAs at a point in time, HPSA designations are 
regularly being updated so the best source of current designation 
status is the HRSA Data Warehouse website at (https://data.hrsa.gov/tools/shortage-area).
    In 2024, BHW will publish two Federal Register notices to inform 
the public of the availability of the complete lists of all geographic 
areas, population groups, and facilities designated as primary medical 
care, dental health, and mental health professional shortage areas. The 
first notice will be on or before May 1, 2024, and will list all 
designated HPSAs and those that are proposed for withdrawal HPSAs that 
will remain in a designated status until the second Federal Register 
notice which will be scheduled on or before November 1, 2024. The 
second Federal Register notice will withdraw all HPSAs that were 
proposed for withdrawl and do not meet the requirements for 
designation. This two-step process provides greater clarity for 
jurisdictions and facilities to prepare for any changes in HPSA 
designation.

Carole Johnson,
Administrator.
[FR Doc. 2023-28844 Filed 12-29-23; 8:45 am]
BILLING CODE 4165-15-P