[Federal Register Volume 89, Number 82 (Friday, April 26, 2024)]
[Notices]
[Pages 32451-32453]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-08931]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Proposed Inclusion of Terrain Factors in the Definition of Rural 
Area for Federal Office of Rural Health Policy Grants

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services (HHS).

ACTION: Request for public comment.

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SUMMARY: HRSA's Federal Office of Rural Health Policy (FORHP) utilizes 
clear, consistent, and data-driven methods of defining rural areas in 
the United States for the purposes of determining eligibility for its 
rural health grant programs. FORHP monitors ongoing national research 
and, as appropriate, considers updates to its definition. Because 
access to needed health care is likely to be reduced when roads are 
most difficult to traverse, with this notice, FORHP proposes to modify 
the definition of rural areas by integrating the new Road Ruggedness 
Scale (RRS) released in 2023 by the Economic Research Service (ERS) of 
the U.S. Department of Agriculture, which characterizes topographic 
variability, or ruggedness, of roads. This proposal does not impact 
rural areas included in the current FORHP definition. This notice seeks 
public comment on FORHP's proposal. This notice also includes a 
technical clarification explaining how FORHP will use Census data to 
identify outlying Metropolitan Statistical Area counties that qualify 
as rural in future updates given the U.S. Census Bureau's 2020 Census 
terminology changes that removed the categories of Urban Clusters and 
Urbanized Areas.

[[Page 32452]]


DATES: Submit comments no later than May 28, 2024.

ADDRESSES: Comments should be submitted to [email protected].

FOR FURTHER INFORMATION CONTACT: Greta Stuhlsatz, Statistician, Policy 
Research Division, FORHP, HRSA, 5600 Fishers Lane, Rockville, Maryland 
20857; (301) 443-0835; and [email protected].

SUPPLEMENTARY INFORMATION:

Background

    Section 711 of the Social Security Act (42 U.S.C. 912) directs 
FORHP to advise the Secretary of HHS on policies affecting rural 
hospitals and health care and coordinating activities within HHS that 
relate to rural health care. Since the 1990s, FORHP has administered 
grants that support activities related to increasing access to health 
care in rural areas. FORHP's authorizing statute does not, however, 
include a definition of ``rural area.'' To carry out this charge, FORHP 
monitors ongoing national research and analysis efforts related to 
defining geographic areas and rurality. As new methods and data become 
available, FORHP may consider revisions to the definition.
    Historically, there have been two principal definitions of 
``rural'' that were in use by the Federal Government: The U.S. Census 
Bureau urban-rural classification (https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural.html) and the Office 
of Management and Budget's definition of metropolitan, also called 
metro, areas (https://www.census.gov/programs-surveys/metro-micro.html). Neither definition defined ``rural'' directly, but rather 
defined areas as either ``urban,'' with all other territory being 
``rural,'' or as ``metro,'' with all other territory being ``non-
metro.''

Current FORHP Definition of Rural Area

    FORHP currently designates the following areas as rural for 
purposes of FORHP's grant programs: \1\
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    \1\ See the notice ``Revised Geographic Eligibility for Federal 
Office of Rural Health Policy Grants,'' 85 FR 59806 (Sept. 23, 
2020), for a full description of the methods and data sources used 
to develop FORHP's definition of rural areas. See the notice 
``Response to Comments on Revised Geographic Eligibility for Federal 
Office of Rural Health Policy Grants,'' 86 FR 2418 (Jan. 12, 2021), 
for FORHP's current definition of rural areas. See Defining Rural 
Population, https://www.hrsa.gov/rural-health/about-us/what-is-rural.
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    (1) All non-metro counties,
    (2) All outlying metro counties without an Urbanized Area,
    (3) All metro census tracts with Rural Urban Commuting Area (RUCA) 
codes 4-10, and
    (4) Metro census tracts of at least 400 square miles in area with 
population density of 35 or less per square mile with RUCA codes 2-3.
    FORHP's current definition finds that 19.7 percent of the 
population, or approximately 60.8 million people, live in rural areas, 
and classifies 86 percent of the land area of the United States as 
rural (based on 2010 Census data; all data will be updated when updated 
RUCA codes are available using data from the 2020 Census). Information 
on whether individual addresses are within a rural area can be 
identified in a search tool at the HRSA Data Warehouse.\2\ HRSA updates 
the search tool as needed to assist rural health grant applicants.
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    \2\ HRSA Data Warehouse: https://data.hrsa.gov/tools/rural-health.
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Adding Rugged Terrain Data to the Definition of Rural Area

    FORHP's definition of rural area was last updated in 2021.\3\ At 
that time, some commenters suggested that FORHP should further modify 
the definition of rural area to account for difficult and mountainous 
terrain because travel on roads through such terrain is more difficult 
and time-consuming. FORHP did not have national data that could 
consistently identify areas of difficult terrain.
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    \3\ ``Response to Comments on Revised Geographic Eligibility for 
Federal Office of Rural Health Policy Grants.'' 86 FR 2418 (Jan. 12, 
2021).
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    In 2023, the ERS published a report, Characterizing Rugged Terrain 
in the United States,\4\ which describes the measurement of topographic 
variation using the Terrain Ruggedness Index. The ERS conducted a study 
to analyze how population, population density, and income vary by 
ruggedness and rurality. The ERS produced two scales:
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    \4\ Research Report No. ERR-322, August 2023. Available at 
https://www.ers.usda.gov/publications/pub-details/?pubid=107027.
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    (1) The Area Ruggedness Scale (ARS) measures the changes in 
elevation for all terrain and classifies census tracts as: (1) level, 
(2) nearly level, (3) slightly rugged, (4) moderately rugged, (5) 
highly rugged, and (6) extremely rugged. This characterizes overall 
ruggedness in the entire tract.
    (2) The RRS measures the changes in elevation beneath roads and 
classifies census tracts as: (1) level, (2) nearly level, (3) slightly 
rugged, (4) moderately rugged, and (5) highly rugged. This 
characterizes overall ruggedness along roads in the tract.\5\
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    \5\ ARS and RRS data are available at https://www.ers.usda.gov/data-products/area-and-road-ruggedness-scales/.
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    The RRS, or roads-only scale, helps to study the impact of rugged 
terrain on travel by vehicle. Based on the ERS analysis of the RRS, 
population density was highest, on average, for nearly level census 
tracts (5,514 people per square mile) and lowest for highly rugged 
census tracts (3,390 people per square mile).

                Table 1--RRS Categories and Census Tracts
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                                             Number of      Percent of
              RRS category                 census tracts   census tracts
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1--Level................................          47,740            65.6
2--Nearly level.........................          16,297            22.4
3--Slightly rugged......................           5,518             7.6
4--Moderately rugged....................           1,956             2.7
5--Highly rugged........................           1,254             1.7
                                         -------------------------------
    Total...............................          72,765           100.0
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    FORHP is proposing to expand its definition of rural by 
incorporating the RRS into the definition for purposes of FORHP's grant 
programs. All areas included in the current definition would remain 
included. The RRS focuses on roads and the difficulty of travelling in 
mountainous terrain, while the ARS more generally classifies the 
topography of the tract's terrain. Access to needed health care is 
likely to be reduced when the roads are most difficult to traverse. 
FORHP proposes including census tracts of at least 20 square miles in 
area in metro counties

[[Page 32453]]

with RRS 5 (highly rugged) and RUCA code 2 or 3 in our definition of 
rural area (tracts with RUCA codes 4-10 regardless of RRS are already 
included). Some small area tracts within or on the edge of cities can 
have rugged terrain (e.g., State or local parks), but they are very 
small size and adjacent to major population centers.
    FORHP estimates that including census tracts that are at least 20 
square miles in area with RRS 5 and RUCA 2-3 in the definition of rural 
area would add 84 census tracts and approximately an additional 304,834 
people to the 60,758,275 people currently living in FORHP-designated 
rural areas, an increase of 0.5 percent in the total number of people 
living in rural areas. The number of eligible census tracts by State is 
included in table 2.
    Only tracts that meet all criteria--RRS 5 and RUCA 2-3 with an area 
over 20 square miles--would be newly eligible under this proposed 
update. Tracts with RRS 5 and RUCA code 1 could not be classified as 
rural areas as tracts with RUCA code 1 contain populations from urban 
areas with over 50,000 residents. Additionally, the RUCA code 1 tracts 
located in metro counties are part of the metropolitan area core and 
have primary commuting flow within the urban area.\6\ For example, San 
Francisco, California has 31 census tracts with RRS 5 and RUCA code 1, 
and these small areas with rugged terrain inside the metropolitan area 
core are not rural in character.
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    \6\ See the description of Rural-Urban Commuting Area Codes at 
https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.

  Table 2--Number of Census Tracts With RRS 5 and RUCA Code 2 or 3 and
                    Area Over 20 Sq. Miles, by State
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                          State                             New tracts
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CA......................................................              24
OR......................................................              16
NC......................................................              12
WA......................................................               9
TN......................................................               7
CO......................................................               6
WV......................................................               6
MT......................................................               2
AK......................................................               1
MD......................................................               1
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    Total...............................................              84
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Note: Data in this table are based on 2010 census tract geographies. For
  a complete list of impacted census tracts see: https://www.hrsa.gov/rural-health/about-us/what-is-rural/data-files.

    FORHP's proposal to modify our definition of rural area for 
purposes of FORHP's grant programs reflects efforts to be responsive to 
stakeholder feedback and target programs towards the intended 
communities. Other rural definitions for other purposes may be set by 
statute or regulation or be designed to meet different program goals.

Notification of FORHP's Technical Clarification in Response to the U.S. 
Census Bureau's 2020 Census Terminology Changes Removing Urban Clusters 
and Urbanized Areas

    Prior to the 2020 Census, the U.S. Census Bureau designated two 
categories of urban areas--Urban Clusters (with a population of 2,500 
to 49,999) and Urbanized Areas (with a population of 50,000 or more). 
With the elimination of these sub-categories to differentiate urban 
areas with large and small populations, the U.S. Census Bureau now only 
designates urban areas (population of 5,000 and up or housing units of 
2,000 or more) and does not sub-categorize urban areas by size. FORHP's 
rural definition excludes outlying metro counties with an Urbanized 
Area. To retain the distinction between urban areas with population 
over and under 50,000 in FORHP's definition of rural area, FORHP will 
identify and categorize urban areas based on population size. With this 
technical clarification, the definition, ``all outlying metro counties 
with no urban population from an urban area of 50,000 or more people,'' 
will replace ``all outlying metro counties without an urbanized area.''
    FORHP will use the urban area population counts published by the 
U.S. Census Bureau in the list of qualifying urban areas for the 2020 
Census (https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural.html) to sub-categorize urban areas as less than 
50,000 people (e.g., a population of 49,999 or fewer) and as 50,000 or 
more people in the next update to rural area data files. Consistent 
with our current definition, FORHP will consider outlying metro 
counties without population from urban areas with 50,000 or more people 
as rural areas, and the entire county would be considered a rural area 
for our grant programs.
    There are 327 outlying metro counties in the Office of Management 
and Budget's Bulletin No. 23-01, released July 21, 2023, that have no 
population part of an urban area with 50,000 or more people. Outlying 
metro counties with any population from urban areas with 50,000 or more 
people would not be considered rural areas, however census tracts 
within those counties would be considered rural areas if they meet the 
RUCA criteria or the RUCA and RRS criteria, as applicable.

Proposed FORHP Definition of Rural Area Incorporating the RRS and the 
Technical Clarification in Response to Census Terminology Changes

    FORHP proposes to designate the following areas as rural for 
purposes of FORHP's grant programs:
    (1) Non-metro counties,
    (2) Outlying metro counties with no urban population from an urban 
area of 50,000 or more people,
    (3) Census tracts in metro counties with RUCA codes 4-10,
    (4) Census tracts in metro counties of at least 400 square miles in 
area with population density of 35 or less per square mile with RUCA 
codes 2-3, and
    (5) Census tracts in metro counties with RRS 5 and RUCA codes 2-3 
that are at least 20 square miles in area.

Request for Public Comment

    FORHP is proposing to modify the current definition of rural area 
for purposes of FORHP's grant programs. FORHP seeks comments from the 
public on the proposed use of the RRS to identify rural areas as 
described above.
    This request for comments is issued solely for information and 
planning purposes; it does not constitute a Request for Proposal, 
applications, proposal abstracts, or quotations. This request does not 
commit the Government to contract for any supplies or services or make 
a grant or cooperative agreement award or take any other official 
action. Further, HRSA is not seeking proposals through this request for 
comments and will not accept unsolicited proposals.

Carole Johnson,
Administrator.
[FR Doc. 2024-08931 Filed 4-25-24; 8:45 am]
BILLING CODE 4165-15-P