Understanding Health Professional Shortage Areas in Louisiana
Geographic areas, populations and facilities with too few primary care physicians, dentists and mental health providers or services are considered Health Professional Shortage Areas (HPSA). Well-Ahead Louisiana uses these designations to focus our resources on meeting the healthcare needs of underserved populations.
What are Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs)?
These designations are reserved for areas and populations that specifically lack of access to primary care services. Medically underserved areas have a shortage of primary healthcare services for residents in a geographic area such as a parish, group of neighboring parishes, a group of census tracts or a group of parish or civil divisions.
Medically underserved population are specific sub-groups of people living in a defined geographic area experiencing a shortage of primary healthcare providers. These include individuals who are considered low-income, homeless, migrant farm workers, Native Americans or Medicaid-eligible.
Federal Opportunities for HPSAs and MUAs/MUPs
The Well-Ahead Louisiana Primary Care Office submits new HPSA and MUA designation applications and updates to the U.S. HHS Health Resources and Services Administration’s Bureau of Workforce who is responsible for the designation process. There are over thirty federal programs that use HPSA designations as a requirement for participation or funds.
Federal opportunities available to Health Professional Shortage Areas include:
- National Health Service Corps Scholarship and Loan Repayment Programs
- Rural Health Clinics
- Medicare Incentive Payments
- J-1 visa waiver physicians
Federal opportunities available to MUAs/MUPs include:
- Federally Qualified Health Centers (FQHC) grants for the planning, development, or operation of community health centers under section 330 of the Public Health Service Act
- Federally Qualified Health Centers (FQHCs) Look-alikes which meet the definition of community health center but are not funded but receive some benefits of FQHCs
- J-1 visa waiver physicians
Find out if you are in a Health Professional Shortage Area
Healthcare professionals can utilize the Health Resources & Services Administration (HRSA) Find Shortage Areas site to determine if their practice facility is in a HPSA/MUA area. You can search your facility location by address, state, or country. HRSA Find provides the type of HPSA (geographic, population, or facility-based), score, HPSA type, and other details.
There are six different types of shortage designations. They are broken out in groups according to the shortage of a specific type of service and geographic, population group and facility shortages.
High needs areas, full-time equivalencies and HPSA ratios are all considered when deciding on the appropriate shortage designation. A high needs area is a place where the 100% Federal Poverty Level is greater than 20%. Full-time equivalency is the total number of hours per week the physician spends in primary care services, either in-office or on-rounds at the hospital, divided by 40. The HPSA ratio can be calculated by taking the total of an area’s full-time equivalencies and dividing it by the population (number of residents per each full-time equivalency).
This designation refers to an area’s access to physicians that practice primarily in one of the following categories:
- Family practice
- General practice
- Internal medicine
The ratio of patients to available providers is used to measure the level of primary care access. Areas with a ratio of 3,500 possible patients to one full-time equivalency primary care physician are considered underserved. Areas are considered High Needs if the ratio is 3,000:1 and the 100% Federal Poverty Level is greater than 20%.
Dental HPSA designations are based on a ratio scheme similar to Primary Care HPSA designations, but take additional factors into consideration. Dental full-time equivalencies are calculated by weighting the number of hours of patient care worked per week by a dentist according to the dentist’s age and number of employed assistants and hygienists. An area must have a 5,000:1 ratio to be designated as a Dental HPSA, while High Needs areas require a ratio of 4,000:1.
Mental Health designations are also determined by the ratio of provider full-time equivalencies to patients. A ratio of 30,000:1 is required to receive this designation. For High Needs areas, this ratio has been adjusted to 20,000:1.
This is the broadest type of designation. It takes into account the entire population of the requested area to all available physicians, dentists or psychiatrists.
Population Group Designation uses a ratio built on the low-income population of an area. Eligibility requires a minimum 200% Federal Poverty Level of 30% of the population.
Only facilities that do not already fall under a geographic or population designation are eligible for facility designation, which is determined using outpatient census, wait times, patients’ residences and staff count. If a geographic or population HPSA covering this site becomes active, the facility designation is removed. Automatically designated Health Professional Shortage Areas and Correctional Facility HPSAs use unique qualifiers based on their specific populations and therefore their facility designations are not removed even if they are located in a geographic or population HPSA.
Shortage Designation Modernization Project
The federal Shortage Designation Modernization Project began in 2013 to streamline the shortage designation process based on the principals of transparency, accountability and parity.
The project began with the development of the Shortage Designation Management System which uses standardized data from multiple trusted sources. Using existing scoring criteria, HRSA updated all automatically designated Health Professional Shortage Areas (Auto-HPSAs) on August 30, 2019. No Auto-HPSA will ever lose its designation due to this type of update and can only be removed if CMS certification is lost. Well-Ahead continues to provide data, local context and input to federal staff to ensure that all HPSA designations are accurate and reflect the reality of provider shortage in communities across the state.
Automatically Designated HPSA Facilities
Federally Qualified Health Centers (FQHCs)
FQHCs are health centers that provide primary care to an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. All organizations receiving grants under Health Center Program Section 330 of the Public Health Service Act are FQHCs.
FQHC Look-A-Likes (LALs)
LALs are community-based healthcare providers that meet requirements of the Health Resources and Services Administration Health Center Program, but do not receive Health Center Program funding.
Indian Health Facilities, Indian Health Service and Tribal Hospitals
These are Federal Indian Health Services, tribally run, and Urban Indian Health clinics and hospitals that provide medical services to members of federally recognized tribes and Alaska Natives.
Dual-funded Community Health Centers and Tribal Clinics
Dual-funded Community Health Centers and Tribal Clinics are health centers that receive funding from tribal entities and the Health Resources and Services Administration to provide medical services to members of federally recognized tribes and Alaska natives.
CMS-Certified Rural Health Clinics (RHCs)
RHCs are outpatient clinics located in non-urbanized areas that CMS certifies. These must meet National Health Service Corps site requirements including accepting Medicaid, Children’s Health Insurance Program and providing services on a sliding fee scale.
Frequently Asked Questions about Automatically Designated HPSA Facilities
How does the national update of Auto-HPSAs affect National Health Service Corps (NHSC) and Nurse Corps?
If an update of Auto-HPSAs changes a HPSA score, it may impact a facility’s competitive status for these programs. The National Shortage Designation Update of Auto-HPSAs does not affect CMS HPSA Bonus Payments or rural health clinics’ enrollment/certification. If an organization’s score decreased because of the national update, it will not immediately affect current NHSC and Nurse Corps participants at the facility. They will be allowed to fulfill their service commitment without contract changes. Following their commitment, NHSC and Nurse Corps participants may apply for a continuation award if they remain in a HPSA. If NHSC and Nurse Corps participants want to transfer to another approved site, they must identify a site in the same tier. If NHSC participants are eligible for a continuation, they may continue to serve at any eligible site with a HPSA.
What is the difference between a Parish HPSA score and a facility’s Auto-HPSA Score?
A facility’s Auto-HPSA score stands alone and is not affiliated with the parish score. The auto-HPSA score remains active regardless of the score or designation of the parish. No Auto-HPSA will ever lose their designation due to this type of update as the designation can only be removed if CMS certification is lost.
Should I use the Parish HPSA Score or the facility’s Auto-HPSA Score?
Providers working in a facility with an auto-HPSA score may choose to use the facility score or the parish score within which their facility is located. This provides the opportunity to choose the higher score.
What can sites do to accurately reflect their score?
Auto-HPSA sites may:
- Submit accurate Uniform Data System (UDS) data.
- Work with the Primary Care Office to ensure all provider data is up-to-date.
- Make sure the nearest source of care (NSC) is not located within the facility.
- Compare facility data to the data used by HRSA for supplemental information (low birth weight/infant mortality rate, ratios of children under 18 and adults 64 and older) to ensure the most accurate data is provided. The Primary Care Office will update the fluoridation, substance abuse and alcohol abuse percentages annually.
- When is my area’s designation scheduled for review?