MONTANA HEALTH PROFESSIONAL SHORTAGE AREA
AND MEDICALLY UNDERSERVED DESIGNATIONS

Section 332 of the Public Health Service Act provides that the Secretary of Health and Human Services shall designate health professional shortage areas (HPSAs). The authority for designations is delegated to the Shortage Designation Branch in the Health Resources and Service Administration (HRSA) Bureau of Health Professions National Center for Health Workforce Analysis which develops shortage designation criteria and uses them to decide whether or not a geographic area or population group is a Health Professional Shortage Area (HPSA) or a Medically Underserved Area or Population (MUA/P). More than 34 federal programs depend on the shortage designations to determine eligibility or as a funding preference. The Shortage Designation Branch maintains a website http://bhpr.hrsa.gov/shortage/ which has the HPSA and MUA/P Guidelines and Criteria and searchable current designation listings (http://www.hpsafind.hrsa.gov/) for the entire United States. The Health Care Safety Net Amendments of 2002 provided for automatic facility HPSA status for all Federally Qualified Health Centers and those Rural Health Clinics (RHCs) that meet the requirement of providing access to care regardless of ability to pay. The new scoring for automatic HPSA facilities and population groups is also available from the website (http://bhpr.hrsa.gov/shortage/).

State Primary Care Offices within state health departments assist local communities with the designation process. The Montana Department of Public Health Human Services Primary Care Office is the state contact for HPSAs and MUA/P assistance. Contact John Schroeck at 406-444-3934 or email jschroeck@mt.gov.

Medically Underserved Areas/Populations

Medically Underserved Areas or Populations (MUA/Ps) are census areas that have a shortage of personal health services. The MUA/P application involves four variables: ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level and percentage of the population age 65 and over. Federal programs that utilize the MUA designation include the community health center program (330 grants) and the rural health center program (PL 95-210).  See http://www.dphhs.mt.gov/PHSD/Primary-Care/primary-care-index.shtml to obtain a map of Montana MUA/Ps.

Health Professional Shortage Areas

Health Professional Shortage Areas (HPSAs) require three basic determinations: (1) the geographic area involved must be rational for the delivery of health services, (2) a specified population to practitioner ratio representing shortage must be exceeded within the area, and (3) resources in contiguous areas must be shown to be over-utilized, excessively distant, or otherwise inaccessible. HPSAs may have shortages of primary medical care, dental or mental health providers and may be urban or rural areas, population groups or medical or other public facilities (State prisons or mental hospitals, federally qualified health centers or certified rural health clinics). Maps showing the primary care, dental and mental health HPSAs in Montana may be downloaded or printed from Primary Care Office website: http://www.dphhs.mt.gov/PHSD/Primary-Care/primary-care-index.shtml (Be sure to check with the PCO to assure the maps are up to date.)

Examples of some of the federal programs that utilize HPSA designations include:

National Health Service Corps Loan Repayment, Scholarship, and SEARCH programs, Rural Health Clinics Act (PL 95-210), Medicare Incentive Payments for Physician Services (PL 100-203, Section 4043 as amended), Area Health Education Center Program. More information on these programs may be obtained from the Primary Care Office contact list above.  The website for the National Health Service Corps program is http://nhsc.bhpr.hrsa.gov/.