[Federal Register: April 21, 2008 (Volume 73, Number 77)]
[Proposed Rules]
[Page 21300-21301]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr21ap08-30]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
42 CFR Parts 5 and 51c
RIN 0906-AA44
Designation of Medically Underserved Populations and Health
Professional Shortage Areas
AGENCY: Department of Health and Human Services (HHS).
ACTION: Notice of proposed rulemaking; extension of public comment
period and clarification.
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SUMMARY: On February 29, 2008, HHS published a notice of proposed
rulemaking, ``Designation of Medically Underserved Populations and
Health Professional Shortage Areas'' (73 FR 11232), to revise and
consolidate the criteria and processes for designating medically
underserved populations (MUPs) and health professional shortage areas
(HPSAs). HHS provided a 60-day public comment period, with written
comments to be received on or before April 29, 2008. HHS and the Health
Resources and Services Administration (HRSA) have received requests for
an extension of the comment period. In consideration of these requests,
HHS is extending the comment period an additional 30 days, with a new
closing date of May 29, 2008.
DATES: Written comments on the proposed rule must be submitted on or
before May 29, 2008. Please refer to SUPPLEMENTARY INFORMATION for
additional information.
ADDRESSES: You may submit comments in one of four ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to http://www.regulations.gov. Click on the
link ``Submit electronic comments on HRSA regulations with an open
comment period.'' (Attachments should be in Microsoft Word,
WordPerfect, or Excel; however, we prefer Microsoft Word.)
2. By Regular Mail. You may mail written comments (one original and
two copies) to the following address only: Health Resources and
Services Administration, Department of Health and Human Services,
Attention: Ms. Andy Jordan, 8C-26 Parklawn Building, 5600 Fishers Lane,
Rockville, MD 20857.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By Express or Overnight Mail. You may send written comments (one
original and two copies) to the following address only: Health
Resources and Services Administration, Department of Health and Human
Services, Attention: Ms. Andy Jordan, 8C-26 Parklawn Building, 5600
Fishers Lane, Rockville, MD 20857.
4. By Hand or Courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period (May 29, 2008) to one of the following
addresses. If you intend to deliver your comments to the Rockville
address, please call telephone number (301) 594-0816 in advance to
schedule your arrival with one of our staff members at these addresses:
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201; or 8C-26 Parklawn Building, 5600 Fishers Lane,
Rockville, MD 20857. (Because access to the interior of the HHH
Building is not readily available to persons without Federal Government
identification, commenters are encouraged to leave their comments in
the HRSA drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing
by stamping in and retaining an extra copy of the comments being
filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
FOR FURTHER INFORMATION CONTACT: Andy Jordan, (301) 594-0197.
SUPPLEMENTARY INFORMATION: HRSA is concerned that the publication of
the proposed HPSA/MUP regulation has created misapprehension among some
health center grantees regarding their ability to meet the proposed
HPSA/MUP designation criteria, and in particular, their eligibility for
current or expanded health center funding opportunities. The proposed
rule includes three methods for making designations. As proposed, none
of the three methods would limit health center eligibility for current,
new or expanded funding.
Currently, all of the designations are made on data that are
submitted by States or communities. Under the proposed rule, this
submission burden would be reduced by HRSA's use of nationally
available data for initial calculations. In addition, States or
communities continue to have the option to submit more specific or
current local data as an alternative for use in calculations. This
option may be particularly important to accurately reflect local
demographic and health service realities. For example, an urban area
may include a subpopulation with high needs, or a rural area may have
recently experienced an acute loss of primary care providers.
In addition to the Tier 1 method, the proposed rule includes two
new designation methods. The first new method (Tier 2) assures that
areas/organizations are not disadvantaged by the presence of federally-
supported resources. The second new method (Safety Net Facility) allows
those organizations that serve high need populations to maintain or
pursue designation. If none of the above methods produces a
designation, this proposed rule continues the possibility of
designation at the request of the Governor pursuant to existing law
(section 330(b)(3)(D), Public Health Service Act).
[[Page 21301]]
To reassess the impact of the proposed regulation on health
centers, HRSA analyzed the most recent data from health center grantees
who reported in calendar year 2006 to the Uniform Data System (UDS) and
HRSA applied the methodologies in the proposed rule using nationally
available data. Based on this analysis, at most, only 16 out of 1,001
health center grantees (1.6 percent) would have to include State or
local data to seek to maintain their current designation status. This
analysis was conducted at the grantee level consistent with HRSA's
health center policy that states: ``The statutory obligations of
serving an MUA or MUP is an organizational level obligation, not a site
specific requirement.'' (http://answers.hrsa.gov/, Answer ID 1216). The
proposed rule does not change this health center policy.
In order to facilitate a better understanding of the proposed rule,
HRSA provided State Primary Care Offices (PCO) with a calculator that
applies the formulas proposed in the rule to determine designation,
with data files, as well as with technical assistance in using the
calculator. We encourage interested parties to contact and work with
their PCOs (http://nhsc.bhpr.hrsa.gov/resources/info/pco.asp) to review
data and understand the implications of the proposed rule.
To allay concerns of some commenters, this notice seeks to draw
attention to and elicit comments on the following matters:
Eligibility for Federal Resources
In the preamble, a statement in section IV. B. Methodology (last
paragraph before subsection C at 73 FR 11247) inaccurately reflects our
intent and the potential effect regarding eligibility for organizations
designated through Tier 1 or Tier 2. It suggests that Tier 2
designations will not be eligible for additional Federal resources.
That is not the case. No provision in the proposed rule imposes any
such limitation and it is not our intent to do so. Under the proposed
rule, whether designated via Tier 1, Tier 2, or Safety Net Facility all
entities will be equally eligible to compete for new or expanded health
center funding. Similarly, all entities designated through Tier 1, Tier
2, or Safety Net Facility will be equally eligible to compete for
National Health Service Corps (NHSC) placements. In contrast to the
health center policy described above, NHSC placements are site specific
pursuant to section 333(a) of the Public Health Service Act. For
example, while a health center grantee may be eligible for health
center funding for all of its sites, only some of its sites may be
eligible under law for NHSC placements. For further information on NHSC
placements, please contact your State PCO.
Scoring for Relative Need
Scores are a numerical expression of relative need derived from
available data about demography, economics, population density, health
status and available primary care providers. Scores are designed to be
used by the NHSC for provider placement and may be used by other
programs. While the proposed rule does not include a specific
methodology for scoring those organizations that receive a designation
for serving high-need populations (Safety Net Facility), a scoring
methodology will have to be established. To determine a Safety Net
Facility designation, HRSA will need data on the proportions of the
applicant organization's patient population that are low-income
uninsured as well as Medicaid-eligible (see 73 FR 11251 of the proposed
rule). We seek comments on how to score these Safety Net Facility
designations so that their need is ranked equitably with the
designations scored in the other methods outlined in the proposed rule,
that is, Tier 1 and Tier 2.
We invite comments on these issues, as well as any other provisions
of the proposed rule. We will respond to all comments when we publish
the final rule.
Dated: April 17, 2008.
Elizabeth M. Duke,
Administrator, Health Resources and Services Administration.
[FR Doc. 08-1167 Filed 4-17-08; 11:32 am]
BILLING CODE 4152-01-P