Rulemaking Committee Recommends New HPSA/MUA Designation Methodology
Do we know where the Health Profession Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs) are located in the United States? Perhaps. But for now, we will need to wait until the Government tells us where they are going to be located in the future. On October 13th, the Negotiated Rulemaking Committee for the Designations of HSPAs and MUAs (created by section 5602 of the Affordable Care Act) approved a report to the Secretary of HHS with methodology for identifying shortage areas. This report was approved by a vote of 21-2 (5 members were not present and did not vote). Under the Negotiated Rulemaking Act of 1990, a unanimous recommendation by the committee was necessary for the Department of Health and Human Services to publish the committee’s recommendations verbatim as the interim rule. However, because the recommendation was not unanimous, the Secretary MAY use our recommendation only as “guidance” in developing an interim final rule. It’s important to remember that HPSAs and MUAs are used in identifying areas and populations that are eligible to receive key safety net resources such as National Health Service Corps providers, provider incentive Medicare payments, and Federal funding to support Community Health Centers (MUA). The current methods used to designate these areas remain largely unchanged since the 1980s. The two members of the committee who voted against the final recommendation both believed that more analysis was needed in order to finalize the proposed designation methods. They believed their “no” votes provided the Secretary with flexibility to ensure the strongest rule possible. I voted “yes” on the report because the new methodology was a clear improvement over the existing status quo for rural America. The proposed new methodology would have eliminated the “Yo-Yo effect” for rural facilities, recognized the important role that nurse practitioners and physician assistants play in the delivery of rural health, and utilized more precise “barriers to care” measures than current methodology. The final report of the committee, along with dissenting reports, will be publicly available in the coming weeks. And for now, we will all have to wait to see how HHS utilizes the committee’s recommendations within the Administration’s interim final rule.