Negotiated Rulemaking

This week, I am once again participating in the HRSA Negotiated Rulemaking Committee that is reconsidering how the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designations are constructed. The Negotiated Rulemaking committee was mandated by the 2010 Affordable Care Act. These methods (HPSA and MUA) are used to designate areas eligible for Federal resources such as National Health Service Corps Physicians, Community Health Centers, and a Medicare Physician payment bonus. Following more than 80 hours of discussion (over a four month period) we have now began to discuss the inclusion of measures for the supply of primary care providers. There was a tremendous amount of detailed issues to discuss; who is a primary care provider, who provides primary care, and what types of providers should be excluded from determining supply for purposes of designation. After significant discussion, the committee requested additional impact analysis on the proposals considered. Without the impact testing results, it is still difficult to determine which decisions could ultimately be made by the committee. In addition, the committee is reviewing materials related to sub-population designations. A tremendous amount of discussion focused on determining what data sources and what measurement and documentation standards are needed for the designation of sub-populations as being medically underserved. The committee is still very much in the data collection and analysis phase of the work. Our Congressionally mandated target date for a draft final proposal is July 2011. Four months down, five months left.

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