[Federal Register Volume 72, Number 85 (Thursday, May 3, 2007)]
[Notices]
[Pages 24589-24591]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-8492]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Request for Public Comment on Use of Rural Urban Commuting Areas 
(RUCAs)

AGENCY: Health Resources and Services Administration, HHS.
SUMMARY: The Health Resources and Services Administration's (HRSA) 
Office of Rural Health Policy (ORHP) has sought to identify clear, 
consistent, and data-driven methods of defining rural areas in the 
Metropolitan counties of the United States. ORHP has funded development 
of Rural-Urban Commuting Area (RUCA) codes as the latest version of the 
Goldsmith Modification. HRSA is seeking comments on ORHP's use of RUCAs 
to better target Rural Health funding and projects. While other 
agencies of HHS may choose to adopt ORHP's definition of ``rural'' 
there is no requirement that they do so and they may choose other, 
alternate definitions that best suit their program requirements.

Background

    The Office of Rural Health Policy (ORHP) was authorized by Congress 
in December 1987 in Public Law 100-203 and located in the Health 
Resources and Services Administration (HRSA). Congress charged the 
Office with informing and advising the Department of Health and Human 
Services on matters affecting rural hospitals and health care and 
coordinating activities within the Department that relate to rural 
health care.
    The fiscal year (FY) 1991 appropriation allocated funds for Health 
Services Outreach Grants in rural areas. The FY 1991 Senate 
Appropriations Committee Conference Report stated that these grants 
were intended for ``outreach to populations in rural areas that do not 
normally seek health or mental health services.''
    With the creation of the Rural Health Outreach Grant Program, HRSA 
assumed the responsibility of determining eligibility for the grants. 
In 1991, there were two principal definitions of ``rural'' that were in 
use by the Federal Government. The oldest was the Census Bureau 
definition, which defined ``rural'' as all areas that were either not 
part of an urbanized area or were not part of an incorporated area of 
at least 2,500 persons. Urbanized areas were defined as densely settled 
areas with a total population of at least 50,000 people. The building 
block of urbanized areas is the census block, a sub-unit of census 
tracts.
    The other major Federal definition in use was based on the Office 
of Management and Budget's (OMB) list of counties that are designated 
as part of a Metropolitan Area. All counties that were not designated 
as Metropolitan were considered ``rural'' or, more accurately, non-
metropolitan. Metropolitan Areas, in 1990, had to

[[Page 24590]]

include ``a city of 50,000 or more population,'' or ``a Census Bureau 
defined urbanized area of at least 50,000 population, provided that the 
component county/counties of the metropolitan statistical area have a 
total population of at least 100,000.'' At that time, around three 
quarters of all counties in the United States were not classified as 
parts of Metropolitan Areas.
    Both the Census Bureau and OMB definitions were criticized for not 
actually defining ``rural'' at all but simply defining rurality by 
exclusion; all areas that are not ``urbanized'' are rural in the Census 
definition, and all counties that are not ``Metropolitan'' are non-
metropolitan or rural under the OMB definition. Under both definitions, 
rurality is not actually defined; rather, rural is simply what is not 
included in the defined classifications.
    Due to ease of use (counties are easily recognizable administrative 
units, while Census blocks are not), ORHP chose to use the OMB 
definition as the basis of determining eligibility for its Rural Health 
Grant Programs. In effect, this meant that the population in all non-
metropolitan counties was eligible, but none of the population in 
Metropolitan counties was eligible. At the same time, ORHP recognized 
that there were still rural areas within the Metropolitan counties. It 
was estimated that approximately 14 percent of the Metropolitan 
population, nearly 25 million people, resided in rural areas as defined 
by the Census Bureau in 1980.
    Rather than exclude large numbers of rural citizens from 
eligibility for the Rural Health Outreach Grants, ORHP sought a 
rational, data-driven method to designate rural areas inside of 
Metropolitan counties. Known as the ``Goldsmith Modification'' for its 
principal developer, Harold F. Goldsmith, this method is described in 
detail in the paper ``Improving the Operational Definition of ``Rural 
Areas'' for Federal Programs'' available at http://ruralhealth.hrsa.gov/pub/Goldsmith.htm. The original Goldsmith 
Modification used data from the 1980 decennial census and applied only 
to Large Metropolitan Counties (LMCs), those of at least 1225 square 
miles in area. Using census tracts as a sub-county unit, the Goldsmith 
Modification enabled the identification of rural areas inside 
Metropolitan counties. The Goldsmith Modification permitted health care 
providers and other organizations in designated rural census tracts in 
LMCs to apply for and receive Rural Health grants. It was also used by 
the Centers for Medicare and Medicaid Services (CMS) to determine 
eligibility for some of its programs. There were, however, certain 
limitations to the use of the Goldsmith Modification. Due to the lack 
of availability of data from the 1990 census, data from the 1980 census 
was used. In addition, analysis of data was limited to counties that 
met the somewhat arbitrary criteria of being larger than 1225 square 
miles in area.
    ORHP continued to pursue means of identifying rural areas using 
sub-county units of measurement. Ideally, use of a sub-county unit 
would allow consideration both of the scale of the population residing 
in the unit and their proximity to other services.
    ORHP has funded the development of RUCA codes as an update to the 
Goldsmith Modification to be used for determining grant eligibility. 
Developed by Richard Morrill and Gary Hart, of the University of 
Washington, and John Cromartie, of the U.S. Department of Agriculture's 
(USDA) Economic Research Service, the RUCAs are described at length in 
a 1999 paper published in the journal Urban Geography.
    RUCAs, like the Goldsmith modification, are based on a sub-county 
unit, the census tract, permitting a finer delineation of what 
constitutes rural areas inside Metropolitan areas. There are over 
60,000 census tracts, none of which overlap county borders. The merits 
of using census tracts as the unit of measurement were described in a 
paper in the USDA publication Rural Development Perspectives in 1996. 
``Census tracts are large enough to have acceptable sampling error 
rates (containing an average of 4,000 people); are consistently defined 
across the Nation; are usually subdivided as population grows to 
maintain geographic comparability over time; and can be aggregated to 
form county-level statistical areas when needed.''
    Using data from the Census Bureau, every census tract in the United 
States is assigned a RUCA code. Currently, there are ten primary RUCA 
codes with 30 secondary codes (see Table 1).

           Table 1.--Rural-Urban Commuting Areas (RUCAs), 2000
 
 
 
1 Metropolitan area core: Primary flow within an urbanized area (UA):
    1.0 No additional code.
    1.1 Secondary flow 30% to 50% to a larger UA.
2 Metropolitan area high commuting: Primary flow 30% or more to a UA:
    2.0 No additional code.
    2.1 Secondary flow 30% to 50% to a larger UA.
3 Metropolitan area low commuting: Primary flow 5% to 30% to a UA:
    3.0 No additional code.
4 Micropolitan area core: Primary flow within an Urban Cluster of 10,000
 to 49,999 (large UC):
    4.0 No additional code.
    4.1 Secondary flow 30% to 50% to a UA.
    4.2 Secondary flow 10% to 30% to a UA.
5 Micropolitan high commuting: Primary flow 30% or more to a large UC:
    5.0 No additional code.
    5.1 Secondary flow 30% to 50% to a UA.
    5.2 Secondary flow 10% to 30% to a UA.
6 Micropolitan low commuting: Primary flow 10% to 30% to a large UC:
    6.0 No additional code.
    6.1 Secondary flow 10% to 30% to a UA.
7 Small town core: Primary flow within an Urban Cluster of 2,500 to
 9,999 (small UC):
    7.0 No additional code.
    7.1 Secondary flow 30% to 50% to a UA.
    7.2 Secondary flow 30% to 50% to a large UC.
    7.3 Secondary flow 10% to 30% to a UA.
    7.4 Secondary flow 10% to 30% to a large UC.
8 Small town high commuting: Primary flow 30% or more to a small UC.
    8.0 No additional code.
    8.1 Secondary flow 30% to 50% to a UA.
    8.2 Secondary flow 30% to 50% to a large UC.
    8.3 Secondary flow 10% to 30% to a UA.
    8.4 Secondary flow 10% to 30% to a large UC.
9 Small town low commuting: Primary flow 10% to 30% to a small UC:
    9.0 No additional code.
    9.1 Secondary flow 10% to 30% to a UA.
    9.2 Secondary flow 10% to 30% to a large UC.
10 Rural areas: Primary flow to a tract outside a UA or UC:
    10.0 No additional code.
    10.1 Secondary flow 30% to 50% to a UA.
    10.2 Secondary flow 30% to 50% to a large UC.
    10.3 Secondary flow 30% to 50% to a small UC.
    10.4 Secondary flow 10% to 30% to a UA.
    10.5 Secondary flow 10% to 30% to a large UC.
    10.6 Secondary flow 10% to 30% to a small UC.
 

    More complete information on the latest iteration of the RUCA codes 
is available at the Department of Agriculture's Web site, measuring 
rurality: Rural-urban commuting area codes http://www.ers.usda.gov/briefing/Rurality/RuralUrbanCommutingAreas/

[[Page 24591]]

and at the WWAMI (Washington, Wyoming, Alaska, Montana, & Idaho) Rural 
Health Research Center's Web site, http://depts.washington.edu/uwruca/.
    In the past, ORHP has issued a list of eligible, rural ZIP codes in 
Metropolitan counties based on the RUCAs rather than eligible census 
tracts due to potential applicants for Rural Health grants being able 
to easily ascertain whether they lived in an eligible ZIP code area. 
However, with the advent of the World Wide Web, applicants are now able 
to easily access information about census tracts, and to identify the 
tract identifying number of any address--(http://www.ffiec.gov/geocode/default.htm). Further information on the ZIP code approximation of the 
census tract-based RUCA codes is available at http://depts.washington.edu/uwruca/approx.html.
    HRSA believes that the use of RUCAs allows more accurate targeting 
of resources intended for the rural population. Both ORHP and CMS have 
been using RUCAs for several years to determine programmatic 
eligibility for rural areas inside of Metropolitan counties.
    ORHP currently considers all census tracts with RUCA codes 4-10 to 
be rural. While use of the RUCA codes has allowed identification of 
rural census tracts in Metropolitan counties, among the more than 
60,000 tracts in the U.S. there are some that are extremely large and 
where use of RUCA codes alone fails to account for distance to services 
and sparse population. In response to these concerns, ORHP has 
designated 132 large area census tracts with RUCA codes 2 or 3 as 
rural. These tracts are at least 400 square miles in area with a 
population density of no more than 35 people.
    ORHP will continue to seek refinements in the use of RUCAs. This 
may include further data on travel times so that areas with heavy 
commuting to urbanized areas, but which are too distant from the 
urbanized area for the residents to be able to easily access health 
care services, can also be designated as rural.
    HRSA is now seeking public comments on:
    1. The use of census tract RUCA codes to determine eligibility 
rather than RUCA codes which have been cross-walked to ZIP code areas,
    2. The possible use of RUCA sub-codes, to more accurately identify 
rural areas inside Metropolitan counties, and
    3. The possible use of travel times along with RUCAs to identify 
census tracts inside Metropolitan counties as rural rather than using 
tract size and population density.

DATES: The public is encouraged to submit written comments on the 
report and its recommendations July 2, 2007.

ADDRESSES: The following mailing address should be used: Office of 
Rural Health Policy, Health Resources and Services Administration, 5600 
Fishers Lane, Parklawn Building, 9A-55, Rockville, MD 20857. HRSA/
ORHP's facsimile number is (301) 443-2803. Comments can also be sent 
via e-mail to <a href="/cdn-cgi/l/email-protection#bfccd7d6cdccdcd7ffd7cdccde91d7d7cc91d8d0c9"><span class="__cf_email__" data-cfemail="becdd6d7cccdddd6fed6cccddf90d6d6cd90d9d1c8">[email protected]</span></a>. All public comments received will 
be available for public inspection at ORHP/HRSA's office between the 
hours of 8:30 a.m. and 5 p.m.

FOR FURTHER INFORMATION CONTACT: Questions about this request for 
public comment can be directed to Steven Hirsch, by e-mail 
(<a href="/cdn-cgi/l/email-protection#d2a1babba0a1b1ba92baa0a1b3fcbabaa1fcb5bda4"><span class="__cf_email__" data-cfemail="d5a6bdbca7a6b6bd95bda7a6b4fbbdbda6fbb2baa3">[email protected]</span></a>) or at the address above.

    Dated: April 25, 2007.
Elizabeth M. Duke,
Administrator.
 [FR Doc. E7-8492 Filed 5-2-07; 8:45 am]
BILLING CODE 4165-15-P


</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>