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[Federal Register Volume 89, Number 225 (Thursday, November 21, 2024)]
[Notices]
[Pages 92131-92133]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-27133]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

Inclusion of Terrain Factors in the Definition of Rural Area for 
Federal Office of Rural Health Policy Grants

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services.

ACTION: Final notice.

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SUMMARY: HRSA's Federal Office of Rural Health Policy (FORHP) is 
modifying the definition of ``rural area'' for the purposes of 
determining geographic eligibility to apply for or receive services 
funded by FORHP's rural health grants. With a data-driven methodology, 
this update to the definition of rural area will integrate the new Road 
Ruggedness Score (RRS) released in 2023 by the Economic Research 
Service of the U.S. Department of Agriculture. This notice responds to 
comments received on proposed modifications to HRSA's FORHP definition 
published in the Federal Register on April 26, 2024.

DATES: All changes will go into effect as of November 21, 2024, and 
will apply to FORHP's Notices of Funding Opportunity released in Fiscal 
Year (FY) 2025 and future years.

FOR FURTHER INFORMATION CONTACT: Greta Stuhlsatz, Statistician, Policy 
Research Division, FORHP, HRSA, 5600 Fishers Lane, Rockville, Maryland 
20857; (301) 443-0835 and [email protected].

SUPPLEMENTARY INFORMATION: This notice updates the definition of rural 
area used for HRSA's FORHP rural health grants programs. HRSA published 
a notice in the Federal Register on April 26, 2024, seeking public 
comment on proposed modifications to the definition of rural area for 
the purposes of determining eligibility for its rural health grant 
programs (89 FR 32451). HRSA proposed a data-driven methodology to 
update the definition of rural area by integrating the new RRS released 
in 2023 by the Economic Research Service of the U.S. Department of 
Agriculture. The RRS characterizes topographic variability, or 
ruggedness, of roads. A

[[Page 92132]]

technical clarification was also proposed in response to terminology 
changes by the U.S. Census Bureau. This notice includes a summary of 
responses to the public comments received.

Background

    In FY 2024, HRSA's FORHP considered the following areas to be rural 
for purposes of FORHP's grant programs:
    (1) All non-metro counties,
    (2) All outlying metro counties without an Urbanized Area,
    (3) All metro census tracts with RUCA codes 4-10, and
    (4) Metro census tracts of at least 400 square miles in area with 
population density of 35 or less per square mile with RUCA codes 2-3.
    In the Federal Register notice published April 26, 2024, HRSA 
proposed modifying its existing FORHP rural definition by adding census 
tracts of at least 20 square miles in area in metropolitan counties 
with RRS 5 (highly rugged) and RUCA code 2 or 3 to FORHP's definition 
of rural area. Only census tracts that meet all criteria--RRS 5 and 
RUCA 2 or 3 with an area of 20 or more square miles--would be newly 
eligible under the proposed update.
    In addition to the proposed rugged terrain update, in HRSA's 
notice, FORHP provided a technical clarification in response to the 
U.S. Census Bureau's 2020 terminology changes removing urban clusters 
and urbanized areas. FORHP's FY 2024 definition excludes outlying 
metropolitan counties with an Urbanized Area while the U.S. Census 
Bureau no longer uses this terminology. To retain the distinction in 
FORHP's definition of rural area between urban areas with population of 
50,000 or more and urban areas with a population less than 50,000, 
FORHP will identify and categorize urban areas based on population 
size. With this technical clarification, HRSA is updating FORHP's rural 
definition by striking the phrase ``outlying metropolitan counties 
without an urbanized area.'' and replacing it with ``outlying 
metropolitan counties with no population from an urban area of 50,000 
or more people.''

Summary of Comments and Responses

    HRSA received 27 comments in response to the notice published April 
26, 2024. Comments responded to both the proposed expansion of the 
definition of rural area and the technical clarification following the 
removal of urbanized areas and urban clusters by the U.S. Census 
Bureau. Most of the comments received (26) were in full or partial 
support of either or both components of the change--the technical 
clarification and the expanded eligibility criteria to include rugged 
terrain factors. One comment was out of scope of this proposal.

Technical Clarification in Response to Census Terminology Changes

    Comment: All comments that referenced the technical clarification 
to retain the distinction between urban areas with population over and 
under 50,000 in FORHP's definition of rural area were supportive of 
changing FORHP's definition to remove reference to Urbanized Areas and 
instead categorize urban areas based on population size.
    Response: We thank the commenters for their support. After 
consideration of the comments received, we are implementing the 
technical clarification as proposed.

Adding Rugged Terrain Data to the Definition of Rural Area

    Many comments were in favor of expanding the definition to include 
rugged terrain using the RRS developed by the Economic Research 
Service. We thank the commenters for their support.
    Some comments suggested modifications or alternatives to the 
proposed change.
    Comment: Some commenters suggested expanding the definition by 
including small counties with a high density of census tracts that are 
RRS 3, 4, and 5. Further, commenters suggested we specifically include 
all census tracts in a county that are greater than 20 square miles in 
area with RUCA codes of 2 or 3 if the county has 12 or fewer census 
tracts and over 80 percent of census tracts within the county are RRS 
3-5.
    Response: Including census tracts greater than 20 square miles with 
RUCA of 2-3 within metropolitan counties is consistent with the 
proposed change. The additional county-level criteria suggested--
limiting the expansion to only counties with 12 or fewer census tracts 
and calculating the percentage of tracts per county with RRS 3 through 
5--would not achieve the objective of the programs or be operationally 
feasible for the purposes of grantmaking. First, aggregating measures 
defined at the census tract level to create a single county-level 
estimate would not further FORHP's goal of identifying rural census 
tracts within metropolitan counties using the individual 
characteristics and data from those tracts to understand local 
conditions. Second, this proposal could introduce state and regional 
inconsistencies because county sizes vary widely across the United 
States. In effect, this proposal would treat counties and states 
differently based primarily on their geographic size. Finally, the 
complexity of the proposed calculation is inconsistent with FORHP's 
intent to use clear, consistent, and data-driven criteria that can be 
easily understood and applied nationwide. For these reasons, we are 
finalizing the language as proposed.
    Comment: A commenter suggested including census tracts with RRS 3 
(slightly rugged) and RRS 4 (moderately rugged) in addition to the 
proposed RRS 5 tracts in the expanded rural definition.
    Response: Including census tracts with RRS 5 that meet the proposed 
criteria for size and RUCA code adds 84 census tracts and 305,000 
people. RRS 3 and RRS 4 includes census tracts in and around major 
urban areas such as Nashville, Tennessee, and census tracts in northern 
New Jersey. Given their lesser topographic variation and their close 
proximity to major urban hubs and urban amenities, we are not 
considering these RRS 3 and RRS 4 tracts for the purpose of our rural 
area definition and are finalizing as proposed.
    Comment: A commenter suggested that Hawaii should be exempt from 
the requirement that census tracts with rugged terrain be at least 20 
square miles in area due to the unique geography of the state.
    Response: Small census tracts are common in densely populated areas 
in all parts of the United States. Applying a different standard in one 
state would not further FORHP's goal of using clear, data-driven 
criteria that can be consistently applied nationwide to identify rural 
areas. For these reasons, we are not adopting this suggestion.
    Comment: Some commenters suggested that road ruggedness should be 
used as a factor for defining rural areas, but FORHP should explore, 
for the future, alternative approaches for identification of 
mountainous roads.
    Response: We thank the commenters for their support for using road 
ruggedness. FORHP continuously monitors ongoing national research and 
analysis efforts related to developing new geographic data sources and 
defining rural areas. We welcome suggestions for alternative data sets 
that are national in scope and that would identify mountainous roads 
more accurately. As new methods and data become available, FORHP may 
consider updating the definition.
    Comment: A commenter suggested that the definition should focus on

[[Page 92133]]

service area rather than specific addresses of providers.
    Response: The purpose of FORHP's rural definition is to delineate 
the land area of the United States as rural or non-rural. The areas 
identified as rural by this definition may include both service areas 
and specific provider addresses.
    After consideration of the public comments received, HRSA is 
implementing the rugged terrain inclusion in the definition of rural 
area as proposed. FORHP is making this change consistent with its 
program authority to award grants to support rural health and rural 
health care services.

Updated Definition of Rural Area

    HRSA is updating FORHP's rural definition to include geographic 
areas meeting any one of the following criteria:

(1) Non-metropolitan counties
(2) Outlying metropolitan counties with no population from an urban 
area of 50,000 or more people
(3) Census tracts with RUCA codes 4-10 in metropolitan counties
(4) Census tracts of at least 400 square miles in area with population 
density of 35 or less per square mile with RUCA codes 2-3 in 
metropolitan counties
(5) Census tracts with RRS 5 and RUCA codes 2-3 that are at least 20 
square miles in area in metropolitan counties

    The changes will go into effect as of November 21, 2024. These 
changes will apply to FORHP's Notices of Funding Opportunity for FY 
2025 and future years for programs that require funded activities and 
services be provided in rural areas, as defined by HRSA. FORHP will 
ensure information about the updated rural definition is available to 
the public on the HRSA website and in funding opportunities. These 
changes reflect FORHP's desire to accurately identify rural areas using 
a data-driven methodology that relies on established geographic 
identifiers and standard, national-level data sources.

Impact

    Incorporating rugged terrain data into the definition of rural area 
using the adopted method adds 84 census tracts and approximately 
305,000 people to the 60.8 million people living in FORHP-designated 
rural areas. This is an increase of 0.5 percent in the total number of 
people living in rural areas. Table 1 show the number of newly rural 
census tracts by state.

          Table 1--Number of Newly Rural Census Tracts by State
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                                                              Number  of
                            State                               tracts
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CA..........................................................          24
OR..........................................................          16
NC..........................................................          12
WA..........................................................           9
TN..........................................................           7
CO..........................................................           6
WV..........................................................           6
MT..........................................................           2
AK..........................................................           1
MD..........................................................           1
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    Total...................................................          84
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Note: Table shows the number of newly rural census tracts with RRS 5 and
  RUCA codes 2-3 that are at least 20 square miles in area in
  metropolitan counties. Data in this table are based on 2010 census
  tract geographies and 2020 metropolitan county delineations. For a
  complete list of impacted census tracts see https://www.hrsa.gov/rural-health/about-us/what-is-rural/data-files.

Carole Johnson,
Administrator.
[FR Doc. 2024-27133 Filed 11-20-24; 8:45 am]
BILLING CODE 4165-15-P
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