Federal Register / Vol. 87, No. 97 / Thursday, May 19, 2022 / Notices 30501 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

Annual 

burden hours 

Children’s Bureau Disaster Information Collection Form ................................ 10 1 1 10 

Family Violence Prevention and Services Program Disaster Information Collection Form ................................................................................................. 10 1 1 10 

Office of Child Care Disaster Information Collection Form ............................. 7 1 2 14 

Office of Head Start Disaster Information Collection Form ............................. 10 1 2 20 

Runaway and Homeless Youth Program Disaster Information Collection 

Form ............................................................................................................. 10 1 1 10 

Future Program Office Disaster Information Collection Forms ....................... 40 1 1.5 60 

Estimated Total Annual Burden 

Hours: 124. 

Authority: 42 U.S.C. 68 Disaster 

Relief; 42 U.S.C. Section 5121; Pub. L. 

113–5. 

Mary B. Jones, 

ACF/OPRE Certifying Officer. 

[FR Doc. 2022–10786 Filed 5–18–22; 8:45 am] 

BILLING CODE 4182–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Criteria for Determining Maternity Care 

Health Professional Target Areas 

AGENCY: Health Resources and Services 

Administration (HRSA), Department of 

Health and Human Services (HHS). 

ACTION: Final response. 

SUMMARY: Section 332 of the Public 

Health Service Act (PHSA) directs the 

Department of Health and Human 

Services (HHS), through the Health 

Resources and Services Administration 

(HRSA), to identify Maternity Care 

Target Areas (MCTA), or geographic 

areas within health professional 

shortage areas that have a shortage of 

maternity care health professionals, for 

the purpose of providing maternity 

health care assistance to such health 

professional shortage areas. On 

September 21, 2021, the Health 

Resources and Services Administration 

(HRSA) published a Federal Register 

notice soliciting feedback on proposed 

criteria to be used to identify Maternity 

Care Target Areas (MCTAs). HRSA 

requested feedback on six proposed 

criteria for inclusion in a composite 

scale to identify MCTAs with the 

greatest shortage of maternity care 

health professionals: (1) Ratio of females 

ages 15–44 -to-full time equivalent 

maternity care health professional ratio; 

(2) percentage of females 15–44 with 

income at or below 200 percent of the 

federal poverty level (FPL); (3) travel 

time and distance to the nearest 

provider location with access to 

comprehensive maternity care services; 

(4) fertility rate; (5) the Social 

Vulnerability Index; and (6) four 

Maternal Health Indicators (prepregnancy obesity, pre-pregnancy 

diabetes, pre-pregnancy hypertension, 

and prenatal care initiation in the first 

trimester). This notice summarizes and 

responds to the comments received 

during the 60-day comment period and 

presents the final criteria which will be 

used to identify and score MCTAs. 

ADDRESSES: Additional information 

about MCTAs is available at https://

bhw.hrsa.gov/workforce-shortage-areas/ 

shortage-designation. 

FOR FURTHER INFORMATION CONTACT: Dr. 

Janelle McCutchen, Chief, Shortage 

Designation Branch, Division of Policy 

and Shortage Designation, Bureau of 

Health Workforce, HRSA, 5600 Fishers 

Lane, Rockville, Maryland 20857, 

sdmp@hrsa.gov, or 301.443.9156. 

SUPPLEMENTARY INFORMATION: Section 

332 of the Public Health Service Act 

(PHSA), 42 U.S.C. 254e, provides that 

the Secretary designate Health 

Professional Shortage Areas (HPSAs) 

based on criteria established by 

regulation. HPSAs are defined in section 

332 to include (1) urban and rural 

geographic areas which the Secretary 

determines have shortages of health 

professionals, (2) population groups 

with such shortages, and (3) public or 

private medical facilities or other public 

facilities with such shortages. The 

required regulations setting forth the 

criteria for designating HPSAs are 

codified at 42 CFR part 5. 

Section 332(k)(1) provides that the 

Secretary, acting through the 

Administrator of HRSA, identify 

shortages of maternity care services 

‘‘within health professional shortage 

areas.’’ Section 332(k)(1) further 

requires HRSA to identify MCTAs and 

distribute maternity care health 

professionals within HPSAs using the 

MCTAs so identified. HRSA must also 

collect and publish data in the Federal 

Register comparing the availability and 

need of maternity care health services in 

HPSAs and must seek input from 

relevant provider organizations and 

other stakeholders. 

In a September 21, 2021, Federal 

Register notice (86 FR 53324), HRSA 

requested feedback on six proposed 

criteria to identify MCTAs: (1) Ratio of 

females ages 15–44 -to-full time 

equivalent maternity care health 

professional ratio; (2) percentage of 

females 15–44 with income at or below 

200 percent of the federal poverty level 

(FPL); (3) travel time and distance to the 

nearest provider location with access to 

comprehensive maternity care services; 

(4) fertility rate; (5) the Social 

Vulnerability Index; and (6) four 

Maternal Health Indicators (prepregnancy obesity, pre-pregnancy 

diabetes, pre-pregnancy hypertension, 

and prenatal care initiation in the first 

trimester). 

HRSA carefully evaluated and 

analyzed the comments received and 

used them to guide the development of 

the final MCTA criteria. 

Comments on the Proposed Criteria for 

Identifying Maternity Care Target 

Areas 

HRSA received 21 responses to the 

request for comments. Comments and 

responses are summarized below. 

Health Care Capacity Factors 

Summary of Comments 

Population-to-Provider Ratio 

All commenters supported the 

inclusion of a population-to-provider 

ratio and agreed with HRSA’s proposal 

of a population ratio of females ages 15– 

44 -to-full time equivalent maternity 

care health professional ratio. However, 

several commenters questioned the use 

of only Obstetrician/Gynecologists (OB/ 

GYNs) and Certified Nurse Midwives 

(CNMs) in the provider ratio and 

recommended the inclusion of family 

medicine physicians, physician 

assistants, and nurse practitioners. 

Specifically, one commenter indicated 


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1 1Roa, Lina et al., ‘‘Travel Time to Access 

Obstetric and Neonatal Care in the United States.’’ 

Obstetrics and Gynecology (New York. 1953) vol. 

136, no. 3 (2020): 610–612. 

‘‘that a comprehensive system of 

maternity healthcare services is 

comprised of multiple types of care and 

considerations should be made for the 

inclusion of family medicine physicians 

in rural areas that deliver maternity care 

services.’’ 

Response 

HRSA appreciates the 

recommendation for the inclusion of 

additional provider types and 

recognizes the important contribution 

all of these professionals play in the 

delivery of obstetrics care. Currently, 

standardized nationwide data is not 

readily available outlining the number 

of hours that individual family 

medicine physicians, physician 

assistants, and nurse practitioners spend 

providing these services, and thus the 

agency would have no way of uniformly 

comparing the hours that these 

providers spend contributing maternity 

care services. HRSA recognizes the 

important role of these clinicians in the 

provision of maternity care and will 

continue to review the availability of 

these data points to determine if 

additional provider types may be 

incorporated into the MCTA scoring 

criteria in the future. We continue to 

welcome recommendations on 

nationally available data sets for the 

incorporation of these provider types 

into MCTAs. Until that data is readily 

available for inclusion, HRSA will 

proceed with the population-to-provider 

ratio as proposed. 

Travel Time and Distance (TTD) to 

Nearest Source of Care (NSC) 

HRSA proposed including a measure 

of travel time and distance (TTD) to the 

nearest source of care (NSC) with access 

to comprehensive maternity care 

services. All commenters supported the 

inclusion of TTD to NSC criteria but 

presented varied methodologies on how 

to implement and score the criteria. 

Some commenters were concerned with 

the TTD point scale outline in the 

proposed criteria and suggested that 

HRSA adjust and expand the scoring 

scale to provide points for facilities 

identified within the 30 minute/mile 

TTD. A separate commenter requested 

that, ‘‘In terms of distance from 

comprehensive services, I would ask 

HRSA to clarify that as the distance 

from a site that has more than one or 

two on-staff OB/GYN.’’ Another 

commenter indicated that TTD should 

be the largest weighted factor, as it 

relates to the geographic accessibility of 

services and is part of the assessment 

needed to fully address the MCTA 

statutory requirements 

Response 

Section 332(k)(5) of the PHSA defines 

‘full scope maternity care health 

services’ as care provided during labor, 

birthing, prenatal care, and postpartum 

care, with no specification regarding the 

quantity of providers available at the 

facility. As to the comment regarding 

including points for distance less than 

30 minute/mile, the United States 

currently lacks an established 

benchmark for timely access to a facility 

for obstetric care. However, the 

American College of Obstetricians and 

Gynecologist (ACOG) proposes a 30- 

mintue capability for decision-toincision for emergency cesarean 

delivery.1 HRSA will therefore retain its 

proposed approach. 

In reference to the comment for the 

explicit definition of ‘‘distance from a 

site that has more than one or two onstaff OB/GYN,’’ HRSA will apply the 

current Primary Care HPSA NSC policy, 

which identifies the NSC based on the 

presence of a provider trained and 

licensed to provide the necessary care 

regardless of the number of providers at 

the location. In response to the 

comment regarding geographic 

accessibility, HRSA recognizes the 

importance of this measure and will 

retain it as proposed and continue to 

monitor this issue in the future. 

Health Care Need Factors 

HRSA proposed the use of four 

Maternal Health Indicators (prepregnancy obesity, pre-pregnancy 

diabetes, pre-pregnancy hypertension, 

and prenatal care initiation in the first 

trimester). 

Summary of Comments 

Inclusion of Cigarette Smoking as 

Maternal Health Indicator 

Several commenters suggested 

inclusion of a tobacco usage indicator. 

Commenters noted that smoking in the 

3 months leading up to pregnancy can 

increase the risk of preterm birth and of 

adverse maternal health outcomes, and 

recommended inclusion of tobacco use 

as an indicator. Additionally, 

commenters highlighted that a 

significant proportion of women who 

smoked cigarettes prior to pregnancy 

continue to smoke into the later stages 

of gestation. 

Response 

HRSA agrees that the smoking of 

cigarettes is a significant risk factor for 

adverse maternal health outcomes and 

will add cigarette smoking as a Maternal 

Health Indicator. For this purpose, 

cigarette smoking will be defined as 

women who report smoking one or more 

cigarettes daily for the 3 months prior to 

pregnancy or during any of the 

trimesters of their pregnancy. 

One point will be added if the 

prevalence of cigarette smoking before 

or during pregnancy in the MCTA is 

greater than or equal to the median 

among all counties in the United States. 

If the prevalence of cigarette smoking 

before or during pregnancy in the 

MCTA is less than the median among all 

counties, zero points will be added. 

Cigarette smoking Points 

Prevalence of Cigarette Smoking Before or During Pregnancy ≥50th percentile .............................................................................. 1 

Prevalence of Cigarette Smoking Before or During Pregnancy <50th percentile .............................................................................. 0 

To accommodate the inclusion of this 

factor, one point will be removed from 

the total possible number of points 

awarded for the percent of the 

population living at or below the 200 

percent Federal Poverty Level indicator. 

The rationale for this change is that 

household income relative to the federal 

poverty line is represented not only in 

this criterion but also in the Social 

Vulnerability Index criterion. 

Lower Point Threshold for Maternal 

Health Indicators 

HRSA proposed that the threshold for 

receiving points for Maternal Health 

Indicators would be 75%. Two 

commenters noted that the threshold to 

receive a point for the Maternal Health 

Indicators was ‘‘too restrictive.’’ One 

commenter recommended that the 

threshold be decreased for each 

indicator from the top quartile (75th 

percentile) to the median (50th 

percentile). 


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2Trost, Susanna L., et al. ‘‘Preventing PregnancyRelated Mental Health Deaths: Insights from 14 US 

Maternal Mortality Review Committees, 2008–17: 

Health Affairs Journal.’’ Health Affairs, 1 Oct. 2021, 

https://www.healthaffairs.org/doi/10.1377/ 

hlthaff.2021.00615. 

3Barrera, C., & Et.Al. (2022). County-Level 

Associations Between Pregnancy-Related Mortality 

Ratios and Contextual Sociospatial Indicators. 

Journal Of Obstet Gynecol, 00(00), 1–11. 

Response 

HRSA conducted an impact analysis 

applying both percentiles to existing 

primary care HPSAs. The results of the 

analysis indicated that lowering the 

percentile threshold for Maternal Health 

Indicators to the median resulted in a 

slightly more standard distribution of 

the points across currently designated 

primary care HPSAs. The chart below 

provides a visual of the difference in the 

score distribution between the two 

thresholds. Based on this analysis, 

HRSA will adjust the threshold for the 

Maternal Health Indicators to reflect the 

50th percentile recommendation of the 

commenters. 

Social Vulnerability Index 

Several commenters requested that 

HRSA provide points based on the 

individual factors of the Social 

Vulnerability Index (SVI) to allow for an 

increased impact of the social 

determinant factors within the SVI. 

Additionally, commenters proposed 

increasing the number of points allotted 

to the entire SVI. 

Response 

HRSA recognizes the importance of 

the SVI in the prioritization and 

distribution of resources. The scientific 

research that correlates the SVI to a 

need for additional health care 

resources was conducted using the 

entire index and not the individual 

factors. In addition, accommodating all 

15 of the individual factors of the SVI 

would dilute the impact of Maternal 

Health Indicators that are more closely 

associated with the need for maternal 

health care. Increasing the weight of the 

SVI in the MCTA scoring criteria would 

decrease the impact of other factors, 

such as initiation of prenatal care and 

pre-pregnancy diabetes. HRSA will 

continue to apply the SVI as a whole to 

the MCTA scoring criteria and maintain 

the proposed point scale. 

Inclusion of Behavioral Health Factor as 

Maternal Health Indicator 

Several commenters recommended 

the inclusion of a behavioral health 

factor as part of the Maternal Health 

Indicators. One commenter specifically 

recommended a composite point based 

on prevalence of perinatal mood, 

anxiety disorders, and substance use 

disorder. Commenters highlighted that a 

pre-pregnancy diagnosis of a mental 

health illness can be an indicator of an 

increased risk of mental health concerns 

during pregnancy, which also increases 

the potential for adverse perinatal/postpartum health outcomes. 

Response 

HRSA recognizes the important 

impact of behavioral health factors on 

maternal health outcomes. A Report 

from the 14-state Maternal Mortality 

Review Committee found that 11% of 

the 421 pregnancy related deaths with 

an identified underlying cause of death 

determination, were due to mental 

health conditions. The Review 

Committee also determined that 100% 

of the pregnancy-related mental health 

deaths with a preventability 

determination were preventable.2

The Centers for Disease Control and 

Prevention (CDC) and Emory University 

conducted a cross-sectional multilevel 

analysis of all pregnancy-related deaths 

and all live births with available ZIP 

code or county data in the Pregnancy 

Mortality Surveillance System during 

2011–2016 for non-Hispanic Black, 

Hispanic (all races), and non-Hispanic 

White women aged 15–44 years. Among 

health care need and service indicators, 

the number of mental health care 

professionals per 100,000 population 

had a strong inverse relationship with 

the pregnancy-related mortality ratio. 

Each standard unit increase in the 

number of mental health care 

professionals was associated with 5.55 

(95% CI ¥8.11 to ¥2.99) fewer deaths 

per 100,000 live births among Black 

women and 1.42 (95% CI ¥2.08 to 

¥0.76) fewer deaths per 100,000 live 

births among White women.3

HRSA agrees that access to behavioral 

health is a significant risk factor for 

adverse maternal health outcomes and 

will include a behavioral health access 

factor as a Maternal Health Indicator. 

One point will be awarded if a portion 

or all of MCTA service area is 

designated as a Mental Health HPSA 

meeting the following population-toprovider median ratio thresholds based 

on its mental health provider type. Zero 

points will be awarded if a portion or 

all of the MCTA service area is not 

designated as a Mental Health HPSA or 


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the Mental Health designation does not meet the population to provider ratio 

threshold. 

Behavioral health Points 

Portion or all of MCTA service area is designated as a Mental Health HPSA meeting the following population-to-provider ratio 

thresholds based on its mental health provider type ....................................................................................................................... 1 

• Psychiatrist ONLY: Psychiatrist population-to-provider ratio ≥45,000:1. 

• Core Mental Health: Core mental health population-to-provider ratio ≥18,000:1. 

• Psychiatrist and Core Mental Health: Psychiatrist population-to-provider ratio ≥35,000:1 and Core mental health population-to-provider ratio ≥6,000:1. 

• No Psychiatrists or Core Mental Health Providers: ≥7,500: 0. 

Portion or all of MCTA service area is designated as a Mental Health HPSA and does not meet the population-to-provider ratio 

thresholds above, OR is not designated as a Mental Health HPSA ............................................................................................... 0 

To accommodate the inclusion of this 

factor, one point will be removed from 

the total possible number of points 

awarded for the travel time and distance 

(TTD) to nearest source of care (NSC) 

criteria. The rationale for this change is 

to ensure that all Health Care Capacity 

Factors are equal in value. 

Conclusion of Comment Response 

HRSA appreciates the comments and 

recommendations received and has used 

them to guide the development of the 

final Maternity Care Health Professional 

Target Area criteria. Comments were not 

received on the proposed Federal 

Poverty Level or Fertility Rate factors; 

they will be finalized as proposed. The 

final MCTA criteria are included below. 

If you have any questions, please 

contact Dr. Janelle McCutchen at sdmp@

hrsa.gov. 

Final Approach for Determining 

Maternity Care Health Professional 

Target Areas 

An MCTA score will be generated for 

each primary care HPSA using the 

HPSA’s service area. The following six 

scoring criteria will be included in a 

composite scale that will be used to 

identify MCTAs with the greatest 

shortage of maternity care health 

professionals: (1) Ratio of females ages 

15–44 -to-full time equivalent maternity 

care health professional ratio; (2) 

percentage of females 15–44 with 

income at or below 200 percent of the 

FPL; (3) travel time and distance to the 

nearest provider trained and licensed to 

provide the necessary care; (4) fertility 

rate; (5) the SVI; and (6) Maternal Health 

Index which contains the following six 

indicators: Pre-pregnancy obesity, prepregnancy diabetes, pre-pregnancy 

hypertension, prenatal care initiation in 

the first trimester, cigarette smoking, 

and the behavioral health factor. Each of 

these six criteria will be assigned a 

relative weight based on the significance 

of that criterion relative to all the others. 

The weighted scores will be summed 

to develop a composite MCTA score 

ranging from zero to 25, with 25 

indicating the greatest need for 

maternity care health professionals in 

the MCTA. Accordingly, the higher the 

composite score, the higher the degree 

of need for maternity care health 

services. 

Score for Population-to-Full-TimeEquivalent Maternity Care Health 

Professional Ratio 

Population-to-provider ratio will 

measure the number of women of 

childbearing age in the service area 

compared to the number of maternity 

care health professionals in the service 

area. Women of childbearing age will be 

defined as women between the ages of 

15–44 years old and maternity care 

health professionals will be defined as 

OB/GYNs and CNMs. A population-toprovider ratio of 1500:1 will be used as 

a minimum requirement for a 

population to be considered reasonably 

served by OB/GYNs and CNMs. 

Population-to-provider Ratio point 

values will be distributed as follows: 

Population-to-provider ratio Points 

Ratio ≥6,000:1, or No CNMs or OB–GYNs and Population (Pop) ≥500 ............................................................................................ 5 

6,000:1 > Ratio ≥5,000:1, or No CNMs or OB–GYNs and Pop ≥400 ................................................................................................ 4 

5,000:1 > Ratio ≥3,000:1, or No CNMs or OB–GYNs and Pop ≥300 ................................................................................................ 3 

3,000:1 > Ratio ≥2,000:1, or No CNMs or OB–GYNs and Pop ≥200 ................................................................................................ 2 

2,000:1 > Ratio ≥1,500:1, or No CNMs or OB–GYNs and Pop ≥100 ................................................................................................ 1 

Ratio <1,500:1, or No CNMs or OB–GYNs and Pop <100 ................................................................................................................ 0 

Score for Percentage of Population With 

Income at or Below 200 Percent of the 

Federal Poverty Level 

The percentage of people living in the 

service area at or below 200 percent of 

the FPL will be used to score MCTAs, 

based on poverty data from the U.S. 

Census Bureau. 

Population with income at or below 

200 percent of the FPL point values will 

be distributed as follows: 

Population with income at or below 200% FPL ratio Points 

Percentage of population with income at or below 200% FPL ≥50% ................................................................................................ 5 

50% > Percentage of population with income at or below 200% FPL ≥45% ..................................................................................... 4 

45% > Percentage of population with income at or below 200% FPL ≥40% ..................................................................................... 3 

40% > Percentage of population with income at or below 200% FPL ≥35% ..................................................................................... 2 

35% > Percentage of population with income at or below 200% FPL ≥30% ..................................................................................... 1 

Percentage of population with income at or below 200% FPL <30% ................................................................................................ 0 


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Score for Travel Distance/Time to 

Nearest Source of Accessible Care 

Outside of the MCTA 

The Nearest Source of Care is defined 

as the nearest provider trained and 

licensed to provide the necessary care, 

as determined by the ESRI StreetMap 

Premium road network. Travel Time 

and Distance is defined as the average 

time to travel by road miles or the actual 

distance in road miles to the nearest 

source of care. 

Travel Time and Distance to the 

Nearest Source of Care point values will 

be distributed as follows: 

Travel time and distance Points 

Time ≥90 min or Distance ≥90 miles .................................................................................................................................................. 5 

90 min > Time ≥75 min or 90 miles > Distance ≥75 miles ................................................................................................................. 4 

75 min > Time ≥60 min or 75 miles > Distance ≥60 miles ................................................................................................................. 3 

60 min > Time ≥45 min or 60 miles > Distance ≥45 miles ................................................................................................................. 2 

45 min > Time ≥30 min or 45 miles > Distance ≥30 miles ................................................................................................................. 1 

Time < 30 min and Distance <30 miles .............................................................................................................................................. 0 

Score for Fertility Rate 

Fertility rate has been included to 

reflect the increased need for maternity 

care services among populations that 

experience a higher rate of births. 

Women of childbearing age will be 

derived from the American Community 

Survey and births will be derived from 

the National Vital Statistics System. 

Fertility Rate point values will be 

distributed as follows: 

Fertility rate Points 

Fertility Rate ≥90th Percentile ............................................................................................................................................................. 2 

90th Percentile > Fertility Rate ≥50th Percentile ................................................................................................................................ 1 

Fertility Rate <50th Percentile ............................................................................................................................................................. 0 

Score for Social Vulnerability 

Social vulnerability is defined as the 

resilience of communities when 

confronted by external hazards such as 

disasters or disease outbreaks per the 

Agency for Toxic Substances and 

Disease Registry’s Geospatial Research, 

Analysis and Services Program within 

the Centers for Disease Control and 

Prevention. A score for overall social 

vulnerability will be incorporated into 

the MCTA composite score using the 

Centers for Disease Control and 

Prevention’s SVI. 

Social Vulnerability point values will 

be distributed as follows: 

Social vulnerability index Points 

Social Vulnerability ≥75th Percentile ................................................................................................................................................... 2 

75th Percentile > Social Vulnerability ≥50th Percentile ...................................................................................................................... 1 

Social Vulnerability <50th Percentile ................................................................................................................................................... 0 

Score for Maternal Health Indicators 

Maternal Health Indicators are 

defined as factors associated with poor 

maternal health outcomes using data 

from the National Vital Statistics System 

and the Shortage Designation 

Management System. Scores will 

consider pre-pregnancy obesity, 

diabetes, hypertension, cigarette 

smoking, and whether prenatal care 

began in the first trimester as well as 

access to behavioral health services. 

Only women of childbearing age will be 

considered for these indicators. HRSA 

will use the National Vital Statistics 

System Natality file as the data source 

to determine the sub-score for prepregnancy obesity, diabetes, 

hypertension, cigarette smoking, and 

whether prenatal care began in the first 

trimester. The Shortage Designation 

Management System Mental Health 

Professional Shortage Area file will be 

the data source to determine the subscore for the behavioral health access 

factor. 

Maternal Health Indicator criteria 

point values will be distributed as 

follows: 

• Pre-Pregnancy Obesity 

Pre-pregnancy obesity is defined as 

having a Body Mass Index of 30 or 

higher. One point will be awarded if the 

prevalence of pre-pregnancy obesity in 

the area is greater than or equal to the 

50th percentile among all counties in 

the United States. If the prevalence of 

pre-pregnancy obesity in the area is less 

than the 50th percentile among all 

counties, zero points will be awarded. 

Pre-pregnancy obesity Points 

Prevalence of pre-pregnancy obesity ≥50th percentile ....................................................................................................................... 1 

Prevalence of pre-pregnancy obesity <50th percentile ....................................................................................................................... 0 

• Pre-Pregnancy Diabetes 

One point will be awarded if the 

prevalence of pre-pregnancy diabetes in 

the area is greater than or equal to the 

50th percentile among all counties in 

the United States. If the prevalence of 

pre-pregnancy diabetes in the area is 

less than the 50th percentile among all 

counties, zero points will be awarded. 


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Pre-pregnancy diabetes Points 

Prevalence of pre-pregnancy diabetes ≥50th percentile ..................................................................................................................... 1 

Prevalence of pre-pregnancy diabetes <50th percentile .................................................................................................................... 0 

• Pre-Pregnancy Hypertension 

One point will be awarded if the 

prevalence of pre-pregnancy 

hypertension among women in the area 

is greater than or equal to the 50th 

percentile among all counties in the 

nation. If the prevalence of prepregnancy hypertension among women 

in the area is less than the 50th 

percentile among all counties, zero 

points will be awarded. 

Pre-pregnancy hypertension Points 

Prevalence of pre-pregnancy hypertension ≥50th percentile .............................................................................................................. 1 

Prevalence of pre-pregnancy hypertension <50th percentile ............................................................................................................. 0 

• Cigarette Smoking 

One point will be awarded if the 

prevalence of cigarette smoking before 

or during pregnancy among women in 

the area is greater than or equal to the 

50th percentile among all counties in 

the nation. Before pregnancy will be 

defined as smoking one or more 

cigarettes daily for the 3 months prior to 

pregnancy. During pregnancy will be 

defined as smoking one or more 

cigarettes during any trimester of 

pregnancy. If the prevalence of cigarette 

smoking before or during pregnancy 

among women in the area is less than 

the 50th percentile among all counties, 

zero points will be awarded. 

Cigarette smoking Points 

Prevalence of Cigarette Smoking Before or During Pregnancy ≥50th percentile .............................................................................. 1 

Prevalence of Cigarette Smoking Before or During Pregnancy <50th percentile .............................................................................. 0 

• Prenatal Care Initiation in the 1st 

Trimester 

One point will be awarded if the 

prevalence of women who did not 

initiate prenatal care in the first 

trimester of their pregnancy is greater 

than or equal to the 50th percentile 

among all counties in the nation. Zero 

points will be awarded if the prevalence 

of women who did not initiate prenatal 

care in the first trimester of their 

pregnancy is less than the 50th 

percentile among all counties. 

Prenatal care in first trimester Points 

Prevalence of No Prenatal Care in First Trimester ≥50th percentile .................................................................................................. 1 

Prevalence of No Prenatal Care in First Trimester <50th percentile .................................................................................................. 0 

• Behavioral Health Factor 

One point will be awarded if a portion 

or all of MCTA service area is 

designated as a Mental Health HPSA 

meeting the following population-toprovider median ratio thresholds based 

on its mental health provider type. Zero 

points will be awarded if a portion or 

all of the MCTA service area is not 

designated as a Mental Health HPSA or 

if the Mental Health designation does 

not meet the population to provider 

ratio threshold. 

Behavioral health factor Points 

Portion or all of MCTA service area is designated as a Mental Health HPSA meeting the following population-to-provider ratio 

thresholds based on its mental health provider type ....................................................................................................................... 1 

• Psychiatrist ONLY: Psychiatrist population-to-provider ratio ≥45,000:1. 

Core Mental Health: Core mental health population-to-provider ratio ≥18,000:1. 

• Psychiatrist and Core Mental Health: Psychiatrist population-to-provider ratio ≥35,000:1 and Core mental health population-to-provider ratio ≥6,000:1. 

• No Psychiatrists or Core Mental Health Providers: ≥7,500: 0 

Portion or all of MCTA service area is designated as a Mental Health HPSA and does not meet the population-to-provider ratio 

thresholds above, OR is not designated as a Mental Health HPSA ............................................................................................... 0 

Paperwork Reduction Act 

The criteria used to identify MCTAs 

under section 332(k) of the PHSA, as 

described in this announcement, will 

not involve data collection activities 

that fall under the purview of the 

Paperwork Reduction Act of 1995. If the 

methods for determining MCTAs fall 

under the purview of the Paperwork 

Reduction Act, HRSA will seek the 

Office of Management and Budget 

clearance for proposed data collection 

activities. 

Carole Johnson, 

Administrator. 

[FR Doc. 2022–10783 Filed 5–18–22; 8:45 am] 

BILLING CODE 4165–15–P 


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