[Federal Register Volume 73, Number 77 (Monday, April 21, 2008)]
[Proposed Rules]
[Pages 21300-21301]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 08-1167]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

42 CFR Parts 5 and 51c

RIN 0906-AA44


Designation of Medically Underserved Populations and Health 
Professional Shortage Areas

AGENCY: Department of Health and Human Services (HHS).

ACTION: Notice of proposed rulemaking; extension of public comment 
period and clarification.

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SUMMARY: On February 29, 2008, HHS published a notice of proposed 
rulemaking, ``Designation of Medically Underserved Populations and 
Health Professional Shortage Areas'' (73 FR 11232), to revise and 
consolidate the criteria and processes for designating medically 
underserved populations (MUPs) and health professional shortage areas 
(HPSAs). HHS provided a 60-day public comment period, with written 
comments to be received on or before April 29, 2008. HHS and the Health 
Resources and Services Administration (HRSA) have received requests for 
an extension of the comment period. In consideration of these requests, 
HHS is extending the comment period an additional 30 days, with a new 
closing date of May 29, 2008.

DATES: Written comments on the proposed rule must be submitted on or 
before May 29, 2008. Please refer to SUPPLEMENTARY INFORMATION for 
additional information.

ADDRESSES: You may submit comments in one of four ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.regulations.gov. Click on the 
link ``Submit electronic comments on HRSA regulations with an open 
comment period.'' (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By Regular Mail. You may mail written comments (one original and 
two copies) to the following address only: Health Resources and 
Services Administration, Department of Health and Human Services, 
Attention: Ms. Andy Jordan, 8C-26 Parklawn Building, 5600 Fishers Lane, 
Rockville, MD 20857.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By Express or Overnight Mail. You may send written comments (one 
original and two copies) to the following address only: Health 
Resources and Services Administration, Department of Health and Human 
Services, Attention: Ms. Andy Jordan, 8C-26 Parklawn Building, 5600 
Fishers Lane, Rockville, MD 20857.
    4. By Hand or Courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period (May 29, 2008) to one of the following 
addresses. If you intend to deliver your comments to the Rockville 
address, please call telephone number (301) 594-0816 in advance to 
schedule your arrival with one of our staff members at these addresses: 
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201; or 8C-26 Parklawn Building, 5600 Fishers Lane, 
Rockville, MD 20857. (Because access to the interior of the HHH 
Building is not readily available to persons without Federal Government 
identification, commenters are encouraged to leave their comments in 
the HRSA drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing 
by stamping in and retaining an extra copy of the comments being 
filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.

FOR FURTHER INFORMATION CONTACT: Andy Jordan, (301) 594-0197.

SUPPLEMENTARY INFORMATION: HRSA is concerned that the publication of 
the proposed HPSA/MUP regulation has created misapprehension among some 
health center grantees regarding their ability to meet the proposed 
HPSA/MUP designation criteria, and in particular, their eligibility for 
current or expanded health center funding opportunities. The proposed 
rule includes three methods for making designations. As proposed, none 
of the three methods would limit health center eligibility for current, 
new or expanded funding.
    Currently, all of the designations are made on data that are 
submitted by States or communities. Under the proposed rule, this 
submission burden would be reduced by HRSA's use of nationally 
available data for initial calculations. In addition, States or 
communities continue to have the option to submit more specific or 
current local data as an alternative for use in calculations. This 
option may be particularly important to accurately reflect local 
demographic and health service realities. For example, an urban area 
may include a subpopulation with high needs, or a rural area may have 
recently experienced an acute loss of primary care providers.
    In addition to the Tier 1 method, the proposed rule includes two 
new designation methods. The first new method (Tier 2) assures that 
areas/organizations are not disadvantaged by the presence of federally-
supported resources. The second new method (Safety Net Facility) allows 
those organizations that serve high need populations to maintain or 
pursue designation. If none of the above methods produces a 
designation, this proposed rule continues the possibility of 
designation at the request of the Governor pursuant to existing law 
(section 330(b)(3)(D), Public Health Service Act).

[[Page 21301]]

    To reassess the impact of the proposed regulation on health 
centers, HRSA analyzed the most recent data from health center grantees 
who reported in calendar year 2006 to the Uniform Data System (UDS) and 
HRSA applied the methodologies in the proposed rule using nationally 
available data. Based on this analysis, at most, only 16 out of 1,001 
health center grantees (1.6 percent) would have to include State or 
local data to seek to maintain their current designation status. This 
analysis was conducted at the grantee level consistent with HRSA's 
health center policy that states: ``The statutory obligations of 
serving an MUA or MUP is an organizational level obligation, not a site 
specific requirement.'' (http://answers.hrsa.gov/, Answer ID 1216). The 
proposed rule does not change this health center policy.
    In order to facilitate a better understanding of the proposed rule, 
HRSA provided State Primary Care Offices (PCO) with a calculator that 
applies the formulas proposed in the rule to determine designation, 
with data files, as well as with technical assistance in using the 
calculator. We encourage interested parties to contact and work with 
their PCOs (http://nhsc.bhpr.hrsa.gov/resources/info/pco.asp) to review 
data and understand the implications of the proposed rule.
    To allay concerns of some commenters, this notice seeks to draw 
attention to and elicit comments on the following matters:

Eligibility for Federal Resources

    In the preamble, a statement in section IV. B. Methodology (last 
paragraph before subsection C at 73 FR 11247) inaccurately reflects our 
intent and the potential effect regarding eligibility for organizations 
designated through Tier 1 or Tier 2. It suggests that Tier 2 
designations will not be eligible for additional Federal resources. 
That is not the case. No provision in the proposed rule imposes any 
such limitation and it is not our intent to do so. Under the proposed 
rule, whether designated via Tier 1, Tier 2, or Safety Net Facility all 
entities will be equally eligible to compete for new or expanded health 
center funding. Similarly, all entities designated through Tier 1, Tier 
2, or Safety Net Facility will be equally eligible to compete for 
National Health Service Corps (NHSC) placements. In contrast to the 
health center policy described above, NHSC placements are site specific 
pursuant to section 333(a) of the Public Health Service Act. For 
example, while a health center grantee may be eligible for health 
center funding for all of its sites, only some of its sites may be 
eligible under law for NHSC placements. For further information on NHSC 
placements, please contact your State PCO.

Scoring for Relative Need

    Scores are a numerical expression of relative need derived from 
available data about demography, economics, population density, health 
status and available primary care providers. Scores are designed to be 
used by the NHSC for provider placement and may be used by other 
programs. While the proposed rule does not include a specific 
methodology for scoring those organizations that receive a designation 
for serving high-need populations (Safety Net Facility), a scoring 
methodology will have to be established. To determine a Safety Net 
Facility designation, HRSA will need data on the proportions of the 
applicant organization's patient population that are low-income 
uninsured as well as Medicaid-eligible (see 73 FR 11251 of the proposed 
rule). We seek comments on how to score these Safety Net Facility 
designations so that their need is ranked equitably with the 
designations scored in the other methods outlined in the proposed rule, 
that is, Tier 1 and Tier 2.
    We invite comments on these issues, as well as any other provisions 
of the proposed rule. We will respond to all comments when we publish 
the final rule.

    Dated: April 17, 2008.
Elizabeth M. Duke,
Administrator, Health Resources and Services Administration.
[FR Doc. 08-1167 Filed 4-17-08; 11:32 am]
BILLING CODE 4152-01-P