Federal Health Professional Shortage Area Designation Process

Activation

• The designation process can be initiated by:
• Community representative/consultant;
• Health care provider; or
• The State.

The analysis area is then reviewed for possible shortage of access to primary care, dental services or mental health services. The completed consultant review is sent directly to the federal Division of Shortage Designation for their evaluation and approval or denial. All reviews that are completed by the State Rural Health and Primary Care are signed by the Director of the Offices of Health Data and Program Management and forwarded to the Division of Shortage Designation.

Procedure

The federal criteria must be met for an area to be designated. Those criteria are:

• The area must be a rational service area. In this state, analysis areas have been established which include all the populated cities, towns and territories. There are currently 62 primary care analysis areas (PCAAs) and 46 mental health analysis areas (MHAAs) and dental care analysis areas (DCAAs).
  
  
• The area must meet the population to provider ratio criterion. The primary care ratio of population to physicians must be at least 3500:1 (3000:1 with unusually high needs); the dental care ratio of population to general practice dentists must be at least 5000:1 (4000:1 with unusually high needs) and the mental health ratio of population to psychiatrists must be at least 30,000:1 (20,000:1 with unusually high needs). An opportunity for designation as a shortage area for mental health providers can also be reviewed by counting all licensed mental health providers with a ratio of 9000:1. If the ratio is too low for designation, then the population that is at or below 200 % of the federal poverty level can be compared to the providers serving MaineCare (Medicaid) patients and offering a sliding fee scale. The required ratios are the same as above.
  
  
• Providers in contiguous areas must be over-utilized, excessively distant or unavailable to the population of the area being reviewed. Over-utilization is based on the population to provider ratio in each area. Primary care is at least 2000:1, dental is 3000:1 and mental health (psychiatrists) is 20,000:1. Excessive distance is more than 30 minutes travel to primary care, more than 40 minutes to dental and mental health care.

At the time of submission, copies are mailed to the person or organization requesting the review, interested parties in the community, the appropriate provider associations and State agencies, the Maine Primary Care Association, and the Governor's Office.

The turn-around time for federal designations depends on staffing and workload at the federal Division of Shortage Designation. There is an automatic 30-day comment period prior to review. The total time to designation can be as brief as two months or as extended as nine or more months.