calculating population to provider ratios: dental health care

IV. CALCULATING POPULATION TO PROVIDER

RATIOS

Dental Health Care

IV-1

CALCULATING POPULATION TOCALCULATING POPULATION TO PROVIDER RATIOS PROVIDER RATIOS

(DENTAL HEALTH CARE)

Objective:

Participants will understand how to:

1) Identify all dental health providers, 2) Calculate full-time-equivalency rates, and 3) Determine the population to provider ratios for

dental health geographic and population designations

IV-2

Population to Provider Ratios Needed for DesignationPopulation to Provider Ratios Needed for Designation(DENTAL HEALTH CARE)

Geographic Area: > 5,000:1

A rational service area - sub-county (MSSA)

Geographic Area w/Unusually High Needs: > 4,000:1

A rational service area plus:

a) At or more than 20% of the population has incomes at or below 100% of the Federal poverty level; or

b) More than 50% of the population has no fluoridated water; orc) Meets insufficient capacity criteria

Population Groups: > 4,000:1

A rational service area plus meets the requirements of the specific designation category (e.g. low-income, homeless, etc.)

Contiguous Areas are overutilized if: > 3,000:1

IV-3

POPULATION SIDE OF THE RATIOPOPULATION SIDE OF THE RATIO(Same as Primary Health Care)

IV-4

________________:

PROVIDER SIDE OF THE RATIOPROVIDER SIDE OF THE RATIO

:____

IV-5

STEPSSTEPS

1) Identify all general practice dentists in the area tobe designated

2) Determine the number of hours each dentist works in direct patient care (office and hospital inpatient) serving the population to be designated

3) Calculate the FTE for each dentist serving the population to be designated

4) Calculate the population to provider ratio

IV-6

STEP 1STEP 1

IdentifyIdentify all general practice all general practice dentistsdentists in the area to be designated. in the area to be designated.

IV-7

List all dentists (D.D.S. or D.M.D.) who:

1) Provide direct patient care in the service area, and

2) Practice principally in general dentistry or pedodontics (pediatric dentistry)

Do not include:

Oral surgeons, orthodontist, or other specialists Dentists engaged solely in administration, research, or teaching Locum tenens serving less than 1 year

Include: Dentists who serve in the NHSC Scholarship or Loan Repayment Programs (exclude their FTEs) Dentists who serve in State Loan Repayment Program Dentists who are Federal providers (e.g. Commissioned Officers at IHS or BOP) Dentists who are planning on retiring but are still seeing patients

Note:All providers who meet these qualifications should be listed, even if their FTE will be 0.

IV-8

Sources of Provider DataSources of Provider Data

State Licensure Lists

National, State, and Local Dental Association Directories

Local Telephone Directory/Yellow Pages

Commercially Developed Listings

IV-9

STEP 2STEP 2

Determine each dentist’s age, number of Determine each dentist’s age, number of auxiliariesauxiliaries11, and number of hours serving , and number of hours serving the population to be designated.the population to be designated.

IV-10

1 Auxiliaries are non-dentists assisting in dental care such as dental assistants, hygienists, etc. They do not include receptionist and other support staff.

Designation Types and Whom To Include In the Provider Count

Designation Type: Count all dentists who

serve all persons: Geographic in the service area

Low-Income in the service area that have incomes Population < 200% of the Federal poverty level

(Medicaid and Sliding Fee)

Medicaid-Eligible in the service area that are Population Medicaid-eligible

Migrant Farmworker in the service area that are Population migrant farmworkers

Native American/ in the service area that are Native Alaskan Native American or Native Alaskan

IV-11

For each dentist, include the number of hours of direct patient care provided in the service area

Dentists under contract with the NHSC Federal Scholarship or Loan Repayment Programs (This does not apply to dentists in the State Loan Repayment Program.) Other Federal providers (e.g. Commissioned Officers at IHS or BOP sites, etc.)

Note:

List these dentists in the application but do not include their hours.

Include:All dentists who provide direct patient care in the service area, including those who:

1. Serve in State Loan Repayment Program2. Serve at Indian Health Clinics and are not Federal providers 3. Plan on retiring but are still seeing patients

IV-12

Except:

Providers

Dentist Name Age Location of

Practice

# of

Auxiliaries

Hours of Direct

Pt. Care/Week

M. Incisor, D.D.S. 29 789 Crown Street

Tooth Fairy, CA 99864

1 45

R. Wisdom, D.D.S. 78 789 Crown Street


1 15

A. Canine, D.D.S. 40 33 Halitosis Road

Smile City, CA 99918

3 37

B. Crown, D.D.S. 39 103 Molar Lane

Chompers, CA 99918

2 24

C. Buck, D.D.S. 32 66 Cavity Place

Mouthtown, CA 99918

2 25

Total Dentists: 5

IV-13

STEP 3STEP 3

Calculate the FTE for each dentist Calculate the FTE for each dentist serving the population to be serving the population to be designated.designated.

IV-14

Equivalency Weights by Number of Auxiliaries and Age

Auxiliaries are non-dentists assisting in dental care such as dental assistants, hygienists, etc.

Auxiliaries <55 55-59 60-64 65+ 0 0.8 0.7 0.6 0.5 1 1.0 0.9 0.8 0.7 2 1.2 1.0 1.0 0.8 3 1.4 1.2 1.0 1.0 > 4 1.5 1.5 1.3 1.2

If an auxiliary is less than full-time, round to nearest whole number (0.4 = 0, 0.5 = 1)

If more than one auxiliary works less than full time, add total hours, divide by 40, and round if not a whole number (0.4 +0.5 + 0.8 = 1.7 = 2)

If number of auxiliaries is not available, use these weights: <55 = 1.2

55 - 59 = 0.9 60 - 64 = 0.8

> 65 = 0.6

If dentist’s age and the number of auxiliaries are not available:

Use weight of 1.2IV-15

FTE CalculationFTE Calculation

40 hours = 1.0 FTE (There are no provisions to reduce the FTE of a dentist in residency.)

Every 4 hours (½ day) is counted as 0.1 FTE

Adjust FTE based on actual hours, age, and auxiliaries

A dentist’s FTE can exceed 1.0 due to auxiliaries

Each dentist’s FTE is rounded to the nearest tenth of a percent prior to totaling:

Examples: 0.875= 0.9 0.817= 0.80.83 = 0.8 0.85 = 0.9Note:

The FTE for low-income population designations is based on the average number of hours per week spent with Medicaid and SFS patients. It is not based on whether the provider is accepting new Medicaid patients.

IV-16

FTEs - Geographic Designation

Dentist Name Age Location of

Practice

# of

Auxiliaries

Hours of Direct Pt.

Care/Week

FTE Based on Hours

Total Rounded FTE

M. Incisor, D.D.S. 29 789 Crown St.


1 45 1.0

(45/40= 1.1=1)

1.0

(1.0x1.0=1.0)

R. Wisdom, D.D.S.9

78 789 Crown St.


1 15 .375 (15/40= .375)

0.3

(.375x.7= .26)

A. Canine, D.D.S.10 40 33 Halitosis Rd.

Smile City, CA 99918

3 37 .925

(37/40= .925)

1.3

(.925x1.4=1.29)

B. Crown, D.D.S.11 39 103 Molar Lane

Chompers, CA 99918

2 25 .6

(25/40=.6)

0.7

(.6x1.2= .72)

C. Buck, D.D.S.12 32 66 Cavity Place

Mouthtown, CA 99918

2 25 .625

(25/40= .625)

0.8

(.625x1.2 =.75)

Total Dentists: 5 Total FTEs: 4.1

9 – Dr. Wisdom works 25 hours/week in another location10 – Dr. Canine spends 2 hours/week in administrative activities11 – Dr. Crown chooses to work 25 hours/week12 – Dr. Buck spends 15 hours/week in childcare activities IV-17

FTEs - Low-Income Designation

Dentist Name Hours of Direct Pt.

Care/Week

Hourly FTE

Adjusted FTE % Medi-Cal

% SFS

% of Low-

Income

Total Low-Income FTE

Total

Rounded L-I

FTE

M. Incisor, D.D.S.

45(45/40= 1.1=1)

1.0 1.0(1x1= 1)

10% 2% 12%(10%+02%=12%)

0.12(.12 x 1 = .12)

0.1

R. Wisdom, D.D.S.

15(15/40=.375)

.375 0.262(.375x.7= .262)

0.0% 0% 0% 0.0(0 x .262 = 0)

0.0

A. Canine, D.D.S.

37(37/40= .925)

.925 1.33(.925x1.4=1.33)

50% 10% 60%(50%+10%=60%)

0.798(.6 x 1.33 = .798)

0.8

B. Crown, D.D.S.

24(24/40=.6)

.6 0.72(.6x1.2= .72)

20% 20% 40%(20%+20%=40%)

0.288(.4 x .72 = .288)

0.3

C. Buck, D.D.S. 25(25/40= .625)

.625 0.75(.625x1.2 =.75)

60% 15% 75%(60%+15%=75%)

0.562(.75 x .75 = .562)

0.6

Total Low-Inc FTEs: 1.8

IV-18

Survey Dentists to Determine Their FTE

Survey all dentists in service area Minimum two-thirds response rate required

Calculation of Non-Responders

Use survey average

Ex: Galt, California - 6 providers4 - respond to survey2 - no response after repeated telephone callsResponse rate: 4/6 = 66.6%Total FTE for the 4 responders= 3.5

1) Divide FTE of responders (3.5) by the number of responders (4) for the average FTE of responders (.87)

2) Multiply number of non-responders (2) by the average FTE of responders (.87) for FTE of non-responders (1.75)

3) Add FTE of responders (3.5) and non-responders (1.75) for total FTE = 5.3

IV-19

STEP 4STEP 4

Calculate the population to providerCalculate the population to provider ratio. ratio.

IV-20

Population to Provider RatiosPopulation to Provider Ratios

Resident-Civilian Population Ratio: Resident Civilian Population = 20,900Dentist FTE = 4.1(20,900/4.1 = 5,098:1)

Resident-Civilian Population (High Needs) Ratio:Resident Civilian Population = 20,900Dentist FTE = 5.2(20,900/5.2 = 4,019:1)(100% Federal poverty level at 18.9%)

Low-Income Population (200% Poverty):Low-Income Population = 10,137 (49.47%)FTE of Dentists Serving that Population = 1.8(10,137/1.8 = 5,632:1)

IV-21

What To Include In The Population to Provider Ratio Dental Health Care Section of Your Application

Population Total adjusted population Source of data

List of Dentists Include the Following for Each Dentist: Name Age Location:

Non-metro areas - name of townMetro areas – complete address with zip code, and CT if available

Specialty (general dentistry and pedodontics) Number of auxiliaries Equivalent weights Number of hours/week of patient care in area Percentage of practice Medicaid (for low-income and Medicaid-eligible designations) Percentage of practice Sliding Fee Scale (for low-income designations) FTE total for each provider rounded to the nearest tenth of a percent Description of how information was obtained (sources, methods of gathering data)

Totals and Ratio Total number of providers Total FTE Population to provider ratio Explanation of any high need indicators

IV-22

What Not To Include In Your Application

Information on the weather or climate

Information on road conditions, construction, or number of avalanches

Personal statements of driving time

Average number of funerals

History of the early settlers of the area

Newspaper articles

Pictures of the mayor

General information on access issues that is not specific to the area or population

Copies of old applications

IV-23

Contiguous Area ResourcesContiguous Area Resources

IV-24

Contiguous Area ResourcesContiguous Area Resources

Objective:

Participants will understand how to identify contiguous areas, determine if they have resources, and if the resources are excessively distant, over-utilized, or inaccessible to the population of the area proposed for designation

Purpose of Contiguous Area Analysis:

To identify nearby sources of care and determine if they are inaccessible to the population in the proposed service area

IV-25

STEPS

1)1) Identify the boundaries of eachIdentify the boundaries of eachcontiguous areacontiguous area

2) Evaluate each area to determine availability of resources

IV-26

Identify the boundaries of each contiguous area

A. Identify on a map the boundaries and population center of the proposed service areaB. Determine the contiguous areas in all directions within 40 minutes from the proposed area’s population center

C. Map the boundaries of each contiguous area in all directions (North, East, South, and West)

BoundariesThe boundaries of each contiguous area may be based on:

• Travel time (40 minutes)• Socio-economic/demographic characteristics• Established neighborhoods• Physical barriers• Designated HPSA

The boundaries of contiguous areas are often (not always) based on the same census delineation as the proposed area

Proposed service area = whole countyContiguous areas = whole counties

Proposed service area = census tracts (MSSA)Contiguous areas = census tracts (MSSA) IV-27

PROCESS OF EVALUATING AVAILABILITY OF RESOURCES

A) Check the HPSA list to determine if any of the contiguous areas are designated as HPSA and therefore considered inaccessible.

If it is not inaccessible HPSA, then

B) Determine if there are significant socio-economic/demographic disparities or physical barriers

If there are not significant socio-economic/demographic disparities orphysical barriers, then

C) Determine if the contiguous area’s providers are located > 40 minutes away from the population center of the proposed area and are therefore inaccessible

due to excessive distance

If they are not excessively distant, then

D) Determine if the resources in the contiguous area exceed the population-to- provider ratio and are therefore over-utilized

If they are not over-utilized, this area cannot be designated.

(Consider a different kind of designation)

IV-28

A) Check the HPSA status of the contiguous areas and determine if this type of HPSA is inaccessible to the proposed area

If the proposed service area is: Then the contiguous area is inaccessible if it is a:

Geographic without high needs Geographic HPSA

Geographic with high needs

(based on 100% poverty indicator)

Geographic HPSA, Low-Income HPSA

Low-Income HPSA Geographic HPSA, Low-Income HPSA

Medicaid Eligible HPSA Geographic, Low-Income, or Medicaid Eligible

Poverty Population HPSA Geographic, Low-Income, Medicaid Eligible or Poverty HPSA

IV-29

B) Determine if Significant Socio-economic/Demographic Disparities or Physical Barriers Exist

Significant demographic disparities between the populationin the service area and the population in the contiguous area which result in the population being isolated from nearby resources

(A 30% or more disparity between the population in the service area and the population in the contiguous area)

Significant socio-economic disparities: 100% poverty rate or 200% poverty rate

(A 30% or more disparity between the population in the service area and the population in the contiguous area)

Significant physical barrier: mountains, large parks, bodiesof water, highways, railway yards, industrial areas, etc. which result in the population being isolated from nearby resources

IV-30

C) Determine If Providers Are Excessively Distant

1) Develop a list of providers in the contiguous area2) Map their office locations3) Determine the travel time from the proposed area’s

population center to the contiguous area

Providers > 40 minutes from the population center are excessively distant

Dental Health Care: > 40 minutesInterstate Roads - 30 miles X 1.33 = 40 minutesPrimary Roads - 25 miles X 1.6 = 40 minutesSecondary Roads - 20 miles X 2.0 = 40 minutes

IV-31

C) Determine If Providers Are Excessively Distant (continued)

Inner Portions of Metropolitan Areas:

Distance is based on time using public transportation during non-rush hour.

Bus routes and schedules must be described (provide narrative description and include bus schedule if possible)

(Use only if the service area has population greater than 20% @ 100% poverty)

IV-32

D) Determine if Contiguous Areas Are Overutilized

Calculate FTE - use same method as used for the proposed service area

If needed, survey providers and determine FTE serving the population. Use same surveying method as used for the proposed service area.

Explain how the information was obtained and calculated, and include population, total FTE, and population to provider ratio

Population to Provider Ratios:

DENTAL HEALTH CARE: > 3,000:1 dentist

IV-33

ExampleExample

Sub-County

Map Analysis: 35-43

IV-34

Sub-County

Identify the boundaries of the proposed service area

MSSA 161c – Downtown (MSSAs) in San Diego

Largest population centerC.T. 41.00

IV-35

Sub-County (Dental HPSA)Sub-County (Dental HPSA)

Proposed Area: MSSA 161c – Golden Hill/Logan Heights, San Diego County:

Summary: Res./Civ. Pop: 75,852 White Pop: 61.04% Black Pop: 10.80% Hispanic Pop: 73.11% Below 200% Pov: 70.60% * Below 100% Pov: 35.69% Age 65 & + Pop: 7.74% * Fluoridated Water: No

*High Need Indicator: (CT 41.00 is the pop center) 1) 100% of Poverty Rate > 20% 2) No fluoridated water

IV-36

Sub-County

A) Determine the contiguous areas in all directions within 40 minutes from the proposed area’s population center

Area 1 (N) MSSA 161e - Kensington (C.T. 16.00)

Area 2 (NE) MSSA 161d - East San Diego (C.T. 27.08)

Area 3 (SE) MSSA 161g - National City (C.T. 33.02)

Area 4 (S) MSSA 161k - Chula Vista (C.T. 125)

Area 5 (W) MSSA 161n - Coronado (C.T. 74)

B) Map the boundaries of each contiguous area

IV-37

Sub-County

Identify the boundaries and population center of the proposed service area

IV-38

Sub-County Sub-County (Contiguous Area)(Contiguous Area)

Proposed Area: MSSA 161c – Golden Hill/ Logan Heights, San Diego County

Summary: Res./Civ. Pop: 75,852

White Pop: 61.04%

Black Pop: 10.80%

Hispanic Pop: 73.11%

Below 200% Pov: 70.60%

Below 100% Pov: 35.69%

65 year or older Pop: 7.74%

Fluoridated Water: No

Area 1 (N) – MSSA 161e – College Heights/Hillcrest Southeast/Kensington/Rolando North/University Heights(Significant Demographic Difference: Hispanic @ 44.46% Disparity)


White Pop: 64.86%

Black Pop: 11.22%


Below 200% Pov: 44.83%

Below 100% Pov: 21.22%



HPSA: No

Travel Time: 57 minutes

IV-39




White Pop: 61.04%

Black Pop: 10.80%


Below 200% Pov: 70.60%

Below 100% Pov: 35.69%



Area 2 (NE) – MSSA 161d – Chollas Creek/City Heights/East San Diego/North Park/Oak Park/South ParkSurvey Required – 14 providers 10 FTE – pop to provider ratio is 10,345:1


White Pop: 39.10%

Black Pop: 11.36%


Below 200% Pov: 60.48%

Below 100% Pov: 31.28%



HPSA: No

Civilian population 103,453/14FTE=10,345:1Travel Time: 30 minutes

IV-40


Area 3 (SE) – MSSA 161g – Encanto/Lincoln Acres/ National City E./Paradise Hills SW.:(Excessively Distant: 55 minutes by public transportation from CT 41.00 St (29th St & F St) to CT 33.02 ( 49th St & Imperial Ave)


White Pop: 30.09%

Black Pop: 19.96%


Below 200% Pov: 49.28%

Below 100% Pov: 20.96%



HPSA: No




White Pop: 61.04%

Black Pop: 10.80%


Below 200% Pov: 70.60%

Below 100% Pov: 35.69%



IV-41




White Pop: 61.04%

Black Pop: 10.80%


Below 200% Pov: 70.60%

Below 100% Pov: 35.69%



Area 4 (S) – MSSA 161k – Chula Vista Central and Northwest/National City West SW.:(Excessively Distant: 60 minutes by public transportation from CT 41 [29th St & F St) to CT 125.00 (Chula Vista/Oaklawn ST)


White Pop: 45.09%

Black Pop: 5.02%


Below 200% Pov: 52.18%

Below 100% Pov: 22.16%



HPSA: No


IV-42




White Pop: 61.04%

Black Pop: 10.80%


Below 200% Pov: 70.60%

Below 100% Pov: 35.69%



Area 5 (W) – MSSA 161n – Coronado/Ocean Beach/ Point Loma:(Significant Demographic Difference: White Pop @ 35.64% and Hispanic Pop @ 54.72% Disparity)


White Pop: 96.68%

Black Pop: 3.79%


Below 200% Pov: 24.01%

Below 100% Pov: 9.49%



HPSA: No

IV-43

ExamplesExamples

Worksheets

IV-44

Sample HPSA Worksheets

IV-45

Sub-County

IV-47IV-47

3 30

IV-28IV-48

IV-49IV-49

Determine the Nearest Source of Non-Designated Care

Needed for HPSA score:

Cannot be a HPSA (of any type) Cannot have significant socio-economic/demographic differences or physical barrier Can be excessively distant Can be overutilized

For all applications: Provide a road map with the proposed service area and contiguous areas outlined On the map, indicate the population center of the proposed service area, the nearest source of care, and the route between these points Provide the name and address of the nearest source of care, route, miles, and minutes For inner portions of metropolitan areas, include: Bus route information from the population center of the proposed area to the nearest source of care Miles and minutes of travel time

IV-51

Time Saving Tips

Survey providers only if necessary:

In contiguous areas, calculate the population to provider ratio counting each

provider as 1.0 FTE. If area meets ratio of > 3,000:1, don’t survey

Collect all possible information in one survey (e.g. Medicaid and

sliding fee scale even for an area designation)

Work with State licensing department to obtain information on

providers

Use claims data for Medicaid FTE (works only in fee-for-service

Medicaid)

IV-52

What To Include In The Contiguous Area Resources Section of Your Application

Map with Census Delineations

Name and boundaries of proposed service area Name and boundaries of contiguous areas Population center for the proposed service area Helpful: current designation status of each of the contiguous areas

Road Map

Outline of proposed area boundaries Location of nearest source of non-designated care For automobile transportation - start, end, and route For public transportation - start and end points of route

IV-53

For Contiguous Areas that are not Excluded with Current Designations, and Whose Providers are Excessively Distant

Travel time to closest provider from population center of service area, including miles, route, and type of road; or public transportation information, including bus routes, start/end points, miles, minutes, and source; include bus schedule if available

For Contiguous Areas that are not Excluded with Current Designations, and have Access Barriers

Description of any significant socio-economic/demographic disparities (e.g. demographic data on racial/ethnic composition or income levels comparing proposed service area population to population in the contiguous area, and source of data), or Description of any significant physical barrier

For Contiguous Areas that are not Excluded with Current Designations, and are Overutilized Population to provider ratios Description of how information was obtained

IV-54

Address of nearest source of non-designated, accessible care, including address, miles, and minutes via public transportation if metropolitan area Location of nearest source on road map (see above)

For All Designation Requests:

For Public Transportation Routes:

Travel time, based on non-rush hour bus schedules Start/End point of route Include time waiting for transfers while in route Map showing proposed area boundaries, start and end points of bus route Bus schedules, if available Cite source of information

(Public transportation can be used for service areas with a 100% poverty population at or greater than 20% of the civilian population.)

IV-55

Websites

Bay Area Public Transit (San Francisco):http://www.transitinfo.org

Southern California Public Transit (San Diego):http://www.sdcommute.com/

Los Angeles County Metropolitan Transportation Authorityhttp://www.metro.net/default.asp

2000 CT Locator:http://ffiec.gov/geocode/default.htm

U.S. Census Bureau – American Factfinderhttp://factfinder.census.gov/home/saff/main.html?_lang=en

IV-56

APPLY FOR DESIGNATION

No ContiguousArea Conditions

Met

1or more Contiguous Area ConditionsMet for EACH

Contiguous Area

Evaluate ContiguousArea

STOP:Area Not Qualified

For Designation

Calculate Population-to-Dentist Ratio

Define Rational ServiceArea

Determine Dental FTEs

Determine Service AreaPopulation

Evaluate Service Area for High-Need Indicators


For Designation


For Designation

No HighNeed Indicators

Present

1 or more High-Need Indicators

Present

Process Model for Geographic Dental Health Professional Shortage Area DesignationProcess Model for Geographic Dental Health Professional Shortage Area Designation

To Use: Follow arrows. Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes

2

3

4 6

9

1

5

9 8

IV-57

Ratio < 3999

9

Ratio 4000-4999

Evaluate Contiguous Area

5

1 or lessInsufficient

CapacityIndicators

Present

2 or moreInsufficient

CapacityIndicators

Present

1 or more ContiguousArea Conditions Met

for EACH Contiguous

Area

No ContiguousArea Conditions

Met


For Designation

9

APPLY FORDESIGNATION

8

Ratio > 5000

Evaluate forInsufficient

Capacity7

Initial Contact

Applicant contacts SDP for technical assistance (TA) and information. SDP provides: TA on appropriate designation Maps Population and demographic data Survey samples Application worksheets

1st Step – Application Received (Lal) Log application on tracking database Assign case number Mail acknowledgment letter

2nd Step – 30-day Comment Notice to: (Oakes) County Health Officer/ Department/Medical Society Primary Care, Dental, or Mental Health Association HRSA/SDB copied Case assigned to SDP staff (Chung)

3rd Step – Application Analysis (complete within 90 days, depending on caseload)

Primary Care HPSA and MUA/MUP (ASAPS Process) Validate application information before entering data into ASAPS (use on-line tools: maps, data tables, MSSA data) Verify provider data Calculate population to provider ratio Conduct contiguous area analysis in mapping interface (does not apply to MUA/MUP) If application is “incomplete”, request

additional data and allow applicant 15 days for resubmission. Verify and enter all additional data needed Prepare notification letter to applicant Prepare ASAPS packet for Manager’s review and approval (Chung) Upon completion, Manager submits recommendation via ASAPS Mail ASAPS packet to applicant and others (Oakes) Update tracking database (Lal)

4th Step - HRSA Review (SDB) Hold all recommendations for 30-day waiting period Perform primary and secondary reviews Upon approval or denial, post designation on HRSA on-line database Send designation letter to SDP and applicant

NOTE:

HPSA designations are valid for 4 years. To maintain the HPSA status, designees must reapply every 4 years. MUA/MUP designations are permanent, unless there is a change in the MSSA boundary then designees must be reapply for the updated boundary.

or

5th Step – SDP Tracking Update Update SDP tracking database (Lal) File designation letter in program file (Lal) Create monthly dynamic maps (Dixon/Pham)

Dental & Mental HPSA

(Manual Process): Define rational service area (MSSA) Verify population, poverty, & demographic data Geo-code and verify provider data Calculate population to provider ratio Verify contiguous area resources Develop proposed and contiguous area maps Determine data is accurate, current, and consistent with all HPSA criteria If application is “incomplete”, request additional data and allow applicant 15 days for resubmission. Prepare recommendation packet to Federal Shortage Designation Branch (SDB) Submit packet for peer review Submit packet for Manager review and approval (Chung) Mail recommendation packet to SDB and copies to applicant & others (Oakes) Update tracking database (Lal)

HPSA and MUA/MUP Application ProcessShortage Designation Program (SDP)

IV-58

calculating population to provider ratios: dental health care

Documents

dentists age

ftes dentists

incomes population

calculating population

dentists ftecanexceed

bop dentists

populationdesignations

listings iv