Proposed Rule Would Strip Health Care Access From Millions

The AAFP and six other organizations are calling on HHS to rescind a proposed rule that could undermine access to care for millions of patients by stripping areas across the United States of their status as health professional shortage areas, or HPSAs, and Medically Underserved Areas, or MUAs.

HHS issued the proposed rule earlier this year, putting forth a plan to consolidate the criteria for HPSAs and MUAs into a single new methodology called the Index of Primary Care Underservice. The proposed rule is intended to improve the way underserved areas and populations are designated while targeting federal resources to the people and communities who need them the most, says a release issued by the Health Resources and Services Administration, or HRSA, an agency of HHS.

The consolidation of HPSAs and MUAs could strip 600 areas of their HPSA status while de-designating more than 900 MUAs, creating new health care shortages and exacerbating existing ones, according to an analysis conducted by the AAFP's Robert Graham Center.

"Approximately 600 HPSAs, containing nearly 32,000 primary care physicians and 32 million people could lose designation under the rule, jeopardizing access to care for underserved people," says a May 8 letter sent to HHS Secretary Michael Leavitt by the AAFP, the Society of Teachers of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, the Association of Departments of Family Medicine, the American College of Physicians and the National Association of Community Health Centers, or NACHC. "It also could de-designate more than 900 MUAs, which contain 38,000 primary care physicians and 31 million people."

According to the letter, "more than 34 federal programs depend on these shortage designations for eligibility and funding preference purposes. For example, Medicare Provider Incentive Payments are made to physician practices in HPSAs, and physician loan repayment programs are dependent on service in HPSAs. The rule does not specify how these programs administered by the department or agency will be affected."

The federal government also places physicians from the National Health Service Corps and the J1-Visa program in HPSAs -- positions that would be eliminated as these areas lose their HPSA designations under the proposed rule. But the nation's community health centers, or CHCs, may suffer the most from the proposal.

The federal government provides funding to CHCs provided they are located in or serve a designated MUA. HRSA says the proposed rule would cause about 2 percent of the nation's 6,000 CHCs to lose funding, but Dan Hawkins, NACHC's senior vice president for policy and programs, says that as many as one-third of all CHCs would lose their formal MUA designation. Instead, they would have to rely on a new "Safety Net Facility" designation -- a category whose value remains unclear -- for funding. Perhaps more importantly, says Hawkins, the proposal would make it much more difficult for areas to secure designations as MUAs, potentially curtailing and eventually decreasing the number of CHCs.

"This rule is just not ready for prime time," says Hawkins, describing the proposed rule as "too flawed, too complex and too uncertain."

Hawkins, like the AAFP, urges HHS to "back up and start over," and to "bring experts to the table, including stakeholders who rely on these designations, and let us work together to come up with a methodology that works for everyone -- one that is equitable and truly measures underservice."