HHS Pulls Proposed Rule on Consolidating HPSAs, Medically Underserved Areas

HHS has withdrawn a proposed rule on the designation of health professional shortage areas, or HPSAs, and medically underserved areas, or MUAs, that could have derailed access to care for millions of Medicare beneficiaries.

HHS issued the proposed rule on Feb. 29, putting forth a plan to consolidate the criteria for HPSAs and MUAs into a single new methodology called the Index of Primary Care Underservice. Shortly after HHS issued the proposal, the AAFP signed onto a letter (3-page PDF; About PDFs) to HHS Secretary Michael Leavitt urging withdrawal of the proposition.

According to the letter, about "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." The proposal also could have de-designated more than 900 MUAs, which contain 38,000 primary care physicians and 31 million people, said the letter.

In all, HHS received more than 500 comments on the proposed rule. The majority of comments urged the agency to either postpone or withdraw the rule altogether.

In a statement published in the July 23 Federal Register, (1-page PDF; About PDFs) HHS announced its withdrawal of the rule, saying that "based on a preliminary review of the comments, it appears that (HHS) will need to make a number of changes in the proposed rule. Instead of issuing a final regulation as the next step, HHS will issue a new Notice of Proposed Rulemaking for further review and public comment prior to issuing a final rule."

The withdrawal of the rule comes just days after Congress overrode a presidential veto and enacted legislation that prevented deep cuts in the Medicare payment rate this year and next. AAFP President Jim King, M.D., of Selmer, Tenn., said the victories represent a turning point for the AAFP and its advocacy efforts.

"It appears that both Congress and the Bush administration realize we have to improve the primary care infrastructure in this country," said King. "But I also think our advocacy efforts are really starting to pay off."

The AAFP and other organizations have asked HHS to enter into a negotiated rule-making process with relevant stakeholders about any future proposed rules and to suspend the review of any existing shortage designations until the negotiated rule is complete. It is not clear what HHS plans to do with the MUAs and HPSAs before issuing a new proposed rule.