National Shortage Designation Update

Shortage designations are used to identify areas that lack providers. The designation serves to identify areas that are eligible to participate in programs designed to assist in recruiting providers to the area. Originally created in 1978 to identify areas in need of physicians and other health care providers from HHS’s National Health Service Corps (NHSC) programs, HPSA designation is now used by a variety of federal programs.

Shortage designations are based on the ratio of providers to population, plus additional criteria and guidelines specific to each of the three types of designations:

• Primary Care
• Dental Health
• Mental Health

Within each discipline for HPSAs, there are three types of designation status:

• Geographic Area
• Population (or Demographic)
• Facility (or Institutional)

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Medically Underserved Areas/Populations (MUA/P) are areas or populations designated by the HRSA as having:

• too few primary care providers
• high infant mortality
• high poverty and/or high elderly population

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Health Professional Shortage Areas (HPSA) and Medically Underserved Areas/Populations (MUA/P) are used to identify areas that lack providers or services. The designations serve to identify areas that are eligible to participate in programs designed to improve access to healthcare. Below are some of the federal programs that use designation as eligibility criteria and the required designation status.

Please note: the designation is required for eligibility to apply; in most cases additional applications are required. Contact us for more information on how to apply for participation in these programs.

The HRSA data warehouse shows the current status for all shortage-designated areas. The list of shortage areas is available online and is the official source for updates regarding shortage designation status.

HPSA Shortage Areas

MUA Shortage Areas

Population and Geographic HPSA Designation TPCO submits applications for all the geographic and population shortage designations in the state. TPCO also submits HPSA updates and responds to requests for new designations. Once TPCO has completed the necessary data collection and analysis, if an area is determined to meet HPSA criteria, the request is submitted to the federal agency. The federal agency reviews all HPSA designation application requests before the designation is made final. This process can take up to six months. For questions about a shortage designation update or a new designation, contact TPCO.

Facility HPSA Designation Facility designations follow a slightly different process which varies by facility type. Contact us for questions.

Email TexasPCO@dshs.texas.gov and include the current Designation ID, county name or facility address.

Facilities with Auto-HPSAs can review the data used for their specific facility in the Auto-HPSA portal. This is the only place that data will be available.

Please note, as we are continually updating provider data, impact on a given area is subject to change before the next National Shortage Designation Update occurs.

As with any update to a HPSA designation, site and participant eligibility for National Health Service Corp (NHSC) Nurse Corps and the State-funded Loan Repayment Programs may be impacted. 

A HPSA score that decreases will impact:

• NHSC and Nurse Corps site eligibility for Scholarship & Student to Service recipients (particularly if the score falls below 14).
• Initial awards

A HPSA score that decreases will not impact:

• Contract extensions for current participants.

A HPSA that is proposed for withdrawal will impact:

• NHSC and Nurse Corps site eligibility
• Contract extensions for current participants

For information on the State-funded Loan Repayment Programs contact either the TX Higher Education Coordinating Board or the State Office of Rural Health. 

As with any update to a HPSA designation, CMS Physician Bonus Payments may be impacted. Bonus payments will not be impacted by decreases in HPSA scores. However, CMS Bonus payments will be impacted beginning January 2019 for geographic primary care or mental health HPSAs that are withdrawn (July 2018).

For more questions regarding CMS Bonus Payments, inquiries, including general questions about the Medicare HPSA bonus program, questions on why or why not a bonus has been paid, or questions on particular Medicare claims to the MAC that processes their claims.

RHC certification and re-certification will not be impacted by decreases in HPSA scores, or HPSAs that are in “proposed for withdrawal” status. 

However, RHC certification and re-certification may be impacted when a HPSA is officially withdrawn with the publication of the Annual Federal Register Notice (July 2018). 

For more questions regarding RHC Certification, please email CMS. 

Auto-HPSA designations are included in the next National Shortage Designation Update. If data applicable to the facility has changed since the last update, the score may change. It will not affect eligibility for the Auto-HPSA if FQHCs retain their 330 Grant, or RHCs maintain NHSC site approval.

A HPSA that is ‘proposed for withdrawal’ indicates that the area no longer meets the federal criteria necessary to be designated a shortage area. HPSAs that are proposed for withdrawal are officially withdrawn with the annual publication of a Federal Register Notice, usually the summer following the National Shortage Designation Update.

An HPSA score that decreases indicates that there is less of a need for health professionals in the given area, but still enough of a need to qualify as a designated HPSA. An HPSA score that increases indicates that there is a greater need for health professionals in the given area.

TPCO contacts healthcare facilities and providers, primarily by phone or fax to validate provider NPI data on an ongoing basis. Provider data is critical to designations and their scores, but we are only able to validate the provider NPI data for which we receive a response. Contact our office to verify whether the provider NPI data for the HPSA in question has been validated, or if we are still waiting on a response from providers in the area. If we have not received responses for provider data in your area.

If you are a primary care provider, psychiatrist, dentist or administrator who works with these types of providers, visit Healthcare Provider Assessment for information on how to submit updated provider/practice information.

TPCO contacts healthcare facilities and providers, primarily by phone or fax to conduct validate provider NPI on an ongoing basis. Provider data is critical to designation and their scores, but we are only able to validate the provider NPI data for which we receive a response.

Contact our office to verify whether the provider NPI data for the HPSA in question has been validated, or if we are still waiting for a response from providers in the area.