Health Center Regulatory Issues, Uncategorized

Negotiated Rule Making Process for Shortage Designations Closes, Committee Makes Nonbinding Recommendations to Secretary Sebelius

By: Alex Sange, Public Policy Associate

After more than a year of meetings, the Negotiated Rule Making (NRM) process to develop new methodologies for designations of Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas/Populations (MUAs/Ps) came to a close last month – without reaching the desired full consensus on proposed new methodologies for both HPSA and MUA/P designations.  These designations are intended to measure the degree to which a community is medically underserved (not enough providers to serve the population) and used to determine a community, area or facility’s eligibility for federal programs including the National Health Service Corps.  The methodology has not been updated in decades and as required under the Affordable Care Act, a committee of 26 members including representatives from the health center community has convened since last September with the goal of identifying, and reaching consensus on, a new process to designating HPSAs and MUA/MUPs.  If the group reached consensus (defined in this process as a unanimous vote), their recommendations to HHS Secretary Kathleen Sebelius about updating the designation process would be binding; without consensus, the Secretary may use the committee’s report for guidance in developing a new rule but it is nonbinding.


The final report was approved by the Committee with 2 dissenting votes out of 26 (5 members not present).  Despite total unanimity, the group did reach agreement on a number of fronts and they have urged the Secretary to seriously consider each of their recommendations. We expect to see a rule published from HHS late next spring or early summer (2012).   A summary of the Committee’s recommendations to the Secretary is here.  Additional information on the Committee’s process and product is here.


  1. Where in all of the rule-making detail are oral health and dental providers? Is there a change in establishing dentally underserved areas or is oral health not in the health field once again?

    1. Mr/Ms Salyk – your point is well-taken; however, the charge to this Negotiated Rulemaking Committee was to revise and update the criteria and methodologies for only PRIMARY MEDICAL CARE HPSA and MUA/P designations. COmmittee members asked early on if we would be asked to provide guidance on Oral Health and mental health designations, and we were told that it was beyond our purview. I remain hopeful that, if this effort undertaken by the NRM Committee succeeds, we may soon see proposed updates to those designations as well.
      Dan Hawkins

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