High Needs Indicated Group 1-FTEc=0 and FTEp=0 Group 2-Rc gte 4,500:1 and FTEP=0 Group 3-Rc gte 4,500:1 and Rp gte 15,000 Group 4(a)-For psychiatrist placements only: All other areas with FTEp-0 or Rp gte 20,000 Group 4(b)-For other mental health practitioner placements: All other areas with Rc gte 6,000:1. D. Determination of Size of Shortage. Size of Shortage (in number of FTE professionals needed) will be computed using the following formulas: (1) For areas without unusually high need: Core professional shortage=area population/ 6,000-number of FTE core professionals Psychiatrist shortage area population/ 20,000-number of FTE psychiatrists (2) For areas with unusually high need: Core professional shortage-area population/ 4,500-number of FTE core professionals Psychiatrist shortage area population/ 15,000 number of FTE psychiatrists Part II-Population Groups A. Criteria. Population groups within particular rational mental health service areas will be designated as having a mental health professional shortage if the following criteria are met: 1. Access barriers prevent the population group from using those core mental health professionals which are present in the area; and 2. One of the following conditions prevails: (a) The ratio of the number of persons in the population group to the number of FTE core mental health professionals serving the population group is greater than or equal to 4,500:1 and the ratio of the number of persons in the population group to the number of FTE psychiatrists serving the population group is greater than or equal to 15,000:1; or, (b) The ratio of the number of persons in the population group to the number of FTE core mental health professionals serving the population group is greater than or equal to 6,000:1; or, (c) The ratio of the number of persons in the population group to the number of FTE psychiatrists serving the population group is greater than or equal to 20,000:1. B. Determination of degree of shortage. Designated population groups will be assigned to the same degree-of-shortage groups defined in part I.C of this appendix for areas with unusually high needs for mental health services, using the computed ratio (Rc) of the number of persons in the population group to the number of FTE core mental health service providers (FTE) serving the population group, and the ration (Rp) of the number of persons in the population group to the num ber of FTE psychiatrists (FTEp) serving the population group. C. Determination of size of shortage. Size of shortage will be computed as follows: Core professional shortage=number of persons in population group/4,500-number of FTE core professionals Psychiatrist shortage-number of persons in population group/15,000-number of FTE psychiatrists Part III-Facilities A. Federal and State Correctional Institutions 1. Criteria. Medium to maximum security Federal and State correctional institutions for adults or youth, and youth detention facilities, will be designated as having a shortage of psychiatric professional(s) if both of the following criteria are met: (a) The institution has more than 250 inmates, and (b) The ratio of the number of internees per year to the number of FTE psychiatrists serving the institution is at least 2,000:1. (Here the number of internees is the number of inmates or residents present at the beginning of the year, plus the number of new inmates or residents entering the institution during the year, including those who left before the end of the year; the number of FTE psychiatrists is computed as in part I, section B, paragraph 3 above.) 2. Determination of Degree of Shortage. Correctional facilities and youth detention facilities will be assigned to degree-of-shortage groups, based on the number of inmates and/or the ratio (R) of internees to FTE psychiatrists, as follows: Group 1-Facilities with 500 or more inmates or residents and no psychiatrist. Group 2-Other facilities with no psychiatrists and facilities with 500 or more inmates or residents and R>3,000. Group 3-All other facilities. B. State and County Mental Hospitals. 1. Criteria. A State or county hospital will be designated as having a shortage of psychiatric professional(s) if both of the following criteria are met: (a) The mental hospital has an average daily inpatient census of at least 100; and (b) The number of workload units per FTE psychiatrists available at the hospital exceeds 300, where workload units are calculated using the following formula: Total workload units = average daily inpatient census + 2 × (number of inpatient admissions per year) + 0.5 × (number of admissions to day care and outpatient services per year). 2. Determination of Degree of Shortage. State or county mental hospitals will be assigned to degree-of-shortage groups, based on the ratio (R) of workload units to number of FTE psychiatrists, as follows: Group 1-No psychiatrists, or R>1,800. Group 4-600>R>300. C. Community Mental Health Centers and Other Public or Nonprofit Private Facilities. 1. Criteria. A community mental health center (CMHC), authorized by Pub. L. 94-63, or other public or nonprofit private facility providing mental health services to an area or population group, may be designated as having a shortage of psychiatric professional(s) if the facility is providing (or is responsible for providing) mental health services to an area or population group designated as having a mental health professional(s), and the facility has insufficient capacity to meet the psychiatric needs of the area or population group. 2. Methodology. In determining whether CMHCS or other public or nonprofit private facilities meet the criteria established in paragraph C.1 of this Part, the following methodology will be used. (a) Provision of Services to a Designated Area or Population Group. The facility will be considered to be providing services to a designated area or population group if either: (i) A majority of the facility's mental health services are being provided to residents of designated mental health professional(s) shortage areas or to population groups designated as having a shortage of mental health professional(s); or (ii) The population within a designated psychiatric shortage area or population group has reasonable access to mental health services provided at the facility. Such reasonable access will be assumed if the population lies within 40 minutes travel time of the facility and nonphysical barriers (relating to demographic and socioeconomic characteristics of the population) do not prevent the population from receiving care at the facility. (b) Responsibility for Provision of Services. This condition will be considered to be met if the facility, by Federal or State statute, administrative action, or contractual agreement, has been given responsibility for providing and/or coordinating mental health services for the area or population group, consistent with applicable State plans. (c) Insufficient capacity to meet mental health service needs. A facility will be considered to have insufficient capacity to meet the mental health service needs of the area or population it serves if: (i) There are more than 1,000 patient visits per year per FTE core mental health professional on staff of the facility, or (ii) There are more than 3,000 patient visits per year per FTE psychiatrist on staff of the facility, or (iii) No psychiatrists are on the staff and this facility is the only facility providing (or responsible for providing) mental health services to the designated area or population. 3. Determination of Degree-of-Shortage. Each designated facility will be assigned to the same degree-of-shortage group as the designated area or population group which it serves. [45 FR 76000, Nov. 17, 1980, as amended at 54 FR 8738, Mar. 2, 1989; 57 FR 2477, Jan. 22, 1992] APPENDIX D TO PART 5 CRITERIA FOR DESIGNATION OF AREAS HAVING Part 1-Geographic Areas A. Criteria. A geographic area will be designated as having a shortage of vision care professional(s) if the following three criteria are met: 1. The area is a rational area for the delivery of vision care services. 2. The estimated number of optometric visits supplied by vision care professional(s) in the area is less than the estimated requirements of the area's population for these visits, and the computed shortage is at least 1,500 optometric visits. 3. Vision care professional(s) in contiguous areas are excessively distant, overutilized, or inaccessible to the population of the area under consideration. B. Methodology. In determining whether an area meets the criteria established by paragraph A of this part, the following methodology will be used: 1. Rational Areas for the Delivery of Vision Care Services. (a) The following areas will be considered rational areas for the delivery of vision care services: (i) A county, or a group of contiguous counties whose population centers are within 40 minutes travel time of each other; (ii) A portion of a county (or an area made up of portions of more than one county) whose population, because of topography, market or transportation patterns, or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 40 minutes to these resources. (b) The following distances will be used as guidelines in determining distances corresponding to 40 minutes travel time: (i) Under normal conditions with primary roads available: 25 miles. For geographic areas where the age distribution of the population is not known, it will be assumed that the percentage distribution, by age groups, for the area is the same as the distribution for the county of which it is a part. (3) Determination of Estimated Supply of Optometric Visits. The estimated supply of optometric services will be determined by use of the following formula: Optometric visits supplied = 3,000 × (number of optometrists under 65) Optometric visits supplied + 2,000 × (number of optometrists 65 and over) Optometric visits supplied + 1,500 × (number of ophthamologists) (4) Determination of Size of Shortage. Size of shortage (in number of optometric visits) will be computed as follows: Optometric visit shortage = visits required - visits supplied (5) Contiguous Area Considerations. Vision care professional(s) in area contiguous to an area being considered for designation will be considered execessively distant, overutilized or inaccessible to the population of the area if one of the following conditions prevails in each contiguous area: (a) Vision care professional(s) in the contiguous area are more than 40 minutes travel time from the center of the area being considered for designation (measured in accordance with paragraph B.1(b) of this part). (b) The estimated requirement for vision care services in the contiguous area exceeds the estimated supply of such services there, based on the requirements and supply calculations previously described. (c) Vision care professional(s) in the contiguous area are inaccessible to the population of the area because of specified access barriers (such as economic or cultural barriers). C. Determination of Degree-of-Shortage. Designated areas (and population groups) will be assigned to degree-of-shortage groups, based on the ratio of optometric vis its supplied to optometric visits required for the area (or group), as follows: Group 1-Areas (or groups) with no optometric visits being supplied (i.e., with no optometrists or ophthalmologists). Group 2-Areas (or groups) where the ratio of optometric visits supplied to optometric visits required is less than 0.5. Group 3-Areas (or groups) where the ratio of optometric visits supplied to optometric visits required is between 0.5 and 1.0. Part II-Population Groups A. Criteria. Population groups within particular geographic areas will be designated if both the following criteria are met: (1) Members of the population group do not have access to vision care resources within the area (or in contiguous areas) because of non-physical access barriers (such as economic or cultural barriers). (2) The estimated number of optometric visits supplied to the population group (as determined under paragraph B.3 of part I of this Appendix) is less than the estimated number of visits required by that group (as determined under paragraph B.2 of part I of this Appendix), and the computed shortage is at least 1,500 optometric visits. B. Determination of Degree of Shortage. The degree of shortage of a given population group will be determined in the same way as described for areas in paragraph C of part I of this appendix. APPENDIX E TO PART 5-CRITERIA FOR DESIGNATION OF AREAS HAVING SHORTAGES OF PODIATRIC PROFESSIONAL(S) Part I-Geographic Areas A. Criteria. A geographic area will be designated as having a shortage of podiatric professional(s) if the following three criteria are met: 1. The area is a rational area for the delivery of podiatric services. 2. The area's ratio of population to foot care practitioners is at least 28,000:1, and the computed podiatrist shortage to meet this ratio is at least 0.5. 3. Podiatric professional(s) in contiguous areas are overutilized, excessively distant, or inaccessible to the population of the area under consideration. B. Methodology. In determining whether an area meets the criteria established by paragraph A of this Part, the following methodology will be used: 1. Rational Areas for the Delivery of Podiatric Services. (a) The following areas will be considered rational areas for the delivery of podiatric services: (i) A county or a group of contiguous counties whose population centers are within 40 minutes travel time of each other. (ii) A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market and/or transportation patterns or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 40 minutes from its population center to these resources. (b) The following distances will be used as guidelines in determining distances responding to 40 minutes travel time: cor (a) Podiatric professional(s) in the contiguous area are more than 40 minutes travel time from the center of the area being considered for designation. (b) The population-to-foot care practitioner ratio in the contiguous areas is in excess of 20,000:1, indicating that contiguous area podiatric professional(s) cannot be expected to help alleviate the shortage situation in the area for which designation is requested. (c) Podiatric professional(s) in the contiguous area are inaccessible to the population of the area under consideration because of specified access barriers (such as economic or cultural barriers). C. Determination of Degree of Shortage. Designated areas will be assigned to groups, based on the ratio (R) of adjusted population to number of foot care practitioners, as follows: Group 1 Areas with no foot care practitioners, and areas with R > 50,000 and no podiatrists. Group 2 Other areas with R > 50,000. APPENDIX F TO PART 5 CRITERIA FOR DESIGNATION OF AREAS HAVING Part 1-Geographic Areas A. Criteria. A geographic area will be designated as having a shortage of pharmacy professional(s) if the following three criteria are met: 1. The area is a rational area for the delivery of pharmacy services. 2. The number of pharmacists serving the area is less than the estimated requirement for pharmacists in the area, and the computed pharmacist shortage is at least 0.5. 3. Pharmacists in contiguous areas are overutilized or excessively distant from the population of the area under consideration. B. Methodology. In determining whether an area meets the criteria established by paragraph A of this Part, the following methodology will be used: 1. Rational Areas for the Delivery of Pharmacy Services. (a) The following areas will be considered rational areas for the delivery of pharmacy services: (i) A county, or a group of contiguous counties whose population centers are within 30 minutes travel time of each other; and (ii) A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market or transportation patterns or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 30 minutes to these resources. (b) The following distances will be used as guidelines in determining distances corresponding to 30 minutes travel time: (i) Under normal conditions with primary roads available: 20 miles. (ii) In mountainous terrain or in areas with only secondary roads available: 15 miles. (iii) In flat terrain or in areas connected by interstate highways: 25 miles. Within inner portions of metropolitan areas, information on the public transportation system will be used to determine the area corresponding to 30 minutes travel time. 2. Counting of Pharmacists. All active pharmacists within the area will be counted, except those engaged in teaching, administration, or pharmaceutical research. 3. Determination of Estimated Requirement for Pharmacists. (a) Basic estimate. The basic estimated requirement for pharmacists will be calculated as follows: Basic pharmacist requirement = .15 x (resi dent civilian population/1,000) + .035 x (total number of physicians engaged in patient care in the area). (b) Adjusted estimate. For areas with less than 20,000 persons, the following adjustment is made to the basic estimate to compensate 5. Contiguous Area Considerations. Pharmacists in areas contiguous to an area being considered for designation will be considered excessively distant or overutilized if either: (a) Pharmacy professional(s) in contiguous areas are more than 30 minutes travel time from the center of the area under consideration, or (b) The number of pharmacists in each contiguous area is less than or equal to the estimated requirement for pharmacists for that contiguous area (as computed above). C. Determination of Degree-of-Shortage. Designated areas will be assigned to degree-of-shortage groups, based on the proportion of the estimated requirement for pharmacists which is currently available in the area, as follows: Group 1-Areas with no pharmacists. Group 2-Areas where the ratio of available pharmacists to pharmacists required is less than 0.5. Group 3-Areas where the ratio of available pharmacists to pharmacists required is between 0.5 and 1.0. APPENDIX G TO PART 5 CRITERIA FOR DESIGNATION OF AREAS HAVING SHORTAGES OF VETERINARY PROFESSIONAL(S) Part 1-Geographic Areas A. Criteria for Food Animal Veterinary Shortage. A geographic area will be designated as having a shortage of food animal veterinary professional(s) if the following three criteria are met: 1. The area is a rational area for the delivery of veterinary services. 2. The ratio of veterinary livestock units to food animal veterinarians in the area is at least 10,000:1, and the computed food animal veterinarian shortage to meet this ratio is at least 0.5. 3. Food animal veterinarians in contiguous areas are overutilized or excessively distant from the population of the area under consideration. B. Criteria for Companion Animal Veterinary Shortage. |