VII. MUA/MUPVII. MUA/MUP

VII-1

Medically Underserved Areas (MUA)Medically Underserved Areas (MUA)& Medically Underserved Populations (MUP)& Medically Underserved Populations (MUP)

Objective:

Participants will understand:

1) The difference between MUAs & MUPs

2) The information required for a complete submission

3) How each factor is weighted and scored to determine

a final Index of Medical Underservice (IMU) Score

VII-2

Designation Requirements for Selected Federal Programs

VII-3

Shortage Designation Option

National Health Service Corps

Federally Qualified Health Center Program

Medicare Incentive Payment

Rural Health Clinic Program

J-1 Visa Waiver

Primary Care HPSA (Area only) X X X X

Primary Care HPSA (Population Only) X X X

Dental Care HPSA (Area & Population) X

Mental Health HPSA (Area only) X X X

Mental Health HPSA (Population only)

X X

Facility HPSA X X

Medically Underserved Area X X X

Medically Underserved Population X X

State Governor’s Certified Eligible Area (for RHC purposes only)

X

(Not in CA)

MUA Criteria

Origin: HMO program and Community/Migrant Health Centers (C/MHC)

Measures the degree of underservice of an area (MUA) or a population (MUP)

 1. Component:

  Rational Service Area (RSA) 

2. Criteria and Weighted Values:  a) [V1] Percent of Population at 100% Poverty

b) [V2] Percent of Population > 65c) [V3] Infant Mortality Rate (IMR)d) [V4] Primary Care Physicians per 1,000 Population

 3) Index of Medical Underservice:

  Value must be < 62.0

VII-4

MUP Criteria

 1. Component:

  Rational Service Area (RSA) 

2. Criteria and Weighted Values:  a) [V1] Percent of Population at 100% Poverty

b) [V2] Percent Population > 65c) [V3] Infant Mortality Rated) [V4] Primary Care Physician serving the low-income pop

(200% poverty level) per 1,000 low-income population

 3. Index of Medical Underservice:

  Value must be < 62.0

VII-5

1. Determine the Rational Service Area (use MSSA)

2. Assemble data

a) Percent of the population at the 100% poverty level

b) Percent of the population > 65

c) Infant mortality rate

d) Primary care physicians per 1,000 population

3. Determine weighted values

4. Compute the Index of Medical Underservice Score

STEPSSTEPS

VII-6

Determine the Rational Service Area Determine the Rational Service Area (use MSSA).(use MSSA).

STEP 1

VII-7

Types of MSSAs

Medical Service Study Areas (MSSAs)

Whole County MSSA Sub-County MSSA

VII-8

Assemble data on:Assemble data on:

a)a) Percent of the population at the Percent of the population at the 100%100% poverty levelpoverty level

b)b) Percent of the population Percent of the population >> 65 65

c)c) Infant mortality rate Infant mortality rate (IMR)(IMR)

d)d) Primary care Primary care physiciansphysicians per 1,000 per 1,000 populationpopulation

STEP 2

VII-9

Determine weighted values of:Determine weighted values of:

STEP 3

VII-10

a)a) Percent of the population at the Percent of the population at the 100%100% poverty levelpoverty level

b)b) Percent of the population Percent of the population >> 65 65

c)c) Infant mortality rate Infant mortality rate (IMR)(IMR)

d)d) Primary care Primary care physiciansphysicians per 1,000 per 1,000 populationpopulation

Step 3a(V1) Percentage Population

at 100% Poverty

Determine the percentage of the population in the area at the 100% poverty level

Use latest available data (2007 Claritas Population Estimates)

Calculate 100% Poverty:

Number at 100% Federal Poverty LevelCivilian Population

Determine the weighed value (see table)1

1 This value is the same for both MUAs and MUPs

VII-11

VII-11

Step 3a (V1) Percent Population at 100% Poverty

Percent Below Poverty

Weighted Value

0 25.1

0.1-2.0 24.6

2.1-4.0 23.7

4.1-6.0 22.8

6.1-8.0 21.9

8.1-10.0 21.0

10.1-12.0 20.0

12.1-14.0 18.7

14.1-16.0 17.4

16.1-18.0 16.2

Percent Below Poverty

Weighted Value

18.1-20.0 14.9

20.1-22.0 13.6

22.1-24.0 12.2

24.1-26.0 10.9

26.1-28.0 9.3

28.1-30.0 7.8

30.1-32.0 6.6

32.1-34.0 5.6

34.1-36.0 4.7

36.1-38.0 3.4

VII-13

Step 3a (V1) Percent Population at 100% Poverty

Percent Below Poverty Weighted Value

38.1-40.0 2.1

40.1-42.0 1.3

42.1-44.0 1.0

44.1-46.0 0.7

46.1-48.0 0.4

48.1-50.0 0.1

50 + 0

VII-14

(continued)

Step 3b (V2) Percentage of Population > 65

Determine the percentage of the population in the area > 65 years old

Use the latest available data (2007 Claritas Population Estimates)

Calculate percent > 65 years old:

Number > 65 years old Civilian Population

Determine the weighted value (see table on next page)1

1 This value is the same for both MUAs and MUPs VII-15

Step 3b (V2) Percent Population > 65

Percent of Pop >65

Weighted Value

0 –7.0 20.2

7.1-8.0 20.1

8.1-9.0 19.9

9.1-10.0 19.8

10.1-11.0 19.6

11.1-12.0 19.4

12.1-13.0 19.1

13.1-14.0 18.9

14.1-15.0 18.7

15.1-16.0 17.8

Percent of Pop >65

Weighted Value

16.1-17.0 16.1

17.1-18.0 14.4

18.1-19.0 12.8

19.1-20.0 11.1

21.1-21.0 9.8

22.1-22.0 8.9

22.1-23.0 8.0

23.1-24.0 7.0

24.1-25.0 6.1

25.1-26.0 5.1

VII-16

(continued)

Step 3b (V2) Percent Population > 65

Percent of Pop >65 Weighted Value

26.1-27.0 4.0

27.1-28.0 2.8

28.1-29.0 1.7

29.1-30.0 0.6

30 + 0

VII-17

(continued)

Step 3c (V3) Infant Mortality Rate (IMR)

Use the OSD available data (5-year average) or OSD-approved State Department of Health data

Department of Public Health’s Center for Health Statistics website: http://www.cdph.ca.gov/certlic/birthdeathmar/Pages/default.aspx

Use the IMR for the service area (MSSA) or countywide

Calculate Infant Mortality Rate

Number of Infant Death Number of Live Births

Determine the weighted value (see table on next page)1

1 This value is the same for both MUAs and MUPsVII-18

x 1,000

Step 3c (V3) Infant Mortality Rate (IMR)

Infant Mortality Rate

Weighted Value

0-8 26.0

8.1-9.0 25.6

9.1-10.0 24.8

10.1-11.0 24.0

11.1-12.0 23.2

12.1-13.0 22.4

13.1-14.0 21.5

14.1-15.0 20.5

15.1-16.0 19.5

16.1-17.0 18.5

Infant Mortality Rate

Weighted Value

17.1-18.0 17.5

18.1-19.0 16.4

19.1-20.0 15.3

20.1-21.0 14.2

21.1-22.0 13.1

22.1-23.0 11.9

23.1-24.0 10.8

24.1-25.0 89.6

25.1-26.0 8.5

26.1-27.0 7.3

VII-19

(continued)

Step 3c (V3) Infant Mortality Rate

Infant Mortality Rate

Weighted Value

27.1-28.0 6.1

28.1-29.0 5.4

29.1-30.0 5.0

30.1-31.0 4.7

31.1-32.0 4.3

32.1-33.0 4.0

33.1-34.0 3.6

34.1-35.0 3.3

35.1-36.0 3.0

36.1-37.0 2.6

Infant Mortality Rate

Weighted Value

37.1-39.0 2.0

39.1-41.0 1.4

41.1-43.0 0.8

43.1-45.0 0.2

45.1+ 0

VII-20

(continued)

Step 3d (V4) Providers per 1,000 Population

Determine the FTE:MUA – All primary care physicians are countedMUP – All primary care physicians servicing the population

group are countedMust collect inpatient and outpatient hours

Determine the population:MUA = civilian populationMUP = number in that population group (e.g., low-income

pop = pop at or below the 200% poverty)

Calculate Providers per 1,000 population: MUA: Total FTE1 MUP: Total FTE

Civilian Pop Pop to be designated

Determine the weighted value (see table)

1 All physician must be counted (including J-1 Visa physicians, NHSC physicians, etc.). For MUA designations, the HPSA adjustment factor for the FTE is not used. VII-21

X 1,000 X 1,000

FTEs - Geographic Designation

1 Dr. Liver is an NHSC loan repayment recipient , counted as 1.0 FTE

2 Dr. Spleen spends 10 hours/week doing research

3 Dr. Lung spends 15 hours/ week in administration

Physician Name Specialty Location of Practice/CT Hours of Direct Patient Care/Week

FTE

A. Liver, MD1 General Practice 86 N. Onion StreetCity, State, Zip

48(48/40=1.2=1.0)

1.0

B. Spleen MD2 Pediatrics 103 Sanfgroid Dr

City, State, Zip

30(30/40=.75)

0.75

C. Heart, MD Internal Medicine 777 Stopper AveCity, State, Zip

40 1.0

D. Kidney, DO OB-GYN 3306 Stone DriveCity, State, Zip

40 1.0

E. Lung, DO3 Family Practice 99 Airborne BlvdCity, State, Zip

25(25/40=.625)

0.625

Total Physicians = 5 Total FTE = 4.375=4.4

VII-22

FTEs – Low-Income Population Designation

Physician Name Spec. Practice Location

Direct Pat. Care Hrs/Wk

FTE % of Medi-Cal

% of Sliding Fee

% of Low-Income

Total Low-Inc FTE

A. Liver, MD GP 86 N. Onion StCity, State, Zip

48 1.0 64% 15% 79% 0.79

B. Spleen MD PED 103 Sanfgroid Dr

City, State, Zip30 0.75 35% 8% 43% 0.3225

C. Heart, MD IM 777 Stopper AveCity, State, Zip

40 1.0 60% 40% 100% 1.0

D. Kidney, DO OB/ GYN

3306 Stone DriveCity, State, Zip

40 1.0 13% 0% 13% 0.13

E. Lung, DO FP 99 Airborne BlvdCity, State, Zip

25 0.625 7% 0% 7% 0.04375

Total Physicians = 5 Total L- I FTE = 2.28625=2.3

VII-23

Step 3d (V4) Providers per 1,000 Population

PC Physicians per 1,000 pop

Weighted Value

0-.05 0

.051-.100 0.5

.101-.150 1.5

.151-.200 2.8

.201-.250 4.1

.251-.300 5.7

.301-.350 7.3

.351-.400 9.0

PC Physicians per 1,000 pop

Weighted Value

.401-.450 10.7

.451-.500 12.6

.501-.550 14.8

.551--.600 16.9

.601-.650 19.1

.651-.700 20.7

.701-.750 21.9

.751-.800 23.1

Left Column – find the range which includes the ratio of primary care physicians per 1,000 population for the area being examined.

VII-24

Step 3d (V4) Providers per 1,000 Population

(continued)

Providers per 1,000 pop

Weighted Value

.801-.850 24.3

.851-.900 25.3

.901-.950 25.9

.951-1.000 26.6

1.001-1.050 27.2

1.051-1.100 27.7

1.101-1.150 28.0

1.151-1.200 28.3

1.201-1.250 28.6

Over 1.250 28.7VII-25

STEP 4

Compute the Index of Medical Underservice Compute the Index of Medical Underservice Score (IMU).Score (IMU).

VII-26

Compute the Index of Medical Underservice Score

The IMU Score is determined by adding the values of each of the four factors.

V1 + V2 + V3 + V4 = IMU Score

IMU < 62.0 Qualifies for designation as an MUA/MUP

IMU > 62.0Does not qualify for designation as an

MUA/MUP

VII-27

Time Saving Tips

Before surveying providers, check the IMU score of the first 3 variables

If V1 + V2 + V3 are > 62.0, the area will not designate as an MUA or MUP

If the IMU > 62, then review rational service area to determine if other boundaries would be appropriate

If not an MUA, check if area would designate as an MUP

VII-28

MUA/MUP Exercise

(Example)

VII-29

VII-30

Percent Population > 65

Percent of Pop >65

Weighted Value

16.1 - 17.0 16.1

17.1 - 18.0 14.4

18.1 - 19.0 12.8

19.1 - 20.0 11.1

21.1 - 21.0 9.8

22.1 - 22.0 8.9

22.1 - 23.0 8.0

23.1 - 24.0 7.0

24.1 - 25.0 6.1

25.1 - 26.0 5.1

Infant Mortality Rate (IMR)

Infant Mortality Rate

Weighted Value

0.0 - 8.0 26.0

8.1 - 9.0 25.6

9.1 - 10.0 24.8

10.1 - 11.0 24.0

11.1 - 12.0 23.2

12.1 - 13.0 22.4

13.1 - 14.0 21.5

14.1 - 15.0 20.5

15.1 - 16.0 19.5

16.1 - 17.0 18.5

Percent Population at 100% Poverty

Percent Below

Poverty

Weighted Value

0 25.1

0.1 - 2.0 24.6

2.1 - 4.0 23.7

4.1 - 6.0 22.8

6.1 - 8.0 21.9

8.1 - 10.0 21.0

10.1 - 12.0 20.0

12.1 - 14.0 18.7

14.1 - 16.0 17.4

16.1 - 18.0 16.2

Providers per 1,000 Population

PC Physicians per 1,000 pop

Weighted Value

.000 - .05 0.0

.051 - .100 0.5

.101 - .150 1.5

.151 - .200 2.8

.201 - .250 4.1

.251 - .300 5.7

.301 - .350 7.3

.351 - .400 9.0

Source: HWDD - Access Database

VII-31

VII-32

1

2

3

Total FTE = 4.375=4.4

Total Physicians = 5

0.62525(25/40=.625)

99 Airborne BlvdCity, State, Zip

Family PracticeE. Lung, DO3

1.0403306 Stone DriveCity, State, Zip

OB-GYND. Kidney, DO

1.040777 Stopper AveCity, State, Zip

Internal MedicineC. Heart, MD

0.7530(30/40=.75)

103 Sanfgroid Dr

City, State, Zip

PediatricsB. Spleen MD2

1.048(48/40=1.2=1.0)

86 N. Onion StreetCity, State, Zip

General PracticeA. Liver, MD1

FTEHours of Direct Patient Care/Week

Location of Practice/CTSpecialtyPhysician Name

Total FTE = 4.375=4.4

Total Physicians = 5

0.62525(25/40=.625)

99 Airborne BlvdCity, State, Zip

Family PracticeE. Lung, DO3

1.0403306 Stone DriveCity, State, Zip

OB-GYND. Kidney, DO

1.040777 Stopper AveCity, State, Zip

Internal MedicineC. Heart, MD

0.7530(30/40=.75)

103 Sanfgroid Dr

City, State, Zip

PediatricsB. Spleen MD2

1.048(48/40=1.2=1.0)

86 N. Onion StreetCity, State, Zip

General PracticeA. Liver, MD1

FTEHours of Direct Patient Care/Week

Location of Practice/CTSpecialtyPhysician Name

Rational Service Area

Cover letter with summary findings Type of Designation (MUA or MUP) Name of the Service Area Name of the County or Counties List of Service Area Parts New or Update Explanation of any changes from current designation Explanation of why area is rational Map of service area (road map and local map showing town(s) or census tracts and surrounding areas)

Population

Population number for type of designation Source of data

What to Include in the MUA/MUP Application

VII-33

What to Include in the MUA/MUP Application (continued)

VII-34

List of Primary Care Physicians: Name

Location Non-Metro areas – name of town Metro area – address with zip code, CT if available

Degree (MD or DO)

Specialty

Average # hours/week of patient care in area

% of practice Medicaid (for low-income, Medicaid-eligible, and poverty population designations)

% of practice Sliding Fee Scale (for low-income, poverty pop designation)

Inpatient care hours

FTE total for each provider rounded to the nearest tenth of a percent

Description of how information obtained (source, method)

What to Include in the MUA/MUP Application (continued)

VII-35

Primary Care Physician per 1,000 Population Total FTE

Primary Care Physician per 1,000 Population

Calculation

Other Variables Percent at 100% Poverty

Infant Mortality Rate

Percent > 65

Source of Data

IMU Score Show weighted values for 4 variables

Show IMU Score

Do not submit applications for IMU > 62.0

VII-36Proposed MSSA is 66a

The orange area is a designated MUA, and part of the designation is in MSSA 66a and part MSSA 63- because of this the whole designation can be thrown out

VII-37

Calculate the IMU Score

Calculate the Ratio of Population to

Primary Care Physician

STOP:

Area Will NotQualify

Calculate the Percentage of Population Age 65 or Over

Define Rational ServiceArea

Calculate Percentage ofPopulation with Income below the Poverty Level

Determine Service AreaPopulation

Process Model for MUA DesignationProcess Model for MUA Designation

Follow arrows: Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes

2

3

4

1

8

Calculate the Infant Mortality Rate

5

Determine Physician FTE6

7

10

62.1 or Above

APPLY FOR DESIGNATION

9 62.0 or Below

VII-38

Calculate the IMU Score

Calculate the Ratio of LowIncome Population to Primary Care Physician Serving that Population

STOP:

Area Will NotQualify

Calculate the Percentage of Population Age 65 or Over

Define Rational Service Area

Calculate Percentage of Population with Income below the Poverty Level

Determine Service Area Population

Process Model for MUP DesignationProcess Model for MUP Designation

Follow arrows: Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes

2

3

4

1

8

Calculate the Infant Mortality Rate 5

Determine Physician FTE6

7

1062.1 or AboveAPPLY FOR

DESIGNATION 9 62.0 or Below

VII-39