Notice2022-10783
Criteria for Determining Maternity Care Health Professional Target Areas
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
May 19, 2022
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
Section 332 of the Public Health Service Act (PHSA) directs the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), to identify Maternity Care Target Areas (MCTA), or geographic areas within health professional shortage areas that have a shortage of maternity care health professionals, for the purpose of providing maternity health care assistance to such health professional shortage areas. On September 21, 2021, the Health Resources and Services Administration (HRSA) published a Federal Register notice soliciting feedback on proposed criteria to be used to identify Maternity Care Target Areas (MCTAs). HRSA requested feedback on six proposed criteria for inclusion in a composite scale to identify MCTAs with the greatest shortage of maternity care health professionals: (1) Ratio of females ages 15-44 - to-full time equivalent maternity care health professional ratio; (2) percentage of females 15-44 with income at or below 200 percent of the federal poverty level (FPL); (3) travel time and distance to the nearest provider location with access to comprehensive maternity care services; (4) fertility rate; (5) the Social Vulnerability Index; and (6) four Maternal Health Indicators (pre-pregnancy obesity, pre- pregnancy diabetes, pre-pregnancy hypertension, and prenatal care initiation in the first trimester). This notice summarizes and responds to the comments received during the 60-day comment period and presents the final criteria which will be used to identify and score MCTAs.
Full Text
<html>
<head>
<title>Federal Register, Volume 87 Issue 97 (Thursday, May 19, 2022)</title>
</head>
<body><pre>
[Federal Register Volume 87, Number 97 (Thursday, May 19, 2022)]
[Notices]
[Pages 30501-30506]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-10783]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Criteria for Determining Maternity Care Health Professional
Target Areas
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services (HHS).
ACTION: Final response.
-----------------------------------------------------------------------
SUMMARY: Section 332 of the Public Health Service Act (PHSA) directs
the Department of Health and Human Services (HHS), through the Health
Resources and Services Administration (HRSA), to identify Maternity
Care Target Areas (MCTA), or geographic areas within health
professional shortage areas that have a shortage of maternity care
health professionals, for the purpose of providing maternity health
care assistance to such health professional shortage areas. On
September 21, 2021, the Health Resources and Services Administration
(HRSA) published a Federal Register notice soliciting feedback on
proposed criteria to be used to identify Maternity Care Target Areas
(MCTAs). HRSA requested feedback on six proposed criteria for inclusion
in a composite scale to identify MCTAs with the greatest shortage of
maternity care health professionals: (1) Ratio of females ages 15-44 -
to-full time equivalent maternity care health professional ratio; (2)
percentage of females 15-44 with income at or below 200 percent of the
federal poverty level (FPL); (3) travel time and distance to the
nearest provider location with access to comprehensive maternity care
services; (4) fertility rate; (5) the Social Vulnerability Index; and
(6) four Maternal Health Indicators (pre-pregnancy obesity, pre-
pregnancy diabetes, pre-pregnancy hypertension, and prenatal care
initiation in the first trimester). This notice summarizes and responds
to the comments received during the 60-day comment period and presents
the final criteria which will be used to identify and score MCTAs.
ADDRESSES: Additional information about MCTAs is available at <a href="https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation">https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation</a>.
FOR FURTHER INFORMATION CONTACT: Dr. Janelle McCutchen, Chief, Shortage
Designation Branch, Division of Policy and Shortage Designation, Bureau
of Health Workforce, HRSA, 5600 Fishers Lane, Rockville, Maryland
20857, <a href="/cdn-cgi/l/email-protection#7407101904341c0607155a131b02"><span class="__cf_email__" data-cfemail="ea998e879aaa8298998bc48d859c">[email protected]</span></a>, or 301.443.9156.
SUPPLEMENTARY INFORMATION: Section 332 of the Public Health Service Act
(PHSA), 42 U.S.C. 254e, provides that the Secretary designate Health
Professional Shortage Areas (HPSAs) based on criteria established by
regulation. HPSAs are defined in section 332 to include (1) urban and
rural geographic areas which the Secretary determines have shortages of
health professionals, (2) population groups with such shortages, and
(3) public or private medical facilities or other public facilities
with such shortages. The required regulations setting forth the
criteria for designating HPSAs are codified at 42 CFR part 5.
Section 332(k)(1) provides that the Secretary, acting through the
Administrator of HRSA, identify shortages of maternity care services
``within health professional shortage areas.'' Section 332(k)(1)
further requires HRSA to identify MCTAs and distribute maternity care
health professionals within HPSAs using the MCTAs so identified. HRSA
must also collect and publish data in the Federal Register comparing
the availability and need of maternity care health services in HPSAs
and must seek input from relevant provider organizations and other
stakeholders.
In a September 21, 2021, Federal Register notice (86 FR 53324),
HRSA requested feedback on six proposed criteria to identify MCTAs: (1)
Ratio of females ages 15-44 -to-full time equivalent maternity care
health professional ratio; (2) percentage of females 15-44 with income
at or below 200 percent of the federal poverty level (FPL); (3) travel
time and distance to the nearest provider location with access to
comprehensive maternity care services; (4) fertility rate; (5) the
Social Vulnerability Index; and (6) four Maternal Health Indicators
(pre-pregnancy obesity, pre-pregnancy diabetes, pre-pregnancy
hypertension, and prenatal care initiation in the first trimester).
HRSA carefully evaluated and analyzed the comments received and
used them to guide the development of the final MCTA criteria.
Comments on the Proposed Criteria for Identifying Maternity Care Target
Areas
HRSA received 21 responses to the request for comments. Comments
and responses are summarized below.
Health Care Capacity Factors
Summary of Comments
Population-to-Provider Ratio
All commenters supported the inclusion of a population-to-provider
ratio and agreed with HRSA's proposal of a population ratio of females
ages 15-44 -to-full time equivalent maternity care health professional
ratio. However, several commenters questioned the use of only
Obstetrician/Gynecologists (OB/GYNs) and Certified Nurse Midwives
(CNMs) in the provider ratio and recommended the inclusion of family
medicine physicians, physician assistants, and nurse practitioners.
Specifically, one commenter indicated
[[Page 30502]]
``that a comprehensive system of maternity healthcare services is
comprised of multiple types of care and considerations should be made
for the inclusion of family medicine physicians in rural areas that
deliver maternity care services.''
Response
HRSA appreciates the recommendation for the inclusion of additional
provider types and recognizes the important contribution all of these
professionals play in the delivery of obstetrics care. Currently,
standardized nationwide data is not readily available outlining the
number of hours that individual family medicine physicians, physician
assistants, and nurse practitioners spend providing these services, and
thus the agency would have no way of uniformly comparing the hours that
these providers spend contributing maternity care services. HRSA
recognizes the important role of these clinicians in the provision of
maternity care and will continue to review the availability of these
data points to determine if additional provider types may be
incorporated into the MCTA scoring criteria in the future. We continue
to welcome recommendations on nationally available data sets for the
incorporation of these provider types into MCTAs. Until that data is
readily available for inclusion, HRSA will proceed with the population-
to-provider ratio as proposed.
Travel Time and Distance (TTD) to Nearest Source of Care (NSC)
HRSA proposed including a measure of travel time and distance (TTD)
to the nearest source of care (NSC) with access to comprehensive
maternity care services. All commenters supported the inclusion of TTD
to NSC criteria but presented varied methodologies on how to implement
and score the criteria. Some commenters were concerned with the TTD
point scale outline in the proposed criteria and suggested that HRSA
adjust and expand the scoring scale to provide points for facilities
identified within the 30 minute/mile TTD. A separate commenter
requested that, ``In terms of distance from comprehensive services, I
would ask HRSA to clarify that as the distance from a site that has
more than one or two on-staff OB/GYN.'' Another commenter indicated
that TTD should be the largest weighted factor, as it relates to the
geographic accessibility of services and is part of the assessment
needed to fully address the MCTA statutory requirements
Response
Section 332(k)(5) of the PHSA defines `full scope maternity care
health services' as care provided during labor, birthing, prenatal
care, and postpartum care, with no specification regarding the quantity
of providers available at the facility. As to the comment regarding
including points for distance less than 30 minute/mile, the United
States currently lacks an established benchmark for timely access to a
facility for obstetric care. However, the American College of
Obstetricians and Gynecologist (ACOG) proposes a 30-mintue capability
for decision-to-incision for emergency cesarean delivery.\1\ HRSA will
therefore retain its proposed approach.
---------------------------------------------------------------------------
\1\ 1Roa, Lina et al., ``Travel Time to Access Obstetric and
Neonatal Care in the United States.'' Obstetrics and Gynecology (New
York. 1953) vol. 136, no. 3 (2020): 610-612.
---------------------------------------------------------------------------
In reference to the comment for the explicit definition of
``distance from a site that has more than one or two on-staff OB/GYN,''
HRSA will apply the current Primary Care HPSA NSC policy, which
identifies the NSC based on the presence of a provider trained and
licensed to provide the necessary care regardless of the number of
providers at the location. In response to the comment regarding
geographic accessibility, HRSA recognizes the importance of this
measure and will retain it as proposed and continue to monitor this
issue in the future.
Health Care Need Factors
HRSA proposed the use of four Maternal Health Indicators (pre-
pregnancy obesity, pre-pregnancy diabetes, pre-pregnancy hypertension,
and prenatal care initiation in the first trimester).
Summary of Comments
Inclusion of Cigarette Smoking as Maternal Health Indicator
Several commenters suggested inclusion of a tobacco usage
indicator. Commenters noted that smoking in the 3 months leading up to
pregnancy can increase the risk of preterm birth and of adverse
maternal health outcomes, and recommended inclusion of tobacco use as
an indicator. Additionally, commenters highlighted that a significant
proportion of women who smoked cigarettes prior to pregnancy continue
to smoke into the later stages of gestation.
Response
HRSA agrees that the smoking of cigarettes is a significant risk
factor for adverse maternal health outcomes and will add cigarette
smoking as a Maternal Health Indicator. For this purpose, cigarette
smoking will be defined as women who report smoking one or more
cigarettes daily for the 3 months prior to pregnancy or during any of
the trimesters of their pregnancy.
One point will be added if the prevalence of cigarette smoking
before or during pregnancy in the MCTA is greater than or equal to the
median among all counties in the United States. If the prevalence of
cigarette smoking before or during pregnancy in the MCTA is less than
the median among all counties, zero points will be added.
------------------------------------------------------------------------
Cigarette smoking Points
------------------------------------------------------------------------
Prevalence of Cigarette Smoking Before or During 1
Pregnancy >=50th percentile............................
Prevalence of Cigarette Smoking Before or During 0
Pregnancy <50th percentile.............................
------------------------------------------------------------------------
To accommodate the inclusion of this factor, one point will be
removed from the total possible number of points awarded for the
percent of the population living at or below the 200 percent Federal
Poverty Level indicator. The rationale for this change is that
household income relative to the federal poverty line is represented
not only in this criterion but also in the Social Vulnerability Index
criterion.
Lower Point Threshold for Maternal Health Indicators
HRSA proposed that the threshold for receiving points for Maternal
Health Indicators would be 75%. Two commenters noted that the threshold
to receive a point for the Maternal Health Indicators was ``too
restrictive.'' One commenter recommended that the threshold be
decreased for each indicator from the top quartile (75th percentile) to
the median (50th percentile).
[[Page 30503]]
Response
HRSA conducted an impact analysis applying both percentiles to
existing primary care HPSAs. The results of the analysis indicated that
lowering the percentile threshold for Maternal Health Indicators to the
median resulted in a slightly more standard distribution of the points
across currently designated primary care HPSAs. The chart below
provides a visual of the difference in the score distribution between
the two thresholds. Based on this analysis, HRSA will adjust the
threshold for the Maternal Health Indicators to reflect the 50th
percentile recommendation of the commenters.
[GRAPHIC] [TIFF OMITTED] TN19MY22.014
Social Vulnerability Index
Several commenters requested that HRSA provide points based on the
individual factors of the Social Vulnerability Index (SVI) to allow for
an increased impact of the social determinant factors within the SVI.
Additionally, commenters proposed increasing the number of points
allotted to the entire SVI.
Response
HRSA recognizes the importance of the SVI in the prioritization and
distribution of resources. The scientific research that correlates the
SVI to a need for additional health care resources was conducted using
the entire index and not the individual factors. In addition,
accommodating all 15 of the individual factors of the SVI would dilute
the impact of Maternal Health Indicators that are more closely
associated with the need for maternal health care. Increasing the
weight of the SVI in the MCTA scoring criteria would decrease the
impact of other factors, such as initiation of prenatal care and pre-
pregnancy diabetes. HRSA will continue to apply the SVI as a whole to
the MCTA scoring criteria and maintain the proposed point scale.
Inclusion of Behavioral Health Factor as Maternal Health Indicator
Several commenters recommended the inclusion of a behavioral health
factor as part of the Maternal Health Indicators. One commenter
specifically recommended a composite point based on prevalence of
perinatal mood, anxiety disorders, and substance use disorder.
Commenters highlighted that a pre-pregnancy diagnosis of a mental
health illness can be an indicator of an increased risk of mental
health concerns during pregnancy, which also increases the potential
for adverse perinatal/post-partum health outcomes.
Response
HRSA recognizes the important impact of behavioral health factors
on maternal health outcomes. A Report from the 14-state Maternal
Mortality Review Committee found that 11% of the 421 pregnancy related
deaths with an identified underlying cause of death determination, were
due to mental health conditions. The Review Committee also determined
that 100% of the pregnancy-related mental health deaths with a
preventability determination were preventable.\2\
---------------------------------------------------------------------------
\2\ Trost, Susanna L., et al. ``Preventing Pregnancy-Related
Mental Health Deaths: Insights from 14 US Maternal Mortality Review
Committees, 2008-17: Health Affairs Journal.'' Health Affairs, 1
Oct. 2021, <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.00615">https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.00615</a>.
---------------------------------------------------------------------------
The Centers for Disease Control and Prevention (CDC) and Emory
University conducted a cross-sectional multilevel analysis of all
pregnancy-related deaths and all live births with available ZIP code or
county data in the Pregnancy Mortality Surveillance System during 2011-
2016 for non-Hispanic Black, Hispanic (all races), and non-Hispanic
White women aged 15-44 years. Among health care need and service
indicators, the number of mental health care professionals per 100,000
population had a strong inverse relationship with the pregnancy-related
mortality ratio. Each standard unit increase in the number of mental
health care professionals was associated with 5.55 (95% CI -8.11 to -
2.99) fewer deaths per 100,000 live births among Black women and 1.42
(95% CI -2.08 to -0.76) fewer deaths per 100,000 live births among
White women.\3\
---------------------------------------------------------------------------
\3\ Barrera, C., & Et.Al. (2022). County-Level Associations
Between Pregnancy-Related Mortality Ratios and Contextual
Sociospatial Indicators. Journal Of Obstet Gynecol, 00(00), 1-11.
---------------------------------------------------------------------------
HRSA agrees that access to behavioral health is a significant risk
factor for adverse maternal health outcomes and will include a
behavioral health access factor as a Maternal Health Indicator.
One point will be awarded if a portion or all of MCTA service area
is designated as a Mental Health HPSA meeting the following population-
to-provider median ratio thresholds based on its mental health provider
type. Zero points will be awarded if a portion or all of the MCTA
service area is not designated as a Mental Health HPSA or
[[Page 30504]]
the Mental Health designation does not meet the population to provider
ratio threshold.
------------------------------------------------------------------------
Behavioral health Points
------------------------------------------------------------------------
Portion or all of MCTA service area is designated as a 1
Mental Health HPSA meeting the following population-to-
provider ratio thresholds based on its mental health
provider type..........................................
<bullet> Psychiatrist ONLY: Psychiatrist population-
to-provider ratio >=45,000:1.
<bullet> Core Mental Health: Core mental health
population-to-provider ratio >=18,000:1.
<bullet> Psychiatrist and Core Mental Health:
Psychiatrist population-to-provider ratio
>=35,000:1 and Core mental health population-to-
provider ratio >=6,000:1.
<bullet> No Psychiatrists or Core Mental Health
Providers: >=7,500: 0.
Portion or all of MCTA service area is designated as a 0
Mental Health HPSA and does not meet the population-to-
provider ratio thresholds above, OR is not designated
as a Mental Health HPSA................................
------------------------------------------------------------------------
To accommodate the inclusion of this factor, one point will be
removed from the total possible number of points awarded for the travel
time and distance (TTD) to nearest source of care (NSC) criteria. The
rationale for this change is to ensure that all Health Care Capacity
Factors are equal in value.
Conclusion of Comment Response
HRSA appreciates the comments and recommendations received and has
used them to guide the development of the final Maternity Care Health
Professional Target Area criteria. Comments were not received on the
proposed Federal Poverty Level or Fertility Rate factors; they will be
finalized as proposed. The final MCTA criteria are included below. If
you have any questions, please contact Dr. Janelle McCutchen at
<a href="/cdn-cgi/l/email-protection#3e4d5a534e7e564c4d5f10595148"><span class="__cf_email__" data-cfemail="a1d2c5ccd1e1c9d3d2c08fc6ced7">[email protected]</span></a>.
Final Approach for Determining Maternity Care Health Professional
Target Areas
An MCTA score will be generated for each primary care HPSA using
the HPSA's service area. The following six scoring criteria will be
included in a composite scale that will be used to identify MCTAs with
the greatest shortage of maternity care health professionals: (1) Ratio
of females ages 15-44 -to-full time equivalent maternity care health
professional ratio; (2) percentage of females 15-44 with income at or
below 200 percent of the FPL; (3) travel time and distance to the
nearest provider trained and licensed to provide the necessary care;
(4) fertility rate; (5) the SVI; and (6) Maternal Health Index which
contains the following six indicators: Pre-pregnancy obesity, pre-
pregnancy diabetes, pre-pregnancy hypertension, prenatal care
initiation in the first trimester, cigarette smoking, and the
behavioral health factor. Each of these six criteria will be assigned a
relative weight based on the significance of that criterion relative to
all the others.
The weighted scores will be summed to develop a composite MCTA
score ranging from zero to 25, with 25 indicating the greatest need for
maternity care health professionals in the MCTA. Accordingly, the
higher the composite score, the higher the degree of need for maternity
care health services.
Score for Population-to-Full-Time-Equivalent Maternity Care Health
Professional Ratio
Population-to-provider ratio will measure the number of women of
childbearing age in the service area compared to the number of
maternity care health professionals in the service area. Women of
childbearing age will be defined as women between the ages of 15-44
years old and maternity care health professionals will be defined as
OB/GYNs and CNMs. A population-to-provider ratio of 1500:1 will be used
as a minimum requirement for a population to be considered reasonably
served by OB/GYNs and CNMs.
Population-to-provider Ratio point values will be distributed as
follows:
------------------------------------------------------------------------
Population-to-provider ratio Points
------------------------------------------------------------------------
Ratio >=6,000:1, or No CNMs or OB-GYNs and Population 5
(Pop) >=500............................................
6,000:1 > Ratio >=5,000:1, or No CNMs or OB-GYNs and Pop 4
>=400..................................................
5,000:1 > Ratio >=3,000:1, or No CNMs or OB-GYNs and Pop 3
>=300..................................................
3,000:1 > Ratio >=2,000:1, or No CNMs or OB-GYNs and Pop 2
>=200..................................................
2,000:1 > Ratio >=1,500:1, or No CNMs or OB-GYNs and Pop 1
>=100..................................................
Ratio <1,500:1, or No CNMs or OB-GYNs and Pop <100...... 0
------------------------------------------------------------------------
Score for Percentage of Population With Income at or Below 200 Percent
of the Federal Poverty Level
The percentage of people living in the service area at or below 200
percent of the FPL will be used to score MCTAs, based on poverty data
from the U.S. Census Bureau.
Population with income at or below 200 percent of the FPL point
values will be distributed as follows:
------------------------------------------------------------------------
Population with income at or below 200% FPL ratio Points
------------------------------------------------------------------------
Percentage of population with income at or below 200% 5
FPL >=50%..............................................
50% > Percentage of population with income at or below 4
200% FPL >=45%.........................................
45% > Percentage of population with income at or below 3
200% FPL >=40%.........................................
40% > Percentage of population with income at or below 2
200% FPL >=35%.........................................
35% > Percentage of population with income at or below 1
200% FPL >=30%.........................................
Percentage of population with income at or below 200% 0
FPL <30%...............................................
------------------------------------------------------------------------
[[Page 30505]]
Score for Travel Distance/Time to Nearest Source of Accessible Care
Outside of the MCTA
The Nearest Source of Care is defined as the nearest provider
trained and licensed to provide the necessary care, as determined by
the ESRI StreetMap Premium road network. Travel Time and Distance is
defined as the average time to travel by road miles or the actual
distance in road miles to the nearest source of care.
Travel Time and Distance to the Nearest Source of Care point values
will be distributed as follows:
------------------------------------------------------------------------
Travel time and distance Points
------------------------------------------------------------------------
Time >=90 min or Distance >=90 miles.................... 5
90 min > Time >=75 min or 90 miles > Distance >=75 miles 4
75 min > Time >=60 min or 75 miles > Distance >=60 miles 3
60 min > Time >=45 min or 60 miles > Distance >=45 miles 2
45 min > Time >=30 min or 45 miles > Distance >=30 miles 1
Time < 30 min and Distance <30 miles.................... 0
------------------------------------------------------------------------
Score for Fertility Rate
Fertility rate has been included to reflect the increased need for
maternity care services among populations that experience a higher rate
of births. Women of childbearing age will be derived from the American
Community Survey and births will be derived from the National Vital
Statistics System.
Fertility Rate point values will be distributed as follows:
------------------------------------------------------------------------
Fertility rate Points
------------------------------------------------------------------------
Fertility Rate >=90th Percentile........................ 2
90th Percentile > Fertility Rate >=50th Percentile...... 1
Fertility Rate <50th Percentile......................... 0
------------------------------------------------------------------------
Score for Social Vulnerability
Social vulnerability is defined as the resilience of communities
when confronted by external hazards such as disasters or disease
outbreaks per the Agency for Toxic Substances and Disease Registry's
Geospatial Research, Analysis and Services Program within the Centers
for Disease Control and Prevention. A score for overall social
vulnerability will be incorporated into the MCTA composite score using
the Centers for Disease Control and Prevention's SVI.
Social Vulnerability point values will be distributed as follows:
------------------------------------------------------------------------
Social vulnerability index Points
------------------------------------------------------------------------
Social Vulnerability >=75th Percentile.................. 2
75th Percentile > Social Vulnerability >=50th Percentile 1
Social Vulnerability <50th Percentile................... 0
------------------------------------------------------------------------
Score for Maternal Health Indicators
Maternal Health Indicators are defined as factors associated with
poor maternal health outcomes using data from the National Vital
Statistics System and the Shortage Designation Management System.
Scores will consider pre-pregnancy obesity, diabetes, hypertension,
cigarette smoking, and whether prenatal care began in the first
trimester as well as access to behavioral health services. Only women
of childbearing age will be considered for these indicators. HRSA will
use the National Vital Statistics System Natality file as the data
source to determine the sub-score for pre-pregnancy obesity, diabetes,
hypertension, cigarette smoking, and whether prenatal care began in the
first trimester. The Shortage Designation Management System Mental
Health Professional Shortage Area file will be the data source to
determine the sub-score for the behavioral health access factor.
Maternal Health Indicator criteria point values will be distributed
as follows:
<bullet> Pre-Pregnancy Obesity
Pre-pregnancy obesity is defined as having a Body Mass Index of 30
or higher. One point will be awarded if the prevalence of pre-pregnancy
obesity in the area is greater than or equal to the 50th percentile
among all counties in the United States. If the prevalence of pre-
pregnancy obesity in the area is less than the 50th percentile among
all counties, zero points will be awarded.
------------------------------------------------------------------------
Pre-pregnancy obesity Points
------------------------------------------------------------------------
Prevalence of pre-pregnancy obesity >=50th percentile... 1
Prevalence of pre-pregnancy obesity <50th percentile.... 0
------------------------------------------------------------------------
<bullet> Pre-Pregnancy Diabetes
One point will be awarded if the prevalence of pre-pregnancy
diabetes in the area is greater than or equal to the 50th percentile
among all counties in the United States. If the prevalence of pre-
pregnancy diabetes in the area is less than the 50th percentile among
all counties, zero points will be awarded.
[[Page 30506]]
------------------------------------------------------------------------
Pre-pregnancy diabetes Points
------------------------------------------------------------------------
Prevalence of pre-pregnancy diabetes >=50th percentile.. 1
Prevalence of pre-pregnancy diabetes <50th percentile... 0
------------------------------------------------------------------------
<bullet> Pre-Pregnancy Hypertension
One point will be awarded if the prevalence of pre-pregnancy
hypertension among women in the area is greater than or equal to the
50th percentile among all counties in the nation. If the prevalence of
pre-pregnancy hypertension among women in the area is less than the
50th percentile among all counties, zero points will be awarded.
------------------------------------------------------------------------
Pre-pregnancy hypertension Points
------------------------------------------------------------------------
Prevalence of pre-pregnancy hypertension >=50th 1
percentile.............................................
Prevalence of pre-pregnancy hypertension <50th 0
percentile.............................................
------------------------------------------------------------------------
<bullet> Cigarette Smoking
One point will be awarded if the prevalence of cigarette smoking
before or during pregnancy among women in the area is greater than or
equal to the 50th percentile among all counties in the nation. Before
pregnancy will be defined as smoking one or more cigarettes daily for
the 3 months prior to pregnancy. During pregnancy will be defined as
smoking one or more cigarettes during any trimester of pregnancy. If
the prevalence of cigarette smoking before or during pregnancy among
women in the area is less than the 50th percentile among all counties,
zero points will be awarded.
------------------------------------------------------------------------
Cigarette smoking Points
------------------------------------------------------------------------
Prevalence of Cigarette Smoking Before or During 1
Pregnancy >=50th percentile............................
Prevalence of Cigarette Smoking Before or During 0
Pregnancy <50th percentile.............................
------------------------------------------------------------------------
<bullet> Prenatal Care Initiation in the 1st Trimester
One point will be awarded if the prevalence of women who did not
initiate prenatal care in the first trimester of their pregnancy is
greater than or equal to the 50th percentile among all counties in the
nation. Zero points will be awarded if the prevalence of women who did
not initiate prenatal care in the first trimester of their pregnancy is
less than the 50th percentile among all counties.
------------------------------------------------------------------------
Prenatal care in first trimester Points
------------------------------------------------------------------------
Prevalence of No Prenatal Care in First Trimester >=50th 1
percentile.............................................
Prevalence of No Prenatal Care in First Trimester <50th 0
percentile.............................................
------------------------------------------------------------------------
<bullet> Behavioral Health Factor
One point will be awarded if a portion or all of MCTA service area
is designated as a Mental Health HPSA meeting the following population-
to-provider median ratio thresholds based on its mental health provider
type. Zero points will be awarded if a portion or all of the MCTA
service area is not designated as a Mental Health HPSA or if the Mental
Health designation does not meet the population to provider ratio
threshold.
------------------------------------------------------------------------
Behavioral health factor Points
------------------------------------------------------------------------
Portion or all of MCTA service area is designated as a 1
Mental Health HPSA meeting the following population-to-
provider ratio thresholds based on its mental health
provider type..........................................
<bullet> Psychiatrist ONLY: Psychiatrist population-
to-provider ratio >=45,000:1.
Core Mental Health: Core mental health population-to-
provider ratio >=18,000:1.
<bullet> Psychiatrist and Core Mental Health:
Psychiatrist population-to-provider ratio
>=35,000:1 and Core mental health population-to-
provider ratio >=6,000:1.
<bullet> No Psychiatrists or Core Mental Health
Providers: >=7,500: 0
Portion or all of MCTA service area is designated as a 0
Mental Health HPSA and does not meet the population-to-
provider ratio thresholds above, OR is not designated
as a Mental Health HPSA................................
------------------------------------------------------------------------
Paperwork Reduction Act
The criteria used to identify MCTAs under section 332(k) of the
PHSA, as described in this announcement, will not involve data
collection activities that fall under the purview of the Paperwork
Reduction Act of 1995. If the methods for determining MCTAs fall under
the purview of the Paperwork Reduction Act, HRSA will seek the Office
of Management and Budget clearance for proposed data collection
activities.
Carole Johnson,
Administrator.
[FR Doc. 2022-10783 Filed 5-18-22; 8:45 am]
BILLING CODE 4165-15-P
</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>Indexed from Federal Register on May 19, 2022.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.