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AZ State Loan Repayment Program & HPSA Updates October 9, 2021 Edith Di Santo| Primary Care Office Chief
AZ State Loan Repayment Program & HPSA Updates
October 9, 2021
Edith Di Santo| Primary Care Office Chief
Arizona Primary Care Office
• To optimize the health of all Arizona residents by developing and strengthening systems services to expand access to primary care and other services with emphasis on the health needs of underserved people and areas
• Implement strategies for strengthening primary care and the health care delivery system
• Increase the number of providers and improve services in underserved areas
• Identify areas that need improved health services and assist with federal/state shortage designations (HPSAs)
• Support statewide partners and provide technical assistance
Goals
• Administers:– Arizona State Loan Repayment Program– J1 Visa Program– National Interest Waiver Program– Evaluation and data collection for the designation of
– AZ Health Professional Shortage Areas (HPSAs) – Medically Underserved Areas/Populations (MUA/P)
– Reviews Sliding Fee Scales
• Technical Assistance/Promotes Federal Programs in AZ:– National Health Service Corps (LRP & Scholarship)
– Nurse Corps (LRP & Scholarship)
Core Functions
Federal Loan Repayment
• National Health Service Corps • Nurse Corps• Faculty• Substance Use Disorder Treatment and
Recovery
Sign Up for Updates
https://www.hrsa.gov/
https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?qsp=HRSA-
subscribe
Arizona State Loan Repayment Program (SLRP)
• Goals:– Award incentives to recruit and retain providers– Increase providers in rural and underserved
areas– Increase access to primary care, dental, and
mental health services
• Modeled after the Federal National Health Service Corps (NHSC) Loan Repayment program
Provider Retention- SLRP
How many more years clinicians anticipate they will remain in…
AZ SLRP (n=110)Average [Median]
their current practice 9.8 years [7 yrs.]
their current community 14.9 years [10 yrs.]
rural practice* 14.1 years [10 yrs.]
a medically underserved area, whether urban or rural
14.2 years [ 10 yrs.]
their current state 21.1 years [20 yrs.]
*Excluded non-rural providers
Eligible Disciplines• Physicians
• Family Medicine, OB/GYN, Pediatrics, Internal Medicine, Geriatrics, Psychiatry
• Dentists• Pharmacists• Advanced Care Providers
• Physician Assistants, Nurse Practitioners, Certified Nurse Midwives
• Behavioral Health Providers • LCSW, LFMT, Psych D, LPC
Contract Year of Service HPSA Score of 18-26 HPSA Score of 14-17 HPSA Score of 0-13Initial Two Years $65,000 $58,500 $52,000
Third year $35,000 $31,500 $28,000Fourth year $25,000 $22,500 $20,000
Fifth year and continuing $15,000 $13,500 $12,000
Physicians and Dentists
Advance Practice Providers, Behavioral Health Providers and PharmacistsContract Year of Service HPSA Score of 18-26 HPSA Score of 14-17 HPSA Score of 0-13
Initial two years $50,000 $45,000 $40,000
Third year $25,000 $22,500 $20,000
Fourth year $20,000 $18,000 $16,000
Fifth year and continuing $10,000 $9,000 $8,000
Award amounts are tax-exempt.
Award Amounts*
*Based on maximum, full-time commitment.
Applicant Health Service Priority Score
1. Geographic location (Rural vs. Urban)2. HPSA score specific to the applicant’s discipline3. Percentage of underserved populations served by Service Site4. Access to the next nearest Sliding Fee Scale clinic of similar type service5. Newly employed at the service site or by the employer6. On-site or in-person service delivery versus telemedicine7. Arizona resident8. Graduate of an Arizona graduate educational institution9. Experience in serving the medically underserved10. Service Hours (Full-time /Half-time)
AZ SLRP Annual Cycle• January-March: sites must register to be active eligible
sites for SLRP for the year
• April 1st: Renewal Applications cycle closes for participants who will be completing their initial 2-year award/obligation
• Mid April - June 1st: Initial 2-year Application cycle closes for new participants
• October: Awards & Contracts are given to awarded applicants.
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76
109
120
107
78
0
20
40
60
80
100
120
140
2017 2018 2019 2020 2021 2022
Total # of SLRP Applications
Demand for SLRP
Demand for SLRP
SLRP by Service Type
FY2021 Providers
Budget
– 2022 Total Budget = $3,800,000
• State Funds= $2,500,000• $500,000 Appropriated• $2,000,000 in S.B.1847
• Federal Funds=$1,000,000• Private Donations approx.$300,000
• Earmarked for behavioral health
– Federal funds must be matched dollar for dollar with non-federal funds (state & private donations)
• Arizona was recognized for two items nationally: – State Match Diversification: AZ & RI have been
champions of securing increased and varied sources of match funds within their respective states.
– Program Growth: AZ, AR, IL and CA are states that have grown their program budgets and health workforce as a direct result of SLRP participation.
Accomplishments
Outreach Efforts
• Presentations to medical, dental, behavioral/mental health services schools in Arizona
• Conferences & professional organizations
• Entities can donate directly to the program.
• Private donations can be earmarked for a specific discipline and/or county.
– For details, please contact Edith Di Santo at [email protected] or call 602-542-1066
Support SLRP
For more information:Arizona State Loan Repayment Programs
https://www.azdhs.gov/prevention/health-systems-development/workforce-programs/loan-
repayment/index.php
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Shortage Designation 101
Identification of an area, population, or facility experiencing a shortage of health services. There are two types of shortage designations, each linked to a HRSA activity or function.
HPSA
• A HPSA designation is a base requirement to qualify for state or federal programs aimed at increasing primary care services to underserved areas and populations
• HPSA Scores are used for:• Funding Preference• Priority in Awards• Award Levels/ Amounts• Scholar Placement
Types of Shortage Designations
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HPSA(Health Professional Shortage Area)
MUA/P(Medically Underserved Area/Population)
Primary Care
Mental Health
Dental Health
PopulationGroup
Facility
A shortage of:
providers in a:
Geographic Area
Primary Care
Limited access to:
services in a:
PopulationGroup
Geographic Area
Area (geo or pop) HPSAs:• Community-based (must follow AZ Primary Care Area boundaries)• Must meet specific criteria regarding population-to-provider ratio• Must eliminate all contiguous areas as potential sources of care• Must be updated regularly
Auto Facility HPSAs:• Only applies to that facility/organization• No ratio or contiguous area requirements for designation• Scores regularly updated through the National Shortage
Designation Update.
Area vs. Facility HPSAs
Auto-HPSAs Facilities
• Indian Health Facilities• IHS and Tribal Hospitals• Dual-funded Community Health
Centers/Tribal Clinics• CMS-Certified Rural Health Clinics (RHCs)• Federally Qualified Health Centers (FQHCs)• FQHC Look-A-Likes (LALs)
HPSAs
Arizona Total HPSAsGeographic/
Area Population Facility
Population of
Designated HPSAs
Percent of Need Met
# Practitioners
Needed to Remove HPSAs
Primary Care 220 52 36 132 2,847,968 40.68% 559
Dental 211 38 47 126 2,340,815 34.39% 382
Mental 213 64 15 134 2,864,727 11.09% 182
National Shortage Designation Update: Area HPSAs: Geographic/ Population
Arizona Geographic-High Needs Geographic
Low income Population
Proposed for
Withdrawal
Not Previously Designated
Currently in
progress
Average Overall HPSA
Average Overall Change
Primary Care 5 24 50 8 38 1 15 (+) 3.3
Dental 6 2 31 11 41 35* 16 (+) 2.5
Mental 18 16 5 38 47 2 16 (+) 1.9
Proposed withdrawal: • previously designated but did not qualify during update• reassessing within next month to determine if can be qualified
based on different HPSA type.Not previously designated: • will be assessed by end of 2021 to determine if HPSA criteria can
be met with new data
National Shortage Designation Update: Auto Facility HPSAs-Average Score
Arizona
Federally Qualified Health
Center (CHC)IHS, Tribal & Urban Indian
Rural Health Clinic
Primary Care 19.3 18.9 16.5
Dental 24.0 21.6 21.6
Mental 18.9 17.9 17.4# of Auto
HPSAs 23 72 19
• For CHCs - Sites will have the same FACILITY HPSA ID & Score but may differ for primary care, dental or mental.
• Sites will usually have DIFFERENT geo/pop HPSA ID/Scores (unless located very close geographically).
Steps:1. Look up each site’s geo/pop HPSA using the HPSA
address search tool, and record those scores.2. Look up the Facility HPSA score using the HPSA Find by
county tool, record that score.3. For each site, select whichever score is higher.
Use highest score for NHSC and SLRP purposes.
Finding Your HPSA Score
HPSA Find - Search by Addresshttps://data.hrsa.gov/tools/shortage-area/by-address
Note that this will NOT give you Facility HPSAs – only Area/HPSAs
Address Search - Example
HPSA Find - Search by Countyhttps://data.hrsa.gov/tools/shortage-area/hpsa-find
Will give all HPSAs in county,
including facilities
Tip: FQHCs are listed only by parent site and county that site is located in.
Edith Di Santo, Primary Care Office Chief, Bureau of Women’s & Children’s Health, ADHSEmail: [email protected]: (602) 542-1066
CONTACT INFORMATION
Patricia Tarango, Bureau Chief, Women’s & Children’s Health, ADHSEmail: [email protected]: (602) 542-1436
Tracy Lenartz, Designations Specialist/Health Planning Consultant Email: [email protected]
Thelma Okotie, Workforce Program Manager, Bureau of Women’s & Children’s Health, ADHSEmail: [email protected]: (602) 542-1211
THANK YOUEdith Di Santo| Primary Care Office [email protected] | 602-542-1066
azhealth.gov@azdhs
facebook.com/azdhs
Arizona Workforce Data Resources
Arizona Center for Rural Health
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The AzCRH Mission is to improve the health & wellness of rural and vulnerable populations
The AzAHEC Mission is to enhance access to quality health care, particularly primary and preventive care, by improving the supply and distribution of health care professionals through academic community educational partnerships in rural and urban medically underserved areas
AzCRH Health Workforce Data System
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• Move from single instance reports towards systematic compilation of health workforce data
• Create online health workforce interactive reports• Regular distribution of reports and briefs• Goal is to answer key questions about the location
and distribution of the health workforce in Arizona with a focus on rural Arizona
Health Workforce Data Use
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• Grants & research proposals• Needs assessments• Informing pathway programs• Educating stakeholders• Informing policy makers• Informing policy• Evaluation & monitoring
Workforce Reports & Briefs
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Arizona Behavioral Health Workforce Report
Arizona’s Maternal Health Workforce Report
Arizona Primary Care Physician Workforce Report
Interactive Data Visualizations
Coming soon! Core Profile Report
Workforce Core Profile Report
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Arizona licensing boards ~ 192,000 records, ~ 145,000 active w/ AZ location
• Physicians (DO and MD)• Physician Assistants• Psychologists• Behavior Analysts• Social Workers• Counselors• Substance Abuse Counselors• Marriage & Family Therapists• Nurses
CountyRuralityZip Code Tabulation AreaTribal AreaLegislative District
Health Professionals by County
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Health Professionals by Rurality
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Health Professionals by Tribal Area
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Licensure as a data source • Snapshot in time• Not available - Clinically active, hours worked,
setting type, insurance accepted, patient demographics
• Does not include professionals at federal facilities with license from another state
Descriptive overview • Does not include comparison of health needs to
health care resource opportunities
Limitations
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• ADHS Primary Care Area Profiles• Occupational Outlook Handbook
• Healthcare Occupations• State Data• Metro and Non-Metro Area Occupation and
Wage Estimates• US Census
• Topics: Employment > Occupation• HRSA – HPSA Data Find
Other Data Sources
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Questions
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