Last Thursday, the the Negotiated Rulemaking Committee on the Designation of HSPAs and MUAs created by section 5602 of the ACA approved a recommendation to the Secretary of HHS for changes to how the federal government identifies Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA) by a vote of 21-2 (5 members were not present and did not vote). These methods are used to identify areas and populations that are eligible to receive key safety net resources such as National Health Service Corps providers (HPSA) or funds to support Community Health Centers (MUA). The current methods used to designate these areas are largely unchanged since the 1970s.
Under the Negotiated Rulemaking Act of 1990 a recommendation that was unanimous would mean that the Secretary of HHS would have to move ahead with our recommendation verbatim as the draft interim rule, at which point the normal comment process on proposed federal rules would take effect. However, because the recommendation was not unanimous, the Secretary may use our recommendation as guidance but also may propose changes before putting forth an interim final rule. The two members of the committee who voted against the final recommendation both said that they felt as though more analysis was needed in order to finalize the proposed designation methods, and that they believed their no votes provided the Secretary with flexibility to ensure the strongest rule possible. I have a great deal of respect for both of these members and take them at their word, and I understand their position.
I voted in favor of the recommendation because I believe it to be a clear improvement over the status quo, and out of respect for the negotiation process in which the committee had engaged. The final report of the committee, along with dissenting reports, will be publicly available in a few weeks, at which time I will write about the methods we decided upon and the research we considered in formulating a new approach.