April 16, 2008

Wyden Questions Planned Rural Health Care Funding Changes

Recommends "Administration consider not going forward with the proposed rule"

WASHINGTON, DC - Working to preserve rural health care in all corners of Oregon, U.S. Senator Ron Wyden (D-Ore.) sent a letter to U.S. Department of Health and Human Services Secretary Michael Leavitt today urging him to extend the public comment period on a proposed alteration to the formula for determining federal rural health care funding.

If the rule is enacted, Oregon's rural health facilities stand to lose a disproportionate share of federal dollars as 79 percent of Oregon's existing rural health center sites would be categorized as either the lowest priority or ineligible for continued funding. Wyden called the potential consequences of the proposed rule "significant."

"I recommend that the Health Resources and Services Administration consider not going forward with the proposed rule because the methodology is based on out-of-date data and is clearly biased against rural states." wrote Wyden. "I strongly believe it would be most beneficial to have at least 150 days to thoroughly analyze and assess the new methodology and its potential impact."

The full text of Wyden's letter is below:

April 16, 2008

Secretary Michael O. Leavitt
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201

Dear Secretary Leavitt:

I am writing to urge you to extend the public comment period for the proposed shortage designation rule published in the Federal Register on February 29, 2008 for "Designation of Medically Underserved Populations and Health Professional Shortage Areas."

As you are aware, this notice of proposed rule making sets out a complex methodology that changes the criteria and process for designating medically underserved populations (MUPs), medically underserved areas (MUAs) and health professional shortage areas (HPSAs) that are used to determine funding for 40 different Federal government programs.

Oregon heavily relies on Federal programs that are directly tied to these designations. In 2008, Oregon had 69 National Health Service Corps physicians, 20 physicians through the J-1 visa program in 2008, and expects 30 physicians through the J-1 visa program in 2009. In addition, Oregon received more than $38.6 million in FY2007 for Community Health Center funding.

In the proposed rule, Health Resources and Services Administration provides an impact analysis of the new methodology on MUA and HPSA designations based on data from 1999. There is no analysis of the impact of the methodology on each state. In the intervening nine years, Oregon has expanded MUA and HPSA designated areas such that the agency's analysis is not a useful for understanding the impact of the rule. In fact, when the agency briefed the Senate Health Education Labor and Pensions committee on March 7, Health Resources and Services Administration staff clearly communicated that the agency did not have the data needed to determine how states would be affected by the rule.

An analysis of the proposed rule, using current data, found that in Oregon may be one of the hardest hit states under this proposed rule. Only nine health center sites (21 percent) of Oregon's 42 Federally Qualified Health Centers and their sites will retain their MUA status—leaving the remaining 33 health center sites (79 percent) in either the lowest priority group or ineligible.[1] The potential consequences of this proposed rule are significant. Considering its importance, the 60-day comment period, set to end on April 29, 2008, does not allow sufficient time for Oregon state officials and local governments to review the methodology, its impact, and provide substantive comments to the Health Resources and Services Administration.

While I support the Health Resources and Services Administration's efforts to improve the way underserved areas and populations are designated and reduce the burden on states and communities by automating the designation process, I strongly believe it would be most beneficial to have at least 150 days to thoroughly analyze and assess the new methodology and its potential impact. Furthermore, I recommend that the Health Resources and Services Administration consider not going forward with the proposed rule because the methodology is based on out-of-date data and is clearly biased against rural states.

I hope that we can work together to develop an equitable methodology that supports our shared goal of efficiently and effectively allocating Federal resources for medically underserved populations and health professional shortage areas.

Thank you for your attention and consideration.

Sincerely,

U.S. Senator Ron Wyden

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[1] The number of Federally Qualified Health Center sites is based on 2005 data from Peter Shin, Leighton Ku, Emily Jones, and Sara Rosenbaum, "Analysis of the Proposed Rule on Designation of Medically Underserved Populations and Health Professional Shortage Areas," Geiger Gibson/RCHN Community Health Foundation, April 14, 2008. Available at http://www.gwumc.edu/sphhs/departments/healthpolicy/chsrp/downloads/MUAreport41108.pdf.

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