Written by Eric Turer, Health Systems Consultant, JSI
As health reform rolls out and Medicaid is expanded, there is going to be a lot of interest in the various federal programs related to Federally Qualified Health Center (FQHC) status and workforce development. Individual organizations and providers who want access to additional federal resources – for example those that are thinking about a transition to FQHC status, becoming a Look-Alike, or applying to the National Health Service Corps for providers – might want to reevaluate their designation status.
Even if you’ve looked at designation status in the past, it may be worth revisiting. JSI has worked with the Office of Shortage Designation to update the designation submission system (ASAPs) with the most recent U.S. Census Bureau data and new provider list. These data may prove more advantageous than what was being used.
Additionally, there is another option available that can significantly simplify the effort of identifying and processing population designations for Health Professional Shortage Areas (HPSA) or Medically Underserved Populations (MUP). There has always been the option to quantify Medicaid capacity using claims instead of a survey, but it has seen relatively little use due to difficulty in accessing data in a useful way, but that may be changing.
Under new rules now in effect, states are expected to report claims to the federal Centers for Medicare and Medicaid Services (CMS) with a provider NPI number, which can be linked to a publicly available database from CMS. This can permit claims to be associated with primary care providers by type and organization location even if such data are not in the Medicaid files. We have worked to develop claim definitions that can be used to define primary care visits in requests for Medicaid departments to query their data.
Challenges do remain, of course, and there are some key steps needed to verify the accuracy of claims data for this purpose. Once obtained and validated, however, this information can be used to assess Medicaid designation potential in a local area or statewide, as well as for other analyses of access patterns amongst Medicaid enrollees.
JSI has long worked with individual providers and several states to evaluate and process shortage designations in a systematic and unified manner. We are currently working with several of these states to help them acquire and process the new census figures and Medicaid claims/NPI data to reassess designation potential. Proactive action by Health and Medicaid Departments can take advantage of this convergence of factors to more easily evaluate, monitor, and process designations to help providers in their state access new resources and work to further improve low-income access.