RULES OF THE TENNESSEE DEPARTMENT OF HEALTH BUREAU OF HEALTH SERVICES ADMINISTRATION CHAPTER 1200-19-1 DETERMINATION OF PHYSICIAN SHORTAGE AREAS

RULES OF THE TENNESSEE DEPARTMENT OF HEALTH BUREAU OF HEALTH SERVICES ADMINISTRATION CHAPTER 1200-19-1 DETERMINATION OF PHYSICIAN SHORTAGE AREAS TABLE OF CONTENTS 1200-19-1-.01 Definitions 1200-19-1-.04 Exceptions 1200-19-1-.02 Designation of Shortage Areas 1200-19-1-.05 Process for Requests for Designation of a 1200-19-1-.03 Criteria for Determination of Physical Shortage Physician Shortage Area Areas 1200-19-1-.01 DEFINITIONS (1) Physician is defined as a person licensed to practice medicine or surgery in Tennessee and a person licensed to practice osteopathy in Tennessee. (2) Physician to Population Ratio: The ratio derived by dividing the population of the area by the number of physicians providing medical service in the area. Only physicians spending 50% or more of their time giving direct patient care, in an office or facility-based practice, and who are under 65 years of age in the year that the ratio is determined, shall be counted; interns, residents and federal physicians are excluded. (3) Physician Shortage Area (PSA): An area in the State of Tennessee designated by the Commissioner of the Tennessee Department of Health, as an area where there is a shortage of primary care physicians. (4) Population: The number of persons residing in an area according to the most recent census of most current issue of “Current Population Reports” as determined and published by the U.S. Department of Commerce/Bureau of Census. (5) Primary Care: Basic level of health care generally rendered by general practitioners, family practitioners, internists, obstetricians, and pediatricians. This type of care emphasizes caring for the patient’s general health needs as opposed to a more specialized or fragmented approach to medical care. This care is usually rendered in an outpatient setting. (6) Health Manpower Shortage Area (HMSA): An area which is designated by the Secretary of the U.S. Department of Health and Human Services pursuant to 42 CFR 5.3(d) as having an acute shortage of health providers. Authority: T.C.A. §49-50-106. Administrative History: Original rule filed June 29, 1983; effective July 29, 1983. 1200-19-1-.02 DESIGNATION OF SHORTAGE AREAS (1) The Commissioner of the Tennessee Department of Health will determine whether an area is eligible to be designated a PSA through the application of criteria and procedures outlined herein. If the Commissioner determines that an area is eligible to be a PSA, the Commissioner will so designate the areas as a PSA. The Commissioner may also de-designate an area when he determines that an area no longer meets the criteria. Upon the designation or de-designation of an area as a PSA, the Commissioner will notify the Tennessee Student Assistance Corporation of his actions. (2) Physicians who locate in a designated area are eligible for loan forgiveness which shall continue so long as they practice in the area regardless of a subsequent de-designation. Physicians who are located DETERMINATION OF PHYSICIAN SHORTAGE AREAS CHAPTER 1200-19-1 in an area which subsequently is designated as a PSA shall be eligible for loan forgiveness from the date of designation for the remainder of the loan. (3) The promulgation of these Rules notwithstanding, physicians receiving financial assistance under the Medical Scholarship Loan Program who have already received official notification of forgiveness under this program, shall continue to have their forgiveness effective and shall not be affected by any changes in designation of a PSA. Authority: T.C.A. §49-50-106. Administrative History: Original rule filed June 29, 1983; effective July 29, 1983. 1200-19-1-.03 CRITERIA FOR DETERMINATION OF PHYSICIAN SHORTAGE AREAS (1) To be designated a PSA, the Commissioner of the Tennessee Department of Health will consider whether: (a) The area is a rational area for the delivery of primary medical care. 1. The following areas will be considered rational areas for the delivery of primary medical care services: (i) A county, or a group of contiguous counties whose population centers are within 30 minutes travel time of each other. (ii) A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market or transportation patterns, distinctive population characteristics or other factors, has limited access to contiguous area resources, as measured generally by a travel time greater than 30 minutes to such resources. (iii) Established neighborhoods and communities within metropolitan areas which displays a strong self-identity (as indicated by a homogeneous socioeconomic or demographic structure and/or a tradition of interaction or interdependency), have limited interaction with contiguous areas, and which, in general, have a minimum population of 20,000. 2. The following distances will be used as guidelines in determining distance corresponding to 30 minutes travel time: (i) Under normal conditions with primary roads available: 20 miles. (ii) In mountainous terrain or in areas with only secondary roads available: 15 miles. (iii) Within inner portions of metropolitan areas, information on the public transportation system will be used to determine the distance corresponding to 30 minutes travel time. (b) The area has a population to full-time-equivalent primary care physician ratio of at least 2,300:1: (c) All Health Manpower Shortage Areas for Primary Care will also be accepted as a PSA for the purposes of the implementation of this act. Authority: T.C.A. §49-50-106. Administrative History: Original rule filed June 29, 1983. DETERMINATION OF PHYSICIAN SHORTAGE AREAS CHAPTER 1200-19-1 1200-19-1-.04 EXCEPTIONS These criteria permit exceptions to the ratio specified above only in the case of obstetrical care. If an area meets the criteria outlined herein as a rational area for the delivery of primary medical services it can be designated as a PSA for Obstetrics if the ratio of the total population (all ages and sexes) to the physicians who perform obstetrical deliveries as part of their normal practice exceeds 15,000:1. This designation as a PSA for Obstetrics would enable a Family Practitioner or Obstetrician who will agree to perform deliveries as part of their normal practice to locate in a PSA for Obstetrics and receive loan forgiveness as specified in Section 49-50-106, Tennessee Code Annotated. Authority: T.C.A. §49-50-106. Administrative History: Original rule filed June 29, 1983; effective July 29, 1983. 1200-19-1-.05 PROCESS FOR REQUESTS FOR DESIGNATION OF A PHYSICIAN SHORTAGE AREA (1) Any citizen, organization, or local governing body of an area that includes any part of a rational area for the delivery of primary medical care that feel that their area deserves designation as a PSA may request designation through the Commissioner of the Tennessee Department of Health. In order to initiate this process, a written request from the individual or community representative should be forwarded to the Commissioner of Health giving the data necessary for designation. These data must include area identification, reference the applicable paragraphs above, and contain all information required by the applicable paragraphs. (2) Any denial of a request to be designated a PSA may be appealed through the procedure established by the Uniform Administrative Procedures Act, Section 4-5-101, et. seq., Tennessee Code Annotated.