Section 7.24.010. Designation as a health care services shortage area.

	(a)  In designating a service area or health care facility as being, or as being located in, a health care services shortage area, for purposes of establishing eligibility under AS 18.29,  the commissioner will  
		(1) make the designation for each of the following categories:  
			(A) areas with shortages of primary medical care providers;  
			(B) areas with shortages of behavioral health care providers;  
			(C) areas with shortages of general dental providers; and  
		(2) assign each area or facility a needs assessment score, up to 100 points, that reflects the severity of the shortage, based on the factors set out in (b) - (f) of this section.  
	(b)  The commissioner will assign up to 35 points based on the ratio of providers to the population in a borough, in a federal census area if the population is in the unorganized borough, or in a community of at least 1,000 inhabitants. For a community of fewer than 1,000 inhabitants, the commissioner will consider the need in the community for a provider and the community's ability to support the provider.  
	(c)  The commissioner will assign up to 30 points based on the remoteness, isolation, and population density of a facility or geographic area where the population served is located. To score  
		(1) a census-designated place or facility not already in a geographic shortage area, the commissioner will calculate an isolation score using the formula set out in volume II, part B, page 6 of the Alaska Rural Primary Care Facility Needs Assessment Project Final Report, dated October 2000 and prepared by the Alaska Native Tribal Health Consortium, the department, and the United States Department of Health and Human Services, Indian Health Service; the formula is adopted by reference;  
		(2) a geographic area as a shortage area, the commissioner will consider  
			(A) population density, based on the number of persons per square mile in the borough or the federal census area, census sub-area, or census tract; and  
			(B) travel time and distance for the population to reach primary medical care services, behavioral health care services, dental care services, and hospital services.  
	(d)  The commissioner will assign up to 15 points based on indicators of a population's health status over a five-year period. To develop the health status component of the needs assessment score for  
		(1) primary medical care, the commissioner will use the highest three scores from the following indicators:  
			(A) low birth weight;  
			(B) post-neonatal mortality rate;  
			(C) births to mothers under 18 years of age, as a percentage of total births;  
			(D) mortality rate from unintentional injuries;  
			(E) mortality rate from heart disease and strokes;  
			(F) incidence of cancer, as indicated in the registry maintained under 7 AAC 27.011;  
		(2) behavioral health care, the commissioner will use the highest three scores from the following indicators:  
			(A) the suicide rate;  
			(B) the rate of adults who have consumed five or more drinks on one more occasions during a 30-day period;  
			(C) the rate of adult tobacco use;  
			(D) rates of substance abuse;  
			(E) the rates at which women at least 15 years of age and not older than 64 years of age are admitted to a hospital as a result of being assaulted;  
			(F) the rate of individuals who fall within the categories of an adult experiencing a serious mental illness under 7 AAC 135.055 or a child experiencing a severe emotional disturbance under 7 AAC 135.065;  
		(3) dental care, the commissioner will use scores from each of the following indicators:  
			(A) the percent of the population without fluoridated water;  
			(B) the percent of the population receiving preventive dental services annually;  
			(C) the percent of the population receiving dental treatment services at least once annually;  
			(D) the incidence of caries, if that rate is available.  
	(e)  The commissioner will assign up to 15 points based on the economic status of the population, to be determined using each of the following factors:  
		(1) the percent of the population without health insurance;  
		(2) the per capita income of the population;  
		(3) the percentage of the population with an annual household income below 200 percent of the federal poverty level for this state; in this paragraph, "federal poverty level for this state" means the federal poverty guidelines for this state established annually by the United States Department of Health and Human Services and adopted by reference in 7 AAC 24.950;  
		(4) a dependency ratio, calculated by dividing the percent of the population that is either younger than 18 years of age or 65 years of age or older by the percent of the population that is working age; for purposes of this paragraph, working age is 18 years of age or older and younger than 65 years of age.  
	(f)  The commissioner will assign up to five points based on the burden to a borough, census area, or census-designated place from influxes of seasonal population. The commissioner will measure that burden by calculating the ratio of observed injury-related hospitalizations to expected injury-related hospitalizations over the most recent five years, based on the borough, census area, or census-designated place where the injury occurred.  
	(g)  In considering and assigning scores for the factors under (b) - (f) of this section, the commissioner may also consider data available from the United States Department of Health and Human Services with respect to designations under 42 U.S.C. 254e and 42 C.F.R. Part 5 of health professional shortage areas.  
	(h)  The department will select health care professionals who are financially supported under AS 18.29  and this chapter in the areas of greatest shortage.  
	(i)  A site that is not already designated as being located in a health care services shortage area may apply to the department for a designation. The site must provide information to support that a shortage exists of providers identified in (a)(1), (2), or (3) of this section. The commissioner will review the application and assign a score as provided in (a) - (g) of this section.  

Authorities

18.29.015;18.29.099

Notes

Reference

7 AAC 24.050

Authority

AS 18.29.015 AS 18.29.099 Editor's note: Volume II, part B, page 6 of the Alaska Rural Primary Care Facility Needs Assessment Project Final Report, adopted by reference in 7 AAC 24.010, may be obtained from the Department of Health and Social Services, Division of Public Health, P.O. Box 110616, Juneau, Alaska 99811-0616.

History

Eff. 2/16/2013, Register 205; am 6/16/2016, Register 218

References

7.24.010