10-144 C.M.R. ch. 509, § IV - CRITERIA FOR UNDERSERVED SPECIALTY PRACTICE DETERMINATION

1. The Commissioner of Human Services will designate a PCAA as underserved for a specific specialty physician if it meets the following criteria:

A. Contiguous area specialty physician resources are considered overutilized if the contiguous area resources there are not sufficient to meet the need of the area being considered for designation as underserved. The contiguous area must have at least the excess capacity as required to serve the area under review.

B. Contiguous area specialty physician resources are considered excessively distant if the specialist physician is located more than 30 miles by secondary roads, 35 miles by primary roads, or 40 miles by interstate/turnpike highways from the center of the service area being considered for designation.

2. The Commissioner of Human Services will consider special designation on a case-by-case basis, at the request of providers or community representatives, based on any of the following circumstances.

A. The Commissioner of Human Services may designate an underserved specialty physician area as a less than full-time site, prorated based on unserved population ratio due to its small population.

B. The Commissioner of Human Services may designate more than one service area as one practice site if areas, when considered alone, do not have sufficient population base to support a specialist physician practice.

C. The Commissioner of Human Services may designate an area-as underserved geographic area which meets at least one of the following criteria:

1 More than 20% of the population (or of all households) have incomes below the poverty level; or the Medicaid population exceeds the most recently calculated state Medicaid rates, or

2 Documentation is provided that none of the area's specialists are accepting new Medicaid patients.

D. The Commissioner of Human Services may designate a specific specialty physician practice as eligible for loan forgiveness of the applicant physician's State obligation if at least 50% of the patients are covered by Medicaid or are indigent without a means of paying for care.

3. The Commissioner of Human Services will designate a hospital as underserved for a specialty if all the following criteria are satisfied:

A. The Hospital provides documentation that demonstrated that the Hospital Board of Directors/Trustees has participated in and formally approved a long range plan for securing the appropriate number of medical staff designed to resolve specialty physician shortages.

B. The hospital provides documentation that attempts over a minimum of one year period to secure the needed specialists have been unsuccessful, including but not limited to advertising in and out of state, communications with specialists who inquire about the position, interview notations.

C. The hospital provides assurances that adequate back-up services needed by that specialty, as determined by nationally approved practice perimeters, are readily available.

Notes

10-144 C.M.R. ch. 509, § IV