Governor's Shortage Designation Criteria and Process

The Governor’s Designation of Shortage Areas for Rural Health Clinics (RHCs) in Wisconsin identifies rural areas that have significant provider shortages and other population indicators of high need, but which do not meet federal criteria for Health Professional Shortage Area (HPSA) designation. This additional type of shortage designation and associated eligibility for RHC certification helps RHCs to increase access to primary and preventive care in these rural areas.

The Governor’s Designation Criteria for Wisconsin requires that RHCs in the Governor’s Health Care Shortage Areas must serve both Medicaid and Medicare enrollees, as well as adopt a sliding-fee schedule to assure access to the low-income population and others who need care the most.

A Governor’s Shortage Designation can be used to maintain and establish financially viable RHCs in communities with high need, and helps to stabilize the state’s safety net provider resources in rural communities. A Governor’s Shortage Designation complements the federal HPSA/Medically Underserved Area (MUA) designation criteria to help the state improve access to primary and preventive care for rural populations through developing and retain RHC safety net providers.

Wisconsin Governor’s Designation Criteria

The following Governor’s Designation Criteria will determine an area’s eligibility for a Wisconsin Governor’s Health Care Shortage Area designation for an RHC:

Wisconsin Governor’s Designation Process

The Governor of the State of Wisconsin delegates signing authority for this Governor’s Shortage Designation to the State Health Officer in DHS. The following is the process to determine eligible Governor’s Health Care Shortage Areas in Wisconsin for RHCs:

1. The applicant clinic must submit a request to the Division of Public Health, Primary Care Program for a Governor’s Health Care Shortage Area designation. Send request to the Primary Care Office. Request must include all required documentation:
   • Reason for request: to retain an existing or establish a new RHC in an area not currently eligible for HPSA/MUA designation;
   • Proposed contiguous service area for the Governor’s Health Care Shortage Area designation request;​
   • Letter of support from the health officer in the local health department that clearly states that a Governor’s Shortage Designation for the RHC is in the public interest to improve access to primary care for the underserved rural population;​
   • Copy of RHC’s schedule of sliding/discounted fees for patients with incomes below 200 percent of the federal poverty level, public notice for the sliding fees, and RHC policy for implementation (see Definitions section for more information); and​
   • High-health need indicator data described in the table above.
2. The Primary Care Program will review the request, documentation of public interest, and physician data in the service area as tracked in the Shortage Designation Management System (SDMS).
3. If the data and the request meet the Wisconsin Governor’s Designation Criteria, the Primary Care Program will submit a Governor’s Health Care Shortage Area designation request for the area through the State Health Officer to the Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), Shortage Designation Branch. If the data and request do not meet all requirements, the Primary Care Program will inform the original requestor.
4. The HRSA Shortage Designation Branch will review the Governor’s request for the area to confirm that it meets the DHHS/HRSA-approved Wisconsin Governor’s Health Care Shortage Area designation criteria, approves the area as HRSA-certified under the Governor’s Health Care Shortage Area designation, and notifies the State Health Officer and Primary Care Program of its’ decision.
5. The Primary Care Office will send the HRSA decision/approval to the original requestor.
6. The requestor may then submit an application to the DHS Division of Quality Assurance for certification as a RHC.

Definition of Terms

The following definitions apply to the Governor’s Designated Shortage Area Criteria and process.

Non-urbanized area:The CMS RHC program requires that RHCs must be located outside an “urbanized area” as defined by the U.S. Census Bureau. To see if an address is rural and eligible for RHC certification, go to “Am I Rural?”

Sliding fee/discount schedule for patients with incomes less than 200% of FPL: The RHC must have and implement a policy:

• To publicly and prominently display a notice about the availability of a discounted fee schedule for patients who are unable to pay for services
• To offer a schedule of sliding/discounted fees for patients whose family incomes are less than 200 percent of the federal poverty level (FPL). This can be initiated at the time of service or after the service has been billed to the patient.
• To make a total of three follow-ups by phone and mail on failure to pay the discounted fees, and to try to negotiate a payment plan and review any change in income for patients with delinquent payments.
• To allow termination of services for patients only after the follow-up policies cited above have failed and been documented.
• For more information on establishing a sliding fee schedule, go to the HRSA website.

Counting primary care physicians: The physician-to-population ratio is an important indicator of the availability of health care services in a community. Primary care physicians will be counted similar to how they are counted for HPSA designations:

• Only primary care physicians are counted. These include family practice, pediatrics, internal medicine, obstetrics and gynecology, and general gynecology.
• Only average hours per week for outpatient care and hospital rounds are counted. Hours spent on administration, teaching, research, and subspecialty care are not counted.