“Disability” and the negotiated rulemaking process for health profession shortage areas and medically underserved populations

The designation criteria for Medically Underserved Populations (MUPs) and Health Professions Shortage Areas (HPSAs) remain true to their 50 year old origins. The 1998 and 2008 efforts to change the designations failed when met with considerable controversy. The Affordable Care Act required that Health Resources and Services Administration (HRSA) establish a comprehensive methodology and criteria for HPSA and MUA designation using a Negotiated Rulemaking process. HRSA established a Negotiated Rulemaking Committee, which included 28 members had to reach consensus on the outcome criteria, through almost monthly between October, 2010 and May, 2011. Previous efforts did not have representation from the disability community. This one did. As one of the “subpopulation” groups with representation on the committee, the disability community, including researcher, self-advocates, and health providers provided significant support for the work of the committee. This presentation provides a first hand account of the constituency, process, and final outcomes of the committee with an emphasis on how the final criteria was developed and how it affects the disability population, disability researchers, and providers who treat individuals with disabilities. Data sources for the final product will be discussed with an emphasis on the role of specific disability data, and future disability data required by ACA, poverty, barriers to care, access to care issues, and safety net issues. Implications for disability policy including Medicare bonus payments and other policies strategies to improve access to care for people with disabilities will be discussed as well as policy implications for disability researchers.