10- 144 C.M.R. ch. 504, § 3

Current through 2024-51, December 18, 2024

Section 144-504-3 - Criteria

A. The Commissioner of Human Services will designate a Primary Care Analysis Area as underserved if: 1) it has a population to primary care physician ratio of 3000 or morel; and, 2) contiguous area primary care resources are overutilized and/or are in excess of 15 miles travel by secondary roads or 20 miles by primary roads or 25 miles by turnpike or interstate highway.

B. The Commissioner of Human Services may designate a Primary Care Analysis Area as underserved if it has a population to primary care physician ratio of between 2,000 and 2,999:1, if, in his judgment, other factors indicate the likelihood of the area's population being underserved and contiguous area primary care resources being overutilized and/or excessively distant as defined in 3.A.2 above. Such factors will include but are not limited to:

1. Insufficient capacity of the Area's existing primary care providers to serve the area's population. Insufficient capacity as determined by the Department say be indicated by any of the following:

a Unusually long waits for appointments for routine medical services (i.e., more than 7 days for established patients and 14 days for new patients);

b Excessive average waiting time at primary care providers (longer than out hour where patients have appointments or two hours where patients are treated on a first-come, first-served basis);

c Evidence of excessive use of emergency room facilities for routine primary care;

d A substantial proportion (2/3 or more) of the area's physicians do not accept new patients;

e A substantial proportion (213 or more) of the area's physicians do, not accept Medicaid patients.

2. Unusually high health needs of the area's population. Such health needs may be indicated by the following:

a The area has sore than 100 births per year per 1,000 women aged

b The area has more than 20 infant deaths per 1,000 live births;

c More than 20% of the population (or of all households) have incomes below the poverty level;

d The area has an incidence rate for preventable and communicable diseases which is higher than the statewide rate;

e The population has a hospital admission rate for diseases or conditions which could have been prevented or treated on an ambulatory basis which is higher than the statewide rate.

10- 144 C.M.R. ch. 504, § 3