National Shortage Designation Update

The Shortage Designation Modernization Project, started in 2013, is a Health Resources and Services Administration (HRSA) initiative to modernize current shortage designation processes while maintaining transparency, accountability, and parity. The project also aims to reduce the burden of data collection on State Primary Care Offices by using publicly available data sets.

One component of the project is the National Shortage Designation Update (NSDU). This involves updating existing geographic, population and some facility HPSA designations, at a single point in time, using national, standardized data sets – American Community Survey Data, Centers for Disease Control Data, and ESRI Data — along with PCO validated National Provider Identified (NPI) data. The initial National Shortage Designation Update of Auto-HPSAs occurred in August 2019. NDSUs are currently scheduled to occur every 3 years.

View the Shortage Designation Modernization Project

Phase 1

Developed and released the Shortage Designation Management System (SDMS) in 2014.

The TPCO uses SDMS to: 

  • Manage health workforce data
  • Apply for Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas/Populations (MUA/Ps)
  • Request Automatic (Auto-)HPSA rescores

HRSA uses SDMS to:

  • Review shortage designation applications
  • Communicate with State PCOs
  • Review Auto-HPSA rescore requests

Phase 2

The first National Shortage Designation Update (NSDU) Occurred in October 2017

Impact to HPSA Designations

Although it is not uncommon for HPSA scores to increase, decrease or be withdrawn, this was the first time that a large number of HPSA designations were updated at a single point in time.

In preparation for the National Shortage Designation Update, HRSA conducted impact analyses to identify what changes may occur to 526 of Texas’ existing geographic, population and Other Facility (OFAC) primary care, dental and mental health HPSA designations when the update takes place.

As of November 4, 2017, the data indicated the following National Shortage Designation Updates for Texas:

  • 222 HPSA scores would increase
  • 157 HPSA scores would decrease
  • 48 HPSA scores would remain the same
  • 98 HPSA scores would be proposed for withdrawal because they would no longer meet the federal criteria for a HPSA.

Designations Proposed for Withdrawal on October 28, 2017 were officially Withdrawn on July 2, 2018, unless additional updates were made to the designation.

Phase 3

The National Shortage Designation Update of Auto-HPSAs occurred in August 2019. Auto-HPSA facilities included in this update:

  • Federally Qualified Health Centers (FQHC) (funded under Sec. 330)
  • Federally Qualified Health Center Look-Alikes (LAL)
  • Tribally-run Clinics
  • Urban Indian Organizations
  • Dual-Funded Tribal Health
  • Federally-run Indian Health Service Clinics
  • Rural Health Clinics (RHC) that met National Health Service Corps (NHSC) site requirements; and are approved NHSC sites

The Auto-HPSA portal was also implemented to allow organizations and facilities to request a rescore of their Auto-HPSAs.

Most recent NSDU

The next NSDU occurred in September 2021 and included geographic and special population HPSAs along with Auto-HPSAs. Those designations proposed for withdrawal during the 2021 NSDU will be officially withdrawn in 2023 when published in the Federal Register, unless additional updates are made to the designation prior to that.

Phase 4

Health Professional Shortage Area Scoring Criteria Request for Information (RFI)

HRSA asked for public input on HPSA scoring criteria. This feedback will inform policy. They accepted comments through September 18, 2020. After reviewing the comments, they may contact some respondents.

Impact on Incentive and Other Programs

As with any update to a HPSA designation, site and participant eligibility for federal and state programs that use shortage designations and scores to determine eligibility and priority rankings may be impacted. These include National Health Service Corp (NHSC) Nurse Corps, State-funded loan repayment programs, Conrad 30 J-1 Visa Waiver Program, Rural Health Clinic (RHC) Certification, CMS Bonus Payments, and others. Please contact our office with any questions.



Texas Primary Care Office
Phone: 512-776-7518  

HRSA Shortage Designation Branch
Designation Questions:

SDMP Questions: