HHS Seeks Input on Method to Designate Frontier Areas

The Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) in early November proposed a new methodology to demarcate frontier areas of the United States using the Frontier and Remote (FAR) system, and requested public comment. Written comments must be submitted no later than Jan. 4, 2013; the National Association for Home Care & Hospice (NAHC)/HAA encourage hospice and home health stakeholders who operate in remote areas and could potentially be affected by the new designations to submit comments. While ultimate acceptance of the new method by HRSA would not obligate the Centers for Medicare & Medicaid Services (CMS) or Congress to use it for payment purposes, at some point in the future it could be used for payment differentials in federal health care programs.

Currently the most commonly used standard for “frontier area” is a county with six or fewer people per square mile. Researchers see a significant lack of precision in reliance on the county as the unit of measurement since counties vary greatly in size. Under telehealth programs, the term “frontier area” is required to be defined by regulation and include population density, travel distance in miles to the nearest medical facility, travel time in minutes to the nearest medical facility, and such other factors as the Secretary determines to be appropriate. The HRSA-proposed methodology for frontier and remote areas delineates degree of population density and remoteness (distance to the nearest edges of an urbanized area of varying population size) and classifies zip codes into one of four FAR Levels of varying remoteness. HRSA is seeking public comments on:

  • The use of a population threshold of 50,000 as the central place from which to measure in defining FAR areas;
  • The use of 60 minutes travel time from the central place;
  • Whether the 50 percent population threshold for assigning frontier status to a ZIP code/census tract is the appropriate level for the four standard provided levels;
  • Other ways of representing urban and rural areas;
  • Alternatives to using grid cells for measuring remoteness;
  • Applicability of the FAR methodology to island populations; and
  • Need for a Census tract and county version of the FAR.

Comments on other aspects of the methodology are welcomed by HRSA; HRSA underscores in the notice that this is only a proposed methodology, and it is not currently tied to any current federal program or allocation of resources. But it may hold hope as a tool to better delineate those isolated and remote areas in the country to help researchers and policy makers better understand the unique circumstances of this geographic subset.

The methodology was published as a notice in the Nov. 5, 2012, issue of the Federal Register and contains instructions on ways to submit written comment.


from the NAHC Report article