Section R9-24-203. Primary Care Index

A.      Every 12 months, the Department shall prepare, according to this Section, a primary care index for designating primary care areas determined under R9-24-204 as Arizona medically underserved areas.

1.        For each primary care area determined under R9-24-204, the Department shall calculate the value for each criterion in subsection (B).

a.         After calculating the value for each criterion in sub- section (B), the Department shall assign points to each value according to Table 1.

b.        A primary care area’s score is the sum of the points received by the primary care area for each criterion in subsection (B).

2.        The Department shall designate as Arizona medically underserved:

a.         The primary care areas that, according to subsection

(B) and Table 1, score within the top 25 percent on the primary care index or that obtain more than 55 points, whichever results in the designation of more Arizona medically underserved areas; and

b.        The primary care areas or parts of primary care areas with the designation described in R9-24-202(1).

B.       For each primary care area determined by the Department under R9-24-204, the primary care index shall include a score for each of the following:

1.        Population-to-primary-care-provider ratio, determined by dividing the population of the primary care area by the number of primary care providers in the primary care area:

a.         Using primary care provider data from the Arizona Medical Board, the Board of Osteopathic Examiners in Medicine and Surgery, the Arizona State Board of Nursing, and the Arizona Regulatory Board of Phy- sician Assistants;

b.        Counting a full-time physician as 1.0, a full-time physician assistant as 0.8, and a full-time registered nurse practitioner as 0.8; and

c.         If the Department determines that a physician, phy- sician assistant, or registered nurse practitioner prac- tices less than full-time in the primary care area, lowering the number obtained under subsection (B)(1)(b) as follows:

i.         Creating a fraction with a numerator that repre- sents the number of hours per week the physi- cian, physician assistant, or registered nurse practitioner practices in the primary care area and with a denominator of 40;

ii.        Multiplying 1.0 or 0.8, whichever is appropri- ate, by the fraction obtained under subsection (B)(1)(c)(i);

iii.      Subtracting the result obtained under subsec- tion (B)(1)(c)(ii) from 1.0 or 0.8, whichever is appropriate; and

iv.       Subtracting the result obtained under subsec- tion (B)(1)(c)(iii) from the number obtained under subsection (B)(1)(b);

2.        Travel distance to the nearest primary care provider, determined by:

a.         Estimating the distance in miles:

i.         From the center of the most densely populated area in the primary care area determined from the most recent Population Estimates for Ari- zona’s Counties, Incorporated Places and Bal- ance of County identified in R9-24-201(28)(b) or, for the year in which the most recent decen- nial census is published, from the most recent decennial census prepared by the U.S. Census Bureau; and

ii.        To the nearest primary care provider deter- mined from the data described in subsection (B)(1)(a); and

b.        Using the most direct street route;

3.        Composite transportation score, determined by:

a.         Compiling data on the following six indicators from the most recent decennial census prepared by the

U.S. Census Bureau:

i.         Percentage of population with calendar year income less than 100 percent of the poverty threshold;

ii.        Percentage of population older than age 65;

iii.      Percentage of population younger than age 14;

iv.       Percentage of population with a work disabil- ity, mobility limitation, or self-care limitation;

v.        Percentage of population without a motor vehi- cle; and

vi.       The motor-vehicle-to-population ratio;

b.        Calculating the statewide average value for each of the six indicators in subsection (B)(3)(a);

c.         Dividing the value of each indicator for each pri- mary care area by the statewide average value for that indicator;

d.        Multiplying the figure calculated under subsection (B)(3)(c) for each indicator by 100; and

e.         Averaging the six indicator values obtained under subsection (B)(3)(d) for each primary care area;

4.        Percentage of population with calendar year income less than 200% of the poverty threshold, determined from data in the most recent decennial census prepared by the

U.S. Census Bureau;

5.        Percentage of population with annual income between 100% and 200% of the poverty threshold, determined from data in the most recent decennial census prepared by the U.S. Census Bureau;

6.        Percentage of uninsured births, determined from Depart- ment birth records reporting payment source as “self- pay” or “unknown;”

7.        Ambulatory care sensitive condition hospital admissions:

a.         Based on the number of hospital admissions for ambulatory care sensitive conditions per 1000 indi- viduals living in the primary care area who are under age 65, and

b.        Determined from hospital inpatient and emergency department services data provided by the Depart- ment;

8.        Percentage of low-weight births, determined from data provided by the Department;

9.        From data provided by the Department, the sum of the percentage of births for which the mothers reported:

a.         No prenatal care,

b.        Prenatal care that began in the second or third tri- mester, and

c.         Four or fewer prenatal care visits;

10.     Percentage of deaths at ages younger than the birth life expectancy, determined from the most recent U.S. life expectancy data and data provided by the Department;

11.     Number of infant deaths per 1000 live births, determined from data provided by the Department;

12.     Supplementary criteria score, based on the presence or absence in a primary care area of the following:

a.         Percentage of minority population greater than the statewide average for all counties, determined from data in the most recent Population Estimates for Ari- zona’s Counties, Incorporated Places and Balance of County identified in R9-24-201(28)(b) and from data in the most recent decennial census;

b.        Percentage of elderly population greater than the statewide average for all counties, determined from data in the most recent Population Estimates for Ari- zona’s Counties, Incorporated Places and Balance of County identified in R9-24-201(28)(b) and from data in the most recent decennial census prepared by the U.S. Census Bureau; and

c.         Average annual unemployment rate greater than the average annual statewide rate, from data in the most recent Arizona Unemployment Statistics Program Special Unemployment Report, prepared by the Ari- zona Department of Economic Security; Research Administration, in cooperation with the U.S. Depart- ment of Labor, Bureau of Labor Statistics, and avail- able at http://www.workforce.az.gov; and

13.     Sole provider or no provider score:

a.         Based on whether a primary care area has only 1.0 or less than 1.0 primary care provider;

b.        Counting a full-time physician as 1.0, a full-time physician assistant as 0.8, and a full-time registered nurse practitioner as 0.8; and

c.         If the Department determines that a physician, phy- sician assistant, or registered nurse practitioner prac- tices less than full-time in the primary care area, lowering the number obtained under subsection (B)(13)(b) as follows:

i.         Creating a fraction with a numerator that repre- sents the number of hours per week the physi- cian, physician assistant, or registered nurse practitioner practices in the primary care area and with a denominator of 40;

ii.        Multiplying 1.0 or 0.8, whichever is appropri- ate, by the fraction obtained under subsection (B)(13)(c)(i);

iii.      Subtracting the result obtained under subsec- tion (B)(13)(c)(ii) from 1.0 or 0.8, whichever is appropriate; and

iv.      

Ambulatory care	£ 8.0	0
sensitive condition	8.1-12.0	2
hospital admissions	12.1-16.0	4
	16.1-20.0	6
	20.1-24.0	8
	> 24.0	10
Percentage of low-	£ 6.0%	0
weight births	6.1-8.0%	2
	8.1-10.0%	4
	10.1-12.0%	6
	12.1-14.0%	8
	>14.0%	10
Sum of the percent-	£ 15.0%	0
age of births with:	15.1-25.0%	2
a. No prenatal care,	25.1-35.0%	4
b. Prenatal care	35.1-45.0%	6
begun in second or	45.1-55.0%	8
third trimester, and	>55.0%	10
c. Prenatal care vis-
its £ 4
Percentage of	£ 40.0%	0
deaths at ages	40.1-50.0%	2
younger than birth	50.1-60.0%	4
life expectancy	60.1-70.0%	6
	70.1-80.0%	8
	>80.0%	10
Number of infant	£ 4.0	0
deaths per 1000 live	4.1-6.0	2
births	6.1-8.0	4
	8.1-10.0	6
	10.1-12.0	8
	>12.0	10
Supplementary cri-	1 Criterion	2
teria score	2 Criteria	4
	3 Criteria	6
Sole provider or no	Primary care provider £ 1.0	5
provider score	Primary care providers > 1.0	0
Key to Symbols £ represents “less than or equal to” > represents “more than”

  

 

Subtracting the result obtained under subsec- tion (B)(13)(c)(iii) from the number obtained under subsection (B)(13)(b).

C.      Every 12 months, according to subsections (A) and (B) and Table 1, the Department shall:

1.        Withdraw an Arizona medically underserved area desig- nation,

2.        Continue an Arizona medically underserved area desig- nation, or

3.        Designate a new Arizona medically underserved area.

D.      A list of current Arizona medically underserved areas is avail- able in the Department’s annual Arizona Medically Under- served Areas (AzMUA) Report at http://www.azdhs.gov/hsd/.

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-203 recodified from R9-24-123 (Supp. 95-2). Section repealed; new Section adopted by final rulemaking at 7

A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effec-

tive September 30, 2006 (Supp. 06-3).