Title 42

PART 5 APPENDIX D

Appendix D to Part 5 - Criteria for Designation of Areas Having Shortages of Vision Care Professional(s)

42:1.0.1.1.6.0.1.5.4 : Appendix D

Appendix D to Part 5 - Criteria for Designation of Areas Having Shortages of Vision Care Professional(s) Part I - Geographic Areas

A. Criteria.

A geographic area will be designated as having a shortage of vision care professional(s) if the following three criteria are met:

1. The area is a rational area for the delivery of vision care services.

2. The estimated number of optometric visits supplied by vision care professional(s) in the area is less than the estimated requirements of the area's population for these visits, and the computed shortage is at least 1,500 optometric visits.

3. Vision care professional(s) in contiguous areas are excessively distant, overutilized, or inaccessible to the population of the area under consideration.

B. Methodology.

In determining whether an area meets the criteria established by paragraph A of this part, the following methodology will be used:

1. Rational Areas for the Delivery of Vision Care Services.

(a) The following areas will be considered rational areas for the delivery of vision care services:

(i) A county, or a group of contiguous counties whose population centers are within 40 minutes travel time of each other;

(ii) A portion of a county (or an area made up of portions of more than one county) whose population, because of topography, market or transportation patterns, or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 40 minutes to these resources.

(b) The following distances will be used as guidelines in determining distances corresponding to 40 minutes travel time:

(i) Under normal conditions with primary roads available: 25 miles.

(ii) In mountainous terrain or in areas with only secondary roads available: 20 miles.

(iii) In flat terrain or in areas connected by interstate highways: 30 miles.

Within inner portions of metropolitan areas, information on the public transportation system will be used to determine the distance corresponding to 40 minutes travel time.

2. Determination of Estimated Requirement for Optometric Visits.

The number of optometric visits required by an area's population will be estimated by multiplying each of the following visit rates by the size of the population within that particular age group and then adding the figures obtained together.

Age	Annual number of optometric visits required per person, by age
Age	Under 20	20-29	30-39	40-49	50-59	60 and over
Number of visits	0.11	0.20	0.24	0.35	0.41	0.48

For geographic areas where the age distribution of the population is not known, it will be assumed that the percentage distribution, by age groups, for the area is the same as the distribution for the county of which it is a part.

The estimated supply of optometric services will be determined by use of the following formula:

Vision care professional(s) in area contiguous to an area being considered for designation will be considered execessively distant, overutilized or inaccessible to the population of the area if one of the following conditions prevails in each contiguous area:

(a) Vision care professional(s) in the contiguous area are more than 40 minutes travel time from the center of the area being considered for designation (measured in accordance with paragraph B.1(b) of this part).

(b) The estimated requirement for vision care services in the contiguous area exceeds the estimated supply of such services there, based on the requirements and supply calculations previously described.

(c) Vision care professional(s) in the contiguous area are inaccessible to the population of the area because of specified access barriers (such as economic or cultural barriers).

Designated areas (and population groups) will be assigned to degree-of-shortage groups, based on the ratio of optometric visits supplied to optometric visits required for the area (or group), as follows:

Group 1 - Areas (or groups) with no optometric visits being supplied (i.e., with no optometrists or ophthalmologists).

Group 2 - Areas (or groups) where the ratio of optometric visits supplied to optometric visits required is less than 0.5.

Group 3 - Areas (or groups) where the ratio of optometric visits supplied to optometric visits required is between 0.5 and 1.0.

Population groups within particular geographic areas will be designated if both the following criteria are met:

(1) Members of the population group do not have access to vision care resources within the area (or in contiguous areas) because of non-physical access barriers (such as economic or cultural barriers).

(2) The estimated number of optometric visits supplied to the population group (as determined under paragraph B.3 of part I of this Appendix) is less than the estimated number of visits required by that group (as determined under paragraph B.2 of part I of this Appendix), and the computed shortage is at least 1,500 optometric visits.

The degree of shortage of a given population group will be determined in the same way as described for areas in paragraph C of part I of this appendix.