59806 Federal Register / Vol. 85, No. 185 / Wednesday, September 23, 2020 / Notices

2020, has changed its format and time. resources and allow more of the rural Census. UCs are defined based on the The meeting will now be a 2-day populations within MSAs to access same criteria as UAs, but represent areas webinar and conference call only on services provided using grant funds. containing at least 2,500 but fewer than Tuesday, December 8, 2020, from 10:00 This notice seeks comments on the 50,000 people. Both UAs and UCs use a.m.–5:00 p.m. Eastern Time (ET) and proposed methodology for designating 500 persons per square mile as their Wednesday, December 9, 2020, from areas eligible for rural health grant minimum density criterion. 10:00 a.m.–2:00 p.m. ET. The webinar programs. The other major federal definition was link, conference dial in number, DATES: Submit written comments no based on the OMB’s list of that meeting materials, and updates will be later than October 23, 2020. are designated as part of a MSA. All available on the COGME website: counties that were not designated as a ADDRESSES: https://www.hrsa.gov/advisory- Written comments should part of a MSA were considered ‘‘rural’’ committees/graduate-medical-edu/ be submitted to [email protected]. or, more accurately, non-metropolitan. meetings/index.html. FOR FURTHER INFORMATION CONTACT: MSAs, in 1990, had to include ‘‘a FOR FURTHER INFORMATION CONTACT: Steve Hirsch, Public Health Analyst of 50,000 or more population,’’ or ‘‘a Shane Rogers, Designated Federal FORHP, HRSA, 5600 Fishers Lane, Census Bureau defined urbanized area Official, Division of Medicine and Rockville, MD 20857, Phone number: of at least 50,000 population, provided Dentistry, Bureau of Health Workforce, (301) 443–0835 or Email: ruralpolicy@ that the component /counties of HRSA, 5600 Fishers Lane, 15N142, hrsa.gov. the MSA have a total population of at Rockville, Maryland 20857; 301–443– SUPPLEMENTARY INFORMATION: FORHP least 100,000.’’ At that time, around 5260; or [email protected]. was authorized by Congress in the three quarters of all counties in the Correction: Meeting will be a 2-day Omnibus Budget Reconciliation Act of United States were non-metropolitan webinar and conference call only rather 1987, Public Law 100–203, codified at and not classified as parts of MSAs. than in-person as previously 42 U.S.C. 912, and located in HRSA. After the 2000 Census, OMB also announced. Congress charged FORHP with began to classify counties using a Maria G. Button, informing and advising the Department smaller urban core. The concept of a Director, Executive Secretariat. of Health and Human Services on Micropolitan statistical area closely parallels that of the MSA, but a [FR Doc. 2020–20940 Filed 9–22–20; 8:45 am] matters affecting rural hospitals and Micropolitan statistical area is based on BILLING CODE 4165–15–P health care and coordinating activities within the Department that relate to an urban core with a population of rural health care. Since the 1990s, 10,000 through 49,999 and Micropolitan DEPARTMENT OF HEALTH AND FORHP has also issued grants for counties are still considered non- HUMAN SERVICES programs of innovative models of health metropolitan. care delivery in rural areas. Historically, As currently classified, OMB builds Health Resources and Services applicant organizations for these grants, both MSAs and Micropolitan Statistical Administration authorized under Section 330A of the Areas around a central county, or Public Health Service Act, were counties, which contains an urban core. Revised Geographic Eligibility for required to be located in rural areas. Surrounding counties can be designated Federal Office of Rural Health Policy However, when the programs were as part of the Core Based Statistical Area Grants recently reauthorized under Section (CBSA) based on the presence of core AGENCY: Health Resources and Services 4214 of the Coronavirus Aid, Relief, and population and/or the commuting Administration (HRSA), Department of Economic Security Act the requirement patterns of the working population. A Health and Human Services. was amended to allow organizations to county may be included in only one CBSA. ACTION: Request for public comment. apply that are located in urban areas but serve rural areas. A county qualifies as a central county SUMMARY: HRSA’s Federal Office of Historically, there have been two of a CBSA if it meets the following Rural Health Policy (FORHP) has sought principal definitions of ‘‘rural’’ that requirements: to identify clear, consistent, and data- were in use by the Federal Government: (a) Has at least 50 percent of the driven methods of defining rural areas the Census Bureau definition (https:// population in urban areas of at least in the United States. FORHP uses the www.census.gov/programs-surveys/ 10,000 population; or Office of Management and Budget geography/guidance/geo-areas/urban- (b) Has within the boundaries a (OMB)’s list of counties designated as rural.html) and the OMB definition population of at least 5,000 located in a part of a Metropolitan Statistical Area (https://www.census.gov/programs- single of at least 10,000 (MSA) as the basis for determining surveys/metro-micro.html). Neither population. eligibility to apply for or receive definition defined ‘‘rural’’ directly, but Since urban areas are not defined by services funded by its rural health grant rather defined ‘‘urban’’ areas and then administrative boundaries, such as city programs. FORHP designates all designated locations that do not meet limits or county borders, they can counties that are not part of a MSA as the ‘‘urban’’ definition as ‘‘rural.’’ extend into one or more counties as long ‘‘rural’’ and eligible for rural health In the early 1990s, the Census Bureau as the population density criterion (a grant funding or services. In addition, defined ‘‘rural’’ as all areas that were minimum of 500 people per square FORHP designates census tracts within not part of an urbanized area (UA) or mile) is met. MSAs as rural for grant purposes using were not part of an incorporated area of A county qualifies as an outlying Rural-Urban Commuting Area (RUCA) at least 2,500 persons. UAs were defined county of a CBSA if it meets the codes. FORHP is proposing as densely settled areas with a total following commuting requirements: modifications to how it designates areas population of at least 50,000 people. (a) At least 25 percent of the workers to be eligible for its rural health grant The building block of UAs is the census living in the county work in the central programs so that block, a sub-unit of census tracts. The county or counties of the CBSA; or organizations serving rural populations Census Bureau introduced the urban (b) At least 25 percent of the within MSAs will be able to apply for cluster (UC) concept for the 2000 employment in the county is accounted

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for by workers who reside in the central the Grand Canyon which is located in determine programmatic eligibility for county or counties of the CBSA. a MSA county. Consequently, one could rural areas inside of MSAs, identified as Outlying counties are not required to argue that the Census Bureau standard rural census tracts within these MSA include any UA or UC population. In includes an over count of the rural counties. some cases, counties may be considered population whereas the OMB standard RUCA codes classify census tracts outlying because of reverse commuting represents an undercount. To address using measures of population density, into the county from other counties in these concerns and find a middle urbanization, and daily commuting. the MSA. ground between the two definitions, RUCA codes are based on the same Because Micropolitan counties are not FORHP funded the development of theoretical concepts used by the OMB to included in MSAs, they are included in Rural-Urban Commuting Area Codes define county-level Metropolitan and the set of non-metropolitan counties (RUCAs) (https://www.ers.usda.gov/ Micropolitan areas. By using the smaller along with counties that are not part of data-products/rural-urban-commuting- census tract unit instead of the county, any CBSA. area-codes/) in partnership with the RUCAs permit a finer delineation of There are measurement challenges Economic Research Service (ERS) of the ‘‘rural’’ and ‘‘urban’’ areas to reflect the with both the Census and OMB Department of Agriculture. FORHP experience of residents. Using data from definitions. Some policy experts note believes RUCAs allow more accurate the Census Bureau, every census tract in that the Census definition classifies targeting of resources intended for the the United States is assigned a RUCA quite a bit of suburban area as rural. The rural population. Both FORHP and the code. Currently, there are ten primary OMB definition includes rural areas in Centers for Medicare & Medicaid RUCA codes with 21 secondary codes MSA counties including, for example, Services (CMS) have used RUCAs to (see Table 1).

TABLE 1—PRIMARY RUCA CODES, 2010

Code classification Description

1 ...... Metropolitan area core: Primary flow within an urbanized area (UA). 2 ...... Metropolitan area high commuting: Primary flow 30% or more to a UA. 3 ...... Metropolitan area low commuting: Primary flow 10% to 30% to a UA. 4 ...... Micropolitan area core: Primary flow within an urban cluster of 10,000 to 49,999 (large UC). 5 ...... Micropolitan high commuting: Primary flow 30% or more to a large UC. 6 ...... Micropolitan low commuting: Primary flow 10% to 30% to a large UC. 7 ...... Small core: Primary flow within an urban cluster of 2,500 to 9,999 (small UC). 8 ...... Small town high commuting: Primary flow 30% or more to a small UC. 9 ...... Small town low commuting: Primary flow 10% to 30% to a small UC. 10 ...... Rural areas: Primary flow to a tract outside a UA or UC. 99 ...... Not coded: Census tract has zero population and no rural-urban identifier information.

Current FORHP Definition of Rural Why We Propose Modifying FORHP’s led to growth in the number of MSA Rural Definition counties that either have no population In addition to all areas of non-metro in either UCs or UAs or that have no counties, specific census tracts in The goal of FORHP is to increase access to care for underserved population in a UA but do have UC Metropolitan counties are considered population. rural and eligible for grant funding or to populations and build health care receive services under FORHP grant capacity in rural areas. To support that Both the designation of outlying counties in MSAs and the classification funding. These include census tracts goal, we must ensure that there are of RUCA codes in census tracts are inside MSAs with RUCA codes 4–10 clear, consistent, and data-driven dependent on commuting data and and 132 large area census tracts with methods of defining rural areas in the therefore the location of jobs. During the RUCA codes 2 and 3 that FORHP has United States. Further, FORHP must ensure that the rural definition used to recession, employment losses in non- designated as rural. The 132 MSA tracts determine eligibility to apply for or metropolitan counties began earlier and with RUCA codes 2–3 are at least 400 receive services under FORHP’s rural were deeper than losses in MSA square miles in area with a population health grant programs accurately counties. While job growth in MSAs and density of no more than 35 people per identifies rural communities. FORHP non-metropolitan counties were initially square mile. believes that the combination of non- similar, in the long term employment in Following the 2010 Census, the metropolitan counties with the set of non-metropolitan areas remained below FORHP definition included ‘‘rural’’ census tracts within MSAs has the level where it had been before the approximately 57 million people, or allowed FORHP to correctly classify recession. According to ERS, ‘‘Between about 18 percent of the population and much of the rural population in the 2010 and 2018, non-metropolitan 84 percent of the area of the United as eligible for rural health employment grew at an average annual States. More information about the grants. However, since the 2010 Census rate of 0.4 percent, compared to 1.5 current FORHP definition of rural is we have received feedback from rural percent per year in MSAs. By the located on the HRSA website (https:// stakeholders expressing concern that second quarter of 2019, non- www.hrsa.gov/rural-health/about-us/ some areas with rural character in MSAs metropolitan employment remained definition/index.html) and information are not being identified through the more than 1 percent below the pre- on whether counties or individual current methodology. recession level, while MSA employment addresses qualify as rural can be FORHP believes that the increasing exceeded the pre-recession level by identified in a search tool at the HRSA concentration of job growth in MSAs more than 9 percent.’’ In the years since Data Warehouse (https://data.hrsa.gov/ and changes in how OMB designates the recession, job growth has been tools/rural-health). outlying counties as part of MSAs have concentrated not just in MSAs, but in

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the largest MSAs. According to a raised the concern that commuting average MSA county population is rural McKinsey Global Institute report from patterns may not reflect suburbs and as defined by the Census Bureau. The 2019, ‘‘Just 25 (megacities and urban amenities spreading outward average non-metropolitan county has high-growth hubs, plus their urban from an urban area into rural areas. only approximately 10 percent of the peripheries) have accounted for more Instead, a lack of job opportunities in population of the average MSA county, than two-thirds of job growth in the last the rural area is causing workers to with the majority of people (59 percent) decade . . . By contrast, trailing cities commute into an urban area from a rural living in Census defined rural areas. have had virtually no job growth for a area. This increased commuting does When looking at central MSA decade—and the counties of Americana not represent an increase in access to counties compared to the outlying MSA and distressed Americana have 360,000 services for rural residents but can counties, there are large differences fewer jobs in 2017 than they did in instead represent a local economic between the two. The average central 2007.’’ decline. As OMB states, ‘‘For instance, county’s population is seven times programs that seek to strengthen rural Starting with the 2000 Census, OMB larger than the average outlying county economies by focusing solely on eliminated the use of measures of and almost half the outlying county’s counties located outside metropolitan settlement structure, such as population population is in Census defined rural statistical areas could ignore a density and percent of population that areas compared to just under 10 percent predominantly rural county that is is urban, as criteria for inclusion of of the average central county’s included in a metropolitan statistical outlying counties as part of an MSA. population. Even more striking, area because a high percentage of the Instead, commuting became the sole comparing outlying MSA counties that county’s residents commute to urban deciding factor as long as have no UA population at all or that (a) at least 25 percent of the employed centers for work.’’ have no UA or UC population at all residents of the county work in the Comparing Rural and Urban Counties shows that these MSA counties without CBSA’s central county or counties, or densely settled areas are much more (b) at least 25 percent of the jobs in The data presented in Table 2 shows similar to non-metropolitan counties the potential outlying county are that outlying MSA counties which have than they are to central MSA counties. accounted for by workers who reside in no UA population are more similar to the CBSA’s central county or counties. non-metropolitan counties than they are In population totals, density, and the After the 2000 Census, the number of to central MSA counties. Table 2 proportion of the population living outlying MSA counties with no urban displays characteristics of the mean outside Census defined UAs and UCs, population quadrupled from 24 in the population and land area for counties in the outlying MSA counties with no UA 1993 OMB listing to 96 in the 2003 the United States (excluding Alaska and population most closely resemble listing. After the 2010 Census, there Puerto Rico). The average MSA county Micropolitan counties. The outlying were 97 MSA outlying counties with no has a large population, over 200,000 counties with no UA or UC population urban population. people, most of whom live in UAs (84 at all, which do not include any town For counties with no urban percent of the total) with another 4 of even 2,500 residents, resemble the population, some stakeholders have percent in UCs. Only 12 percent of the non-CBSA counties. TABLE 2—COUNTIES BY URBANIZATION AND DENSITY 1

Pop. Land County Number Urban Urban UA % UC % Census % density area in County classification pop. of pop. (%) pop. UA pop. UC rural Rural per sq. sq. counties pop. mile miles

Metro ...... 224,809 1,166 197,393 88 188,132 84 9,262 4 27,416 12 276 813 Metro Central...... 331,742 728 300,832 91 291,341 88 9,491 3 30,910 9 367 929 Metro Outlying...... 47,077 438 25,468 54 16,588 35 8,880 19 21,609 46 76 621 Metro Outlying w/No Urbanized Area 2 ...... 23,185 286 6,969 46 0 0 6,969 46 16,216 54 36 650 Metro Outlying w/No Urban Population ...... 10,880 97 0 0 0 0 0 0 10,880 100 17 624 Nonmetro ...... 23,341 1,946 9,468 40.60 125 0.50 9,344 40.00 13,872 59 23 1,034 Micropolitan ...... 42,004 654 21,576 51.40 350 0.80 21,226 50.50 20,428 48 39 1,074 Neither ...... 14,255 1,292 3,486 24.50 12 0.10 3,474 24.40 10,769 75.50 14 1,013

Proposed Methodology To Determine impacts. The current set of eligible non- counties would become fully eligible. Eligibility for Rural Health Grants metropolitan counties and rural census These 86 counties include 42 outlying FORHP proposes to modify its tracts within metropolitan counties MSA counties that have no UA or UC existing rural definition by adding would still be eligible. Additional population at all. Lists of the counties outlying MSA counties with no UA counties would gain eligibility for rural that will be designated as rural if this population to its list of areas eligible to health grants. proposal is adopted are available at apply for or receive services funded by Using OMB’s April 2018 update of https://www.hrsa.gov/rural-health/ FORHP’s rural health grants. Compared MSAs and the 2010 Census data on about-us/definition/datafiles.html. It is also important to note that there to the current definition, this urban population by counties, there are is no single definitive source for modification would have the following 287 counties (286 reflected in Table 2 assigning rurality to a particular plus one county equivalent in Alaska) geographic area 34 Rural definitions are 1 This table excludes counties in Alaska and that are outlying counties in an MSA Puerto Rico. Alaskan (county equivalents) that have no UA population. Out of are much larger than counties in other states. One 3 U.S. Census Bureau. 2019. Understanding and Alaskan would qualify as Metro Outlying those counties, 97 had no UA or UC Using American Community Survey Data: What with No Urbanized Area. population at all. Many of the 287 Users of Data for Rural Areas Need to Know. 2 The two bolded, italicized rows represent the counties (201) are already partially or Available from: https://www.census.gov/programs- counties that would become eligible in their fully eligible for Rural Health grants surveys/acs/guidance/handbooks/rural.html. entirety for Rural Health grants after this notice. Accessed December 20, 2019. The number of counties with no UA includes the because they contain eligible census 4 U.S. Department of Agriculture, Economic counties that have no Urban population. tracts. However, 86 previously ineligible Research Service. What is Rural? Available from:

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highly context dependent and while responding to this request will be solely Sherrette Funn, the Reports Clearance definitions of rurality may take into at the interested party’s expense. Officer, [email protected], or call account a range of characteristics (e.g., 202–795–7714. List of References population density, commuting SUPPLEMENTARY INFORMATION: Interested distance, land use, etc.), rural Urban Area Criteria for Census 2000. Federal persons are invited to send comments definitions do not reflect any single, Register, Vol. 67, No. 51. 15, 2002 regarding this burden estimate or any 5 https://www.federalregister.gov/ inherent geographic attribute. FORHP’s other aspect of this collection of proposal to modify our eligibility documents/2002/03/15/02-6186/urban- area-criteria-for-census-2000. information, including any of the criteria to apply for or receive services Rural Employment Trends in Recession and following subjects: (1) The necessity and funded by FORHP’s rural health grants Recovery. Economic Research Report utility of the proposed information reflects our efforts to be responsive to Number 172, August 2014. https:// collection for the proper performance of stakeholder feedback and best target our www.ers.usda.gov/webdocs/ the agency’s functions; (2) the accuracy _ programs towards the intended publications/45258/48731 of the estimated burden; (3) ways to communities. This does not eliminate err172.pdf?v=0. enhance the quality, utility, and clarity the fact that other rural definitions may Rural America at a Glance, 2019 Edition. https://www.ers.usda.gov/webdocs/ of the information to be collected; and be set by statute or regulation or the fact (4) the use of automated collection that other programs established outside publications/95341/eib-212.pdf?v=3322. The future of work in America: People and techniques or other forms of information of FORHP’s 330A authorization may places, today and tomorrow. McKinsey technology to minimize the information need to use a different definition of Global Institute. July 2019. https:// collection burden. rural to meet program goals. No single www.mckinsey.com/featured-insights/ Title of the Collection: HHS definition of rural is perfect or advisable future-of-work/the-future-of-work-in- Teletracking COVID–19 Portal (U.S. given the geographic variation that america-people-and-places-today-and- Healthcare COVID–19 Portal). tomorrow#. exists nationally and the varying needs Type of Collection: In use without an of rural programs. Standards for Defining Metropolitan and Micropolitan Statistical Areas. Federal OMB number. Request for Public Comment Register/Vol. 65, No. 249/December 27, OMB No.: 0990–XXXX OS/OCIO. FORHP is proposing to modify the 2000. 82228–82238 https://www.bls.gov/ Abstract: The data collected through rural definition it uses to determine lau/frn249.pdf. this ICR informs the Federal 2010 Standards for Delineating Metropolitan Government’s understanding of disease geographic areas eligible to apply for or and Micropolitan Statistical Areas; receive services funded by FORHP’s patterns and furthers the development Notice. Federal Register/Vol. 75, No. of policies for prevention and control of rural health grants and requests 123, June 28, 2010. 37246–37252. comments from the public on the https://www.govinfo.gov/content/pkg/ disease spread and impact related to the proposed methodology described above. FR-2010-06-28/pdf/2010-15605.pdf. 2019 Novel Coronavirus (COVID–19). This request for comments is issued One of the most important uses of the solely for information and planning Thomas J. Engels, data collected through this ICR is to purposes; it does not constitute a Administrator. determine critical allocations of limited Request for Proposal, applications, [FR Doc. 2020–20971 Filed 9–22–20; 8:45 am] supplies (e.g., protective equipment and proposal abstracts, or quotations. This BILLING CODE 4165–15–P medication). For instance, this request does not commit the collection has been used to distribute Government to contract for any supplies Remdesivir, a vital therapeutic that HHS or services or make a grant or DEPARTMENT OF HEALTH AND distributes to the American healthcare cooperative agreement award or take HUMAN SERVICES system, via distinct data calls on regular any other official action. Further, HRSA [Document Identifier: OS–0990–xxxx] intervals. As of July 10, HHS reduced is not seeking proposals through this the number requests for data from Request for Information and will not Agency Information Collection hospitals to support allocations of accept unsolicited proposals. Request; 60-Day Public Comment Remdesivir. HHS has stopped sending HRSA is not obligated to summarize Request out one-time requests for data to aid in or publish a response to feedback the distribution of Remdesivir or any received, or to respond to questions AGENCY: Office of the Secretary, HHS. other treatments or supplies. This about the policy issues raised in this ACTION: Notice. consolidated daily reporting is the only request. Responders are advised that the mechanism used for the distribution SUMMARY: In compliance with the United States Government will not pay requirement of the Paperwork calculations, and daily reports are for any information or administrative Reduction Act of 1995, the Office of the needed to ensure accurate calculations. costs incurred in response to this Secretary (OS), Department of Health Type of Respondent: We acknowledge request; all costs associated with and Human Services, is publishing the the burden placed on many hospitals, following summary of a proposed including resource constraints, and have https://www.ers.usda.gov/topics/rural-economy- collection for public comment. allowed for some flexibilities, such as population/rural-classifications/what-is-rural.aspx. back-submissions or submitting every Accessed December 20, 2019. DATES: Comments on the ICR must be 5 For a deeper discussion of this topic, please see: business days, with the understanding received on or before November 23, that respondents may not have (a) National Academies of Sciences, Engineering, 2020. and Medicine 2016. Rationalizing Rural Area sufficient staff working over the Classifications for the Economic Research Service: ADDRESSES: Submit your comments to weekend. It is our belief that collection A Workshop Summary. Washington, DC: The [email protected] or by calling National Academies Press. Accessed December 20, of this information daily is the most 2019. Available from: https://doi.org/10.17226/ (202) 795–7714. effective way to detect outbreaks and 21843; and (b) Ratcliffe M, Burd C, Holder K, and FOR FURTHER INFORMATION CONTACT: needs for Federal assistance over time, Fields A, ‘‘Defining Rural at the U.S. Census When submitting comments or by hospital and geographical area, and Bureau,’’ ACSGEO–1, U.S. Census Bureau, Washington, DC, 2016. Available from: https:// requesting information, please include to alert the appropriate officials for www.census.gov/content/dam/Census/library/ the document identifier 0990-New-60D, action. It’s requested that 5,500 publications/2016/acs/acsgeo-1.pdf. and project title for reference, to hospitals, submit data daily on the

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