August 19, 2014 Letter on Policy Briefs

The Honorable Sylvia Burwell, Secretary
U.S. Department of Health and Human Services
200 Independence Ave, SW
Washington, D.C. 20201

Dear Secretary Burwell,

On behalf of the National Advisory Committee on Rural Health and Human
Services, I am sending you two policy briefs and accompanying recommendations. The first examines network adequacy and premium prices for insurance plans sold in rural areas on the new health insurance exchanges. The second examines issues of homelessness in rural America. In preparing these briefs, the Committee met at the University of Nebraska Medical Center and conducted site visits in rural communities in the region.

The Health Subcommittee visited two Critical Access Hospitals — Nemaha County Hospital, in Auburn, Nebraska, and Myrtue Medical Center, in Harlan, Iowa. This allowed the Committee to examine the issue of premium pricing in a Medicaid-expansion state and a non-expansion state. Our recommendations include continuing to educate states on the effects of the small rating area designation; including rural health clinics in the Essential Community Provider definition; and, instructing the Department to evaluate all premium pricing, enrollment, and network adequacy data through a rural lens. The Committee also recommends that hospitals be allowed to offer Outreach and Enrollment information and assistance for their patients without limitations on how they contact patients in their service areas.

Also at this meeting, The Human Services Subcommittee visited two Administration for Children and Families grantees who work with individuals and families experiencing homelessness in rural Nebraska. The Subcommittee was hosted for a site visit by the Northeast Nebraska Community Action Partnership at the Care Corps Shelter in Fremont, Nebraska. They also visited Youth Emergency Services in Bellevue, Nebraska, a provider that works with runaway and homeless youth.

These site visits informed several recommendations on the topic of rural homelessness, including working with the U.S. Interagency Council on Homelessness to consider the rural homeless as a special population with unique needs and developing a pilot project to create flexible funding streams to promote effective service delivery for individuals and families experiencing homelessness in rural America.

The Committee also recommends that the Department develop clearer guidelines for mailing benefits to individuals and families experiencing homelessness in rural America and encourage states to do the same, since that population is unable to use shelter addresses to receive mail in counties that do not have providers. One idea that was suggested was for rural post offices to accept mail for individuals and families experiencing homelessness. 

Our next meeting, in Sioux Falls, South Dakota, will be held from September 24th -26th, 2014. We are looking forward to hearing from Kim Gillan, the HHS Region VIII Director, as we begin work on the issue of intimate partner violence in rural communities and how telehealth technology can support the Affordable Care Act focus on moving toward more value in health care delivery.


The Honorable Ronnie Musgrove

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