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Department of Health and Human Services
The National Advisory Committee on Rural Health and Human Services
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July 16, 2013 Letter to Secretary Sebelius

July 16, 2013

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

Dear Secretary Sebelius,

The National Advisory Committee on Rural Health and Human Services is pleased to provide you with a policy brief on the challenges of providing hospice care in rural areas. In preparing this brief, the Committee met at the site of the Hospice & Palliative Care of Western Colorado in Grand Junction, Colorado. Section 3132(a) of the Affordable Care Act (Patient Protection and Affordable Care Act, 2010) requires the Secretary to revise Medicare’s payment system for hospice care and the Committee wants to bring to your attention the issues that were raised at our meeting.

The Committee saw the central site of the Hospice and visited two satellite offices as well. This one hospice serves an area of over 7500 square miles and visiting both the central site and seeing the satellite in a frontier area informed the recommendations we make to you. These include allowing physician assistants and practitioners at rural health clinics to furnish and bill for hospice services, providing greater flexibility to Critical Access Hospitals in the provision of hospice services, and reexamining the disparities in costs incurred in travel (i.e., windshield time) between urban and rural hospice providers.

Also at this meeting the Committee continued its examination of the intersection of rural poverty with federal human services programs, the subject that was suggested to us by George Sheldon, acting Administrator of the Administration for Children & Families. The Human Services members went to Montrose, CO, the site of the county’s human services office, to hear more about how poverty programs deal with the unique situation of America’s rural poor. Colorado uses a county based system to provide services to its residents. During our meeting in Montana we will contrast two different models of local human services delivery: Colorado’s state-supervised, county-government-administered model and Montana’s more private, non-profit (Community Action Agency) based model.
Our next meeting, in Bozeman, Montana, will be held from September 4-6, 2013. We would welcome having you or your designee join us there as we continue to review provision of Human Services in rural areas as well as the ACA’s impact on rural Americans.

As always, please let us know if we can assist you in any way.


The Honorable Ronnie Musgrove