Rural Health Care Pilot Program: Bridging the Digital Divide in Rural Healthcare

The Federal Communications Commission (FCC) launched the Rural Health Care Pilot Program to address a critical challenge in the United States: providing equitable access to quality healthcare in rural areas. This initiative aimed to leverage the power of broadband technology to connect healthcare providers in rural locations with advanced medical resources, specialists, and information networks, regardless of geographical limitations. This article delves into the intricacies of this groundbreaking program, its objectives, benefits, and impact on rural communities.

Understanding the FCC’s Rural Health Care Pilot Program

Initiated by the FCC, the Rural Health Care Pilot Program was designed as a pioneering funding mechanism to foster the development of a dedicated nationwide broadband network for healthcare. This network was envisioned to connect public and private non-profit healthcare providers across both rural and urban settings, fostering collaboration and resource sharing across geographical boundaries. The program was meticulously structured, and information regarding its various facets was made readily available through FCC orders, news releases, and comprehensive documentation.

The program’s overview, presented in a detailed PDF slide presentation, offered a clear understanding of its scope and objectives. For those interested in participation, detailed applications guidelines were provided. To further clarify the program’s operational aspects, the FCC also compiled a list of Frequently Asked Questions and Answers (FAQs), addressing common queries and concerns. A supplementary set of FAQs specifically addressed the 2010 NPRM, providing clarity on proposed reforms and future directions.

For direct access to program resources and administrative details, the Universal Service Administrative Company (USAC) Pilot Program Website served as a central hub. Complementing this, the U.S. Department of Health and Human Services Health Information Technology Website offered a broader perspective on the program’s alignment with national health IT initiatives.

It is crucial to note that the program overviews and FAQs were intended for general informational purposes and should not be considered official interpretations of the FCC order establishing the program. These resources were subject to periodic updates, and interested parties were advised to consult the official FCC website for the most current information.

Key Program Documents and Updates

The FCC consistently provided updates and important documents related to the Rural Health Care Pilot Program through notices and press releases. These publications offered insights into the program’s evolution, evaluations, and key decisions. Notable examples include:

• 8/13/12 Wireline Competition Bureau Evaluation of Rural Health Care Pilot Program Staff Report: This report (Word | Acrobat) provided an in-depth evaluation of the program’s performance and impact.

• 6/21/11 FCC Preserves Rural Health Care Support for Over 200 Providers: This order and NPRM (Word | Acrobat) demonstrated the FCC’s commitment to sustaining support for rural healthcare providers through the program.

• Orders and Public Notices on Deadline Extensions and Funding Requests (2010-2011): A series of orders and public notices (Word | Acrobat, Word | Acrobat, Word | Acrobat, Word | Acrobat, Word | Acrobat, Word | Acrobat, Word | Acrobat, Word | Acrobat, Word | Acrobat) indicated the program’s responsiveness to the needs of participants, addressing challenges related to vendor selection and funding commitments.

• Instruction Letter to USAC Released (02/15/11): This letter (Word | Acrobat) highlighted the FCC’s proactive approach to program management, incorporating recommendations from the Government Accountability Office to enhance program effectiveness.

• Public Notice on Rural Health Care NPRM (08/09/10): This public notice (Word | Acrobat) signaled the FCC’s ongoing efforts to refine and expand the Rural Health Care program, seeking public comment on proposed reforms.

• FCC Seeks Comment on Reforms to the Universal Service Rural Health Care Fund (07/15/10): This Notice of Proposed Rulemaking (Word | Acrobat) and related News Release (Word | Acrobat) demonstrated the FCC’s commitment to long-term improvements in rural healthcare through broadband.

• Statements on Rural Health Care Pilot Program Commitments (02/18/10): Chairman Julius Genachowski’s statement (Word | Acrobat) and related FCC update (Word | Acrobat) underscored the program’s progress and the FCC’s dedication to its success.

• Order Extending Deadline for Vendor Selection and Funding Commitment (02/18/10): This order (Word | Acrobat) further illustrated the FCC’s flexibility and support for program participants.

• Public Notices on Deadline Extensions (2009): Public notices (Word | Acrobat, Word | Acrobat) from late 2009 showed proactive adjustments to program timelines to accommodate participant needs.

• Oregon Health Network Milestone News Release (12/4/09): This news release (Word | Acrobat) highlighted tangible progress and success stories emerging from the program.

• National Broadband Plan Comments Sought (11/12/09): This Public Notice (Word | Acrobat) linked the Pilot Program to broader national broadband initiatives, indicating its strategic importance.

• Commissioners Discuss Telemedicine Services (10/5/09): This news release (Word | Acrobat) showcased the program’s real-world implications and the FCC’s active engagement with the healthcare community.

• Rural Health Care Pilot Program Quarterly Reports Reminder (09/28/09): This Public Notice (Word | Acrobat) emphasized program accountability and data collection for evaluation.

• Pennsylvania RHCPP Merger Order (08/12/09): This order (Word | Acrobat) demonstrated the program’s adaptability and support for collaborative projects.

• Rural Health Care Pilot Program Form 466-A Deadline Waiver PN (08/10/09): This Public Notice (Word | Acrobat) addressed administrative aspects and provided flexibility in program compliance.

• Merger Order for North Carolina RHCPP Projects (07/31/09): This order (Word | Acrobat) further highlighted support for project consolidation and efficiency.

• Comment Sought On Request To Merge North Carolina Rural Health Care Pilot Program Projects (06/05/09): This Public Notice (Word | Acrobat) showed the FCC’s openness to stakeholder input and project optimization.

• Comment Sought On Request To Merge Pennsylvania Rural Health Care Pilot Program Projects (05/06/09): This Public Notice (Word | Acrobat) reiterated the FCC’s commitment to facilitating efficient program implementation.

• FCC Update on Rural Health Care Pilot Program Initiative (04/16/09): This News Release (Word | Acrobat) provided ongoing updates on the program’s progress and impact.

• WCB Grants Merger Request for Texas RHCPP Projects (04/16/09): This order (Word | Acrobat) continued to demonstrate support for project streamlining.

• Comment Sought on Request to Merge Texas Rural Health Care Pilot Program Projects (03/13/09): This Public Notice (Word | Acrobat) exemplified the FCC’s transparent and consultative approach.

• Merger Orders for Ohio and Mississippi RHCPP Projects (2008): Orders (Acrobat, Acrobat) from December 2008 further showcased the program’s support for efficient resource utilization through project mergers.

• WCB Letter to USAC on Rural Health Care Pilot Program Eligible Costs, Restrictions on Resale, and Sustainability (10/24/08): This letter (Acrobat) provided crucial guidance on program compliance and long-term viability.

• Public Notice on Holzer Consolidated Health Systems (HCHS) and Southern Ohio Health Care Network (SOHCN) Merger Request (10/01/08): This Public Notice (Word | Acrobat) illustrated the FCC’s detailed oversight of program implementation.

• Comment Sought On Request To Merge Mississippi Rural Health Care Pilot Program Projects (09/19/08): This Public Notice (Word | Acrobat) continued to emphasize stakeholder engagement and program refinement.

• Rural Health Care Pilot Program Participants’ Quarterly Reports Due (07/28/08): This Public Notice (Word | PDF) reinforced the importance of regular program monitoring and reporting.

• OMB Approves Rural Health Care Pilot Program Information Collection Requirements (01/22/08): This Public Notice (Word | PDF | Text) highlighted the program’s adherence to regulatory standards and data management protocols.

• WCB Letter to USAC on Rural Health Care Pilot Program Carry-Over of Funds (01/17/08): This letter (Acrobat) addressed financial management aspects and program flexibility.

• WCB Letter Congratulating RHC Pilot Program Selected Participants (12/20/07): This letter (Acrobat | Text) marked a significant milestone, celebrating the selection of program participants.

• FCC Launches Initiative to Increase Access to Health Care in Rural America Through Broadband Telehealth (11/19/07): This news release (Word | PDF) and related documents (Word | PDF, Word | PDF, Word | PDF, Word | PDF, Word | PDF, Word | PDF, Word | PDF, Word | PDF, Word | PDF) formally announced the program’s launch and its commitment to bridging the rural healthcare gap through telehealth.

• Chairman Martin Discusses Benefits of Deploying Broadband Telehealth Networks (11/13/07): This news release (Word | PDF) and speech (Word | PDF, PDF) highlighted the vision and anticipated positive outcomes of the program.

• HHS Letter Identifying Ways the Pilot Program Can Advance National Health Information Network Initiative (08/17/07): This letter (PDF) underscored the program’s alignment with broader national health IT strategies and inter-agency collaboration.

• FCC Announces Deadline for Pilot Program Applications (03/09/07): This Public Notice (Word | PDF) provided crucial information for potential applicants and program outreach.

• FCC Expands Eligibility for Backbone Connections in Rural Health Pilot (02/06/07): This news release (Word | PDF) and order (Word | PDF) demonstrated program adaptability and efforts to maximize its reach.

• FCC Launches “Rural Health Care Pilot Program” Website (11/21/06): This news release (Word | PDF) marked a key step in program accessibility and information dissemination.

• WCB Seeks Comment on Petition for Reconsideration or Clarification (11/06/06): This Public Notice (Word | PDF) showed the FCC’s commitment to addressing stakeholder concerns and program refinement.

• FCC Adopts Pilot Program Under Rural Health Care Mechanism (09/26/06): This order (Word | PDF) and related documents (Word | PDF, Word | PDF, Word | PDF, Word | PDF, Word | PDF, Word | PDF) formally established the Rural Health Care Pilot Program, marking its official inception.

Frequently Asked Questions: Pilot Program Deep Dive

To provide further clarity, the FCC compiled a comprehensive list of Frequently Asked Questions (FAQs) regarding the Rural Health Care Pilot Program. These FAQs are categorized for easy navigation and cover critical aspects of the program.

Program Scope, Selection, and Denials

1. What is the FCC’s Rural Health Care Pilot Program?

   Launched on November 19, 2007, with the Rural Health Care Pilot Program Selection Order, the program selected 69 participants across 42 states and three U.S. territories. These participants were granted eligibility for funding covering up to 85% of costs associated with:

   • Building state or regional broadband networks and delivering advanced telecommunications and information services.
   • Connecting to Internet 2 or National LambdaRail (NLR).
   • Establishing connections to the public Internet.

   The Universal Service Administrative Company (USAC) was designated to administer the program under FCC oversight. USAC, a non-profit entity created by the FCC, also manages the Universal Service Fund (USF) and its programs for rural high-cost areas, low-income consumers, schools, libraries, and rural healthcare providers.

   The total funding allocated to the 69 participants was approximately $417 million over three years (Funding Years 2007-2009), equating to roughly $139 million per year. Network build-outs were required to be completed within five years of receiving initial funding commitment letters from USAC.

   The primary objective of the Pilot Program was to gather practical insights into modifying the existing universal service Rural Health Care mechanism to better support a nationwide broadband healthcare network, particularly in underserved rural areas.

2. How does the Pilot Program differ from the existing Rural Health Care Program?

   The pre-existing Rural Health Care program aimed to equalize costs for rural healthcare providers, ensuring they paid no more than their urban counterparts for telecommunications and internet access. In contrast, the Pilot Program adopted a broader approach, funding up to 85% of infrastructure design and construction costs for broadband networks dedicated to healthcare.

   Furthermore, the Pilot Program extended funding to connect state or regional networks to Internet2 or National LambdaRail, and also supported connections to the public internet. A key distinction was the Pilot Program’s focus on connecting rural healthcare providers with urban centers, facilitating telehealth and telemedicine access to medical hubs typically located in urban areas.

3. What are the benefits of the Pilot Program?

   Broadband-enabled telehealth and telemedicine applications offer substantial advantages, particularly in rural areas where access to specialized medical care is often limited. A connected broadband network for healthcare providers brings numerous benefits:

   • Enhanced Specialist Access: Patients can consult specialists in cardiology, pediatrics, radiology, and other fields remotely, eliminating the need to travel long distances.
   • National Medical Expertise Network: Connecting statewide and regional networks to national backbones links government research institutions, academic centers, and public/private healthcare institutions, creating a vast repository of medical knowledge and expertise.
   • Remote Patient Monitoring: Intensive care units can remotely monitor critically ill patients across multiple locations, improving care coordination and timely intervention.
   • Advanced Continuing Education and Research: Healthcare providers gain access to advanced educational resources and research collaborations, fostering professional development and innovation.
   • Improved Emergency Response: A nationwide healthcare network strengthens communities’ ability to respond rapidly and effectively to public health crises and enhances disaster preparedness and emergency response capabilities.

4. Who is able to receive funding under the Pilot Program?

   Eligibility for Pilot Program funding was restricted to public and non-profit healthcare providers, aligning with the definition in Section 254(h)(7)(B) of the Communications Act and FCC rules for the existing Rural Health Care program. Eligible entities included:

   • Post-secondary educational institutions offering healthcare instruction, teaching hospitals, or medical schools.
   • Community health centers or migrant health centers.
   • Local health departments or agencies, including dedicated emergency departments of rural for-profit hospitals.
   • Community mental health centers.
   • Non-profit hospitals.
   • Rural health clinics, including mobile clinics.
   • Consortia of eligible healthcare providers.
   • Part-time eligible entities within otherwise ineligible facilities.

   While emergency medical service facilities themselves were not eligible, funding could support connecting them to eligible healthcare providers if they were part of the eligible provider network.

   Ineligible providers included for-profit institutions (except rural for-profit hospital emergency departments), private physician offices, nursing homes, emergency medical service facilities (as standalone entities), residential substance abuse treatment facilities, hospices, for-profit hospitals (except for dedicated emergency departments in rural areas), home health agencies, blood banks, social service agencies, and community/youth/vocational rehabilitation centers.

5. Are data centers eligible for funding under the Pilot Program?

   Data centers could be eligible as network components if directly connected to eligible healthcare providers and involved in data transmission to and from them. For example, the Rural Wisconsin Health Cooperative Consortium used Pilot Program funding for an electronic health records (EHR) data center serving numerous eligible providers.

   However, stand-alone data centers not directly connected to eligible healthcare providers were not eligible for funding as they did not qualify as eligible healthcare providers themselves.

   For products or services with both eligible and ineligible components, costs needed to be allocated proportionally. Data center costs specific to Pilot Program projects could be reimbursed, while shared data centers serving both eligible and ineligible entities could receive partial funding for eligible use portions.

6. May health care providers not initially selected participate in the Pilot Program?

   Direct participation in the Pilot Program was limited to the 69 entities selected in the Rural Health Care Pilot Program Selection Order. However, healthcare providers not initially included could explore options to join the networks of selected participants.

   Furthermore, all eligible healthcare providers were encouraged to contact USAC to explore participation in the existing Rural Health Care support mechanism, which offered discounts on telecommunications and internet access services. The FCC also indicated plans to revisit and improve the broader Rural Health Care program in the future, encouraging ongoing participation from all eligible providers.

7. How will the Pilot Program aid emergency coordination between public safety and healthcare officials?

   The Pilot Program was designed to support the national goal of interoperable health information technology infrastructure, as outlined in a 2004 Presidential Executive Order. To this end, funded participants were required to:

   • Use interoperable health IT systems and products meeting HHS standards.
   • Utilize health IT products certified by the Certification Commission for Healthcare Information Technology.
   • Support the Nationwide Health Information Network (NHIN) architecture.
   • Utilize resources from HHS’s Agency for Healthcare Research and Quality National Resource Center for Health Information Technology.
   • Coordinate with the HHS Assistant Secretary for Public Response regarding telehealth and emergency preparedness, aligning with the Pandemic and All Hazards Preparedness Act.
   • Use resources from HHS’s Centers for Disease Control and Prevention (CDC) Public Health Information Network to enhance interoperability with public health and emergency organizations.

   Pilot Program participants were mandated to collaborate with HHS and the CDC, particularly during public health emergencies. Where feasible, they were expected to provide network access to HHS, CDC, and other public health officials to facilitate coordinated responses.

Pilot Program Administration and Audits

8. Who will administer the program?

   As previously stated, the Universal Service Administrative Company (USAC) was responsible for program administration under the oversight of the FCC. USAC’s role included managing the administrative processes, ensuring compliance, and conducting outreach to program participants.

9. What is the reimbursement process for selected Participants?

   The reimbursement process involved a series of steps and FCC forms to ensure accountability and proper fund disbursement:

   • FCC Form 465 (Bona Fide Request): Participants filed this form with USAC to request bids for supported services, certifying their eligibility. USAC then posted these forms publicly, initiating a 28-day waiting period before vendor selection.
   • FCC Form 466-A (Service Selection and Contract Information): After choosing vendors, participants submitted this form detailing services ordered, costs, vendor information, and service agreement terms. They also certified cost-effectiveness and included network cost worksheets breaking down eligible and ineligible costs, demonstrating how ineligible participants would cover their share.
   • FCC Form 467 (Service Activation/Discontinuation): This form notified USAC when services began, were discontinued, or were not activated within the funding year.
   • Invoice Submission: USAC disbursed funds based on monthly invoices from service providers, detailing actual eligible expenses. Providers could only invoice for services attributable to eligible healthcare provider network participants.

10. What types of costs are eligible for Pilot Program funding?

    Eligible costs covered a range of network development and operational expenses:

    • Initial network design studies.
    • Construction and network deployment.
    • Transmission facilities.
    • Recurring and non-recurring costs of advanced telecommunications and information services, including public internet access.
    • Costs for connecting to Internet2 or National LambdaRail, if requested.

11. What types of costs are ineligible?

    Certain cost categories were explicitly deemed ineligible for Pilot Program funding:

    • Most personnel costs, except for those directly involved in network design, engineering, installation, construction, and management. This excluded program management, administration, and marketing personnel.
    • Travel costs.
    • Legal costs.
    • Most training costs, except for basic training directly related to network installation and operation. End-user training (e.g., telemedicine application training) was ineligible.
    • Program administration or technical coordination not directly related to network design, engineering, operations, installation, or construction.
    • Inside wiring and networking equipment on healthcare provider premises (e.g., video conferencing, wireless devices), except for carrier transmission facility termination equipment and directly connected routers/switches.
    • Computers and related hardware (servers, printers, scanners, laptops), unless exclusively used for network management.
    • Helpdesk equipment, software, and services.
    • Software, unless for network management, maintenance, or operations. Excluded software development (except network-related), web server hosting, and website/portal development.
    • Telemedicine applications and software, clinical or medical equipment.
    • Electronic records management and expenses.
    • Connections to ineligible network participants (e.g., for-profit providers) and associated network costs.
    • Administration and marketing costs, including general administrative expenses, marketing studies, outreach, and evaluation studies.

12. Do network design study funding include consultant, personnel, or program administration costs?

    Yes. Pilot Program funding for network design studies encompassed all costs related to setting up, analyzing technical and non-technical requirements, and developing feasible network designs. This included personnel costs (salaries, benefits) for staff directly involved in network design, as well as program administration or technical coordination costs specifically related to network design.

13. Can participants lease or sell network facilities or capacity funded by the Pilot Program?

    No. Pilot Program participants were prohibited from selling, leasing, or transferring network facilities or capacity supported by universal service funding. This restriction aligned with 47 U.S.C. § 254(h)(3) and 47 C.F.R. § 54.617(a), ensuring that program funds were used for their intended purpose of dedicated telehealth networks.

    However, participants could share excess network capacity with ineligible entities if those entities paid their fair share of network costs for the capacity used and program funding was not used for that portion.

14. Does the program restrict funding to specific technologies?

    No. The program was technology-neutral, consistent with section 254(h)(2)(A) of the 1996 Act. Eligible healthcare providers could choose any technology and broadband infrastructure provider to deliver telehealth services, provided they complied with program requirements and competitive bidding rules. Vendor selection was subject to competitive bidding to ensure cost-effectiveness and prevent technology bias.

15. Are there restrictions on the source of the 15% participant contribution?

    Yes. The required 15% minimum contribution from participants had to come from eligible sources, including:

    • Applicant or eligible healthcare provider funds.
    • State grants, funding, or appropriations.
    • Federal funding, grants, loans, or appropriations (excluding Rural Health Care funding).
    • Other grant funding, including private grants.

    Ineligible sources included in-kind contributions, contributions from telecom carriers, utilities, contractors, or for-profit participants. Participants could not use funds from the existing Rural Health Care support mechanism for their 15% contribution.

16. Can ARRA broadband grant or loan funding be used for Pilot Program networks?

    Yes. Participants could use broadband grants and loans authorized by the American Recovery and Reinvestment Act of 2009 (ARRA) to cover their 15% minimum contribution, provided it was consistent with ARRA requirements. The FCC did not oversee ARRA funding; the NTIA and RUS were responsible for administering those programs.

17. Can applicants modify their proposed network after selection?

    Yes. Selected participants could upgrade, replace technology, or add eligible healthcare providers to their proposed networks before or during the competitive bidding process, as long as it remained within their maximum funding limit and used for eligible expenses. Funding commitment letters (FCLs) capped support for specific services and funding years, with any unused funds (“cap carry over”) being applied to the next funding year.

18. How do Participants choose their vendors?

    The Pilot Program adhered to the FCC’s universal service rules, including competitive bidding requirements. A limited exception allowed pre-selection of Internet2 or National LambdaRail as nationwide backbone providers in initial applications. Otherwise, all funding requests were subject to competitive bidding to ensure cost-effectiveness and fair vendor selection.

19. Can participants “self-provision” project components?

    Yes. Participants could choose to “self-provision” components like network design studies, but only after a competitive bidding process demonstrated they were the most cost-effective provider. Participants had to certify that they selected the most cost-effective option, whether self-provisioning or choosing an external vendor.

20. Are letters of agency needed for network design study bids?

    Yes. Participants were required to submit Letters of Agency (LOAs) from each participating healthcare facility with their FCC Form 465. These LOAs authorized the lead project coordinator to act on their behalf, confirmed provider participation, and prevented duplicate support for providers involved in multiple networks.

21. What steps ensure Pilot Program funds are used as intended?

    The FCC implemented several measures to ensure proper fund utilization:

    • Required USAC Forms and detailed worksheets on network costs.
    • Certifications confirming funds would be used for intended purposes.
    • Letters of Agency from participating providers.
    • Detailed invoices showing actual project build-out costs.
    • Audits by the Office of the Inspector General (OIG) for all participants and service providers.

22. How will Pilot Program funds be disbursed?

    USAC disbursed funds monthly based on invoices detailing actual eligible expenses. This process ensured project progress while allowing USAC and the FCC to monitor expenditures and prevent misuse of funds. USAC followed a bi-monthly invoicing payment plan for service provider invoices.

23. How will the FCC prevent participants from gaming the system?

    Preventative measures included:

    • Competitive bidding requirements to ensure cost-effectiveness.
    • Random site visits by USAC to verify fund usage.
    • OIG audits and investigations for all participants and service providers.
    • Requirement to disclose consultants and outside experts involved in application preparation.

24. What information should be in a participant’s sustainability plan?

    Sustainability plans were crucial for ensuring long-term network viability and responsible fund allocation. Key elements of a sustainability plan included:

    • Minimum 15% Funding Match: Status of securing the 15% match, including any conditions on funding sources.
    • Projected Sustainability Period: Duration of sustainability and its relation to initial investment (ideally 10 years or commensurate with investment).
    • Principal Factors: Narrative and budget details on factors demonstrating sustainability.
    • Terms of Network Membership: Agreements, financial/time commitments from members, financing for network growth bandwidth, fee structures for members.
    • Excess Capacity: Funding for any non-healthcare dedicated network capacity, cost allocation, and agreements between healthcare and excess capacity portions.
    • Ownership Structure: Network element ownership and arrangements for continued use during the sustainability period.
    • Sources of Future Support: Details on fee-based revenue models from healthcare providers or other members, and demand projections for network usage or excess capacity.
    • Management: Structure for the sustainability period and funding for management costs.

25. How will the Commission evaluate Pilot Program success?

    Program success evaluation relied on:

    • Quarterly reports from participants to USAC and the FCC, containing specified data.
    • Analysis of cost-effectiveness and efficacy of funded networks based on collected data.
    • Assessment of program compliance with section 254 of the 1996 Act, program orders, and FCC rules.
    • Data collection to prevent waste, fraud, and abuse and ensure funds reached intended purposes.

26. Can existing Rural Health Care (RHC) discounts be part of a participant’s sustainability plan?

    Yes. Reliance on existing RHC discounts for sustainability was permissible if supported by evidence that facilities/services currently received or were eligible for such discounts. Participants could provide this evidence in quarterly reports.

27. May vendor selection consider a vendor’s commitment to provide excess capacity for community use?

    Yes, under specific conditions:

    • USF funds could not pay for excess capacity.
    • Excess capacity provision could not increase costs for the dedicated healthcare network.
    • Participants had to demonstrate that vendor selection was still cost-effective for the dedicated healthcare network.
    • RFPs should clarify that bids without excess capacity commitments would also be considered.

    If a vendor paid incremental costs for excess capacity, ownership remained with the participant and eligible healthcare providers. If the vendor paid a fair share, they could retain ownership and sell excess capacity. Participants needed to obtain sufficient cost information to separate costs for dedicated healthcare network and excess capacity.

2010 NPRM: Frequently Asked Questions and Answers

In 2010, the FCC issued a Notice of Proposed Rulemaking (NPRM) seeking comments on reforms to the Universal Service Rural Health Support Mechanism. To clarify the NPRM, the FCC provided a set of Frequently Asked Questions:

WC Docket No. 02-60 Frequently Asked Questions (FAQ) for NPRM (FCC 10-125)

1. What is the purpose of the 2010 Rural Health Care Support Mechanism NPRM?

   The 2010 NPRM aimed to reform the universal service healthcare support mechanism, aligning with the National Broadband Plan’s recommendations to expand broadband connectivity for public and non-profit healthcare providers. The goal was to promote state-of-the-art Health IT solutions across over 12,000 hospitals and clinics nationwide.

2. What initiatives does the 2010 Rural Health Care Support Mechanism NPRM propose?

   The NPRM proposed several key initiatives:

   • Health Infrastructure Program: Supporting up to 85% of construction costs for new regional or statewide networks serving public and non-profit healthcare providers in areas with insufficient broadband.
   • Health Broadband Services Program: Subsidizing 50% of monthly recurring broadband access costs for eligible rural healthcare providers, focusing on dedicated, reliable, and secure connections.
   • Expanded Definition of “Eligible Health Care Provider”: Including acute care facilities like skilled nursing facilities and renal dialysis centers.
   • Expanded Definition to Include Administrative Offices and Data Centers: Extending eligibility to off-site administrative offices and data centers performing critical support functions for healthcare provision.

3. What will happen to the current Telecommunications Program?

   The existing telecommunications program, which subsidized rates to eliminate rural/urban price differences for telecommunications services, was not proposed for changes in the NPRM. However, healthcare providers receiving support under the new health broadband services program could not receive simultaneous support from the telecommunications program for the same service.

4. What will happen to the Rural Health Care Pilot Program?

   The Rural Health Care Pilot Program was to continue under USAC administration. The NPRM, drawing lessons from the Pilot Program, proposed a permanent health infrastructure program to fund up to 85% of eligible costs for designing, constructing, and deploying dedicated broadband networks for public and non-profit healthcare providers in underserved areas. This program aimed to support state or regional broadband networks connecting rural and urban providers, facilitating real-time video and data transmission, and enhancing communication resources. Infrastructure projects could include new facilities or upgrades. Funding could also support connections to Internet2 or National LambdaRail.

5. What will happen to the Internet Access Program?

   The NPRM proposed replacing the existing Internet access program, which provided a flat 25% discount, with a new health broadband services program. This new program would subsidize 50% of recurring monthly costs for advanced telecommunications and information services providing point-to-point broadband connectivity, including dedicated internet access.

6. How can parties offer input on the NPRM?

   The FCC invited public comments on the NPRM, with deadlines for comments and reply comments in September 2010. Parties could also request to make oral presentations. Contact information for further inquiries was provided.

This comprehensive overview of the Rural Health Care Pilot Program and related initiatives provides valuable insights into the FCC’s efforts to leverage broadband technology to improve healthcare access and delivery in rural America. The program’s focus on infrastructure development, funding mechanisms, and stakeholder collaboration underscores its significance in bridging the digital divide and fostering a more equitable healthcare landscape.