At its July Open Meeting, the FCC adopted a Notice of Proposed Rulemaking (“NPRM”) to propose a pilot program within the Universal Service Fund (“USF”) to support broadband connections for telemedicine, or “connected care” for low-income Americans and veterans. Healthcare-related items have received a great deal of attention at the FCC recently, as the agency also adopted an order, which has not yet been released, at its August Open Meeting last week to reform its Rural Health Care Program to focus on telehealth in rural areas. The Connected Care NPRM proposes a three-year pilot at a cost of $100 million to be collected from USF assessments separate from the other USF programs. The NPRM was championed by Commissioner Carr and supported by all five FCC commissioners, although Commissioner O’Rielly expressed some reservations with the fact that the pilot would assess another $100 million on USF ratepayers outside of the individual program caps or budgets. His concerns likely relate to the fact that, at the same time, he is trying to advance a proposal to place an overall cap on the USF, which has received significant opposition. Last week, the Connected Care NPRM was published in the Federal Register, triggering a comment deadline of August 29th and a reply deadline of September 30th.
Chairman Pai and Commissioners Carr, Rosenworcel, and Starks all relayed stories from their travels of people they met that are benefiting from, or could benefit from, broadband connections to distant healthcare providers for connected care services, such as monitoring chronic conditions like diabetes, high-risk pregnancies, and opioid dependency. In an earlier Notice of Inquiry, the FCC had proposed funding 20 projects at $5 million each, but now it proposes a more flexible and varied approach for each selected pilot project. The pilot would require participation by an eligible health care provider (i.e., generally non-profits) that would purchase broadband services and equipment from eligible service providers (which are not required to be eligible telecommunications carriers or “ETCs” like in the High Cost and Low Income Programs) pursuant to a competitive bidding process (and gift restrictions) for connected care services to patients. The patients would not choose their service provider. The pilot would provide funding to the service providers through monthly 85% discounts on the cost of service or eligible equipment purchased by the healthcare provider. The healthcare provider would be required to cover the other 15% of the cost of the broadband service. The pilot proposes to fund some network equipment, but not administrative or outreach expenses or end-user devices.
The NPRM states that the pilot is open to eligible healthcare providers in both urban and rural areas; however, it proposes to award “additional points” to projects “that would serve geographic areas or populations where there are well-documented health care disparities (Tribal lands, rural areas, or veteran populations) or that treat certain health crises or chronic conditions that significantly impact many Americans and are documented to benefit from connected care.” It seeks comments on proxies for rural residence because using individual patient addresses would be too complex to administer. Similarly, the NPRM seeks comment on whether eligible healthcare providers should be required to serve a certain percentage of uninsured patients or Medicaid patients and whether the pilot can fund projects that would serve a patient population that is primarily, but not entirely, low-income.
Finally, the pilot proposes to establish goals to be achieved and metrics and reporting to measure its success. The pilot’s goals are: “(1) improving health outcomes through connected care; (2) reducing health care costs for patients, facilities, and the health care system; (3) supporting the trend towards connected care everywhere; and (4) determining how USF funding can positively impact existing telehealth initiatives.” The NPRM also proposes and seeks comment on metrics to demonstrate meeting these goals; recordkeeping and auditing requirements; and quarterly or annual reporting requirements – including numbers of patients, health conditions and costs savings, as well as patient surveys.