Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program (rule, 85 FR 19892, April 9, 2020)
Summary
A Report and Order from the Federal Communications Commission, published in the Federal Register on April 9, 2020 (Vol. 85, No. 69; WC Docket Nos. 18–213 and 20–89; FCC 20–44), establishing two programs. The COVID–19 Telehealth Program is designed to distribute the $200 million appropriated to the FCC under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The money is to help health care providers provide connected care services to patients at their homes or mobile locations during the pandemic. The Connected Care Pilot Program is designed to make available up to $100 million over three years from the Universal Service Fund to examine how the fund can support connected care for low-income consumers. The Report and Order is effective May 11, 2020, except for certain portions.
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Cite this document
“Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program (rule, 85 FR 19892, April 9, 2020).”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/promoting-telehealth-for-low-income-consumers-covid-19-telehealth-prog-16b009d448/
, SHA-256 42ccb7b91d0de4c1a7dc39dbe64dee46efca9247e004749211e536ced3d4ba2e.Full text
19892 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
G. Executive Order 13045: Protection of Dated: March 17, 2020. OMB approval of the COVID–19
Children From Environmental Health Alexandra Dapolito Dunn, Telehealth Program information
Risks and Safety Risks Assistant Administrator, Office of Chemical collection requirements on April 6,
Safety and Pollution Prevention. 2020, and those requirements are
This action is not subject to Executive effective April 9, 2020. The Pilot
Therefore, 40 CFR chapter I is
Order 13045 (62 FR 19885, April 23, Program requirements will not become
amended as follows:
1997), because this is not an effective until approved by OMB. The
economically significant regulatory PART 711—[AMENDED] Federal Communications Commission
action as defined under Executive Order will publish a document in the Federal
12866, and it does not address ■ 1. The authority citation for part 711 Register announcing the effective date
environmental health or safety risks continues to read as follows: of OMB approval of the Pilot Program
disproportionately affecting children. Authority: 15 U.S.C. 2607(a). requirements.
H. Executive Order 13211: Actions ■ 2. In § 711.20, revise the third FOR FURTHER INFORMATION CONTACT:
Concerning Regulations That sentence to read as follows. Please email
Significantly Affect Energy Supply, EmergencyTelehealthSupport@fcc.gov
§ 711.20 When to report. with questions related to the COVID–19
Distribution, or Use * * * The 2020 CDR submission Telehealth Program, and
This action is not subject to Executive period is from June 1, 2020, to ConnCarePltProg@fcc.gov with
Order 13211 (66 FR 28355, May 22, November 30, 2020. Subsequent questions related to the Pilot Program.
2001), because this action is not recurring submission periods are from SUPPLEMENTARY INFORMATION: This is a
expected to affect energy supply, June 1 to September 30 at 4-year summary of the Commission’s
distribution, or use and because this intervals, beginning in 2024. * * * Promoting Telehealth for Low-Income
action is not a significant regulatory [FR Doc. 2020–06074 Filed 4–8–20; 8:45 am] Consumers; COVID–19 Telehealth
action under Executive Order 12866. BILLING CODE 6560–50–P Program, Report and Order (R&O), in
WC Docket Nos. 18–213 and 20–89; FCC
I. National Technology Transfer and 20–44, adopted March 31, 2020 and
Advancement Act (NTTAA) FEDERAL COMMUNICATIONS released April 2, 2020. Due to the
COMMISSION COVID–19 pandemic, the Commission’s
Since this action does not involve any headquarters will be closed to the
technical standards, NTTAA section 47 CFR Part 54 general public until further notice. The
12(d), 15 U.S.C. 272 note, does not full text of this document is available at
apply to this action. [WC Docket Nos. 18–213 and 20–89; FCC
20–44; FRS 16647] the following internet address: https://
J. Executive Order 12898: Federal docs.fcc.gov/public/attachments/FCC-
Actions To Address Environmental Promoting Telehealth for Low-Income 20-44A1.pdf.
Justice in Minority Populations and Consumers; COVID–19 Telehealth I. Introduction
Low-Income Populations Program
1. The novel Coronavirus disease
AGENCY: Federal Communications 2019 (COVID–19) pandemic and
This action does not entail special
Commission. associated respiratory illness have
considerations of environmental justice
related issues as delineated by ACTION: Final order; announcement of spread throughout the United States in
effective date. recent weeks. In response to this
Executive Order 12898 (59 FR 7629,
pandemic, many health care providers
February 16, 1994). SUMMARY: In this document, the Federal are expanding existing telehealth
III. Congressional Review Act (CRA) Communications Commission services and implementing new
(Commission) establishes two programs: telehealth services, and the demand for
This action is subject to the CRA, 5 The COVID–19 Telehealth Program connected care services provided
U.S.C. 801 et seq., and EPA will submit designed to distribute a $200 million directly to patients in their homes or
a rule report to each House of the appropriation from Congress under the their mobile locations is skyrocketing.
Congress and to the Comptroller General Coronavirus Aid, Relief, and Economic As a result, many health care providers
of the United States. The CRA allows Security (CARES) Act, to help health are facing new challenges in technical
the issuing agency to make a rule care providers provide connected care infrastructure and experiencing staffing
effective sooner than otherwise services to patients at their homes or issues. In response to the outbreak, on
provided by the CRA if the agency mobile locations in response to the March 27, 2020, President Trump
makes a good cause finding that notice novel Coronavirus 2019 disease signed the Coronavirus Aid, Relief, and
and comment rulemaking procedures (COVID–19) pandemic, and the Economic Security (CARES), Act into
Connected Care Pilot Program (Pilot law, Public Law 116–136, 134 Stat. 281
are impracticable, unnecessary or
Program) designed to make available up (2020), providing, among a panoply of
contrary to the public interest (5 U.S.C.
to $100 million over three years to other actions, $200 million to the FCC
808(2)). The EPA has made a good cause examine how the Universal Service
finding for this rule as discussed in Unit to support health care providers in the
Fund can help support the trend fight against the ongoing pandemic.
I.C., including the basis for that finding. towards connected care services to 2. In the R&O, to effectuate Congress’
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List of Subjects in 40 CFR Part 711 consumers, particularly for low-income intent in enacting the CARES Act, the
Americans and veterans. Commission establishes a $200 million
Environmental protection, Chemicals, DATES: The Report and Order is effective emergency COVID–19 Telehealth
Confidential Business Information (CBI), May 11, 2020, except for the Program to implement the CARES Act
Hazardous materials, Importer, information collections requiring Office and ensure access to connected care
Manufacturer, Reporting and of Management and Budget (OMB) services and devices in response to the
recordkeeping requirements. approval. The Commission received ongoing COVID–19 pandemic and surge
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Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations 19893
in demand for connected care services. related to the COVID–19 pandemic, the rolling basis, and continue reviewing
The support provided through the COVID–19 Telehealth Program will be additional applications and selecting
COVID–19 Telehealth Program will help open to eligible health care providers, participants until it has committed all
eligible health care providers purchase whether located in rural or non-rural COVID–19 Telehealth Program funding
telecommunications services, areas, and will provide eligible health or the current pandemic has ended. In
information services, and devices care providers support to purchase reviewing applications, the Commission
necessary to provide critical connected telecommunications, information has a strong interest in targeting funding
care services, whether for treatment of services, and connected devices to towards areas that have been hardest hit
coronavirus or other health conditions provide connected care services in by COVID–19. In addition, given the
during the coronavirus pandemic. The response to the coronavirus pandemic. public health emergency and
COVID–19 Telehealth Program is The COVID–19 Telehealth Program will widespread scope of the coronavirus
funded through a $200 million only fund monitoring devices (e.g., pandemic, unlike the broader Pilot
appropriation signed into law as part of pulse-ox, BP monitoring devices), that Program, the Commission will not target
the CARES Act, and the program will are themselves connected. The COVID– COVID–19 Telehealth Program funding
not rely on Universal Service Fund 19 Telehealth Program will not fund toward specific medical conditions,
(USF or Fund) support. The unconnected devices that patients can patient populations, or geographic areas.
Commission also establishes a longer- use at home and then share the results However, the Commission strongly
term Connected Care Pilot Program with their medical professional encourages selected applicants to target
(Pilot Program) within the Universal remotely. the funding they receive through the
Service Fund that will make available 4. The COVID–19 Telehealth Program COVID–19 Telehealth Program to high-
up to $100 million over three years to will provide selected applicants full risk and vulnerable patients to the
examine how the Fund can help support funding for eligible services and extent practicable. The Commission
the trend towards connected care devices. The COVID–19 Telehealth recognizes that some health care
services, particularly for low-income Program has a congressionally providers may have been under pre-
Americans and veterans. The Pilot appropriated $200 million budget, and existing strain (e.g., large underserved or
Program will help defray eligible health these funds will be available until they low-income patient population; health
care providers’ costs of providing are expended or until the current care provider shortages; rural hospital
connected care services, with a pandemic has ended. In order to ensure closures; limited broadband access and/
particular emphasis on supporting these as many applicants as possible receive or internet adoption) and encourage
services for eligible low-income available funding, the Commission does applicants to document such factors in
Americans and veterans. The not anticipate awarding more than $1 their applications. While health care
Commission expects that the Pilot million to any single applicant. The providers may use the COVID–19
Program will benefit many low-income Commission will award support to Telehealth Program to treat patients that
and veteran patients who are eligible applicants based on the have COVID–19, the program is not
responding to a wide variety of health estimated costs of the supported limited to treating those types of
challenges such as diabetes services and connected devices they patients as long as program funds are
management, opioid dependency, high- intend to purchase, as described in each used ‘‘to prevent, prepare for, and
risk pregnancies, pediatric heart disease, health care provider’s respective respond to coronavirus.’’ For instance,
mental health conditions, and cancer. application. However, in order to give treating other types of conditions or
The Commission also expects that the each health care provider maximum
patient groups through the
Pilot Program will provide meaningful flexibility to respond to changing
Commission’s COVID–19 Telehealth
data that will help to better understand circumstances during the pandemic, the
Program could free up resources,
how universal service funds can support Commission does not require applicants
including physical space and equipment
health care provider and patient use of to purchase only the services and
in a brick-and-mortar health care
connected care services, and how connected devices identified in their
facility, allow health care providers to
supporting health care provider and applications. They may rather use
remotely treat patients with other
patient use of connected care services awarded support to purchase any
conditions who could risk contracting
can improve health outcomes and necessary eligible services and
coronavirus by visiting a health care
reduce health care costs. The connected devices. In addition,
applicants that have exhausted initially facility, and could reduce health care
Commission anticipates that the data
awarded funding may request additional professionals’ unnecessary exposure to
and information collected through the
support. coronavirus. The Commission will also
Pilot Program could also have the
5. Application, Evaluation, and consider as part of a health care
ancillary benefit of aiding policy makers
Selection Process. Because of the provider’s application a showing that
and legislators in the consideration of
urgency attendant in combating the telemedicine directly aids in the
broader reforms—such as statutory
COVID–19 outbreak, the Commission prevention of pandemic spread by
changes or updates to rules
administered by other agencies—that establishes a streamlined application facilitating social distancing and similar
could support this trend towards process for the COVID–19 Telehealth measures in the community. Connected
connected care. Program, separate from the longer devices and services like patient-
application process adopted for the reported outcome platforms funded
II. COVID–19 Telehealth Program broader Pilot Program. The Commission through the COVID–19 Telehealth
3. The COVID–19 Telehealth Program directs the Wireline Competition Bureau Program must be integral to patient care.
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is one piece of a comprehensive (Bureau) to review the applications, in 6. Eligible Health Care Providers.
approach to reducing barriers to consultation with the FCC’s Consistent with the 1996 Act and the
telehealth services for health care Connect2Health Task Force and its CARES Act, the Commission limits the
providers and their patients throughout medical and public health experts, and program to nonprofit and public eligible
the country in response to the COVID– announce selected participants and health care providers that fall within the
19 pandemic. Working in step with funding amounts for each selected categories of health care providers in
other federal efforts to provide relief applicant as rapidly as possible on a section 254(h)(7)(B) of the 1996 Act: (1)
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19894 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
Post-secondary educational institutions COVID–19 has impacted your area, your modified in connection with the
offering health care instruction, teaching patient population, and the approximate COVID–19 pandemic. Further,
hospitals, and medical schools; (2) number of patients that could be treated applicants will also be required to
community health centers or health by the health care provider’s connected certify that they are not already
centers providing health care to care services during the COVID–19 receiving or expecting to receive other
migrants; (3) local health departments or pandemic. If you intend to use the federal or state funding for the exact
agencies; (4) community mental health COVID–19 Telehealth Program funding same services or devices for which they
centers; (5) not-for-profit hospitals; (6) to treat patients without COVID–19, are requesting support under the
rural health clinics; (7) skilled nursing describe how this would free up your COVID–19 Telehealth Program.
facilities; or (8) consortia of health care resources that will be used to treat 10. The Wireline Bureau will issue a
providers consisting of one or more COVID–19 and/or how this would public notice announcing the date when
entities falling into the first seven otherwise prevent, prepare for, or COVID–19 Telehealth Program
categories. The Commission has more respond to the disease by, for example, applications will be accepted and
than two decades of experience facilitating social distancing. instructions for filing applications with
administering its RHC Program for these • Description of the estimated the Commission. This date will be after
types of health care providers, and number of patients to be treated. April 9, 2020. Applicants will be
limiting the COVID–19 Telehealth • Description of the required to complete each section of the
Program to public and nonprofit health telecommunications services, application and make the required
care providers that fall within these information services, or ‘‘devices certifications at the end of the
statutory categories is in the public necessary to enable the provision of application. Applicants may request
interest because it will facilitate the telehealth services’’ requested, the total that any materials or information
administration of the program and amount of funding requested, as well as submitted to the Commission in its
ensure that funding is targeted to health the total monthly amount of funding application be withheld from public
care providers that are likely to be most requested for each eligible item. If inspection pursuant to the procedures
in need of funding to respond to this requesting funding for devices, set forth in section 0.459 of the
pandemic while helping ensure that description of all types of devices for Commission’s rules.
funding is used for its intended which funding is requested, how the 11. Instructions for Filing
purposes. devices are integral to patient care, and Applications. COVID–19 Telehealth
7. Interested health care providers whether the devices are for patient use Program applications must reference
that do not already have an eligibility or for the health care provider’s use. As WC Docket No. 20–89, and must be filed
determination can obtain one by filing noted in the document, monitoring electronically consistent with the
an FCC Form 460 with the Universal devices (e.g. pulse-ox, BP monitoring instructions provided in a subsequent
Service Administrative Company devices) will only be funded if they are public notice. All filings must be
(USAC). The Commission directs USAC themselves connected. addressed to the Commission’s
to review and process eligibility forms • Supporting documentation for the Secretary, Office of the Secretary,
for health care providers interested in costs indicated in their application, Federal Communications Commission.
participating in the COVID–19 such as a vendor or service provider Applicants must also send a courtesy
Telehealth Program as expeditiously as quote, invoice, or similar information. copy of their application via email to
possible. Health care providers that are • A timeline for deployment of the EmergencyTelehealthSupport@fcc.gov.
interested in the COVID–19 Telehealth proposed service(s) and a summary of 12. Evaluation of Applications and
Program, but do not yet have an the factors the applicant intends to track Selection Process. The Bureau, in
eligibility determination from USAC, that can help measure the real impact of consultation with the FCC’s
can still submit applications for the supported services and devices. Connect2Health Task Force, will
COVID–19 Telehealth Program while 9. Additionally, COVID–19 Telehealth evaluate the COVID–19 Telehealth
their FCC Form 460 is pending. Program applicants will also be Program applications and will select
8. Application Process. To be required, at the time of submission of participants based on applicants’
considered for participation in the their application, to certify, among other responses to the criteria listed in the
COVID–19 Telehealth Program, things, that they will comply with the document. The Commission’s goal is to
interested eligible health care providers Health Insurance Portability and select applications that target areas that
must submit applications that, at a Accountability Act (HIPAA) and other have been hardest hit by COVID–19 and
minimum, contain the information applicable privacy and reimbursement where the support will have the most
detailed in the following. laws and regulations, and applicable impact on addressing the health care
• Names, addresses, county, and medical licensing laws and regulations, needs. In selecting applicants, the
health care provider numbers (if as waived or modified in connection Commission directs the Bureau to
available), for health care providers with the COVID–19 pandemic, as well consider the funding sought by each
seeking funding through the COVID–19 as all applicable COVID–19 Telehealth applicant compared to the total COVID–
Telehealth Program application and the Program requirements and procedures, 19 Telehealth Program budget. This
lead health care provider for including the requirement to retain does not mean that the Bureau will
applications involving multiple health records to demonstrate compliance with evaluate applications based solely on
care providers. the COVID–19 Telehealth Program requested funding, but the Bureau will
• Contact information for the requirements and procedures for three seek to select as many applicants as
individual that will be responsible for years following the last date of service, reasonably possible within the COVID–
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the application (telephone number, subject to audit. Health care providers 19 Telehealth Program’s limited budget.
mailing address, and email address). that participate in the COVID–19 Upon selection, the Bureau will provide
• Description of the anticipated Telehealth Program must also comply additional guidance to program
connected care services to be provided, with all applicable federal and state participants, as necessary, to facilitate
the conditions to be treated, and the laws, including the False Claims Act, the implementation of the COVID–19
goals and objectives. This should the Anti-Kickback Statute, and the Civil Telehealth Program. Applicants who are
include a brief description of how Monetary Penalties Law, as waived or selected for the COVID–19 Telehealth
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Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations 19895
Program may later submit applications are prohibited from selling, reselling, or Telehealth Program and must provide
to participate in the broader Pilot transferring services or devices funded documentation related to their
Program but may not request funding through the COVID–19 Telehealth participation in the COVID–19
for the same exact services from both Program in consideration for money or Telehealth Program in connection with
programs at the same time. any other thing of value. any such audit.
13. Requesting Funding, Invoicing, 15. Procurement for COVID–19 17. Outreach for COVID–19
and Disbursements. The Commission Telehealth Program-Supported Services Telehealth Program. Upon release of the
directs the Bureau and the Office of the and Equipment, and Document R&O, in order to ensure that health care
Managing Director (OMD) to develop Retention. The COVID–19 Telehealth providers are aware of available funding
processes for selected applicants to Program is funded through a under the COVID–19 Telehealth
submit invoices and receive congressional appropriation and not the Program, the Commission will, to the
reimbursements for services and devices USF. Given the immediate need to extent possible, coordinate with other
supported through the COVID–19 award and disburse the COVID–19 federal agencies to distribute
Telehealth Program, and any necessary Telehealth Program funding to health information about the program to the
subsequent filings. The Commission care providers, the Commission will not health care community. The
also directs OMD and the Bureau to require COVID–19 Telehealth Program Commission also directs the Bureau to
include in the application forms or participants to conduct a competitive coordinate with the FCC’s
subsequent filings by program bidding process to solicit and select Connect2Health Task Force and USAC
participants any information necessary eligible services or devices, or otherwise as necessary to promote and announce
to satisfy the Commission’s oversight comply with the competitive bidding the COVID–19 Telehealth Program to
responsibilities and/or agency specific/ requirements that apply to the RHC interested stakeholders including
government-wide reporting obligations Program and the broader Pilot Program. service providers and health care
associated with the $200 million The Commission finds that, in light of providers. The Commission is
appropriation by Congress. After the coronavirus pandemic and ongoing committed to addressing the needs of
receiving the eligible services and/or community efforts to slow its spread, health care providers as demand for
equipment, health care provider will requiring COVID–19 Telehealth Program connected care services increases to
submit invoicing forms on a monthly participants to seek competitive bids address the coronavirus pandemic. Such
basis and supporting documentation to prior to requesting funding would cause coordination and outreach will improve
the Commission to receive unnecessary delays and pose an the overall efficacy of the COVID–19
reimbursement for the cost of the unreasonable burden on health care Telehealth Program.
eligible services and/or devices they providers during this unprecedented 18. Post-Program Feedback. Within
have received from their applicable time. The Commission also finds that it six months after the conclusion of the
service providers or vendors under the would not be in the public interest COVID–19 Telehealth Program, COVID–
COVID–19 Telehealth Program. The during this national health crisis to 19 Telehealth Program participants
Bureau and OMD shall develop a prohibit participating health care should provide a report to the
process for reviewing the monthly providers from receiving gifts or things Commission in a format to be
invoicing forms and supporting of value from service providers valued determined by the Bureau on the
documentation and for issuing at over $20, including, but not limited effectiveness of the COVID–19
disbursements directly to the to devices, equipment, free upgrades or Telehealth Program funding on health
participating health care providers other items. outcomes, patient treatment, health care
rather than to the applicable service 16. While the Commission will not facility administration, and any other
providers or vendors. COVID–19 require health care providers to conduct relevant aspects of the pandemic. Such
Telehealth Program health care provider a competitive procurement process to information could include feedback on
participants will be required to make receive COVID–19 Telehealth Program the application and invoicing processes,
certifications as part of the invoicing funding, the Commission strongly in what ways funding was helpful in
form submission to ensure that COVID– encourages applicants to purchase cost- providing or expending telehealth
19 Telehealth Program funds are used effective eligible services and devices to services, including anonymized patient
for their intended purpose. the extent practicable during this time. accounts, how funding promoted
14. The COVID–19 Telehealth The Commission also emphasizes that innovation and improved health
Program will not provide funding for health care providers and service outcomes, and other areas for
health care provider administrative providers must comply with the improvement. Specific information
costs associated with participating in requirements applicable to the COVID– about how to provide feedback and
the COVID–19 Telehealth Program (e.g., 19 Telehealth Program. To help guard associated deadlines will be provided to
costs associated with completing against potential waste, fraud, and COVID–19 Telehealth Program
COVID–19 Telehealth Program abuse, participants in the COVID–19 participants at a later time. This
applications and other submissions) or Telehealth Program must maintain information will assist efforts to respond
other miscellaneous expenses (e.g., records related to their participation in to pandemics and other national
doctor and staff time spent on the the COVID–19 Telehealth Program to emergencies in the future.
COVID–19 Telehealth Program and demonstrate their compliance with the
outreach). The Commission emphasizes program requirements for at least three III. Connected Care Pilot Program
that COVID–19 Telehealth Program years from the last date of service under 19. The Pilot Program will make
funds may only be used for services and the program and must present that available up to $100 million over a
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devices covered under the CARES Act. information to the Commission or its three-year funding period, separate from
The costs of ineligible items must not be delegates upon request. Health care the budgets of the existing universal
included in the reimbursement requests providers participating in the COVID–19 service programs, to cover 85% of the
for the COVID–19 Telehealth Program. Telehealth Program may also be subject eligible costs of broadband connectivity,
To guard against potential waste, fraud, to compliance audits in order to ensure network equipment, and information
and abuse, the Commission makes clear compliance with the rules and services necessary to provide connected
that participating health care providers requirements for the COVID–19 care services to the intended patient
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19896 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
population. All eligible nonprofit and Pilot Program funding on these 24. Discount Level. The Pilot Program
public health care providers that fall conditions identified best ensures that will provide universal service support
within the statutory categories under limited Pilot Program resources are for 85% of the cost of eligible services
section 254(h)(7)(B), regardless of targeted to populations that are most in and equipment. This support amount
whether they are non-rural or rural, can need. Moreover, targeting these types of will allow for funding of a sufficient
apply for the Pilot Program. Eligible health conditions, which impact large number of pilot projects to provide
health care providers must first submit segments of the population, and often meaningful data and provide substantial
applications to the Commission, and require several months or more of financial incentive for health care
after review, the Commission will treatment, or are public health crises providers to participate in the Pilot
announce the selected projects and will provide more meaningful data to Program. Consistent with the
provide further information on track progress towards the Pilot Program Commission’s existing rules for the
additional requirements for the Pilot goals of helping health care providers to Healthcare Connect Fund Program,
Program. improve health outcomes and reduce health care providers must contribute
20. For purposes of the Pilot Program, costs, and will also promote the their portion of the eligible costs from
the Commission considers ‘‘connected efficient, fiscally responsible use of eligible sources (e.g., the applicant,
care’’ as a subset of telehealth that uses universal service funds. eligible health care provider,
broadband internet access service- 22. Budget Number of Pilot Projects participating patients, or state, federal,
enabled technologies to deliver directly and Support Amount Per Project, or Tribal funding or grants) and cannot
to patients’ remote medical, diagnostic, Funding Duration, and Discount Level. use ineligible sources (e.g., direct
and treatment-related services outside of The Pilot Program will make available payments from vendors or service
traditional brick and mortar medical up to $100 million over three years for providers) to pay their share of the
facilities—specifically to patients at selected pilot projects. Targeting this requested services.
their mobile location or residence. For amount of funding for qualifying 25. Number of Pilot Projects and
purposes of the Pilot Program, the eligible services and equipment under Support Amount Per Project. Based on
Commission also defines ‘‘telehealth’’ as the Pilot Program is sufficient to obtain the record, the Commission declines to
the broad range of health care-related meaningful data and ensure significant set a limit on the number of pilot
applications that depend upon interest from a wide range of projects selected for the Pilot Program or
broadband connectivity, including participants. Funding the Pilot Program the amount of support requested per
telemedicine; exchange of electronic in this manner will not significantly pilot project. Setting a fixed number of
health records; collection of data increase the contributions burden on pilot projects or a fixed amount per-
through Health Information Exchanges consumers and will not impact the project will artificially limit the number
and other entities; exchange of large budgets of, or disbursements for, the of pilot projects to be funded even
image files (e.g., X-ray, MRIs, and CAT other existing universal service before pilot project proposals are
scans); and the use of real-time and programs. submitted and evaluated, and will not
delayed video conferencing for a wide 23. To secure the funds for the Pilot provide enough flexibility to select a
range of telemedicine, consultation, Program, the Commission directs USAC diverse group of pilot projects. The
training, and other health care purposes. to separately collect funds for the Pilot Commission does not anticipate
Connected care services can be provided Program each quarter beginning with allocating all of the Pilot Program funds
by doctors, nurses, or other health care the demand filing for the fourth quarter on one or two large projects. In
professionals. Health care providers will of 2020. USAC should collect necessary reviewing pilot project applications, the
have the flexibility to identify the funds up to the amount of the budget Commission will be mindful of the
medical conditions to be treated through over the entire three-year period in reasonableness of the estimated total
their proposed pilot projects, and order to minimize any impact on the support amount indicated in each
whether to treat a single medical contribution factor. The Commission application, looking specifically at the
condition or multiple medical anticipates the collection schedule proportion to the total Pilot Program
conditions. For purposes of the Pilot would increase the quarterly budget and individual project size, to
Program, the Commission uses the U.S. contribution factor by approximately provide sufficient funding to enough
Department of Health and Human 0.11%. Moreover, by starting the projects to generate meaningful data.
Services’ definition of ‘‘medical collection before selecting the pilot 26. Duration. The Pilot Program will
condition’’ to identify the types of projects, USAC will have funding on provide selected pilot projects support
health conditions that can be treated hand as soon as the pilot projects begin for a three-year funding period with
through the Pilot—‘‘any condition, to seek support. Requests for funding separate transition periods of up to six
whether physical or mental, including may vary year to year and therefore Pilot months before and after the three-year
but not limited to any condition Program funding may not be distributed funding period. Specifically, selected
resulting from illness, injury (whether evenly each year. While anticipating pilot participants will have up to six
or not the injury is accidental), significant participation in the Pilot months from the date of their initial
pregnancy, or congenital malformation.’’ Program, total amount disbursed will funding commitment letter from USAC
21. In reviewing applications, the depend upon those funds ultimately to organize and start their pilot projects
Commission is interested in targeting committed by USAC, invoiced, and (including, but not limited to procuring
limited Pilot Program funding towards disbursed. Unused collected Pilot eligible services or network equipment),
pilot projects that are primarily focused Program funds will be carried forward and up to six months after the funding
on treating public health epidemics, to subsequent quarters over the duration end date on their final funding
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opioid dependency, mental health of the Pilot Program for use by pilot commitment letters to wind down their
conditions, high-risk pregnancy, or projects and need not be returned to pilot projects and complete any
chronic or recurring conditions that offset future collections. Any unused necessary administrative tasks.
typically require at least several months funds that remain at the end of the Pilot Providing a ramp up period of up to six
to treat, including, but not limited to, Program will be used to reduce months will allow sufficient time for
diabetes, cancer, kidney disease, heart collections for the ongoing universal health care providers to implement pilot
disease, and stroke recovery. Focusing service programs. project plans and begin offering
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Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations 19897
connected care services. Extending the care provider, government agency, or appropriately targeting the population
Pilot Program for too long risks stale designated telehealth resource center of patients that the Commission intends
data, and therefore providing selected with such experience that will work to primarily benefit from connected care
pilot projects up to six months to ramp with the health care provider to services through the Pilot Program.
and up to six months to wind down to implement its proposed pilot project. 32. Health care providers may
ensure a reasonable timeframe to obtain These types of health care providers are determine whether a patient qualifies as
meaningful, current data. There may be more likely to submit pilot projects that a veteran for purposes of the Pilot
unforeseen circumstances that arise can be successfully implemented within Program by confirming that the patient
when implementing or operating the the three-year period and better enable qualifies for health care through the VA.
pilot projects, and therefore the Bureau the Commission to collect meaningful The Commission declines to apply an
is delegated authority to grant limited data on the impact of the Pilot Program. income limit to veterans. While certain
extensions of deadlines in order to At the same time, this approach also veterans who are eligible for health care
ensure the successful operation of the provides a path for eligible health care through the VA undergo means testing
Pilot Program. providers that lack telehealth when enrolling for VA health care, other
27. Eligible Health Care Providers, experience, many of which may serve veterans (e.g., those with service-
Patients, and Service Providers. The high percentages of veterans and low- connected disabilities) may not be
Commission establishes the Pilot income patient populations, to required to undergo means testing. The
Program pursuant to the legal authority participate in the Pilot Program. Commission believes that veterans,
under section 254(h)(2)(A), which 30. Targeted Patient Populations. The regardless of income level, who are
directs the Commission to establish Commission has a strong preference for eligible for health care through the VA
competitively neutral rules to enhance, pilot projects that can demonstrate that are an important population to include
to the extent technically feasible and they will primarily benefit veterans or in the Pilot Program. As reported in the
economically reasonable, access to low-income individuals. Veteran and Bureau’s Veterans Broadband Report to
‘‘advanced telecommunications and low-income patients are more likely to Congress (May 1, 2019), a significant
information services’’ for public and have complex, high-cost health care number of veterans suffer from a
nonprofit health care providers. needs, reside in areas with physician disability, reside in rural areas, and/or
Accordingly, for purposes of the Pilot shortages, and may not have mobile or are older than the general population,
Program, the Commission limits residential internet access for connected and therefore would stand to benefit
participation to the statutorily- care services. Therefore, emphasizing from connected care services. While the
enumerated categories of ‘‘health care pilot projects that will primarily benefit Commission declines to adopt an
provider.’’ Eligible nonprofit or public low-income patients or veterans is income criterion for veterans, the
health care providers include: (1) Post- appropriate as it will expand connected expectation is that pilot projects focused
secondary educational institutions care services to individuals who are less on serving veterans will primarily focus
offering health care instruction, teaching likely to have access to these innovative on veteran populations that are more
hospitals, and medical schools; (2) services without universal service likely to experience issues accessing
community health centers or health support. Participating patients may only health care.
centers providing health care to participate in one pilot project and 33. Service Providers. Eligible health
migrants; (3) local health departments or cannot participate in multiple pilot care providers that participate in the
agencies; (4) community mental health projects as part of the Pilot Program. Pilot Program can receive support for
centers; (5) not-for-profit hospitals; (6) 31. The Commission also concludes qualifying broadband service from any
rural health clinics; (7) skilled nursing that health care providers are in the best broadband provider, regardless of
facilities; or (8) consortia of health care position to identify patients for their whether that provider is designated as
providers consisting of one or more pilot projects. To the extent a selected an eligible telecommunications carrier
entities falling into the first seven pilot project asserts that it will primarily (ETC). Section 254(c)(3) makes clear
categories. benefit low-income or veteran patients, that, in addition to the supported
28. To promote diversity among pilot the pilot project must maintain adequate services included in the definition of
projects, and to maximize the data documentation of the numbers of universal service in section 254(c), ‘‘the
collected, Pilot Program support will be participating veterans or low-income Commission may designate additional
available to health care providers patients served through that pilot services for such support mechanisms
located in both rural and non-rural project compared to other patients for . . . health care providers for the
areas. Section 254(h)(2)(A) does not served. For purposes of the Pilot purposes of subsection (h).’’ Section
limit the provision of universal service Program, health care providers can 254(h)(2)(A) in turn directs the
support to health care providers in rural determine whether a patient is Commission ‘‘to enhance to the extent
areas. Consistent with the record, the considered low-income by determining technically feasible and economically
Commission believes that the Pilot whether (1) the patient is eligible for reasonable, access to advanced
Program should target vulnerable and Medicaid or (2) the patient’s household telecommunications services and
medically underserved patients income is at or below 135% of the U.S. information services’’ for health care
regardless of whether these patients or Department of Health and Human providers and does not by its language
their health care providers are located in Services Federal Poverty Guidelines. require that such services be provided
a rural or non-rural area. Using these two criteria to identify low- by ETCs. The Commission has
29. In selecting pilot projects, the income patients for purposes of the Pilot previously explained that language in
Commission has a strong preference for Program will allow a large number of section 254(e) limiting universal service
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health care providers that have either (1) low-income Americans to participate in reimbursements to ETCs does not apply
experience with providing telehealth or the Pilot Program, including many to services supported under section
connected care services to patients (e.g., residents of medically underserved rural 254(h)(2)(A). Moreover, allowing non-
remote patient monitoring, store-and- areas. In addition, using these criteria ETCs to provide broadband service
forward imaging, or video conferencing) will facilitate efficient program through the Pilot Program will incent
beyond using electronic health records, administration, minimize the potential participation among a diverse range of
or (2) a partnership with another health for waste, fraud, and abuse, while still both health care providers and service
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19898 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
providers while promoting flexibility, internet access service to identify the which provides funding for health care
competition, and innovation. estimated number of patient broadband provider broadband connectivity.
34. Eligible Services and Equipment. connections that the health care 39. To avoid duplicate funding and to
The Pilot Program will fund 85% of the provider intends to purchase for stretch limited Pilot Program funds,
qualifying costs incurred by eligible purposes of providing connected care eligible health care providers
health care providers. These costs services to patients who lack broadband participating in the Pilot Program may
include: (1) Patient broadband internet service or have insufficient broadband not request or receive funding for
access services, (2) health care provider services. A health care provider seeking broadband data connections for which
broadband data connections, (3) other funding for patient broadband internet they already receive funding through
connected care information services, access service must also explain in its the Healthcare Connect Fund Program
and (4) certain network equipment. application how it plans to assess or other federal programs, and similarly
35. Patient Broadband internet Access may not request or receive funding for
whether a patient lacks broadband
Service. Funding health care provider broadband data connections through the
service or has insufficient broadband
purchases of broadband internet access Healthcare Connect Fund Program or
internet access service for the proposed
service for participating patients to other federal programs for which they
receive connected care services will connected care service based on speed,
have already received funding through
help expand connected care services to technology (e.g., fixed or mobile
the Pilot Program. In addition, the Pilot
many Americans, particularly low- broadband), or other appropriate service Program will not fund broadband
income and veteran patients. Many low- characteristics. It is appropriate under connections between health care
income consumers and veterans do not section 254(h)(2)(A) to fund the whole providers as these connections are
have broadband internet access service patient broadband connection as long as already eligible for funding through the
at all, while other low-income it is ‘‘primarily’’ used for activities that Healthcare Connect Fund Program, and
consumers and veterans may not have are integral, immediate, and proximate the Commission does not believe that
broadband internet access service that is to the provision of connected care funding connections between health
sufficient to receive connected care services to participating patients. In care providers is necessary for the Pilot
services. Aside from the VA’s tablet loan contrast to broadband connectivity for a Program given the focus on supporting
program, which serves a limited number single health care provider facility, it the provision of connected care services
of veterans, it appears that no other would not be ‘‘technically feasible and to participating patients in their homes
federal program provides health care economically reasonable,’’ for health or mobile locations.
providers funding dedicated to purchase care providers to track, monitor, and 40. Other Connected Care Information
patient broadband internet access cost-allocate non-connected care uses of Services. The Pilot Program will also
service for connected care services. the supported patient broadband provide support for information services
Some health care providers are already connections. other than broadband connectivity that
addressing this gap by funding patient 38. Health Care Provider Broadband eligible, participating health care
broadband internet access service for Data Connections. The Pilot Program providers use for connected care as part
certain low-income or vulnerable will also provide support for eligible, of the Pilot Program. Health care
patients who lack broadband service at participating health care providers to providers incur significant costs to
home. purchase the broadband data provide connected care services,
36. The Pilot Program will provide including, but not limited to, the costs
connections needed to provide
funding for participating health care of services (other than broadband) for
connected care services under the Pilot
providers to purchase mobile or fixed connected care, and that many of these
Program. While many eligible health
broadband internet access service for costs typically are not reimbursable
participating patients who do not care providers may already have the
through health care payors, which can
already have broadband internet access broadband connectivity necessary to
present an obstacle to connected care
service or who lack sufficient broadband participate in the Pilot Program, other
services. Funding information services
internet access service necessary to eligible health care providers may for health care providers’ use for
participate in the specific pilot project. require new or additional broadband connected care through the Pilot
Insufficient broadband for connected data connections to participate in the Program, therefore, could enhance
care services could include Pilot Program. Providing funding for health care providers’ access to such
subscriptions to low-bandwidth health care provider broadband data information services and encourage
connections, low usage allowances, or connections in this latter situation will innovation in the way health care
other inadequate service levels—all of incentivize health care provider providers provide connected care
which negatively impact patients’ and participation, which, in turn, will aid in services to their patients. The
health care providers’ ability to use the ability to collect meaningful data. Commission also believes funding these
telehealth services. For the Pilot Moreover, requiring Pilot Program information services will encourage
Program, funding these services will applicants that require broadband data broader participation in the Pilot
expand health care providers’ digital connections in order to provide Program. The Commission, however,
footprints for purposes of providing connected care services to seek support will not fund the costs associated with
connected care services, and allow for those connections through the medical professional review of data or
health care providers to serve more Healthcare Connect Fund would images transmitted or stored through
patients through the Pilot Program and produce duplicative application such services, or services which have a
thus enhance health care providers’ requirements with minimal benefit to primary purpose other than capturing,
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access to advanced telecommunications either program. The Commission transmitting and storing data to
and information services. expects that funding health care facilitate connected care. These costs
37. To ensure that funding for patient provider connectivity under these fall outside the scope of the
broadband internet access service is circumstances will not subsume the Commission’s statutory authority under
targeted appropriately, the Commission budget for the Pilot Program given the Section 254(h)(2)(A). Mobile
will require Pilot Program applicants broad participation in the existing applications will only be funded to the
seeking support for patient broadband Healthcare Connect Fund Program extent that they are part of a qualifying
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Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations 19899
information service. Eligible health care could significantly reduce the Pilot information that will facilitate the
providers that seek Pilot Program Program funding available for the costs evaluation and eventual selection of
support for an information service directly associated with providing high-quality pilot projects in order to
should include in their application a connected care services, and would participate in the Pilot Program.
thorough description of the service, limit the number of pilot projects the Specifically, the applicant must show
including a description of the primary Commission can select. The record how its proposed pilot project meets the
function/s of the service, and whether indicates that some selected pilot criteria outlined in the following. The
and how it facilitates the capturing, projects may be able to obtain grant Commission expects each applicant to
transmission (including video visits), funding and other funding for end-user present a clear research and evaluation
and storage of data for connected care. devices or medical equipment where strategy for meeting the health care
41. Network Equipment. The Pilot needed to participate in the Pilot needs of participating patients through
Program will provide funding to Program. The Commission therefore the use of connected care services and
eligible, participating health care encourages eligible health care how the proposed pilot project will
providers for necessary network providers to explore available grant and accomplish these objectives. Successful
equipment for broadband connectivity other funding opportunities, potential applicants will be able to demonstrate
funded through the Pilot Program for partnerships and other avenues that that they have a viable strategic plan for
connected care services. This funding could help them obtain end-user and delivering innovative connected care
can only be used for network equipment medical devices necessary to participate services directly to patients while
that is necessary to make Pilot Program in the Pilot Program. leveraging existing resources or
funded broadband services for 43. Administrative Expenses and telehealth programs within their state or
connected care services functional, or to Other Miscellaneous Expenses. region. The Commission will give
operate, manage, or control such Consistent with the RHC Program and greater consideration to applications
services, and must not be used for the RHC Pilot Program, the Pilot that propose to provide connected care
purposes other than providing Program will not provide funding for services to a significant number of low-
connected care services under the Pilot health care provider administrative income or veteran patients in a given
Program. Health care providers seeking costs associated with participating in state or region. An application that
funding for qualifying network the Pilot Program (e.g., costs associated intends to provide connected care
equipment for other health care uses with completing Pilot Program services to only a de minimis number of
may apply for such funding under the applications and other submissions) or low-income or veteran patients will not
Healthcare Connect Fund Program. other miscellaneous expenses (e.g., be selected.
Further, to avoid duplicate funding doctor and staff time spent on the Pilot 45. To be eligible for participation in
issues, eligible health care providers Program and outreach). This is also the Pilot Program, interested parties
participating in the Pilot Program may consistent with the U.S. Department of should submit applications that, at a
not request and receive funding for Agriculture’s Distance Learning and minimum, contain the following
network equipment for which they Telemedicine grant program. Section required information:
already applied or received funding 254 focuses on the availability of and • Names and addresses of all health
through the Healthcare Connect Fund access to ‘‘services.’’ Funding care providers that will participate in
Program or another federal program, and administrative or miscellaneous the proposed pilot project and the lead
similarly may not request and receive expenses associated with participating health care provider for proposals
through the Healthcare Connect Fund in the Pilot Program would not fulfill involving multiple health care
Program or another federal program this statutory focus. Allocating scarce providers.
funding for network equipment for Pilot Program funding to administrative • Contact information for the
which the health care provider receives costs would significantly reduce the individual that will be responsible for
funding through the Pilot Program. Pilot Program funding available for the the management and operation of the
Moreover, consistent with § 54.9 of the costs directly associated with providing proposed pilot project (telephone
Commission’s rules, the Pilot Program connected care services. Additionally, if number, mailing address, and email
will prohibit health care providers from the Commission was to provide direct address).
using universal service funds to support for administrative expenses, it • Health care provider number(s) and
purchase equipment or services for use would necessitate additional type(s) (e.g., not-for-profit hospital,
through the Pilot Program that are application requirements, guidelines, community mental health center,
produced or provided by a company and other administrative controls to community health center, rural health
that the Commission has identified as protect such funding from waste, fraud, clinic), for each health care provider
posing a national security threat to the and abuse. This would increase the included in proposal.
integrity of communications networks administrative burden on USAC and on • Description of each participating
or the communications supply chain. applicants as well. health care provider’s previous
42. End-User Devices and Medical 44. Application and Evaluation experience with providing telehealth
Equipment. Consistent with the Process. To participate in the Pilot services (other than electronic health
Commission’s long-standing approach Program, a prospective health care records) or experience and name of a
to implementing its universal service provider must first obtain an eligibility partnering health care provider or
programs, the Pilot Program will not determination from USAC by submitting organization.
fund end-user devices or medical an FCC Form 460 (Eligibility and • Description of the plan for
equipment. The Commission has Registration Form) along with implementing and operating the pilot
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consistently declined to fund equipment supporting documentation to USAC to project, including how the pilot project
unless it is ‘‘necessary’’ for the verify its eligibility to participate in the intends to recruit patients, estimated
transmission function of the service. Pilot Program. After confirming its amount of ramp-up time necessary for
Additionally, providing limited Pilot eligibility for the Pilot Program, the the pilot project (not to exceed six
Program funding to end-user devices applicant must submit its pilot project months), plans to obtain any necessary
and medical equipment costs may not proposal to the Commission describing end-user devices (e.g., tablets,
be economically reasonable because it its proposed pilot project and providing smartphones) and medical devices for
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19900 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
the connected care services that the proposed pilot project. This entry must depression, anxiety disorders,
pilot project will provide, and to what include the total estimated eligible schizophrenia, eating disorders and
extent the pilot project can be self- funding (85%) to be requested from the addictive behavior) or conditions of a
sustaining once established. Pilot Program per year over the three- chronic or long term nature (including,
• Description of the connected care year funding period. but not limited to heart diseases,
services the proposed pilot project will • A list of anticipated sources of diabetes, cancer, stroke).
provide, the conditions to be treated, the financial support for the pilot project 46. Additionally, applicants will also
health care provider’s experience with costs not covered by the Pilot Program. be required, at the time of submission of
treating those conditions, the goals and • Description of the metrics for the their application, to certify, among other
objectives of the proposed pilot project proposed pilot project that are relevant things, that they will comply with the
(including the health care provider’s to the Pilot Program goals and how the Health Insurance Portability and
anticipated goals with respect to participating providers will collect Accountability Act (HIPAA) and other
reaching new or additional patients, and those metrics. Examples of the types of applicable privacy and reimbursement
improved patient health outcomes), metrics the Commission is interested in laws and regulations, and applicable
expected health care benefits to the include: reductions in potential medical licensing laws and regulations,
patients, health care provider, or the emergency room or urgent care visits; as well as all applicable Pilot Program
health care industry that will result decreases in hospital admissions or requirements and procedures, including
from the proposed pilot project, and readmissions; condition-specific the requirement to retain records to
how the pilot project will achieve each outcomes, such as reductions in demonstrate compliance with the Pilot
of the goals of the Pilot Program. premature births or acute incidents Program rules and requirement for five
• Documentation of the participating among suffers of a chronic illness, and years, subject to audit. Health care
health care provider(s)’s financial health patient satisfaction as to with their providers that participate in the Pilot
(e.g., recent audited balance sheets and overall health status. Program must also comply with all
income statements that are no more than • Description of how the health care applicable federal and state laws,
two years old). provider intends to collect, track, and including the False Claims Act, the
• Description of the estimated store, the required Pilot Program data. Anti-Kickback Statute, and the Civil
number of patients to be treated. Further, to facilitate the review in Monetary Penalties Law. The
• Description of any commitments selecting a diverse set of projects and Commission understands that health
from community partners, including target Pilot Program funds to geographic care providers must routinely navigate
physicians, hospitals, health systems, areas and populations most in need of these laws in other contexts. Thus,
and home health/community providers USF support for connected care, health care providers that are interested
to the success of the proposed pilot applicants should also provide the in applying for the Pilot Program should
project. following information, as applicable: speak to their compliance experts prior
• Description of the anticipated level • Description of whether the health to submitting an application to
of broadband service required for the care provider is located in a rural area, participate in the Pilot Program.
proposed pilot project, including the on Tribal lands, or is associated with a Further, applicants will also be required
necessary speeds, the technologies to be Tribe, or part of the Indian Health to certify that they are not already
used (e.g., mobile or fixed broadband) Service. If the health care provider is receiving or expecting to receive other
and any other relevant service not located in a rural area, include a federal funding for the exact same
characteristics (e.g., LTE service). description of whether the health care services eligible for support under the
• Description of the estimated provider will primarily serve veterans or Pilot Program. The Commission
number of patient broadband low-income patients located in rural recognizes the need to possibly waive
connections that the health care areas as defined in the RHC Program certain of the RHC Program rules that
provider intends to purchase for rules, and identify those specific rural extend to the Pilot Program in order to
purposes of providing connected care areas. implement the Pilot Program, and
services to patients who lack broadband • Listing of all Department of Health therefore also request that applicants
service or have insufficient broadband and Human Services, Health Resources identify in their application, as
services. This description must include & Services Administration (HRSA) applicable, any Commission rules that
an explanation of how the health care designated Health Professional Shortage extend to the Pilot Program in the R&O
provider plans to assess whether a Areas (for primary care or mental health from which they may need a waiver in
patient lacks broadband service or has care only) or HRSA designated order to participate in the Pilot Program,
insufficient broadband internet access Medically Underserved Areas that will if selected.
service for the indicated connected care be served by the proposed project. 47. Instructions for Filing
service based on speed, technology or • Description of whether the pilot Applications. The Bureau will issue a
data cap limitations. project will primarily benefit low- public notice announcing the deadline
• If seeking support for an income or veteran patients, and if so, for submitting Pilot Program
information service used to provide the estimated number or percentage of applications and instructions for filing
connected care, other than broadband those patients the project will serve applications with the Commission. Pilot
connectivity, used to provide connected compared to the total number of Program applications will be due the
care, a description of the service, patients that the pilot project estimates later of 45 days from the effective date
including a description of the primary serving. of the Pilot Program rules or July 31,
function/s of the service, and whether it • Description of whether the primary 2020. Applicants will be required to
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facilitates the capturing, transmission, purpose of the proposed pilot project is complete each section of the application
and storage of data for connected care. to provide connected care services to and make the required certifications at
• Estimated total project costs, respond to a public health epidemic, or the end of the application. Applicants
including costs eligible for support to provide connected care services for may request that any materials or
through the Pilot Program and costs not opioid dependency, high-risk information submitted to the
eligible for Pilot Program support but pregnancy/maternal mortality, mental Commission in its application be
still necessary to implement the health conditions (e.g., substance abuse, withheld from public inspection
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pursuant to the procedures set forth in projects. After the selection of pilot • The eligible health care provider
§ 0.459 of the Commission’s rules. projects, additional specifics will also seeks support for $10,000 or less of total
Applications must reference WC Docket be provided concerning the undiscounted eligible expenses for a
No. 18–213 only, and will be required requirements outlined in the R&O, single year, if the term of the contract is
to file electronically consistent with the including additional instructions and one year or less; or
instructions provided in a subsequent procedural information regarding, • The eligible health care provider
public notice. All filings must be requests for funding, invoicing, and the already has entered into a legally
addressed to the Commission’s specific data to be reported and binding agreement with a service
Secretary, Office of the Secretary, reporting format. provider for services or equipment
Federal Communications Commission. 51. Procurement of Supported eligible for support in the Pilot Program
Applicants must also send a courtesy Services. The Commission is adopting, and that legally binding agreement itself
copy of their application via email to to the extent feasible, the competitive was the product of competitive bidding.
ConnCarePltProg@fcc.gov. bidding requirements for the Healthcare In the absence of an applicable
48. Evaluation of Proposals and Connect Fund Program for participants exemption, applicants will have to seek
Selection of Pilot Projects. The in the Pilot Program. Specifically, health competitive bids for services and
Commission plans to evaluate the care providers can seek bids for multi- equipment that are eligible for support
applications and select pilot project year or single-year contracts during the through the Pilot Program. Applicants
proposals based on applicants’ competitive bidding process. If a health will be required to follow the RHC
responses to the criteria. The care provider only seeks bids for a Program’s competitive bidding
Commission will also consider the cost single-year contract, it will need to requirements, which include submitting
of the proposed pilot project compared conduct a new competitive bidding a Request for Services and Request for
to the total Pilot Program budget. This process for each year of the Pilot Proposal (RFP) (as applicable) for USAC
does not mean the Commission will Program. The competitive bidding to post on its website, seeking bids,
evaluate proposed pilot projects based requirements for the Pilot Program are waiting 28 days before selecting a
solely on a proposed pilot project’s total in addition to and do not supplant any service provider, conducting a bid
budget but will seek to select an array applicable state or local procurement evaluation to select a service provider,
of pilot projects that can all be funded requirements. and then selecting the most-cost
within the Pilot Program’s budget. effective service. All potential bidders
52. Similar to the competitive bidding
49. In choosing participants for the must have access to the same
exemptions provided under the
Pilot Program, the Commission will also information and be treated in the same
Healthcare Connect Fund Program,
consider whether the applicant has manner during the competitive bidding
eligible health care providers
successfully developed, coordinated, or period to ensure that the process is ‘‘fair
participating in the Pilot Program will
otherwise implemented a telehealth and open.’’ Gifts from service providers
not be required to seek competitive bids will also be prohibited.
program. While the Commission will
consider applicants’ responses to all of if: 53. Requesting Funding, Invoicing,
the application criteria factors listed in • The eligible health care provider Disbursements, and Material Changes.
the document when evaluating pilot seeks support for services and Once selected, Pilot Program
project proposals, they are not equipment purchased from Master participants will be required to submit
determinative of whether a pilot project Services Agreements (MSAs) negotiated a Request for Funding to USAC no later
will be selected because recognition that by federal, state, Tribal, or local than six months after the selection date
each pilot project proposal will have its government entities on behalf of such with specific pricing and service
own unique strengths and potential health care providers and others, if such information for the funding they are
challenges. However, the Commission’s MSAs were awarded pursuant to requesting through the Pilot Program.
goal is to select pilot projects that applicable federal, state, Tribal, or local Participating health care providers with
present a well-defined plan for meeting competitive bidding requirements; multi-year contracts may submit a single
the health care needs of participating • The eligible health care provider funding request for the full period
patients, with a particular emphasis on opts into an existing MSA approved covered by the contract. However, if a
eligible low-income and veteran under the Rural Health Care Pilot participating health care provider elects
patients and the Pilot Program goals. Program or Healthcare Connect Fund to enter into a one-year contract, it will
50. The Commission directs the Program and seeks support for services have to submit a new funding request
Bureau to establish an application and equipment purchased from the for each subsequent year of Pilot
schedule consistent with the direction MSA, if the MSA was developed and Program funding. USAC will review the
provided in the R&O, to review the negotiated in response to an RFP that funding requests and issue funding
applications, to consult with the FCC’s specifically solicited proposals that commitment letters to the participating
Office of Economics and Analytics, included a mechanism for adding health care providers and service
Office of Managing Director, Office of additional sites to the MSA; providers indicating the amount
General Counsel, and the FCC • The eligible health care provider committed under the Pilot Program for
Connect2Health Task Force, as needed, has a multi-year contract designated as the selected pilot project. Given that
and to recommend pilot project ‘‘evergreen’’ by USAC and seeks to Pilot Program funding will be collected
selections to the Commission. To the exercise a voluntary option to extend an over a multiple year period, while
extent possible in reviewing evergreen contract without undergoing participating health care providers with
applications, the Commission also additional competitive bidding; multi-year contracts can submit a single
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encourages the Bureau to consult with • The eligible health care provider is funding request covering the contract
federal agencies with expertise in in a consortium with participants in the period, the Commission anticipates that
telehealth or the federally designated schools and libraries universal service USAC will issue funding commitments
Telehealth Resource Centers. After the support program (E-Rate program) and a for one year at a time rather than for
Commission selects the pilot projects to party to the consortium’s existing multiple years.
participate in the Pilot Program, the contract, if the contract was approved in 54. Selected pilot projects will be
Bureau will announce the selected pilot the E-Rate program as a master contract; required to report to the Commission
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19902 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
any material change in the participating applicable to all of the selected pilot procedures and will improve the overall
health care providers’ or pilot projects’ projects. efficacy of the Pilot Program. The
status (e.g., health care provider site has 57. Accordingly, the Commission will Commission also encourages selected
closed, or pilot project has ceased determine the specific data to be participants to contact USAC with any
operations) within 30 days of such reported by pilot projects and format of questions prior to filing their forms or
material change in status. In instances the required data after review of the supporting documentation. The
where a selected Pilot Program pilot project proposals. Participating direction the Commission provides to
participant is unable to participate in health care providers will also be USAC will not lessen or preclude any of
the Pilot Program for the three-year required to submit final reports within its review procedures. The Commission
period due to extenuating six months of the end dates of their pilot retains the commitment to detecting and
circumstances, a successor may be projects summarizing the final results deterring potential instances of waste,
designated by the Bureau. To facilitate and explaining whether the pilot fraud, and abuse by ensuring that USAC
the tracking and monitoring of the Pilot projects met their stated goals and the scrutinizes Pilot Program submissions
Program budget and guard against goals of the Pilot Program. These data and takes steps to educate selected
potential waste, fraud and abuse, will assist the Commission in participants in a manner that fosters
selected pilot projects must notify determining whether and how universal appropriate Pilot Program participation.
USAC within 30 days of any decrease of service funds can efficiently and 59. Pilot Program Goals and Metrics.
5% or more in the number of patients effectively be used for connected care, The Commission adopts three explicit
participating in their respective pilot will enable the Commission to ensure goals for the Pilot Program to determine
project. that universal service funds are being how USF support provided to health
55. After providing the eligible used in a manner consistent with care providers for the costs associated
services and/or equipment, service section 254, the Commission’s rules and with providing connected care services
providers will be required to make procedures, and the goals of the Pilot can enable them to: (1) Improve health
certain certifications and then submit Program. In accordance with § 54.631 of outcomes through connected care; (2)
invoicing forms on a monthly basis and the Commission’s rules, health care reduce health care costs for patients,
supporting documentation to USAC to providers and selected participants, in facilities and the health care system;
receive reimbursement for the cost of addition to maintaining records related and (3) support the trend towards
the eligible services and/or equipment to their pilot projects to demonstrate connected care everywhere. The goals
they have provided to participating their compliance with the Pilot Program adopted for the Pilot Program are sound
health care providers under the Pilot rules and requirements, must also keep and measurable goals, and will help
Program. USAC will review the monthly supporting documentation for these advance the Commission’s statutory
invoicing forms and supporting reports for at least five years after the obligation to promote universal service
documentation and issue disbursements conclusion of their pilot project and by providing the Commission with
to the applicable service providers or must present that information to the information that will help inform about
vendors, whether a broadband service Commission or USAC upon request. how to best allocate limited universal
provider, or other provider. Pilot Consistent with § 54.631 of the service funding.
Program participants will also be Commission’s rules, pilot projects will 60. Legal Authority. The Commission
required to make certifications as part of also be subject to random compliance found that section 254(h)(2)(A) of the
the form submissions to USAC to ensure audits to ensure compliance with the 1996 Act authorizes establishing the
that Pilot Program funds are used for Pilot Program rules and requirements. Pilot Program to help defray health care
their intended purpose and to ensure 58. USAC Outreach. After provider’s eligible costs of providing
that all participating health care announcement of the selected Pilot connected care services to low-income
providers and service providers are in Program projects, each selected pilot or veteran patients. Specifically, section
compliance with the Commission’s project will be required to provide to 254(h)(2)(A) directs the Commission to
rules and procedures. USAC, within 14 calendar days of such ‘‘establish competitively neutral rule[s]
56. Data Reporting, Document announcement, the name, mailing to enhance, to the extent technically
Retention, and Audits. The Commission address, email address, and telephone feasible and economically reasonable,
directs the Bureau to issue a report number of the lead project coordinator access to advanced telecommunications
detailing the results of the Pilot Program for its pilot project. Within 30 days of and information services for all public
after it has been completed. To assist the date announcing the selected Pilot and nonprofit . . . health care
with the report, the Commission will Program projects, USAC shall conduct providers.’’ The Pilot Program will fund
require participating health care an initial coordination meeting with broadband connectivity for participating
providers to submit periodically selected Pilot Program participants. health care providers and patients,
anonymized, aggregated data, such as USAC shall further conduct a targeted certain network equipment, and other
reductions in emergency room or urgent outreach program, such as a webinar or information services that may facilitate
care visits in a particular geographic similar outreach, to educate and inform the provision of connected care services
area or among a certain class of patients; selected participants on the Pilot provided through the Pilot Program.
decreases in hospital admissions or re- Program administrative process, These connected care services may be
admissions for a certain patient group; including various filing requirements defined as either telecommunications
condition-specific outcomes such as and deadlines, in order to minimize the services or information services.
reductions in premature births or acute possibility of selected participants 61. For the Pilot Program, funding
incidents among sufferers of a chronic making inadvertent errors in completing patient broadband internet access
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illness; and patient satisfaction as to the required forms. The Commission services would expand health care
health status to the Bureau regarding expects that the outreach and providers’ digital footprints for purposes
their pilot project to the Bureau after educational efforts will assist selected of providing connected care services
each year of funding for that pilot participants in meeting the Pilot and allow health care providers to serve
project. However, the scope of the pilot Program’s requirements. Further, such more eligible low-income patients and
project proposals is unknown at this an outreach program will increase veterans through the Pilot Program and,
time, and some metrics may not be awareness of the filing rules and thus, enhance health care providers’
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Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations 19903
access to ‘‘advanced 63. Recognizing that the Commission 254(b)(3) provides that ‘‘[c]onsumers in
telecommunications and information has not previously relied on section all regions of the Nation, including low-
services.’’ Accordingly, funding health 254(h)(2)(A) of the Act to specifically income consumers and those in rural,
care provider purchase of broadband defray eligible health care provider costs insular, and high cost areas, should
internet access service for participating of providing connected care services by have access to telecommunications and
patients through this discrete, limited supporting broadband connections for information services, including
duration Pilot Program falls within the patient use or other information services interexchange services and advanced
scope of section 254(h)(2)(A) of the Act. necessary to provide connected care telecommunications and information
Relying on this statutory provision also services. The Commission previously services, that are reasonably comparable
ensures that the Pilot Program is health concluded, however, that it has ‘‘broad to those services provided in urban
care provider-driven and enables discretion regarding how to fulfill this areas and that are available at rates that
participating health care providers to statutory mandate’’ under section are reasonably comparable to rates
select from the broadest range of 254(h)(2)(A). The Commission believes charged for similar services in urban
broadband internet access service establishing the limited Pilot Program areas.’’ As explained in the document,
providers to meet the health care needs for this purpose is consistent with that the Pilot Program will fund eligible
of participating patients. discretion. Advances in information health care provider purchases of
62. First, the Pilot Program will be technologies and services are allowing broadband internet access services for
‘‘competitively neutral,’’ which means health care providers to expand their participating patients to use for
that ‘‘universal service support digital footprint by using broadband and purposes of connected care services.
mechanisms and rules neither unfairly broadband enabled devices to provide IV. Procedural Matters
advantage nor disadvantage one connected care services to patients in
provider over another, and neither their homes or mobile locations, and A. Paperwork Reduction Act Analysis
unfairly favor nor disfavor one there is growing evidence of the benefits 65. This document contains new
technology over another.’’ The Pilot of connected care services both for information collection requirements
Program satisfies this requirement health care providers and their patients. subject to the Paperwork Reduction Act
because eligible health care providers Further, the record indicates that the of 1995 (PRA), Public Law 104–13. The
are free to choose any broadband costs of broadband internet access information collection requirements
connectivity technology and broadband service for patient use in their homes or related to the COVID–19 Telehealth
connectivity provider, in compliance mobile locations, and the costs of other Program were approved on April 6,
with the applicable competitive bidding information services necessary to 2020 by the Office of Management and
requirements for the Pilot Program- provide connected care services, are an Budget (OMB) pursuant to the PRA, 44
supported services needed to provide obstacle for certain health care U.S.C. 3507(j). The information
connected care services through their providers and their patients to adopt collection requirements related to the
respective pilot projects. In addition, connected care services. Because of the Pilot Program will also be submitted to
participating health care providers are growing evidence of the benefits of OMB for review under Section 3507(d)
not required to adopt any specific non- providing connected care services for of the PRA. OMB, the general public,
broadband information service to both health care providers and their and other federal agencies will be
provide broadband-enabled connected patients, and the fact that many health invited to comment on the new
care services through the Pilot Program. care providers and patients have yet to information collection requirements.
Second, the Pilot Program will be adopt these services, the Commission Applications for the COVID–19
‘‘technically feasible’’ because the Pilot believes that it is appropriate to Telehealth Program will be accepted by
Program will not require the establish the Pilot Program to examine the Commission after the Bureau
development of any new technology and whether and how universal service can releases a public notice providing
gives participating health care providers play a role in helping all Americans instructions for filing applications with
flexibility to use any available access and obtain the benefits of the Commission. Applications to
technology to implement their connected care services. The participate in the Pilot Program will be
respective pilot projects. Third, the Pilot Commission thus believes that the due 45 days from the effective date of
Program will be ‘‘economically specific services and network the Pilot Program rules or July 31, 2020,
reasonable.’’ In discussing economic equipment funded under the Pilot whichever comes later. The Bureau will
reasonableness, the Commission has Program are within the scope of the issue a public notice announcing the
generally focused on the effect that any statutory directive under section deadline for submitting Pilot Program
new rules would have on growth in the 254(h)(2)(A) to enhance eligible health applications and instructions for filing
universal service support mechanisms. care providers’ access to advanced applications with the Commission. In
The Commission establishes a budget telecommunications and information addition, pursuant to the Small
separate from the existing universal services. Business Paperwork Relief Act of 2002,
service programs and limit the Pilot 64. While the Commission relies on Public Law 107–198, see 44 U.S.C.
Program budget to at most $100 million, authority under section 254(h)(2)(A) to 3506(c)(4), the Commission sought
which provides a reasonable cap and establish the Pilot Program, the Pilot specific comment on how it might
will not significantly increase the Program is also consistent with the further reduce the information
contributions burden on consumers. directive that the Commission base collection burden for small business
Additionally, the Commission has policies for the advancement of concerns with fewer than 25 employees.
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developed measures to promote the universal service on the principles In the Report and Order, the
fiscally responsible use of Pilot Program outlined in section 254(b) of the Act. Commission has assessed the effects of
funds, including requiring that Specifically, section 254(b)(2) provides the information collection on small
evaluations of pilot project proposals that ‘‘[a]ccess to advanced businesses, and find that the benefits of
include a comparison of the estimated telecommunications and information providing support to help defray eligible
costs of each proposed pilot project to services should be provided in all health care providers costs to provide
the total Pilot Program budget. regions of the Nation’’ and section connected care services to their patients
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19904 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
and COVID–19 relief to help eligible Health Care (RHC) Program which Program will provide meaningful data
health care providers meet the health supports health care providers’ access to that will help better understand how the
care needs of their patients during the communications technologies. However, USF can support health care provider
COVID–19 pandemic outweigh any there are developments in telehealth, and patient use of connected care
significant economic impact on small including increased use of connected services, and how supporting health
entities. care services, that the Commission has care provider and patient use of
not yet fully explored. With remote connected care services can improve
B. Congressional Review Act
patient monitoring and mobile health health outcomes and reduce health care
66. The Commission has determined, applications that can be accessed on a costs. The data and information
and the Administrator of the Office of smartphone or tablet, health care collected through the Pilot Program
Information and Regulatory Affairs, providers now have the technology to could also have the ancillary benefit of
Office of Management and Budget deliver quality health care directly to aiding policy makers and legislators in
(OMB), concurs that the rules patients, regardless of where they are the consideration of broader reforms—
implementing the COVID–19 Telehealth located. Despite the numerous benefits whether statutory changes or updates to
Program are ‘‘major’’ and the rules of connected care services to patients rules administered by other agencies—
implementing the Pilot Program are and health care providers alike, patients that could support this trend towards
‘‘non-major’’ under the Congressional who cannot afford or who otherwise connected care.
Review Act, 5 U.S.C. 804(2). The lack reliable, robust broadband internet 70. In the R&O, in response to the
Commission will send a copy of the access connectivity, including many public health emergency associated
R&O, including this FRFA, to Congress low-income Americans and veterans, with the coronavirus disease (COVID–
and the Government Accountability are not realizing the benefits of these 19), the Commission also establishes a
Office pursuant to 5 U.S.C. 801(a)(1)(A). innovative telehealth technologies. separate, emergency COVID–19
In addition, the Commission will send Also, the costs necessary to provide Telehealth Program focused on
a copy of the R&O, including the FRFA, connected care services may limit some connected care in response to the
to the Chief Counsel for Advocacy of the health care providers’ ability to treat ongoing COVID–19 pandemic and surge
Small Business Administration. low-income Americans and veterans in demand for connected care services.
C. Final Regulatory Flexibility Analysis with connected care services. The Commission expects this additional
support will help eligible health care
67. As required by the Regulatory 69. Thus, in August 2018, the providers purchase broadband
Flexibility Act of 1980 (RFA), as Commission released the Connected connectivity, network equipment and
amended, the Federal Communications Care Notice of Inquiry, FCC 18–112 information services to provide critical
Commission (Commission) included an (NOI) seeking information on ‘‘how the connected care services whether for
Initial Regulatory Flexibility Analysis Commission can help advance and treatment of coronavirus or other health
(IRFA) of the possible significant support the movement towards conditions during this time.
economic impact on a substantial connected care everywhere and improve 71. Summary of Significant Issues
number of small entities by the policies access to the life-saving broadband- Raised by Public Comments in Response
and requirements proposed in the enabled telehealth services it makes to the IRFA. There were no comments
NPRM in WC Docket No. 18–213. The possible.’’ Subsequently, in July 2019, filed that specifically address the rules
Commission sought written public the Commission adopted the NPRM that and policies proposed in the IRFA.
comment on the proposals in the NPRM, proposed and sought comment on a 72. Response to Comments by the
including comment on the IRFA. The Pilot Program that would help defray Chief Counsel for Advocacy of the Small
Commission did not receive any health care provider costs of providing Business Administration. Pursuant to
comments in response to the IRFA. This connected care services to low-income the Small Business Jobs Act of 2010,
Final Regulatory Flexibility Analysis Americans and veterans. In the R&O, which amended the RFA, the
(FRFA) conforms to the RFA. given the benefits of connected care Commission is required to respond to
68. Need for, and Objectives of, the services provided through broadband any comments filed by the Chief
Report and Order. In the connections, the Commission takes the Counsel of the Small Business
Telecommunications Act of 1996 (1996 important step of establishing a Pilot Administration (SBA), and to provide a
Act), Congress recognized the value of Program to explore whether and how detailed statement of any change made
providing rural health care providers the Universal Service Fund (USF) can to the proposed rule(s) as a result of
with ‘‘an affordable rate for the services help defray health care providers’ those comments. The Chief Counsel did
necessary for the provision of qualifying costs of providing connected not file any comments in response to the
telemedicine and instruction relating to care services, including low-income proposed policies and requirements in
such services.’’ The 1996 Act mandated Americans and veterans. The ultimate the proceeding.
that telecommunications carriers goal of the Pilot Program is to examine 73. Description and Estimate of the
provide telecommunications services for how USF support can be used to help Number of Small Entities to Which the
health care purposes to rural public or health care providers improve health Rules Will Apply. The RFA directs
nonprofit health care providers at rates outcomes and reduce health care costs, agencies to provide a description of and,
that are ‘‘reasonably comparable’’ to thereby supporting efforts to advance where feasible, an estimate of the
rates in urban areas. The 1996 Act also connected care initiatives. The number of small entities that may be
directed the Commission to establish Commission expects that the Pilot affected by the proposed rules. The RFA
competitively neutral rules to enhance, Program will benefit many eligible generally defines the term ‘‘small
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to the extent technically feasible and patients who are responding to a wide entity’’ as having the same meaning as
economically reasonable, access to variety of health challenges, such as the terms ‘‘small business,’’ ‘‘small
‘‘advanced telecommunications and diabetes management, opioid organization,’’ and ‘‘small governmental
information services’’ for public and dependency, high-risk pregnancies, jurisdiction.’’ In addition, the term
nonprofit health care providers. Based pediatric heart disease, mental health ‘‘small business’’ has the same meaning
on this legislative mandate, the conditions, and cancer. The as the term ‘‘small business concern’’
Commission established the Rural Commission also expects that the Pilot under the Small Business Act. A small
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Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations 19905
business concern is one that: (1) Is providers offering them services, entities. The Commission seeks to strike
independently owned and operated; (2) including telecommunications service a balance between requiring applicants
is not dominant in its field of operation; providers, internet Service Providers, to submit enough information that
and (3) satisfies any additional criteria and service providers of the services allows the selection high-quality, cost-
established by the SBA. and equipment used for dedicated effective pilot projects that would best
74. Small Businesses, Small broadband networks. further the goals of the Pilot Program,
Organizations, Small Governmental 78. Description of Projected but also minimizing the administrative
Jurisdictions. The Commission actions, Reporting, Recordkeeping, and Other burdens on entities that seek to apply.
over time, may affect small entities that Compliance Requirements for Small The R&O provides specific information
are not easily categorized at present. Entities. In the R&O, the Commission that health care providers are required
Therefore, at the outset, three broad establishes a Pilot Program within the to submit in their applications for each
groups of small entities that could be USF that will make available up to $100 pilot project proposal, including, but
directly affected herein. First, while million over three years to help defray not limited to, information on the
there are industry specific size eligible health care providers’ costs of participating health care provider(s),
standards for small businesses that are providing connected care services description of the pilot project and how
used in the regulatory flexibility primarily to low-income or veteran it would further the goals of the Pilot
analysis, according to data from the patients for purposes of connected care. Program, estimated pilot project budget,
SBA’s Office of Advocacy, in general a The Commission also establishes an patient populations and the geographic
small business is an independent COVID–19 Telehealth Program funded areas to be served and health conditions
business having fewer than 500 through a $200 million Congressional to be treated. The R&O also establishes
employees. These types of small appropriation under the Coronavirus a streamlined application process for
businesses represent 99.9% of all Aid, Relief, and Economic Security the COVID–19 Telehealth Program in
businesses in the United States, which (CARES) Act, Public Law 116–136, 134 order to more expeditiously address the
translates to 30.7 million businesses. Stat. 281, for COVID–19 relief to help needs of health care providers affected
75. Next, the type of small entity eligible health care providers meet the by the coronavirus epidemic.
described as a ‘‘small organization’’ is health care needs of their patients
generally ‘‘any not-for-profit enterprise 80. After evaluation of the pilot
during the COVID–19 pandemic. The
which is independently owned and program applications, the Bureau will
Pilot Program is structured to target
operated and is not dominant in its announce the selected pilot projects and
funding to eligible health care providers
field.’’ The Internal Revenue Service serving patients that are most likely to provide further information on the
(IRS) uses a revenue benchmark of need USF support for connected care specific requirements for the Pilot
$50,000 or less to delineate its annual services, and to ensure that the Pilot Program. Selected pilot program
electronic filing requirements for small Program provides meaningful, participants will be required to conduct
exempt organizations. Nationwide, for measurable data. To participate in the a competitive bidding process (unless a
tax year 2018, there were approximately Pilot Program, health care providers competitive bidding exemption applies),
571,709 small exempt organizations in must satisfy the definition of an eligible including submitting the required
the U.S. reporting revenues of $50,000 health care provider under section competitive bidding forms, for the
or less according to the registration and 254(h)(7)(B) of the Act and receive an eligible equipment and services that are
tax data for exempt organizations eligibility determination from the supported through the Pilot Program.
available from the IRS. Universal Service Administrative Participating health care providers will
76. Finally, the small entity described Company (USAC), the administrator of then be required to submit a request for
as a ‘‘small governmental jurisdiction’’ the USF programs. Applicants must funding with USAC with specific
is defined generally as ‘‘governments of then submit an application to the pricing and service information, and
cities, counties, towns, townships, Commission regarding their pilot will also be required to submit invoicing
villages, school districts, or special projects by the application deadline forms and supporting documentation on
districts, with a population of less than ultimately established for the Pilot a monthly basis for the supported
fifty thousand.’’ U.S. Census Bureau Program. While the COVID–19 equipment and services. Participating
data from the 2017 Census of Telehealth Program is structured a bit health care providers will also be
Governments indicate that there were differently than the Pilot Program, required to periodically submit data to
90,075 local governmental jurisdictions applicants for both programs will be the Bureau concerning their pilot
consisting of general purpose required to certify that they will comply project after each year of funding during
governments and special purpose with all applicable Pilot Program the three-year period of the pilot project,
governments in the United States. Of requirements and procedures. and will also be required to submit a
this number there were 36,931 general Applicants among other things, will also final report concerning their pilot
purpose governments (county, be required to comply with the Health projects. For the COVID–19 Telehealth
municipal and town or township) with Insurance Portability and Program, within six months after the
populations of less than 50,000 and Accountability Act (HIPAA) and other conclusion of the COVID–19 Telehealth
12,040 special purpose governments— applicable privacy and reimbursement Program, participants should provide a
independent school districts with laws and regulations, and applicable report to the Commission on the
enrollment populations of less than medical licensing laws and regulations, effectiveness of the program. While
50,000. Accordingly, based on the 2017 as well as all applicable Pilot Program some of the requirements of the Pilot
U.S. Census of Governments data, the requirements and procedures, including Program and the COVID–19 Telehealth
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Commission estimates that at least document retention requirements, Program will result in additional
48,971 entities fall into the category of subject to audit. recordkeeping and compliance
‘‘small governmental jurisdictions.’’ 79. As part of Pilot Program, the requirements for small entities, the
77. The small entities that may be Commission seeks a diverse set of pilot Commission has determined that the
affected by the reforms include eligible projects from a wide variety of eligible benefits of establishing these programs
nonprofit and public health care health care providers and eligible outweighs the burden of any increased
providers and the eligible service service providers, including small recordkeeping and compliance
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19906 Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations
requirements for those small entities health care providers that participate in shall become effective April 9, 2020
that choose to participate in the Pilot the Pilot Program will be required to pursuant to 5 U.S.C. 553(d) and 5 U.S.C.
Program and the COVID–19 Telehealth collect and submit data to the 808(2) and the portions containing
Program. Additionally, the requirements Commission at designated intervals information collection requirements that
are intended to ensure universal service during the Pilot Program. The have not been approved by the Office of
funds are used for their intended Commission has yet established metrics Budget and Management (OMB).
purpose and designed so that the to measure the Pilot Program goals and 84. It is further ordered that
Commission can obtain meaningful data seek information from applicants on the applications to participate in the
to evaluate the Pilot Program and inform metrics plans to use and how plans to COVID–19 Telehealth Program shall be
the policy decisions. collect those metrics in order to filed after the Wireline Competition
81. Steps Taken to Minimize the minimize any impact on small entities Bureau issues a public notice
Significant Economic Impact on Small when establishing metrics for the Pilot announcing the date when applications
Entities and Significant Alternatives Program. The collection of this will be accepted and instructions for
Considered. The RFA requires an information, however, is necessary to filing applications with the
agency to describe any significant evaluate the impact of the Pilot Commission. This date will be after
alternatives that it has considered in Program, including whether the Pilot April 9, 2020.
reaching its proposed approach, which Program achieves its goals. Thus, the
may include (among others) the 85. It is further ordered that, pursuant
benefits of collecting this information
following four alternatives: (1) The to the Paperwork Reduction Act of 1995,
outweigh any significant economic
establishment of differing compliance or Section 3507(d), the Connected Care
impact on small entities. Moreover, the
reporting requirements or timetables Pilot Program information collection
Commission sought comment on the
that take into account the resources requirements shall become effective
IRFA and did not receive any comments
available to small entities; (2) the in response to the IRFA. Further, in after announcement in the Federal
clarification, consolidation, or order to minimize the economic impact Register of Office of Management and
simplification of compliance or on small entities, the Commission Budget approval of the rules, and on the
reporting requirements under the rule establishes an emergency COVID–19 effective date announced therein.
for small entities; (3) the use of Telehealth Program, which is one piece 86. It is further ordered that
performance, rather than design, of a comprehensive approach to applications to participate in the
standards; and (4) an exemption from reducing barriers to telehealth services Connected Care Pilot Program shall be
coverage of the rule, or any part thereof, for patients and health care facilities filed 45 days after the effective date of
for small entities. throughout the country to provide relief the Connected Care Pilot Program rules
82. The Pilot Program is for a discrete, related to the COVID–19 pandemic. The or July 31, 2020, whichever comes later.
limited period of time. The Commission Commission therefore believes that the 87. It is further ordered that the
expects to apply the Commission’s rules requirements of the R&O will not have Commission’s Consumer and
applicable to the Healthcare Connect a significant economic impact on a Governmental Affairs Bureau, Reference
Fund Program to the Pilot Program, substantial number of small entities. Information Center, shall send a copy of
which some entities may already be the R&O, including the Final Regulatory
familiar with if they currently V. Ordering Clauses
Flexibility Analysis, to the Chief
participate in the Healthcare Connect 83. Accordingly, it is ordered that, Counsel for Advocacy of the Small
Fund Program. With no expectation of pursuant to the authority contained in Business Administration.
the small entities to be sections 201, 254, 303(r), and 403 of the 88. It is further ordered that the
disproportionately impacted. In Communications Act of 1934, as Commission shall send a copy of the
evaluating the applications, the amended, 47 U.S.C. 201, 254, 303(r), R&O to the Congress and the
Commission seeks to select a diverse set and 403, and DIVISION B of the Government Accountability Office
of pilot projects and will consider Coronavirus Aid, Relief, and Economic pursuant to the Congressional Review
whether the proposed pilot projects Security Act, Public Law 116–136, 134 Act, see 5 U.S.C. 801(a)(1)(A).
promotes entrepreneurs and other small Stat. 281, the Report and Order is
businesses in the provision and adopted and shall become effective May Federal Communications Commission.
ownership of telecommunications and 11, 2020, pursuant to 47 U.S.C. 408, Cecilia Sigmund,
information services, including those with the exception of those portions Federal Register Liaison Officer.
that may be socially and economically related to the COVID–19 Telehealth [FR Doc. 2020–07587 Filed 4–8–20; 8:45 am]
disadvantaged businesses. All eligible Program in the Report and Order which BILLING CODE 6712–01–P
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- www.govinfo.gov