Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program

 
CONTENT
Federal Register, Volume 85 Issue 69 (Thursday, April 9, 2020)
[Federal Register Volume 85, Number 69 (Thursday, April 9, 2020)]
[Rules and Regulations]
[Pages 19892-19906]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-07587]
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FEDERAL COMMUNICATIONS COMMISSION
47 CFR Part 54
[WC Docket Nos. 18-213 and 20-89; FCC 20-44; FRS 16647]
Promoting Telehealth for Low-Income Consumers; COVID-19
Telehealth Program
AGENCY: Federal Communications Commission.
ACTION: Final order; announcement of effective date.
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SUMMARY: In this document, the Federal Communications Commission
(Commission) establishes two programs: The COVID-19 Telehealth Program
designed to distribute a $200 million appropriation from Congress under
the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help
health care providers provide connected care services to patients at
their homes or mobile locations in response to the novel Coronavirus
2019 disease (COVID-19) pandemic, and the Connected Care Pilot Program
(Pilot Program) designed to make available up to $100 million over
three years to examine how the Universal Service Fund can help support
the trend towards connected care services to consumers, particularly
for low-income Americans and veterans.
DATES: The Report and Order is effective May 11, 2020, except for the
information collections requiring Office of Management and Budget (OMB)
approval. The Commission received OMB approval of the COVID-19
Telehealth Program information collection requirements on April 6,
2020, and those requirements are effective April 9, 2020. The Pilot
Program requirements will not become effective until approved by OMB.
The Federal Communications Commission will publish a document in the
Federal Register announcing the effective date of OMB approval of the
Pilot Program requirements.
FOR FURTHER INFORMATION CONTACT: Please email
[email protected] with questions related to the COVID-
19 Telehealth Program, and [email protected] with questions
related to the Pilot Program.
SUPPLEMENTARY INFORMATION: This is a summary of the Commission's
Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth
Program, Report and Order (R&O), in WC Docket Nos. 18-213 and 20-89;
FCC 20-44, adopted March 31, 2020 and released April 2, 2020. Due to
the COVID-19 pandemic, the Commission's headquarters will be closed to
the general public until further notice. The full text of this document
is available at the following internet address: https://docs.fcc.gov/public/attachments/FCC-20-44A1.pdf.
I. Introduction
 1. The novel Coronavirus disease 2019 (COVID-19) pandemic and
associated respiratory illness have spread throughout the United States
in recent weeks. In response to this pandemic, many health care
providers are expanding existing telehealth services and implementing
new telehealth services, and the demand for connected care services
provided directly to patients in their homes or their mobile locations
is skyrocketing. As a result, many health care providers are facing new
challenges in technical infrastructure and experiencing staffing
issues. In response to the outbreak, on March 27, 2020, President Trump
signed the Coronavirus Aid, Relief, and Economic Security (CARES), Act
into law, Public Law 116-136, 134 Stat. 281 (2020), providing, among a
panoply of other actions, $200 million to the FCC to support health
care providers in the fight against the ongoing pandemic.
 2. In the R&O, to effectuate Congress' intent in enacting the CARES
Act, the Commission establishes a $200 million emergency COVID-19
Telehealth Program to implement the CARES Act and ensure access to
connected care services and devices in response to the ongoing COVID-19
pandemic and surge
[[Page 19893]]
in demand for connected care services. The support provided through the
COVID-19 Telehealth Program will help eligible health care providers
purchase telecommunications services, information services, and devices
necessary to provide critical connected care services, whether for
treatment of coronavirus or other health conditions during the
coronavirus pandemic. The COVID-19 Telehealth Program is funded through
a $200 million appropriation signed into law as part of the CARES Act,
and the program will not rely on Universal Service Fund (USF or Fund)
support. The Commission also establishes a longer-term Connected Care
Pilot Program (Pilot Program) within the Universal Service Fund that
will make available up to $100 million over three years to examine how
the Fund can help support the trend towards connected care services,
particularly for low-income Americans and veterans. The Pilot Program
will help defray eligible health care providers' costs of providing
connected care services, with a particular emphasis on supporting these
services for eligible low-income Americans and veterans. The Commission
expects that the Pilot Program will benefit many low-income and veteran
patients who are responding to a wide variety of health challenges such
as diabetes management, opioid dependency, high-risk pregnancies,
pediatric heart disease, mental health conditions, and cancer. The
Commission also expects that the Pilot Program will provide meaningful
data that will help to better understand how universal service funds
can support health care provider and patient use of connected care
services, and how supporting health care provider and patient use of
connected care services can improve health outcomes and reduce health
care costs. The Commission anticipates that the data and information
collected through the Pilot Program could also have the ancillary
benefit of aiding policy makers and legislators in the consideration of
broader reforms--such as statutory changes or updates to rules
administered by other agencies--that could support this trend towards
connected care.
II. COVID-19 Telehealth Program
 3. The COVID-19 Telehealth Program is one piece of a comprehensive
approach to reducing barriers to telehealth services for health care
providers and their patients throughout the country in response to the
COVID-19 pandemic. Working in step with other federal efforts to
provide relief related to the COVID-19 pandemic, the COVID-19
Telehealth Program will be open to eligible health care providers,
whether located in rural or non-rural areas, and will provide eligible
health care providers support to purchase telecommunications,
information services, and connected devices to provide connected care
services in response to the coronavirus pandemic. The COVID-19
Telehealth Program will only fund monitoring devices (e.g., pulse-ox,
BP monitoring devices), that are themselves connected. The COVID-19
Telehealth Program will not fund unconnected devices that patients can
use at home and then share the results with their medical professional
remotely.
 4. The COVID-19 Telehealth Program will provide selected applicants
full funding for eligible services and devices. The COVID-19 Telehealth
Program has a congressionally appropriated $200 million budget, and
these funds will be available until they are expended or until the
current pandemic has ended. In order to ensure as many applicants as
possible receive available funding, the Commission does not anticipate
awarding more than $1 million to any single applicant. The Commission
will award support to eligible applicants based on the estimated costs
of the supported services and connected devices they intend to
purchase, as described in each health care provider's respective
application. However, in order to give each health care provider
maximum flexibility to respond to changing circumstances during the
pandemic, the Commission does not require applicants to purchase only
the services and connected devices identified in their applications.
They may rather use awarded support to purchase any necessary eligible
services and connected devices. In addition, applicants that have
exhausted initially awarded funding may request additional support.
 5. Application, Evaluation, and Selection Process. Because of the
urgency attendant in combating the COVID-19 outbreak, the Commission
establishes a streamlined application process for the COVID-19
Telehealth Program, separate from the longer application process
adopted for the broader Pilot Program. The Commission directs the
Wireline Competition Bureau (Bureau) to review the applications, in
consultation with the FCC's Connect2Health Task Force and its medical
and public health experts, and announce selected participants and
funding amounts for each selected applicant as rapidly as possible on a
rolling basis, and continue reviewing additional applications and
selecting participants until it has committed all COVID-19 Telehealth
Program funding or the current pandemic has ended. In reviewing
applications, the Commission has a strong interest in targeting funding
towards areas that have been hardest hit by COVID-19. In addition,
given the public health emergency and widespread scope of the
coronavirus pandemic, unlike the broader Pilot Program, the Commission
will not target COVID-19 Telehealth Program funding toward specific
medical conditions, patient populations, or geographic areas. However,
the Commission strongly encourages selected applicants to target the
funding they receive through the COVID-19 Telehealth Program to high-
risk and vulnerable patients to the extent practicable. The Commission
recognizes that some health care providers may have been under pre-
existing strain (e.g., large underserved or low-income patient
population; health care provider shortages; rural hospital closures;
limited broadband access and/or internet adoption) and encourage
applicants to document such factors in their applications. While health
care providers may use the COVID-19 Telehealth Program to treat
patients that have COVID-19, the program is not limited to treating
those types of patients as long as program funds are used ``to prevent,
prepare for, and respond to coronavirus.'' For instance, treating other
types of conditions or patient groups through the Commission's COVID-19
Telehealth Program could free up resources, including physical space
and equipment in a brick-and-mortar health care facility, allow health
care providers to remotely treat patients with other conditions who
could risk contracting coronavirus by visiting a health care facility,
and could reduce health care professionals' unnecessary exposure to
coronavirus. The Commission will also consider as part of a health care
provider's application a showing that telemedicine directly aids in the
prevention of pandemic spread by facilitating social distancing and
similar measures in the community. Connected devices and services like
patient-reported outcome platforms funded through the COVID-19
Telehealth Program must be integral to patient care.
 6. Eligible Health Care Providers. Consistent with the 1996 Act and
the CARES Act, the Commission limits the program to nonprofit and
public eligible health care providers that fall within the categories
of health care providers in section 254(h)(7)(B) of the 1996 Act: (1)
[[Page 19894]]
Post-secondary educational institutions offering health care
instruction, teaching hospitals, and medical schools; (2) community
health centers or health centers providing health care to migrants; (3)
local health departments or agencies; (4) community mental health
centers; (5) not-for-profit hospitals; (6) rural health clinics; (7)
skilled nursing facilities; or (8) consortia of health care providers
consisting of one or more entities falling into the first seven
categories. The Commission has more than two decades of experience
administering its RHC Program for these types of health care providers,
and limiting the COVID-19 Telehealth Program to public and nonprofit
health care providers that fall within these statutory categories is in
the public interest because it will facilitate the administration of
the program and ensure that funding is targeted to health care
providers that are likely to be most in need of funding to respond to
this pandemic while helping ensure that funding is used for its
intended purposes.
 7. Interested health care providers that do not already have an
eligibility determination can obtain one by filing an FCC Form 460 with
the Universal Service Administrative Company (USAC). The Commission
directs USAC to review and process eligibility forms for health care
providers interested in participating in the COVID-19 Telehealth
Program as expeditiously as possible. Health care providers that are
interested in the COVID-19 Telehealth Program, but do not yet have an
eligibility determination from USAC, can still submit applications for
the COVID-19 Telehealth Program while their FCC Form 460 is pending.
 8. Application Process. To be considered for participation in the
COVID-19 Telehealth Program, interested eligible health care providers
must submit applications that, at a minimum, contain the information
detailed in the following.
 Names, addresses, county, and health care provider numbers
(if available), for health care providers seeking funding through the
COVID-19 Telehealth Program application and the lead health care
provider for applications involving multiple health care providers.
 Contact information for the individual that will be
responsible for the application (telephone number, mailing address, and
email address).
 Description of the anticipated connected care services to
be provided, the conditions to be treated, and the goals and
objectives. This should include a brief description of how COVID-19 has
impacted your area, your patient population, and the approximate number
of patients that could be treated by the health care provider's
connected care services during the COVID-19 pandemic. If you intend to
use the COVID-19 Telehealth Program funding to treat patients without
COVID-19, describe how this would free up your resources that will be
used to treat COVID-19 and/or how this would otherwise prevent, prepare
for, or respond to the disease by, for example, facilitating social
distancing.
 Description of the estimated number of patients to be
treated.
 Description of the telecommunications services,
information services, or ``devices necessary to enable the provision of
telehealth services'' requested, the total amount of funding requested,
as well as the total monthly amount of funding requested for each
eligible item. If requesting funding for devices, description of all
types of devices for which funding is requested, how the devices are
integral to patient care, and whether the devices are for patient use
or for the health care provider's use. As noted in the document,
monitoring devices (e.g. pulse-ox, BP monitoring devices) will only be
funded if they are themselves connected.
 Supporting documentation for the costs indicated in their
application, such as a vendor or service provider quote, invoice, or
similar information.
 A timeline for deployment of the proposed service(s) and a
summary of the factors the applicant intends to track that can help
measure the real impact of supported services and devices.
 9. Additionally, COVID-19 Telehealth Program applicants will also
be required, at the time of submission of their application, to
certify, among other things, that they will comply with the Health
Insurance Portability and Accountability Act (HIPAA) and other
applicable privacy and reimbursement laws and regulations, and
applicable medical licensing laws and regulations, as waived or
modified in connection with the COVID-19 pandemic, as well as all
applicable COVID-19 Telehealth Program requirements and procedures,
including the requirement to retain records to demonstrate compliance
with the COVID-19 Telehealth Program requirements and procedures for
three years following the last date of service, subject to audit.
Health care providers that participate in the COVID-19 Telehealth
Program must also comply with all applicable federal and state laws,
including the False Claims Act, the Anti-Kickback Statute, and the
Civil Monetary Penalties Law, as waived or modified in connection with
the COVID-19 pandemic. Further, applicants will also be required to
certify that they are not already receiving or expecting to receive
other federal or state funding for the exact same services or devices
for which they are requesting support under the COVID-19 Telehealth
Program.
 10. The Wireline Bureau will issue a public notice announcing the
date when COVID-19 Telehealth Program applications will be accepted and
instructions for filing applications with the Commission. This date
will be after April 9, 2020. Applicants will be required to complete
each section of the application and make the required certifications at
the end of the application. Applicants may request that any materials
or information submitted to the Commission in its application be
withheld from public inspection pursuant to the procedures set forth in
section 0.459 of the Commission's rules.
 11. Instructions for Filing Applications. COVID-19 Telehealth
Program applications must reference WC Docket No. 20-89, and must be
filed electronically consistent with the instructions provided in a
subsequent public notice. All filings must be addressed to the
Commission's Secretary, Office of the Secretary, Federal Communications
Commission. Applicants must also send a courtesy copy of their
application via email to [email protected].
 12. Evaluation of Applications and Selection Process. The Bureau,
in consultation with the FCC's Connect2Health Task Force, will evaluate
the COVID-19 Telehealth Program applications and will select
participants based on applicants' responses to the criteria listed in
the document. The Commission's goal is to select applications that
target areas that have been hardest hit by COVID-19 and where the
support will have the most impact on addressing the health care needs.
In selecting applicants, the Commission directs the Bureau to consider
the funding sought by each applicant compared to the total COVID-19
Telehealth Program budget. This does not mean that the Bureau will
evaluate applications based solely on requested funding, but the Bureau
will seek to select as many applicants as reasonably possible within
the COVID-19 Telehealth Program's limited budget. Upon selection, the
Bureau will provide additional guidance to program participants, as
necessary, to facilitate the implementation of the COVID-19 Telehealth
Program. Applicants who are selected for the COVID-19 Telehealth
[[Page 19895]]
Program may later submit applications to participate in the broader
Pilot Program but may not request funding for the same exact services
from both programs at the same time.
 13. Requesting Funding, Invoicing, and Disbursements. The
Commission directs the Bureau and the Office of the Managing Director
(OMD) to develop processes for selected applicants to submit invoices
and receive reimbursements for services and devices supported through
the COVID-19 Telehealth Program, and any necessary subsequent filings.
The Commission also directs OMD and the Bureau to include in the
application forms or subsequent filings by program participants any
information necessary to satisfy the Commission's oversight
responsibilities and/or agency specific/government-wide reporting
obligations associated with the $200 million appropriation by Congress.
After receiving the eligible services and/or equipment, health care
provider will submit invoicing forms on a monthly basis and supporting
documentation to the Commission to receive reimbursement for the cost
of the eligible services and/or devices they have received from their
applicable service providers or vendors under the COVID-19 Telehealth
Program. The Bureau and OMD shall develop a process for reviewing the
monthly invoicing forms and supporting documentation and for issuing
disbursements directly to the participating health care providers
rather than to the applicable service providers or vendors. COVID-19
Telehealth Program health care provider participants will be required
to make certifications as part of the invoicing form submission to
ensure that COVID-19 Telehealth Program funds are used for their
intended purpose.
 14. The COVID-19 Telehealth Program will not provide funding for
health care provider administrative costs associated with participating
in the COVID-19 Telehealth Program (e.g., costs associated with
completing COVID-19 Telehealth Program applications and other
submissions) or other miscellaneous expenses (e.g., doctor and staff
time spent on the COVID-19 Telehealth Program and outreach). The
Commission emphasizes that COVID-19 Telehealth Program funds may only
be used for services and devices covered under the CARES Act. The costs
of ineligible items must not be included in the reimbursement requests
for the COVID-19 Telehealth Program. To guard against potential waste,
fraud, and abuse, the Commission makes clear that participating health
care providers are prohibited from selling, reselling, or transferring
services or devices funded through the COVID-19 Telehealth Program in
consideration for money or any other thing of value.
 15. Procurement for COVID-19 Telehealth Program-Supported Services
and Equipment, and Document Retention. The COVID-19 Telehealth Program
is funded through a congressional appropriation and not the USF. Given
the immediate need to award and disburse the COVID-19 Telehealth
Program funding to health care providers, the Commission will not
require COVID-19 Telehealth Program participants to conduct a
competitive bidding process to solicit and select eligible services or
devices, or otherwise comply with the competitive bidding requirements
that apply to the RHC Program and the broader Pilot Program. The
Commission finds that, in light of the coronavirus pandemic and ongoing
community efforts to slow its spread, requiring COVID-19 Telehealth
Program participants to seek competitive bids prior to requesting
funding would cause unnecessary delays and pose an unreasonable burden
on health care providers during this unprecedented time. The Commission
also finds that it would not be in the public interest during this
national health crisis to prohibit participating health care providers
from receiving gifts or things of value from service providers valued
at over $20, including, but not limited to devices, equipment, free
upgrades or other items.
 16. While the Commission will not require health care providers to
conduct a competitive procurement process to receive COVID-19
Telehealth Program funding, the Commission strongly encourages
applicants to purchase cost-effective eligible services and devices to
the extent practicable during this time. The Commission also emphasizes
that health care providers and service providers must comply with the
requirements applicable to the COVID-19 Telehealth Program. To help
guard against potential waste, fraud, and abuse, participants in the
COVID-19 Telehealth Program must maintain records related to their
participation in the COVID-19 Telehealth Program to demonstrate their
compliance with the program requirements for at least three years from
the last date of service under the program and must present that
information to the Commission or its delegates upon request. Health
care providers participating in the COVID-19 Telehealth Program may
also be subject to compliance audits in order to ensure compliance with
the rules and requirements for the COVID-19 Telehealth Program and must
provide documentation related to their participation in the COVID-19
Telehealth Program in connection with any such audit.
 17. Outreach for COVID-19 Telehealth Program. Upon release of the
R&O, in order to ensure that health care providers are aware of
available funding under the COVID-19 Telehealth Program, the Commission
will, to the extent possible, coordinate with other federal agencies to
distribute information about the program to the health care community.
The Commission also directs the Bureau to coordinate with the FCC's
Connect2Health Task Force and USAC as necessary to promote and announce
the COVID-19 Telehealth Program to interested stakeholders including
service providers and health care providers. The Commission is
committed to addressing the needs of health care providers as demand
for connected care services increases to address the coronavirus
pandemic. Such coordination and outreach will improve the overall
efficacy of the COVID-19 Telehealth Program.
 18. Post-Program Feedback. Within six months after the conclusion
of the COVID-19 Telehealth Program, COVID-19 Telehealth Program
participants should provide a report to the Commission in a format to
be determined by the Bureau on the effectiveness of the COVID-19
Telehealth Program funding on health outcomes, patient treatment,
health care facility administration, and any other relevant aspects of
the pandemic. Such information could include feedback on the
application and invoicing processes, in what ways funding was helpful
in providing or expending telehealth services, including anonymized
patient accounts, how funding promoted innovation and improved health
outcomes, and other areas for improvement. Specific information about
how to provide feedback and associated deadlines will be provided to
COVID-19 Telehealth Program participants at a later time. This
information will assist efforts to respond to pandemics and other
national emergencies in the future.
III. Connected Care Pilot Program
 19. The Pilot Program will make available up to $100 million over a
three-year funding period, separate from the budgets of the existing
universal service programs, to cover 85% of the eligible costs of
broadband connectivity, network equipment, and information services
necessary to provide connected care services to the intended patient
[[Page 19896]]
population. All eligible nonprofit and public health care providers
that fall within the statutory categories under section 254(h)(7)(B),
regardless of whether they are non-rural or rural, can apply for the
Pilot Program. Eligible health care providers must first submit
applications to the Commission, and after review, the Commission will
announce the selected projects and provide further information on
additional requirements for the Pilot Program.
 20. For purposes of the Pilot Program, the Commission considers
``connected care'' as a subset of telehealth that uses broadband
internet access service-enabled technologies to deliver directly to
patients' remote medical, diagnostic, and treatment-related services
outside of traditional brick and mortar medical facilities--
specifically to patients at their mobile location or residence. For
purposes of the Pilot Program, the Commission also defines
``telehealth'' as the broad range of health care-related applications
that depend upon broadband connectivity, including telemedicine;
exchange of electronic health records; collection of data through
Health Information Exchanges and other entities; exchange of large
image files (e.g., X-ray, MRIs, and CAT scans); and the use of real-
time and delayed video conferencing for a wide range of telemedicine,
consultation, training, and other health care purposes. Connected care
services can be provided by doctors, nurses, or other health care
professionals. Health care providers will have the flexibility to
identify the medical conditions to be treated through their proposed
pilot projects, and whether to treat a single medical condition or
multiple medical conditions. For purposes of the Pilot Program, the
Commission uses the U.S. Department of Health and Human Services'
definition of ``medical condition'' to identify the types of health
conditions that can be treated through the Pilot--``any condition,
whether physical or mental, including but not limited to any condition
resulting from illness, injury (whether or not the injury is
accidental), pregnancy, or congenital malformation.''
 21. In reviewing applications, the Commission is interested in
targeting limited Pilot Program funding towards pilot projects that are
primarily focused on treating public health epidemics, opioid
dependency, mental health conditions, high-risk pregnancy, or chronic
or recurring conditions that typically require at least several months
to treat, including, but not limited to, diabetes, cancer, kidney
disease, heart disease, and stroke recovery. Focusing Pilot Program
funding on these conditions identified best ensures that limited Pilot
Program resources are targeted to populations that are most in need.
Moreover, targeting these types of health conditions, which impact
large segments of the population, and often require several months or
more of treatment, or are public health crises will provide more
meaningful data to track progress towards the Pilot Program goals of
helping health care providers to improve health outcomes and reduce
costs, and will also promote the efficient, fiscally responsible use of
universal service funds.
 22. Budget Number of Pilot Projects and Support Amount Per Project,
Funding Duration, and Discount Level. The Pilot Program will make
available up to $100 million over three years for selected pilot
projects. Targeting this amount of funding for qualifying eligible
services and equipment under the Pilot Program is sufficient to obtain
meaningful data and ensure significant interest from a wide range of
participants. Funding the Pilot Program in this manner will not
significantly increase the contributions burden on consumers and will
not impact the budgets of, or disbursements for, the other existing
universal service programs.
 23. To secure the funds for the Pilot Program, the Commission
directs USAC to separately collect funds for the Pilot Program each
quarter beginning with the demand filing for the fourth quarter of
2020. USAC should collect necessary funds up to the amount of the
budget over the entire three-year period in order to minimize any
impact on the contribution factor. The Commission anticipates the
collection schedule would increase the quarterly contribution factor by
approximately 0.11%. Moreover, by starting the collection before
selecting the pilot projects, USAC will have funding on hand as soon as
the pilot projects begin to seek support. Requests for funding may vary
year to year and therefore Pilot Program funding may not be distributed
evenly each year. While anticipating significant participation in the
Pilot Program, total amount disbursed will depend upon those funds
ultimately committed by USAC, invoiced, and disbursed. Unused collected
Pilot Program funds will be carried forward to subsequent quarters over
the duration of the Pilot Program for use by pilot projects and need
not be returned to offset future collections. Any unused funds that
remain at the end of the Pilot Program will be used to reduce
collections for the ongoing universal service programs.
 24. Discount Level. The Pilot Program will provide universal
service support for 85% of the cost of eligible services and equipment.
This support amount will allow for funding of a sufficient number of
pilot projects to provide meaningful data and provide substantial
financial incentive for health care providers to participate in the
Pilot Program. Consistent with the Commission's existing rules for the
Healthcare Connect Fund Program, health care providers must contribute
their portion of the eligible costs from eligible sources (e.g., the
applicant, eligible health care provider, participating patients, or
state, federal, or Tribal funding or grants) and cannot use ineligible
sources (e.g., direct payments from vendors or service providers) to
pay their share of the requested services.
 25. Number of Pilot Projects and Support Amount Per Project. Based
on the record, the Commission declines to set a limit on the number of
pilot projects selected for the Pilot Program or the amount of support
requested per pilot project. Setting a fixed number of pilot projects
or a fixed amount per-project will artificially limit the number of
pilot projects to be funded even before pilot project proposals are
submitted and evaluated, and will not provide enough flexibility to
select a diverse group of pilot projects. The Commission does not
anticipate allocating all of the Pilot Program funds on one or two
large projects. In reviewing pilot project applications, the Commission
will be mindful of the reasonableness of the estimated total support
amount indicated in each application, looking specifically at the
proportion to the total Pilot Program budget and individual project
size, to provide sufficient funding to enough projects to generate
meaningful data.
 26. Duration. The Pilot Program will provide selected pilot
projects support for a three-year funding period with separate
transition periods of up to six months before and after the three-year
funding period. Specifically, selected pilot participants will have up
to six months from the date of their initial funding commitment letter
from USAC to organize and start their pilot projects (including, but
not limited to procuring eligible services or network equipment), and
up to six months after the funding end date on their final funding
commitment letters to wind down their pilot projects and complete any
necessary administrative tasks. Providing a ramp up period of up to six
months will allow sufficient time for health care providers to
implement pilot project plans and begin offering
[[Page 19897]]
connected care services. Extending the Pilot Program for too long risks
stale data, and therefore providing selected pilot projects up to six
months to ramp and up to six months to wind down to ensure a reasonable
timeframe to obtain meaningful, current data. There may be unforeseen
circumstances that arise when implementing or operating the pilot
projects, and therefore the Bureau is delegated authority to grant
limited extensions of deadlines in order to ensure the successful
operation of the Pilot Program.
 27. Eligible Health Care Providers, Patients, and Service
Providers. The Commission establishes the Pilot Program pursuant to the
legal authority under section 254(h)(2)(A), which directs the
Commission to establish competitively neutral rules to enhance, to the
extent technically feasible and economically reasonable, access to
``advanced telecommunications and information services'' for public and
nonprofit health care providers. Accordingly, for purposes of the Pilot
Program, the Commission limits participation to the statutorily-
enumerated categories of ``health care provider.'' Eligible nonprofit
or public health care providers include: (1) Post-secondary educational
institutions offering health care instruction, teaching hospitals, and
medical schools; (2) community health centers or health centers
providing health care to migrants; (3) local health departments or
agencies; (4) community mental health centers; (5) not-for-profit
hospitals; (6) rural health clinics; (7) skilled nursing facilities; or
(8) consortia of health care providers consisting of one or more
entities falling into the first seven categories.
 28. To promote diversity among pilot projects, and to maximize the
data collected, Pilot Program support will be available to health care
providers located in both rural and non-rural areas. Section
254(h)(2)(A) does not limit the provision of universal service support
to health care providers in rural areas. Consistent with the record,
the Commission believes that the Pilot Program should target vulnerable
and medically underserved patients regardless of whether these patients
or their health care providers are located in a rural or non-rural
area.
 29. In selecting pilot projects, the Commission has a strong
preference for health care providers that have either (1) experience
with providing telehealth or connected care services to patients (e.g.,
remote patient monitoring, store-and-forward imaging, or video
conferencing) beyond using electronic health records, or (2) a
partnership with another health care provider, government agency, or
designated telehealth resource center with such experience that will
work with the health care provider to implement its proposed pilot
project. These types of health care providers are more likely to submit
pilot projects that can be successfully implemented within the three-
year period and better enable the Commission to collect meaningful data
on the impact of the Pilot Program. At the same time, this approach
also provides a path for eligible health care providers that lack
telehealth experience, many of which may serve high percentages of
veterans and low-income patient populations, to participate in the
Pilot Program.
 30. Targeted Patient Populations. The Commission has a strong
preference for pilot projects that can demonstrate that they will
primarily benefit veterans or low-income individuals. Veteran and low-
income patients are more likely to have complex, high-cost health care
needs, reside in areas with physician shortages, and may not have
mobile or residential internet access for connected care services.
Therefore, emphasizing pilot projects that will primarily benefit low-
income patients or veterans is appropriate as it will expand connected
care services to individuals who are less likely to have access to
these innovative services without universal service support.
Participating patients may only participate in one pilot project and
cannot participate in multiple pilot projects as part of the Pilot
Program.
 31. The Commission also concludes that health care providers are in
the best position to identify patients for their pilot projects. To the
extent a selected pilot project asserts that it will primarily benefit
low-income or veteran patients, the pilot project must maintain
adequate documentation of the numbers of participating veterans or low-
income patients served through that pilot project compared to other
patients served. For purposes of the Pilot Program, health care
providers can determine whether a patient is considered low-income by
determining whether (1) the patient is eligible for Medicaid or (2) the
patient's household income is at or below 135% of the U.S. Department
of Health and Human Services Federal Poverty Guidelines. Using these
two criteria to identify low-income patients for purposes of the Pilot
Program will allow a large number of low-income Americans to
participate in the Pilot Program, including many residents of medically
underserved rural areas. In addition, using these criteria will
facilitate efficient program administration, minimize the potential for
waste, fraud, and abuse, while still appropriately targeting the
population of patients that the Commission intends to primarily benefit
from connected care services through the Pilot Program.
 32. Health care providers may determine whether a patient qualifies
as a veteran for purposes of the Pilot Program by confirming that the
patient qualifies for health care through the VA. The Commission
declines to apply an income limit to veterans. While certain veterans
who are eligible for health care through the VA undergo means testing
when enrolling for VA health care, other veterans (e.g., those with
service-connected disabilities) may not be required to undergo means
testing. The Commission believes that veterans, regardless of income
level, who are eligible for health care through the VA are an important
population to include in the Pilot Program. As reported in the Bureau's
Veterans Broadband Report to Congress (May 1, 2019), a significant
number of veterans suffer from a disability, reside in rural areas,
and/or are older than the general population, and therefore would stand
to benefit from connected care services. While the Commission declines
to adopt an income criterion for veterans, the expectation is that
pilot projects focused on serving veterans will primarily focus on
veteran populations that are more likely to experience issues accessing
health care.
 33. Service Providers. Eligible health care providers that
participate in the Pilot Program can receive support for qualifying
broadband service from any broadband provider, regardless of whether
that provider is designated as an eligible telecommunications carrier
(ETC). Section 254(c)(3) makes clear that, in addition to the supported
services included in the definition of universal service in section
254(c), ``the Commission may designate additional services for such
support mechanisms for . . . health care providers for the purposes of
subsection (h).'' Section 254(h)(2)(A) in turn directs the Commission
``to enhance to the extent technically feasible and economically
reasonable, access to advanced telecommunications services and
information services'' for health care providers and does not by its
language require that such services be provided by ETCs. The Commission
has previously explained that language in section 254(e) limiting
universal service reimbursements to ETCs does not apply to services
supported under section 254(h)(2)(A). Moreover, allowing non-ETCs to
provide broadband service through the Pilot Program will incent
participation among a diverse range of both health care providers and
service
[[Page 19898]]
providers while promoting flexibility, competition, and innovation.
 34. Eligible Services and Equipment. The Pilot Program will fund
85% of the qualifying costs incurred by eligible health care providers.
These costs include: (1) Patient broadband internet access services,
(2) health care provider broadband data connections, (3) other
connected care information services, and (4) certain network equipment.
 35. Patient Broadband internet Access Service. Funding health care
provider purchases of broadband internet access service for
participating patients to receive connected care services will help
expand connected care services to many Americans, particularly low-
income and veteran patients. Many low-income consumers and veterans do
not have broadband internet access service at all, while other low-
income consumers and veterans may not have broadband internet access
service that is sufficient to receive connected care services. Aside
from the VA's tablet loan program, which serves a limited number of
veterans, it appears that no other federal program provides health care
providers funding dedicated to purchase patient broadband internet
access service for connected care services. Some health care providers
are already addressing this gap by funding patient broadband internet
access service for certain low-income or vulnerable patients who lack
broadband service at home.
 36. The Pilot Program will provide funding for participating health
care providers to purchase mobile or fixed broadband internet access
service for participating patients who do not already have broadband
internet access service or who lack sufficient broadband internet
access service necessary to participate in the specific pilot project.
Insufficient broadband for connected care services could include
subscriptions to low-bandwidth connections, low usage allowances, or
other inadequate service levels--all of which negatively impact
patients' and health care providers' ability to use telehealth
services. For the Pilot Program, funding these services will expand
health care providers' digital footprints for purposes of providing
connected care services, and allow health care providers to serve more
patients through the Pilot Program and thus enhance health care
providers' access to advanced telecommunications and information
services.
 37. To ensure that funding for patient broadband internet access
service is targeted appropriately, the Commission will require Pilot
Program applicants seeking support for patient broadband internet
access service to identify the estimated number of patient broadband
connections that the health care provider intends to purchase for
purposes of providing connected care services to patients who lack
broadband service or have insufficient broadband services. A health
care provider seeking funding for patient broadband internet access
service must also explain in its application how it plans to assess
whether a patient lacks broadband service or has insufficient broadband
internet access service for the proposed connected care service based
on speed, technology (e.g., fixed or mobile broadband), or other
appropriate service characteristics. It is appropriate under section
254(h)(2)(A) to fund the whole patient broadband connection as long as
it is ``primarily'' used for activities that are integral, immediate,
and proximate to the provision of connected care services to
participating patients. In contrast to broadband connectivity for a
single health care provider facility, it would not be ``technically
feasible and economically reasonable,'' for health care providers to
track, monitor, and cost-allocate non-connected care uses of the
supported patient broadband connections.
 38. Health Care Provider Broadband Data Connections. The Pilot
Program will also provide support for eligible, participating health
care providers to purchase the broadband data connections needed to
provide connected care services under the Pilot Program. While many
eligible health care providers may already have the broadband
connectivity necessary to participate in the Pilot Program, other
eligible health care providers may require new or additional broadband
data connections to participate in the Pilot Program. Providing funding
for health care provider broadband data connections in this latter
situation will incentivize health care provider participation, which,
in turn, will aid in the ability to collect meaningful data. Moreover,
requiring Pilot Program applicants that require broadband data
connections in order to provide connected care services to seek support
for those connections through the Healthcare Connect Fund would produce
duplicative application requirements with minimal benefit to either
program. The Commission expects that funding health care provider
connectivity under these circumstances will not subsume the budget for
the Pilot Program given the broad participation in the existing
Healthcare Connect Fund Program which provides funding for health care
provider broadband connectivity.
 39. To avoid duplicate funding and to stretch limited Pilot Program
funds, eligible health care providers participating in the Pilot
Program may not request or receive funding for broadband data
connections for which they already receive funding through the
Healthcare Connect Fund Program or other federal programs, and
similarly may not request or receive funding for broadband data
connections through the Healthcare Connect Fund Program or other
federal programs for which they have already received funding through
the Pilot Program. In addition, the Pilot Program will not fund
broadband connections between health care providers as these
connections are already eligible for funding through the Healthcare
Connect Fund Program, and the Commission does not believe that funding
connections between health care providers is necessary for the Pilot
Program given the focus on supporting the provision of connected care
services to participating patients in their homes or mobile locations.
 40. Other Connected Care Information Services. The Pilot Program
will also provide support for information services other than broadband
connectivity that eligible, participating health care providers use for
connected care as part of the Pilot Program. Health care providers
incur significant costs to provide connected care services, including,
but not limited to, the costs of services (other than broadband) for
connected care, and that many of these costs typically are not
reimbursable through health care payors, which can present an obstacle
to connected care services. Funding information services for health
care providers' use for connected care through the Pilot Program,
therefore, could enhance health care providers' access to such
information services and encourage innovation in the way health care
providers provide connected care services to their patients. The
Commission also believes funding these information services will
encourage broader participation in the Pilot Program. The Commission,
however, will not fund the costs associated with medical professional
review of data or images transmitted or stored through such services,
or services which have a primary purpose other than capturing,
transmitting and storing data to facilitate connected care. These costs
fall outside the scope of the Commission's statutory authority under
Section 254(h)(2)(A). Mobile applications will only be funded to the
extent that they are part of a qualifying
[[Page 19899]]
information service. Eligible health care providers that seek Pilot
Program support for an information service should include in their
application a thorough description of the service, including a
description of the primary function/s of the service, and whether and
how it facilitates the capturing, transmission (including video
visits), and storage of data for connected care.
 41. Network Equipment. The Pilot Program will provide funding to
eligible, participating health care providers for necessary network
equipment for broadband connectivity funded through the Pilot Program
for connected care services. This funding can only be used for network
equipment that is necessary to make Pilot Program funded broadband
services for connected care services functional, or to operate, manage,
or control such services, and must not be used for purposes other than
providing connected care services under the Pilot Program. Health care
providers seeking funding for qualifying network equipment for other
health care uses may apply for such funding under the Healthcare
Connect Fund Program. Further, to avoid duplicate funding issues,
eligible health care providers participating in the Pilot Program may
not request and receive funding for network equipment for which they
already applied or received funding through the Healthcare Connect Fund
Program or another federal program, and similarly may not request and
receive through the Healthcare Connect Fund Program or another federal
program funding for network equipment for which the health care
provider receives funding through the Pilot Program. Moreover,
consistent with Sec. 54.9 of the Commission's rules, the Pilot Program
will prohibit health care providers from using universal service funds
to purchase equipment or services for use through the Pilot Program
that are produced or provided by a company that the Commission has
identified as posing a national security threat to the integrity of
communications networks or the communications supply chain.
 42. End-User Devices and Medical Equipment. Consistent with the
Commission's long-standing approach to implementing its universal
service programs, the Pilot Program will not fund end-user devices or
medical equipment. The Commission has consistently declined to fund
equipment unless it is ``necessary'' for the transmission function of
the service. Additionally, providing limited Pilot Program funding to
end-user devices and medical equipment costs may not be economically
reasonable because it could significantly reduce the Pilot Program
funding available for the costs directly associated with providing
connected care services, and would limit the number of pilot projects
the Commission can select. The record indicates that some selected
pilot projects may be able to obtain grant funding and other funding
for end-user devices or medical equipment where needed to participate
in the Pilot Program. The Commission therefore encourages eligible
health care providers to explore available grant and other funding
opportunities, potential partnerships and other avenues that could help
them obtain end-user and medical devices necessary to participate in
the Pilot Program.
 43. Administrative Expenses and Other Miscellaneous Expenses.
Consistent with the RHC Program and the RHC Pilot Program, the Pilot
Program will not provide funding for health care provider
administrative costs associated with participating in the Pilot Program
(e.g., costs associated with completing Pilot Program applications and
other submissions) or other miscellaneous expenses (e.g., doctor and
staff time spent on the Pilot Program and outreach). This is also
consistent with the U.S. Department of Agriculture's Distance Learning
and Telemedicine grant program. Section 254 focuses on the availability
of and access to ``services.'' Funding administrative or miscellaneous
expenses associated with participating in the Pilot Program would not
fulfill this statutory focus. Allocating scarce Pilot Program funding
to administrative costs would significantly reduce the Pilot Program
funding available for the costs directly associated with providing
connected care services. Additionally, if the Commission was to provide
direct support for administrative expenses, it would necessitate
additional application requirements, guidelines, and other
administrative controls to protect such funding from waste, fraud, and
abuse. This would increase the administrative burden on USAC and on
applicants as well.
 44. Application and Evaluation Process. To participate in the Pilot
Program, a prospective health care provider must first obtain an
eligibility determination from USAC by submitting an FCC Form 460
(Eligibility and Registration Form) along with supporting documentation
to USAC to verify its eligibility to participate in the Pilot Program.
After confirming its eligibility for the Pilot Program, the applicant
must submit its pilot project proposal to the Commission describing its
proposed pilot project and providing information that will facilitate
the evaluation and eventual selection of high-quality pilot projects in
order to participate in the Pilot Program. Specifically, the applicant
must show how its proposed pilot project meets the criteria outlined in
the following. The Commission expects each applicant to present a clear
research and evaluation strategy for meeting the health care needs of
participating patients through the use of connected care services and
how the proposed pilot project will accomplish these objectives.
Successful applicants will be able to demonstrate that they have a
viable strategic plan for delivering innovative connected care services
directly to patients while leveraging existing resources or telehealth
programs within their state or region. The Commission will give greater
consideration to applications that propose to provide connected care
services to a significant number of low-income or veteran patients in a
given state or region. An application that intends to provide connected
care services to only a de minimis number of low-income or veteran
patients will not be selected.
 45. To be eligible for participation in the Pilot Program,
interested parties should submit applications that, at a minimum,
contain the following required information:
 Names and addresses of all health care providers that will
participate in the proposed pilot project and the lead health care
provider for proposals involving multiple health care providers.
 Contact information for the individual that will be
responsible for the management and operation of the proposed pilot
project (telephone number, mailing address, and email address).
 Health care provider number(s) and type(s) (e.g., not-for-
profit hospital, community mental health center, community health
center, rural health clinic), for each health care provider included in
proposal.
 Description of each participating health care provider's
previous experience with providing telehealth services (other than
electronic health records) or experience and name of a partnering
health care provider or organization.
 Description of the plan for implementing and operating the
pilot project, including how the pilot project intends to recruit
patients, estimated amount of ramp-up time necessary for the pilot
project (not to exceed six months), plans to obtain any necessary end-
user devices (e.g., tablets, smartphones) and medical devices for
[[Page 19900]]
the connected care services that the pilot project will provide, and to
what extent the pilot project can be self-sustaining once established.
 Description of the connected care services the proposed
pilot project will provide, the conditions to be treated, the health
care provider's experience with treating those conditions, the goals
and objectives of the proposed pilot project (including the health care
provider's anticipated goals with respect to reaching new or additional
patients, and improved patient health outcomes), expected health care
benefits to the patients, health care provider, or the health care
industry that will result from the proposed pilot project, and how the
pilot project will achieve each of the goals of the Pilot Program.
 Documentation of the participating health care
provider(s)'s financial health (e.g., recent audited balance sheets and
income statements that are no more than two years old).
 Description of the estimated number of patients to be
treated.
 Description of any commitments from community partners,
including physicians, hospitals, health systems, and home health/
community providers to the success of the proposed pilot project.
 Description of the anticipated level of broadband service
required for the proposed pilot project, including the necessary
speeds, the technologies to be used (e.g., mobile or fixed broadband)
and any other relevant service characteristics (e.g., LTE service).
 Description of the estimated number of patient broadband
connections that the health care provider intends to purchase for
purposes of providing connected care services to patients who lack
broadband service or have insufficient broadband services. This
description must include an explanation of how the health care provider
plans to assess whether a patient lacks broadband service or has
insufficient broadband internet access service for the indicated
connected care service based on speed, technology or data cap
limitations.
 If seeking support for an information service used to
provide connected care, other than broadband connectivity, used to
provide connected care, a description of the service, including a
description of the primary function/s of the service, and whether it
facilitates the capturing, transmission, and storage of data for
connected care.
 Estimated total project costs, including costs eligible
for support through the Pilot Program and costs not eligible for Pilot
Program support but still necessary to implement the proposed pilot
project. This entry must include the total estimated eligible funding
(85%) to be requested from the Pilot Program per year over the three-
year funding period.
 A list of anticipated sources of financial support for the
pilot project costs not covered by the Pilot Program.
 Description of the metrics for the proposed pilot project
that are relevant to the Pilot Program goals and how the participating
providers will collect those metrics. Examples of the types of metrics
the Commission is interested in include: reductions in potential
emergency room or urgent care visits; decreases in hospital admissions
or readmissions; condition-specific outcomes, such as reductions in
premature births or acute incidents among suffers of a chronic illness,
and patient satisfaction as to with their overall health status.
 Description of how the health care provider intends to
collect, track, and store, the required Pilot Program data.
 Further, to facilitate the review in selecting a diverse set of
projects and target Pilot Program funds to geographic areas and
populations most in need of USF support for connected care, applicants
should also provide the following information, as applicable:
 Description of whether the health care provider is located
in a rural area, on Tribal lands, or is associated with a Tribe, or
part of the Indian Health Service. If the health care provider is not
located in a rural area, include a description of whether the health
care provider will primarily serve veterans or low-income patients
located in rural areas as defined in the RHC Program rules, and
identify those specific rural areas.
 Listing of all Department of Health and Human Services,
Health Resources & Services Administration (HRSA) designated Health
Professional Shortage Areas (for primary care or mental health care
only) or HRSA designated Medically Underserved Areas that will be
served by the proposed project.
 Description of whether the pilot project will primarily
benefit low-income or veteran patients, and if so, the estimated number
or percentage of those patients the project will serve compared to the
total number of patients that the pilot project estimates serving.
 Description of whether the primary purpose of the proposed
pilot project is to provide connected care services to respond to a
public health epidemic, or to provide connected care services for
opioid dependency, high-risk pregnancy/maternal mortality, mental
health conditions (e.g., substance abuse, depression, anxiety
disorders, schizophrenia, eating disorders and addictive behavior) or
conditions of a chronic or long term nature (including, but not limited
to heart diseases, diabetes, cancer, stroke).
 46. Additionally, applicants will also be required, at the time of
submission of their application, to certify, among other things, that
they will comply with the Health Insurance Portability and
Accountability Act (HIPAA) and other applicable privacy and
reimbursement laws and regulations, and applicable medical licensing
laws and regulations, as well as all applicable Pilot Program
requirements and procedures, including the requirement to retain
records to demonstrate compliance with the Pilot Program rules and
requirement for five years, subject to audit. Health care providers
that participate in the Pilot Program must also comply with all
applicable federal and state laws, including the False Claims Act, the
Anti-Kickback Statute, and the Civil Monetary Penalties Law. The
Commission understands that health care providers must routinely
navigate these laws in other contexts. Thus, health care providers that
are interested in applying for the Pilot Program should speak to their
compliance experts prior to submitting an application to participate in
the Pilot Program. Further, applicants will also be required to certify
that they are not already receiving or expecting to receive other
federal funding for the exact same services eligible for support under
the Pilot Program. The Commission recognizes the need to possibly waive
certain of the RHC Program rules that extend to the Pilot Program in
order to implement the Pilot Program, and therefore also request that
applicants identify in their application, as applicable, any Commission
rules that extend to the Pilot Program in the R&O from which they may
need a waiver in order to participate in the Pilot Program, if
selected.
 47. Instructions for Filing Applications. The Bureau will issue a
public notice announcing the deadline for submitting Pilot Program
applications and instructions for filing applications with the
Commission. Pilot Program applications will be due the later of 45 days
from the effective date of the Pilot Program rules or July 31, 2020.
Applicants will be required to complete each section of the application
and make the required certifications at the end of the application.
Applicants may request that any materials or information submitted to
the Commission in its application be withheld from public inspection
[[Page 19901]]
pursuant to the procedures set forth in Sec. 0.459 of the Commission's
rules. Applications must reference WC Docket No. 18-213 only, and will
be required to file electronically consistent with the instructions
provided in a subsequent public notice. All filings must be addressed
to the Commission's Secretary, Office of the Secretary, Federal
Communications Commission. Applicants must also send a courtesy copy of
their application via email to [email protected].
 48. Evaluation of Proposals and Selection of Pilot Projects. The
Commission plans to evaluate the applications and select pilot project
proposals based on applicants' responses to the criteria. The
Commission will also consider the cost of the proposed pilot project
compared to the total Pilot Program budget. This does not mean the
Commission will evaluate proposed pilot projects based solely on a
proposed pilot project's total budget but will seek to select an array
of pilot projects that can all be funded within the Pilot Program's
budget.
 49. In choosing participants for the Pilot Program, the Commission
will also consider whether the applicant has successfully developed,
coordinated, or otherwise implemented a telehealth program. While the
Commission will consider applicants' responses to all of the
application criteria factors listed in the document when evaluating
pilot project proposals, they are not determinative of whether a pilot
project will be selected because recognition that each pilot project
proposal will have its own unique strengths and potential challenges.
However, the Commission's goal is to select pilot projects that present
a well-defined plan for meeting the health care needs of participating
patients, with a particular emphasis on eligible low-income and veteran
patients and the Pilot Program goals.
 50. The Commission directs the Bureau to establish an application
schedule consistent with the direction provided in the R&O, to review
the applications, to consult with the FCC's Office of Economics and
Analytics, Office of Managing Director, Office of General Counsel, and
the FCC Connect2Health Task Force, as needed, and to recommend pilot
project selections to the Commission. To the extent possible in
reviewing applications, the Commission also encourages the Bureau to
consult with federal agencies with expertise in telehealth or the
federally designated Telehealth Resource Centers. After the Commission
selects the pilot projects to participate in the Pilot Program, the
Bureau will announce the selected pilot projects. After the selection
of pilot projects, additional specifics will also be provided
concerning the requirements outlined in the R&O, including additional
instructions and procedural information regarding, requests for
funding, invoicing, and the specific data to be reported and reporting
format.
 51. Procurement of Supported Services. The Commission is adopting,
to the extent feasible, the competitive bidding requirements for the
Healthcare Connect Fund Program for participants in the Pilot Program.
Specifically, health care providers can seek bids for multi-year or
single-year contracts during the competitive bidding process. If a
health care provider only seeks bids for a single-year contract, it
will need to conduct a new competitive bidding process for each year of
the Pilot Program. The competitive bidding requirements for the Pilot
Program are in addition to and do not supplant any applicable state or
local procurement requirements.
 52. Similar to the competitive bidding exemptions provided under
the Healthcare Connect Fund Program, eligible health care providers
participating in the Pilot Program will not be required to seek
competitive bids if:
 The eligible health care provider seeks support for
services and equipment purchased from Master Services Agreements (MSAs)
negotiated by federal, state, Tribal, or local government entities on
behalf of such health care providers and others, if such MSAs were
awarded pursuant to applicable federal, state, Tribal, or local
competitive bidding requirements;
 The eligible health care provider opts into an existing
MSA approved under the Rural Health Care Pilot Program or Healthcare
Connect Fund Program and seeks support for services and equipment
purchased from the MSA, if the MSA was developed and negotiated in
response to an RFP that specifically solicited proposals that included
a mechanism for adding additional sites to the MSA;
 The eligible health care provider has a multi-year
contract designated as ``evergreen'' by USAC and seeks to exercise a
voluntary option to extend an evergreen contract without undergoing
additional competitive bidding;
 The eligible health care provider is in a consortium with
participants in the schools and libraries universal service support
program (E-Rate program) and a party to the consortium's existing
contract, if the contract was approved in the E-Rate program as a
master contract;
 The eligible health care provider seeks support for
$10,000 or less of total undiscounted eligible expenses for a single
year, if the term of the contract is one year or less; or
 The eligible health care provider already has entered into
a legally binding agreement with a service provider for services or
equipment eligible for support in the Pilot Program and that legally
binding agreement itself was the product of competitive bidding.
 In the absence of an applicable exemption, applicants will have to
seek competitive bids for services and equipment that are eligible for
support through the Pilot Program. Applicants will be required to
follow the RHC Program's competitive bidding requirements, which
include submitting a Request for Services and Request for Proposal
(RFP) (as applicable) for USAC to post on its website, seeking bids,
waiting 28 days before selecting a service provider, conducting a bid
evaluation to select a service provider, and then selecting the most-
cost effective service. All potential bidders must have access to the
same information and be treated in the same manner during the
competitive bidding period to ensure that the process is ``fair and
open.'' Gifts from service providers will also be prohibited.
 53. Requesting Funding, Invoicing, Disbursements, and Material
Changes. Once selected, Pilot Program participants will be required to
submit a Request for Funding to USAC no later than six months after the
selection date with specific pricing and service information for the
funding they are requesting through the Pilot Program. Participating
health care providers with multi-year contracts may submit a single
funding request for the full period covered by the contract. However,
if a participating health care provider elects to enter into a one-year
contract, it will have to submit a new funding request for each
subsequent year of Pilot Program funding. USAC will review the funding
requests and issue funding commitment letters to the participating
health care providers and service providers indicating the amount
committed under the Pilot Program for the selected pilot project. Given
that Pilot Program funding will be collected over a multiple year
period, while participating health care providers with multi-year
contracts can submit a single funding request covering the contract
period, the Commission anticipates that USAC will issue funding
commitments for one year at a time rather than for multiple years.
 54. Selected pilot projects will be required to report to the
Commission
[[Page 19902]]
any material change in the participating health care providers' or
pilot projects' status (e.g., health care provider site has closed, or
pilot project has ceased operations) within 30 days of such material
change in status. In instances where a selected Pilot Program
participant is unable to participate in the Pilot Program for the
three-year period due to extenuating circumstances, a successor may be
designated by the Bureau. To facilitate the tracking and monitoring of
the Pilot Program budget and guard against potential waste, fraud and
abuse, selected pilot projects must notify USAC within 30 days of any
decrease of 5% or more in the number of patients participating in their
respective pilot project.
 55. After providing the eligible services and/or equipment, service
providers will be required to make certain certifications and then
submit invoicing forms on a monthly basis and supporting documentation
to USAC to receive reimbursement for the cost of the eligible services
and/or equipment they have provided to participating health care
providers under the Pilot Program. USAC will review the monthly
invoicing forms and supporting documentation and issue disbursements to
the applicable service providers or vendors, whether a broadband
service provider, or other provider. Pilot Program participants will
also be required to make certifications as part of the form submissions
to USAC to ensure that Pilot Program funds are used for their intended
purpose and to ensure that all participating health care providers and
service providers are in compliance with the Commission's rules and
procedures.
 56. Data Reporting, Document Retention, and Audits. The Commission
directs the Bureau to issue a report detailing the results of the Pilot
Program after it has been completed. To assist with the report, the
Commission will require participating health care providers to submit
periodically anonymized, aggregated data, such as reductions in
emergency room or urgent care visits in a particular geographic area or
among a certain class of patients; decreases in hospital admissions or
re-admissions for a certain patient group; condition-specific outcomes
such as reductions in premature births or acute incidents among
sufferers of a chronic illness; and patient satisfaction as to health
status to the Bureau regarding their pilot project to the Bureau after
each year of funding for that pilot project. However, the scope of the
pilot project proposals is unknown at this time, and some metrics may
not be applicable to all of the selected pilot projects.
 57. Accordingly, the Commission will determine the specific data to
be reported by pilot projects and format of the required data after
review of the pilot project proposals. Participating health care
providers will also be required to submit final reports within six
months of the end dates of their pilot projects summarizing the final
results and explaining whether the pilot projects met their stated
goals and the goals of the Pilot Program. These data will assist the
Commission in determining whether and how universal service funds can
efficiently and effectively be used for connected care, will enable the
Commission to ensure that universal service funds are being used in a
manner consistent with section 254, the Commission's rules and
procedures, and the goals of the Pilot Program. In accordance with
Sec. 54.631 of the Commission's rules, health care providers and
selected participants, in addition to maintaining records related to
their pilot projects to demonstrate their compliance with the Pilot
Program rules and requirements, must also keep supporting documentation
for these reports for at least five years after the conclusion of their
pilot project and must present that information to the Commission or
USAC upon request. Consistent with Sec. 54.631 of the Commission's
rules, pilot projects will also be subject to random compliance audits
to ensure compliance with the Pilot Program rules and requirements.
 58. USAC Outreach. After announcement of the selected Pilot Program
projects, each selected pilot project will be required to provide to
USAC, within 14 calendar days of such announcement, the name, mailing
address, email address, and telephone number of the lead project
coordinator for its pilot project. Within 30 days of the date
announcing the selected Pilot Program projects, USAC shall conduct an
initial coordination meeting with selected Pilot Program participants.
USAC shall further conduct a targeted outreach program, such as a
webinar or similar outreach, to educate and inform selected
participants on the Pilot Program administrative process, including
various filing requirements and deadlines, in order to minimize the
possibility of selected participants making inadvertent errors in
completing the required forms. The Commission expects that the outreach
and educational efforts will assist selected participants in meeting
the Pilot Program's requirements. Further, such an outreach program
will increase awareness of the filing rules and procedures and will
improve the overall efficacy of the Pilot Program. The Commission also
encourages selected participants to contact USAC with any questions
prior to filing their forms or supporting documentation. The direction
the Commission provides to USAC will not lessen or preclude any of its
review procedures. The Commission retains the commitment to detecting
and deterring potential instances of waste, fraud, and abuse by
ensuring that USAC scrutinizes Pilot Program submissions and takes
steps to educate selected participants in a manner that fosters
appropriate Pilot Program participation.
 59. Pilot Program Goals and Metrics. The Commission adopts three
explicit goals for the Pilot Program to determine how USF support
provided to health care providers for the costs associated with
providing connected care services can enable them to: (1) Improve
health outcomes through connected care; (2) reduce health care costs
for patients, facilities and the health care system; and (3) support
the trend towards connected care everywhere. The goals adopted for the
Pilot Program are sound and measurable goals, and will help advance the
Commission's statutory obligation to promote universal service by
providing the Commission with information that will help inform about
how to best allocate limited universal service funding.
 60. Legal Authority. The Commission found that section 254(h)(2)(A)
of the 1996 Act authorizes establishing the Pilot Program to help
defray health care provider's eligible costs of providing connected
care services to low-income or veteran patients. Specifically, section
254(h)(2)(A) directs the Commission to ``establish competitively
neutral rule[s] to enhance, to the extent technically feasible and
economically reasonable, access to advanced telecommunications and
information services for all public and nonprofit . . . health care
providers.'' The Pilot Program will fund broadband connectivity for
participating health care providers and patients, certain network
equipment, and other information services that may facilitate the
provision of connected care services provided through the Pilot
Program. These connected care services may be defined as either
telecommunications services or information services.
 61. For the Pilot Program, funding patient broadband internet
access services would expand health care providers' digital footprints
for purposes of providing connected care services and allow health care
providers to serve more eligible low-income patients and veterans
through the Pilot Program and, thus, enhance health care providers'
[[Page 19903]]
access to ``advanced telecommunications and information services.''
Accordingly, funding health care provider purchase of broadband
internet access service for participating patients through this
discrete, limited duration Pilot Program falls within the scope of
section 254(h)(2)(A) of the Act. Relying on this statutory provision
also ensures that the Pilot Program is health care provider-driven and
enables participating health care providers to select from the broadest
range of broadband internet access service providers to meet the health
care needs of participating patients.
 62. First, the Pilot Program will be ``competitively neutral,''
which means that ``universal service support mechanisms and rules
neither unfairly advantage nor disadvantage one provider over another,
and neither unfairly favor nor disfavor one technology over another.''
The Pilot Program satisfies this requirement because eligible health
care providers are free to choose any broadband connectivity technology
and broadband connectivity provider, in compliance with the applicable
competitive bidding requirements for the Pilot Program-supported
services needed to provide connected care services through their
respective pilot projects. In addition, participating health care
providers are not required to adopt any specific non-broadband
information service to provide broadband-enabled connected care
services through the Pilot Program. Second, the Pilot Program will be
``technically feasible'' because the Pilot Program will not require the
development of any new technology and gives participating health care
providers flexibility to use any available technology to implement
their respective pilot projects. Third, the Pilot Program will be
``economically reasonable.'' In discussing economic reasonableness, the
Commission has generally focused on the effect that any new rules would
have on growth in the universal service support mechanisms. The
Commission establishes a budget separate from the existing universal
service programs and limit the Pilot Program budget to at most $100
million, which provides a reasonable cap and will not significantly
increase the contributions burden on consumers. Additionally, the
Commission has developed measures to promote the fiscally responsible
use of Pilot Program funds, including requiring that evaluations of
pilot project proposals include a comparison of the estimated costs of
each proposed pilot project to the total Pilot Program budget.
 63. Recognizing that the Commission has not previously relied on
section 254(h)(2)(A) of the Act to specifically defray eligible health
care provider costs of providing connected care services by supporting
broadband connections for patient use or other information services
necessary to provide connected care services. The Commission previously
concluded, however, that it has ``broad discretion regarding how to
fulfill this statutory mandate'' under section 254(h)(2)(A). The
Commission believes establishing the limited Pilot Program for this
purpose is consistent with that discretion. Advances in information
technologies and services are allowing health care providers to expand
their digital footprint by using broadband and broadband enabled
devices to provide connected care services to patients in their homes
or mobile locations, and there is growing evidence of the benefits of
connected care services both for health care providers and their
patients. Further, the record indicates that the costs of broadband
internet access service for patient use in their homes or mobile
locations, and the costs of other information services necessary to
provide connected care services, are an obstacle for certain health
care providers and their patients to adopt connected care services.
Because of the growing evidence of the benefits of providing connected
care services for both health care providers and their patients, and
the fact that many health care providers and patients have yet to adopt
these services, the Commission believes that it is appropriate to
establish the Pilot Program to examine whether and how universal
service can play a role in helping all Americans access and obtain the
benefits of connected care services. The Commission thus believes that
the specific services and network equipment funded under the Pilot
Program are within the scope of the statutory directive under section
254(h)(2)(A) to enhance eligible health care providers' access to
advanced telecommunications and information services.
 64. While the Commission relies on authority under section
254(h)(2)(A) to establish the Pilot Program, the Pilot Program is also
consistent with the directive that the Commission base policies for the
advancement of universal service on the principles outlined in section
254(b) of the Act. Specifically, section 254(b)(2) provides that
``[a]ccess to advanced telecommunications and information services
should be provided in all regions of the Nation'' and section 254(b)(3)
provides that ``[c]onsumers in all regions of the Nation, including
low-income consumers and those in rural, insular, and high cost areas,
should have access to telecommunications and information services,
including interexchange services and advanced telecommunications and
information services, that are reasonably comparable to those services
provided in urban areas and that are available at rates that are
reasonably comparable to rates charged for similar services in urban
areas.'' As explained in the document, the Pilot Program will fund
eligible health care provider purchases of broadband internet access
services for participating patients to use for purposes of connected
care services.
IV. Procedural Matters
A. Paperwork Reduction Act Analysis
 65. This document contains new information collection requirements
subject to the Paperwork Reduction Act of 1995 (PRA), Public Law 104-
13. The information collection requirements related to the COVID-19
Telehealth Program were approved on April 6, 2020 by the Office of
Management and Budget (OMB) pursuant to the PRA, 44 U.S.C. 3507(j). The
information collection requirements related to the Pilot Program will
also be submitted to OMB for review under Section 3507(d) of the PRA.
OMB, the general public, and other federal agencies will be invited to
comment on the new information collection requirements. Applications
for the COVID-19 Telehealth Program will be accepted by the Commission
after the Bureau releases a public notice providing instructions for
filing applications with the Commission. Applications to participate in
the Pilot Program will be due 45 days from the effective date of the
Pilot Program rules or July 31, 2020, whichever comes later. The Bureau
will issue a public notice announcing the deadline for submitting Pilot
Program applications and instructions for filing applications with the
Commission. In addition, pursuant to the Small Business Paperwork
Relief Act of 2002, Public Law 107-198, see 44 U.S.C. 3506(c)(4), the
Commission sought specific comment on how it might further reduce the
information collection burden for small business concerns with fewer
than 25 employees. In the Report and Order, the Commission has assessed
the effects of the information collection on small businesses, and find
that the benefits of providing support to help defray eligible health
care providers costs to provide connected care services to their
patients
[[Page 19904]]
and COVID-19 relief to help eligible health care providers meet the
health care needs of their patients during the COVID-19 pandemic
outweigh any significant economic impact on small entities.
B. Congressional Review Act
 66. The Commission has determined, and the Administrator of the
Office of Information and Regulatory Affairs, Office of Management and
Budget (OMB), concurs that the rules implementing the COVID-19
Telehealth Program are ``major'' and the rules implementing the Pilot
Program are ``non-major'' under the Congressional Review Act, 5 U.S.C.
804(2). The Commission will send a copy of the R&O, including this
FRFA, to Congress and the Government Accountability Office pursuant to
5 U.S.C. 801(a)(1)(A). In addition, the Commission will send a copy of
the R&O, including the FRFA, to the Chief Counsel for Advocacy of the
Small Business Administration.
C. Final Regulatory Flexibility Analysis
 67. As required by the Regulatory Flexibility Act of 1980 (RFA), as
amended, the Federal Communications Commission (Commission) included an
Initial Regulatory Flexibility Analysis (IRFA) of the possible
significant economic impact on a substantial number of small entities
by the policies and requirements proposed in the NPRM in WC Docket No.
18-213. The Commission sought written public comment on the proposals
in the NPRM, including comment on the IRFA. The Commission did not
receive any comments in response to the IRFA. This Final Regulatory
Flexibility Analysis (FRFA) conforms to the RFA.
 68. Need for, and Objectives of, the Report and Order. In the
Telecommunications Act of 1996 (1996 Act), Congress recognized the
value of providing rural health care providers with ``an affordable
rate for the services necessary for the provision of telemedicine and
instruction relating to such services.'' The 1996 Act mandated that
telecommunications carriers provide telecommunications services for
health care purposes to rural public or nonprofit health care providers
at rates that are ``reasonably comparable'' to rates in urban areas.
The 1996 Act also directed the Commission to establish competitively
neutral rules to enhance, to the extent technically feasible and
economically reasonable, access to ``advanced telecommunications and
information services'' for public and nonprofit health care providers.
Based on this legislative mandate, the Commission established the Rural
Health Care (RHC) Program which supports health care providers' access
to communications technologies. However, there are developments in
telehealth, including increased use of connected care services, that
the Commission has not yet fully explored. With remote patient
monitoring and mobile health applications that can be accessed on a
smartphone or tablet, health care providers now have the technology to
deliver quality health care directly to patients, regardless of where
they are located. Despite the numerous benefits of connected care
services to patients and health care providers alike, patients who
cannot afford or who otherwise lack reliable, robust broadband internet
access connectivity, including many low-income Americans and veterans,
are not realizing the benefits of these innovative telehealth
technologies. Also, the costs necessary to provide connected care
services may limit some health care providers' ability to treat low-
income Americans and veterans with connected care services.
 69. Thus, in August 2018, the Commission released the Connected
Care Notice of Inquiry, FCC 18-112 (NOI) seeking information on ``how
the Commission can help advance and support the movement towards
connected care everywhere and improve access to the life-saving
broadband-enabled telehealth services it makes possible.''
Subsequently, in July 2019, the Commission adopted the NPRM that
proposed and sought comment on a Pilot Program that would help defray
health care provider costs of providing connected care services to low-
income Americans and veterans. In the R&O, given the benefits of
connected care services provided through broadband connections, the
Commission takes the important step of establishing a Pilot Program to
explore whether and how the Universal Service Fund (USF) can help
defray health care providers' qualifying costs of providing connected
care services, including low-income Americans and veterans. The
ultimate goal of the Pilot Program is to examine how USF support can be
used to help health care providers improve health outcomes and reduce
health care costs, thereby supporting efforts to advance connected care
initiatives. The Commission expects that the Pilot Program will benefit
many eligible patients who are responding to a wide variety of health
challenges, such as diabetes management, opioid dependency, high-risk
pregnancies, pediatric heart disease, mental health conditions, and
cancer. The Commission also expects that the Pilot Program will provide
meaningful data that will help better understand how the USF can
support health care provider and patient use of connected care
services, and how supporting health care provider and patient use of
connected care services can improve health outcomes and reduce health
care costs. The data and information collected through the Pilot
Program could also have the ancillary benefit of aiding policy makers
and legislators in the consideration of broader reforms--whether
statutory changes or updates to rules administered by other agencies--
that could support this trend towards connected care.
 70. In the R&O, in response to the public health emergency
associated with the coronavirus disease (COVID-19), the Commission also
establishes a separate, emergency COVID-19 Telehealth Program focused
on connected care in response to the ongoing COVID-19 pandemic and
surge in demand for connected care services. The Commission expects
this additional support will help eligible health care providers
purchase broadband connectivity, network equipment and information
services to provide critical connected care services whether for
treatment of coronavirus or other health conditions during this time.
 71. Summary of Significant Issues Raised by Public Comments in
Response to the IRFA. There were no comments filed that specifically
address the rules and policies proposed in the IRFA.
 72. Response to Comments by the Chief Counsel for Advocacy of the
Small Business Administration. Pursuant to the Small Business Jobs Act
of 2010, which amended the RFA, the Commission is required to respond
to any comments filed by the Chief Counsel of the Small Business
Administration (SBA), and to provide a detailed statement of any change
made to the proposed rule(s) as a result of those comments. The Chief
Counsel did not file any comments in response to the proposed policies
and requirements in the proceeding.
 73. Description and Estimate of the Number of Small Entities to
Which the Rules Will Apply. The RFA directs agencies to provide a
description of and, where feasible, an estimate of the number of small
entities that may be affected by the proposed rules. The RFA generally
defines the term ``small entity'' as having the same meaning as the
terms ``small business,'' ``small organization,'' and ``small
governmental jurisdiction.'' In addition, the term ``small business''
has the same meaning as the term ``small business concern'' under the
Small Business Act. A small
[[Page 19905]]
business concern is one that: (1) Is independently owned and operated;
(2) is not dominant in its field of operation; and (3) satisfies any
additional criteria established by the SBA.
 74. Small Businesses, Small Organizations, Small Governmental
Jurisdictions. The Commission actions, over time, may affect small
entities that are not easily categorized at present. Therefore, at the
outset, three broad groups of small entities that could be directly
affected herein. First, while there are industry specific size
standards for small businesses that are used in the regulatory
flexibility analysis, according to data from the SBA's Office of
Advocacy, in general a small business is an independent business having
fewer than 500 employees. These types of small businesses represent
99.9% of all businesses in the United States, which translates to 30.7
million businesses.
 75. Next, the type of small entity described as a ``small
organization'' is generally ``any not-for-profit enterprise which is
independently owned and operated and is not dominant in its field.''
The Internal Revenue Service (IRS) uses a revenue benchmark of $50,000
or less to delineate its annual electronic filing requirements for
small exempt organizations. Nationwide, for tax year 2018, there were
approximately 571,709 small exempt organizations in the U.S. reporting
revenues of $50,000 or less according to the registration and tax data
for exempt organizations available from the IRS.
 76. Finally, the small entity described as a ``small governmental
jurisdiction'' is defined generally as ``governments of cities,
counties, towns, townships, villages, school districts, or special
districts, with a population of less than fifty thousand.'' U.S. Census
Bureau data from the 2017 Census of Governments indicate that there
were 90,075 local governmental jurisdictions consisting of general
purpose governments and special purpose governments in the United
States. Of this number there were 36,931 general purpose governments
(county, municipal and town or township) with populations of less than
50,000 and 12,040 special purpose governments--independent school
districts with enrollment populations of less than 50,000. Accordingly,
based on the 2017 U.S. Census of Governments data, the Commission
estimates that at least 48,971 entities fall into the category of
``small governmental jurisdictions.''
 77. The small entities that may be affected by the reforms include
eligible nonprofit and public health care providers and the eligible
service providers offering them services, including telecommunications
service providers, internet Service Providers, and service providers of
the services and equipment used for dedicated broadband networks.
 78. Description of Projected Reporting, Recordkeeping, and Other
Compliance Requirements for Small Entities. In the R&O, the Commission
establishes a Pilot Program within the USF that will make available up
to $100 million over three years to help defray eligible health care
providers' costs of providing connected care services primarily to low-
income or veteran patients for purposes of connected care. The
Commission also establishes an COVID-19 Telehealth Program funded
through a $200 million Congressional appropriation under the
Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law
116-136, 134 Stat. 281, for COVID-19 relief to help eligible health
care providers meet the health care needs of their patients during the
COVID-19 pandemic. The Pilot Program is structured to target funding to
eligible health care providers serving patients that are most likely to
need USF support for connected care services, and to ensure that the
Pilot Program provides meaningful, measurable data. To participate in
the Pilot Program, health care providers must satisfy the definition of
an eligible health care provider under section 254(h)(7)(B) of the Act
and receive an eligibility determination from the Universal Service
Administrative Company (USAC), the administrator of the USF programs.
Applicants must then submit an application to the Commission regarding
their pilot projects by the application deadline ultimately established
for the Pilot Program. While the COVID-19 Telehealth Program is
structured a bit differently than the Pilot Program, applicants for
both programs will be required to certify that they will comply with
all applicable Pilot Program requirements and procedures. Applicants
among other things, will also be required to comply with the Health
Insurance Portability and Accountability Act (HIPAA) and other
applicable privacy and reimbursement laws and regulations, and
applicable medical licensing laws and regulations, as well as all
applicable Pilot Program requirements and procedures, including
document retention requirements, subject to audit.
 79. As part of Pilot Program, the Commission seeks a diverse set of
pilot projects from a wide variety of eligible health care providers
and eligible service providers, including small entities. The
Commission seeks to strike a balance between requiring applicants to
submit enough information that allows the selection high-quality, cost-
effective pilot projects that would best further the goals of the Pilot
Program, but also minimizing the administrative burdens on entities
that seek to apply. The R&O provides specific information that health
care providers are required to submit in their applications for each
pilot project proposal, including, but not limited to, information on
the participating health care provider(s), description of the pilot
project and how it would further the goals of the Pilot Program,
estimated pilot project budget, patient populations and the geographic
areas to be served and health conditions to be treated. The R&O also
establishes a streamlined application process for the COVID-19
Telehealth Program in order to more expeditiously address the needs of
health care providers affected by the coronavirus epidemic.
 80. After evaluation of the pilot program applications, the Bureau
will announce the selected pilot projects and provide further
information on the specific requirements for the Pilot Program.
Selected pilot program participants will be required to conduct a
competitive bidding process (unless a competitive bidding exemption
applies), including submitting the required competitive bidding forms,
for the eligible equipment and services that are supported through the
Pilot Program. Participating health care providers will then be
required to submit a request for funding with USAC with specific
pricing and service information, and will also be required to submit
invoicing forms and supporting documentation on a monthly basis for the
supported equipment and services. Participating health care providers
will also be required to periodically submit data to the Bureau
concerning their pilot project after each year of funding during the
three-year period of the pilot project, and will also be required to
submit a final report concerning their pilot projects. For the COVID-19
Telehealth Program, within six months after the conclusion of the
COVID-19 Telehealth Program, participants should provide a report to
the Commission on the effectiveness of the program. While some of the
requirements of the Pilot Program and the COVID-19 Telehealth Program
will result in additional recordkeeping and compliance requirements for
small entities, the Commission has determined that the benefits of
establishing these programs outweighs the burden of any increased
recordkeeping and compliance
[[Page 19906]]
requirements for those small entities that choose to participate in the
Pilot Program and the COVID-19 Telehealth Program. Additionally, the
requirements are intended to ensure universal service funds are used
for their intended purpose and designed so that the Commission can
obtain meaningful data to evaluate the Pilot Program and inform the
policy decisions.
 81. Steps Taken to Minimize the Significant Economic Impact on
Small Entities and Significant Alternatives Considered. The RFA
requires an agency to describe any significant alternatives that it has
considered in reaching its proposed approach, which may include (among
others) the following four alternatives: (1) The establishment of
differing compliance or reporting requirements or timetables that take
into account the resources available to small entities; (2) the
clarification, consolidation, or simplification of compliance or
reporting requirements under the rule for small entities; (3) the use
of performance, rather than design, standards; and (4) an exemption
from coverage of the rule, or any part thereof, for small entities.
 82. The Pilot Program is for a discrete, limited period of time.
The Commission expects to apply the Commission's rules applicable to
the Healthcare Connect Fund Program to the Pilot Program, which some
entities may already be familiar with if they currently participate in
the Healthcare Connect Fund Program. With no expectation of the small
entities to be disproportionately impacted. In evaluating the
applications, the Commission seeks to select a diverse set of pilot
projects and will consider whether the proposed pilot projects promotes
entrepreneurs and other small businesses in the provision and ownership
of telecommunications and information services, including those that
may be socially and economically disadvantaged businesses. All eligible
health care providers that participate in the Pilot Program will be
required to collect and submit data to the Commission at designated
intervals during the Pilot Program. The Commission has yet established
metrics to measure the Pilot Program goals and seek information from
applicants on the metrics plans to use and how plans to collect those
metrics in order to minimize any impact on small entities when
establishing metrics for the Pilot Program. The collection of this
information, however, is necessary to evaluate the impact of the Pilot
Program, including whether the Pilot Program achieves its goals. Thus,
the benefits of collecting this information outweigh any significant
economic impact on small entities. Moreover, the Commission sought
comment on the IRFA and did not receive any comments in response to the
IRFA. Further, in order to minimize the economic impact on small
entities, the Commission establishes an emergency COVID-19 Telehealth
Program, which is one piece of a comprehensive approach to reducing
barriers to telehealth services for patients and health care facilities
throughout the country to provide relief related to the COVID-19
pandemic. The Commission therefore believes that the requirements of
the R&O will not have a significant economic impact on a substantial
number of small entities.
V. Ordering Clauses
 83. Accordingly, it is ordered that, pursuant to the authority
contained in sections 201, 254, 303(r), and 403 of the Communications
Act of 1934, as amended, 47 U.S.C. 201, 254, 303(r), and 403, and
DIVISION B of the Coronavirus Aid, Relief, and Economic Security Act,
Public Law 116-136, 134 Stat. 281, the Report and Order is adopted and
shall become effective May 11, 2020, pursuant to 47 U.S.C. 408, with
the exception of those portions related to the COVID-19 Telehealth
Program in the Report and Order which shall become effective April 9,
2020 pursuant to 5 U.S.C. 553(d) and 5 U.S.C. 808(2) and the portions
containing information collection requirements that have not been
approved by the Office of Budget and Management (OMB).
 84. It is further ordered that applications to participate in the
COVID-19 Telehealth Program shall be filed after the Wireline
Competition Bureau issues a public notice announcing the date when
applications will be accepted and instructions for filing applications
with the Commission. This date will be after April 9, 2020.
 85. It is further ordered that, pursuant to the Paperwork Reduction
Act of 1995, Section 3507(d), the Connected Care Pilot Program
information collection requirements shall become effective after
announcement in the Federal Register of Office of Management and Budget
approval of the rules, and on the effective date announced therein.
 86. It is further ordered that applications to participate in the
Connected Care Pilot Program shall be filed 45 days after the effective
date of the Connected Care Pilot Program rules or July 31, 2020,
whichever comes later.
 87. It is further ordered that the Commission's Consumer and
Governmental Affairs Bureau, Reference Information Center, shall send a
copy of the R&O, including the Final Regulatory Flexibility Analysis,
to the Chief Counsel for Advocacy of the Small Business Administration.
 88. It is further ordered that the Commission shall send a copy of
the R&O to the Congress and the Government Accountability Office
pursuant to the Congressional Review Act, see 5 U.S.C. 801(a)(1)(A).
Federal Communications Commission.
Cecilia Sigmund,
Federal Register Liaison Officer.
[FR Doc. 2020-07587 Filed 4-8-20; 8:45 am]
 BILLING CODE 6712-01-P