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

• Published date: 09 April 2020
• Citation: 85 FR 19892
• Record Number: 2020-07587
• Section: Rules and Regulations
• Court: Federal Communications Commission

19892

Federal Register / Vol. 85, No. 69 / Thursday, April 9, 2020 / Rules and Regulations

G. Executive Order 13045: Protection of

Children From Environmental Health

Risks and Safety Risks

This action is not subject to Executive

Order 13045 (62 FR 19885, April 23,

1997), because this is not an

economically significant regulatory

action as defined under Executive Order

12866, and it does not address

environmental health or safety risks

disproportionately affecting children.

H. Executive Order 13211: Actions

Concerning Regulations That

Significantly Affect Energy Supply,

Distribution, or Use

This action is not subject to Executive

Order 13211 (66 FR 28355, May 22,

2001), because this action is not

expected to affect energy supply,

distribution, or use and because this

action is not a significant regulatory

action under Executive Order 12866.

I. National Technology Transfer and

Advancement Act (NTTAA)

Since this action does not involve any

technical standards, NTTAA section

12(d), 15 U.S.C. 272 note, does not

apply to this action.

J. Executive Order 12898: Federal

Actions To Address Environmental

Justice in Minority Populations and

Low-Income Populations

This action does not entail special

considerations of environmental justice

related issues as delineated by

Executive Order 12898 (59 FR 7629,

February 16, 1994).

III. Congressional Review Act (CRA)

This action is subject to the CRA, 5

U.S.C. 801 et seq., and EPA will submit

a rule report to each House of the

Congress and to the Comptroller General

of the United States. The CRA allows

the issuing agency to make a rule

effective sooner than otherwise

provided by the CRA if the agency

makes a good cause finding that notice

and comment rulemaking procedures

are impracticable, unnecessary or

contrary to the public interest (5 U.S.C.

808(2)). The EPA has made a good cause

finding for this rule as discussed in Unit

I.C., including the basis for that finding.

List of Subjects in 40 CFR Part 711

Environmental protection, Chemicals,

Confidential Business Information (CBI),

Hazardous materials, Importer,

Manufacturer, Reporting and

recordkeeping requirements.

Dated: March 17, 2020.

Alexandra Dapolito Dunn,

Assistant Administrator, Office of Chemical

Safety and Pollution Prevention.

Therefore, 40 CFR chapter I is

amended as follows:

PART 711—[AMENDED]

■1. The authority citation for part 711

continues to read as follows:

Authority: 15 U.S.C. 2607(a).

■2. In § 711.20, revise the third

sentence to read as follows.

§ 711.20 When to report.

* * * The 2020 CDR submission

period is from June 1, 2020, to

November 30, 2020. Subsequent

recurring submission periods are from

June 1 to September 30 at 4-year

intervals, beginning in 2024. * * *

[FR Doc. 2020–06074 Filed 4–8–20; 8:45 am]

BILLING CODE 6560–50–P

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.

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

EmergencyTelehealthSupport@fcc.gov

with questions related to the COVID–19

Telehealth Program, and

ConnCarePltProg@fcc.gov 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

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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)

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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

EmergencyTelehealthSupport@fcc.gov.

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

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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

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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

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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

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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

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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 § 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

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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

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pursuant to the procedures set forth in

§ 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

ConnCarePltProg@fcc.gov.

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

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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 § 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 § 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’

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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

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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

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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

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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

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