Time for the FCC to Modernize the Rural Health Care Program
December 16, 2015


Every day, broadband is playing a bigger and bigger role in health care. Broadband can play a role in eliminating disparities in health care between urban and rural areas, and telemedicine can significantly lower the costs of care for everyone. But gaps in broadband availability, especially in rural areas, are preventing video-based diagnoses, remote patient monitoring, and electronic health record operability.

When Congress passed the Telecommunications Act of 1996, it gave the Federal Communications Commission broad authority to address broadband needs of rural health providers to remedy these disparities. But nearly 20 years later, Congress’ vision remains unrealized.

In a recent filing, the Schools, Health & Libraries Broadband (“SHLB”) Coalition(1) and a consortium of health care providers asked the FCC to initiate a rulemaking to modernize the Commission’s Rural Health Care program so it can help improve the quality of health care available to patients in rural communities and ensure that rural health care providers have access to telecommunications and broadband services.

The SHLB Coalition includes a diverse membership of commercial and non-commercial organizations who support open, affordable, high-capacity broadband connections for anchor institutions and their surrounding communities. The Coalition has been a contributor to the National Broadband Plan and the efforts to reform the FCC’s other programs that ensure affordable broadband is available throughout the United States: the Connect America Fund, which deploys advanced telecommunications in rural areas; the E-rate program, which discounts broadband service for schools and libraries; and the Lifeline program targeted at low-income consumers. It is time to reform the Rural Health Care program so that it, too, makes high-capacity broadband available and affordable to these vital community health institutions.

The FCC’s Pilot Program in 2007, and the creation of the Healthcare Connect Fund in 2012 were steps in the right direction. These decisions were properly intended to drive greater investment in broadband networks serving health providers. But the results so far have been a bit disappointing. The decision to increase the applicant match from 15% to 35% has been very challenging for rural communities, and the complexity of the rules and application processing have discouraged many rural areas from seeking funding. The trends are working against rural communities; aging populations, increasing poverty, and changes in the health care industry driven by rapid technological and regulatory shifts are making rural health more difficult than ever. Many rural hospitals and clinics are shutting down because of the difficult economics. There is wide agreement that increased adoption of broadband-enabled care models by all health care providers is essential to meeting and overcoming these challenges.

Together, the SHLB Coalition and the consortium of health care providers are asking the FCC to further modernize the Rural Health Care program to increase the availability of affordable, modern, quality broadband capable of meeting the needs of health care in the 21st Century. These changes include lowering the applicant match in the Healthcare Connect Fund to ensure rural health care providers have access to, and can afford, the quality broadband necessary to support broadband-enabled care. We are also proposing changes to support the deployment of remote patient monitoring and to further spur the formation of consortia capable of ensuring all safety-net health care providers participate in the unfolding broadband revolution.

To ensure the Rural Health Care program remains on sound financial footing, we are asking the FCC to:

  • Update its analysis of eligible health care providers, to consider minimum levels of connectivity needed by those providers, and to recalibrate the Rural Health Care program cap based on such an analysis;
  • Choose from a number of options to ensure there is sufficient funding to address rural broadband health needs; and
  • Ensure efficient program administration by clarifying existing rules and ensuring that the program’s administrator, the Universal Service Administrative Company, has the resources necessary to support program reforms and program growth.

We are seeking changes to the FCC’s definition of “rural” and the establishment of a limited waiver process for entities that serve rural areas but don’t meet the definition of rural. We also want the FCC to clarify eligibility categories and issue guidance to ensure potential program beneficiaries can reasonably determine their eligibility status in advance. Finally, in order to encourage skilled nursing facilities and other presently-ineligible health care providers to participate in consortia networks, we’d like the FCC to expand the scope of what constitutes an “eligible connection” for consortia participating in the Healthcare Connect Fund.

Health care, after many years of slow evolution, is undergoing increasingly rapid change. We’d like the FCC to take this opportunity and build on past reform efforts. In this rapidly evolving environment, it is vital for the FCC to ensure universal service for rural health care continues to efficiently and cost effectively promote access to affordable modern broadband.

The FCC is seeking public comment on the SHLB Coalition petition. Comments are due January 14 and reply comments are due January 29, 2016. Like the FCC, the SHLB Coalition welcomes any reaction to our petition.

John Windhausen, Jr. is the Executive Director of the Schools, Health & Libraries Broadband (SHLB) Coalition, a diverse coalition of community anchor institutions, broadband companies, foundations and public interest groups.

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