Proposed Rule2022-05191
Promoting Telehealth in Rural America
Primary source
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Published
March 15, 2022
Issuing agencies
Federal Communications Commission
Abstract
In this document, the Federal Communications Commission (Commission) seeks comment on revisions to the Rural Health Care Telecommunications (Telecom) Program rules to ensure that rural healthcare providers receive funding necessary to access the broadband and telecommunications services necessary to provide vital healthcare services; proposes to modify the applicability of the internal funding cap on upfront costs and multi-year commitments in the Rural Health Care Healthcare Connect Fund Program, proposes to streamline the invoice process in the Telecom Program, and seeks comment on ways to further increase the speed of funding commitments.
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[Federal Register Volume 87, Number 50 (Tuesday, March 15, 2022)]
[Proposed Rules]
[Pages 14421-14439]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-05191]
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Proposed Rules
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains notices to the public of
the proposed issuance of rules and regulations. The purpose of these
notices is to give interested persons an opportunity to participate in
the rule making prior to the adoption of the final rules.
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Federal Register / Vol. 87, No. 50 / Tuesday, March 15, 2022 /
Proposed Rules
[[Page 14421]]
FEDERAL COMMUNICATIONS COMMISSION
47 CFR Part 54
[WC Docket No. 17-310; FCC 22-15; FR ID 75595]
Promoting Telehealth in Rural America
AGENCY: Federal Communications Commission.
ACTION: Proposed rule.
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SUMMARY: In this document, the Federal Communications Commission
(Commission) seeks comment on revisions to the Rural Health Care
Telecommunications (Telecom) Program rules to ensure that rural
healthcare providers receive funding necessary to access the broadband
and telecommunications services necessary to provide vital healthcare
services; proposes to modify the applicability of the internal funding
cap on upfront costs and multi-year commitments in the Rural Health
Care Healthcare Connect Fund Program, proposes to streamline the
invoice process in the Telecom Program, and seeks comment on ways to
further increase the speed of funding commitments.
DATES: Comments are due on or before April 14, 2022 and reply comments
are due on or before May 16, 2022. If you anticipate that you will be
submitting comments but find it difficult to do so within the period of
time allowed by this document, you should advise the listed contact as
soon as possible.
ADDRESSES: You may submit comments, identified by WC Docket No. 17-310,
by any of the following methods:
<bullet> Electronic Filers: Comments may be filed electronically
using the internet by accessing the ECFS: <a href="https://www.fcc.gov/ecfs/">https://www.fcc.gov/ecfs/</a>.
<bullet> Paper Filers: Parties who choose to file by paper must
file an original and one copy of each filing.
<bullet> Filings can be sent by commercial overnight courier or by
first-class or overnight U.S. Postal Service mail. All filings must be
addressed to the Commission's Secretary, Office of the Secretary,
Federal Communications Commission.
<bullet> Commercial overnight mail (other than U.S. Postal Service
Express Mail and Priority Mail) must be sent to 9050 Junction Drive,
Annapolis Junction, MD 20701.
<bullet> U.S. Postal Service first-class, Express, and Priority
mail must be addressed to 45 L Street NE, Washington, DC 20554.
<bullet> Effective March 19, 2020, and until further notice, the
Commission no longer accepts any hand or messenger delivered filings at
its headquarters. This is a temporary measure taken to help protect the
health and safety of individuals, and to mitigate the transmission of
COVID-19. See FCC Announces Closure of FCC Headquarters Open Window and
Change in Hand-Delivery Policy, Public Notice, A 20-304 (March 19,
2020), <a href="https://www.fcc.gov/document/fcc-closes-headquarters-open-window-and-changes-hand-delivery-policy">https://www.fcc.gov/document/fcc-closes-headquarters-open-window-and-changes-hand-delivery-policy</a>.
People with Disabilities: To request materials in accessible
formats for people with disabilities (Braille, large print, electronic
files, audio format), send an email to <a href="/cdn-cgi/l/email-protection#91f7f2f2a4a1a5d1f7f2f2bff6fee7"><span class="__cf_email__" data-cfemail="6e080d0d5b5e5a2e080d0d40090118">[email protected]</span></a> or call the
Consumer & Governmental Affairs Bureau at (202) 418-0530 (voice), (202)
418-0432 (TTY). For detailed instructions for submitting comments and
additional information on the rulemaking process, see the SUPPLEMENTARY
INFORMATION section of this document.
FOR FURTHER INFORMATION CONTACT: Bryan P. Boyle, Wireline Competition
Bureau, 202-418-7400 or by email at <a href="/cdn-cgi/l/email-protection#3371414a525d1d715c4a5f56735550501d545c45"><span class="__cf_email__" data-cfemail="480a3a312926660a2731242d082e2b2b662f273e">[email protected]</span></a>. Requests for
accommodations should be made as soon as possible in order to allow the
agency to satisfy such requests whenever possible. Send an email to
<a href="/cdn-cgi/l/email-protection#b9dfdada8c898df9dfdada97ded6cf"><span class="__cf_email__" data-cfemail="5d3b3e3e686d691d3b3e3e733a322b">[email protected]</span></a> or call the Consumer and Governmental Affairs Bureau at
(202) 418-0530.
SUPPLEMENTARY INFORMATION: This is a synopsis of the Commission's
Further Notice of Proposed Rulemaking (FNPRM) in WC Docket No. 17-310;
FCC 22-15, adopted on February 18, 2022 and released on February 22,
2022. 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: <a href="https://docs.fcc.gov/public/attachments/FCC-22-15A1.pdf">https://docs.fcc.gov/public/attachments/FCC-22-15A1.pdf</a>.
I. Introduction
1. In the FNPRM the Commission proposes and seeks comment on
several revisions to the Commission's Rural Health Care Program (RHC
Program) rules designed to ensure that rural healthcare providers
receive funding necessary to access the broadband and
telecommunications services necessary to provide vital healthcare
services while limiting costly inefficiencies and the potential for
waste, fraud, and abuse. The RHC Program provides vital support to
assist rural health care providers with the costs of broadband and
other communications services. Reliable high speed connectivity is
critical for rural health care providers to serve patients in rural
areas that often have limited resources, fewer doctors, and higher
rates for broadband and telecommunications services than urban areas.
Recent years have also seen an explosion in demand for telehealth
services, a trend accelerated by the COVID-19 pandemic, that has
increased the bandwidth needs of rural health care providers. The
Commission seeks comment on proposed revisions to the RHC Program's
funding determination mechanisms and administrative processes in an
effort to improve the accuracy and fairness of RHC Program support and
increase the efficiency of program administration.
II. Discussion
2. In the FNPRM, the Commission seeks comment on options for
determining support in the Telecom Program and propose revisions to
Telecom Program forms to improve the quality and consistency of Telecom
Program data. The Commission also seeks comment on an alternative rate
determination mechanism to the Rates Database to improve the accuracy
of rates in the Telecom Program. Additionally, it proposes to limit the
applicability of the internal funding cap on upfront payments and
multi-year commitments to instances in which demand exceeds available
funding; to target funding for the current funding year over future
years when the internal cap is exceeded; and to simplify the invoicing
process in the Telecom Program while strengthening protections against
waste, fraud and
[[Page 14422]]
abuse. The Commission also seeks comment on ways to expedite and
streamline the application and funding commitment process.
3. Determining Accurate Rate in the Telecom Program, Defining cost
factors and service technologies for a rate setting mechanism. As an
initial matter, the Commission examines how to classify the inputs used
to determine rates in the Telecom Program. To determine rates that
reflect the cost of delivering service to health care providers, the
data inputs used to determine rates must capture, consistent with
section 254(h)(1)(A) of the Telecommunications Act of 1996 (Act), which
health care providers are in ``comparable rural areas,'' as well as
which Telecom Program supported services are ``similar.'' The
Commission seeks therefore comment on several inputs related to
rurality classifications for health care providers and categorization
of eligible services.
4. Rurality classifications for health care providers. The
Commission seeks input on how to evaluate rurality to determine what
areas are comparable for purposes of determining rates. First,
examining how the Commission defines rurality for the RHC Program,
proposing to maintain the current standard for ``rural'' used to
determine whether a health care provider may participate in the RHC
Program. Then seek comment on what factors to consider to differentiate
rural areas.
5. Defining ``Rural Area'' for the Purposes of Program
Participation. Support under section 254(h)(1)(A) of the Act is limited
to services provided to persons who reside in ``rural areas.'' The RHC
Program employs a definition of ``rural area'' that relies upon a
healthcare provider's location relative to the Census Bureau's Core
Based Statistical Area designation. In the 2019 Promoting Telehealth
Report and Order, 84 FR 54952, October 11, 2019), the Commission
declined to adopt a new definition of ``rural area'' for the RHC
Program because the existing definition served the needs of the
program. The Commission also explained that changes to the definition
could cause uncertainty and eligibility issues for program
participants. The Commission believes these justifications for
maintaining the existing definition of ``rural area'' remain applicable
today and therefore propose to maintain the current definition of
``rural area'' for the RHC Program.
6. Despite the Commission's belief that the existing definition of
``rural area'' remains applicable today, the Commission seeks comment
on whether the proposal to maintain the current definition of ``rural
area'' is appropriate for purposes of RHC Program participation. Does
the current definition meet the needs of the RHC Program for purposes
of eligibility? Are there any alternative definitions that would be
more appropriate? For instance, should the Commission adopt a
definition that does not rely (or does not exclusively rely) on a
healthcare provider's location in relation to relatively densely
settled areas, and would such a definition capture areas that
reasonably could be viewed as ``rural'' within the meaning of section
254(h)(1)(A) of the Act? Until 2004, the Commission followed the
definition used by the Federal Office of Rural Health Policy (FORHP)
located within the Health Resources and Services Administration. Are
there any definitions used by other government agencies, such as FORHP,
or medical organizations that would be more appropriate at this time
for the RHC Program? Are there definitions that take into account the
geographic features that are unique to Alaska? Commenters are
encouraged to describe the effects on Program participants of any
potential modifications to the current definition. After the Commission
adopted a new standard for ``rural area'' in 2004, it permitted health
care providers that were participating in the RHC Program under the
previous definition but did not qualify as rural under the new
definition to continue to participate in the RHC Program. If the
Commission maintains the current definition, should the Commission
continue to allow health care providers that do not fall under the
current definition, but who were grandfathered under the old
definition, to participate in the RHC Program? In the event the
Commission adopts a new definition of ``rural area'' that does not
encompass health care providers that fall under the current definition,
should the Commission permit those providers to continue participating
in the RHC Program?
7. Identification of Geographic Cost Factors. The Commission next
turns to how to identify methods for further classifying gradients or
tiers of rurality and what already-existing tools might be used to
differentiate gradients or tiers of rurality for the purpose of setting
rural and urban rates in the Telecom Program. Under section
254(h)(1)(A) of the Act, carriers must be reimbursed using rates for
similar services provided to other customers in ``comparable rural
areas'' in the state. In the Promoting Telehealth Report and Order, the
Commission amended its definition of ``comparable rural areas'' from
just the areas immediately surrounding the health care provider to also
include similar rural areas. The Commission proposes to maintain a
definition of ``comparable rural areas'' that includes the areas
immediately surrounding the health care provider and also similar areas
within the state and agree with the Commission's previous determination
that such an approach reflects a faithful interpretation of the
statutory obligation to reimburse carriers for similar services for
other customers in ``comparable rural areas'' in the state. The
Commission seeks comment on this approach.
8. The Commission also seeks comment on the factors to consider in
determining what are ``comparable rural areas'' when establishing rates
for telecommunication services. Under the existing Commission rules,
rurality tiers are used to determine the comparable rural areas in a
state or territory. In the Promoting Telehealth Report and Order, the
Commission decided that the determination of what rural areas are
``comparable'' should be based on the factors impacting the cost to
provide services, and adopted rurality tiers based on the assumption
that the costs to provide telecommunication services increases as the
population density of an area decreases. The Commission continues to
believe that grouping health care providers by geographic area is the
best way to ensure that carriers are compensated based on services
provided to health care providers in ``comparable rural areas'' and
that it is appropriate to consider comparability of rural areas by
looking at the factors impacting cost and seek to identify what those
factors might be. In addition to population density, distance to the
nearest metropolitan area, topography, and existing infrastructure may
impact the cost to provide telecommunications services as well. The
Commission seeks comment on the extent to which population density,
distance, topography, and existing infrastructure could be factors to
consider when determining ``comparable rural areas.'' To what extent
may these factors affect rates for telecommunications services? Are
there other geographic cost factors the Commission should consider that
affect telecommunication service rates? Are there geographic cost
factors specific to Alaska that should be considered if elected to
establish specific rules for ``comparable rural areas'' in Alaska?
9. The Commission seeks comment on whether establishing specific
rurality metrics for each health care provider based on multiple
geographic cost factors could more accurately determine
[[Page 14423]]
prices available to health care providers in rural areas. Specifically,
the Commission seeks comment on whether measuring a combined set of
factors such as population density, distance to a nearby urban area,
topography, and existing infrastructure would be effective in
establishing levels of rurality that more accurately reflect the cost
of service. How can the Commission account for variances in health care
providers' location and topography? Are there any other specific cost
factors to consider based on the existing data that are more closely
related to or affected by rurality? Finally, given the unique geography
and topography of Alaska, are there specific cost factors that impact
rates in Alaska only?
10. Applying Geographic Cost Factors to Rurality Tiers. Next, the
Commission considers whether there are methods to delineate rurality
that are preferable to the rurality tier system based on Core Based
Statistical Areas adopted by the Promoting Telehealth Report and Order.
One of the primary reasons for adopting the rurality tiers in the Rates
Database was to ensure that rates increased as the level of rurality
increased, to reflect a presumed increase in cost of providing service
as rurality increased. However, outputs of the Rates Database revealed
examples of lower median rural rates in more rural tiers than in less
rural tiers (i.e., higher rates in the Rural and Less Rural tiers than
in the Extremely Rural and Frontier tiers), and higher median rural
rates in less rural tiers than in more rural tiers (i.e., lower rates
in the Extremely Rural and Frontier tiers than the Rural and Less Rural
tiers). These anomalies raise questions about whether the rurality
tiers based on Core Based Statistical Areas accurately group comparable
rural areas for purposes of determining telecommunications rates. The
Commission seeks comment on whether the current rurality tiers used to
determine ``comparable rural areas'' are appropriate for determining
accurate and reasonable rates. Despite the anomalies, did the Rates
Database deliver rates that are ``rates for similar services provided
to other customers in comparable rural areas in that State'' as
required by the Telecommunications Act of 1996? Could the current
rurality tiers be improved by subdividing them? If so, how could the
Commission do so in an objective and administratively feasible way? Are
there other explanations besides the classification of rurality tiers
for these anomalies? For example, would these anomalies disappear or
dissipate if the Commission had better controls for different services
or for different service level agreements?
11. With respect to anomalies in Alaska, rates for the Rural tier
are consistently higher than rates in the Extremely Rural tier due
primarily to the state's Census Bureau categorizations. Most of Alaska
is not part of a Core Based Statistical Area (CBSA) and therefore
Extremely Rural. Juneau and Ketchikan are located in a CBSA and are
defined as Rural under Telecom Program rules because they do not
contain any Urban Area with a population of 25,000 or greater. However,
these areas are isolated in the southeast portion of Alaska, are not
necessarily connected by roads despite being located in a CBSA, and are
therefore relatively expensive to serve. Would adjusting rurality tiers
so that health care providers located in the Juneau and Ketchikan CBSAs
fall into the Extremely Rural tier resolve some anomalies? Are there
other adjustments that can be made to address this issue?
12. The Commission also seeks comment on replacing the current
rurality tiers with alternative methods of determining degrees of
rurality, such as the Index of Relative Rurality (IRR). The IRR is a
``continuous, threshold-free, and unit-free measure of rurality.'' IRR
addresses degrees of rurality instead of simply designating an area as
urban or rural. The IRR focuses on four dimensions of rurality, which
include size, density, remoteness, and built-up area, and has three
major advantages over typology-based rurality measures. First, it is
``spatially flexible'' in that it is not confined to a particular
spatial scale such as counties but can be designed for any spatial
units such as townships or census tracts; second, it is a relative and
continuous measure and thus treats rurality as a concept rather than a
traditional classification; and lastly it is easier to analyze than
threshold-based typologies. The Commission seeks comment on using the
IRR to replace the current rurality tier system. What would be the
advantages and disadvantages of using the IRR to evaluate rurality?
What groupings of IRR scores would be appropriate for evaluating
rurality tiers? Is the IRR spatially flexible enough to account for
Alaska's unique geography? If not, do commenters have specific ideas on
how the Commission might build off the IRR to accommodate Alaska?
13. Alternatively, would the Rural Urban Commuting Area (RUCA)
codes be preferable to determine rurality tiers? The RUCA codes are a
census tract-based classification scheme that uses measures of
population density and urbanization in combination with commuting
information to characterize all of the nation's census tracts regarding
their rural and urban status and relationships to one another. One of
the reasons the Commission stopped using FORHP's definition of ``rural
area'' in 2004 was because part of FORHP's methodology changed to
incorporate the RUCA methodology which at the time failed to
incorporate the most recent census data. Since their creation, the RUCA
codes have been updated several times with new Census data. The most
recent RUCA codes were created by the FORHP, the University of North
Dakota Center for Rural Health, and the United States Department of
Agriculture (USDA) Economic Research Service and are based on data from
the 2010 decennial census and the 2006-10 American Community Survey.
The Commission seeks comment on using the RUCA codes to replace the
current rurality tiers. What would be the advantages and disadvantages
of using the RUCA codes to evaluate rurality? Are the RUCA codes
granular enough for Alaska given its unique geography and topography?
14. The Commission seeks comment on other known methods that could
more accurately determine degrees of rurality. Are there any other
objective and administratively feasible methodologies that should be
considered? If so, are these methods appropriate for all states,
including Alaska? If the Commission maintains the current definition of
``rural'' for eligibility purposes, how will these new methods interact
with the current definition? For example, are there any scenarios in
which a particular area is rural under the current definition but would
not be sufficiently rural under one of these other methodologies to
receive funding? The Commission asks that commenters describe alternate
ways to evaluate rurality and, when possible, provide data showing
whether these alternatives accurately reflect geographic cost factors
in telecommunications rates.
15. The Commission also seeks comment on whether to eliminate
rurality tiers altogether and establish rates based on an applicant's
census tract information. Examples of such information could include
population and business density, measures of terrain and topography
such as elevation and slope, measures of distance from urban areas,
percentage of built-up areas, etc. Such an approach would be similar to
the IRR approach, but instead of producing an index, would directly
estimate the impact of various dimensions of rurality on
[[Page 14424]]
service prices in a given location. The Commission seeks comment on the
feasibility of using specific census tract information to evaluate
rurality and determine rates. What are the benefits of using census
tract information to determine rates? Do commenters believe that moving
away from rurality tiers and relying on census-tract information would
more accurately determine reasonable rates? If so, should such an
approach be incorporated into the nationwide pricing model that seeks
comments.? The Commission also seeks comment on how to use specific
census tract information to determine rates if the Commission adopts
such an approach. Should the Commission average rates among all
``rural'' census tracts within a state to determine rates? Should the
Commission group census tracts that have similar data to evaluate
rurality without using specific tiers? How should the Commission group
the data? The Commission encourages commenters to suggest creative ways
to evaluate rurality and establish rates based on an applicant's census
tract information.
16. Alaska-only Rurality Tiers. In light of Alaska's unique
topography, the Commission seeks comment on whether establishing
distinct tiers for Alaska is appropriate for purposes of the Telecom
Program. If the Commission adopts one of the alternate methods, will it
be appropriate for Alaska, even if it is functional for other states?
Should an entirely different method be implemented for evaluating
rurality for Alaska than for other states? What specific dimensions of
geography and rurality are unique to Alaska that would need to be
accounted for in any Alaska-specific methodology? In the 2019 Promoting
Telehealth Report and Order, the Commission created a Frontier tier
unique to Alaska, comprised of off-road areas in the state. The
Commission declined, however, to further sub-divide off-road
communities in Alaska for determining comparable rural areas. The
Commission recognizes that, even in Alaskan off-road communities,
different levels of communications infrastructure may exist resulting
in different costs for providing and obtaining services. If the
Commission maintains the current rurality tiers, should the Commission
further sub-divide Alaskan off-road areas to capture these variances in
service deployment? If so, what methodology could be used that is
objective, administratively feasible, and transparent?
17. Funding Prioritization. In the event the Commission adopts a
new rurality tier system or an alternative to rurality tiers
altogether, the Commission seeks comment on whether the new system
should also be used for prioritization. When program demand exceeds
available funding, the Commission's current prioritization system
prioritizes health care providers in Medically Underserved Areas and
health care providers in more rural rurality tiers using the
Commission's current methodology for evaluating rurality. If the
Commission changes the current methodology for evaluating rurality,
should that new methodology replace the current rurality tiers in the
prioritization system? Commenters that oppose using the same
methodology for evaluating rurality and prioritization should provide
viable alternative ways to prioritize funding.
18. Categorizing service technologies purchased by health care
providers. The Commission examines the categorization of services
supported by the Telecom Program. The Commission first seeks comment on
approaches to analyzing existing data that would result in more
accurate urban and rural rates. The Commission then seeks comment on
potential changes to the Telecom Program's categorization of service
technologies that could further improve the accuracy of urban and rural
rates in future funding years.
19. The Telecom Program subsidizes the difference between the urban
rate for a service in the health care provider's State, which must be
``reasonably comparable to the rates charged for similar services in
urban areas in that State,'' and the rural rate, which is ``the rate
for similar services provided to other customers in comparable rural
areas'' in the State. Correct categorization of ``similar services'' is
therefore critical to ensuring that the rates charged to rural health
care providers and supported by Telecom Program funds align with the
cost of delivering those services and that health care providers
receive equitable, consistent funding. Accurate categorization also
helps to eliminate the potential for waste and gamesmanship in the
Program by, for example, removing incentives for service providers to
mischaracterize lower cost services as similar to higher cost services
in order to increase Telecom Program funding.
20. The Commission currently analyzes the similarity of services
based on whether the services are ``functionally similar as viewed from
the perspective of the end user,'' rather than assessing similarity
based on technical similarities of the technologies used to deliver
service. If a rural health care provider purchases a service that
provides a similar user experience to another service, then regardless
of underlying media, protocol(s), implementation, or commercial sales/
product name, the Commission considers the two services to be
functionally similar. For example, if a rural health care provider
purchases a satellite service, that service is functionally similar to
a DS3 service or Ethernet service from the health care provider's
perspective because the services offer features and functions that
provide a similar user experience. The Commission proposes to maintain
this approach of viewing functional similarity from the perspective of
the end user for the purpose of determining urban and rural rates,
while also seeking comment about improving the service details
incorporated into the rate determination consideration, and the
Commission seeks comment on this proposal.
21. In the Promoting Telehealth Report and Order the Commission
decided to consider services to be ``similar'' if the advertised speed
is 30 percent above or below the speed of the service requested by the
health care provider. The Commission explained that a 30 percent range
would ``provide a sufficiently large range of functionally similar
services to enable reasonable rate comparisons.'' The Commission also
recognized that factors other than bandwidth such as reliability and
security are important to accurately characterizing the functional
similarity of services and that these enhanced functions may not be
part of a best efforts service. The Commission therefore instructed
Universal Service Administrative Company (USAC) to take into account
whether a health care provider requests dedicated service or other
service level guarantees when grouping similar services for the purpose
of rate determination. The Commission further instructed USAC to expand
the scope of its inquiry into similar services beyond
telecommunications services to include all services that are
functionally similar from an end user perspective regardless of
regulatory classification. The Commission proposes to continue this
technologically-agnostic approach because it is consistent with
determining functional similarity from the end user perspective. The
Commission seeks comment on maintaining this general approach,
including considering advertised speeds within a 30 percent range to be
similar.
22. Existing service category data. The Commission seeks comment on
how to conduct more effective analysis of Telecom Program data which
has been previously reported, or will be reported
[[Page 14425]]
using the current FCC Form 466, to calculate more accurate urban and
rural rates. In the Promoting Telehealth Report and Order, the
Commission did not elect to consider FCC Form 466 data beyond
bandwidth, whether the service is dedicated or best efforts, and
whether upload and download speeds are symmetrical or asymmetrical when
grouping services within each rurality tier in a State. Is there other
data currently available to USAC, or other data that could be provided
to USAC such as contract term or volume discounts, that should be
factored into rate determination to improve the accuracy of urban and
rural rates? Are there adjustments to how USAC groups similar services
or otherwise applies data from FCC Form 466 to rate determinations that
would improve the accuracy of urban and rural rates?
23. The Commission also seeks comment on recategorizing or refining
categorizations for existing Telecom Program service data so that the
data more accurately identifies the services being purchased by rural
health care providers. The Commission's initial analysis of FCC Form
466 submissions reveals that services reported as ``Ethernet'' or
``MPLS'' that have similar bandwidths frequently have significantly
different monthly rates that likely reflect a wide range of customized
bundled services and functionalities that can directly impact total
costs. These differences are likely attributable in part to overly
broad terminology. Telecom Program forms treat multi-protocol label
switching (MPLS) as a service when in fact MPLS is a networking
technique for routing packets on the internet. There is no standardized
meaning of the commercial term ``MPLS,'' and therefore it is possible
for service providers to label very different services as MPLS.
Furthermore, service providers use a wide variety of pricing models for
``MPLS'' service that make it complicated to compare offerings.
Similarly, ``Ethernet'' services are often generic constructs used to
create a broad range of services. As a result, it is likely that some
of the significant differences in monthly rates for ``Ethernet''
services with comparable bandwidths are due to significant differences
in the actual services purchased. A health care provider that selects
MPLS or Ethernet service may choose specific security, network
management systems, performance guarantees, or technical support that
in sum cost significantly more than the basic transmission component of
the telecommunications service. Factors beyond the components of the
selected service, such as geography, distance, and local exchange
carrier channel termination rates can impact the rate for end-to-end
service. These non-bandwidth related components of the delivered
service may be a significant source of the irregular behavior of the
Rates Database, creating anomalies from an inappropriate grouping of
rates within a bandwidth or rurality tier that reflect services that
are not functionally similar despite having similar bandwidths.
Consequently, the medians calculated using these groupings are likely
to be unreliable. The Commission seeks comment on this analysis. To the
extent these non-bandwidth components impact rates, how should the
Commission reconcile its definition and treatment of end-to-end rates?
24. Revision to service categories. The Commission seeks comment on
updating the Telecom Program's categorization of services to more
accurately reflect the functionality and cost of services purchased by
rural health care providers by incorporating certain key data points
into the similar service determination. For example, one rural health
care provider might purchase point-to-point transmission services only,
while another's purchase might include, at an additional charge,
network management services. Failure to control for such a difference
could lead to price anomalies. A more rural low-bandwidth transmission
only service could be less expensive than a less rural higher-bandwidth
service that includes substantial network management. Similarly,
Commission staff's analysis of service and rate data submitted by rural
health care providers in recent Telecom Program funding years indicates
that many rural health care providers choose to purchase
telecommunications services with different service level agreements
(SLAs). Distinguishing between basic transmission and enhanced services
and between services with different service level agreements should
more accurately group similar services from the perspective of the
functionality delivered to the end user.
25. One potential approach to service categorization could be to
first separate data transmission from more comprehensive service
offerings and then collect a limited, defined set of data points about
the service purchased to enable similar services to be more accurately
grouped together when determining rural rates. Different services would
be comparable if they provide a comparable user experience, regardless
of each service's underlying transmission media, protocol(s),
implementation, or commercial sales/product name. This approach would
classify services based upon functionality of the service provided,
regardless of its commercial name. For example, rural health care
providers completing the FCC Form 466 could identify their service
functionality based on three factors: system type, system scope, and
additional services. System type covers whether the network is a
private network, a managed performance network, or a best effort public
network. System scope covers network endpoints, i.e., how many separate
facilities are to be connected, and if more than one endpoint, whether
there is a hybrid mix of transmission media (fiber, microwave,
satellite) or service (MPLS, SD-WAN, Ethernet). For each endpoint the
following factors would be considered: Connectivity, i.e., whether it
is point-to-point (1:1), point-to-multipoint (1:N), and multipoint-to-
multipoint (N:N); facility type, i.e., copper, cable, microwave or
other terrestrial wireless, fiber and satellite; bandwidth/speed,
separately for download and upload; and billable distance if
applicable. Additional services would allow for reporting of premises
equipment (managed router service administration); priority maintenance
support; security; redundancy/diversity options; availability; failover
options; overflow options; data CAP; peak/non-peak options; VoIP; and
service level agreements.
26. The Commission seeks comment on questions related to this
approach. When considering service level agreements, what should be the
focus? For example, is it enough to distinguish from all other
contracts, contracts that guarantee a minimum amount of downtime and
provide liquidated damages or penalty payments when that guarantee is
violated? If so, should the Commission distinguish between different
downtime minimums and how? If not, what other service level guarantees
should be taken into account? Should the Commission ignore any service
level guarantees which do not come with material liquidated damages or
penalty payments?
27. The Commission also welcomes recommendations for alternative
approaches to service categorization. Proponents of an alternative
approach should provide an analysis that seeks to demonstrate why their
preferred approach will yield more accurate rural and urban rates than
those produced by the Rates Database prior to its waiver. Commenters
should also discuss whether their alternative approach would be
consistent with viewing the
[[Page 14426]]
similarity of services from the end user perspective as proposed.
28. Improving reporting requirements and data quality. The
Commission seeks comment on proposed revisions to Telecom Program forms
and corresponding USAC online portals to improve the quality and
consistency of Telecom Program data. The Commission seeks comment on
revisions to the FCC Form 466 as well as any other RHC Program forms,
including Healthcare Connect Fund Program (HCF Program) forms, that
would allow the collection of more detailed service information to
allow for more accurate comparisons of rates for similar services
consistent with the revised rurality classifications and service
categories proposed in the FNPRM. The Commission also seeks general
comment on the data collected for the Telecom Program. Is there
additional data that could improve the accuracy of urban and rural rate
determinations? Is there additional data that would be helpful to
ensure program integrity and to minimize waste, fraud, and abuse? Is
any data collected on FCC Form 466 unnecessary for evaluating the
efficacy of Telecom Program expenditures? How should the Telecom
Program balance the importance of data quality with concerns about
overburdening health care providers with reporting requirements? The
Commission also seeks comment on adding a process for updating,
correcting, or removing unreliable or inappropriate rate observations.
Should a process exist for validating the rate data that is included in
the Rates Database, and if so, what should it entail?
29. The Commission also seeks comment on revisions to current
sources of urban and rural rates that are used to populate the rate
determination mechanism, be it a database or some alternative. In the
Promoting Telehealth Report and Order, the Commission established a
``broadly inclusive'' list of sources for urban and rural rates
including rates from ``service providers' websites, rate cards,
contracts such as state master contracts, undiscounted rates charged to
E-Rate Program applicants, prior funding years RHC Program pricing
data, and National Exchange Carrier Association (NECA) tariff rates.''
The Commission seeks comment on the benefits and drawbacks of
continuing to compile rates from multiple sources as opposed to
limiting rate data to rates paid by disbursements from the Telecom
Program. Does relying on a large sample of rates actually available in
the market increase the accuracy of median rates? Would limiting the
relevant rates to those submitted by health care providers on FCC Form
466 result in too narrow a sample that is skewed by the lack of
competition in many rural areas? How should the Commission balance the
benefits of increasing the pool of sample rates with concerns about
whether services purchased by other commercial customers are comparable
to those purchased by health care providers participating in the
Telecom program? If FCC Form 466 reporting requirements are revised to
better identify the service being offered, will it still be feasible to
compile rates from other sources that do not have similar reporting
requirements? The Commission seeks comment on whether, if continuing to
collect data from a large range of sources, statistical tools could be
used, such as indicator variables in the proposed nationwide regression
model, to control for data sourcing.
30. The Commission also seeks comment on whether there is certain
information regarding the technical details or components of
telecommunications services that rural health care providers cannot
access or lack the technical expertise to report to USAC and should
therefore be reported by service providers. How can the Commission
ensure that health care providers, who may not have technical expertise
over the telecommunications services they receive, accurately report
the services they receive in the RHC Program? Should the Commission
require service providers to submit service information to USAC? How
should the Commission balance the value of detailed service data with
the importance of minimizing burdens on health care providers and
service providers, and also avoiding redundancies in data submissions?
31. Selecting a rate determination mechanism. The Commission seeks
comment on the most effective method for determining urban and rural
rates in an objective, transparent manner that can be uniformly applied
to all Telecom Program applications. The Commission also seeks comment
on whether, and if so how, to factor market competition into the rate
determination mechanism. Are there areas where rural healthcare
providers that receive Telecom Program support have competing service
alternatives sufficient to enable the Commission to rely on competition
to establish reasonable rural rates? If an area has multiple service
providers but only one bidder offers to provide service to the rural
healthcare provider, should a rate determination mechanism consider the
market to be competitive? How should the rate determination mechanism
factor in rates for deregulated commercial services that may be similar
to services sought through the Telecom Program but are not publicly
available?
32. Modifications to the current urban and rural rates database.
The Commission first seeks comment on whether to retain the requirement
that health care providers and service providers use a modified version
of the Rates Database to determine urban and rural rates when the
current waiver expires. Pursuant to the Nationwide Rates Database
Waiver Order, DA 21-394, Sec. Sec. 54.604(a) and 54.605(a) of the
Commission's rules are waived for funding year 2021 and funding year
2022, delaying implementation of the Rates Database. Should the
Commission revise the Rates Database to incorporate the modified
rurality classifications and service categorizations? Will the
revisions to those key data inputs be sufficient to resolve the
anomalies that resulted in the waiver?
33. The intent of the rate determination process is to establish
transparent, predictable, easy-to-administer rural and urban rates that
also fulfill the requirements of section 254 of the Act so that Telecom
Program subsidies result in rural health care providers paying rates
that are reasonably comparable to rates for functionally similar
services in urban areas of the health care provider's state and
universal service support to service providers that is based on ``rates
for similar services provided to other customers in comparable rural
areas.'' The Commission seeks comment on whether modifications could be
made to a future iteration of the Rates Database to enhance
transparency, predictability, or efficient administration.
34. Wireline Competition Bureau's (Bureau) waiver of the Rates
Database was due primarily to significant anomalies in median rural
rate outputs, specifically instances where median rural rates were
lower in more rural areas of state when compared to less rural areas
and several instances where median rates for higher bandwidth services
were lower than lower bandwidth services in comparable areas. If more
effective collection of rates and service descriptions significantly
reduces the anomalies found in the current approach, the Commission
seeks comment on whether the resulting Rates Database, or some similar
set of rate comparisons, should be used for setting urban and rural
rates. The Commission seeks comment on whether the modifications to
rurality tiers and service categorizations discussed in the FNPRM, or
any further modifications
[[Page 14427]]
identified by commenters, will sufficiently address those anomalies.
35. The Commission also seeks more general comment on the Rates
Database. What are the overall benefits and drawbacks of the Rates
Database? How, if at all, have those benefits and drawbacks changed
since the Commission adopted the Rates Database in the Promoting
Telehealth Report and Order? Is a Rates Database framework the best
solution for Alaska? Are there alternative methods for determining
rates in Alaska that would be objective, independent, and
administratively efficient?
36. In the event that the Rates Database is retained for future
funding years, the Commission seeks comment on whether to take further
action or rescind the guidance previously issued to USAC by the Bureau
regarding administration and implementation of the Rates Database. The
Commission seeks comment on further guidance or clarifications that
would further the goal of promoting transparency and predictability in
the rates determination process. Are there additional changes to the
Rates Database that might resolve the anomalies the FNPRM? Would
determining rates using the average, rather than the median, of inputs
provide sufficient and predictable funding?
37. Alternative rate determination methods. The Commission seeks
comment on potential alternative rate setting mechanisms to the Rates
Database. The Commission seeks comment on the benefits and drawbacks of
these alternative approaches.
38. Pricing model with nationwide rate data. The Commission seeks
comment on creating a nationwide regression model to estimate rural and
urban rates and determine Telecom program reimbursement on a state-by-
state basis. As with the Rates Database, with a regression model,
health care providers would enter information about the services for
which they seek support. A regression model would estimate the rural
and urban rates for Telecom Program-eligible services as determined by
the characteristics that are reasonably expected to affect those rates.
While the Commission does not know exactly how providers, including
providers of Telecom Program services, set prices, certain
characteristics are expected to influence a service's price, known as
explanatory variables for the purposes of this analysis. For example,
based on data submitted by health care providers on the FCC Form 466,
the Commission has an indication of the service type (e.g., Ethernet,
MPLS, satellite), bandwidth, the health care provider's location, and
whether there are service-level agreements associated with the service
contract. Using the same data that is used to construct the Rates
Database or any new data that may be collected, a Telecom Program
regression model would analyze how these explanatory variables
influence price, and it would then estimate the rural and urban rates
for the particular service purchased by a health care provider in a
particular state. The Regression Model Technical Analysis, provides
details on the relationship between explanatory variables and the
estimated rates (the outcome variables). The Commission seeks comment
on the regression model analysis.
39. Model inputs. The Commission seeks comment on the appropriate
set of explanatory variables for use in such a model. The data used to
construct the current Rates Database contain a range of information
about both the services that are eligible for Telecom Program support
and related services. The Rates Database categorizes services by three
sets of characteristics: bandwidth, rurality tier, and the presence or
absence of a service level agreement (i.e., whether the service was
dedicated or best efforts). A regression model would account for the
same or an expanded set of characteristics by analyzing a large number
of existing rural and urban rates. The Commission seeks comment on
using the same characteristics from the Rates Database as explanatory
variables in a regression model. The Commission also seeks comment on
whether it is beneficial to identify and include in the regression
model a broader set of characteristics that are likely determinative of
rates. The Commission anticipates that using an expanded list of
characteristics would be superior to a model that only relies on
bandwidth, rurality tier, and presence or absence of a service-level
agreement, because staff review of the data used to construct the Rates
Database suggests that other characteristics could significantly
contribute to the variation in rates. Further, it is possible to revise
the existing set of explanatory variables to better specify the
relevant factors that drive rates. For example, modifications to
rurality tiers and service categories on which the Commission seeks
comment in the FNPRM could improve the model estimates by improving the
quality of those key variables and strengthening their relationship to
how services are priced.
40. A regression model could also be applied to a subset of the
data used to construct the Rates Database based on the underlying
source of data (for example, the FCC Form 466 versus E-Rate forms), or
alternatively, it could easily account for new data that are
subsequently collected. The Commission seeks comment on the best
immediately available data that should be included in a regression
model if the Commission were to adopt such an approach. Should the
Commission include the universe of rates used to determine medians in
the Rates Database? Should records used in the regression model be
limited to RHC Program rates from FCC Forms 466? How many years of rate
data should the regression analysis include? Regression models can
control for relatively simple time trends. For example, including data
year as an explanatory variable can capture price movements from one
year to another. In such cases, using all the available years of data
is to be preferred to excluding some of them. However, ensuring time
effects are appropriately modeled becomes increasingly difficult when
the effect of other explanatory variables on prices also varies with
time. In such instances the use of old data may confound, rather than
reveal, more recent relationships. The Commission also seeks comment on
the type of data to include in a nationwide regression analysis going
forward. Would newly collected data stemming from changes to reporting
requirements proposed in the FNPRM improve the regression model
results? What other data should the Commission consider that could
improve the model's ability to estimate rural and urban rates? Beyond
conventional regression analysis, should other data-driven approaches
be considered, such as machine learning?
41. State-specific analysis. Section 254(h)(1)(A) of the Act
requires that urban rates be ``reasonably comparable to rates charged
for similar services in urban areas in that State'' and that rural
rates be ``rates for similar services provided to other customers in
comparable rural areas of the state.'' The Commission seeks comment as
to whether it would be consistent with the statute to use nationwide
inputs as a part of a regression analysis that determines the urban and
rural rates within a state. A nationwide regression model would
distinguish the independent effects of a range of explanatory variables
that influence rates in a statistically coherent fashion, while taking
into account the influence of state-specific factors that are not
accounted for by the other explanatory variables. Thus, if rates in a
given state are higher than other states, the regression model would
account for
[[Page 14428]]
these differences. Furthermore, additional local factors that influence
rates beyond those used by the Rates Database, such as the terrain of a
given location or existing network density, could be included within
the regression model to further refine state-by-state results.
42. A regression model considers how any explanatory variable the
Commission could measure (service type, bandwidth, rurality, state,
etc.) affects rates holding the other variables constant. Such an
approach separates out the independent effect of each variable on the
rate. Thus, the Commission can account for effects on rates that are
constant within a state but vary among states, such as state laws that
affect construction, labor or other costs, or unique geographic or
demographic conditions, by using the state as an explanatory variable
in the regression model.
43. In addition, a regression model gains accuracy with more data.
Knowledge about how bandwidth or service type affect rates in one state
can assist the model in determining how these same factors affect rates
in another. Could the use of nationwide data in a regression framework
improve the Commission's capacity to set reasonably comparable rates
for similar services in any state? The Commission also seeks comment on
how to account for factors that are unique to each state.
44. Rurality-based discount tiers. Alternatively, the Commission
seeks comment on whether to adopt discount rates based on the rurality
of the health care provider for the Telecom Program as a way to satisfy
the statutory requirements for establishing rates under section
254(h)(1)(A) of the Act. Under a discount rate system, the amount of
support would be a percentage of the price of the service listed in the
contract, and the percentage paid by the Universal Service Fund would
increase as rurality increases. In the E-Rate program, schools and
libraries may receive discounts ranging from 20 to 90 percent of the
pre-discount price of eligible services and equipment based on
indicators of need. The Commission seeks comment on whether an
analogous approach establishing discount tiers based on the health care
provider's rurality would be an effective, reasonable, and workable
method of determining rates for the Telecom Program.
45. The Commission seeks comment on whether a discount rate
approach could meet section 254(h)(1)(A) of the Act's requirement that
telecommunications carriers provide services to rural health care
providers at ``rates that are reasonably comparable to rates charged
for similar services in urban areas in that State.'' Historically, the
Commission has implemented this statutory mandate by allowing health
care providers to report their exact urban rates on their own. Section
254(h)(1)(A) of the Act, however, does not require that the rate
charged to the health care provider be equal to the rate charged for
similar services in a state. It merely requires that the rate charged
to the health care provider be ``reasonably comparable'' to that rate.
Section 254(h)(1)(A) of the Act also requires that the level of support
be the difference between rates charged in urban areas and ``rates for
similar services provided to other customers in comparable rural areas
in the state.'' Would the amount that a health care provider pays in a
discount rate system satisfy the requirements under section
254(h)(1)(A) of the Act given that the costs incurred by the health
care provider under such a system would change depending on the price
of the service?
46. The Commission also seeks comment on the advantages and
disadvantages of a discount rate system in the Telecom Program. Under
current program rules, the health care provider does not receive any
financial benefit from a reduction in its rural rate because it pays
the same urban rate regardless of what the rural rate is. Would a
discount rate system incentivize healthcare providers to search for or
negotiate lower priced contracts? Would this mechanism consequently
apply competitive pressure on telecommunications carriers to submit
more competitive bids during the bidding process?
47. The Commission adopted the E-Rate program percentage discount
mechanism as recommended by the Joint Board on Universal Service. The
Joint Board's recommendation was based on its finding that percentage
discounts would ``establish incentives for efficiency and
accountability'' by both requiring schools and libraries to pay a share
of the cost and encouraging schools and libraries to seek out the
lowest pre-discount cost in order to reduce their post-discount cost.
However, the Joint Board recognized the importance of focusing the
highest discounts on the most disadvantaged schools and libraries and
set discounts for those schools and libraries at 90 percent. The
Commission seeks comment on potential discount percentages for the
Telecom Program as well as whether discount percentage tiers could be
determined strictly by the health care provider's rurality or if other
data points should factor into discount tier determination. What level
of discount would be necessary to ensure reasonable comparability
considering the very high cost of services in remote areas,
particularly regions of Alaska currently classified as Frontier, and
the limited resources of many rural health care providers? Due to the
unique challenges that Tribal health care providers face, should Tribal
health care providers receive a higher discount rate than non-Tribal
providers in comparable rural areas? Would providing a higher discount
rate for Tribal health care providers or considering factors other than
rurality in determining discount rates comply with section 254(h)(1)(A)
of the Act? Are there any other considerations beyond rurality that
should be factored into a discount tier approach?
48. Cost curves. The Commission also seeks comment on whether
independent, reliable cost curves might be used in a future rates
determination process to account for the relationship between bandwidth
and rates. Although rates generally increase as bandwidth increases if
all other factors are unchanged, cost on a per megabit per second basis
generally decreases as bandwidth increases. A pricing curve shows how
the relationship between cost and bandwidth changes as bandwidth
increases. Using a pricing curve might make it possible to increase the
sample size of inputs that are used to calculate the rates used to
determine support in the Telecom Program beyond inputs 30 percent above
or below the speed of the requested service, thereby improving
reliability. The Commission could use the pricing curve to establish a
baseline per megabit per second rate for inputs consisting of rates
that are actually charged, use those inputs to calculate a per megabit
per second rate, and then extrapolate the rate for the requested
bandwidth with the pricing curve. This option would not be viable
without an independent, pricing curve that accurately reflects the
relationship between bandwidth and price and can be verified by
interested parties. What, if any, independent cost curves reflect the
relationship between bandwidth and price? Do these cost curves
accurately reflect the relationship between bandwidth and price across
all parts of the country? Would a single cost curve be appropriate for
all technologies, or does the relationship between bandwidth and cost
vary depending on the technology used to deliver the service? Would a
single nationwide cost curve produce accurate rates across all
geographies? Would the unique
[[Page 14429]]
geographic characteristics of Alaska require a separate cost curve?
Would the use of a cost curve allow for support that is ``reasonably
comparable to rates charged for similar services'' in urban areas? What
other aspects of the use of a cost curve should the Commission
consider?
49. Other potential rate determination methods. In addition to the
alternatives, the Commission seeks comment on any other alternative
rate determination methods that would increase rate transparency while
ensuring program integrity and promoting program administration. SHLB
suggested that the Commission change the ``amount of the subsidy in the
Telecom Program from 100 percent of the difference between the urban
and rural rate to 95 percent of the difference between the urban and
rural rate,'' while requiring health care providers to pay the
remaining five percent. SHLB claimed at the time that such an approach
``would ensure that HCPs are price sensitive to the total cost of the
services.'' The Commission seeks comment on such an approach. If the
Commission adopted such an approach, would five percent be an
appropriate portion of the urban/rural rate difference for health care
providers to pay, or should another percentage be adopted? Should
health care providers always pay the same percentage of the urban/rural
rate difference or should the percentage vary depending on the
circumstances of the health care provider? If the latter, how should
the Commission determine when and how the percentage varies? Should the
Commission consider capping the total amount that a health care
provider would pay under such a system? Would this approach be workable
for health care providers in Alaska given the higher costs of providing
service in that state? In the 2019 Promoting Telehealth Report and
Order, the Commission declined to follow this approach, finding that
``it would be inconsistent with the goal of section 254'' of the Act.
Are there reasons for the Commission to reconsider that analysis?
50. Potential transition period. The Bureau's waiver of the use of
the Rates Database expires at the end of funding year 2022 and the
current Telecom Program rules and forms will govern the rate
determination process and Telecom Program data collection at least
through funding year 2022 and potentially further into the future
depending on rulemaking and implementation timelines. The Commission
acknowledges that competitive bidding for funding year 2023 is
approaching and may begin as early as July 1, 2022. The Commission
seeks comment on how to manage this transition period. To the extent
that the new rules established for determining urban and rural rates
are not in effect in time for use in funding year 2023, the Commission
seeks comment on how to determine urban and rural rates during any
transition period that may occur. Should the current waiver of
Commission rules governing the Rates Database be extended to permit
time for implementation of new rates determination rules and any
associated modifications to RHC Program forms and systems? Are there
viable alternatives to extending the waiver? If the Commission
implements changes to Telecom Program rules and forms, should the Rates
Database waiver also be extended for an additional funding year so that
USAC can collect one funding year of data under the new rules to
repopulate the Rates Database? If the Commission retains the Rates
Database, should the reinstated Rates Database continue to rely on rate
data collected under previous Telecom Program rules? Should older rates
be phased out gradually?
51. Reforming the Internal Cap on Multi-Year Commitments and
Upfront Payments. In 2018, the Commission increased the annual RHC
Program funding cap to $571 million, annually adjusted the RHC Program
funding cap to reflect inflation using the Gross Domestic Product
Chain-type Price Index (GDP-CPI), beginning with funding year 2018, and
established a process to carry-forward unused funds from past funding
years for use in future funding years. In the 2019 Promoting Telehealth
Report and Order, it further directed the Bureau to adjust the $150
million funding cap on multi-year commitments and upfront payments in
the HCF Program (internal cap) pursuant to the same index established
for adjusting the overall RHC Program cap, the GDP-CPI inflation index.
Any increases to the internal cap is accounted for within the overall
RHC Program cap, i.e., an increase in the internal cap on multi-year
commitments and upfront payments will not increase the overall RHC
Program cap. In each of the funding years 2018, 2019, and 2020, gross
demand for multi-year commitments and upfront payments exceeded the
$150 million internal cap, and the Commission took actions to avoid
proration or prioritization reductions of the support for those funding
requests. With this history in mind, the Commission proposes reforming
the funding cap rules to more efficiently and effectively handle the
internal cap on multi-year commitments and upfront payments in the HCP
Program by having the internal cap apply only when overall demand
exceeds available funding and, if it does apply, targeting funding for
equipment and services needed in the funding year at issue.
52. First, to promote the efficiency of the RHC program and reduce
delays of funding commitments, the Commission proposes amending the
rules to limit the application of the internal cap to only funding
years for which the total demand exceeds the total remaining support
available. In other words, when the total support available for the
funding year, which is the sum of the inflation-adjusted RHC Program
aggregate cap in Sec. 54.619(a) of the Commission's rules and the
proportion of unused funding determined for use in the RHC Program
pursuant to Sec. 54.619(a)(5) of the Commission's rules, could satisfy
the total demand, the internal cap would not apply. Specifically, in an
initial filing window, the internal cap would apply only when the total
program demand during the filing window exceeds the total support
available in the RHC Program for the funding year. In the unlikely
event that there is an additional filing window in a given year, and if
the total demand during the additional filing window exceeds the total
remaining support available for the funding year, funding for upfront
payment and multi-year commitment requests submitted during the
additional filing window will be capped at the remaining support
available within the internal cap.
53. This proposed amendment to Commission rules would preserve the
internal cap's intended purpose of preventing multi-year and upfront
payment requests from encroaching on the funding available for single-
year requests, because the internal cap would still apply in the same
way as before when the total demand exceeds the total remaining support
available. The Commission seeks comment on this proposed new rule. In
particular, will it have any negative impact on the RHC Program? The
Commission recognizes there might be concerns that a very large demand
for upfront payments and multi-year commitments could consume a
significant amount of the unused funds, and consequently could impact
the available funding for single-year requests in the next funding year
because there would be less unused funding available to be carried
forward to the next funding year. The more likely result of fully
funding a large demand for upfront payments and multi-year commitments,
however, is that less funding would be required for
[[Page 14430]]
single-year requests in the next funding year. This would be the case
because there likely will be fewer single-year requests in the next
funding year given that some of the multi-year commitments may have
their second-year requests filed as single-year requests in the next
funding year if not fully funded. Thus, the full-funding of a large
demand for upfront payments and multi-year commitments would be
unlikely to cause single-year request prioritization in the next
funding year. Nevertheless, the Commission believes that this proposed
new rule will not result in all or most unused funding from prior
funding years being exhausted in a single funding year because the
Bureau, in consultation with the Office of the Managing Director,
controls the proportion of unused funding to be used in the RHC
Program. Are these assessments reasonable?
54. Second, when the internal cap applies and is exceeded, the
Commission proposes to target funding for upfront costs and the first
year of multi-year commitment requests and to fund the second and third
year of multi-year commitments with any leftover funding. Currently,
when funding requests for upfront payments and multi-year commitments
must be prioritized, requests falling in a higher prioritization
category will be fully funded before requests in the next lower
prioritization category can be funded, provided that there are funds
available and the internal cap has not been reached. For example, a
three-year multi-year commitment request in a ``Priority 2'' tier may
have all three years' services funded while a three-year multi-year
commitment request in a ``Priority 6'' tier may not be funded at all,
including the first year's service.
55. The current prioritization process will inevitably result in
some health care providers, likely those in the lower prioritization
categories, losing all or a portion of their requested support when the
requests must be prioritized while other health care providers receive
commitments for the second and third years of multi-year commitments,
even though they could request funding for these services in the next
two funding years. To mitigate the adverse impact on those health care
providers, the Commission proposes amending Sec. 54.621 of the
Commission's rules to fund upfront payments and the first year of
multi-year commitments for all priority tiers (provided funding is
available), and then the second and third years of the multi-year
commitments until the internal cap is reached. This way, it is more
likely that all health care providers that requested upfront payments
and multi-year commitments can at least have their current funding
year's financial need satisfied. Applicants can still request the
second and third year funding in the next funding year. The Commission
seeks comment on the proposed change to Sec. 54.621 of the
Commission's rules. Alternatively, should the internal cap apply only
to self-construction, in order to reduce its impact on other forms of
upfront payments, such as funding for equipment, and on multi-year
commitments?
56. The Commission also proposes allowing the underlying contracts
associated with those multi-year requests that are not fully funded to
be designated as ``evergreen,'' provided that the contracts satisfy the
criteria set forth in Sec. 54.622(i)(3)(ii) of the Commission's rules.
The evergreen designation will exempt applicants from having to
complete the competitive bidding process for the contracts when
subsequently filing requests for support pursuant to these contracts.
As a result, applicants can request multi-year commitments pursuant to
these contracts in the next funding year without going through the
competitive bidding process. The Commission seeks comment on this
proposal.
57. The proposed method for prioritizing upfront payment and multi-
year commitment requests applies when both the total support available
and the internal cap are exceeded. Should this method also apply when
the total support available is exceeded but the internal cap is not
exceeded? Currently, if the total demand exceeds the total support
available but the demand for upfront payments and multi-year
commitments is within the internal cap, all eligible requests (single-
year requests and upfront payment and multi-year commitment requests)
submitted during the filing window will be prioritized according to the
priority schedule defined in Sec. 54.621(b) of the Commission's rules.
In such a case, no separate prioritization of the upfront payment and
multi-year commitment requests will be conducted because the internal
cap is not exceeded. If the proposed method should also apply when the
total support available is exceeded but the internal cap is not
exceeded, the Commission proposes funding all single-year requests,
upfront payments, and the first-year of multi-year commitment requests
in accordance with Sec. 54.621(b) of the Commission's rules before
funding the second year and third year of multi-year commitment
requests.
58. The Commission acknowledges that some health care providers,
especially those in the higher prioritization categories, may be
inconvenienced under the proposed method because they would have to
file applications in future funding years for services that otherwise
would fall under the second and third year of a multi-year commitment.
The Commission tentatively concludes that this inconvenience to those
health care providers is outweighed by the benefit to health care
providers who, without this rule change, could have funding requests
for upfront costs and services in the first year of a multi-year
commitment request denied or prorated. Do program participants agree
with this tentative conclusion? Are there any additional disadvantages
associated with this method? Are there any other approaches to better
handle the prioritization reduction of upfront payments and multi-year
commitments? Rather than making these changes, would it be better to
simply eliminate the internal cap on upfront costs and multi-year
commitments? The Commission also seeks comment on whether the current
funding cap is sufficient to satisfy demand now and in the coming years
for the RHC Program, including whether the current inflation adjustment
mechanism accurately reflects changes in the cost to provide broadband
and telecommunications services.
59. Harmonizing Telecom Program Invoicing With HCP Program
Invoicing. In the 2019 Promoting Telehealth Report and Order, the
Commission established a number of improvements to the invoicing
process for both the HCF Program and Telecom Program. Specifically, the
Commission established a uniform invoice filing deadline for the RHC
Program, beginning with funding year 2020, established a one-time
invoice deadline extension allowing service providers and billed
entities to request and automatically receive a single one-time 120-day
extension of the invoice deadline, and strengthened the certifications
under both the Telecom Program and HCF Program.
60. The Commission proposes to fully harmonize the invoicing
process between the Telecom Program and the HCF Program. Currently,
there are separate invoicing processes for the two programs. Under the
Commission's rules, Telecom Program participants ``must submit
documentation to [USAC] confirming the service start date, the service
end or disconnect date, or whether the service was never turned on.''
Health care providers send this
[[Page 14431]]
information to USAC via the FCC Form 467 (Connection Certification).
After that, USAC generates a Health Care Provider Support Schedule
(HSS), which the service provider uses to determine how much credit the
applicant will receive for the services. When the HSS is generated, the
service provider reviews the HSS for accuracy and applies the credit to
the health care provider's account. Once the credit is applied to the
health care provider's account, the service provider can file invoices
through USAC's online filing system, My Portal. After an HSS is issued,
it is the responsibility of the health care provider to submit a
request for an FCC Form 467 revision if services are delayed or not
turned on. Absent requests for an FCC Form 467 revision, the service
provider may submit invoices for services for the exact amount listed
on the HSS and USAC will continue to disburse funds according to the
schedule.
61. The Commission tentatively concludes that HSSs compromise the
ability of USAC to administer the Telecom Program effectively and
efficiently because once a service provider files an invoice and
receives a disbursement, the FCC Form 467 can no longer be revised even
when there is a change in service. Due to this limitation, if a service
is later disconnected or was never actually installed, the service
provider could still submit invoices for the service (but only for the
amount established in the HSS) and receive disbursements from USAC. In
My Portal, when a service provider submits an invoice, the amount
requested for disbursement is pre-populated and must match the amount
determined in the HSS even if the actual costs reflected in the bill
are for less than the HSS amount. In recent years, the Enforcement
Bureau discovered instances where invoices submitted under a valid HSS
were inaccurate. Specifically, the invoices were for disconnected or
uninstalled services, which resulted in funding disbursements to the
service provider that exceeded the amount of Telecom Program support to
which it was entitled.
62. The HCF Program uses a simpler invoicing process. To invoice in
the HCF Program, the participating service provider and the health care
provider must submit an invoice for broadband service using FCC Form
463 (Invoice and Request for Disbursement Form) to USAC after services
are provided. Once a health care provider receives a bill from its
service provider, it can create an invoice for the services received
using the FCC Form 463. The health care provider must certify that the
information in the form and attachments is accurate and that it or
another eligible source has paid the 35 percent contribution. The
health care provider then sends the FCC Form 463 to the service
provider for approval through My Portal. The service provider reviews
the FCC Form 463 and certifies its accuracy, and then submits the form
to USAC. Once USAC receives the FCC Form 463, it processes the form
and, if approved, funds are then distributed to the service provider.
Thus, funding is only disbursed in the HCF Program when actual costs
are reflected in an invoice from the service provider. The process of
confirming costs with invoices reduces the possibility of over-
invoicing because funding is disbursed only when expenses are actually
incurred, which differs from the Telecom Program where a service
provider may receive funds when the service was never installed or was
disconnected.
63. To alleviate inefficiencies and to further protect against
waste, fraud, and abuse in the RHC Program, the Commission proposes to
revise the rules to eliminate the use of HSSs in the Telecom Program
and align the Telecom Program's invoicing process with the HCF
Program's invoicing rules. Specifically, the Commission proposes to
have participants in both programs invoice USAC for services actually
provided using the FCC Form 463 rather than use HSSs in the Telecom
Program. The Commission tentatively concludes that eliminating the use
of HSSs in the Telecom Program would increase the efficient and
effective distribution of program funds because funds would be
distributed according to actual costs rather than according to a
predetermined schedule. The Commission seeks comment on this tentative
conclusion. If the proposal to eliminate HSSs is adopted, the use of
the FCC Form 467 would be unnecessary because health care providers
would no longer need to file the form to receive HSSs. The Commission
therefore proposes to eliminate the use of the FCC Form 467 and retire
the form. The Commission tentatively concludes that removing the burden
of reporting changes in service would better protect the Telecom
Program from waste, fraud, and abuse because it would reduce the
possibility that service providers could over invoice USAC for services
not provided. The Commission seeks comment on these proposals and
invite commenters to comment on whether there is an alternative method
for revising the invoicing rules in the Telecom Program to protect
against waste, fraud, and abuse.
64. Application Processing, Funding Decisions, and Appeals of
Decisions. The Commission seeks comment on any additional measures
beyond those already taken by the Commission and USAC that could
further enhance the efficiency of application processing and the speed
in which funding commitment decisions are made. To ensure distribution
of support in accordance with program rules and to make the application
process as smooth as possible for health care providers, in the
Promoting Telehealth Report and Order, the Commission directed USAC to
develop procedures for application review and to develop outreach
materials to help participants navigate program processes.
Additionally, USAC recently began a multi-step overhaul of its
application platform that should make the funding review process faster
and more efficient. Analysis conducted by Commission staff indicates
that USAC's processing for RHC Program applications has improved in
recent funding years. The Commission seeks comment on what additional
steps, if any, the Commission or USAC can take to further expedite
application processing while still protecting the integrity of the
Fund. Should the Commission consider requiring USAC to process
applications and make funding commitment decisions within a specified
period of time after the close of the filing window or after the
requisite forms and responses to USAC information requests have been
deemed received by USAC after initial cursory review? One stakeholder
raised concerns that program rules are unclear regarding the
eligibility of equipment, leading to inconsistent funding decisions. If
this is the case, in what way are program rules unclear regarding the
eligibility of equipment and how can they be made clearer? The
Commission also seeks comment on whether there are changes that can be
made to the existing appeals process for appeals with USAC and the
Commission, including whether the Commission or USAC should be required
to act on such appeals within a specified period of time.
65. Finally, The Commission seeks comment on whether there are
other reforms the Commission should consider to eliminate common errors
with the application review and decision-making process. Stakeholders
have previously expressed concern about administrative errors on the
part of USAC that lead to lengthy delays. Do these types of errors
remain a concern?
[[Page 14432]]
Are there steps the Commission can take to reduce the administrative
costs and burdens on health care providers while maintaining the
integrity of the Fund and protecting against waste, fraud, and abuse?
66. Digital Equity and Inclusion. The Commission, as part of its
continuing effort to advance digital equity for all, including people
of color, persons with disabilities, persons who live in rural or
Tribal areas, and others who are or have been historically underserved,
marginalized, or adversely affected by persistent poverty or
inequality, invites comment on any equity-related considerations and
benefits (if any) that may be associated with the proposals and issues
discussed herein. Specifically, the Commissions seek comment on how the
proposals may promote or inhibit advances in diversity, equity,
inclusion, and accessibility, as well the scope of the Commission's
relevant legal authority.
III. Procedural Matters
A. Initial Paperwork Reduction Act Analysis
67. This document contains proposed new or modified information
collection requirements. The Commission, as part of its continuing
effort to reduce paperwork burdens, invites the general public and the
Office of Management and Budget (OMB) to comment on the information
collection requirements contained in this document, as required by the
Paperwork Reduction Act of 1995, Public Law 104-13. 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 seeks specific
comment on how to further reduce the information collection burden for
small business concerns with fewer than 25 employees.
B. Initial Regulatory Flexibility Analysis
68. The Regulatory Flexibility Act of 1980, as amended (RFA),
requires that an agency prepare a regulatory flexibility analysis for
notice-and-comment rulemaking proceedings, unless the agency certifies
that ``the rule will not, if promulgated, have a significant economic
impact on a substantial number of small entities'' by the policies and
rules proposed in the FNPRM. Accordingly, the Commission has prepared
an Initial Regulatory Flexibility Analysis (IRFA) concerning potential
rule and policy changes contained in the FNPRM. Written public comments
are requested on this IRFA. Comments must be identified as responses to
the IRFA and must be filed by the deadlines for comments on the FNPRM.
The Commission will send a copy of the FNPRM, including this IRFA, to
the Chief Counsel for Advocacy of the Small Business Administration
(SBA). In addition, the FNPRM and IRFA (or summaries thereof) will be
published in the Federal Register.
69. Need for, and Objective of, the Proposed Rules. Through the
FNPRM, the Commission seeks to improve the Rural Health Care (RHC)
Program's capacity to distribute telecommunications and broadband
support to health care providers- especially small, rural healthcare
providers (HCPs)--in the most equitable and efficient manner as
possible. Over the years, telehealth has become an increasingly vital
component of healthcare delivery to rural Americans. Rural healthcare
facilities are typically limited by the equipment and supplies they
have and the scope of services they can offer which ultimately can have
an impact on the availability of high-quality health care. Therefore,
the RHC Program plays a critical role in overcoming some of the
obstacles healthcare providers face in healthcare delivery in rural
communities. Considering the significance of RHC Program support, the
Commission proposes and seeks comment on several measures to most
effectively meet HCPs' needs while responsibly distributing the RHC
Program's limited funds.
70. In the FNPRM, the Commission seeks comment on several measures
to improve the process of determining accurate and reasonable rates in
the Telecom Program. Specifically, the Commission seeks comment on
various data inputs related to rurality classifications for health care
providers and categorization of eligible services to determine rates
that reflect the cost of delivering service to health care providers.
The Commission also seeks comment on how to improve the current rate
determination mechanism to prevent some of the inconsistencies and
anomalies in Rates Database. The Commission seeks additional comment on
alternatives to the Rates Database, including a regression model.
71. The Commission also proposes and seeks comment on a few
procedural matters that would improve the overall effectiveness of the
RHC Program. For example, the Commission seeks comment on reforming the
RHC Program's internal funding cap. Specifically, the Commission
proposes to amend the current rules so that the internal cap for
upfront costs and multi-year commitments applies only if available
funding for the entire program is exceeded. The Commission seeks
comment on a two-tiered system that would prioritize first the funding
of upfront costs and the first year of multi-year commitments and then
the second and third year of multi-year commitments until the internal
cap is reached.
72. To alleviate inefficiencies and to further protect against
waste, fraud, and abuse in the RHC Program, the Commission also
proposes to revise the rules to eliminate the use of Health Care
Provider Support Schedules (HSSs) in the Telecom Program and harmonize
the Telecom Program's invoicing process with the HCF Program's
invoicing rules.
73. Legal Basis. The legal basis for the FNPRM is contained in
sections 1 through 4(g)(D)(i)-(j), 201-205, 254, 303(r), and 403 of the
Communications Act of 1934, as amended by the Telecommunications Act of
1996, 47 U.S.C. 151 through 154(i), (j), 201 through 205, 254, 303(r),
and 403.
74. Description and Estimate of the Number of Small Entities to
Which the Proposed 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, if
adopted. 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 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 Small Business Administration
(SBA).
75. Small Businesses, Small Organizations, Small Governmental
Jurisdictions. The Commission's actions, over time, may affect small
entities that are not easily categorized at present. Therefore, at the
outset, there are 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 percent of all businesses in the United States which translates to
31.7 million businesses.
76. 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
[[Page 14433]]
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.
77. 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 indicates 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 39, 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 populations of less than 50,000. Based on the 2017 U.S.
Census Bureau data the Commission estimates that at least 48, 971
entities fall in the category of ``small governmental jurisdictions.''
78. Small entities potentially affected by the proposals herein
include eligible rural non-profit and public health care providers and
the eligible service providers offering them services, including
telecommunications service providers, internet Service Providers
(ISPs), and vendors of the services and equipment used for dedicated
broadband networks.
79. Healthcare Providers, Offices of Physicians (except Mental
Health Specialists). This U.S. industry comprises establishments of
health practitioners having the degree of M.D. (Doctor of Medicine) or
D.O. (Doctor of Osteopathy) primarily engaged in the independent
practice of general or specialized medicine (except psychiatry or
psychoanalysis) or surgery. These practitioners operate private or
group practices in their own offices (e.g., centers, clinics) or in the
facilities of others, such as hospitals or HMO medical centers. The SBA
has created a size standard for this industry, which is annual receipts
of $12 million or less. According to 2012 U.S. Economic Census, 152,468
firms operated throughout the entire year in this industry. Of that
number, 147,718 had annual receipts of less than $10 million, while
3,108 firms had annual receipts between $10 million and $24,999,999.
Based on this data, the Commission concludes that a majority of firms
operating in this industry are small under the applicable size
standard.
80. Offices of Dentists. This U.S. industry comprises
establishments of health practitioners having the degree of D.M.D.
(Doctor of Dental Medicine), D.D.S. (Doctor of Dental Surgery), or
D.D.Sc. (Doctor of Dental Science) primarily engaged in the independent
practice of general or specialized dentistry or dental surgery. These
practitioners operate private or group practices in their own offices
(e.g., centers, clinics) or in the facilities of others, such as
hospitals or HMO medical centers. They can provide either comprehensive
preventive, cosmetic, or emergency care, or specialize in a single
field of dentistry. The SBA has established a size standard for that
industry of annual receipts of $8 million or less. The 2012 U.S.
Economic Census indicates that 115,268 firms operated in the dental
industry throughout the entire year. Of that number 114,417 had annual
receipts of less than $5 million, while 651 firms had annual receipts
between $5 million and $9,999,999. Based on this data, the Commission
concludes that a majority of business in the dental industry are small
under the applicable standard.
81. Offices of Chiropractors. This U.S. industry comprises
establishments of health practitioners having the degree of D.C.
(Doctor of Chiropractic) primarily engaged in the independent practice
of chiropractic. These practitioners provide diagnostic and therapeutic
treatment of neuromusculoskeletal and related disorders through the
manipulation and adjustment of the spinal column and extremities, and
operate private or group practices in their own offices (e.g., centers,
clinics) or in the facilities of others, such as hospitals or HMO
medical centers. The SBA has established a size standard for this
industry, which is annual receipts of $8 million or less. The 2012 U.S.
Economic Census statistics show that in 2012, 33,940 firms operated
throughout the entire year. Of that number 33,910 operated with annual
receipts of less than $5 million per year, while 26 firms had annual
receipts between $5 million and $9,999,999. Based on this data, the
Commission concludes that a majority of chiropractors are small.
82. Offices of Optometrists. This U.S. industry comprises
establishments of health practitioners having the degree of O.D.
(Doctor of Optometry) primarily engaged in the independent practice of
optometry. These practitioners examine, diagnose, treat, and manage
diseases and disorders of the visual system, the eye and associated
structures as well as diagnose related systemic conditions. Offices of
optometrists prescribe and/or provide eyeglasses, contact lenses, low
vision aids, and vision therapy. They operate private or group
practices in their own offices (e.g., centers, clinics) or in the
facilities of others, such as hospitals or HMO medical centers, and may
also provide the same services as opticians, such as selling and
fitting prescription eyeglasses and contact lenses. The SBA has
established a size standard for businesses operating in this industry,
which is annual receipts of $8 million or less. The 2012 Economic
Census indicates that 18,050 firms operated the entire year. Of that
number, 17,951 had annual receipts of less than $5 million, while 70
firms had annual receipts between $5 million and $9,999,999. Based on
this data, the Commission concludes that a majority of optometrists in
this industry are small.
83. Offices of Mental Health Practitioners (except Physicians).
This U.S. industry comprises establishments of independent mental
health practitioners (except physicians) primarily engaged in (1) the
diagnosis and treatment of mental, emotional, and behavioral disorders
and/or (2) the diagnosis and treatment of individual or group social
dysfunction brought about by such causes as mental illness, alcohol and
substance abuse, physical and emotional trauma, or stress. These
practitioners operate private or group practices in their own offices
(e.g., centers, clinics) or in the facilities of others, such as
hospitals or HMO medical centers. The SBA has created a size standard
for this industry, which is annual receipts of $8 million or less. The
2012 U.S. Economic Census indicates that 16,058 firms operated
throughout the entire year. Of that number, 15,894 firms received
annual receipts of less than $5 million, while 111 firms had annual
receipts between $5 million and $9,999,999. Based on this data, the
Commission concludes that a majority of mental health practitioners who
do not employ physicians are small.
84. Offices of Physical, Occupational and Speech Therapists and
Audiologists. This U.S. industry comprises establishments of
independent health practitioners primarily engaged in one of the
following: (1) Providing physical therapy services to patients who have
impairments, functional limitations, disabilities, or changes in
physical functions and health status resulting from injury, disease or
other causes, or who require prevention, wellness or
[[Page 14434]]
fitness services; (2) planning and administering educational,
recreational, and social activities designed to help patients or
individuals with disabilities, regain physical or mental functioning or
to adapt to their disabilities; and (3) diagnosing and treating speech,
language, or hearing problems. These practitioners operate private or
group practices in their own offices (e.g., centers, clinics) or in the
facilities of others, such as hospitals or HMO medical centers. The SBA
has established a size standard for this industry, which is annual
receipts of $8 million or less. The 2012 U.S. Economic Census indicates
that 20,567 firms in this industry operated throughout the entire year.
Of this number, 20,047 had annual receipts of less than $5 million,
while 270 firms had annual receipts between $5 million and $9,999,999.
Based on this data, the Commission concludes that a majority of
businesses in this industry are small.
85. Offices of Podiatrists. This U.S. industry comprises
establishments of health practitioners having the degree of D.P.M.
(Doctor of Podiatric Medicine) primarily engaged in the independent
practice of podiatry. These practitioners diagnose and treat diseases
and deformities of the foot and operate private or group practices in
their own offices (e.g., centers, clinics) or in the facilities of
others, such as hospitals or HMO medical centers. The SBA has
established a size standard for businesses in this industry, which is
annual receipts of $8 million or less. The 2012 U.S. Economic Census
indicates that 7,569 podiatry firms operated throughout the entire
year. Of that number, 7,545 firms had annual receipts of less than $5
million, while 22 firms had annual receipts between $5 million and
$9,999,999. Based on this data, the Commission concludes that a
majority of firms in this industry are small.
86. Offices of All Other Miscellaneous Health Practitioners. This
U.S. industry comprises establishments of independent health
practitioners (except physicians; dentists; chiropractors;
optometrists; mental health specialists; physical, occupational, and
speech therapists; audiologists; and podiatrists). These practitioners
operate private or group practices in their own offices (e.g., centers,
clinics) or in the facilities of others, such as hospitals or HMO
medical centers. The SBA has established a size standard for this
industry, which is annual receipts of $8 million or less. The 2012 U.S.
Economic Census indicates that 11,460 firms operated throughout the
entire year. Of that number, 11,374 firms had annual receipts of less
than $5 million, while 48 firms had annual receipts between $5 million
and $9,999,999. Based on this data, the Commission concludes the
majority of firms in this industry are small.
87. Family Planning Centers. This U.S. industry comprises
establishments with medical staff primarily engaged in providing a
range of family planning services on an outpatient basis, such as
contraceptive services, genetic and prenatal counseling, voluntary
sterilization, and therapeutic and medically induced termination of
pregnancy. The SBA has established a size standard for this industry,
which is annual receipts of $12 million or less. The 2012 Economic
Census indicates that 1,286 firms in this industry operated throughout
the entire year. Of that number 1,237 had annual receipts of less than
$10 million, while 36 firms had annual receipts between $10 million and
$24,999,999. Based on this data, the Commission concludes that the
majority of firms in this industry is small.
88. Outpatient Mental Health and Substance Abuse Centers. This U.S.
industry comprises establishments with medical staff primarily engaged
in providing outpatient services related to the diagnosis and treatment
of mental health disorders and alcohol and other substance abuse. These
establishments generally treat patients who do not require inpatient
treatment. They may provide a counseling staff and information
regarding a wide range of mental health and substance abuse issues and/
or refer patients to more extensive treatment programs, if necessary.
The SBA has established a size standard for this industry, which is
$16.5 million or less in annual receipts. The 2012 U.S. Economic Census
indicates that 4,446 firms operated throughout the entire year. Of that
number, 4,069 had annual receipts of less than $10 million while 286
firms had annual receipts between $10 million and $24,999,999. Based on
this data, the Commission concludes that a majority of firms in this
industry are small.
89. HMO Medical Centers. This U.S. industry comprises
establishments with physicians and other medical staff primarily
engaged in providing a range of outpatient medical services to the
health maintenance organization (HMO) subscribers with a focus
generally on primary health care. These establishments are owned by the
HMO. Included in this industry are HMO establishments that both provide
health care services and underwrite health and medical insurance
policies. The SBA has established a size standard for this industry,
which is $35 million or less in annual receipts. The 2012 U.S. Economic
Census indicates that 14 firms in this industry operated throughout the
entire year. Of that number, 5 firms had annual receipts of less than
$25 million, while 1 firm had annual receipts between $25 million and
$99,999,999. Based on this data, the Commission concludes that
approximately one-third of the firms in this industry are small.
90. Freestanding Ambulatory Surgical and Emergency Centers. This
U.S. industry comprises establishments with physicians and other
medical staff primarily engaged in (1) providing surgical services
(e.g., orthoscopic and cataract surgery) on an outpatient basis or (2)
providing emergency care services (e.g., setting broken bones, treating
lacerations, or tending to patients suffering injuries as a result of
accidents, trauma, or medical conditions necessitating immediate
medical care) on an outpatient basis. Outpatient surgical
establishments have specialized facilities, such as operating and
recovery rooms, and specialized equipment, such as anesthetic or X-ray
equipment. The SBA has established a size standard for this industry,
which is annual receipts of $16.5 million or less. The 2012 U.S.
Economic Census indicates that 3,595 firms in this industry operated
throughout the entire year. Of that number, 3,222 firms had annual
receipts of less than $10 million, while 289 firms had annual receipts
between $10 million and $24,999,999. Based on this data, the Commission
concludes that a majority of firms in this industry are small.
91. All Other Outpatient Care Centers. This U.S. industry comprises
establishments with medical staff primarily engaged in providing
general or specialized outpatient care (except family planning centers,
outpatient mental health and substance abuse centers, HMO medical
centers, kidney dialysis centers, and freestanding ambulatory surgical
and emergency centers). Centers or clinics of health practitioners with
different degrees from more than one industry practicing within the
same establishment (i.e., Doctor of Medicine and Doctor of Dental
Medicine) are included in this industry. The SBA has established a size
standard for this industry, which is annual receipts of $22 million or
less. The 2012 U.S. Economic Census indicates that 4,903 firms operated
in this industry throughout the entire year. Of this number, 4,269
firms had annual receipts of less than $10 million, while 389 firms had
annual receipts between $10
[[Page 14435]]
million and $24,999,999. Based on this data, the Commission concludes
that a majority of firms in this industry are small.
92. Blood and Organ Banks. This U.S. industry comprises
establishments primarily engaged in collecting, storing, and
distributing blood and blood products and storing and distributing body
organs. The SBA has established a size standard for this industry,
which is annual receipts of $35 million or less. The 2012 U.S. Economic
Census indicates that 314 firms operated in this industry throughout
the entire year. Of that number, 235 operated with annual receipts of
less than $25 million, while 41 firms had annual receipts between $25
million and $49,999,999. Based on this data, the Commission concludes
that approximately three-quarters of firms that operate in this
industry are small.
93. All Other Miscellaneous Ambulatory Health Care Services. This
U.S. industry comprises establishments primarily engaged in providing
ambulatory health care services (except offices of physicians,
dentists, and other health practitioners; outpatient care centers;
medical and diagnostic laboratories; home health care providers;
ambulances; and blood and organ banks). The SBA has established a size
standard for this industry, which is annual receipts of $16.5 million
or less. The 2012 U.S. Economic Census indicates that 2,429 firms
operated in this industry throughout the entire year. Of that number,
2,318 had annual receipts of less than $10 million, while 56 firms had
annual receipts between $10 million and $24,999,999. Based on this
data, the Commission concludes that a majority of the firms in this
industry is small.
94. Medical Laboratories. This U.S. industry comprises
establishments known as medical laboratories primarily engaged in
providing analytic or diagnostic services, including body fluid
analysis, generally to the medical profession or to the patient on
referral from a health practitioner. The SBA has established a size
standard for this industry, which is annual receipts of $35 million or
less. The 2012 U.S. Economic Census indicates that 2,599 firms operated
in this industry throughout the entire year. Of this number, 2,465 had
annual receipts of less than $25 million, while 60 firms had annual
receipts between $25 million and $49,999,999. Based on this data, the
Commission concludes that a majority of firms that operate in this
industry are small. Centers. This U.S. industry comprises
establishments known as diagnostic imaging centers primarily engaged in
producing images of the patient generally on referral from a health
practitioner. The SBA has established size standard for this industry,
which is annual receipts of $16.5 million or less. The 2012 U.S.
Economic Census indicates that 4,209 firms operated in this industry
throughout the entire year. Of that number, 3,876 firms had annual
receipts of less than $10 million, while 228 firms had annual receipts
between $10 million and $24,999,999. Based on this data, the Commission
concludes that a majority of firms that operate in this industry are
small.
95. Home Health Care Services. This U.S. industry comprises
establishments primarily engaged in providing skilled nursing services
in the home, along with a range of the following: Personal care
services; homemaker and companion services; physical therapy; medical
social services; medications; medical equipment and supplies;
counseling; 24-hour home care; occupation and vocational therapy;
dietary and nutritional services; speech therapy; audiology; and high-
tech care, such as intravenous therapy. The SBA has established a size
standard for this industry, which is annual receipts of $16.5 million
or less. The 2012 U.S. Economic Census indicates that 17,770 firms
operated in this industry throughout the entire year. Of that number,
16,822 had annual receipts of less than $10 million, while 590 firms
had annual receipts between $10 million and $24,999,999. Based on this
data, the Commission concludes that a majority of firms that operate in
this industry are small.
96. Ambulance Services. This U.S. industry comprises establishments
primarily engaged in providing transportation of patients by ground or
air, along with medical care. These services are often provided during
a medical emergency but are not restricted to emergencies. The vehicles
are equipped with lifesaving equipment operated by medically trained
personnel. The SBA has established a size standard for this industry,
which is annual receipts of $16.5 million or less. The 2012 U.S.
Economic Census indicates that 2,984 firms operated in this industry
throughout the entire year. Of that number, 2,926 had annual receipts
of less than $15 million, while 133 firms had annual receipts between
$10 million and $24,999,999. Based on this data, the Commission
concludes that a majority of firms in this industry is small.
97. Kidney Dialysis Centers. This U.S. industry comprises
establishments with medical staff primarily engaged in providing
outpatient kidney or renal dialysis services. The SBA has established a
size standard for this industry, which is annual receipts of $41.5
million or less. The 2012 U.S. Economic Census indicates that 396 firms
operated in this industry throughout the entire year. Of that number,
379 had annual receipts of less than $25 million, while 7 firms had
annual receipts between $25 million and $49,999,999. Based on this
data, the Commission concludes that a majority of firms in this
industry are small.
98. General Medical and Surgical Hospitals. This U.S. industry
comprises establishments known and licensed as general medical and
surgical hospitals primarily engaged in providing diagnostic and
medical treatment (both surgical and nonsurgical) to inpatients with
any of a wide variety of medical conditions. These establishments
maintain inpatient beds and provide patients with food services that
meet their nutritional requirements. These hospitals have an organized
staff of physicians and other medical staff to provide patient care
services. These establishments usually provide other services, such as
outpatient services, anatomical pathology services, diagnostic X-ray
services, clinical laboratory services, operating room services for a
variety of procedures, and pharmacy services. The SBA has established a
size standard for this industry, which is annual receipts of $41.5
million or less. The 2012 U.S. Economic Census indicates that 2,800
firms operated in this industry throughout the entire year. Of that
number, 877 has annual receipts of less than $25 million, while 400
firms had annual receipts between $25 million and $49,999,999. Based on
this data, the Commission concludes that approximately one-quarter of
firms in this industry are small.
99. Psychiatric and Substance Abuse Hospitals. This U.S. industry
comprises establishments known and licensed as psychiatric and
substance abuse hospitals primarily engaged in providing diagnostic,
medical treatment, and monitoring services for inpatients who suffer
from mental illness or substance abuse disorders. The treatment often
requires an extended stay in the hospital. These establishments
maintain inpatient beds and provide patients with food services that
meet their nutritional requirements. They have an organized staff of
physicians and other medical staff to provide patient care services.
Psychiatric, psychological, and social work services are available at
the facility. These hospitals usually provide
[[Page 14436]]
other services, such as outpatient services, clinical laboratory
services, diagnostic X-ray services, and electroencephalograph
services. The SBA has established a size standard for this industry,
which is annual receipts of $41.5 million or less. The 2012 U.S.
Economic Census indicates that 404 firms operated in this industry
throughout the entire year. Of that number, 185 had annual receipts of
less than $25 million, while 107 firms had annual receipts between $25
million and $49,999,999. Based on this data, the Commission concludes
that more than one-half of the firms in this industry are small.
100. Specialty (Except Psychiatric and Substance Abuse) Hospitals.
This U.S. industry consists of establishments known and licensed as
specialty hospitals primarily engaged in providing diagnostic, and
medical treatment to inpatients with a specific type of disease or
medical condition (except psychiatric or substance abuse). Hospitals
providing long-term care for the chronically ill and hospitals
providing rehabilitation, restorative, and adjustive services to
physically challenged or disabled people are included in this industry.
These establishments maintain inpatient beds and provide patients with
food services that meet their nutritional requirements. They have an
organized staff of physicians and other medical staff to provide
patient care services. These hospitals may provide other services, such
as outpatient services, diagnostic X-ray services, clinical laboratory
services, operating room services, physical therapy services,
educational and vocational services, and psychological and social work
services. The SBA has established a size standard for this industry,
which is annual receipts of $41.5 million or less. The 2012 U.S.
Economic Census indicates that 346 firms operated in this industry
throughout the entire year. Of that number, 146 firms had annual
receipts of less than $25 million, while 79 firms had annual receipts
between $25 million and $49,999,999. Based on this data, the Commission
concludes that more than one-half of the firms in this industry are
small.
101. Emergency and Other Relief Services. This industry comprises
establishments primarily engaged in providing food, shelter, clothing,
medical relief, resettlement, and counseling to victims of domestic or
international disasters or conflicts (e.g., wars). The SBA has
established a size standard for this industry which is annual receipts
of $35 million or less. The 2012 U.S. Economic Census indicates that
541 firms operated in this industry throughout the entire year. Of that
number, 509 had annual receipts of less than $25 million, while 7 firms
had annual receipts between $25 million and $49,999,999. Based on this
data, the Commission concludes that a majority of firms in this
industry are small.
102. Providers of Telecommunications and Other Services,
Telecommunications Service Providers. Incumbent Local Exchange Carriers
(LECs). Neither the Commission nor the SBA has developed a small
business size standard specifically for incumbent local exchange
services. The closest applicable NAICS Code category is Wired
Telecommunications Carriers. Under the applicable SBA size standard,
such a business is small if it has 1,500 or fewer employees. U.S.
Census Bureau data for 2012 indicate that 3,117 firms operated the
entire year. Of this total, 3,083 operated with fewer than 1,000
employees. Consequently, the Commission estimates that most providers
of incumbent local exchange service are small businesses that may be
affected by the Commission's actions. According to Commission data, one
thousand three hundred and seven (1,307) Incumbent Local Exchange
Carriers reported that they were incumbent local exchange service
providers. Of this total, an estimated 1,006 have 1,500 or fewer
employees. Thus, using the SBA's size standard the majority of
incumbent LECs can be considered small entities.
103. Interexchange Carriers (IXCs). Neither the Commission nor the
SBA has developed a small business size standard specifically for
Interexchange Carriers. The closest applicable NAICS Code category is
Wired Telecommunications Carriers. The applicable size standard under
SBA rules is that such a business is small if it has 1,500 or fewer
employees. U.S. Census Bureau data for 2012 indicate that 3,117 firms
operated for the entire year. Of that number, 3,083 operated with fewer
than 1,000 employees. According to internally developed Commission
data, 359 companies reported that their primary telecommunications
service activity was the provision of interexchange services. Of this
total, an estimated 317 have 1,500 or fewer employees. Consequently,
the Commission estimates that the majority of interexchange service
providers are small entities.
104. Competitive Access Providers. Neither the Commission nor the
SBA has developed a definition of small entities specifically
applicable to competitive access services providers (CAPs). The closest
applicable definition under the SBA rules is Wired Telecommunications
Carriers and under the size standard, such a business is small if it
has 1,500 or fewer employees. U.S. Census Bureau data for 2012
indicates that 3,117 firms operated during that year. Of that number,
3,083 operated with fewer than 1,000 employees. Consequently, the
Commission estimates that most competitive access providers are small
businesses that may be affected by these actions. According to
Commission data the 2010 Trends in Telephone Report, 1,442 CAPs and
competitive local exchange carriers (competitive LECs) reported that
they were engaged in the provision of competitive local exchange
services. Of these 1,442 CAPs and competitive LECs, an estimated 1,256
have 1,500 or few employees and 186 have more than 1,500 employees.
Consequently, the Commission estimates that most providers of
competitive exchange services are small businesses.
105. 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.
106. Vendors and Equipment Manufactures. Vendors of Infrastructure
Development or ``Network Buildout.'' The Commission has not developed a
small business size standard specifically directed toward manufacturers
of network facilities. There are two applicable SBA categories in which
manufacturers of network facilities could fall and each have different
size standards under the SBA rules. The SBA categories are ``Radio and
Television Broadcasting and Wireless Communications Equipment'' with a
size standard of 1,250 employees or less and ``Other Communications
Equipment Manufacturing'' with a size standard of 750 employees or
less.'' U.S. Census Bureau data for 2012 shows that for Radio and
Television Broadcasting and Wireless Communications Equipment firms 841
establishments operated for the entire year. Of that number, 828
establishments operated with fewer than 1,000 employees, and 7
establishments operated with between 1,000 and 2,499 employees. For
Other Communications Equipment Manufacturing, U.S. Census Bureau data
for 2012, show that 383 establishments operated for the year. Of that
number 379 operated with fewer than 500 employees and 4 had 500 to
[[Page 14437]]
999 employees. Based on this data, the Commission concludes that the
majority of Vendors of Infrastructure Development or ``Network
Buildout'' are small.
107. Telephone Apparatus Manufacturing. This industry comprises
establishments primarily engaged in manufacturing wire telephone and
data communications equipment. These products may be stand-alone or
board-level components of a larger system. Examples of products made by
these establishments are central office switching equipment, cordless
and wire telephones (except cellular), PBX equipment, telephone
answering machines, LAN modems, multi-user modems, and other data
communications equipment, such as bridges, routers, and gateways. The
SBA has developed a small business size standard for Telephone
Apparatus Manufacturing, which consists of all such companies having
1,250 or fewer employees. U.S. Census Bureau data for 2012 show that
there were 266 establishments that operated that year. Of this total,
262 operated with fewer than 1,000 employees. Thus, under this size
standard, the majority of firms in this industry can be considered
small.
108. Radio and Television Broadcasting and Wireless Communications
Equipment Manufacturing. This industry comprises establishments
primarily engaged in manufacturing radio and television broadcast and
wireless communications equipment. Examples of products made by these
establishments are: Transmitting and receiving antennas, cable
television equipment, GPS equipment, pagers, cellular phones, mobile
communications equipment, and radio and television studio and
broadcasting equipment. The SBA has established a small business size
standard for this industry of 1,250 or fewer employees. U.S. Census
Bureau data for 2012 show that 841 establishments operated in this
industry in that year. Of that number, 828 establishments operated with
fewer than 1,000 employees, 7 establishments operated with between
1,000 and 2,499 employees and 6 establishments operated with 2,500 or
more employees. Based on this data, the Commission concludes that a
majority of manufacturers in this industry are small.
109. Other Communications Equipment Manufacturing. This industry
comprises establishments primarily engaged in manufacturing
communications equipment (except telephone apparatus, and radio and
television broadcast, and wireless communications equipment). Examples
of such manufacturing include fire detection and alarm systems
manufacturing, Intercom systems and equipment manufacturing, and
signals (e.g., highway, pedestrian, railway, traffic) manufacturing.
The SBA has established a size standard for this industry as all such
firms having 750 or fewer employees. U.S. Census Bureau data for 2012
shows that 383 establishments operated in that year. Of that number,
379 operated with fewer than 500 employees and 4 had 500 to 999
employees. Based on this data, the Commission concludes that the
majority of Other Communications Equipment Manufacturers are small.
110. Steps Taken to Minimize the Significant Economic Impact of
Small Entities and Significant Alternatives Considered. The RFA
requires an agency to describe any significant, specifically small
business, alternatives that it has considered in reaching its proposed
approach, which may include the following four alternatives (among
others): ``(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 and reporting requirements under the rule
for such 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 such small entities.'' The Commission expects to consider
all of these factors when it has received substantive comment from the
public and potentially affected entities.
111. Largely, the proposals in the FNPRM if adopted will have no
impact on or will reduce the economic impact of current regulations on
small entities. Certain proposals could have a positive economic impact
on small entities. In the FNPRM, the Commission seeks comment on
changes that would streamline and simplify the application process;
maximize efficient and fair distribution of support; and increase
support for small entities relative to their larger counterparts,
thereby decreasing the net economic burden on small entities. In the
instances in which a proposed change would increase the financial
burden on small entities, the Commission has determined that the net
financial and other benefits from such changes would outweigh the
increased burdens on small entities.
112. Determining Accurate Rates in the Telecom Program. To minimize
potential rate variances and anomalies, the Commission seeks comment on
how to determine accurate and reasonable urban and rural rates in the
Telecom Program. The Commission specifically seeks input on how to
define and evaluate rurality to determine what areas are comparable for
purposes of determining rates. The Commission then seeks comment on
what factors to consider when differentiating rural areas. The
Commission seeks comment on approaches to analyzing existing data that
would result in more accurate urban and rural rates such as
establishing potential changes to the Telecom Program's categorization
of service technologies that could further improve the accuracy of
urban and rural rates in future funding years. The Commission also
seeks comment on ways to improve and modify the current rate
determination mechanism, the Rates Database, based on existing data.
The Commission also seeks comment on an alternative model to the Rates
Database.
113. Harmonizing the Invoicing Process in the Telecom and HCF
Program. Currently, there are separate invoicing processes for the two
programs. To alleviate inefficiencies and to further protect against
waste, fraud, and abuse in the RHC Program, the Commission proposes to
revise the rules to eliminate the use of HSSs in the Telecom Program
and align the Telecom Program's invoicing process with the HCF
Program's invoicing rules, which are simpler than the Telecom Program's
current invoicing rules. Specifically, the Commission proposes to have
participants in both programs invoice for services actually provided
using the FCC Form 463 rather than use HSSs in the Telecom Program.
114. Reform of Program Funding Cap. The Commission proposes and
seeks comment on reforming the RHC Program's funding cap. Specifically,
the Commission proposes to amend the current rules so that the internal
cap for upfront costs and multi-year commitments apply only if
available funding for the entire program is exceeded. The Commission
additionally seeks comment on a two-tiered system that would distribute
funding first to upfront costs and the first year of multi-year
commitments and then the second and third year of multi-year
commitments until the internal cap is reached.
115. Federal Rules That May Duplicate, Overlap, or Conflict With
the Proposed Rules. None.
116. Ex Parte Rules--Permit-But-Disclose. The proceeding the FNPRM
is a part of shall be treated as a ``permit-but-disclose'' proceeding
in accordance with the Commission's ex parte rules. Persons making ex
parte presentations
[[Page 14438]]
must file a copy of any written presentation or a memorandum
summarizing any oral presentation within two business days after the
presentation (unless a different deadline applicable to the Sunshine
period applies). Persons making oral ex parte presentations are
reminded that memoranda summarizing the presentation must (1) list all
persons attending or otherwise participating in the meeting at which
the ex parte presentation was made, and (2) summarize all data
presented and arguments made during the presentation. If the
presentation consisted in whole or in part of the presentation of data
or arguments already reflected in the presenter's written comments,
memoranda or other filings in the proceeding, the presenter may provide
citations to such data or arguments in his or her prior comments,
memoranda, or other filings (specifying the relevant page and/or
paragraph numbers where such data or arguments can be found) in lieu of
summarizing them in the memorandum. Documents shown or given to
Commission staff during ex parte meetings are deemed to be written ex
parte presentations and must be filed consistent with Commission rule
1.1206(b). In proceedings governed by Commission rule 1.49(f) or for
which the Commission has made available a method of electronic filing,
written ex parte presentations and memoranda summarizing oral ex parte
presentations, and all attachments thereto, must be filed through the
electronic comment filing system available for that proceeding, and
must be filed in their native format (e.g., .doc, .xml, .ppt,
searchable .pdf). Participants in this proceeding should familiarize
themselves with the Commission's ex parte rules.
117. Description of Projected Reporting, Recordkeeping, and Other
Compliance Requirements for Small Entities. The reporting,
recordkeeping, and other compliance requirements proposed in the FNPRM
likely would positively and negatively financially impact both large
and small entities, including healthcare providers and service
providers, and any resulting financial burdens may disproportionately
impact small entities given their typically more limited resources. In
weighing the likely financial benefits and burdens of the proposed
requirements, however, the Commission has determined that the proposed
changes would result in more equitable, effective, efficient, clear,
and predictable distribution of RHC support, far outweighing any
resultant financial burdens on small entity participants.
118. Application Documentation. The Commission seeks comment on
proposed revisions to Telecom Program forms and corresponding USAC
online portals to improve the quality and consistency of Telecom
Program data. The Commission seeks comment on revisions to the FCC Form
466 as well as any other RHC Program forms including HCF Program forms
that might allow for the collection of more detailed service
information to allow for more accurate comparisons of rates for similar
services consistent with the revised rurality classifications and
service categories proposed in the FNPRM. The Commission also seeks
comment on whether there is certain information regarding the technical
details or components of telecommunications services that rural health
care providers cannot access or lack the technical expertise to report
to USAC and should therefore be reported by service providers.
119. Invoicing Requirements. To harmonize the Commission's rules
under the Telecom and HCF Programs, and to ensure sufficient program
oversight, efficiency, and certainty, the Commission proposes to
harmonize the invoicing process between the Telecom Program and the HCF
Program.
120. Improving Data Collection. As the Commission seeks to better
monitor RHC Program effectiveness, the Commission seeks general comment
on the data collected for the Telecom Program.
IV. Ordering Clauses
121. Accordingly, it is ordered that, pursuant to the authority
contained in sections 1 through 4, 201-205, 254, 303(r), and 403 of the
Communications Act of 1934, as amended by the Telecommunications Act of
1996, 47 U.S.C. 151 through 154, 201 through 205, 254, 303(r), and 403,
the Further Notice of Proposed Rulemaking is adopted.
122. It is further ordered that, pursuant to applicable procedures
set forth in Sec. Sec. 1.415 and 1.419 of the Commission's rules, 47
CFR 1.415, 1.419, interested parties may file comments on the FNPRM on
or before April 14, 2022, and reply comments on or before May 16, 2022.
123. It is further ordered that the Commission's Consumer and
Governmental Affairs Bureau, Reference Information Center, shall send a
copy of the Further Notice of Proposed Rulemaking, including the
Initial Regulatory Flexibility Analysis, to the Chief Counsel for
Advocacy of the Small Business Administration.
List of Subjects in 47 CFR part 54
Communications common carriers, Health facilities, Infants and
children, internet, Telecommunications, Telephone.
Federal Communications Commission.
Katura Jackson,
Federal Register Liaison Officer.
Proposed Rules
For the reasons discussed in the preamble, the Federal
Communications Commission proposes to amend 47 CFR part 54 as follows:
PART 54--UNIVERSAL SERVICE
0
1. The authority citation for part 54 continues to read as follows:
Authority: 47 U.S.C. 151, 154(i), 155, 201, 205, 214, 219, 220,
229, 254, 303(r), 403, 1004, 1302, and 1601-1609 unless otherwise
noted.
0
2. Amend Sec. 54.619 by revising paragraph (b) to read as follows:
Sec. 54.619 Cap.
* * * * *
(b) Application of the internal cap on multi-year commitments and
upfront payments in the Healthcare Connect Fund Program. The internal
cap on multi-year commitments and upfront payments in the Healthcare
Connect Fund Program applies only when the total demand during a filing
window period exceeds the total remaining support available for the
funding year. The total remaining support available for the funding
year is based on the inflation-adjusted aggregate annual cap, the
proportion of unused funding for use in the Rural Health Care Program
determined in paragraph (a)(5) of this section, and the amount of
funding allocated in one or more previous filing window periods, if
any, of the funding year.
0
3. Amend Sec. 54.621 by adding paragraph (b)(3) to read as follows:
Sec. 54.621 Filing window for requests and prioritization of support.
* * * * *
(b) * * *
(3) Prioritization of upfront payment and multi-year commitment
requests. When the internal cap on multi-year commitments and upfront
payments applies pursuant to Sec. 54.619(b) and the demand for upfront
payments and multi-year commitments during a filing window period
exceeds the internal cap on multi-year commitments and upfront payments
in the Healthcare Connect Fund Program, the Administrator shall
[[Page 14439]]
fund upfront payments and the first year of the multi-year commitments
in all eligible requests in accordance with paragraph (b) of this
section before funding the second year and the third year, if
applicable, of the multi-year commitment requests in accordance with
paragraph (b) of this section until the internal cap is reached or no
available funds remaining. The Administrator shall also designate the
underlying contracts associated with the multi-year commitment requests
that are not fully funded as ``evergreen'' provided those contracts
meet the requirements under Sec. 54.622(i)(3)(ii).
0
4. Amend Sec. 54.627 by revising paragraph (c) to read as follows:
Sec. 54.627 Invoicing process and certifications.
* * * * *
(c) Certifications.
(1) Before the Administrator may process and pay an invoice, both
the health care provider and the service provider must make the
following certifications.
(i) The health care provider must certify that:
(A) The service has been or is being provided to the health care
provider;
(B) The universal service credit will be applied to the
telecommunications service billing account of the health care provider
or the billed entity as directed by the health care provider;
(C) It is authorized to submit this request on behalf of the health
care provider;
(D) It has examined the invoice and supporting documentation and
that to the best of its knowledge, information and belief, all
statements of fact contained in the invoice and supporting
documentation are true;
(E) It or the consortium it represents satisfies all of the
requirements and will abide by all of the relevant requirements,
including all applicable Commission rules, with respect to universal
service benefits provided under 47 U.S.C. 254; and
(F) It understands that any letter from the Administrator that
erroneously states that funds will be made available for the benefit of
the applicant may be subject to rescission.
(ii) The service provider must certify that:
(A) The information contained in the invoice is correct and the
health care providers and the Billed Account Numbers have been credited
with the amounts shown under ``Support Amount to be Paid by USAC;''
(B) It has abided by all of the relevant requirements, including
all applicable Commission rules;
(C) It has received and reviewed the invoice form and accompanying
documentation, and that the rates charged for the telecommunications
services, to the best of its knowledge, information and belief, are
accurate and comply with the Commission's rules;
(D) It is authorized to submit the invoice;
(E) The health care provider paid the appropriate urban rate for
the telecommunications services;
(F) The rural rate on the invoice does not exceed the appropriate
rural rate determined by the Administrator;
(G) It has charged the health care provider for only eligible
services prior to submitting the invoice for payment and accompanying
documentation;
(H) It has not offered or provided a gift or any other thing of
value to the applicant (or to the applicant's personnel, including its
consultant) for which it will provide services; and
(I) The consultants or third parties it has hired do not have an
ownership interest, sales commission arrangement, or other financial
stake in the service provider chosen to provide the requested services,
and that they have otherwise complied with Rural Health Care Program
rules, including the Commission's rules requiring fair and open
competitive bidding.
(J) As a condition of receiving support, it will provide to the
health care providers, on a timely basis, all documents regarding
supported equipment or services that are necessary for the health care
provider to submit required forms or respond to Commission or
Administrator inquiries.
* * * * *
[FR Doc. 2022-05191 Filed 3-14-22; 8:45 am]
BILLING CODE 6712-01-P
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</html>Indexed from Federal Register on March 15, 2022.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.