[Federal Register Volume 68, Number 247 (Wednesday, December 24, 2003)]
[Proposed Rules]
[Pages 74538-74541]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-31684]


=======================================================================
-----------------------------------------------------------------------

FEDERAL COMMUNICATIONS COMMISSION

47 CFR Part 54

[WC Docket No. 02-60; FCC 03-288]


Rural Health Care Support Mechanism

AGENCY: Federal Communications Commission.

ACTION: Notice of proposed rulemaking.

-----------------------------------------------------------------------

SUMMARY: In this document, the Commission seeks comment on 
modifications to the definition of ``rural area'' for the rural health 
care support mechanism, whether additional modifications to our rules 
are appropriate to facilitate the provision of support to mobile rural 
health clinics for satellite services, and additional outreach efforts 
and measures to streamline further the application process.

DATES: Comments are due on or before February 23, 2004. Reply comments 
are due on or before April 7, 2004. Written comments on the proposed 
information collection(s) must be submitted by the public, Office of 
Management and Budget (OMB), and other interested parties on or before 
February 23, 2004.

ADDRESSES: All filings must be sent to the Commission's Secretary, 
Marlene H. Dortch, Office of the Secretary, Federal Communications 
Commission, 445 12th Street, SW., Washington, DC 20554. In addition to 
filing comments with the Secretary, a copy of any Paperwork Reduction 
Act (PRA) comments on the information collection(s) contained herein 
should be submitted to Judith B. Herman, Federal Communications 
Commission, Room 1-C804, 445 12th Street, SW., Washington, DC 20554, or 
via the Internet to [email protected], and to Kim A. Johnson, OMB 
Desk Officer, Room 10236 NEOB, 725 17th Street, NW., Washington, DC 
20503, or via the Internet to [email protected] or by fax to 
202-395-5167. Parties should also send three paper copies of their 
filings to Sheryl Todd, Telecommunications Access Policy Division, 
Wireline Competition Bureau, Federal Communications Commission, 445 
Twelfth Street, SW., Room 5-B540, Washington, DC 20554. See 
Supplemental Information for further filing instructions.

FOR FURTHER INFORMATION CONTACT: Shannon Lipp, Attorney, (202) 418-7400 
or Regina Brown, Attorney, (202) 418-7400, Wireline Competition Bureau, 
Telecommunications Access Policy Division. For additional information 
concerning the information collection(s) contained in this document, 
contact Judith B. Herman at 202-418-0214, or via the Internet at 
[email protected].

SUPPLEMENTARY INFORMATION: This is a summary of the Commission's 
Further Notice of Proposed Rulemaking in WC Docket No. 02-60 released 
on November 17, 2003. A companion Report and Order and Order on 
Reconsideration was also released in WC Docket No. 02-60 on November 
17, 2003. The full text of this document is available for public 
inspection during regular business hours in the FCC Reference Center, 
Room CY-A257, 445 Twelfth Street, SW., Washington, DC 20554.
    This Further Notice of Proposed Rulemaking (FNPRM) contains 
proposed information collection(s) subject to the Paperwork Reduction 
Act of 1995 (PRA). It has been submitted to the Office of Management 
and Budget (OMB) for review under the PRA. OMB, the general public, and 
other Federal agencies are invited to comment on the proposed 
information collections contained in this proceeding.

Paperwork Reduction Act

    The FNPRM contained proposed information collections. 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(s) contained in 
this FNPRM, as required by the Paperwork Reduction Act (PRA) of 1995, 
Public Law 104-13. Public and agency comments on the proposed 
information collections discussed in this FNPRM are due on or before 
February 23, 2004. PRA comments should address: (a) Whether the 
proposed collection of information is necessary for the proper 
performance of the functions of the Commission, including whether the 
information shall have practical utility; (b) the accuracy of the 
Commission's burden estimates; (c) ways to enhance the quality, 
utility, and clarity of the information collected; and (d) ways to 
minimize the burden of the collection of information on the 
respondents, including the use of automated collection techniques or 
other forms of information technology.
    OMB Control Number: 3060-0804.
    Title: Universal Service--Health Care Providers Universal Service 
Program.
    Form No.: FCC Forms 465, 466, 466-A, and 467.
    Type of Review: Proposed revised collection.
    Respondents: Business or other for-profit; not for profit 
institutions.

----------------------------------------------------------------------------------------------------------------
                                                                    Number of     Frequency  of    Total  annual
                             Title                                 respondents       response         burden
----------------------------------------------------------------------------------------------------------------
1. FCC Form 465--Description of Service Requested and                     1,600              1.5          96,000
 Certification.................................................
2. FCC Form 466--Funding Request And Certification.............           1,600              2           192,000
3. FCC Form 466-A--Internet Toll Charge Discount Request.......               5              1               200
4. FCC Form 467--Connection Certification......................           1,600              1            81,000

[[Page 74539]]

 
    Total Annual Burden:                                         ..............  ...............         369,200
Total Annual Costs: $0
----------------------------------------------------------------------------------------------------------------

    Needs and Uses: In the FNPRM, we seek comment on ways to streamline 
further the application process and expand outreach efforts. In the 
companion Report and Order, we note that USAC has implemented many 
steps to streamline the application process and has increased its 
outreach efforts, since the NPRM, 67 FR 34653, May 15, 2002, was 
released in 2002. Among other things, USAC has implemented on-line 
application filing and has arranged for electronic forms to be filled 
automatically with the previous year's information for repeat on-line 
filers. Nevertheless, we seek comment on what additional steps the 
Universal Service Administrative Commission (USAC) could take to ease 
further the burdens associated with the application process. For 
example, what would be the advantages and disadvantages of implementing 
multi-year applications, so that beneficiaries would not need to apply 
every funding year? We also seek comment on whether there are 
additional outreach efforts that USAC could take to inform eligible 
applicants of the benefits of the program. For instance, should USAC 
conduct focus groups among rural health care providers to develop ideas 
on how to identify providers that operate only on a part-time basis? 
Should USAC contact service providers in rural areas to solicit 
suggestions for potential eligible users in the area? All rural health 
care providers applying for discounts on eligible telecommunications 
and information services must currently file FCC Forms 465, 466, 466-A, 
and 467. The purpose of these forms is for rural health care providers 
to certify their eligibility, describe program needs so that service 
providers are able to bid on the services, indicate that they have 
selected the most cost-effective methods, apply for discounts, and 
inform the program's administrator that they have begun to receive or 
stopped receiving services for which support was allocated.

I. Further Notice of Proposed Rulemaking

A. Definition of ``rural area''

    1. In this FNPRM, we seek comment on modifications to the 
definition of ``rural area'' for the rural health care universal 
service support mechanism. Currently, an area qualifies as rural if it 
is located in a non-metropolitan county as defined by the Office of 
Management and Budget or is specifically identified in the Goldsmith 
Modification to 1990 Census data published by the Office of Rural 
Health Care Policy (ORHP). In response to the NPRM, several commenters 
state that ORHP no longer utilizes the definition adopted by the 
Commission in 1997 and that there will be no Goldsmith Modification to 
the most recent 2000 Census data. Several commenters suggest that the 
Commission adopt the rural designation system currently utilized by 
ORHP, the Rural Urban Commuting Area (RUCA) system. Others propose to 
define rural as non-urbanized areas, as specified by the Census Bureau. 
Finally, some commenters assert that if the Commission adopts a new 
definition of rural, it should grandfather existing areas that 
currently qualify as rural, if they would no longer qualify under the 
new definition.
    2. We seek comment on whether we should adopt a new definition of 
rural area for the rural health care program, and, if so, what that new 
definition should be. We seek comment on whether there are any 
definitions for rural areas used by other government agencies or 
medical organizations that would be appropriate for the rural health 
care program. In addition to describing any proposed new definitions, 
we ask commenters to address the specific proposals that have already 
been raised in the record. Commenters are encouraged to describe the 
effects of any new definition to the program, e.g. how many existing 
rural areas would become non-rural and vice versa. We also seek comment 
on whether there are reasons we should or should not use the same 
definition of ``rural'' for both the rural health care and schools and 
libraries support mechanisms.

B. Support for Satellite Services for Mobile Rural Health Clinics

    3. We also seek comment on whether additional modifications to our 
rules are appropriate to facilitate the provision of support to mobile 
rural health clinics for satellite services. Satellite services may be 
used by mobile rural health clinics that operate in vans or boats to 
deliver telemedical services via satellite to residents in rural areas. 
For example, one non-profit entity is launching the first mobile 
telemammography van to diagnose breast cancer in women in four rural 
tribal lands in North and South Dakota early next year. This van will 
conduct mammograms and deliver results to rural American Indian women 
while they wait. The van's clinician will send the mammogram via 
satellite, which is contained in sixty-four megabytes of data, to 
doctors at the University of Colorado, who will diagnose any 
abnormalities and email the van with the patient's results. The van 
will serve approximately 12,000 women among the four tribes, at a rate 
of ten to twelve women a day. The van will be stationed at each 
reservation for approximately two weeks at a time and will travel 
approximately 200-300 days a year, depending on travel time and 
maintenance and repairs to the van. Satellite service for the van will 
cost approximately $10,000 a month.
    4. In the companion Report and Order, we conclude that support for 
satellite services should be capped at the amount a provider would 
receive if it received functionally-similar terrestrial-based services. 
We seek comment on whether it is appropriate to apply this rule to 
mobile rural health care providers, which by their very nature, are 
unlikely to be able to utilize terrestrially-based services 
effectively. In particular, due to the mobile nature of a telemedical 
unit and the large volume of data it will likely send, would a 
satellite connection be the most cost-effective method of providing 
service, even if a terrestrial alternative is available? Should a 
terrestrial alternative be deemed available and ``functionally 
similar,'' if by its nature it is tied to a fixed location? We seek 
comment on how mobile health care providers should make a cost-
effective determination for satellite services and whether they should 
consider the installation and disconnection charges that would be 
incurred if the mobile rural health clinic were to order a wireline 
connection at each docking location. Commenters should also discuss 
whether mobile rural health clinics should be required to service a 
specific number of locations before satellite services are deemed cost-
effective.
    5. In the event we conclude that the cap on the provision of 
support for satellite services where terrestrial service is available 
should not apply in

[[Page 74540]]

these circumstances, how should support be provided (i.e., how should 
discounts be calculated) for satellite services? Commenters are 
encouraged to discuss whether rural satellite services for mobile rural 
health clinics should be compared to urban terrestrial services and 
under what circumstances. We note that two other commenters in this 
proceeding proposed to provide support for satellite services for 
mobile health care providers. Commenters should discuss these 
commenters' proposals. We also ask commenters to estimate the amount of 
support a mobile rural health clinic would likely receive and the 
number of mobile units that would likely be eligible. The non-profit 
entity associated with the telemammography van states that distance-
based charges will not apply to satellite services in the continental 
United States. We seek comment on whether other similarly situated 
mobile rural health clinics would be subject to distance-based charges 
using satellite services and, if so, how the revised Maximum Allowable 
Distance (MAD) would impact support levels.
    6. We seek comment on how we should determine whether a mobile 
health clinic serves rural areas. In particular, should that 
determination depend on the principal place of business of the provider 
(such as its mailing address), or should it depend on where the mobile 
health clinic actually provides service? We also seek comment on 
whether support for a mobile rural health clinic should be prorated if 
it also serves non-rural locations.

C. Administrative Matters

    7. In addition, we seek comment on ways to streamline further the 
application process and expand outreach efforts. In the companion 
Report and Order, we note that USAC has implemented many steps to 
streamline the application process and has increased its outreach 
efforts, since the NPRM was released in 2002. Among other things, USAC 
has implemented on-line application filing and has arranged for 
electronic forms to be filled automatically with the previous year's 
information for repeat on-line filers. Nevertheless, we seek comment on 
what additional steps USAC could take to ease further the burdens 
associated with the application process. For example, what would be the 
advantages and disadvantages of implementing multi-year applications, 
so that beneficiaries would not need to apply every funding year? We 
also seek comment on whether there are additional outreach efforts that 
USAC could take to inform eligible applicants of the benefits of the 
program. For instance, should USAC conduct focus groups among rural 
health care providers to develop ideas on how to identify providers 
that operate only on a part-time basis? Should USAC contact service 
providers in rural areas to solicit suggestions for potential eligible 
users in the area?

II. Procedural Matters

A. Initial Regulatory Flexibility Act Analysis

    8. As required by the Regulatory Flexibility Act of 1980, as 
amended (RFA), the Commission has prepared this Initial Regulatory 
Flexibility Analysis (IRFA) of the possible significant economic impact 
on a substantial number of small entities by the policies and rules 
proposed in this FNPRM. Written public comments are requested on this 
IRFA. Comments must be identified as responses to the IRFA and must be 
filed by the deadline for comments on the FNPRM. The Commission will 
send a copy of this 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.
1. Need for, and Objectives of, the Proposed Rules
    9. The Commission is required by section 254 of the Act to 
promulgate rules to implement the universal service provisions of 
section 254. On May 8, 1997, the Commission adopted rules that reformed 
its system of universal service support mechanisms so that universal 
service is preserved and advanced as markets move toward competition. 
Among other things, the Commission adopted a mechanism to provide 
discounted telecommunications services to public or non-profit health 
care providers that serve persons in rural areas. Over the last few 
years, important changes in the rural health community prompt us to 
review the rural health care universal service support mechanism.
    10. In this FNPRM, we seek comment on whether and how to modify the 
definition of rural area as utilized in the rural health care support 
mechanism. We also seek comment on whether additional modifications to 
our rules are appropriate to facilitate the provision of support to 
mobile rural health clinics for satellite services. Lastly, we seek 
comments on ways to streamline further the application process and 
expand outreach efforts.
2. Legal Basis
    11. This FNPRM is adopted pursuant to sections 1, 4(i), (4j), 201-
205, 251, 252, and 303 of the Communications Act of 1934, as amended, 
47 U.S.C. 151, 154(i), (j), 201-205, 251, 252, and 303.
3. Description and Estimate of the Number of Small Entities to Which 
Rules Will Apply
    12. 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 rules adopted herein. 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, unless the Commission has developed one or more definitions that 
are appropriate to its activities. 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) meets 
any additional criteria established by the Small Business 
Administration (SBA).
    13. We have described in detail, supra, in the FRFA, the categories 
of entities that may be directly affected by any rules or proposals 
adopted in our efforts to reform the universal service rural health 
care support mechanism. For this IRFA, we hereby incorporate those 
entity descriptions by reference.
4. Description of Projected Reporting, Recordkeeping, and Other 
Compliance Requirements
    14. The FNPRM seeks comment on potential changes to the definition 
of ``rural area'' for the rural health care support mechanism. This 
potential change will not impact reporting or recordkeeping 
requirements, however, it could impact the overall pool of eligible 
applicants. The FNPRM also seeks comment on whether additional support 
should be provided to mobile rural health clinics that utilize 
satellite services. If changes are adopted, mobile rural health 
clinics, including small rural health clinics, could potentially be 
required to submit additional information regarding their mobile 
services, if they choose to seek discounts. Lastly, the FNPRM seeks 
comment on ways to streamline further the application process. If the 
application process is streamlined further, this would eliminate some 
of the paperwork associated with the application process.

[[Page 74541]]

5. Steps Taken To Minimize Significant Economic Impact on Small 
Entities, and Significant Alternatives Considered
    15. The RFA requires an agency to describe any significant 
alternatives that it has considered in reaching its proposed approach 
impacting small business, which may include the following four 
alternatives (among others): (1) The establishment of differing 
compliance and reporting requirements or timetables that take into 
account the resources available to small entities; (2) the 
clarification, consolidation, or simplification of compliance or 
reporting requirements under the rule for small entities; (3) the use 
of performance, rather than design, standards; and (4) an exemption 
from coverage of the rule, or part thereof, for small entities.
    16. In this FNPRM, we seek comment on a new definition of rural 
area. If a new definition is adopted, this could change the size of the 
overall pool of eligible applicants for universal service support for 
rural health care providers. We also seek comment on whether to provide 
additional support to mobile rural health clinics that utilize 
satellite services. In seeking to minimize the burdens imposed on small 
entities where doing so does not compromise the goals of the universal 
service mechanism, we invite comment on definitions and proposals for 
additional support for mobile rural health clinics that might be made 
less burdensome for small entities. In addition, we seek comment on 
ways to streamline further the application process and expand outreach 
efforts. If the application process is streamlined further, this could 
ease the burden on small entities associated with the application 
process. Additionally, outreach efforts would better inform such 
businesses about the benefits of the rural health care program and 
potentially increase small business participation in the program.
6. Federal Rules That May Duplicate, Overlap, or Conflict With the 
Proposed Rules
    17. None.

B. Initial Paperwork Reduction Act of 1995 Analysis

    18. This FNPRM contained proposed information collections. 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 collections contained in 
this FNPRM, as required by the Paperwork Reduction Act (PRA) of 1995, 
Public Law 104-13. Public and agency comments are due February 23, 
2004. It will be submitted to the Office of Management and Budget (OMB) 
for review under the PRA. PRA comments should address: (a) Whether the 
proposed collection of information is necessary for the proper 
performance of the functions of the Commission, including whether the 
information shall have practical utility; (b) the accuracy of the 
Commission's burden estimates; (c) ways to enhance the quality, 
utility, and clarity of the information collected; and (d) ways to 
minimize the burden of the collection of information on the 
respondents, including the use of automated collection techniques or 
other forms of information technology.

C. Comment Filing Procedures

    19. We invite comment on the issues and questions set forth in the 
FNPRM and Initial Regulatory Flexibility Analysis contained herein. 
Pursuant to applicable procedures set forth in sections 1.415 and 1.419 
of the Commission's rules, interested parties may file comments on or 
before February 23, 2004, and reply comments on or before April 7, 
2004. All filings should refer to WC Docket No. 02-60. Comments may be 
filed using the Commission's Electronic Comment Filing System (ECFS) or 
by filing paper copies.
    20. Comments filed through the ECFS can be sent as an electronic 
file via the Internet to http://www.fcc.gov/e-file/ecfs.html. 
Generally, only one copy of an electronic submission must be filed. If 
multiple docket or rulemaking numbers appear in the caption of this 
proceeding, however, commenters must transmit one electronic copy of 
the comments to each docket or rulemaking number referenced in the 
caption. In completing the transmittal screen, commenters should 
include their full name, U.S. Postal Service mailing address, and the 
applicable docket or rulemaking number. Parties may also submit an 
electronic comment by Internet e-mail. To get filing instructions for 
e-mail comments, commenters should send an e-mail to [email protected], and 
should include the following words in the body of the message, ``get 
form .'' A sample form and directions 
will be sent in reply.
    21. Parties who choose to file by paper must file an original and 
four copies of each filing. If more than one docket or rulemaking 
number appears in the caption of this proceeding, commenters must 
submit two additional copies for each additional docket or rulemaking 
number. Filings can be sent by hand or messenger delivery, by 
commercial overnight courier, or by first-class or overnight U.S. 
Postal Service mail (although we continue to experience delays in 
receiving U.S. Postal Service mail). The Commission's contractor, 
Natek, Inc., will receive hand-delivered or messenger-delivered paper 
filings for the Commission's Secretary at 236 Massachusetts Avenue, 
NE., Suite 110, Washington, DC 20002. The filing hours at this location 
are 8 a.m. to 7 p.m. All hand deliveries must be held together with 
rubber bands or fasteners. Any envelopes must be disposed of before 
entering the building. Commercial overnight mail (other than U.S. 
Postal Service Express Mail and Priority Mail) must be sent to 9300 
East Hampton Drive, Capitol Heights, MD 20743. U.S. Postal Service 
first-class mail, Express Mail, and Priority Mail should be addressed 
to 445 12th Street, SW., Washington, DC 20554. All filings must be 
addressed to the Commission's Secretary, Marlene H. Dortch, Office of 
the Secretary, Federal Communications Commission.
    22. Parties also must send three paper copies of their filing to 
Sheryl Todd, Telecommunications Access Policy Division, Wireline 
Competition Bureau, Federal Communications Commission, 445 12th Street, 
SW., Room 5-B540, Washington, DC 20554. In addition, commenters must 
send diskette copies to the Commission's copy contractor, Qualex 
International, Portals II, 445 12th Street, SW., Room CY-B402, 
Washington, DC 20054.

III. Ordering Clauses

    23. Pursuant to the authority contained in sections 1, 4(i), 4(j), 
201-205, 214, 254, and 403 of the Communications Act of 1934, as 
amended, this Further Notice of Proposed Rulemaking is adopted.
    24. The Commission's Consumer and Governmental Affairs Bureau, 
Reference Information Center, shall send a copy of this 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

    Libraries, Reporting and recordkeeping requirements, Schools, 
Telecommunications, Telephone.

Federal Communications Commission.
Marlene H. Dortch,
Secretary.
[FR Doc. 03-31684 Filed 12-23-03; 8:45 am]
BILLING CODE 6712-01-P