[Federal Register Volume 85, Number 69 (Thursday, April 9, 2020)]
[Rules and Regulations]
[Pages 19892-19906]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-07587]


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FEDERAL COMMUNICATIONS COMMISSION

47 CFR Part 54

[WC Docket Nos. 18-213 and 20-89; FCC 20-44; FRS 16647]


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

AGENCY: Federal Communications Commission.

ACTION: Final order; announcement of effective date.

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SUMMARY: In this document, the Federal Communications Commission 
(Commission) establishes two programs: The COVID-19 Telehealth Program 
designed to distribute a $200 million appropriation from Congress under 
the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help 
health care providers provide connected care services to patients at 
their homes or mobile locations in response to the novel Coronavirus 
2019 disease (COVID-19) pandemic, and the Connected Care Pilot Program 
(Pilot Program) designed to make available up to $100 million over 
three years to examine how the Universal Service Fund can help support 
the trend towards connected care services to consumers, particularly 
for low-income Americans and veterans.

DATES: The Report and Order is effective May 11, 2020, except for the 
information collections requiring Office of Management and Budget (OMB) 
approval. The Commission received OMB approval of the COVID-19 
Telehealth Program information collection requirements on April 6, 
2020, and those requirements are effective April 9, 2020. The Pilot 
Program requirements will not become effective until approved by OMB. 
The Federal Communications Commission will publish a document in the 
Federal Register announcing the effective date of OMB approval of the 
Pilot Program requirements.

FOR FURTHER INFORMATION CONTACT: Please email 
[email protected] with questions related to the COVID-
19 Telehealth Program, and [email protected] with questions 
related to the Pilot Program.

SUPPLEMENTARY INFORMATION: This is a summary of the Commission's 
Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth 
Program, Report and Order (R&O), in WC Docket Nos. 18-213 and 20-89; 
FCC 20-44, adopted March 31, 2020 and released April 2, 2020. Due to 
the COVID-19 pandemic, the Commission's headquarters will be closed to 
the general public until further notice. The full text of this document 
is available at the following internet address: https://docs.fcc.gov/public/attachments/FCC-20-44A1.pdf.

I. Introduction

    1. The novel Coronavirus disease 2019 (COVID-19) pandemic and 
associated respiratory illness have spread throughout the United States 
in recent weeks. In response to this pandemic, many health care 
providers are expanding existing telehealth services and implementing 
new telehealth services, and the demand for connected care services 
provided directly to patients in their homes or their mobile locations 
is skyrocketing. As a result, many health care providers are facing new 
challenges in technical infrastructure and experiencing staffing 
issues. In response to the outbreak, on March 27, 2020, President Trump 
signed the Coronavirus Aid, Relief, and Economic Security (CARES), Act 
into law, Public Law 116-136, 134 Stat. 281 (2020), providing, among a 
panoply of other actions, $200 million to the FCC to support health 
care providers in the fight against the ongoing pandemic.
    2. In the R&O, to effectuate Congress' intent in enacting the CARES 
Act, the Commission establishes a $200 million emergency COVID-19 
Telehealth Program to implement the CARES Act and ensure access to 
connected care services and devices in response to the ongoing COVID-19 
pandemic and surge

[[Page 19893]]

in demand for connected care services. The support provided through the 
COVID-19 Telehealth Program will help eligible health care providers 
purchase telecommunications services, information services, and devices 
necessary to provide critical connected care services, whether for 
treatment of coronavirus or other health conditions during the 
coronavirus pandemic. The COVID-19 Telehealth Program is funded through 
a $200 million appropriation signed into law as part of the CARES Act, 
and the program will not rely on Universal Service Fund (USF or Fund) 
support. The Commission also establishes a longer-term Connected Care 
Pilot Program (Pilot Program) within the Universal Service Fund that 
will make available up to $100 million over three years to examine how 
the Fund can help support the trend towards connected care services, 
particularly for low-income Americans and veterans. The Pilot Program 
will help defray eligible health care providers' costs of providing 
connected care services, with a particular emphasis on supporting these 
services for eligible low-income Americans and veterans. The Commission 
expects that the Pilot Program will benefit many low-income and veteran 
patients who are responding to a wide variety of health challenges such 
as diabetes management, opioid dependency, high-risk pregnancies, 
pediatric heart disease, mental health conditions, and cancer. The 
Commission also expects that the Pilot Program will provide meaningful 
data that will help to better understand how universal service funds 
can support health care provider and patient use of connected care 
services, and how supporting health care provider and patient use of 
connected care services can improve health outcomes and reduce health 
care costs. The Commission anticipates that the data and information 
collected through the Pilot Program could also have the ancillary 
benefit of aiding policy makers and legislators in the consideration of 
broader reforms--such as statutory changes or updates to rules 
administered by other agencies--that could support this trend towards 
connected care.

II. COVID-19 Telehealth Program

    3. The COVID-19 Telehealth Program is one piece of a comprehensive 
approach to reducing barriers to telehealth services for health care 
providers and their patients throughout the country in response to the 
COVID-19 pandemic. Working in step with other federal efforts to 
provide relief related to the COVID-19 pandemic, the COVID-19 
Telehealth Program will be open to eligible health care providers, 
whether located in rural or non-rural areas, and will provide eligible 
health care providers support to purchase telecommunications, 
information services, and connected devices to provide connected care 
services in response to the coronavirus pandemic. The COVID-19 
Telehealth Program will only fund monitoring devices (e.g., pulse-ox, 
BP monitoring devices), that are themselves connected. The COVID-19 
Telehealth Program will not fund unconnected devices that patients can 
use at home and then share the results with their medical professional 
remotely.
    4. The COVID-19 Telehealth Program will provide selected applicants 
full funding for eligible services and devices. The COVID-19 Telehealth 
Program has a congressionally appropriated $200 million budget, and 
these funds will be available until they are expended or until the 
current pandemic has ended. In order to ensure as many applicants as 
possible receive available funding, the Commission does not anticipate 
awarding more than $1 million to any single applicant. The Commission 
will award support to eligible applicants based on the estimated costs 
of the supported services and connected devices they intend to 
purchase, as described in each health care provider's respective 
application. However, in order to give each health care provider 
maximum flexibility to respond to changing circumstances during the 
pandemic, the Commission does not require applicants to purchase only 
the services and connected devices identified in their applications. 
They may rather use awarded support to purchase any necessary eligible 
services and connected devices. In addition, applicants that have 
exhausted initially awarded funding may request additional support.
    5. Application, Evaluation, and Selection Process. Because of the 
urgency attendant in combating the COVID-19 outbreak, the Commission 
establishes a streamlined application process for the COVID-19 
Telehealth Program, separate from the longer application process 
adopted for the broader Pilot Program. The Commission directs the 
Wireline Competition Bureau (Bureau) to review the applications, in 
consultation with the FCC's Connect2Health Task Force and its medical 
and public health experts, and announce selected participants and 
funding amounts for each selected applicant as rapidly as possible on a 
rolling basis, and continue reviewing additional applications and 
selecting participants until it has committed all COVID-19 Telehealth 
Program funding or the current pandemic has ended. In reviewing 
applications, the Commission has a strong interest in targeting funding 
towards areas that have been hardest hit by COVID-19. In addition, 
given the public health emergency and widespread scope of the 
coronavirus pandemic, unlike the broader Pilot Program, the Commission 
will not target COVID-19 Telehealth Program funding toward specific 
medical conditions, patient populations, or geographic areas. However, 
the Commission strongly encourages selected applicants to target the 
funding they receive through the COVID-19 Telehealth Program to high-
risk and vulnerable patients to the extent practicable. The Commission 
recognizes that some health care providers may have been under pre-
existing strain (e.g., large underserved or low-income patient 
population; health care provider shortages; rural hospital closures; 
limited broadband access and/or internet adoption) and encourage 
applicants to document such factors in their applications. While health 
care providers may use the COVID-19 Telehealth Program to treat 
patients that have COVID-19, the program is not limited to treating 
those types of patients as long as program funds are used ``to prevent, 
prepare for, and respond to coronavirus.'' For instance, treating other 
types of conditions or patient groups through the Commission's COVID-19 
Telehealth Program could free up resources, including physical space 
and equipment in a brick-and-mortar health care facility, allow health 
care providers to remotely treat patients with other conditions who 
could risk contracting coronavirus by visiting a health care facility, 
and could reduce health care professionals' unnecessary exposure to 
coronavirus. The Commission will also consider as part of a health care 
provider's application a showing that telemedicine directly aids in the 
prevention of pandemic spread by facilitating social distancing and 
similar measures in the community. Connected devices and services like 
patient-reported outcome platforms funded through the COVID-19 
Telehealth Program must be integral to patient care.
    6. Eligible Health Care Providers. Consistent with the 1996 Act and 
the CARES Act, the Commission limits the program to nonprofit and 
public eligible health care providers that fall within the categories 
of health care providers in section 254(h)(7)(B) of the 1996 Act: (1)

[[Page 19894]]

Post-secondary educational institutions offering health care 
instruction, teaching hospitals, and medical schools; (2) community 
health centers or health centers providing health care to migrants; (3) 
local health departments or agencies; (4) community mental health 
centers; (5) not-for-profit hospitals; (6) rural health clinics; (7) 
skilled nursing facilities; or (8) consortia of health care providers 
consisting of one or more entities falling into the first seven 
categories. The Commission has more than two decades of experience 
administering its RHC Program for these types of health care providers, 
and limiting the COVID-19 Telehealth Program to public and nonprofit 
health care providers that fall within these statutory categories is in 
the public interest because it will facilitate the administration of 
the program and ensure that funding is targeted to health care 
providers that are likely to be most in need of funding to respond to 
this pandemic while helping ensure that funding is used for its 
intended purposes.
    7. Interested health care providers that do not already have an 
eligibility determination can obtain one by filing an FCC Form 460 with 
the Universal Service Administrative Company (USAC). The Commission 
directs USAC to review and process eligibility forms for health care 
providers interested in participating in the COVID-19 Telehealth 
Program as expeditiously as possible. Health care providers that are 
interested in the COVID-19 Telehealth Program, but do not yet have an 
eligibility determination from USAC, can still submit applications for 
the COVID-19 Telehealth Program while their FCC Form 460 is pending.
    8. Application Process. To be considered for participation in the 
COVID-19 Telehealth Program, interested eligible health care providers 
must submit applications that, at a minimum, contain the information 
detailed in the following.
     Names, addresses, county, and health care provider numbers 
(if available), for health care providers seeking funding through the 
COVID-19 Telehealth Program application and the lead health care 
provider for applications involving multiple health care providers.
     Contact information for the individual that will be 
responsible for the application (telephone number, mailing address, and 
email address).
     Description of the anticipated connected care services to 
be provided, the conditions to be treated, and the goals and 
objectives. This should include a brief description of how COVID-19 has 
impacted your area, your patient population, and the approximate number 
of patients that could be treated by the health care provider's 
connected care services during the COVID-19 pandemic. If you intend to 
use the COVID-19 Telehealth Program funding to treat patients without 
COVID-19, describe how this would free up your resources that will be 
used to treat COVID-19 and/or how this would otherwise prevent, prepare 
for, or respond to the disease by, for example, facilitating social 
distancing.
     Description of the estimated number of patients to be 
treated.
     Description of the telecommunications services, 
information services, or ``devices necessary to enable the provision of 
telehealth services'' requested, the total amount of funding requested, 
as well as the total monthly amount of funding requested for each 
eligible item. If requesting funding for devices, description of all 
types of devices for which funding is requested, how the devices are 
integral to patient care, and whether the devices are for patient use 
or for the health care provider's use. As noted in the document, 
monitoring devices (e.g. pulse-ox, BP monitoring devices) will only be 
funded if they are themselves connected.
     Supporting documentation for the costs indicated in their 
application, such as a vendor or service provider quote, invoice, or 
similar information.
     A timeline for deployment of the proposed service(s) and a 
summary of the factors the applicant intends to track that can help 
measure the real impact of supported services and devices.
    9. Additionally, COVID-19 Telehealth Program applicants will also 
be required, at the time of submission of their application, to 
certify, among other things, that they will comply with the Health 
Insurance Portability and Accountability Act (HIPAA) and other 
applicable privacy and reimbursement laws and regulations, and 
applicable medical licensing laws and regulations, as waived or 
modified in connection with the COVID-19 pandemic, as well as all 
applicable COVID-19 Telehealth Program requirements and procedures, 
including the requirement to retain records to demonstrate compliance 
with the COVID-19 Telehealth Program requirements and procedures for 
three years following the last date of service, subject to audit. 
Health care providers that participate in the COVID-19 Telehealth 
Program must also comply with all applicable federal and state laws, 
including the False Claims Act, the Anti-Kickback Statute, and the 
Civil Monetary Penalties Law, as waived or modified in connection with 
the COVID-19 pandemic. Further, applicants will also be required to 
certify that they are not already receiving or expecting to receive 
other federal or state funding for the exact same services or devices 
for which they are requesting support under the COVID-19 Telehealth 
Program.
    10. The Wireline Bureau will issue a public notice announcing the 
date when COVID-19 Telehealth Program applications will be accepted and 
instructions for filing applications with the Commission. This date 
will be after April 9, 2020. Applicants will be required to complete 
each section of the application and make the required certifications at 
the end of the application. Applicants may request that any materials 
or information submitted to the Commission in its application be 
withheld from public inspection pursuant to the procedures set forth in 
section 0.459 of the Commission's rules.
    11. Instructions for Filing Applications. COVID-19 Telehealth 
Program applications must reference WC Docket No. 20-89, and must be 
filed electronically consistent with the instructions provided in a 
subsequent public notice. All filings must be addressed to the 
Commission's Secretary, Office of the Secretary, Federal Communications 
Commission. Applicants must also send a courtesy copy of their 
application via email to [email protected].
    12. Evaluation of Applications and Selection Process. The Bureau, 
in consultation with the FCC's Connect2Health Task Force, will evaluate 
the COVID-19 Telehealth Program applications and will select 
participants based on applicants' responses to the criteria listed in 
the document. The Commission's goal is to select applications that 
target areas that have been hardest hit by COVID-19 and where the 
support will have the most impact on addressing the health care needs. 
In selecting applicants, the Commission directs the Bureau to consider 
the funding sought by each applicant compared to the total COVID-19 
Telehealth Program budget. This does not mean that the Bureau will 
evaluate applications based solely on requested funding, but the Bureau 
will seek to select as many applicants as reasonably possible within 
the COVID-19 Telehealth Program's limited budget. Upon selection, the 
Bureau will provide additional guidance to program participants, as 
necessary, to facilitate the implementation of the COVID-19 Telehealth 
Program. Applicants who are selected for the COVID-19 Telehealth

[[Page 19895]]

Program may later submit applications to participate in the broader 
Pilot Program but may not request funding for the same exact services 
from both programs at the same time.
    13. Requesting Funding, Invoicing, and Disbursements. The 
Commission directs the Bureau and the Office of the Managing Director 
(OMD) to develop processes for selected applicants to submit invoices 
and receive reimbursements for services and devices supported through 
the COVID-19 Telehealth Program, and any necessary subsequent filings. 
The Commission also directs OMD and the Bureau to include in the 
application forms or subsequent filings by program participants any 
information necessary to satisfy the Commission's oversight 
responsibilities and/or agency specific/government-wide reporting 
obligations associated with the $200 million appropriation by Congress. 
After receiving the eligible services and/or equipment, health care 
provider will submit invoicing forms on a monthly basis and supporting 
documentation to the Commission to receive reimbursement for the cost 
of the eligible services and/or devices they have received from their 
applicable service providers or vendors under the COVID-19 Telehealth 
Program. The Bureau and OMD shall develop a process for reviewing the 
monthly invoicing forms and supporting documentation and for issuing 
disbursements directly to the participating health care providers 
rather than to the applicable service providers or vendors. COVID-19 
Telehealth Program health care provider participants will be required 
to make certifications as part of the invoicing form submission to 
ensure that COVID-19 Telehealth Program funds are used for their 
intended purpose.
    14. The COVID-19 Telehealth Program will not provide funding for 
health care provider administrative costs associated with participating 
in the COVID-19 Telehealth Program (e.g., costs associated with 
completing COVID-19 Telehealth Program applications and other 
submissions) or other miscellaneous expenses (e.g., doctor and staff 
time spent on the COVID-19 Telehealth Program and outreach). The 
Commission emphasizes that COVID-19 Telehealth Program funds may only 
be used for services and devices covered under the CARES Act. The costs 
of ineligible items must not be included in the reimbursement requests 
for the COVID-19 Telehealth Program. To guard against potential waste, 
fraud, and abuse, the Commission makes clear that participating health 
care providers are prohibited from selling, reselling, or transferring 
services or devices funded through the COVID-19 Telehealth Program in 
consideration for money or any other thing of value.
    15. Procurement for COVID-19 Telehealth Program-Supported Services 
and Equipment, and Document Retention. The COVID-19 Telehealth Program 
is funded through a congressional appropriation and not the USF. Given 
the immediate need to award and disburse the COVID-19 Telehealth 
Program funding to health care providers, the Commission will not 
require COVID-19 Telehealth Program participants to conduct a 
competitive bidding process to solicit and select eligible services or 
devices, or otherwise comply with the competitive bidding requirements 
that apply to the RHC Program and the broader Pilot Program. The 
Commission finds that, in light of the coronavirus pandemic and ongoing 
community efforts to slow its spread, requiring COVID-19 Telehealth 
Program participants to seek competitive bids prior to requesting 
funding would cause unnecessary delays and pose an unreasonable burden 
on health care providers during this unprecedented time. The Commission 
also finds that it would not be in the public interest during this 
national health crisis to prohibit participating health care providers 
from receiving gifts or things of value from service providers valued 
at over $20, including, but not limited to devices, equipment, free 
upgrades or other items.
    16. While the Commission will not require health care providers to 
conduct a competitive procurement process to receive COVID-19 
Telehealth Program funding, the Commission strongly encourages 
applicants to purchase cost-effective eligible services and devices to 
the extent practicable during this time. The Commission also emphasizes 
that health care providers and service providers must comply with the 
requirements applicable to the COVID-19 Telehealth Program. To help 
guard against potential waste, fraud, and abuse, participants in the 
COVID-19 Telehealth Program must maintain records related to their 
participation in the COVID-19 Telehealth Program to demonstrate their 
compliance with the program requirements for at least three years from 
the last date of service under the program and must present that 
information to the Commission or its delegates upon request. Health 
care providers participating in the COVID-19 Telehealth Program may 
also be subject to compliance audits in order to ensure compliance with 
the rules and requirements for the COVID-19 Telehealth Program and must 
provide documentation related to their participation in the COVID-19 
Telehealth Program in connection with any such audit.
    17. Outreach for COVID-19 Telehealth Program. Upon release of the 
R&O, in order to ensure that health care providers are aware of 
available funding under the COVID-19 Telehealth Program, the Commission 
will, to the extent possible, coordinate with other federal agencies to 
distribute information about the program to the health care community. 
The Commission also directs the Bureau to coordinate with the FCC's 
Connect2Health Task Force and USAC as necessary to promote and announce 
the COVID-19 Telehealth Program to interested stakeholders including 
service providers and health care providers. The Commission is 
committed to addressing the needs of health care providers as demand 
for connected care services increases to address the coronavirus 
pandemic. Such coordination and outreach will improve the overall 
efficacy of the COVID-19 Telehealth Program.
    18. Post-Program Feedback. Within six months after the conclusion 
of the COVID-19 Telehealth Program, COVID-19 Telehealth Program 
participants should provide a report to the Commission in a format to 
be determined by the Bureau on the effectiveness of the COVID-19 
Telehealth Program funding on health outcomes, patient treatment, 
health care facility administration, and any other relevant aspects of 
the pandemic. Such information could include feedback on the 
application and invoicing processes, in what ways funding was helpful 
in providing or expending telehealth services, including anonymized 
patient accounts, how funding promoted innovation and improved health 
outcomes, and other areas for improvement. Specific information about 
how to provide feedback and associated deadlines will be provided to 
COVID-19 Telehealth Program participants at a later time. This 
information will assist efforts to respond to pandemics and other 
national emergencies in the future.

III. Connected Care Pilot Program

    19. The Pilot Program will make available up to $100 million over a 
three-year funding period, separate from the budgets of the existing 
universal service programs, to cover 85% of the eligible costs of 
broadband connectivity, network equipment, and information services 
necessary to provide connected care services to the intended patient

[[Page 19896]]

population. All eligible nonprofit and public health care providers 
that fall within the statutory categories under section 254(h)(7)(B), 
regardless of whether they are non-rural or rural, can apply for the 
Pilot Program. Eligible health care providers must first submit 
applications to the Commission, and after review, the Commission will 
announce the selected projects and provide further information on 
additional requirements for the Pilot Program.
    20. For purposes of the Pilot Program, the Commission considers 
``connected care'' as a subset of telehealth that uses broadband 
internet access service-enabled technologies to deliver directly to 
patients' remote medical, diagnostic, and treatment-related services 
outside of traditional brick and mortar medical facilities--
specifically to patients at their mobile location or residence. For 
purposes of the Pilot Program, the Commission also defines 
``telehealth'' as the broad range of health care-related applications 
that depend upon broadband connectivity, including telemedicine; 
exchange of electronic health records; collection of data through 
Health Information Exchanges and other entities; exchange of large 
image files (e.g., X-ray, MRIs, and CAT scans); and the use of real-
time and delayed video conferencing for a wide range of telemedicine, 
consultation, training, and other health care purposes. Connected care 
services can be provided by doctors, nurses, or other health care 
professionals. Health care providers will have the flexibility to 
identify the medical conditions to be treated through their proposed 
pilot projects, and whether to treat a single medical condition or 
multiple medical conditions. For purposes of the Pilot Program, the 
Commission uses the U.S. Department of Health and Human Services' 
definition of ``medical condition'' to identify the types of health 
conditions that can be treated through the Pilot--``any condition, 
whether physical or mental, including but not limited to any condition 
resulting from illness, injury (whether or not the injury is 
accidental), pregnancy, or congenital malformation.''
    21. In reviewing applications, the Commission is interested in 
targeting limited Pilot Program funding towards pilot projects that are 
primarily focused on treating public health epidemics, opioid 
dependency, mental health conditions, high-risk pregnancy, or chronic 
or recurring conditions that typically require at least several months 
to treat, including, but not limited to, diabetes, cancer, kidney 
disease, heart disease, and stroke recovery. Focusing Pilot Program 
funding on these conditions identified best ensures that limited Pilot 
Program resources are targeted to populations that are most in need. 
Moreover, targeting these types of health conditions, which impact 
large segments of the population, and often require several months or 
more of treatment, or are public health crises will provide more 
meaningful data to track progress towards the Pilot Program goals of 
helping health care providers to improve health outcomes and reduce 
costs, and will also promote the efficient, fiscally responsible use of 
universal service funds.
    22. Budget Number of Pilot Projects and Support Amount Per Project, 
Funding Duration, and Discount Level. The Pilot Program will make 
available up to $100 million over three years for selected pilot 
projects. Targeting this amount of funding for qualifying eligible 
services and equipment under the Pilot Program is sufficient to obtain 
meaningful data and ensure significant interest from a wide range of 
participants. Funding the Pilot Program in this manner will not 
significantly increase the contributions burden on consumers and will 
not impact the budgets of, or disbursements for, the other existing 
universal service programs.
    23. To secure the funds for the Pilot Program, the Commission 
directs USAC to separately collect funds for the Pilot Program each 
quarter beginning with the demand filing for the fourth quarter of 
2020. USAC should collect necessary funds up to the amount of the 
budget over the entire three-year period in order to minimize any 
impact on the contribution factor. The Commission anticipates the 
collection schedule would increase the quarterly contribution factor by 
approximately 0.11%. Moreover, by starting the collection before 
selecting the pilot projects, USAC will have funding on hand as soon as 
the pilot projects begin to seek support. Requests for funding may vary 
year to year and therefore Pilot Program funding may not be distributed 
evenly each year. While anticipating significant participation in the 
Pilot Program, total amount disbursed will depend upon those funds 
ultimately committed by USAC, invoiced, and disbursed. Unused collected 
Pilot Program funds will be carried forward to subsequent quarters over 
the duration of the Pilot Program for use by pilot projects and need 
not be returned to offset future collections. Any unused funds that 
remain at the end of the Pilot Program will be used to reduce 
collections for the ongoing universal service programs.
    24. Discount Level. The Pilot Program will provide universal 
service support for 85% of the cost of eligible services and equipment. 
This support amount will allow for funding of a sufficient number of 
pilot projects to provide meaningful data and provide substantial 
financial incentive for health care providers to participate in the 
Pilot Program. Consistent with the Commission's existing rules for the 
Healthcare Connect Fund Program, health care providers must contribute 
their portion of the eligible costs from eligible sources (e.g., the 
applicant, eligible health care provider, participating patients, or 
state, federal, or Tribal funding or grants) and cannot use ineligible 
sources (e.g., direct payments from vendors or service providers) to 
pay their share of the requested services.
    25. Number of Pilot Projects and Support Amount Per Project. Based 
on the record, the Commission declines to set a limit on the number of 
pilot projects selected for the Pilot Program or the amount of support 
requested per pilot project. Setting a fixed number of pilot projects 
or a fixed amount per-project will artificially limit the number of 
pilot projects to be funded even before pilot project proposals are 
submitted and evaluated, and will not provide enough flexibility to 
select a diverse group of pilot projects. The Commission does not 
anticipate allocating all of the Pilot Program funds on one or two 
large projects. In reviewing pilot project applications, the Commission 
will be mindful of the reasonableness of the estimated total support 
amount indicated in each application, looking specifically at the 
proportion to the total Pilot Program budget and individual project 
size, to provide sufficient funding to enough projects to generate 
meaningful data.
    26. Duration. The Pilot Program will provide selected pilot 
projects support for a three-year funding period with separate 
transition periods of up to six months before and after the three-year 
funding period. Specifically, selected pilot participants will have up 
to six months from the date of their initial funding commitment letter 
from USAC to organize and start their pilot projects (including, but 
not limited to procuring eligible services or network equipment), and 
up to six months after the funding end date on their final funding 
commitment letters to wind down their pilot projects and complete any 
necessary administrative tasks. Providing a ramp up period of up to six 
months will allow sufficient time for health care providers to 
implement pilot project plans and begin offering

[[Page 19897]]

connected care services. Extending the Pilot Program for too long risks 
stale data, and therefore providing selected pilot projects up to six 
months to ramp and up to six months to wind down to ensure a reasonable 
timeframe to obtain meaningful, current data. There may be unforeseen 
circumstances that arise when implementing or operating the pilot 
projects, and therefore the Bureau is delegated authority to grant 
limited extensions of deadlines in order to ensure the successful 
operation of the Pilot Program.
    27. Eligible Health Care Providers, Patients, and Service 
Providers. The Commission establishes the Pilot Program pursuant to the 
legal authority under section 254(h)(2)(A), which directs the 
Commission to establish competitively neutral rules to enhance, to the 
extent technically feasible and economically reasonable, access to 
``advanced telecommunications and information services'' for public and 
nonprofit health care providers. Accordingly, for purposes of the Pilot 
Program, the Commission limits participation to the statutorily-
enumerated categories of ``health care provider.'' Eligible nonprofit 
or public health care providers include: (1) Post-secondary educational 
institutions offering health care instruction, teaching hospitals, and 
medical schools; (2) community health centers or health centers 
providing health care to migrants; (3) local health departments or 
agencies; (4) community mental health centers; (5) not-for-profit 
hospitals; (6) rural health clinics; (7) skilled nursing facilities; or 
(8) consortia of health care providers consisting of one or more 
entities falling into the first seven categories.
    28. To promote diversity among pilot projects, and to maximize the 
data collected, Pilot Program support will be available to health care 
providers located in both rural and non-rural areas. Section 
254(h)(2)(A) does not limit the provision of universal service support 
to health care providers in rural areas. Consistent with the record, 
the Commission believes that the Pilot Program should target vulnerable 
and medically underserved patients regardless of whether these patients 
or their health care providers are located in a rural or non-rural 
area.
    29. In selecting pilot projects, the Commission has a strong 
preference for health care providers that have either (1) experience 
with providing telehealth or connected care services to patients (e.g., 
remote patient monitoring, store-and-forward imaging, or video 
conferencing) beyond using electronic health records, or (2) a 
partnership with another health care provider, government agency, or 
designated telehealth resource center with such experience that will 
work with the health care provider to implement its proposed pilot 
project. These types of health care providers are more likely to submit 
pilot projects that can be successfully implemented within the three-
year period and better enable the Commission to collect meaningful data 
on the impact of the Pilot Program. At the same time, this approach 
also provides a path for eligible health care providers that lack 
telehealth experience, many of which may serve high percentages of 
veterans and low-income patient populations, to participate in the 
Pilot Program.
    30. Targeted Patient Populations. The Commission has a strong 
preference for pilot projects that can demonstrate that they will 
primarily benefit veterans or low-income individuals. Veteran and low-
income patients are more likely to have complex, high-cost health care 
needs, reside in areas with physician shortages, and may not have 
mobile or residential internet access for connected care services. 
Therefore, emphasizing pilot projects that will primarily benefit low-
income patients or veterans is appropriate as it will expand connected 
care services to individuals who are less likely to have access to 
these innovative services without universal service support. 
Participating patients may only participate in one pilot project and 
cannot participate in multiple pilot projects as part of the Pilot 
Program.
    31. The Commission also concludes that health care providers are in 
the best position to identify patients for their pilot projects. To the 
extent a selected pilot project asserts that it will primarily benefit 
low-income or veteran patients, the pilot project must maintain 
adequate documentation of the numbers of participating veterans or low-
income patients served through that pilot project compared to other 
patients served. For purposes of the Pilot Program, health care 
providers can determine whether a patient is considered low-income by 
determining whether (1) the patient is eligible for Medicaid or (2) the 
patient's household income is at or below 135% of the U.S. Department 
of Health and Human Services Federal Poverty Guidelines. Using these 
two criteria to identify low-income patients for purposes of the Pilot 
Program will allow a large number of low-income Americans to 
participate in the Pilot Program, including many residents of medically 
underserved rural areas. In addition, using these criteria will 
facilitate efficient program administration, minimize the potential for 
waste, fraud, and abuse, while still appropriately targeting the 
population of patients that the Commission intends to primarily benefit 
from connected care services through the Pilot Program.
    32. Health care providers may determine whether a patient qualifies 
as a veteran for purposes of the Pilot Program by confirming that the 
patient qualifies for health care through the VA. The Commission 
declines to apply an income limit to veterans. While certain veterans 
who are eligible for health care through the VA undergo means testing 
when enrolling for VA health care, other veterans (e.g., those with 
service-connected disabilities) may not be required to undergo means 
testing. The Commission believes that veterans, regardless of income 
level, who are eligible for health care through the VA are an important 
population to include in the Pilot Program. As reported in the Bureau's 
Veterans Broadband Report to Congress (May 1, 2019), a significant 
number of veterans suffer from a disability, reside in rural areas, 
and/or are older than the general population, and therefore would stand 
to benefit from connected care services. While the Commission declines 
to adopt an income criterion for veterans, the expectation is that 
pilot projects focused on serving veterans will primarily focus on 
veteran populations that are more likely to experience issues accessing 
health care.
    33. Service Providers. Eligible health care providers that 
participate in the Pilot Program can receive support for qualifying 
broadband service from any broadband provider, regardless of whether 
that provider is designated as an eligible telecommunications carrier 
(ETC). Section 254(c)(3) makes clear that, in addition to the supported 
services included in the definition of universal service in section 
254(c), ``the Commission may designate additional services for such 
support mechanisms for . . . health care providers for the purposes of 
subsection (h).'' Section 254(h)(2)(A) in turn directs the Commission 
``to enhance to the extent technically feasible and economically 
reasonable, access to advanced telecommunications services and 
information services'' for health care providers and does not by its 
language require that such services be provided by ETCs. The Commission 
has previously explained that language in section 254(e) limiting 
universal service reimbursements to ETCs does not apply to services 
supported under section 254(h)(2)(A). Moreover, allowing non-ETCs to 
provide broadband service through the Pilot Program will incent 
participation among a diverse range of both health care providers and 
service

[[Page 19898]]

providers while promoting flexibility, competition, and innovation.
    34. Eligible Services and Equipment. The Pilot Program will fund 
85% of the qualifying costs incurred by eligible health care providers. 
These costs include: (1) Patient broadband internet access services, 
(2) health care provider broadband data connections, (3) other 
connected care information services, and (4) certain network equipment.
    35. Patient Broadband internet Access Service. Funding health care 
provider purchases of broadband internet access service for 
participating patients to receive connected care services will help 
expand connected care services to many Americans, particularly low-
income and veteran patients. Many low-income consumers and veterans do 
not have broadband internet access service at all, while other low-
income consumers and veterans may not have broadband internet access 
service that is sufficient to receive connected care services. Aside 
from the VA's tablet loan program, which serves a limited number of 
veterans, it appears that no other federal program provides health care 
providers funding dedicated to purchase patient broadband internet 
access service for connected care services. Some health care providers 
are already addressing this gap by funding patient broadband internet 
access service for certain low-income or vulnerable patients who lack 
broadband service at home.
    36. The Pilot Program will provide funding for participating health 
care providers to purchase mobile or fixed broadband internet access 
service for participating patients who do not already have broadband 
internet access service or who lack sufficient broadband internet 
access service necessary to participate in the specific pilot project. 
Insufficient broadband for connected care services could include 
subscriptions to low-bandwidth connections, low usage allowances, or 
other inadequate service levels--all of which negatively impact 
patients' and health care providers' ability to use telehealth 
services. For the Pilot Program, funding these services will expand 
health care providers' digital footprints for purposes of providing 
connected care services, and allow health care providers to serve more 
patients through the Pilot Program and thus enhance health care 
providers' access to advanced telecommunications and information 
services.
    37. To ensure that funding for patient broadband internet access 
service is targeted appropriately, the Commission will require Pilot 
Program applicants seeking support for patient broadband internet 
access service to identify the estimated number of patient broadband 
connections that the health care provider intends to purchase for 
purposes of providing connected care services to patients who lack 
broadband service or have insufficient broadband services. A health 
care provider seeking funding for patient broadband internet access 
service must also explain in its application how it plans to assess 
whether a patient lacks broadband service or has insufficient broadband 
internet access service for the proposed connected care service based 
on speed, technology (e.g., fixed or mobile broadband), or other 
appropriate service characteristics. It is appropriate under section 
254(h)(2)(A) to fund the whole patient broadband connection as long as 
it is ``primarily'' used for activities that are integral, immediate, 
and proximate to the provision of connected care services to 
participating patients. In contrast to broadband connectivity for a 
single health care provider facility, it would not be ``technically 
feasible and economically reasonable,'' for health care providers to 
track, monitor, and cost-allocate non-connected care uses of the 
supported patient broadband connections.
    38. Health Care Provider Broadband Data Connections. The Pilot 
Program will also provide support for eligible, participating health 
care providers to purchase the broadband data connections needed to 
provide connected care services under the Pilot Program. While many 
eligible health care providers may already have the broadband 
connectivity necessary to participate in the Pilot Program, other 
eligible health care providers may require new or additional broadband 
data connections to participate in the Pilot Program. Providing funding 
for health care provider broadband data connections in this latter 
situation will incentivize health care provider participation, which, 
in turn, will aid in the ability to collect meaningful data. Moreover, 
requiring Pilot Program applicants that require broadband data 
connections in order to provide connected care services to seek support 
for those connections through the Healthcare Connect Fund would produce 
duplicative application requirements with minimal benefit to either 
program. The Commission expects that funding health care provider 
connectivity under these circumstances will not subsume the budget for 
the Pilot Program given the broad participation in the existing 
Healthcare Connect Fund Program which provides funding for health care 
provider broadband connectivity.
    39. To avoid duplicate funding and to stretch limited Pilot Program 
funds, eligible health care providers participating in the Pilot 
Program may not request or receive funding for broadband data 
connections for which they already receive funding through the 
Healthcare Connect Fund Program or other federal programs, and 
similarly may not request or receive funding for broadband data 
connections through the Healthcare Connect Fund Program or other 
federal programs for which they have already received funding through 
the Pilot Program. In addition, the Pilot Program will not fund 
broadband connections between health care providers as these 
connections are already eligible for funding through the Healthcare 
Connect Fund Program, and the Commission does not believe that funding 
connections between health care providers is necessary for the Pilot 
Program given the focus on supporting the provision of connected care 
services to participating patients in their homes or mobile locations.
    40. Other Connected Care Information Services. The Pilot Program 
will also provide support for information services other than broadband 
connectivity that eligible, participating health care providers use for 
connected care as part of the Pilot Program. Health care providers 
incur significant costs to provide connected care services, including, 
but not limited to, the costs of services (other than broadband) for 
connected care, and that many of these costs typically are not 
reimbursable through health care payors, which can present an obstacle 
to connected care services. Funding information services for health 
care providers' use for connected care through the Pilot Program, 
therefore, could enhance health care providers' access to such 
information services and encourage innovation in the way health care 
providers provide connected care services to their patients. The 
Commission also believes funding these information services will 
encourage broader participation in the Pilot Program. The Commission, 
however, will not fund the costs associated with medical professional 
review of data or images transmitted or stored through such services, 
or services which have a primary purpose other than capturing, 
transmitting and storing data to facilitate connected care. These costs 
fall outside the scope of the Commission's statutory authority under 
Section 254(h)(2)(A). Mobile applications will only be funded to the 
extent that they are part of a qualifying

[[Page 19899]]

information service. Eligible health care providers that seek Pilot 
Program support for an information service should include in their 
application a thorough description of the service, including a 
description of the primary function/s of the service, and whether and 
how it facilitates the capturing, transmission (including video 
visits), and storage of data for connected care.
    41. Network Equipment. The Pilot Program will provide funding to 
eligible, participating health care providers for necessary network 
equipment for broadband connectivity funded through the Pilot Program 
for connected care services. This funding can only be used for network 
equipment that is necessary to make Pilot Program funded broadband 
services for connected care services functional, or to operate, manage, 
or control such services, and must not be used for purposes other than 
providing connected care services under the Pilot Program. Health care 
providers seeking funding for qualifying network equipment for other 
health care uses may apply for such funding under the Healthcare 
Connect Fund Program. Further, to avoid duplicate funding issues, 
eligible health care providers participating in the Pilot Program may 
not request and receive funding for network equipment for which they 
already applied or received funding through the Healthcare Connect Fund 
Program or another federal program, and similarly may not request and 
receive through the Healthcare Connect Fund Program or another federal 
program funding for network equipment for which the health care 
provider receives funding through the Pilot Program. Moreover, 
consistent with Sec.  54.9 of the Commission's rules, the Pilot Program 
will prohibit health care providers from using universal service funds 
to purchase equipment or services for use through the Pilot Program 
that are produced or provided by a company that the Commission has 
identified as posing a national security threat to the integrity of 
communications networks or the communications supply chain.
    42. End-User Devices and Medical Equipment. Consistent with the 
Commission's long-standing approach to implementing its universal 
service programs, the Pilot Program will not fund end-user devices or 
medical equipment. The Commission has consistently declined to fund 
equipment unless it is ``necessary'' for the transmission function of 
the service. Additionally, providing limited Pilot Program funding to 
end-user devices and medical equipment costs may not be economically 
reasonable because it could significantly reduce the Pilot Program 
funding available for the costs directly associated with providing 
connected care services, and would limit the number of pilot projects 
the Commission can select. The record indicates that some selected 
pilot projects may be able to obtain grant funding and other funding 
for end-user devices or medical equipment where needed to participate 
in the Pilot Program. The Commission therefore encourages eligible 
health care providers to explore available grant and other funding 
opportunities, potential partnerships and other avenues that could help 
them obtain end-user and medical devices necessary to participate in 
the Pilot Program.
    43. Administrative Expenses and Other Miscellaneous Expenses. 
Consistent with the RHC Program and the RHC Pilot Program, the Pilot 
Program will not provide funding for health care provider 
administrative costs associated with participating in the Pilot Program 
(e.g., costs associated with completing Pilot Program applications and 
other submissions) or other miscellaneous expenses (e.g., doctor and 
staff time spent on the Pilot Program and outreach). This is also 
consistent with the U.S. Department of Agriculture's Distance Learning 
and Telemedicine grant program. Section 254 focuses on the availability 
of and access to ``services.'' Funding administrative or miscellaneous 
expenses associated with participating in the Pilot Program would not 
fulfill this statutory focus. Allocating scarce Pilot Program funding 
to administrative costs would significantly reduce the Pilot Program 
funding available for the costs directly associated with providing 
connected care services. Additionally, if the Commission was to provide 
direct support for administrative expenses, it would necessitate 
additional application requirements, guidelines, and other 
administrative controls to protect such funding from waste, fraud, and 
abuse. This would increase the administrative burden on USAC and on 
applicants as well.
    44. Application and Evaluation Process. To participate in the Pilot 
Program, a prospective health care provider must first obtain an 
eligibility determination from USAC by submitting an FCC Form 460 
(Eligibility and Registration Form) along with supporting documentation 
to USAC to verify its eligibility to participate in the Pilot Program. 
After confirming its eligibility for the Pilot Program, the applicant 
must submit its pilot project proposal to the Commission describing its 
proposed pilot project and providing information that will facilitate 
the evaluation and eventual selection of high-quality pilot projects in 
order to participate in the Pilot Program. Specifically, the applicant 
must show how its proposed pilot project meets the criteria outlined in 
the following. The Commission expects each applicant to present a clear 
research and evaluation strategy for meeting the health care needs of 
participating patients through the use of connected care services and 
how the proposed pilot project will accomplish these objectives. 
Successful applicants will be able to demonstrate that they have a 
viable strategic plan for delivering innovative connected care services 
directly to patients while leveraging existing resources or telehealth 
programs within their state or region. The Commission will give greater 
consideration to applications that propose to provide connected care 
services to a significant number of low-income or veteran patients in a 
given state or region. An application that intends to provide connected 
care services to only a de minimis number of low-income or veteran 
patients will not be selected.
    45. To be eligible for participation in the Pilot Program, 
interested parties should submit applications that, at a minimum, 
contain the following required information:
     Names and addresses of all health care providers that will 
participate in the proposed pilot project and the lead health care 
provider for proposals involving multiple health care providers.
     Contact information for the individual that will be 
responsible for the management and operation of the proposed pilot 
project (telephone number, mailing address, and email address).
     Health care provider number(s) and type(s) (e.g., not-for-
profit hospital, community mental health center, community health 
center, rural health clinic), for each health care provider included in 
proposal.
     Description of each participating health care provider's 
previous experience with providing telehealth services (other than 
electronic health records) or experience and name of a partnering 
health care provider or organization.
     Description of the plan for implementing and operating the 
pilot project, including how the pilot project intends to recruit 
patients, estimated amount of ramp-up time necessary for the pilot 
project (not to exceed six months), plans to obtain any necessary end-
user devices (e.g., tablets, smartphones) and medical devices for

[[Page 19900]]

the connected care services that the pilot project will provide, and to 
what extent the pilot project can be self-sustaining once established.
     Description of the connected care services the proposed 
pilot project will provide, the conditions to be treated, the health 
care provider's experience with treating those conditions, the goals 
and objectives of the proposed pilot project (including the health care 
provider's anticipated goals with respect to reaching new or additional 
patients, and improved patient health outcomes), expected health care 
benefits to the patients, health care provider, or the health care 
industry that will result from the proposed pilot project, and how the 
pilot project will achieve each of the goals of the Pilot Program.
     Documentation of the participating health care 
provider(s)'s financial health (e.g., recent audited balance sheets and 
income statements that are no more than two years old).
     Description of the estimated number of patients to be 
treated.
     Description of any commitments from community partners, 
including physicians, hospitals, health systems, and home health/
community providers to the success of the proposed pilot project.
     Description of the anticipated level of broadband service 
required for the proposed pilot project, including the necessary 
speeds, the technologies to be used (e.g., mobile or fixed broadband) 
and any other relevant service characteristics (e.g., LTE service).
     Description of the estimated number of patient broadband 
connections that the health care provider intends to purchase for 
purposes of providing connected care services to patients who lack 
broadband service or have insufficient broadband services. This 
description must include an explanation of how the health care provider 
plans to assess whether a patient lacks broadband service or has 
insufficient broadband internet access service for the indicated 
connected care service based on speed, technology or data cap 
limitations.
     If seeking support for an information service used to 
provide connected care, other than broadband connectivity, used to 
provide connected care, a description of the service, including a 
description of the primary function/s of the service, and whether it 
facilitates the capturing, transmission, and storage of data for 
connected care.
     Estimated total project costs, including costs eligible 
for support through the Pilot Program and costs not eligible for Pilot 
Program support but still necessary to implement the proposed pilot 
project. This entry must include the total estimated eligible funding 
(85%) to be requested from the Pilot Program per year over the three-
year funding period.
     A list of anticipated sources of financial support for the 
pilot project costs not covered by the Pilot Program.
     Description of the metrics for the proposed pilot project 
that are relevant to the Pilot Program goals and how the participating 
providers will collect those metrics. Examples of the types of metrics 
the Commission is interested in include: reductions in potential 
emergency room or urgent care visits; decreases in hospital admissions 
or readmissions; condition-specific outcomes, such as reductions in 
premature births or acute incidents among suffers of a chronic illness, 
and patient satisfaction as to with their overall health status.
     Description of how the health care provider intends to 
collect, track, and store, the required Pilot Program data.
    Further, to facilitate the review in selecting a diverse set of 
projects and target Pilot Program funds to geographic areas and 
populations most in need of USF support for connected care, applicants 
should also provide the following information, as applicable:
     Description of whether the health care provider is located 
in a rural area, on Tribal lands, or is associated with a Tribe, or 
part of the Indian Health Service. If the health care provider is not 
located in a rural area, include a description of whether the health 
care provider will primarily serve veterans or low-income patients 
located in rural areas as defined in the RHC Program rules, and 
identify those specific rural areas.
     Listing of all Department of Health and Human Services, 
Health Resources & Services Administration (HRSA) designated Health 
Professional Shortage Areas (for primary care or mental health care 
only) or HRSA designated Medically Underserved Areas that will be 
served by the proposed project.
     Description of whether the pilot project will primarily 
benefit low-income or veteran patients, and if so, the estimated number 
or percentage of those patients the project will serve compared to the 
total number of patients that the pilot project estimates serving.
     Description of whether the primary purpose of the proposed 
pilot project is to provide connected care services to respond to a 
public health epidemic, or to provide connected care services for 
opioid dependency, high-risk pregnancy/maternal mortality, mental 
health conditions (e.g., substance abuse, depression, anxiety 
disorders, schizophrenia, eating disorders and addictive behavior) or 
conditions of a chronic or long term nature (including, but not limited 
to heart diseases, diabetes, cancer, stroke).
    46. Additionally, applicants will also be required, at the time of 
submission of their application, to certify, among other things, that 
they will comply with the Health Insurance Portability and 
Accountability Act (HIPAA) and other applicable privacy and 
reimbursement laws and regulations, and applicable medical licensing 
laws and regulations, as well as all applicable Pilot Program 
requirements and procedures, including the requirement to retain 
records to demonstrate compliance with the Pilot Program rules and 
requirement for five years, subject to audit. Health care providers 
that participate in the Pilot Program must also comply with all 
applicable federal and state laws, including the False Claims Act, the 
Anti-Kickback Statute, and the Civil Monetary Penalties Law. The 
Commission understands that health care providers must routinely 
navigate these laws in other contexts. Thus, health care providers that 
are interested in applying for the Pilot Program should speak to their 
compliance experts prior to submitting an application to participate in 
the Pilot Program. Further, applicants will also be required to certify 
that they are not already receiving or expecting to receive other 
federal funding for the exact same services eligible for support under 
the Pilot Program. The Commission recognizes the need to possibly waive 
certain of the RHC Program rules that extend to the Pilot Program in 
order to implement the Pilot Program, and therefore also request that 
applicants identify in their application, as applicable, any Commission 
rules that extend to the Pilot Program in the R&O from which they may 
need a waiver in order to participate in the Pilot Program, if 
selected.
    47. Instructions for Filing Applications. The Bureau will issue a 
public notice announcing the deadline for submitting Pilot Program 
applications and instructions for filing applications with the 
Commission. Pilot Program applications will be due the later of 45 days 
from the effective date of the Pilot Program rules or July 31, 2020. 
Applicants will be required to complete each section of the application 
and make the required certifications at the end of the application. 
Applicants may request that any materials or information submitted to 
the Commission in its application be withheld from public inspection

[[Page 19901]]

pursuant to the procedures set forth in Sec.  0.459 of the Commission's 
rules. Applications must reference WC Docket No. 18-213 only, and will 
be required to file electronically consistent with the instructions 
provided in a subsequent public notice. All filings must be addressed 
to the Commission's Secretary, Office of the Secretary, Federal 
Communications Commission. Applicants must also send a courtesy copy of 
their application via email to [email protected].
    48. Evaluation of Proposals and Selection of Pilot Projects. The 
Commission plans to evaluate the applications and select pilot project 
proposals based on applicants' responses to the criteria. The 
Commission will also consider the cost of the proposed pilot project 
compared to the total Pilot Program budget. This does not mean the 
Commission will evaluate proposed pilot projects based solely on a 
proposed pilot project's total budget but will seek to select an array 
of pilot projects that can all be funded within the Pilot Program's 
budget.
    49. In choosing participants for the Pilot Program, the Commission 
will also consider whether the applicant has successfully developed, 
coordinated, or otherwise implemented a telehealth program. While the 
Commission will consider applicants' responses to all of the 
application criteria factors listed in the document when evaluating 
pilot project proposals, they are not determinative of whether a pilot 
project will be selected because recognition that each pilot project 
proposal will have its own unique strengths and potential challenges. 
However, the Commission's goal is to select pilot projects that present 
a well-defined plan for meeting the health care needs of participating 
patients, with a particular emphasis on eligible low-income and veteran 
patients and the Pilot Program goals.
    50. The Commission directs the Bureau to establish an application 
schedule consistent with the direction provided in the R&O, to review 
the applications, to consult with the FCC's Office of Economics and 
Analytics, Office of Managing Director, Office of General Counsel, and 
the FCC Connect2Health Task Force, as needed, and to recommend pilot 
project selections to the Commission. To the extent possible in 
reviewing applications, the Commission also encourages the Bureau to 
consult with federal agencies with expertise in telehealth or the 
federally designated Telehealth Resource Centers. After the Commission 
selects the pilot projects to participate in the Pilot Program, the 
Bureau will announce the selected pilot projects. After the selection 
of pilot projects, additional specifics will also be provided 
concerning the requirements outlined in the R&O, including additional 
instructions and procedural information regarding, requests for 
funding, invoicing, and the specific data to be reported and reporting 
format.
    51. Procurement of Supported Services. The Commission is adopting, 
to the extent feasible, the competitive bidding requirements for the 
Healthcare Connect Fund Program for participants in the Pilot Program. 
Specifically, health care providers can seek bids for multi-year or 
single-year contracts during the competitive bidding process. If a 
health care provider only seeks bids for a single-year contract, it 
will need to conduct a new competitive bidding process for each year of 
the Pilot Program. The competitive bidding requirements for the Pilot 
Program are in addition to and do not supplant any applicable state or 
local procurement requirements.
    52. Similar to the competitive bidding exemptions provided under 
the Healthcare Connect Fund Program, eligible health care providers 
participating in the Pilot Program will not be required to seek 
competitive bids if:
     The eligible health care provider seeks support for 
services and equipment purchased from Master Services Agreements (MSAs) 
negotiated by federal, state, Tribal, or local government entities on 
behalf of such health care providers and others, if such MSAs were 
awarded pursuant to applicable federal, state, Tribal, or local 
competitive bidding requirements;
     The eligible health care provider opts into an existing 
MSA approved under the Rural Health Care Pilot Program or Healthcare 
Connect Fund Program and seeks support for services and equipment 
purchased from the MSA, if the MSA was developed and negotiated in 
response to an RFP that specifically solicited proposals that included 
a mechanism for adding additional sites to the MSA;
     The eligible health care provider has a multi-year 
contract designated as ``evergreen'' by USAC and seeks to exercise a 
voluntary option to extend an evergreen contract without undergoing 
additional competitive bidding;
     The eligible health care provider is in a consortium with 
participants in the schools and libraries universal service support 
program (E-Rate program) and a party to the consortium's existing 
contract, if the contract was approved in the E-Rate program as a 
master contract;
     The eligible health care provider seeks support for 
$10,000 or less of total undiscounted eligible expenses for a single 
year, if the term of the contract is one year or less; or
     The eligible health care provider already has entered into 
a legally binding agreement with a service provider for services or 
equipment eligible for support in the Pilot Program and that legally 
binding agreement itself was the product of competitive bidding.
    In the absence of an applicable exemption, applicants will have to 
seek competitive bids for services and equipment that are eligible for 
support through the Pilot Program. Applicants will be required to 
follow the RHC Program's competitive bidding requirements, which 
include submitting a Request for Services and Request for Proposal 
(RFP) (as applicable) for USAC to post on its website, seeking bids, 
waiting 28 days before selecting a service provider, conducting a bid 
evaluation to select a service provider, and then selecting the most-
cost effective service. All potential bidders must have access to the 
same information and be treated in the same manner during the 
competitive bidding period to ensure that the process is ``fair and 
open.'' Gifts from service providers will also be prohibited.
    53. Requesting Funding, Invoicing, Disbursements, and Material 
Changes. Once selected, Pilot Program participants will be required to 
submit a Request for Funding to USAC no later than six months after the 
selection date with specific pricing and service information for the 
funding they are requesting through the Pilot Program. Participating 
health care providers with multi-year contracts may submit a single 
funding request for the full period covered by the contract. However, 
if a participating health care provider elects to enter into a one-year 
contract, it will have to submit a new funding request for each 
subsequent year of Pilot Program funding. USAC will review the funding 
requests and issue funding commitment letters to the participating 
health care providers and service providers indicating the amount 
committed under the Pilot Program for the selected pilot project. Given 
that Pilot Program funding will be collected over a multiple year 
period, while participating health care providers with multi-year 
contracts can submit a single funding request covering the contract 
period, the Commission anticipates that USAC will issue funding 
commitments for one year at a time rather than for multiple years.
    54. Selected pilot projects will be required to report to the 
Commission

[[Page 19902]]

any material change in the participating health care providers' or 
pilot projects' status (e.g., health care provider site has closed, or 
pilot project has ceased operations) within 30 days of such material 
change in status. In instances where a selected Pilot Program 
participant is unable to participate in the Pilot Program for the 
three-year period due to extenuating circumstances, a successor may be 
designated by the Bureau. To facilitate the tracking and monitoring of 
the Pilot Program budget and guard against potential waste, fraud and 
abuse, selected pilot projects must notify USAC within 30 days of any 
decrease of 5% or more in the number of patients participating in their 
respective pilot project.
    55. After providing the eligible services and/or equipment, service 
providers will be required to make certain certifications and then 
submit invoicing forms on a monthly basis and supporting documentation 
to USAC to receive reimbursement for the cost of the eligible services 
and/or equipment they have provided to participating health care 
providers under the Pilot Program. USAC will review the monthly 
invoicing forms and supporting documentation and issue disbursements to 
the applicable service providers or vendors, whether a broadband 
service provider, or other provider. Pilot Program participants will 
also be required to make certifications as part of the form submissions 
to USAC to ensure that Pilot Program funds are used for their intended 
purpose and to ensure that all participating health care providers and 
service providers are in compliance with the Commission's rules and 
procedures.
    56. Data Reporting, Document Retention, and Audits. The Commission 
directs the Bureau to issue a report detailing the results of the Pilot 
Program after it has been completed. To assist with the report, the 
Commission will require participating health care providers to submit 
periodically anonymized, aggregated data, such as reductions in 
emergency room or urgent care visits in a particular geographic area or 
among a certain class of patients; decreases in hospital admissions or 
re-admissions for a certain patient group; condition-specific outcomes 
such as reductions in premature births or acute incidents among 
sufferers of a chronic illness; and patient satisfaction as to health 
status to the Bureau regarding their pilot project to the Bureau after 
each year of funding for that pilot project. However, the scope of the 
pilot project proposals is unknown at this time, and some metrics may 
not be applicable to all of the selected pilot projects.
    57. Accordingly, the Commission will determine the specific data to 
be reported by pilot projects and format of the required data after 
review of the pilot project proposals. Participating health care 
providers will also be required to submit final reports within six 
months of the end dates of their pilot projects summarizing the final 
results and explaining whether the pilot projects met their stated 
goals and the goals of the Pilot Program. These data will assist the 
Commission in determining whether and how universal service funds can 
efficiently and effectively be used for connected care, will enable the 
Commission to ensure that universal service funds are being used in a 
manner consistent with section 254, the Commission's rules and 
procedures, and the goals of the Pilot Program. In accordance with 
Sec.  54.631 of the Commission's rules, health care providers and 
selected participants, in addition to maintaining records related to 
their pilot projects to demonstrate their compliance with the Pilot 
Program rules and requirements, must also keep supporting documentation 
for these reports for at least five years after the conclusion of their 
pilot project and must present that information to the Commission or 
USAC upon request. Consistent with Sec.  54.631 of the Commission's 
rules, pilot projects will also be subject to random compliance audits 
to ensure compliance with the Pilot Program rules and requirements.
    58. USAC Outreach. After announcement of the selected Pilot Program 
projects, each selected pilot project will be required to provide to 
USAC, within 14 calendar days of such announcement, the name, mailing 
address, email address, and telephone number of the lead project 
coordinator for its pilot project. Within 30 days of the date 
announcing the selected Pilot Program projects, USAC shall conduct an 
initial coordination meeting with selected Pilot Program participants. 
USAC shall further conduct a targeted outreach program, such as a 
webinar or similar outreach, to educate and inform selected 
participants on the Pilot Program administrative process, including 
various filing requirements and deadlines, in order to minimize the 
possibility of selected participants making inadvertent errors in 
completing the required forms. The Commission expects that the outreach 
and educational efforts will assist selected participants in meeting 
the Pilot Program's requirements. Further, such an outreach program 
will increase awareness of the filing rules and procedures and will 
improve the overall efficacy of the Pilot Program. The Commission also 
encourages selected participants to contact USAC with any questions 
prior to filing their forms or supporting documentation. The direction 
the Commission provides to USAC will not lessen or preclude any of its 
review procedures. The Commission retains the commitment to detecting 
and deterring potential instances of waste, fraud, and abuse by 
ensuring that USAC scrutinizes Pilot Program submissions and takes 
steps to educate selected participants in a manner that fosters 
appropriate Pilot Program participation.
    59. Pilot Program Goals and Metrics. The Commission adopts three 
explicit goals for the Pilot Program to determine how USF support 
provided to health care providers for the costs associated with 
providing connected care services can enable them to: (1) Improve 
health outcomes through connected care; (2) reduce health care costs 
for patients, facilities and the health care system; and (3) support 
the trend towards connected care everywhere. The goals adopted for the 
Pilot Program are sound and measurable goals, and will help advance the 
Commission's statutory obligation to promote universal service by 
providing the Commission with information that will help inform about 
how to best allocate limited universal service funding.
    60. Legal Authority. The Commission found that section 254(h)(2)(A) 
of the 1996 Act authorizes establishing the Pilot Program to help 
defray health care provider's eligible costs of providing connected 
care services to low-income or veteran patients. Specifically, section 
254(h)(2)(A) directs the Commission to ``establish competitively 
neutral rule[s] to enhance, to the extent technically feasible and 
economically reasonable, access to advanced telecommunications and 
information services for all public and nonprofit . . . health care 
providers.'' The Pilot Program will fund broadband connectivity for 
participating health care providers and patients, certain network 
equipment, and other information services that may facilitate the 
provision of connected care services provided through the Pilot 
Program. These connected care services may be defined as either 
telecommunications services or information services.
    61. For the Pilot Program, funding patient broadband internet 
access services would expand health care providers' digital footprints 
for purposes of providing connected care services and allow health care 
providers to serve more eligible low-income patients and veterans 
through the Pilot Program and, thus, enhance health care providers'

[[Page 19903]]

access to ``advanced telecommunications and information services.'' 
Accordingly, funding health care provider purchase of broadband 
internet access service for participating patients through this 
discrete, limited duration Pilot Program falls within the scope of 
section 254(h)(2)(A) of the Act. Relying on this statutory provision 
also ensures that the Pilot Program is health care provider-driven and 
enables participating health care providers to select from the broadest 
range of broadband internet access service providers to meet the health 
care needs of participating patients.
    62. First, the Pilot Program will be ``competitively neutral,'' 
which means that ``universal service support mechanisms and rules 
neither unfairly advantage nor disadvantage one provider over another, 
and neither unfairly favor nor disfavor one technology over another.'' 
The Pilot Program satisfies this requirement because eligible health 
care providers are free to choose any broadband connectivity technology 
and broadband connectivity provider, in compliance with the applicable 
competitive bidding requirements for the Pilot Program-supported 
services needed to provide connected care services through their 
respective pilot projects. In addition, participating health care 
providers are not required to adopt any specific non-broadband 
information service to provide broadband-enabled connected care 
services through the Pilot Program. Second, the Pilot Program will be 
``technically feasible'' because the Pilot Program will not require the 
development of any new technology and gives participating health care 
providers flexibility to use any available technology to implement 
their respective pilot projects. Third, the Pilot Program will be 
``economically reasonable.'' In discussing economic reasonableness, the 
Commission has generally focused on the effect that any new rules would 
have on growth in the universal service support mechanisms. The 
Commission establishes a budget separate from the existing universal 
service programs and limit the Pilot Program budget to at most $100 
million, which provides a reasonable cap and will not significantly 
increase the contributions burden on consumers. Additionally, the 
Commission has developed measures to promote the fiscally responsible 
use of Pilot Program funds, including requiring that evaluations of 
pilot project proposals include a comparison of the estimated costs of 
each proposed pilot project to the total Pilot Program budget.
    63. Recognizing that the Commission has not previously relied on 
section 254(h)(2)(A) of the Act to specifically defray eligible health 
care provider costs of providing connected care services by supporting 
broadband connections for patient use or other information services 
necessary to provide connected care services. The Commission previously 
concluded, however, that it has ``broad discretion regarding how to 
fulfill this statutory mandate'' under section 254(h)(2)(A). The 
Commission believes establishing the limited Pilot Program for this 
purpose is consistent with that discretion. Advances in information 
technologies and services are allowing health care providers to expand 
their digital footprint by using broadband and broadband enabled 
devices to provide connected care services to patients in their homes 
or mobile locations, and there is growing evidence of the benefits of 
connected care services both for health care providers and their 
patients. Further, the record indicates that the costs of broadband 
internet access service for patient use in their homes or mobile 
locations, and the costs of other information services necessary to 
provide connected care services, are an obstacle for certain health 
care providers and their patients to adopt connected care services. 
Because of the growing evidence of the benefits of providing connected 
care services for both health care providers and their patients, and 
the fact that many health care providers and patients have yet to adopt 
these services, the Commission believes that it is appropriate to 
establish the Pilot Program to examine whether and how universal 
service can play a role in helping all Americans access and obtain the 
benefits of connected care services. The Commission thus believes that 
the specific services and network equipment funded under the Pilot 
Program are within the scope of the statutory directive under section 
254(h)(2)(A) to enhance eligible health care providers' access to 
advanced telecommunications and information services.
    64. While the Commission relies on authority under section 
254(h)(2)(A) to establish the Pilot Program, the Pilot Program is also 
consistent with the directive that the Commission base policies for the 
advancement of universal service on the principles outlined in section 
254(b) of the Act. Specifically, section 254(b)(2) provides that 
``[a]ccess to advanced telecommunications and information services 
should be provided in all regions of the Nation'' and section 254(b)(3) 
provides that ``[c]onsumers in all regions of the Nation, including 
low-income consumers and those in rural, insular, and high cost areas, 
should have access to telecommunications and information services, 
including interexchange services and advanced telecommunications and 
information services, that are reasonably comparable to those services 
provided in urban areas and that are available at rates that are 
reasonably comparable to rates charged for similar services in urban 
areas.'' As explained in the document, the Pilot Program will fund 
eligible health care provider purchases of broadband internet access 
services for participating patients to use for purposes of connected 
care services.

IV. Procedural Matters

A. Paperwork Reduction Act Analysis

    65. This document contains new information collection requirements 
subject to the Paperwork Reduction Act of 1995 (PRA), Public Law 104-
13. The information collection requirements related to the COVID-19 
Telehealth Program were approved on April 6, 2020 by the Office of 
Management and Budget (OMB) pursuant to the PRA, 44 U.S.C. 3507(j). The 
information collection requirements related to the Pilot Program will 
also be submitted to OMB for review under Section 3507(d) of the PRA. 
OMB, the general public, and other federal agencies will be invited to 
comment on the new information collection requirements. Applications 
for the COVID-19 Telehealth Program will be accepted by the Commission 
after the Bureau releases a public notice providing instructions for 
filing applications with the Commission. Applications to participate in 
the Pilot Program will be due 45 days from the effective date of the 
Pilot Program rules or July 31, 2020, whichever comes later. The Bureau 
will issue a public notice announcing the deadline for submitting Pilot 
Program applications and instructions for filing applications with the 
Commission. In addition, pursuant to the Small Business Paperwork 
Relief Act of 2002, Public Law 107-198, see 44 U.S.C. 3506(c)(4), the 
Commission sought specific comment on how it might further reduce the 
information collection burden for small business concerns with fewer 
than 25 employees. In the Report and Order, the Commission has assessed 
the effects of the information collection on small businesses, and find 
that the benefits of providing support to help defray eligible health 
care providers costs to provide connected care services to their 
patients

[[Page 19904]]

and COVID-19 relief to help eligible health care providers meet the 
health care needs of their patients during the COVID-19 pandemic 
outweigh any significant economic impact on small entities.

B. Congressional Review Act

    66. The Commission has determined, and the Administrator of the 
Office of Information and Regulatory Affairs, Office of Management and 
Budget (OMB), concurs that the rules implementing the COVID-19 
Telehealth Program are ``major'' and the rules implementing the Pilot 
Program are ``non-major'' under the Congressional Review Act, 5 U.S.C. 
804(2). The Commission will send a copy of the R&O, including this 
FRFA, to Congress and the Government Accountability Office pursuant to 
5 U.S.C. 801(a)(1)(A). In addition, the Commission will send a copy of 
the R&O, including the FRFA, to the Chief Counsel for Advocacy of the 
Small Business Administration.

C. Final Regulatory Flexibility Analysis

    67. As required by the Regulatory Flexibility Act of 1980 (RFA), as 
amended, the Federal Communications Commission (Commission) included an 
Initial Regulatory Flexibility Analysis (IRFA) of the possible 
significant economic impact on a substantial number of small entities 
by the policies and requirements proposed in the NPRM in WC Docket No. 
18-213. The Commission sought written public comment on the proposals 
in the NPRM, including comment on the IRFA. The Commission did not 
receive any comments in response to the IRFA. This Final Regulatory 
Flexibility Analysis (FRFA) conforms to the RFA.
    68. Need for, and Objectives of, the Report and Order. In the 
Telecommunications Act of 1996 (1996 Act), Congress recognized the 
value of providing rural health care providers with ``an affordable 
rate for the services necessary for the provision of telemedicine and 
instruction relating to such services.'' The 1996 Act mandated that 
telecommunications carriers provide telecommunications services for 
health care purposes to rural public or nonprofit health care providers 
at rates that are ``reasonably comparable'' to rates in urban areas. 
The 1996 Act also directed the Commission to establish competitively 
neutral rules to enhance, to the extent technically feasible and 
economically reasonable, access to ``advanced telecommunications and 
information services'' for public and nonprofit health care providers. 
Based on this legislative mandate, the Commission established the Rural 
Health Care (RHC) Program which supports health care providers' access 
to communications technologies. However, there are developments in 
telehealth, including increased use of connected care services, that 
the Commission has not yet fully explored. With remote patient 
monitoring and mobile health applications that can be accessed on a 
smartphone or tablet, health care providers now have the technology to 
deliver quality health care directly to patients, regardless of where 
they are located. Despite the numerous benefits of connected care 
services to patients and health care providers alike, patients who 
cannot afford or who otherwise lack reliable, robust broadband internet 
access connectivity, including many low-income Americans and veterans, 
are not realizing the benefits of these innovative telehealth 
technologies. Also, the costs necessary to provide connected care 
services may limit some health care providers' ability to treat low-
income Americans and veterans with connected care services.
    69. Thus, in August 2018, the Commission released the Connected 
Care Notice of Inquiry, FCC 18-112 (NOI) seeking information on ``how 
the Commission can help advance and support the movement towards 
connected care everywhere and improve access to the life-saving 
broadband-enabled telehealth services it makes possible.'' 
Subsequently, in July 2019, the Commission adopted the NPRM that 
proposed and sought comment on a Pilot Program that would help defray 
health care provider costs of providing connected care services to low-
income Americans and veterans. In the R&O, given the benefits of 
connected care services provided through broadband connections, the 
Commission takes the important step of establishing a Pilot Program to 
explore whether and how the Universal Service Fund (USF) can help 
defray health care providers' qualifying costs of providing connected 
care services, including low-income Americans and veterans. The 
ultimate goal of the Pilot Program is to examine how USF support can be 
used to help health care providers improve health outcomes and reduce 
health care costs, thereby supporting efforts to advance connected care 
initiatives. The Commission expects that the Pilot Program will benefit 
many eligible patients who are responding to a wide variety of health 
challenges, such as diabetes management, opioid dependency, high-risk 
pregnancies, pediatric heart disease, mental health conditions, and 
cancer. The Commission also expects that the Pilot Program will provide 
meaningful data that will help better understand how the USF can 
support health care provider and patient use of connected care 
services, and how supporting health care provider and patient use of 
connected care services can improve health outcomes and reduce health 
care costs. The data and information collected through the Pilot 
Program could also have the ancillary benefit of aiding policy makers 
and legislators in the consideration of broader reforms--whether 
statutory changes or updates to rules administered by other agencies--
that could support this trend towards connected care.
    70. In the R&O, in response to the public health emergency 
associated with the coronavirus disease (COVID-19), the Commission also 
establishes a separate, emergency COVID-19 Telehealth Program focused 
on connected care in response to the ongoing COVID-19 pandemic and 
surge in demand for connected care services. The Commission expects 
this additional support will help eligible health care providers 
purchase broadband connectivity, network equipment and information 
services to provide critical connected care services whether for 
treatment of coronavirus or other health conditions during this time.
    71. Summary of Significant Issues Raised by Public Comments in 
Response to the IRFA. There were no comments filed that specifically 
address the rules and policies proposed in the IRFA.
    72. Response to Comments by the Chief Counsel for Advocacy of the 
Small Business Administration. Pursuant to the Small Business Jobs Act 
of 2010, which amended the RFA, the Commission is required to respond 
to any comments filed by the Chief Counsel of the Small Business 
Administration (SBA), and to provide a detailed statement of any change 
made to the proposed rule(s) as a result of those comments. The Chief 
Counsel did not file any comments in response to the proposed policies 
and requirements in the proceeding.
    73. Description and Estimate of the Number of Small Entities to 
Which the Rules Will Apply. The RFA directs agencies to provide a 
description of and, where feasible, an estimate of the number of small 
entities that may be affected by the proposed rules. The RFA generally 
defines the term ``small entity'' as having the same meaning as the 
terms ``small business,'' ``small organization,'' and ``small 
governmental jurisdiction.'' In addition, the term ``small business'' 
has the same meaning as the term ``small business concern'' under the 
Small Business Act. A small

[[Page 19905]]

business concern is one that: (1) Is independently owned and operated; 
(2) is not dominant in its field of operation; and (3) satisfies any 
additional criteria established by the SBA.
    74. Small Businesses, Small Organizations, Small Governmental 
Jurisdictions. The Commission actions, over time, may affect small 
entities that are not easily categorized at present. Therefore, at the 
outset, three broad groups of small entities that could be directly 
affected herein. First, while there are industry specific size 
standards for small businesses that are used in the regulatory 
flexibility analysis, according to data from the SBA's Office of 
Advocacy, in general a small business is an independent business having 
fewer than 500 employees. These types of small businesses represent 
99.9% of all businesses in the United States, which translates to 30.7 
million businesses.
    75. Next, the type of small entity described as a ``small 
organization'' is generally ``any not-for-profit enterprise which is 
independently owned and operated and is not dominant in its field.'' 
The Internal Revenue Service (IRS) uses a revenue benchmark of $50,000 
or less to delineate its annual electronic filing requirements for 
small exempt organizations. Nationwide, for tax year 2018, there were 
approximately 571,709 small exempt organizations in the U.S. reporting 
revenues of $50,000 or less according to the registration and tax data 
for exempt organizations available from the IRS.
    76. Finally, the small entity described as a ``small governmental 
jurisdiction'' is defined generally as ``governments of cities, 
counties, towns, townships, villages, school districts, or special 
districts, with a population of less than fifty thousand.'' U.S. Census 
Bureau data from the 2017 Census of Governments indicate that there 
were 90,075 local governmental jurisdictions consisting of general 
purpose governments and special purpose governments in the United 
States. Of this number there were 36,931 general purpose governments 
(county, municipal and town or township) with populations of less than 
50,000 and 12,040 special purpose governments--independent school 
districts with enrollment populations of less than 50,000. Accordingly, 
based on the 2017 U.S. Census of Governments data, the Commission 
estimates that at least 48,971 entities fall into the category of 
``small governmental jurisdictions.''
    77. The small entities that may be affected by the reforms include 
eligible nonprofit and public health care providers and the eligible 
service providers offering them services, including telecommunications 
service providers, internet Service Providers, and service providers of 
the services and equipment used for dedicated broadband networks.
    78. Description of Projected Reporting, Recordkeeping, and Other 
Compliance Requirements for Small Entities. In the R&O, the Commission 
establishes a Pilot Program within the USF that will make available up 
to $100 million over three years to help defray eligible health care 
providers' costs of providing connected care services primarily to low-
income or veteran patients for purposes of connected care. The 
Commission also establishes an COVID-19 Telehealth Program funded 
through a $200 million Congressional appropriation under the 
Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 
116-136, 134 Stat. 281, for COVID-19 relief to help eligible health 
care providers meet the health care needs of their patients during the 
COVID-19 pandemic. The Pilot Program is structured to target funding to 
eligible health care providers serving patients that are most likely to 
need USF support for connected care services, and to ensure that the 
Pilot Program provides meaningful, measurable data. To participate in 
the Pilot Program, health care providers must satisfy the definition of 
an eligible health care provider under section 254(h)(7)(B) of the Act 
and receive an eligibility determination from the Universal Service 
Administrative Company (USAC), the administrator of the USF programs. 
Applicants must then submit an application to the Commission regarding 
their pilot projects by the application deadline ultimately established 
for the Pilot Program. While the COVID-19 Telehealth Program is 
structured a bit differently than the Pilot Program, applicants for 
both programs will be required to certify that they will comply with 
all applicable Pilot Program requirements and procedures. Applicants 
among other things, will also be required to comply with the Health 
Insurance Portability and Accountability Act (HIPAA) and other 
applicable privacy and reimbursement laws and regulations, and 
applicable medical licensing laws and regulations, as well as all 
applicable Pilot Program requirements and procedures, including 
document retention requirements, subject to audit.
    79. As part of Pilot Program, the Commission seeks a diverse set of 
pilot projects from a wide variety of eligible health care providers 
and eligible service providers, including small entities. The 
Commission seeks to strike a balance between requiring applicants to 
submit enough information that allows the selection high-quality, cost-
effective pilot projects that would best further the goals of the Pilot 
Program, but also minimizing the administrative burdens on entities 
that seek to apply. The R&O provides specific information that health 
care providers are required to submit in their applications for each 
pilot project proposal, including, but not limited to, information on 
the participating health care provider(s), description of the pilot 
project and how it would further the goals of the Pilot Program, 
estimated pilot project budget, patient populations and the geographic 
areas to be served and health conditions to be treated. The R&O also 
establishes a streamlined application process for the COVID-19 
Telehealth Program in order to more expeditiously address the needs of 
health care providers affected by the coronavirus epidemic.
    80. After evaluation of the pilot program applications, the Bureau 
will announce the selected pilot projects and provide further 
information on the specific requirements for the Pilot Program. 
Selected pilot program participants will be required to conduct a 
competitive bidding process (unless a competitive bidding exemption 
applies), including submitting the required competitive bidding forms, 
for the eligible equipment and services that are supported through the 
Pilot Program. Participating health care providers will then be 
required to submit a request for funding with USAC with specific 
pricing and service information, and will also be required to submit 
invoicing forms and supporting documentation on a monthly basis for the 
supported equipment and services. Participating health care providers 
will also be required to periodically submit data to the Bureau 
concerning their pilot project after each year of funding during the 
three-year period of the pilot project, and will also be required to 
submit a final report concerning their pilot projects. For the COVID-19 
Telehealth Program, within six months after the conclusion of the 
COVID-19 Telehealth Program, participants should provide a report to 
the Commission on the effectiveness of the program. While some of the 
requirements of the Pilot Program and the COVID-19 Telehealth Program 
will result in additional recordkeeping and compliance requirements for 
small entities, the Commission has determined that the benefits of 
establishing these programs outweighs the burden of any increased 
recordkeeping and compliance

[[Page 19906]]

requirements for those small entities that choose to participate in the 
Pilot Program and the COVID-19 Telehealth Program. Additionally, the 
requirements are intended to ensure universal service funds are used 
for their intended purpose and designed so that the Commission can 
obtain meaningful data to evaluate the Pilot Program and inform the 
policy decisions.
    81. Steps Taken to Minimize the Significant Economic Impact on 
Small Entities and Significant Alternatives Considered. The RFA 
requires an agency to describe any significant alternatives that it has 
considered in reaching its proposed approach, which may include (among 
others) the following four alternatives: (1) The establishment of 
differing compliance or reporting requirements or timetables that take 
into account the resources available to small entities; (2) the 
clarification, consolidation, or simplification of compliance or 
reporting requirements under the rule for small entities; (3) the use 
of performance, rather than design, standards; and (4) an exemption 
from coverage of the rule, or any part thereof, for small entities.
    82. The Pilot Program is for a discrete, limited period of time. 
The Commission expects to apply the Commission's rules applicable to 
the Healthcare Connect Fund Program to the Pilot Program, which some 
entities may already be familiar with if they currently participate in 
the Healthcare Connect Fund Program. With no expectation of the small 
entities to be disproportionately impacted. In evaluating the 
applications, the Commission seeks to select a diverse set of pilot 
projects and will consider whether the proposed pilot projects promotes 
entrepreneurs and other small businesses in the provision and ownership 
of telecommunications and information services, including those that 
may be socially and economically disadvantaged businesses. All eligible 
health care providers that participate in the Pilot Program will be 
required to collect and submit data to the Commission at designated 
intervals during the Pilot Program. The Commission has yet established 
metrics to measure the Pilot Program goals and seek information from 
applicants on the metrics plans to use and how plans to collect those 
metrics in order to minimize any impact on small entities when 
establishing metrics for the Pilot Program. The collection of this 
information, however, is necessary to evaluate the impact of the Pilot 
Program, including whether the Pilot Program achieves its goals. Thus, 
the benefits of collecting this information outweigh any significant 
economic impact on small entities. Moreover, the Commission sought 
comment on the IRFA and did not receive any comments in response to the 
IRFA. Further, in order to minimize the economic impact on small 
entities, the Commission establishes an emergency COVID-19 Telehealth 
Program, which is one piece of a comprehensive approach to reducing 
barriers to telehealth services for patients and health care facilities 
throughout the country to provide relief related to the COVID-19 
pandemic. The Commission therefore believes that the requirements of 
the R&O will not have a significant economic impact on a substantial 
number of small entities.

V. Ordering Clauses

    83. Accordingly, it is ordered that, pursuant to the authority 
contained in sections 201, 254, 303(r), and 403 of the Communications 
Act of 1934, as amended, 47 U.S.C. 201, 254, 303(r), and 403, and 
DIVISION B of the Coronavirus Aid, Relief, and Economic Security Act, 
Public Law 116-136, 134 Stat. 281, the Report and Order is adopted and 
shall become effective May 11, 2020, pursuant to 47 U.S.C. 408, with 
the exception of those portions related to the COVID-19 Telehealth 
Program in the Report and Order which shall become effective April 9, 
2020 pursuant to 5 U.S.C. 553(d) and 5 U.S.C. 808(2) and the portions 
containing information collection requirements that have not been 
approved by the Office of Budget and Management (OMB).
    84. It is further ordered that applications to participate in the 
COVID-19 Telehealth Program shall be filed after the Wireline 
Competition Bureau issues a public notice announcing the date when 
applications will be accepted and instructions for filing applications 
with the Commission. This date will be after April 9, 2020.
    85. It is further ordered that, pursuant to the Paperwork Reduction 
Act of 1995, Section 3507(d), the Connected Care Pilot Program 
information collection requirements shall become effective after 
announcement in the Federal Register of Office of Management and Budget 
approval of the rules, and on the effective date announced therein.
    86. It is further ordered that applications to participate in the 
Connected Care Pilot Program shall be filed 45 days after the effective 
date of the Connected Care Pilot Program rules or July 31, 2020, 
whichever comes later.
    87. It is further ordered that the Commission's Consumer and 
Governmental Affairs Bureau, Reference Information Center, shall send a 
copy of the R&O, including the Final Regulatory Flexibility Analysis, 
to the Chief Counsel for Advocacy of the Small Business Administration.
    88. It is further ordered that the Commission shall send a copy of 
the R&O to the Congress and the Government Accountability Office 
pursuant to the Congressional Review Act, see 5 U.S.C. 801(a)(1)(A).

Federal Communications Commission.
Cecilia Sigmund,
Federal Register Liaison Officer.
[FR Doc. 2020-07587 Filed 4-8-20; 8:45 am]
 BILLING CODE 6712-01-P