- The Federal Communications Commission is considering increasing funding for broadband expansion to rural America, a move that would pave the way for more – and better - telehealth and telemedicine programs where healthcare access is limited.
The FCC issued a notice of proposed rulemaking late last week to immediately increase the $400 million annual cap on the Rural Health Care Program for FY 2017, and to create a framework for increasing that cap in future years. The proposal will likely be discussed at the FCC’s Dec. 14 meeting.
Congress established the RHC Program in the Telecommunications Act of 1996, and set a $400 million cap on RHC’s Telecom Program “to subsidize the difference between urban and rural rates for telecommunications services.” A second part of RHC, the HCF Program, was established in 2012 to allow telecoms to provide a flat 65 percent discount on a variety of communications services “to promote the use of broadband services and facilitate the formation of healthcare provider consortia.”
But driven by a strong interest in telemedicine and telehealth services, as well as educational outreach programs, the RHC Program exceeded the cap by $20 million in FY 2017; the agency expects the cap will be surpassed by increases in both funding requests and the number of projects in FY 2017, which runs through June 20, 2018.
The current proposal suggests carrying forward unused funds from past years to cover additional FY 2017 expenditures on a one-time-only basis, while creating a new formula to adjust the cap – which hasn’t changed since 1997 – each year. One suggestion is to adjust the cap annually for inflation; that formula would have set the FY 2017 cap at about $517 million.
The proposal also calls for a new process to evaluate funding requests, noting “part of that growth is due to an increase in waste, fraud and abuse in the RHC Program.” And it calls for discussion on several aspects of the program, including an analysis of how telehealth and telemedicine impact the fund, how economic need and healthcare professional shortages should be factored in, whether the definition of a “rural area” should be modified, whether funding requests should be prioritized based on type of service or whether they come from consortia, and whether the Telecom and RHC programs should be separated and prioritized differently.
Several healthcare organizations, consortia and providers have lobbied the FCC and Congress to increase federal support of broadband expansion, including the American Hospital Association, American Medical Informatics Association, American Telemedicine Association, Healthcare Information and Management Systems Society (HIMSS), Personal Connected Health Alliance (PCHA), the Alaska Collaborative for Telemedicine and Telehealth, Alaska Native Health Board, Arizona Hospital and Healthcare Association, California Telehealth Network, CHRISTUS Health, the Indiana Rural Health Association, the New England Telehealth Consortium, the North Carolina Telehealth Network, the Southern Ohio Health Care Network and the University of New Mexico Center for Telehealth.
Most of those groups signed a letter earlier this month to U.S. Reps. Greg Walden and Frank Pallone, the chairman and ranking member of the House Energy and Commerce Committee, asking that the RHC Program’s cap be doubled to $800 million.
“Rural communities that encounter a severe shortage of doctors, aging populations, and a greater distance to medical experts are in dire need of easily accessible telemedicine services,” John Windhausen, Jr., executive director of the Schools, Health & Libraries Broadband (SHLB) Coalition, said in the letter. “The RHC program has the power to elevate the health of these communities, but only if the program is revamped to promote rural broadband.”
Separately, the AHA proposed several amendments to the RHC program earlier this year, including boosting the amount of federal support for providers delivering telehealth services to rural locations from 65 percent to 85 percent and modifying the definition of a “rural” community to enable more communities to access federal funding for broadband expansion.
“With modest changes to the HCF, the FCC can incent greater participation and further expansion of broad, closing this aspect of the digital divide, and improving the lives of rural Americans,” Ashley Thompson, the AHA’s Senior Vice President of Public Policy Analysis and Development, said.
By far the state most affected by this funding squeeze is Alaska, which received almost of third of the RHC Program funding – about $119 million – in FY 2016 (healthcare providers in the state, meanwhile, spent just $2.4 million for telecom services, making the average discount rate 98 percent).
This past April, Alaska’s Legislature passed a joint resolution urging the FCC to increase its funding cap on the RHC Program.
“The long-distance delivery of quality healthcare via telemedicine has made great strides in rural Alaska in recent years,” Rep. Bryce Edgmon (D-Dillingham), the resolution’s sponsor, said in a news release. “However, we’re about to hit a roadblock. Increasing the FCC support budget will allow healthcare providers in isolated communities to continue expanding local treatment options in ways we never could have dreamed of just a few years ago.”
“Telehealth allows patients in rural parts of Alaska access to state-of-the-art diagnostic tools and treatments that can help the sick and afflicted,” added Rep. Zach Fansler (D-Bethel). “This resolution puts the House on record supporting a proactive solution to a looming problem potentially jeopardizing healthcare for hundreds of thousands.”