The Federal Communications Commission is moving forward with plans to reform how funding is distributed for the agency's rural telemedicine program.
The FCC on Thursday voted to adopt a report and order for its Rural Health Care Program, which helps fund broadband and telecommunications services for some healthcare providers in rural areas. A major part of the program involves subsidizing the difference between urban and rural rates for telecommunications services.
In recent years, demand for the program has surpassed available funding, FCC Chairman Ajit Pai said at an open meeting Thursday.
To begin to address the demand, last summer the FCC increased funding for the Rural Health Care Program for the first time since its launch in 1997. The Rural Health Care Program now boasts a cap of $571 million per year, up from its initial funding cap of $400 million.
But while the funding increase was "the necessary change," it was "not a sufficient one to guarantee the program's long-term health," Pai said Thursday, as demand has continued to stress the program.
With the new report and order, the FCC said it will reform the way it distributes Rural Health Care Program funding and take steps to guard against possible waste and inefficiencies in program costs.
In the event program demand outpaces available funding, the FCC now plans to prioritize support based on "rurality tiers," as well as whether the Health Resources and Services Administration designates a provider's area as part of a medically underserved population.
That means "extremely rural" areas will receive higher priority than less rural and urban areas, with the FCC defining extremely rural counties as those outside the metropolitan and micropolitan statistical areas defined by Office of Management and Budget, known as core-based statistical areas.
The FCC also plans to outline a single method to determine subsidies for healthcare providers. Subsidies will be based on the median rates telecommunications providers charge for similar services in the state and the rurality tier that the healthcare provider is located. Today, discounts are calculated based on a few methods.
The Universal Service Administrative Co., an independent not-for-profit designated by the FCC to administer telecommunications funding, will determine the rates for telecommunications services as part of the program.
A bipartisan group of senators in July urged the FCC to delay adopting the report and order, arguing it did not adequately address key issues in the rural health program.
"The proposal, for instance, does not address the need for more funding," the letter read, noting that last year's funding boost did not adequately address continued program demand. "It delegates rate-setting to the Universal Service Administrative Company, an entity that does not have relevant subject matter experience."
The FCC's two Democratic commissioners repeated similar concerns at Thursday's meeting, suggesting the agency hasn't sufficiently studied how these calculation changes will impact facilities receiving funding today. "Because there is no model, we don't know if this will reduce the support available to some rural communities," FCC Commissioner Jessica Rosenworcel said.
FCC Commissioner Michael O'Rielly, a Republican, also raised concerns on how to best divvy up the program's limited funding.
"While I am hopeful the new rules will inject much more efficiency in the program, I remain dismayed by our continued decision to fund urban applicants, even if (they) remain on the lowest rung of priority when demand exceeds available funding," he said. "The money now allocated for urban centers could be used to fund a lot of good in needy rural areas."
The FCC's decision to reform funding for the Rural Health Care Program comes on the heels of a July vote to advance a proposal for a $100 million telemedicine pilot, dubbed the Connected Care Pilot. Unlike the rural health program, the Connected Care Pilot would focus on projects that connect patients with healthcare services directly and outside of a hospital.
