Universal Service Support for Rural Health Care

Georgia Partnership for TeleHealth Conference – March 26, 2010

Rural Health Care DivisionUniversal Service Administrative Company

Washington, D.C.

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USAC Organization

Rural Health Care

$61M Primary $139M Pilot

School & Library

(E-Rate) Program

$2.25 Billion

High CostProgram

$4.5 Billion

Low IncomeProgram

$1.3 Billion

USAC(Fund Administration, Billing

Collection & Disbursement)

$8.25 Billion

FCCImplemented Universal Svc. Program

of Telecommunications Act of 1996

Eligible Public and Non-profit Rural Health Care Providers

• Post-secondary educational institutions offering health care instruction, teaching hospitals, or medical schools

• Community health centers or health centers providing health care to migrants

• Local health departments or agencies

• Community mental health centers

• Not-for-profit hospitals

• Rural health clinics

• Consortia of one or more of the above entities

• Part-time HCPs (of above types)

• Emergency rooms of for-profit hospitals

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Eligible telecommunications providers (ETPs) may provide discounted telecommunications (Urban/Rural difference support) or 25% discount on Internet access.

Internet Service Providers (ISPs), cable companies, or others, may only provide discounted Internet access.

Support is for monthly recurring cost and standard installation charges.

Support cannot include equipment, internal wiring or network buildout.

Services must be for the provision of health care.

Service Provider Eligibility

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Funding Year 2004 2005 2006 2007 2008 2009

Form 465's Posted 2945 3449 3353 3564 3563 3520

Post-secondary ed institution 34 34 32 32 23 23

Community health center 333 360 389 352 389 274

Local health department/agency 359 596 513 404 383 395

Community mental health center 265 267 270 312 304 276

Not-for-profit hospital 973 1,106 1,047 1,122 1,102 1096

Rural health clinic 970 1,033 1,092 1,335 1,360 1,454

Consortium of the above 3 40 3     

Emergency dept for-profit hosp 6 12 7 7 2 2

Part-time eligible entity 2 1       

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FCC FORM 466

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FCC FORM 466-A

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USAC Rural Health Care Primary Program Funding CommitmentsState* FY05 FY06 FY07 FY08**FY09** FY05 FY06 FY07 FY08** FY09** Total 98-09

Alabama 121 52 60 62 10 $339,679 $45,236 $169,200 $264,671 $90,664 $1,006,012Alaska 237 231 236 229 2 $21,747,418 $25,701,518 $30,142,687 $25,218,452 $1,176 $174,953,331Am Samoa 1 1 $116,650 $141,191 $257,841Arizona 70 78 81 65 17 $1,450,953 $1,630,104 $1,743,822 $1,334,412 $172,042 $11,371,678Arkansas 24 61 59 66 2 $118,644 $196,430 $289,156 $598,540 $534 $1,879,871California 73 90 109 113 14 $531,303 $593,986 $793,113 $1,021,831 $54,884 $4,751,571Colorado 14 15 19 24 6 $129,832 $113,145 $119,758 $253,108 $36,342 $1,469,493Delaware 1 2 2 $63 $413 $350 $825Florida 15 31 33 21 2 $181,718 $432,008 $487,546 $354,243 $16,559 $2,513,313Georgia 60 89 73 97 38 $550,062 $950,569 $1,402,319 $1,718,752 $665,683 $5,618,807Guam 1 2 2 2 $6,189 $83,109 $54,179 $54,471 $197,949Hawaii 20 19 20 16 $237,388 $216,097 $192,524 $142,560 $2,183,944Idaho 28 28 40 30 3 $123,670 $164,258 $245,511 $221,720 $13,720 $1,396,557Illinois 49 62 77 71 11 $560,499 $630,777 $874,489 $1,091,196 $194,549 $4,488,827Indiana 11 37 52 60 15 $195,019 $376,327 $630,677 $884,329 $75,728 $2,379,077Iowa 54 63 69 72 9 $306,740 $427,728 $534,195 $556,650 $19,468 $2,744,037Kansas 78 66 39 56 13 $504,173 $556,281 $225,193 $286,644 $16,425 $3,348,006Kentucky 86 54 79 75 6 $243,474 $180,500 $521,298 $481,982 $31,994 $3,742,175Louisiana 45 25 24 20 $843,503 $69,923 $68,995 $69,134 $1,090,404Maine 19 10 7 7 $47,358 $52,398 $51,128 $21,865 $362,351Maryland 1 $418 $418Massachusetts 2 2 3 3 1 $35,487 $57,633 $128,955 $151,250 $21,425 $396,635Michigan 61 74 108 104 13 $789,485 $866,751 $1,282,522 $1,398,229 $45,819 $7,615,144Minnesota 162 194 190 197 22 $1,490,620 $1,760,929 $2,282,787 $2,646,432 $174,971 $13,017,749Mississippi 25 22 28 24 5 $208,293 $87,922 $166,638 $179,100 $48,989 $1,190,580Missouri 19 20 53 64 5 $89,456 $143,817 $358,423 $522,954 $113,698 $1,710,526Montana 60 57 67 79 1 $528,308 $518,217 $696,706 $869,024 $6,455 $5,467,530Nebraska 93 89 95 113 51 $1,513,960 $1,721,642 $1,581,960 $1,515,723 $778,552 $10,391,239Nevada 7 11 13 14 $37,478 $56,256 $71,135 $94,256 $600,126New Hampshire 1 2 2 $4,816 $6,765 $14,658 $86,997New Mexico 45 50 55 60 $404,849 $372,985 $509,364 $756,947 $3,471,532New York 14 22 20 16 4 $41,550 $74,216 $75,081 $52,954 $4,696 $462,530North Carolina 16 23 41 52 2 $152,304 $176,423 $236,228 $325,555 $4,257 $1,858,184North Dakota 88 88 97 103 11 $759,973 $761,618 $687,102 $1,230,480 $124,385 $6,203,749Ohio 9 7 21 36 1 $167,869 $112,135 $293,630 $388,561 $4,860 $1,516,744Oklahoma 26 31 45 49 2 $232,458 $303,394 $470,851 $627,662 $81,000 $2,209,582Oregon 9 12 19 21 3 $11,868 $84,064 $202,682 $300,797 $64,529 $918,513Pennsylvania 11 7 16 14 1 $85,746 $66,026 $132,086 $103,740 $3,600 $586,550South Carolina 16 14 15 5 $57,699 $47,842 $47,633 $11,453 $291,603South Dakota 80 78 89 86 7 $995,541 $1,081,124 $1,188,929 $1,358,894 $165,584 $6,712,252Tennessee 40 37 35 20 6 $178,764 $193,532 $395,552 $201,624 $51,384 $1,278,885Texas 65 47 42 62 5 $1,631,984 $297,827 $275,151 $1,037,417 $26,100 $4,157,151Utah 36 37 48 54 3 $752,228 $745,981 $540,804 $753,203 $102,038 $4,794,512Vermont 12 20 23 22 $82,653 $131,685 $146,417 $108,355 $507,286Virgin Islands 8 11 12 10 9 $43,559 $48,678 $56,804 $46,404 $43,493 $728,235Virginia 57 124 148 145 105 $342,760 $767,330 $1,033,533 $769,166 $343,434 $4,234,223Washington 28 31 34 32 1 $83,248 $65,990 $79,233 $61,556 $4,229 $724,680West Virginia 21 20 26 22 3 $138,870 $109,141 $208,092 $209,634 $26,363 $1,084,270Wisconsin 223 236 259 288 16 $2,429,893 $3,002,792 $4,440,644 $4,513,020 $145,272 $17,510,079Wyoming 13 12 11 14 2 $125,409 $191,649 $212,408 $115,969 $34,725 $1,252,238Totals 2253 2392 2695 2800 427 $41,535,170 $46,274,820 $56,464,201 $55,081,118 $3,809,626 $326,735,809 * There are no rural areas in DC and no applications from CT, NJ, PR, or RI. Rural Health Care Division

** Applications as of 12/31/09. FY08 about 90% complete, FY09 about 5% complete. Universal Service Administrative Company

This data is not certified. Completed years may be adjusted due to audit or appeal resolutions. www.usac.org/rhc/

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1000

2000

3000

4000

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1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

HCPs, FRNs and Funding (Non AK) HCPsFRNs (Services)Total Funded ($Mil)$ per HCP (Thousands)

HCPs FY 1998Total Of HCPNum by ZIP Code                                   

Total Of HCPNum by ZIP Code

8 to 374

7 to 7.9

6 to 6.9

5 to 5.9

4 to 4.9

3 to 3.9

2 to 2.9

1 to 1.9

Sites per Zip Code

HCPs FY 2000Total Of HCPNum by ZIP Code                                   

Total Of HCPNum by ZIP Code

8 to 374

7 to 7.9

6 to 6.9

5 to 5.9

4 to 4.9

3 to 3.9

2 to 2.9

1 to 1.9

Sites per Zip Code

HCPs FY 2002Total Of HCPNum by ZIP Code                                   

Total Of HCPNum by ZIP Code

8 to 374

7 to 7.9

6 to 6.9

5 to 5.9

4 to 4.9

3 to 3.9

2 to 2.9

1 to 1.9

Sites per Zip Code

HCPs FY 2004Total Of HCPNum by ZIP Code                                   

Total Of HCPNum by ZIP Code

8 to 374

7 to 7.9

6 to 6.9

5 to 5.9

4 to 4.9

3 to 3.9

2 to 2.9

1 to 1.9

Sites per Zip Code

HCPs FY 2005Total Of HCPNum by ZIP Code                                   

Total Of HCPNum by ZIP Code

8 to 374

7 to 7.9

6 to 6.9

5 to 5.9

4 to 4.9

3 to 3.9

2 to 2.9

1 to 1.9

Sites per Zip Code

HCPs FY 2006Total Of HCPNum by ZIP Code                                   

Total Of HCPNum by ZIP Code

8 to 374

7 to 7.9

6 to 6.9

5 to 5.9

4 to 4.9

3 to 3.9

2 to 2.9

1 to 1.9

Sites per Zip Code

HCPs FY 2007

Total Of HCPNum by ZIP Code

8 to 374

7 to 7.9

6 to 6.9

5 to 5.9

4 to 4.9

3 to 3.9

2 to 2.9

1 to 1.9

Sites per Zip Code

All Fund Years CombinedTotal Of HCPNum by ZIP Code                                   

Total Commitments by Zip

$545,000 to $58 Mil

$224,000 to $544,999

$124,000 to $223,999

$77,500 to $123,999

$46,500 to $77,499

$24,300 to $46,499

$9,200 to $24,299

$0.00 to $9,199

Total Commitments for All Fund Years

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FOR IMMEDIATE RELEASESeptember 26, 2006

FCC ADOPTS PILOT PROGRAM UNDER RURAL HEALTH CARE MECHANISM

Pilot will Enhance Access Health Care Providers’ Access to Advanced Telecommunications and Information Services

Washington, D.C. – Today, the Federal Communications Commission (FCC) adopted an Order that establishes a pilot program to help public and non-profit health care providers build state and region-wide broadband networks dedicated to the provision of health care services, and connect those networks to [a] dedicated nationwide backbone…

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Overview of Pilot Program

• Support for state or regional broadband networks and to connect to I2, NLR, or public Internet for health care.

• Support is 85% (15% match required).

• Urban HCPs eligible, but network must connect more than deminimis number of rural HCPs.

• HCP eligibility same as Primary program, but non-eligibles may join networks if they pay fair share.

• Projects submit quarterly reports to show progress and compliance with FCC rules.

• Quarterly reports also help FCC evaluate possible changed to the Primary Program

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Overview of Pilot Program

• 81 applications filed, 69 selected by FCC 11/07, with combined $417.8M budget over 3 years (2007-2009).

• With mergers, there are now 62 projects.

• One year no cost extension for all projects for 2010.

• Selected projects represent:

42 States

3 territories

6,000 HCPs

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Launch internet explorer browser.lnk

Locations Posted for Bids

Replace 25% Internet Access support with Broadband Fund Create Broadband Infrastructure Fund to build networks. Support long-term care, admin, data ctr and similar facilities. HCPs to meet performance measures like meaningful use. Periodically publish a Health Care Broadband Status Report. Congress should consider supporting for-profit institutions

serving vulnerable populations.

The FCC will soon issue Notices of Proposed Rulemaking (NPRMs) to detail and seek public comment on

implementing these items. USAC will highlight NPRMs on its website.

National Broadband PlanRecommends FCC Revamp RHC Program

QUESTIONS?

William England, Ph.D., J.D.Vice-President, Rural Health

Care Division, USACPh 202-776-0200

wengland@usac.org