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FCC Eliminates Use of Urban-Rural Database for Healthcare Telecom Subsidies

The commission said the database that determined healthcare subsidies had cost ‘anomalies.’

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WASHINGTON, January 26, 2023 – The Federal Communications Commission adopted a measure Thursday to eliminate the use of a database that determined the differences in telecommunications service rates in urban and rural areas that was used to provide funding to health care facilities for connectivity.

The idea behind the database, which was adopted by the commission in 2019, was to figure out the cost difference between similar broadband services in urban and rural areas in a given state so the commission’s Telecom Program can subsidize the difference to ensure connectivity in those areas, especially as the need for telehealth technology grows.

But the commission has had to temporarily provide waivers to the rules due to inconsistencies with how the database calculated cost differences. The database included rural tiers that the commission said were “too broad and did not accurately represent the cost of serving dissimilar communities.”

FCC Chairwoman Jessica Rosenworcel gave an example at Thursday’s open meeting of the database calculating certain rural services being cheaper than in urban areas, when the denser latter areas are generally less expensive.

As such, the commission Thursday decided to revert the methods used to determine Telecom Program support to before the 2019 database order until it can determine a more sustainable method. The database rescission also applies to urban cost determinations.

“Because the Rates Database was deficient in its ability to set adequate rates, we find that restoration of the previous rural rate determination rules, which health care providers have continued to use to determine rural rates in recent funding years under the applicable Rates Database waivers, is the best available option pending further examination in the Second Further Notice, to ensure that healthcare providers have adequate, predictable support,” the commission said in the decision.

Healthcare providers are now permitted to reuse one of three rural rates calculations before the 2019 order: averaging the rates that the carrier charges to other non-health care provider commercial customers for the same or similar services in rural areas; average rates of another service provider for similar services over the same distance in the health care provider’s area; or a cost-based rate approved by the commission.

These calculations are effective for the funding year 2024, the commission said. “Reinstating these rules promotes administrative efficiency and protects the Fund while we consider long-term solutions,” the commission said.

The new rules are in response to petitions from a number of organizations, including Alaska Communications; the North Carolina Telehealth Network Association and Southern Ohio Health Care Network; trade association USTelecom; and the Schools, Health and Libraries Broadband Coalition.

“The FCC listened to many of our suggestions, and we are especially pleased that the Commission extended the use of existing rates for an additional year to provide applicants more certainty,” John Windhausen Jr., executive director of the SHLB Coalition, said in a statement.

Comment on automating rate calculation

The commission is launching a comment period to develop an automated process to calculate those rural rates by having the website of the Universal Service Administrative Company – which manages programs of the FCC – “auto-generate the rural rate after the health care and/or service provider selects sites that are in the same rural area” as the health care provider.

The commission is asking questions including whether this new system would alleviate administrative burdens, whether there are disadvantages to automating the rate, and whether there should be a challenge process outside of the normal appeals process.

The Telecom Program is part of the FCC’s Rural Health Care program that is intended to reduce the cost of telehealth broadband and telecom services to eligible healthcare providers.

Support for satellite services

The commission is also proposing that a cap on Telecom Program funding for satellite services be reinstated. In the 2019 order, a spending cap on satellite services was lifted because the commission determined that costs for satellite services were decreasing as there were on-the-ground services to be determined by the database.

But the FCC said costs for satellite services to health care service providers has progressively increased from 2020 to last year.

“This steady growth in demand for satellite services appears to demonstrate the need to reinstitute the satellite funding cap,” the commission said. “Without the constraints on support for satellite services imposed by the Rates Database, it appears that commitments for satellite services could increase to an unsustainable level.”

Soon-to-be health care providers funding eligibility

The FCC also responded to a SHLB request that future health care provider be eligible for Rural Health Care subsidies even though they aren’t established yet.

The commission is asking for comment on a proposal to amend the RHC program to conditionally approve “entities that are not yet but will become eligible health care providers in the near future to begin receiving” such program funding “shortly after they become eligible.”

Comments on the proposals are due 30 days after it is put in the Federal Register.

Managing Editor Ahmad Hathout has spent the last half-decade reporting on the Canadian telecommunications and media industries for leading publications. He started the scoop-driven news site downup.io to make Canadian telecom news more accessible and digestible. Follow him on Twitter @ackmet.

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Expert Opinion

Ar’Sheill Monsanto: Houston, We Have a Connectivity Program

More than 400,000 Houston households are eligible for Affordable Connectivity Program. But only 30% have adopted.

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The author of this Expert Opinion is Ar’Sheill Monsanto, manager of Link Health

In 2020, I watched countless headlines in Houston media that chronicled the absence of thousands of students that were missing from class. Yet the students did not disappear, they simply were not able to attend classes during the global pandemic because they lacked access to devices and the internet.

This issue of the digital divide wasn’t unique to Houston, the disparity in internet access was happening across America. In fact, in 2019, the Federal Communications Commission estimated that over 20 million Americans didn’t possess strong broadband access.

In  July, I was tasked to lead a new nonprofit organization in Houston called Link Health. At Link Health, our organization leverages the health sector to connect patients to the Affordable Connectivity Program and close the digital divide in healthcare.

The organization was founded by an emergency room physician and Harvard University Professor, Dr. Alister Martin, who tapped university students to serve as fellows and digital equity ambassadors. The fellows and ambassadors are placed in clinics and hospitals to actively enroll patients into the Affordable Connectivity Program while they wait to see the doctors. These college students are attacking the problem with fervor and urgency!

In Houston, over 400,000 households are eligible for the Affordable Connectivity Program, but there has only been a 30% adoption rate. Through our partnership with healthcare systems like Legacy Community Health, San Jose Clinic and Lone Star Health Center we have an opportunity to enroll over 200,000 people who are current patients of those systems. In our work, we found that many of those patients that are eligible for the Affordable Connectivity Program need support in completing the application, uploading documentation and then getting the actual discount applied to their internet service account. Our team is there from start to finish in this process.

Although our program is new, we have found success in our clinic- to- community partnerships. Our team has screened over 10,000 patients and enrolled almost 1,000 families into the program. We estimate that through Affordable Connectivity Program enrollments we have helped families save over $290,000 on home internet and our work is just beginning.

We recognize that the Affordable Connectivity Program is slated to sunset when the funds are exhausted. However, in the meantime, our student-led organization will continue to meet people where they are. We will move forward with bringing on new clinical partners and guiding their patients to receive access to these necessary discounts. To broaden our reach, we are sharing resources and marketing material for community health sites that include posters, RX discharge paperwork, brochures and other graphics that promote the ACP.

While news stations are no longer constantly covering stories about students’ connectivity challenges, the issue is still extremely prevalent in many communities. At Link Health we want to assist eligible families in connecting to the internet so that they have access to other resources like telehealth. Opening up access to the internet is one sure fire way to address social determinants of health and we are poised to connect people to the world.

Ar’Sheill Monsanto is the manager of Link Health, which connects patients to broadband access. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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WISPA Panel Urges Small Broadband Providers to Embrace Telehealth

Connecting healthcare clinics can benefit communities, the panel said.

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Photo of Layne Sisk from his LinkedIn page

LAS VEGAS, October 10, 2023 – A panel urged broadband providers on Tuesday not to fear approaching healthcare centers with telehealth plans at WISPAPALOOZA, the annual conference of small and fixed wireless broadband providers.

“Don’t write them off just because they’re outside your comfort zone or what you’re used to,” said Max Joseph, a business development manager at AT&T. “There’s huge potential to market to these communities.”

Hospitals, doctor’s offices, and clinics often want to provide telehealth – services like counseling and appointments conducted via the internet, said Layne Sisk, CEO of broadband consulting firm ServerPlus. But healthcare providers often lack the technical knowledge to implement the service on their own. 

Photo of the panel at WISPAPALOOZA by Jake Neenan

In rural areas, implementing telehealth can involve getting connected to adequate broadband for video calls.

“To them, this is overwhelming. This is like magic,” he said.

The panel cited HIPAA, the law outlining privacy protections for patient health data, as a common concern preventing broadband providers from approaching healthcare clinics and getting them connected.

But HIPAA requirements, said Vonda Dilley, a sales manager at broadband provider Horizon Connects, are not distributed equally on a network. If a broadband provider only serves a clinic with internet connectivity, its compliance requirements are lower than the clinic’s internal IT systems and patient portal.

“You’re considered a conduit,” she said.

Expanding telehealth in rural areas can benefit those communities by giving them easier access to healthcare, plus specialists that are physically far away.

“The idea behind this is not just to make it more convenient, it’s a better quality of care,” Sisk said.

He pointed to a counseling center that operates in the same building as his office. During the pandemic, he said, that counseling center was able to see patients with more severe mental health because of the easier access to remote sessions.

The Federal Communications Commission launched a three-year pilot program in 2021 to study the impacts of making telehealth a permanent part of the Universal Service Fund, a roughly $8 billion yearly internet subsidy program.

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Expert Opinion

Craig Settles: And a Little Child Shall Lead Them — Digitally

How many communities are leveraging their teen populations in the pursuit of broadband and digital equity?

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The author of this Expert Opinion is Craig Settles, who leads telehealth-broadband integration initiatives.

In 2011 at the MoBroadbandNow Summit in Missouri, I listened to the CIO of the City of Springfield explain why his city included teenagers in important broadband needs assessment and planning meetings. “In your home, who do you call when you’re trying to figure out how to use the VCR?”

His point? Springfield learned a valuable lesson: Teens push the edges of technology, and understand how to use technology better than many adults do. Therefore, it is imperative to include teenagers in the planning of what is and will be their main future technologies. The brain power and the creativity alone will lead to the success of tapping this demographic.

Fast forward to 2023. How many communities are leveraging their teen populations in the pursuit of broadband and digital equity? “Kids want to get a look into the future,” said Kevin Morris in a video. “That’s the thing that drives many of them in school.” Morris talks to many students as the director of college, careers and community services for the Duarte Unified School District.

What about their future in broadband, I wondered, when a friend talked to me about her efforts to recruit internship positions for the K12 Foothill Consortium? Many of the high school students in the Consortium are anxious to intern remotely or in-person near their homes in Southern California. It hit me — take the Springfield model of teen engagement to the rest of America!

Imagine the possibilities for local broadband or digital equity teams, local government and nonprofits if they can channel bright, tech-savvy, energetic, inquisitive teens on a mission to help bring the digital equity solutions to communities. Remote or in person interns can help with focus groups, town halls logistics, preparing and writing newsletters, usability testing and Affordable Connectivity Program enrollments.

The K12 Foothill Consortium is recruiting internship hosts for the June through August period and for at least 60 hours total. Those groups and organizations engaged with broadband and digital inclusion projects get the benefit of interns’ prior training in coding, health care, web design, engineering and other related disciplines. Since interns prefer paid internships, the Consortium also raises money for organizations that may be too cash-strapped to offer a stipend but can offer meaningful internships.

Photo of Career Technical Education students courtesy of the K12 Foothill Consortium

Internship hosts view the relationships as a win-win for everyone involved. Ivan Ayro, director of adult and career technical education at Charter Oak Unified School District, agrees. “Students are able to connect the educational experience they’re getting from Career Technical Education classes with real-life experience from workplace learning. Through the internships, many of our students are able to realize in high school if this is something that they want to do for the rest of their lives.”

A recent US News & World Report article states that, although internships are traditionally for college students, high school students increasingly are participating in them. Benjamin Caldarelli, co-founder of Princeton College Consulting, a New Jersey-based educational consulting company, said, “High school students want to work somewhere that interests them and potentially make what they feel is a more meaningful contribution. They see internships as an enrichment activity and opportunity to make an impact rather than simply trading time for a little money.”

More than 205,000 new jobs will need to be created to complete the Broadband Equity, Access and Deployment expansion plans, many of them skilled workers. “There is a lot of focus placed on building broadband networks, but we cannot build them without a proper workforce,” Fiber Broadband Association CEO Gary Bolton said in a press release. “Failure to ensure the availability of high-skilled labor will result in workforce bottlenecks, which will ultimately lead to higher costs and project delays.”

The National Telecommunications and Information Association is requiring every state to have a five-year workforce development strategy. FBA published a guidebook to help states develop that strategy. Broadband and digital inclusion teams need to pencil in “internships” as part of their plans.

High school broadband and digital inclusion interns may not be considered skilled workers, obviously, but the interns should be considered the beginning levels of workforce development campaigns in every community. Start people thinking about broadband and all things digital in high school and use internships to shape their college or post-high school plans. Don’t forget that Gen Z can be an important part of broadband discussions, even if they’re not interns.

Amy Foell, principal of Amy Foell Consulting LLC, heads the K12 Foothill Consortium for Azusa, Charter Oak, Duarte and Monrovia Unified School Districts’ CTE. Their mission is to educate and train students to provide a community-sourced talent pool to sustain a healthy, balanced, local economy. Foell also supports workforce development programs across the San Gabriel Valley, including Pasadena Unified School District.

“I like to have an initial phone call and 15 to 20 Zoom sessions to ensure prospective internship sites understand the program,” said Foell. “Before we meet, it’s advisable to create a brief description of the internship project — be sure to share the organization’s purpose and mission. We’ll help hosts identify and interview candidates in May to early June, and students can start mid-June.”

Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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