The Federal Communications Commission on March 31, 2020, established two programs to help eligible healthcare providers purchase and deploy telehealth technology. Both programs limit eligibility to healthcare providers who are public or nonprofit institutions. The programs provide immediate relief in response to the current coronavirus (COVID-19) pandemic and aim to improve telehealth outcomes over the longer term.
The $200 million COVID-19 Telehealth Program is funded by appropriations from the CARES Act to allocate funds for connected care services, including direct funding for devices and services. Eligible healthcare providers may use these devices and services to treat COVID-19 patients directly or in other applications to respond to the pandemic.
The three-year, $100 million Connected Care Pilot Program is designed to study and improve telehealth services for low-income and veteran Americans. The pilot program will fund eligible healthcare provider and patient broadband internet access and other connected care information services.
Broadband service providers, device makers, and other telehealth industry participants should proactively reach out to healthcare industry customers who are likely to be interested in participating in these new telehealth funding sources.
Eligible Healthcare Providers. The COVID-19 Telehealth Program will be open to nonprofit and public healthcare providers in rural and nonrural areas. The Federal Communications Commission (FCC) limited the program to eligible healthcare providers as defined in the universal service rules of the Communications Act of 1996, which consists of the following eight categories:
Healthcare providers that do not already have an eligibility determination should seek an expedited determination by filling an FCC Form 460 with the Universal Service Administrative Company (USAC) and applying for support under the COVID-19 Telehealth Program while their eligibility determination is pending.
The FCC’s Wireline Competition Bureau, in consultation with the FCC’s Connect2Health Task Force, will review applications and award funding on a rolling basis. The FCC anticipates a $1 million funding limit for each applicant and expects to “target areas that have been hardest hit by COVID-19 and where the support will have the most impact.”
Eligible Services and Devices. The COVID-19 Telehealth Program provides funding for “connected care services.” The order defines connected care services as a “subset of telehealth that uses broadband internet access service-enabled technologies to deliver remote medical, diagnostic, patient-centered, and treatment-related services directly to patients outside of traditional brick-and-mortar medical facilities—including specifically to patients at their mobile location or residence.”[1]
The program also provides funding for “devices.” Eligible devices include end-user devices such as smartphones or tablets that allow a patient to “report his or her health conditions directly to a provider,” so long as the connected devices and services are “integral to patient care.” The program will only fund monitoring devices that are “themselves connected,” and not “unconnected devices that patients can use at home and then share the results with their medical professional remotely.”
The funds are not limited to treating COVID-19 patients as long as they are used “to prevent, prepare for, and respond to coronavirus.” Treating other patient groups with connected care could, for example, free up resources, including physical space and reduce unnecessary exposure to coronavirus.
Application Process. The order establishes a streamlined, electronic application process. Applications describe the anticipated connected care services, the conditions to be treated, the estimated number of patients, and the goals and objectives of the connected care services. The applications must include a description of the telecommunications services, information services and devices requested, the amount of funding requested, supporting documentation such as vendor quotes or invoices, and the “total monthly amount of funding requested for each eligible item.”
Applicants must include a deployment timeline and a “summary of the factors the applicant intends to track that can help measure the real impact supported services and devices.” Applicants will need to certify that they will comply with the Health Insurance Portability and Accountability Act (HIPAA) and all applicable privacy regulations and laws, and that they are not receiving duplicate funding for the devices or services.
Timeline. The FCC will begin accepting applications for the COVID-19 Telehealth Program immediately after the Office of Management and Budget’s (OMB) approval of the program is published in the Federal Register, which can take up to 90 days but is expected to occur much sooner.
Healthcare providers will receive reimbursement directly from the FCC for eligible services and devices. The FCC will not require program participants to conduct a competitive bidding process to select eligible services or devices. Participants will need to provide supporting documentation for invoice and a six-month progress report, and retain records demonstrating compliance with program requirements for at least three years from the date of last service.
The FCC has temporarily waived the gift rules for E-Rate and Rural Healthcare (RHC) participants, so that service providers can provide gifts of value greater than $20 including devices, increased capacity and other upgrades to program participants. The FCC extends this waiver of the gift rules to COVID-19 Telehealth Program participants.
The pilot program is a three-year, $100 million initiative to provide connected care services. It will “cover 85% of the eligible costs of broadband connectivity, network equipment, and information services necessary to provide connected care services to the intended patient population.”
Its goals are to “(1) improve health outcomes through connected care; (2) reduce healthcare costs for patients, facilities, and the healthcare system; and (3) support the trend towards connected care everywhere.”
Eligible Healthcare Providers. Pilot program recipients must qualify as a “healthcare provider” as defined in the Communications Act of 1996 and receive an eligibility determination from the USAC.
In selecting pilot projects, the FCC will give preference to healthcare providers that have existing telehealth experience such as remote patient monitoring, store-and-forward imaging, and video conferencing capabilities, and to providers that have existing telehealth partnerships. Priority will be given to projects that focus on low-income and veteran Americans.[2]
The order does not adopt a limit on the amount of funding per recipient or the number of projects.
Eligible Services. The pilot program adopts the same definition of “connected care services” as the COVID-19 Telehealth Program. The order defines “telehealth” to include “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 telemedicine and other healthcare purposes.
Eligible costs include: (1) patient broadband internet access services, (2) healthcare provider broadband data connections, (3) other connected care information services such as “store-and-forward” technology and remote patient monitoring capability, and (4) certain network equipment such as routers and servers that are “necessary to manage, control, or maintain a supported broadband service.” Networking equipment must be used in the specific pilot project.
The pilot program will not fund end-user devices or medical equipment, and it will not fund healthcare provider administrative costs associated with participating in the pilot program. Pilot program participants will be required to collect and report specific data (to be determined at a later date).
Application Process. Applicants must submit pilot project proposals electronically to the FCC. Applications should demonstrate a research and evaluation strategy and a strategic plan for delivering connected care services, a description of the provider’s telehealth experience, a plan for the implementation and operation of the pilot project, the connected care services to be provided, the conditions and patients to be treated, and the geographic area in which the project will operate.
Applications for the pilot program should include technical information such as the anticipated broadband speeds, technologies (e.g., mobile or fixed broadband), and any other relevant service characteristics, and the estimated number of patient broadband connections the healthcare provider intends to purchase.
Financial information such as costs must be submitted as part of the application process, and applicants must include a plan on how the pilot project will collect and store required pilot program data. Applicants will need to certify that they will comply with HIPAA and all applicable privacy regulations and laws, and retain compliance documentation for five years.
Successful pilot program applicants will need to conduct a competitive bid procurement process that complies with the Healthcare Connect Fund Program, which allows exemptions from competitive bidding in certain instances.
Timeline. The deadline for filing applications for the pilot program is 45 days from the effective date of the pilot program rules or July 31, 2020, whichever is later. Funding requests must be submitted to the USAC within six months of selection as a pilot project, and projects with multi-year contracts may submit a single funding request for the full period covered by the contract.
Supporting documentation must be submitted to USAC on a monthly basis for reimbursement. Any material change to a pilot project must be reported within 30 days, and the USAC must be notified within 30 days of any decrease of 5% or more in the number of patients participating in a pilot project.
For further details, please consult the full Report and Order, released on April 2, 2020.
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[1]Examples the FCC provides of eligible services include “remote patient monitoring (e.g., use of patient reporting outcome platforms, glucometers, pulse oximeters, sphygmomanometers, chest straps, wearables, passive sensors, or other devices to consistently monitor patient vitals), patient health education, store and forward services (e.g., asynchronous transfer of patient images and data for interpretation by a physician), and synchronous video consultations and visits.”
[2]The order also states that priority will be given to 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.”