The FCC’s Rural Health Care Program Federal Universal Service Support for Rural Health Care

Federal Universal Service Support: Four Programs “Universal service” is a principle that has been recognized for over 100 years: all Americans should have access to communications services. Congress in 1996 extended universal service beyond basic telecommunications. Authorized the FCC to establish four programs: High Cost (Connect America) – ensures rural telephone companies can provide affordable services Lifeline – ensures eligible low income Americans have access to telecommunications Schools & Libraries (E-rate) – ensures schools and libraries have access to broadband Rural Health Care – ensures rural health care providers have access to broadband

Where Does the Money Come From? Annual funding comes from providers of interstate telecommunications Percentage assessment against revenue Often passed-through to consumers Program 2015 Authorized Disbursements High Cost (Connect America) $4.5 billion Lifeline (Low Income) $1.49 billion Schools & Libraries (E-rate) $2.09 billion Rural Health Care $0.28 billion TOTAL $8.355 billion

Rural Health Care Program

Eligible Healthcare Providers Post-secondary educational institution offering health care instruction Community health center or health center providing health care to migrants Local health department or agency Community mental health center Not-for-profit hospital Rural health clinic Skilled nursing facilities (can apply starting January 1, 2017) Also: connections to hospital data centers or administrative offices.

Consortia “[A] group of two or more health care provider sites that request support through a single application.” May include eligible and ineligible HCPs (Ineligible HCPs cannot receive support.) Members need not be affiliated Majority of eligible HCPs must be rural Each consortium must have a “lead entity.” Can be: The consortium itself (if a legal entity) State or other governmental organization Public sector entity Other non-profit entity

Benefits of Consortia Consortia Aggregated demand increases purchasing power and negotiating leverage with service providers Ineligible entities allowed to benefit from negotiated lower rates Aggregated demand may incentivize carrier broadband investments Sometimes offer value-adds: e.g., telemedicine consulting and support Open consortia make it easier for safety-net providers to participate E.g., public hospitals, community health centers, rural clinics, local health departments; substantial share patient mix uninsured, Medicaid, and other vulnerable populations.

Has the RHC Program run out of money? $400 million will continue to be available every year Funding year 2015: requests totaled $377 million Unexpected surge in Telecom Program demand Funding year 2016: New: Skilled nursing facilities eligible What will operating “at the cap” mean? For applicants that file late in the funding cycle, risks will increase: Reduced (pro-rated) support Funding denial What about consortia with multi-year funding commitments? Does the FCC need permission from Congress to raise the cap?

Program Integrity Competitive bidding It’s the law (e.g., 47 C.F.R. sections 54.603 and 54.642) Must select the most cost-effective service that meets your needs Cost doesn’t have to be the biggest factor No factor can be weighted higher than cost Essential to ensuring that limited program funding is used wisely If your organization is part of the a consortium, the lead entity shoulders this responsibility If your organization is an individual applicant, you are responsible (even if you hire a consultant to handle it for you)

California Telehealth Network Eric Brown President & ceo

California Safety Net Healthcare Landscape Rural healthcare delivery system is struggling California Healthcare Foundation reports that over half of rural safety net clinics and hospitals are cash flow negative Shortage of primary care physicians Shortage of specialty care physicians Rural hospitals and health clinics struggle to survive Difficulty recruiting and retaining clinicians Local patients go to urban cities to receive medical care Low patient volumes make it difficult to survive economically Regulatory and industry move to technology enabled health care require broadband and other cloud based technologies Limited and expensive access to broadband Difficulty recruiting and retaining IT talent required to operate cloud based technology platforms

Covered California and Medi-Cal Expansion More Californians have health insurance Many patients are being seen and diagnosed with specialty care conditions Primary care physicians having difficulty finding a specialist in reasonable proximity to refer Medi-Cal patients – long wait times to see a physician As a result, demand for telemedicine specialty care consultations is up significantly all over California

CTN Mission Statement To promote advanced information technologies and services to improve access to high quality healthcare focusing on medically underserved and rural Californians.

Broadband Related Services Broadband needs assessments Enroll eligible sites in the FCC Healthcare Connect Fund and California Teleconnect Fund CTN operates a private broadband network dedicated to healthcare Interconnected with all California academic medical centers Interconnected with Indian Health Services and the California Rural Indian Health Board

HEALTHCARE CONNECT FUND CTN serves over 430 sites of which roughly 250 HCF are subsidized sites 60% of sites in urban California AT&T, Charter/Time Warner Business are the approved HCF vendors

Non Broadband Related Services CTN Connect web based video-conferencing platform Tier 1 technical support Telemedicine equipment, consulting, implementation and support Cyber security assessments, ongoing intrusion monitoring and support Disaster Recovery and Business Continuity solutions for HIPAA compliance

Telemedicine Consultations

T Telehealth Specialties Utilized

Thank You!

Jim Rogers President jrogers@healthconnectnetworks.com (207)922-4120

The New England Project 2006 Founded New England Telehealth Consortium (NETC) 2007 FCC/RHCPP award winner $24.6 million award Non-profit, tax-exempt New England healthcare consortium with 320 sites in ME, NH and VT Hospitals, Clinics, Behavioral Health, Medical Schools

NETC the Network Private/Redundant Network, 120Gb Backbone Supports Quality of Service Symmetrical Bandwidth (1.5Mb to 2Gb) Commodity Internet and Internet2 Supports IPv4, IPv6 and BGP 24x7 NOC for Management Support Network Uptime (Core: 100%, Edge 99.981%)

NETC – 320 Site, 120Gb Broadband Network

Healthcare Connect Fund - Consortia Consortia of Health Care Providers are Cost Effective Share Information: Rural with Urban High Bandwidth and Quality of Service Rural and Urban HCPs receive discounts Multi-Year Subsidy Funding Economy of Scale: Purchasing and Administration

Urban Access to Healthcare

Rural Access to Healthcare - Frenchboro

Rural Access to Healthcare – Cranberry

Growth and Outreach beyond RHCPP Expansion of NETC: Additional 500 HCPs in New England Working with 340+ HCPs in 12 states Working with Palmetto Care Connections to bring more HCF money to South Carolina HCPs

Thank You! Jim Rogers jrogers@healthconnectnetworks.com (207)922-4120

Palmetto State Providers Network (PSPN) PCC is new Consortium Leader for PSPN as of July 1, 2015 Spirit Communications is the service provider for PSPN per the awarding of the RFP back in 2009 Working with Health Connect Networks to add new carriers for PSPN members who may have existing contracts

PSPN Since becoming new Consortium Leader in 2015, we have added 20 new members to PSPN Currently 36 new member sites that have been approved and waiting on installation of circuit 1st Consortium to obtain funding approval for alcohol & drug abuse sites (DAODAS) as mental health providers

PSPN Over last 3 years, subsidies generated more that $3.4 million in savings for health care providers in SC PSPN Consortium is currently 57% rural meaning that 43% of sites are urban and would not be eligible for 65% subsidy without being part of this Consortium New partnership with Health Connect Networks will enable PSPN to better assist hcps who utilize carriers other than Spirit Communications as they were awarded RFP in 2009

PSPN If interested In learning more about PSPN Opportunities or determine if your HCP is eligible for subsidy, call Matt Hiatt Or Kathy Schwarting at 803-245-2672 Stop by the PCC table for more information! www.palmettocareconnections.org