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

2. 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

3. 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

4. Rural Health Care Program

5. 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.

6. 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

7. 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.

8. 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?

9. Program Integrity Competitive bidding
It’s the law (e.g., 47 C.F.R. sections and )
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)

10. California Telehealth Network
Eric Brown
President & ceo

11. 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

12. 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

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

14. 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

15. 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

16. 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

17. Telemedicine Consultations

18. T Telehealth Specialties Utilized

19. Thank You!

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

21. 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

23. 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 %)

25. NETC – 320 Site, 120Gb Broadband Network

26. 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

27. Urban Access to Healthcare

28. Rural Access to Healthcare - Frenchboro

29. Rural Access to Healthcare – Cranberry

30. 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

31. Thank You!
Jim Rogers
(207)

32. 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

33. 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

34. 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

35. 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 Stop by the PCC table for more information!