Rural Health Care Program

A Telecommunication Universal Service Support Program Sponsored by the Federal Communications Commission

The Rural Health Care Program is a universal service support program authorized by Congress and designed by the Federal Communications Commission (FCC) to provide reduced rates to rural Health Care Providers (HCPs) for telecommunications services related to the use of telemedicine & telehealth. The FCC established the program to fund up to $400 million annually so that rural health care providers pay no more than their urban counterparts for the same or similar telecommunication services.

On November 13, 2003, the FCC adopted a "Report and Order, Order on Reconsideration, and Further Notice of Proposed Rulemaking," which describes several changes made to the rural health care program to improve the program, increase Rural Health Care Provider participation, and ensure that program benefits continue to be distributed in a fair and equitable manner. These changes include: expanding the definition of an eligible health care provider, supporting 25% of the monthly charge for internet access, web addresses and/or web hosting, and modifying the calculation of discounted services.

The Rural Health Care Division (RHCD) is the program administrator for the Rural Health Care Program. Answers to specific questions about the program may be found on the RHCD web site. For example, it provides a list of eligible services, a list of categories of eligible health care providers, and an explanation of the process overview. Rural Health Care Providers may also submit applications on-line and view and download application forms from the RHCD web site.

The FCC issued an order on September 29, 2006, establishing a pilot program within the rural health care program. The pilot program provides funding for the construction of broadband network that connects health care providers in a state or region. Over $417 million will be allocated for the construction of 62 statewide or regional broadband telehealth networks in 42 states and three U.S. territories. Additionally, the FCC modified the program by spreading funding equally over a three-year period. This is to accommodate the 62 qualified applicants in an economically reasonable and fiscally responsible manner. In April 2009 the FCC announced the approval of funding for six projects, and on February 18, 2010, it announced that 16 additional broadband telehealth networks are eligible to receive up to $145 million in reimbursement. These projects in total could receive up to $191.2 million for costs related to network deployment. The deadline to select vendors is extended to June 30, 2011, to help ensure the success of the projects within this pilot. More information on this program is available here.

Also, on March 16, 2010, the FCC delivered its plan titled Connecting America: The National Broadband Plan (Plan) to congress. Included within the Plan is a chapter addressing healthcare (i.e., Chapter 10). The following recommendations were made: 1) create appropriate incentives for e-care utilization; 2) modernize regulation to enable health information technology adoption; 3) unlock the value of data; and 4) ensure sufficient connectivity for health care delivery locations.

For Funding Year 2010, RHCD will continue to accept Form 465 until June 30, 2011. The application window for Funding Year 2011 is now open to submit Form 465.

Also note, as of Funding Year 2005, the definition of "rural" has changed. A listing of the eligible communities under this new definition is found under the heading "List of Rural Areas".   Originally, if a health care provider is no longer eligible using the new definition but has participated in the program at some point, that health care provider is able to participate for an additional three years.  However, the FCC released, “Order on Reconsideration,” on February 14, 2008, (i.e., FCC 08-47 and WC Docket No. 02-60) which added three more years to provide the FCC more time to evaluate the effect the changes in the “rural” definition would have on the health care providers.  The last eligible funding period now ends on June 30, 2011. 

Eligible Services

Health Care Providers (HCPs) are permitted to apply to receive reduced rates for a variety of telecommunication services under the RHCD program. HCPs may seek support for multiple telecommunications services of any bandwidth.

Ineligible Telecommunications Equipment and Charges

Telecommunications equipment does not qualify for support under the RHCD program. The following items are not eligible:

Special Eligibility for Internet Access

Usage and toll charges are not eligible for support with the exception of long distance charges incurred to connect to an Internet Service Provider (ISP).

Not-for-profit HCPs, in both rural and urban areas, may qualify for Internet access assistance if they are unable to access the Internet via a toll-free or local call, and must dial into the Internet via a toll (long distance) call. In this case, HCPs may receive the lesser of 30 hours or $180.00 per month to pay for these toll-charges. ISPs such as AOL or Erols are not eligible. The program only covers the toll-charges, not the access fee or monthly charge from the service provider.

Eligible Internet services are limited to the following:

• Monthly Internet access charge
• Email
• Web hosting

The following equipment and services are not eligible for support under the RHCD program:

• Caching
• Filtering content
• Training
• Servers
• Web casting
• Equipment and wiring

Eligible Health Care Providers (HCPs)

To qualify for universal service support, HCPs and telecommunications carriers must meet the following criteria:

• Public and Non-Profit Health Care Providers
  • post-secondary educational institution offering health care instruction, teaching hospital, or medical school
  • 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
  • consortia of health care providers consisting of one or more of these entities (e.g., networks including urban medical centers)
• Located in "rural" area

For funding year 2004, the following are also eligible:

• Dedicated emergency department of a rural for-profit hospital
• Part-time eligible entity located in an otherwise ineligible facility

List of Rural Areas

The first column of the table below contains a list of counties that have only portions of the county considered rural with the exception of Des Moines County, which has been labeled “urban.” The second column contains a description of the specific area(s) defined as rural. If a county is not included in the list, the entire county has been designated rural.

Eligibility Process

There is a multi-step process that needs to be completed in order to take advantage of the Rural Health Care Program. Click on the link below to access information on this process. To return to the IUB web site, click on the "Back" button.
http://www.rhc.universalservice.org/overview/processmap.asp

Calculation

The standard urban distance (SUD) is a mileage allowance for urban areas and determines HCP support for mileage sensitive charges. The SUD rate for Iowa is 11 miles. RHCD supports mileage charges beyond the SUD and up to the maximum allowable distance (MAD). The MAD is the distance from the HCP location to the far side of the largest city in the same state as the HCP.

Example:
HCP located in Iowa.
MAD = 100
SUD for Iowa = 11 miles
Circuit distance = 110 miles
Cost per mile for circuit = $10 per mile per month
RHCD supports mileage beyond the SUD up to the MAD.

Therefore, support is as follows:

(100 miles - 11 miles) x $10 per mile = $890 per month

Since the circuit distance is greater than the MAD, RHCD supports mileage up to the MAD

NOTE: This example information is estimated. RHCD will determine the actual mileage and rates. You can contact RHCD Customer Service Support Center (CSSC) at 1-800-229-5476.

Links

Rural Health Care Division

Contacts

If you have any questions concerning the Rural Health Care Program, please contact: Vince Hanrahan at 515.725.7319.

You may also call the RHCD Customer Service Support Center (CSSC) at 1-800-229-5476.