The Federal Communications Commission (FCC) recently took another significant step on the path towards expanding the availability of connected healthcare for certain underserved communities. Through the creation of a Connected Care Pilot Program (CC Pilot Program), the FCC aims to increase access to remote healthcare for patients who do not live near physical facilities, low-income urban patients and veterans, thereby promoting quality care and better outcomes.
On July 10, 2019, the FCC adopted a Notice of Proposed Rulemaking (Rulemaking Notice) concerning its creation of the CC Pilot Program, which would initially make $100 million available to assist healthcare providers and telecommunications carriers in implementing connected care technologies to serve the targeted patients in rural and urban communities, tribal lands and other medically underserved areas. The FCC proposes to fund the CC Pilot Program from its existing Universal Service Fund (USF), which draws support from fees assessed to telecommunications companies, and which the FCC uses to advance the principle that all Americans should have access to communications services.
The Rulemaking Notice lists four primary goals for the CC Pilot Program: “(1) improving health outcomes through connected care; (2) reducing healthcare costs for patients, facilities, and the healthcare system; (3) supporting the trend towards connected care everywhere; and (4) determining how USF funding can positively impact existing telehealth initiatives.” The FCC also hopes that the CC Pilot Program will reveal the cost savings that result from connected care services, and the long-term viability of a broader connected care subsidy program.
The proposed CC Pilot Program comes several years after the FCC’s deployment of funds in connection with its Rural Health Care Pilot Program (RHC Pilot Program). The RHC Pilot Program contributed to the improvement of broadband connectivity for healthcare providers throughout the United States, but it did not lead to a meaningful increase in the sort of telehealth services that would allow patients to remotely access providers from the comfort of their own homes or communities, and it did not contemplate the expansion of connected care services to low-income urban patients and veterans. If implemented, the CC Pilot Program will address these RHC Pilot Program omissions. Thus, as compared to the RHC Pilot Program (which primarily yielded improvements in telecommunication among healthcare providers), it appears that the CC Pilot Program will strive to improve telecommunications between healthcare providers and their patients.
As it did with the RHC Pilot Program, the FCC proposes that end-user devices, medical devices and most mobile applications will be ineligible for support in the CC Pilot Program. In support of that proposal, the FCC cites its previous conclusion that it lacks statutory authority to support those devices and applications. The FCC also proposes to limit the CC Pilot Program to post-secondary educational institutions offering healthcare instruction, teaching hospitals, medical schools, community health centers, migrant-oriented health centers, local health departments and agencies, community mental health centers, non-profit hospitals, rural health clinics, skilled nursing facilities and healthcare consortia that consist of these entities.
The FCC seeks comment on the scope of the CC Pilot Program and supported services, including:
- the proposal that the selected projects will receive funding for three years, and will receive the benefit of separate ramp-up and wind-down periods of up to six months;
- the proposal that the CC Pilot Program will be limited to projects that primarily focus on conditions that typically require at least several months to treat (e.g., behavioral health, opioid dependency, chronic health conditions, mental health conditions and high-risk pregnancies);
- whether Section 254 of the Communications Act of 1934 (47 U.S.C. § 254) requires the FCC to limit the CC Pilot Program to non-profit or public healthcare providers (as discussed above);
- the proposal that the FCC should limit the program to those providers regardless of whether Section 254 imposes that requirement;
- the proposal that the CC Pilot Program will subsidize 85% of eligible costs for each project (reasoning that the CC Pilot Program participants should have “skin in the game”);
- the establishment of a maximum amount of CC Pilot Program funds that can be allocated to a single project (although the FCC initially proposed funding twenty projects with awards of $5 million per project, commenters persuaded the FCC to neither limit the number of selected projects nor predetermine the funding amounts for each project); and
- the criteria and point allocation process that the FCC will use in selecting the CC Pilot Program participants (e.g., the merits of awarding additional points (see discussion below) for projects primarily focused on treating chronic health conditions or health crises such as opioid dependency, high-risk pregnancy and mental health conditions).
The FCC envisions an application process whereby interested parties would describe their proposed projects and provide certain information—the contours of which remain subject to further consideration—to the FCC. In turn, the FCC would use that information to filter each proposed project through a weighted, point-based evaluation process. The programs selected to participate in the CC Pilot Program (i.e., the programs earning the most points) would be those most tailored to the advancement of the CC Pilot Program goals.
Given the FCC’s apparent focus on longer-term conditions, cost savings and improved outcomes that would result from access to connected care, healthcare providers and telehealth companies that are interested in shaping the CC Pilot Program or participating in it (either directly or as a vendor/partner) should consider highlighting how their technology or service would further those objectives.