Wireline Competition Bureau Seeks Comment on Covid-19 Telehealth Program Application Evaluation Metrics, 8356-8359 [2021-02255]

Agencies

• FEDERAL COMMUNICATIONS COMMISSION

[Federal Register Volume 86, Number 23 (Friday, February 5, 2021)]
[Notices]
[Pages 8356-8359]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-02255]


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FEDERAL COMMUNICATIONS COMMISSION

[WC Docket No. 20-89; DA 21-14; FRS 17428]


Wireline Competition Bureau Seeks Comment on Covid-19 Telehealth 
Program Application Evaluation Metrics

AGENCY: Federal Communications Commission.

ACTION: Notice.

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SUMMARY: In this document, the Wireline Competition Bureau (Bureau) 
seeks comments on the metrics the Commission should use to evaluate 
applications for funding and how the Commission should treat 
applications filed during the funding rounds for awards from the COVID-
19 Telehealth Program using amounts appropriated under the CARES Act.

DATES: Comments were initially due by January 19, 2021. The Bureau will 
continue to accept comments on the metrics at any time.

ADDRESSES: You may submit comments, identified by WC Docket No. 20-89, 
by any of the following methods:
     Electronic Filers: Comments may be filed electronically 
using the internet by accessing the ECFS: https://www.fcc.gov/ecfs/.
     Paper Filers: Parties who choose to file by paper must 
file an original and one copy of each filing.
    [cir] Filings can be sent by commercial overnight courier or by 
first-class or overnight U.S. Postal Service mail. All filings must be 
addressed to the Commission's Secretary, Office of the Secretary, 
Federal Communications Commission.
    [cir] Commercial overnight mail (other than U.S. Postal Service 
Express Mail and Priority Mail) must be sent to 9050 Junction Drive, 
Annapolis Junction, MD 20701.
    [cir] U.S. Postal Service first-class, Express, and Priority mail 
must be addressed to 45 L Street, NE, Washington, DC 20554.
    [cir] Effective March 19, 2020, and until further notice, the 
Commission no longer accepts any hand or messenger delivered filings. 
This is a temporary measure taken to help protect the health and safety 
of individuals, and to mitigate the transmission of COVID-19. See FCC 
Announces Closure of FCC Headquarters Open Window and Change in Hand-
Delivery Policy, Public Notice, DA 20-304 (March 19, 2020), https://www.fcc.gov/document/fcc-closes-headquarters-open-window-and-changes-hand-delivery-policy.
     People with Disabilities: To request materials in 
accessible formats for people with disabilities (Braille, large print, 
electronic files, audio format), send an email to [email protected] or 
call the Consumer & Governmental Affairs Bureau at (202) 418-0530 
(voice), (202) 418-0432 (TTY).
For detailed instructions for submitting comments and additional 
information on the rulemaking process, see the SUPPLEMENTARY 
INFORMATION section of this document.

FOR FURTHER INFORMATION CONTACT: Stephanie Minnock, Assistant Division 
Chief, Telecommunications Access Policy Division, Wireline Competition 
Bureau, [email protected] or 202-418-7400 or TTY: 202-418-0484.

[[Page 8357]]


SUPPLEMENTARY INFORMATION: This is a synopsis of the Commission's 
Public Notice in WC Docket No. 20-89; DA 21-14 released January 6, 
2021. Due to the COVID-19 pandemic, the Commission's headquarters will 
be closed to the general public until further notice. The full text of 
this document is available at the following internet address: https://docs.fcc.gov/public/attachments/DA-21-14A1.pdf. The proceeding shall be 
treated as a ``permit-but-disclose'' proceeding in accordance with the 
Commission's ex parte rules. Persons making ex parte presentations must 
file a copy of any written presentation or a memorandum summarizing any 
oral presentation within two business days after the presentation 
(unless a different deadline applicable to the Sunshine period 
applies). Persons making oral ex parte presentations are reminded that 
memoranda summarizing the presentation must (1) list all persons 
attending or otherwise participating in the meeting at which the ex 
parte presentation was made, and (2) summarize all data presented and 
arguments made during the presentation. If the presentation consisted 
in whole or in part of the presentation of data or arguments already 
reflected in the presenter's written comments, memoranda or other 
filings in the proceeding, the presenter may provide citations to such 
data or arguments in his or her prior comments, memoranda, or other 
filings (specifying the relevant page and/or paragraph numbers where 
such data or arguments can be found) in lieu of summarizing them in the 
memorandum. Documents shown or given to Commission staff during ex 
parte meetings are deemed to be written ex parte presentations and must 
be filed consistent with rule Sec.  1.1206(b). In proceedings governed 
by rule Sec.  1.49(f) or for which the Commission has made available a 
method of electronic filing, written ex parte presentations and 
memoranda summarizing oral ex parte presentations, and all attachments 
thereto, must be filed through the electronic comment filing system 
available for that proceeding, and must be filed in their native format 
(e.g., .doc, .xml, .ppt, searchable .pdf). Participants in this 
proceeding should familiarize themselves with the Commission's ex parte 
rules.

I. Introduction

    1. Telehealth is a critical tool in the fight against the ongoing 
COVID-19 pandemic. It can allow medical professionals to monitor non-
critical COVID patients in a non-clinical setting, reduce demands on 
hospital staff and supplies, and avoid potential exposure to the 
coronavirus for patients seeking treatment for other conditions. The 
Commission's COVID-19 Telehealth Program awarded $200 million Congress 
previously appropriated for that purpose, targeting applications from 
providers in the hardest hit areas that would have the greatest impact 
on the pandemic. However, demand for the program significantly exceeded 
available funding.
    2. To build on the success of the Commission's COVID-19 Telehealth 
Program, in the Consolidated Appropriations Act, 2021 Congress 
appropriated an additional $249.95 million for the Program. The Act 
requires the Commission to seek comment on ``the metrics the Commission 
should use to evaluate applications for funding'' and ``how the 
Commission should treat applications filed during the funding rounds 
for awards from the COVID-19 Telehealth Program using amounts 
appropriated under the CARES Act . . . .'' Through the Public Notice, 
the Bureau seeks comments on these matters, as well as how to meet the 
Act's other requirements for the COVID-19 Telehealth Program and other 
improvements to the application, review, and invoicing process.

II. Request for Comment

    3. Prioritizing Round 2 Funding. The Act directs the Commission to 
seek comment on the metrics used to evaluate applications for Round 2 
Program funding. During Round 1, the Bureau evaluated the Program 
applications on a rolling basis, targeting funding to areas that were 
hardest hit by COVID-19 and where the support would have the most 
impact on addressing health care needs. Although Round 1 funding was 
not targeted toward specific medical conditions, patient populations, 
or geographic areas, the Commission strongly encouraged applicants to 
target the funding received to high-risk and vulnerable patients to the 
extent practicable. The Commission encouraged applicants under pre-
existing strain (e.g., providing care for a large underserved or low-
income patient population, facing health care provider shortages, or 
dealing with rural hospital closures) to document such factors in their 
applications. The Commission directed the Bureau to select as many 
applicants as reasonably possible within the funding appropriated by 
the CARES Act. To ensure that as many applicants as possible receive 
available funding, the Commission did not anticipate awarding more than 
$1 million to any single applicant.
    4. The Bureau seeks comments on whether to continue to target 
funding to health care providers in areas ``hardest hit'' by COVID-19 
at the time of the funding decision. During Round 1, the pandemic 
impacted some regions much more severely than others, thus allowing the 
Bureau to identify particular hotspots that were ``hardest hit'' in 
comparison to other parts of the country by referencing data published 
and collected by Johns Hopkins. Given the broader infection rate 
currently in the U.S., should the Bureau continue to target funding to 
hardest hit areas? If so, how should the ``hardest hit'' areas be 
defined?
    5. Similarly, in Round 1 the Commission targeted funding to health 
care providers under pre-existing strain, which included health care 
providers that were facing difficulty providing telehealth services 
prior to the pandemic. In Round 2, what weight should the Bureau give 
pre-existing strain faced by applicant health care providers? Should 
pre-existing strains be distinguished from pandemic-related strains 
many providers now face?
    6. During Round 1 of the Program, the Commission ``did not 
anticipate awarding more than $1 million'' per applicant to ensure that 
as many applicants as possible receive funding. Should the Bureau 
maintain this approach? How should the Bureau address applications 
filed by statewide entities, large health care providers or health care 
provider systems with numerous sites?
    7. Are there other equitable limitations that will help the Program 
spread funding to a greater number of health care providers without 
sacrificing the needs of larger health care providers struggling to 
treat patients during the pandemic? Should applicants from Round 1 that 
did not receive $1 million be eligible to receive additional funding? 
Should applicants from Round 1 that did receive $1 million be eligible 
to receive additional support in Round 2?
    8. Are there any other metrics the Bureau should use to prioritize 
applications during the evaluation process? Should the Bureau 
prioritize health care providers serving a large percentage of COVID-19 
patients? Are there specific types of telehealth and connected care 
services that should be prioritized? Should the Bureau prioritize 
applications from health care providers that seek funding to treat 
specific at-risk populations, such as Tribal, low-income, or rural 
communities? If so, how should those populations be defined? Should 
these applicants be prioritized only if a

[[Page 8358]]

certain percentage of their patient base, i.e., the total amount of 
patients who visited a facility in a year, is at-risk? What percentage 
would be reasonable to achieve the goal of prioritizing funding for at-
risk populations? Are there other criteria the Bureau should 
prioritize?
    9. Ensuring Nationwide Distribution of Funding. The Act directs the 
Commission, to the extent feasible, to ensure ``that not less than 1 
applicant in each of the 50 States and the District of Columbia has 
received funding'' from the Program since the program's inception, 
``unless there is no such applicant eligible for assistance in a State 
or in the District of Columbia.'' To fulfill this requirement, the 
Bureau proposes accepting Round 2 applications and establishing an 
application filing window rather than accepting applications on a 
rolling basis. Although accepting and evaluating applications on a 
rolling basis allowed the Bureau to quickly review applications and 
issue funding commitments for the funding appropriated by the CARES 
Act, this evaluation method will not ensure that funding will be 
available for applicants in each State and the District of Columbia. 
Establishing an application filing window would allow the Bureau to 
prioritize applications using pre-defined evaluation metrics and ensure 
that funding is provided, to the extent feasible, to at least one 
applicant in each of the 50 states and the District of Columbia. This 
approach would also provide all applicants the same period of time to 
prepare and file applications. The Bureau seeks comments on this 
approach. If an application filing window is established, how long 
should the window remain open?
    10. Is there an alternative approach that would ensure that the 
Commission meets this legislative provision? Should the Bureau instead 
continue to accept applications on a rolling basis, but set aside a 
portion of funding, e.g., $1 million for each state and the District of 
Columbia, to ensure that an applicant from each State and the District 
of Columbia receive Round 2 funding?
    11. Treatment of Round 1 Applications. The Act directs the 
Commission to seek comment on ``how the Commission should treat 
applications filed during'' Round 1 of the Program. The Act also 
requires the Commission to allow an applicant who filed an application 
during Round 1 ``the opportunity to update or amend that application as 
necessary.''
    12. The Bureau proposes to require applicants to update and 
resubmit applications that were filed during Round 1 if they want them 
to be considered for Round 2. The Bureau proposes that Round 1 
applications that are not resubmitted during the filing window will not 
be considered for Round 2. The Bureau makes this proposal because many 
of the remaining Round 1 applications need to be refreshed and some 
require substantial amendments. From April to June 2020, the Commission 
received thousands of applications for Round 1, and committed funding 
to 539 applicants before the available funding was exhausted. Many of 
the remaining applications are from ineligible entities or require 
substantial supplementation to be considered materially complete. Some 
applicants no longer need funding because they received support for 
telehealth services from other sources. And, because these applications 
were filed between April and June 2020, all the remaining applications 
contain stale information--COVID-19 infection rates in many areas were 
dramatically lower at that time than they are today, the pandemic was 
less widespread, and health care providers have had time to refine 
their strategies for providing services during the pandemic, making it 
likely that these applicants would, given the opportunity, request 
different amounts and types of connected devices and eligible services. 
The Bureau seeks comments on this approach.
    13. The Bureau also proposes this approach because the application 
system used during Round 1 of the Program, which was developed quickly 
given the emergency situation, is functionally limited, and is not 
designed to let applicants amend or update their applications after 
they have been filed. In addition, certain information required to 
comply with the Act, such as the new evaluation criteria, was not 
collected in Round 1. Thus, it would be less burdensome for both Round 
1 applicants and Commission staff to have Round 1 applicants submit new 
applications during the Round 2 filing window than to update Round 1 
applications in the existing portal. Requiring Round 1 applicants to 
submit new applicants will increase the speed at which Commission or 
Universal Service Administrative Company (USAC) staff are able to 
process and award Round 2 funding. Therefore, the Bureau proposes 
requiring Round 1 applicants that continue to seek funding to update or 
amend their applications by submitting a new application for Round 2.
    14. Should the Bureau review Round 2 applications filed by Round 1 
applicants before evaluating applications from new entities during the 
Round 2 review process? Should the Bureau prioritize funding 
applications submitted during Round 2 by applicants that applied, but 
did not receive any or all of the requested funding, during Round 1? 
Relatedly, how should the Bureau treat applicants for Round 2 funding 
that received the full amount of their requested funding during Round 
1?
    15. Additional Program Improvements. During the process of standing 
up this Program, the Bureau learned valuable lessons about the unique 
needs of connected care and health care providers. To build on the 
lessons learned during Round 1, the Bureau proposes updating the 
Program's application and invoicing processes and seeks comments on 
implementing these proposed improvements during Round 2. Specifically, 
the Bureau proposes using the Universal Service Administrative Company 
(USAC) to assist in administering the remaining work necessary to 
complete Round 1 of the Program as well as Round 2. The Bureau further 
proposes directing USAC to update the portal that will be used by Round 
2 applicants, including Round 1 applicants that wish to renew their 
request for funding under the Program, to submit applications for the 
funding appropriated by the Act; to conduct an initial review of Round 
2 invoices; and to provide outreach and guidance about the application 
process to applicants. Updating the portal will ensure that all 
applicants provide the information needed for review under the updated 
Round 2 application evaluation metrics, facilitate program 
administration, and reduce administrative burdens on both applicants 
and Commission staff. However, under this approach Commission staff 
would make final funding determinations, subject to the requirements of 
the Act. The Bureau seeks comments on this approach.
    16. During Round 1, applicants were required to file FCC Forms 460 
to obtain eligibility determinations for all participating health care 
provider sites. As part of the eligibility determination process, 
health care provider sites seeking an eligibility determination were 
assigned a health care provider number by USAC. The Bureau found that 
requiring health care providers to file FCC Forms 460 for each site 
delayed our ability to move quickly on many applications, especially 
those applications with a large number of sites in need of eligibility 
determinations. Using a different method to determine whether a site is 
eligible could reduce the administrative burden on applications, the 
Commission, and USAC during the application review process. 
Accordingly, the Bureau seeks

[[Page 8359]]

comments on directing USAC to include eligibility review as part of the 
application process, but not requiring applicants to file FCC Forms 
460. Are there other means of identifying health care providers and 
determining their eligibility for support in the program that should be 
considered?
    17. Finally, are there additional improvements the Bureau should 
consider making to the application, review, and invoicing processes? 
For example, during the Round 1 application process, applicants were 
required to submit documentation demonstrating that funding requests 
were for equipment and services eligible for Program support, and 
funding commitments were made based on the anticipated costs of the 
eligible services requested on their applications. After receiving 
Round 1 commitments, however, some health care providers seeking 
support for eligible services and equipment experienced supply chain 
disruptions and equipment shortages, while other health care providers 
determined that, due to shifting pandemic response strategies, they 
needed different services or equipment than those requested in their 
application. Anticipating these issues, the Commission gave health care 
providers flexibility to respond to changing circumstances by not 
requiring health care providers that received funding commitments to 
purchase only the services and connected devices identified in their 
applications. Accordingly, health care providers that received funding 
commitments may have been allowed to substitute vendors, eligible 
services, and/or eligible connected devices as long as the substituted 
items are eligible and the total amount sought for reimbursement does 
not exceed the commitment amount.
    18. Should the Bureau maintain this flexibility, but streamline the 
application process by requiring applicants demonstrate the eligibility 
of the connected devices and services purchased using Round 2 support 
only during the invoicing process? Are health care providers still 
experiencing supply chain delays or noticing shortages of certain 
connected devices? Have health care providers' pandemic response 
strategies solidified to the point where they will be able to 
accurately identify the telecommunication services, information 
services, or connected devices needed on their application for Round 2? 
If the Bureau does not require applicants to demonstrate the 
eligibility of the services and connected devices for which they seek 
funding on their applications during Round 2, what documentation or 
demonstration should the Bureau require the applicant to submit to 
demonstrate that they will use the funding requested for services and 
devices that are eligible for support? What safeguards should the 
Bureau consider implementing to ensure that this proposal does not lead 
to waste, fraud, or abuse of Program funding? Should additional 
certifications be required on applications and for each invoice to 
ensure applicants/awardees understand what is expected of them and the 
potential penalties for waste, fraud, or abuse? Relatedly, should a 
list of eligible and ineligible equipment and services to provide 
applicants with specific guidance on what may be requested for 
reimbursement be published?

Federal Communications Commission.

Cheryl L. Callahan,
Assistant Chief, Telecommunications Access Policy Division, Wireline 
Competition Bureau.
[FR Doc. 2021-02255 Filed 2-4-21; 8:45 am]
BILLING CODE 6712-01-P