Promoting Telehealth for Low-Income Consumers, 37061-37068 [2021-14891]

Agencies

• FEDERAL COMMUNICATIONS COMMISSION

[Federal Register Volume 86, Number 132 (Wednesday, July 14, 2021)]
[Rules and Regulations]
[Pages 37061-37068]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-14891]


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FEDERAL COMMUNICATIONS COMMISSION

47 CFR Chapter 1

[WC Docket No. 18-213; FCC 21-74; FR ID 36878]


Promoting Telehealth for Low-Income Consumers

AGENCY: Federal Communications Commission.

ACTION: Final rule.

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SUMMARY: In this document, the Federal Communications Commission 
(Commission) offers further guidance on the administration of the 
Connected Care Pilot Program, including guidance on eligible services, 
competitive bidding, invoicing, and data reporting for selected 
participants, allowing selected Pilot Program participants to begin 
their Pilot projects.

DATES: Effective August 13, 2021.

FOR FURTHER INFORMATION CONTACT: Bryan Boyle, Wireline Competition 
Bureau, 202-418-7400 or by email at [email protected]. The Commission 
asks that requests for accommodations be made as soon as possible to 
allow the agency time to satisfy such requests whenever possible. Send 
an email to [email protected] or call the Consumer and Governmental 
Affairs Bureau at (202) 418-0530.

SUPPLEMENTARY INFORMATION: This is a summary of the Commission's Second 
Report and Order (R&O) in WC Docket No. 18-213; FCC 21-74, adopted on 
June 17, 2021 and released on June 21, 2021. Due to the COVID-19 
pandemic, the Commission's headquarters will be closed to the general 
public until further

[[Page 37062]]

notice. The full text of this document is available at the following 
internet address: https://docs.fcc.gov/public/attachments/FCC-21-74A1.pdf.

I. Introduction

    1. Through the R&O, the Commission continues its efforts to 
implement its Connected Care Pilot Program (Pilot Program) created 
pursuant to the Commission's authority under section 254(h)(2)(A) of 
the Communications Act. The Commission offers further guidance on the 
administration of the Pilot Program, including guidance on eligible 
services, competitive bidding, invoicing, and data reporting for 
selected participants.
    2. The Commission received more than 200 Pilot Program applications 
from many health care providers whose patients lack internet 
connections sufficient to transmit a video visit or receive health care 
through connected care and providers who indicate that their systems 
and bandwidth are inadequate to carry the new and significantly 
increased loads. Selected projects will directly benefit thousands of 
low-income patients and veterans facing a wide variety of health 
challenges, such as diabetes, hypertension, stroke recovery, opioid 
dependency, high-risk pregnancy, pediatric heart disease, mental health 
conditions, and cancer. Through these projects, the Commission will 
develop a better understanding of how the Universal Service Fund (USF 
or Fund) can help support the adoption of connected care services among 
patients and their health care providers.

II. Discussion

    3. The Commission now provides selected Pilot Program participants 
with additional information on the rules and requirements for 
participation so that they can begin their projects.
    4. Connected Care Pilot Project Selection Evaluation Criteria. In 
reviewing applications, the Commission sought to identify projects that 
would serve a high number of patients in the target populations, in 
areas most in need of USF support for connected care, treating many of 
the targeted conditions, and using products and services eligible for 
purchase with USF support. To do so, the Commission used the evaluation 
criteria set out in the Connected Care Report and Order, 85 FR 19892, 
April 9, 2020, and reviewed applications in accordance with these 
criteria. For instance, the Commission considered whether an 
application would serve low-income or veteran patients, as the 
Connected Care Report and Order established a strong preference for 
Pilot projects that can demonstrate that they will primarily benefit 
these patient groups. For purposes of the Pilot Program, a patient is 
considered low-income by determining whether (1) the patient is 
eligible for Medicaid or (2) the patient's household income is at or 
below 135% of the U.S. Department of Health and Human Services Federal 
Poverty Guidelines, and a patient is considered a veteran if they 
qualify for health care through the U.S. Department of Veterans 
Affairs' Veterans Health Administration.
    5. Pursuant to the Connected Care Report and Order, the Commission 
also considered whether an application is primarily focused on treating 
certain conditions, such as public health epidemics, opioid dependency, 
mental health conditions, high-risk pregnancy/maternal health, or 
chronic or recurring conditions that typically require at least several 
months to treat, including, but not limited to, diabetes, cancer, 
kidney disease, heart disease, and stroke recovery. Further, the 
Commission gave particular emphasis to health care providers that have 
either experience with providing telehealth or connected care services 
to patients, or a partnership with another health care provider, 
government agency, or designated telehealth resource center with such 
experience.
    6. In addition, the Commission stated a desire in the Connected 
Care Report and Order to select a diverse set of projects and target 
Pilot Program funds to geographic areas and populations most in need of 
USF support for connected care. Consistent with this directive, the 
Commission considered whether applications would serve rural or Tribal 
areas or patients residing in those areas, or would serve patients in 
Health Professional Shortage Areas or Medically Underserved Areas. The 
Commission also considered whether applications would promote the goals 
of the Pilot Program. Lastly, the Commission reviewed applications to 
determine whether they sought funding for eligible products and 
services, to ensure that the Pilot Program would use its limited 
funding efficiently.
    7. Connected Care Pilot Program Requirements. This section 
summarizes the requirements of the Connected Care Report and Order, and 
provides additional instructions and procedures about the 
administration, budget, and eligible services for the Connected Care 
Pilot Program. The Commission reminds all Pilot Program participants to 
review the Pilot Program's eligible services information prior to 
procuring services.
    8. Program Administration and Budget. As a general matter, the 
traditional funding year period (e.g., July 1 to June 30 of each year) 
for the Rural Health Care Program will not apply to the Pilot Program. 
Because of the nature of the Pilot Program, and given the funding 
request submission deadline and ramp-up period deadline, the Commission 
will not require selected Pilot Program participants to follow the 
traditional funding year process for the Rural Health Care Program. 
Pilot Program participants should therefore pay careful attention to 
any dates contained in official Pilot Program correspondence and on the 
Commission and the Universal Service Administrative Company (USAC or 
Administrator) web pages to ensure compliance with all applicable dates 
and deadlines.
    9. The Commission directs USAC to commit no more than the total 
amount associated with each project over a three-year period not to 
exceed the duration of the Pilot Program. This will ensure that total 
disbursements remain under the program budget. Further, to fund the 
Pilot Program, the Commission directs USAC to collect only the total 
amount associated with the actual commitments for each selected 
project. Because maximum expenditures based on each Pilot project 
budget were tracked before selection, selected participants will be 
able to request funding and receive funding commitments for multiple 
funding years. Allowing funding requests and commitments to cover 
multiple years will reduce administrative burdens on Pilot Program 
participants by reducing the number of Funding Request Forms (FCC Form 
462) they file and will allow them to know what their total funding 
commitment for the Pilot Program will be.
    10. Eligible Services. The Pilot Program will provide Pilot Program 
participants funding to cover up to 85% of the cost of eligible 
services, which fall under the following categories: (1) Patient 
broadband internet access services; (2) health care provider broadband 
data connections; (3) connected care information services; and (4) 
certain network equipment. The Commission provides two clarifications 
on services eligible for support in the Pilot Program. First, the 
Commission clarifies that the Pilot Program will reimburse network 
equipment purchases necessary to make broadband services functional, 
even if the Pilot Program is not directly supporting the costs of those 
broadband services. The Connected Care Report and Order states that the 
Pilot Program will fund ``network equipment that is necessary to make 
Pilot Program funded broadband

[[Page 37063]]

services for connected care services functional, or to operate, manage, 
or control such services.'' However, Pilot Program applicants have also 
indicated a need for network equipment to make a supported broadband 
service functional even if they do not require new or upgraded 
broadband from the Pilot Program as part of their Pilot project, and a 
need for network equipment to make the connected care services they are 
providing through their Pilot project functional. Accordingly, some 
Pilot projects do not require upgraded or new broadband service to 
participate in the Pilot Program but do require upgraded network 
equipment (e.g., switches) to make existing broadband services 
functional given the increased volume of network traffic associated 
with connected care services. To ensure these projects have the network 
equipment they need to provide broadband-enabled connected care 
services, the Pilot Program will provide funding to eligible, 
participating health care providers for necessary network equipment to 
make a broadband service functional for providing connected care 
services through the Pilot Program.
    11. Second, the Commission clarifies that the Pilot Program will 
reimburse network equipment purchases necessary to make a connected 
care information service functional (e.g., a server necessary for 
storing video conferences or facilitating video transmissions). 
Although the Connected Care Report and Order stated that equipment 
necessary to make a broadband service functional was supported, it did 
not specifically address eligibility of equipment necessary to make a 
connected care service functional. Many applicants requested funding 
for this type of network equipment and explained that this equipment 
was necessary, for example, to handle the increased volume of network 
traffic or storage needs associated with connected care services. 
Funding this additional network equipment for the limited purposes of 
the Pilot Program is consistent with the Commission's decision to fund 
connected care information services through the Pilot Program and is 
critical to the successful operation of the participating Pilot 
projects that requested such equipment. Further, funding this equipment 
for the limited purposes of the Pilot Program is within the scope of 
the Commission's statutory authority consistent with the legal 
rationale that the Commission relies on in the Healthcare Connect Fund 
to fund network equipment necessary to make a supported broadband 
service functional. To ensure these additional types of funded network 
equipment are within the scope of our statutory authority and Pilot 
Program purpose, where projects requested network equipment necessary 
to make a connected care service functional, the equipment must be 
purchased either because of the increase in internet traffic caused by 
the connected care services, or because the equipment would be 
primarily used for connected care information services. While the 
Commission's approach to fund network equipment necessary to make a 
broadband service functional even if the Pilot Program is not funding 
the broadband service and to fund network equipment necessary to make a 
connected care information service functional is more expansive than 
the Rural Health Care Program's (RHC) reimbursement for network 
equipment purchases, the Commission believes it is appropriate in this 
time-limited Pilot Program effort, focused on determining how USF funds 
can best support the trend towards connected care to be slightly more 
inclusive to ensure the success of selected Pilot Program participants.
    12. The Pilot Program will not fund devices, including end-user 
connected devices (e.g., tablets, smart phones, or remote patient 
monitoring equipment), medical equipment, health care provider 
administrative costs, personnel costs (including, but not limited to 
medical professional costs), or other miscellaneous expenses. The Pilot 
Program also will not fund network deployment, the construction of 
networks between health care providers, internal connections for health 
care providers, or connectivity services between health care provider 
sites. Pilot Program participants must cost allocate all ineligible 
services and/or equipment that are included in bundles, packages, or 
suites of services used in Pilot Program projects. Funding for Pilot 
Program participants is limited to three years. As a reminder, patient 
broadband internet access service funded through the Pilot Program is 
intended for patients who lack broadband or have an internet connection 
insufficient to receive connected care, and the funded patient 
broadband connection must be ``primarily'' used for activities that are 
integral, immediate, and proximate to the provision of connected care 
services to participating patients.
    13. During application review, the Wireline Competition Bureau 
(Bureau) reviewers identified clearly ineligible services and equipment 
when they were apparent on the application, but USAC reviewers will 
review FCC Form 462s in order to take further steps to ensure that no 
funding will be committed for ineligible services or equipment. Pilot 
Program participants that seek competitive bids and submit requests for 
funding should refer to the Bureau's previously published guidance on 
eligible services and equipment to ensure that they are only requesting 
funding for eligible items. Pilot Program participants should be aware 
that selection does not guarantee that all items in an application are 
eligible and will be funded upon request.
    14. Finally, the Commission reminds Pilot Program participants that 
they are prohibited from using Universal Service support to purchase or 
obtain any equipment or services produced or provided by a covered 
company posing a national security threat to the integrity of 
communications networks or the communications supply chain. In 
addition, Pilot Program participants are prohibited from using Federal 
subsidies to purchase, rent, lease, or otherwise obtain any covered 
communications equipment or service, or maintain any covered 
communications equipment or service previously purchased, rented, 
leased, or otherwise obtained. A list of covered equipment and services 
was posted on the Commission's website on March 12, 2021 and will be 
updated to reflect any future determinations.
    15. Connected Care Pilot Program Rules and Procedures. This section 
provides details for Pilot Program participants about the competitive 
bidding process, requesting funding, receiving funding commitments, 
making changes to their projects, and seeking reimbursement through 
submitting invoices. To ensure efficient and predictable 
administration, the Pilot Program will use rules and procedures for the 
RHC Healthcare Connect Fund Program to the extent feasible. For 
purposes of the Connected Care Pilot Program, the Commission directs 
USAC to develop new versions of FCC Form 461 (Request for Services 
Form), FCC Form 462 (Funding Request Form), and FCC Form 463 (Invoice 
and Request for Disbursement Form) and make them publicly available. 
These forms should be clearly marked to indicate their association with 
the Connected Care Pilot Program and avoid confusion with other 
versions. Pilot Program participants may now begin the competitive 
bidding process and, if a competitive bidding exemption applies, may 
file a Request for Funding.
    16. Funding Request Process Overview. Following selection by the 
Commission, Pilot Program participants can begin to follow the process 
outlined in this document. Generally, Pilot

[[Page 37064]]

projects are to operate using Pilot Program funds for no more than 
three years from the first date of service. Expenses for which Pilot 
Program funding is requested and invoiced must be incurred within three 
years from the first date of service for the respective project, and by 
no later than June 30, 2025.
     Conduct Competitive Bidding. The FCC Form 461 initiates 
the competitive bidding process for all products and services for which 
competitive bids are required. The Pilot Program participant will 
describe the required services and equipment for its project, develop 
scoring criteria to evaluate bids, and post the resulting request for 
services to USAC's website for at least 28 days. Following the 28-day 
posting, the Pilot Program participant must choose the most cost-
effective service provider and may then enter into a contract. This 
requirement does not apply to any products or services for which the 
Pilot Program participant is exempt from seeking competitive bids 
pursuant to a competitive bidding exemption, as outlined in this 
document:
     Request Funding. Pilot Program participants must request 
funding by submitting the FCC Form 462 to USAC. Note that for Pilot 
Program participants in Appendices A and B, the submission of the FCC 
Form 462 to USAC must occur no later than six months after the 
effective date of this Report and Order. Any future Pilot Program 
selections must submit their respective FCC Form 462 to USAC no later 
than six months after the announcement of their selection.
     Receive a Funding Commitment. USAC will review the FCC 
Form 462 and, if approved, issue funding commitment letters (FCLs) to 
the Pilot Program participants (and vendors, if necessary), indicating 
the amount committed under the Pilot Program for the FCC Form 462. The 
FCL contains other important information such as the service delivery 
deadline, and Pilot Program participants are reminded to read their 
FCLs closely.
     Begin the Pilot Project. Pilot Program participants must 
begin their Pilot projects no later than six months after receipt of 
their FCL from USAC.
     Make Project Modifications, if Needed. Pilot Program 
participants may request site or service substitutions or contract 
modifications pursuant to the procedures outlined in this Report and 
Order.
     Request Reimbursement. After equipment or services have 
been delivered, Pilot Program participants may seek reimbursement by 
submitting the FCC Form 463 to USAC. Pilot Program participants are 
encouraged to seek reimbursement on a monthly basis, if possible. Note 
that certain vendors, for instance, internet Service Providers enrolled 
with the RHC program, will submit the FCC Form 463 directly to USAC, 
upon request by the health care provider (or consortium).
    17. Competitive Bidding--FCC Form 461. In the Connected Care Report 
and Order, the Commission adopted, to the extent feasible, the 
competitive bidding requirements for the Healthcare Connect Fund 
Program for participants in the Pilot Program. Unless a competitive 
bidding exemption applies, Pilot Program participants must participate 
in a competitive bidding process, follow any additional applicable 
state, local or other procurement requirements, and select the most 
cost-effective option for services and equipment eligible for Connected 
Care Pilot Program support. The Commission provides further guidance on 
these requirements.
    18. To satisfy the competitive bidding requirements, Pilot Program 
participants must submit an FCC Form 461 for USAC to post. In some 
circumstances, Pilot Program participants will be required to prepare a 
formal Request for Proposal (RFP) to be posted along with their FCC 
Form 461. The FCC Form 461 should include a description of the services 
and equipment for which the Pilot Program participant is seeking 
support.
    19. The Pilot Program participant must wait at least 28 days from 
the date on which the Form 461 is posted on USAC's website before 
selecting a service provider. After seeking bids from potential service 
providers, Pilot Program participants should conduct a bid evaluation 
to select the most cost-effective means of meeting their needs, and 
thereafter participants may enter into a legally binding agreement with 
the selected service provider. Pilot Program participants may enter 
into a service agreement or sign a contract with the selected provider 
on or after the Allowable Contract Selection Date (ACSD), the day after 
the required number of days the FCC Form 461 is posted on the USAC 
website. If Pilot Program participants enter into a new contract or 
service agreement before the ACSD, funding will be denied for services 
covered under that contract or service agreement. Pilot Program 
participants will also be required to make certain certifications 
regarding the competitive bidding process before submitting the FCC 
Form 461. The FCC Form 461 will be made available to Pilot Program 
participants in USAC's online My Portal system with additional 
information provided to Pilot Program participants by USAC during 
outreach.
    20. ``Fair and Open'' Competitive Bidding Process. Pilot Program 
participants must conduct a fair and open competitive bidding process. 
To satisfy the ``fair and open'' standard, all potential bidders must 
have access to the same information and be treated in the same manner 
during the competitive bidding period to ensure that the process is 
``fair and open.'' Further, service providers who intend to bid on 
supported services may not simultaneously help the Pilot Program 
participant to complete its RFP or Request for Services form. Service 
providers who have submitted a bid to provide supported services, 
equipment, or facilities to a health care provider may not 
simultaneously help the health care provider evaluate submitted bids or 
choose a winning bid. Pilot Program participants must respond to all 
service providers that have submitted questions or proposals during the 
competitive bidding process. All Pilot Program participants and service 
providers must comply with any applicable state, Tribal, or local 
procurement laws, in addition to the Commission's competitive bidding 
requirements. The competitive bidding requirements in this section are 
not intended to preempt such state, Tribal, or local requirements. 
Additionally, the Commission's prohibitions against gifts from service 
providers apply to the Connected Care Pilot Program. Although service 
providers may make charitable contributions to Pilot Program 
participants, such gifts may not be directly or indirectly related to 
Connected Care Pilot Program procurement activities. Further, Pilot 
Program participants are reminded that services purchased pursuant to 
universal support mechanisms shall not be sold, resold, or transferred 
in consideration for money or any other thing of value.
    21. Competitive Bidding Exemptions. Pilot Program participants are 
not required to engage in competitive bidding if a competitive bidding 
exemption applies. All of the competitive bidding exemptions under the 
Healthcare Connect Fund Program, plus an additional exemption, apply to 
the Pilot Program as follows:
     Government Master Services Agreement. The eligible health 
care provider seeks support for services and equipment purchased from 
Master Services Agreements (MSAs) negotiated by federal, state, Tribal, 
or local government entities on behalf of such health care providers 
and others, if such MSAs were awarded pursuant to applicable federal, 
state, Tribal, or local competitive bidding requirements;

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     Pre-approved Master Services Agreement. The eligible 
health care provider opts into an existing MSA approved under the Rural 
Health Care Pilot Program or Healthcare Connect Fund Program and seeks 
support for services and equipment purchased from the MSA, if the MSA 
was developed and negotiated in response to an RFP that specifically 
solicited proposals that included a mechanism for adding additional 
sites to the MSA;
     Evergreen contract. The eligible health care provider has 
a multi-year contract designated as ``evergreen'' by USAC and seeks to 
exercise a voluntary option to extend an evergreen contract without 
undergoing additional competitive bidding;
     E-Rate contract. The eligible health care provider is in a 
consortium with participants in the schools and libraries universal 
service support program (E-Rate program) and a party to the 
consortium's existing contract, if the contract was approved in the E-
Rate program as a master contract;
     Annual undiscounted cost of $10,000 or less. The eligible 
health care provider seeks support for $10,000 or less of total 
undiscounted eligible expenses for a single year, if the term of the 
contract is one year or less; or
     Pre-existing contract (Connected Care Pilot Program only). 
The eligible health care provider already has entered into a legally 
binding agreement with a service provider for services or equipment 
eligible for support in the Pilot Program and that legally binding 
agreement itself was the product of competitive bidding. The Commission 
clarifies that this exemption applies only when the contract was signed 
before the applicant was selected to participate in the Pilot Program 
and the contract was not entered into solely for purposes of the Pilot 
Program. The prior competitive bidding process must have included 
public solicitation of bids or the applicant must have evaluated 
multiple quotes or bids before signing the contract.
    22. Requests for Funding--FCC Form 462. In the Connected Care Pilot 
Program Report and Order, the Commission indicated that additional 
information on filing a request for funding would be forthcoming. The 
Commission now lays out the process for requesting funding. Pilot 
Program participants must request funding from USAC by filing the FCC 
Form 462, a formal request for funding that provides specific 
information on pricing and services. Pilot Program participants in 
Appendices A and B must file their initial FCC Form 462(s) no later 
than six months after the effective date of this Report and Order, and 
any subsequent Pilot Program selections must file their initial FCC 
Form 462(s) within six months of the announcement of their selection. 
As discussed in this document, Pilot Program participants must wait at 
least 28 days from the date of posting the FCC Form 461 before signing 
a contract or service agreement with a service provider and filing the 
Form 462. The 28-day period does not apply to those Pilot Program 
participants that are exempt from seeking competitive bids for certain 
products or services. Pilot Program participants that are exempt from 
seeking competitive bids for some but not all, of the Pilot-supported 
products and services, are encouraged to seek competitive bids as 
necessary, and file one Form 462 seeking funding for all requested 
products and services, being sure to wait 28 days as necessary.
    23. Requests for Multi-Year Commitments. Pilot Program participants 
may seek bids for multi-year or single-year contracts during the 
competitive bidding process. If a project only seeks bids for a single-
year contract, it will need to conduct a new competitive bidding 
process for each year of the Pilot Program, unless an exemption 
applies. Pilot Program participants may then submit multi-year or 
single-year funding requests to USAC. Also, as noted in this document, 
the competitive bidding requirements for the Pilot Program are in 
addition to and do not supplant any applicable state or local 
procurement requirements.
    24. Funding Commitments. After USAC reviews the FCC Form 462 and 
makes funding determinations, USAC will issue an FCL for each FCC Form 
462 filed for the Pilot Program that details the amount of committed 
funding and contains other important information. The amount of funding 
specified in the FCL is the total amount for which a Pilot Program 
participant may request reimbursement. Pilot Program participants may 
begin to receive supported recurring services on the start date of 
their Pilot project. To ensure that projects start in a timely manner, 
Pilot Program participants may install equipment or pay for other 
supported non-recurring services before the start date, but may not 
invoice for this equipment and services until after the start date. 
Services must be delivered by the service delivery deadline applicable 
to the funding year of the last day of the funding commitment. To aid 
in administration of the Pilot Program, all funding commitments shall 
end three years from the first date of service for the respective Pilot 
project, and by no later than June 30, 2025. Participants that seek 
one-year funding commitments may access unused funds in future years of 
the Pilot Program's three year period. Pilot Program participants may 
request site and service substitutions as necessary pursuant to the 
process detailed in paragraph 26.
    25. Changes to Projects. Pilot Program participants are required to 
report to the Commission any material change in the participating 
health care providers' or Pilot projects' status (e.g., the health care 
provider site has closed, or the pilot project has ceased operations) 
within 30 days of such material change in status. In instances where a 
Pilot Program participant is unable to participate in the Pilot Program 
for their proposed project period, a successor may be designated by the 
Bureau. Further, to facilitate the tracking and monitoring of the Pilot 
Program budget and guard against potential waste, fraud and abuse, 
Pilot Program participants must notify USAC within 30 days of any 
decrease of 5% or more in the number of patients participating in their 
respective Pilot projects. Pilot Program participants can notify USAC 
of these changes via My Portal. The Commission directs USAC to advise 
the Bureau of project changes that could impact committed funding 
(e.g., changes to the cost of patient broadband or decrease in service 
quantities).
    26. Site and Service Substitutions. To provide flexibility to Pilot 
Program participants, the Pilot Program will permit site and service 
substitutions within a project, consistent with the site and service 
substitution rules in the Rural Health Care Program. Both individual 
and consortium projects may make service substitutions. USAC shall 
approve a site or service substitution for the Pilot Program if: (1) 
The substitution is provided for in the contract, within the change 
clause, or constitutes a minor modification; (2) the site is an 
eligible HCP and the service is an eligible service under the Pilot 
Program; (3) the substitution does not violate any contract provision 
or state or local procurement laws; and, (4) the requested change is 
within the scope of the controlling FCC Form 461, including any 
applicable Request for Proposal. A site or service substitution cannot 
increase the total funding commitment. Pilot Program participants may 
request site and service substitutions via My Portal.
    27. Contract Modifications. Contract modifications are permissible 
if they would be considered minor and therefore exempt from state, 
local, or tribal competitive bidding requirements. If the 
jurisdiction's laws are silent or

[[Page 37066]]

otherwise inapplicable on whether a modification would be permitted 
without rebidding, the Commission adheres to the ``cardinal change'' 
doctrine, which looks at whether the modified terms are essentially the 
same as in the original contract. To qualify for reimbursement, any 
items provided pursuant to a minor contract modification must also be 
eligible services under the rules of the Pilot Program.
    28. Seeking Reimbursement--FCC Form 463. The Commission provides 
additional details on invoicing requirements and processes. The Pilot 
Program will provide universal service support for 85% of the cost of 
eligible services and equipment. Consistent with the Commission's 
existing rules for the Healthcare Connect Fund Program, Pilot Program 
participants must contribute the other 15% of the cost of eligible 
services or equipment. Only funds from eligible sources, including the 
applicant or eligible health care provider participants, participating 
patients, or state, federal, or Tribal funding or grants, may be 
applied toward the health care provider's required contribution. Health 
care providers cannot use ineligible sources (e.g., direct payments 
from vendors or service providers) to pay their required share of 
requested services or equipment.
    29. After eligible equipment or services have been delivered, 
service providers, in conjunction with the participating health care 
providers, will be required to make certain certifications and submit 
invoicing forms, i.e., FCC Form 463 (Invoice and Request for 
Disbursement Form), with supporting documentation to USAC. USAC will 
review the invoicing forms and supporting documentation and issue 
disbursements to the applicable service providers or vendors. So that 
the Pilot Program can operate easily with existing invoicing systems, 
service providers will receive reimbursement directly, rather than 
through the health care provider, consistent with the standard practice 
in the Healthcare Connect Fund Program. Both broadband service 
providers and other vendors must have a valid Service Provider 
Identification Number from USAC, also known as a 498 ID, to receive 
payments.
    30. Finally, the Commission waives the procedural rule established 
in the Connected Care Report and Order that invoices be submitted 
monthly. While the Commission strongly encourages Pilot Program 
participants to submit invoices monthly when possible, requiring 
invoices to be submitted on a monthly basis may pose an undue 
administrative burden for some Pilot Program participants and would be 
difficult to enforce. Because the Commission is tracking the 
expenditures for each project to ensure that total disbursements remain 
under the $100 million cap, and because the Pilot Program has a number 
of reporting requirements to further monitor the progress of projects, 
requiring monthly invoicing is not necessary to ensure that total 
disbursements will be under the cap. The Commission therefore found 
good cause under Sec.  1.3 of the Commission's rules to not require 
invoices to be submitted on a monthly basis, but still encourages 
participants to submit their invoices promptly upon incurring an 
expense. All invoices must be submitted to USAC by the invoice deadline 
for the RHC Program, which is 120 days after the service delivery 
deadline, but no later than six months following the conclusion of each 
project.
    31. Wind Down Period and Project Conclusion. Pilot Program 
participants may begin receiving service and eligible network equipment 
upon receipt of an FCL from USAC and must begin receiving service no 
later than six months following receipt of the FCL. Projects are to 
last for three years from the first date of service, and no later than 
June 30, 2025. Following the conclusion of the three-year period, Pilot 
Program participants will have an additional six months to wind down 
their projects or transition to a funding source other than the Pilot 
Program. During this period, Pilot Program participants may submit any 
remaining invoices for expenses incurred during the three-year Pilot 
project period, submit final data reporting (discussed in paragraph 
32), and conclude any administrative tasks. Additional guidance may be 
provided by the Bureau regarding project conclusion.
    32. Additional Pilot Program Requirements--Data Reporting and 
Bureau Report on Pilot. The Commission established the Pilot Program to 
examine how the Fund can help support the trend towards connected care 
services, particularly for low-income Americans and veterans. In 
particular, the Commission expects that the Pilot Program will benefit 
many low-income and veteran patients who are responding to a wide 
variety of health challenges such as infectious diseases, diabetes, 
opioid dependency, high-risk pregnancies, pediatric heart disease, 
mental health conditions, and cancer. The Commission also expects that 
the Pilot Program will provide meaningful data that will help it better 
understand how USF funds can support health care provider and patient 
use of connected care services. To this end, the Commission established 
three specific goals for the Pilot Program: To determine how USF 
support can be used to (1) improve health outcomes through connected 
care; (2) reduce health care costs for patients, facilities and the 
health care system; and (3) support the trend towards connected care 
everywhere.
    33. To help evaluate the Pilot Program, the Commission directed the 
Bureau to issue a report detailing the results of the Pilot Program 
after it has been completed. To assist with this report, the Commission 
will require Pilot Program participants to submit anonymized, 
aggregated data to the Bureau regarding their Pilot project. Pilot 
Program participants are required to submit three total reports: An 
annual report after their first year of funding, after their second 
year of funding, and a final report after their third year of funding 
that contains data for the third year of funding, summarizes final 
results, and explains whether goals of the Pilot project were met and 
how the Pilot project served the Commissions' goals for the program. 
The Bureau will draw on the data from individual Pilot projects to 
prepare a final report upon the conclusion of the Pilot Program.
    34. The Commission directs the Bureau to develop a form template 
for Pilot Program participants to use in reporting data annually and at 
the Pilot project's conclusion. The Commission directs the Bureau to 
make the template available as close to the start of the Pilot projects 
as possible to ensure that each project can gather data while the 
project is underway and be in position to report to the Commission at 
the conclusion of each year of the Pilot project. The Commission 
further directs the Bureau to provide guidance on how Pilot Program 
participants can access the template, and how participants can submit 
the report to the Bureau, as well as establish deadlines as necessary. 
The Commission expects that Pilot Program participants will be asked to 
report data such as: The number of patients served and percentage of 
those who were low-income and veteran patients; changes from the 
estimated patient population; progress in meeting the project's goals 
and objectives; impact of funding on number of patients treated with 
connected care; patient satisfaction with connected care and with 
health status; changes in treatment adherence; reductions in emergency 
room or urgent care visits; decreases in hospital admissions, re-
admissions or lengths of stay; reductions or improvements in condition-
specific outcomes or acute incidents among those who suffer from

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a chronic illness; impact of funding patient broadband connections; 
decreases in missed appointments; estimated cost-savings for health 
care providers and patients; reduced patient travel or time (e.g., 
reduction in travel time or time missed from work); and other metrics 
that may demonstrate progress toward achieving the Pilot Program's 
goals, and general feedback on program administration. The Commission 
expects that the final report from Pilot Program participants will, at 
a minimum, include an overall summary of the information in the annual 
reports, an explanation of how the project helped advance the goals and 
objectives of the Pilot Program, an explanation of whether the Pilot 
project met its specific goals and objectives, information on any 
lessons learned concerning the provision and utilization of connected 
care services, and, particularly for low-income patients and veterans, 
lessons learned concerning patient retention, patient training, and how 
best to address digital literacy challenges. Pilot projects must 
collect data sufficient to provide substantive responses for the 
required reports. Failure to provide the data may result in either the 
elimination of the selected participant from the Pilot Program, loss or 
reduction of support, or recovery of prior distributions.
    35. USAC Outreach. All Pilot Program participants listed in the R&O 
have 14 calendar days from the effective date of the R&O to provide or 
update, as needed, contact information for the lead project coordinator 
to USAC, including the lead project coordinator's name, mailing 
address, email address, and telephone number. Any future selections 
will need to provide or update this information within 14 calendar days 
of the announcement of their selection. Within 30 days of the effective 
date of the R&O, USAC will conduct an initial coordination meeting with 
Pilot Program participants identified in Appendices A and B of the R&O. 
For any future selections, the Commission directs USAC to conduct an 
initial coordination meeting with additional selected Pilot Program 
participants within 30 days of their selection. USAC will also conduct 
a targeted outreach program, such as a webinar or similar outreach, to 
educate and inform selectees about the Pilot Program administrative 
process, including filing requirements and deadlines. In addition to 
the structured outreach, participants are encouraged to contact USAC 
support staff, who will be available to respond to individual questions 
about how to file forms or submit proper supporting documents. Pilot 
Program participants can also find information on USAC's website for 
the Connected Care Pilot Program. And as noted in this document, most 
program forms and other program documents can be found in My Portal.
    36. Document Retention, Audits, and Protection Against Waste, 
Fraud, ad Abuse. As in the Healthcare Connect Fund, health care 
providers and selected participants, in addition to maintaining records 
related to their Pilot projects to demonstrate their compliance with 
the Pilot Program rules and requirements, must also keep supporting 
documentation for the required reports for at least five years after 
the conclusion of their Pilot project and must present that information 
to the Commission or USAC upon request. Pilot projects will also be 
subject to random compliance audits to ensure compliance with the Pilot 
Program rules and requirements.
    37. One indicator of the Pilot Program's success will be the 
avoidance of waste, fraud, and abuse and the careful stewardship of USF 
resources. Pilot Program participants must carefully adhere to program 
rules, file timely and accurate reports, and promptly consult with USAC 
when questions regarding Pilot Program rules or processes arise. The 
Commission retains the discretion to evaluate the uses of monies 
disbursed through the USF programs and to determine on a case-by-case 
basis that waste, fraud, or abuse of program funds occurred, and that 
recovery is warranted. Additionally, in the event the Commission 
discovers any improper activity resulting from the Pilot Program, it 
will subject the offending party to all available penalties at our 
disposal, and will direct USAC to recover funds, assess retroactive 
fees and/or interest, or both. The Commission remains committed to 
ensuring the integrity of the USF programs and will continue to 
aggressively pursue instances of waste, fraud, or abuse under our own 
procedures and in cooperation with law enforcement agencies.
    38. Further, consistent with the Commission's existing rules for 
the Healthcare Connect Fund Program, Pilot Program participants must 
contribute their 15% share of the eligible costs from eligible sources 
(e.g., the applicant, patient charges, an eligible health care 
provider, or state, federal, or Tribal funding or grants) and cannot 
apply funds from ineligible sources (including other FCC programs, such 
as the Universal Service Fund and the COVID-19 Telehealth Program, or 
direct payments from vendors or service providers). Pilot Program 
participants are also reminded that on their program application, they 
certified that no funds from any source--private, state, or federal--
have been received or are expected to be received for the exact same 
services or equipment that are claimed as eligible for support under 
the Pilot Program. All Pilot Program participants are strongly 
encouraged to review their active certification commitments, including 
those related to HIPAA compliance, document retention, and proper use 
of funds.
    39. Finally, the Commission reminds Pilot Program participants that 
Pilot projects are prohibited from receiving duplicative funding from 
the Pilot Program and the COVID-19 Telehealth Program, or any other 
source, for those exact same items. If a Pilot Program participant is 
also selected for participation in the COVID-19 Telehealth Program, it 
must ensure that it does not request disbursements for the same 
services or equipment from both programs. If any Pilot Program 
participant is also selected to participate in the COVID-19 Telehealth 
Program, the participant shall notify the Administrator immediately, 
and the Commission directs the Administrator to compare that 
participant's Pilot Program funding request(s) against its COVID-19 
Telehealth Program application to ensure that participants do not 
receive duplicative funding.
    40. Payment Administration. FCC Red Light Rule. To implement the 
requirements of the Debt Collection Improvement Act of 1996, the 
Commission established what is commonly referred to as the ``red light 
rule.'' Under the red light rule, the Commission will not take action 
on applications or other requests by an entity that is found to owe 
debts to the Commission until full payment or resolution of that debt. 
If the delinquent debt remains unpaid or other arrangements have not 
been made within 30 days of being notified of the debt, the Commission 
will dismiss any pending applications. If a Pilot Program participant 
or service provider is currently on red light status, it will need to 
satisfy or make arrangements to satisfy any debts that it owes to the 
Commission before its application can be processed.
    41. System for Award Management Registration. All Pilot Program 
participants and service providers must also register with the System 
for Award Management (SAM). SAM is a web-based, government-wide 
application that collects, validates, stores, and disseminates business 
information

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about the federal government's partners in support of federal awards, 
grants, and electronic payment processes. Registration in SAM provides 
the Commission with an authoritative source of information necessary to 
provide funding to Pilot Program participants and to ensure accurate 
reporting pursuant to the Federal Funding Accountability and 
Transparency Act of 2006 (FFATA), as amended by the Digital 
Accountability and Transparency Act of 2014 (DATA Act). Only those 
applicants and service providers that are actively registered in SAM 
will be able to receive reimbursement from the Pilot Program. Pilot 
Program participants and service providers that are already registered 
with SAM do not need to re-register with that system in order to 
receive payment from the Pilot Program. Pilot Program participants who 
are not already registered with SAM may still participate in the Pilot 
Program, apply for funding, and receive program commitments, but Pilot 
Program participants and service providers must be registered in SAM 
before any payments can be issued for the Pilot Program. To assist 
participants who are not registered with SAM, the Commission directs 
USAC to provide information and guidance to participants regarding the 
SAM registration process. To the extent that Pilot Program participants 
subaward the payments they receive from the Pilot Program, as defined 
by FFATA/DATA Act regulations, Pilot Program participants may be 
required to submit data on those subawards.
    42. Do Not Pay. Pursuant to the requirements of the Payment 
Integrity Information Act of 2019, the Commission is required to ensure 
that a thorough review of available databases with relevant information 
on eligibility occurs to determine program or award eligibility and 
prevent improper payments before the release of any federal funds. To 
meet this requirement, the Commission and USAC will make full use of 
the Do Not Pay system administered by the U.S. Treasury's Bureau of the 
Fiscal Service. If a check of the Do Not Pay system results in a 
finding that a Pilot Program participant or service provider should not 
be paid, the Commission will withhold issuing commitments and payments. 
The Pilot Program participant or service provider is responsible for 
working with the relevant agency to correct its information in the Do 
Not Pay system before payment can be issued.
    43. Appeals of USAC Decisions. Affected parties may seek review of 
a USAC decision pursuant to the rules and procedures outlined in 
Sec. Sec.  54.719 to 54.725 of the Commission's rules. Specifically, an 
affected party may seek review of a decision by USAC by filing a 
request for review with USAC within 60 days of the date of the 
decision. An affected party may seek Commission review of a USAC 
decision, only after first seeking review of the decision with USAC, 
and may file a request for review with the Commission within 60 days 
after USAC's decision on appeal. An affected party may only request a 
waiver of the Commission's rules, or a waiver of a decision by USAC, by 
filing such request with the Commission, within 60 days of USAC's 
decision. All other requirements for appeals and requests for waiver, 
including the form the filings must take, can be found in Sec. Sec.  
54.719 to 54.725 of the Commission's rules.
    44. Delegations of Authority. In order to ease program 
administration, the Commission delegates to the Bureau, consistent with 
the goals of the Pilot Program, the authority to waive certain program 
deadlines, clarify any inconsistencies or ambiguities in the Pilot 
Program rules, adjust Pilot project funding commitments, or to perform 
other administrative tasks as may be necessary for the smooth operation 
of the Pilot Program. The Commission also delegates to the Bureau the 
authority to grant limited extensions of deadlines to Pilot projects, 
and other authority as may be necessary to ensure a successful Pilot 
Program.
    45. The Commission delegates financial oversight of this program to 
the Commission's Managing Director and direct the Office of the 
Managing Director (OMD) to work in coordination with the Bureau to 
ensure that all financial aspects of the program have adequate internal 
controls. These duties fall within OMD's current delegated authority to 
ensure that the Commission operates in accordance with federal 
financial statutes and guidance. OMD performs this role with respect to 
USAC's administration of the Commission's Universal Service programs 
and the Commission anticipates that OMD will leverage existing policies 
and procedures, to the extent practicable and consistent with the 
Connected Care Pilot Program, to ensure the efficient and effective 
management of the program. Finally, the Commission notes that OMD is 
required to consult with the Bureau on any policy matters affecting the 
program, consistent with Sec.  0.91(a) of the Commission's rules.

III. Procedural Matters

A. Paperwork Reduction Act Analysis

    46. This document contains new information collection requirements. 
The Commission, as part of its continuing effort to reduce paperwork 
burdens, will invite the general public and the Office of Management 
and Budget (OMB) to comment on the information collection requirements 
contained in this document, as required by the Paperwork Reduction Act 
of 1995 (PRA), Public Law 104-13. In addition, pursuant to the Small 
Business Paperwork Relief Act of 2002, Public Law 107-198, see 44 
U.S.C. 3506(c)(4), the Commission seeks specific comment on how it 
might further reduce the information collection burden for small 
business concerns with fewer than 25 employees.

B. Congressional Review Act

    47. The Commission will not send a copy of the R&O to Congress and 
the Government Accountability Office pursuant to the Congressional 
Review Act, see 5 U.S.C. 801(a)(1)(A) because no rules are being 
adopted in the R&O.

IV. Ordering Clauses

    48. Accordingly, it is ordered that, pursuant to the authority 
contained in sections 201, 254, and 303(r) of the Communications Act of 
1934, as amended, 47 U.S.C. 201, 254, and 303(r) the R&O is adopted and 
shall become effective August 13, 2021, pursuant to 47 U.S.C. 408.
    49. It is further ordered that, pursuant to the authority contained 
in sections 201, 254, and 303(r) of the Communications Act of 1934, as 
amended, 47 U.S.C. 201, 254, and 303(r), and Sec.  1.3 of the 
Commission's rules, 47 CFR 1.3, the monthly invoice submission 
requirement is waived, to the extent discussed herein.

Federal Communications Commission.
Marlene Dortch,
Secretary.
[FR Doc. 2021-14891 Filed 7-13-21; 8:45 am]
BILLING CODE 6712-01-P