By Eric Wicklund, mHealth Intelligence | August 2, 2019
The Federal Communications Commission is tweaking its Rural Health Care Program in a bid to improve funding opportunities for new and expanding telehealth programs.
The agency this week issued a Report and Order that aims to “ensure limited program funds are disbursed efficiently and equitably, promote transparency and predictability in the program’s administration, and strengthen safeguards against waste, fraud, and abuse.” The move follows a widely publicized decision last year to boost funding for the program, which funds expanded broadband connectivity for connected health services.
“The RHC Program has long supported vital telehealth services and helps rural communities overcome obstacles to accessing healthcare,” the FCC said in its order. “Today’s action takes a number of steps to reform the distribution of RHC funding, in particular by revising the rules governing the Telecom Program to simplify calculation of the urban rate – the amount health care providers pay – and the rural rate – the amount that service providers receive.”
Specifically, by FY 2021, the agency plans to:
- Target funding to rural areas in the most need of health care services and ensure that, when demand exceeds available funding, eligible rural health care providers continue to benefit from RHC Program funding by prioritizing support based on rurality and whether the area is medically underserved.
- Reform competitive bidding in the RHC Program to make it a more productive mechanism for health care providers to identify and select cost-effective service offerings available to them in rural areas; and
- Adopt a series of Program-wide rules and procedures to simplify the application process for program participants and provide more clarity regarding the RHC Program procedures.
In June 2018, the FCC voted to increase the funding cap on the RHC Program from $400 million – the amount set when the program was created in 1997 – to $571 million, a 43 percent increase, noting the increase in demand for funding from rural communities and programs.
“This was a necessary change, but not a sufficient one to guarantee the program’s long term health,” FCC Chairman Ajit Pai said in a statement accompanying this week’s decision. “We also need to do more to root out waste, fraud, and abuse in the program, for every dollar misspent is a dollar not devoted to telemedicine and the patients who need it. So today, we are taking steps to ensure that every dollar in the program is being spent efficiently.”
“These measures will promote transparency, accountability, and predictability in the Rural Health Care Program,” he added. “This Order will replace guesswork with certainty for rural health care providers. They will have greater insight into the amount of support available for requested services. They will receive funding decisions more quickly so that they can focus on delivering cutting-edge health care to their patients. And these reforms will also reduce waste by ending communications service providers’ ability to manipulate the calculation of rates for their own benefit.”
The FCC’s decision wasn’t entirely unanimous. Commissioners Jessica Rosenworcel and Geoffrey Starks, while both approving the plan, also offered dissenting comments. Both said the agency’s plan to create new methods for determining and prioritizing funding requests could end up doing more harm than good for rural healthcare providers.
“It puts in place a new funding scheme for the Telecommunications Program that has never been tested, modeled, or assessed for its impact on the rural health facilities that rely on the program today,” Rosenworcel said in a separate statement. “This creates a truckload of uncertainty for rural America.”
“This is complex, so it is hard to unpack the consequences,” she added. “But for starters, limiting support based on median rates could very easily cut off the most far-flung health facilities in remote locations that depend on these funds for operation. Plus, the map the FCC offered to explain its tiers for rural rates is not all illuminating. It offers no detail, is not searchable and it originally omitted one state entirely. On top of this, late last night, the agency added another tier to its mix of state urban and rural areas, making it even harder to understand the real consequences on the ground.”
“The order does not describe or analyze the expected impact of these changes for health care providers or for the telecommunications providers who provide service to them,” added Starks, who noted “the entire Alaska Congressional delegation and a separate group of 14 senators had asked the commission to delay the order to do more research. “I have similar concerns about portions of the order that create a new system of prioritizing support requests and that adopt new rules for healthcare consortia members.”
“This is essentially a data problem, where better information about the problem the Commission is trying to solve would lead to better decisions,” Starks concluded. “I believe that in this case, and in any instance where the Commission faces complex policy choices, it needs to make sure that it has the data necessary to fully understand the problem, the policy options, and the impacts they will have. Only then can it create effective, data driven policy solutions.”
While voting for the measure, Commissioner Michael O’Reilly also saw problems with the plan – including continued funding of urban projects in a program that was designed to focus on rural healthcare access. In his letter, O’Reilly said he expects more debate on the plan before it goes into effect.
“I think it is important to recognize that the application of this item is on a prospective basis, with the rate database not going into effect until Funding Year 2021,” he said. “Indeed, when the Commission recognizes that its rules are not meeting expectations, it makes all the sense in the world to modify a program on a going-forward basis.”