59–006 

114TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 114–582 

RURAL HEALTH CARE CONNECTIVITY ACT OF 2016 

MAY 23, 2016.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 4111] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 4111) to include skilled nursing facilities as a type 

of health care provider under section 254(h) of the Communications 

Act of 1934, having considered the same, report favorably thereon 

with an amendment and recommend that the bill as amended do 

pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 4 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 7 

Duplication of Federal Programs ............................................................................ 7 

Disclosure of Directed Rule Makings ..................................................................... 7 

Advisory Committee Statement .............................................................................. 7 

Applicability to Legislative Branch ........................................................................ 7 

Section-by-Section Analysis of the Legislation ...................................................... 7 

Changes in Existing Law Made by the Bill, as Reported ..................................... 7 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


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SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Rural Health Care Connectivity Act of 2016’’. 

SEC. 2. TELECOMMUNICATIONS SERVICES FOR SKILLED NURSING FACILITIES. 

(a) IN GENERAL.—Section 254(h)(7)(B) of the Communications Act of 1934 (47 

U.S.C. 254(h)(7)(B)) is amended— 

(1) in clause (vi), by striking ‘‘and’’ at the end; 

(2) by redesignating clause (vii) as clause (viii); 

(3) by inserting after clause (vi) the following: 

‘‘(vii) skilled nursing facilities (as defined in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a))); and’’; and 

(4) in clause (viii), as redesignated, by striking ‘‘clauses (i) through (vi)’’ and 

inserting ‘‘clauses (i) through (vii)’’. 

(b) SAVINGS CLAUSE.—Nothing in subsection (a) shall be construed to affect the 

aggregate annual cap on Federal universal service support for health care providers 

under section 54.675 of title 47, Code of Federal Regulations, or any successor regulation. 

(c) EFFECTIVE DATE.—The amendments made by subsection (a) shall apply beginning on the date that is 180 days after the date of the enactment of this Act. 

PURPOSE AND SUMMARY

H.R. 4111, Rural Health Care Connectivity Act of 2016, expands 

the definition of a ‘‘health care provider’’ under the Healthcare 

Connect Fund, a program within the Universal Service Fund. The 

term ‘‘health care provider’’ would be expanded to include skilled 

nursing facilities (SNFs), allowing those facilities to be eligible for 

support under the Healthcare Connect Fund. The purpose of the 

legislation is to increase broadband connectivity for health care 

providers in rural areas to improve care and advance innovative 

health technologies. In addition, the legislation provides the Federal Communications Commission (FCC) and the Universal Service 

Administrative Company (USAC) six months to implement the necessary changes to the program. 

BACKGROUND AND NEED FOR LEGISLATION

The principle that all Americans should have access to communications services is implemented through the Universal Service 

Fund. As a way to facilitate that goal, the Telecommunications Act 

of 1996 instructed the FCC to expand the traditional purpose of the 

Universal Service Fund to include increased access to advanced 

services. To fulfill the statute, four programs were established: the 

high-cost support program (now called the Connect America Fund), 

the schools and libraries program (E-Rate), the low-income program (now called Lifeline), and the Rural Health Care program. 

These programs are funded by contributions from telecommunications providers based on a formula based on the needs of the 

Fund and anticipated interstate telecommunications revenue. 

The four programs, and the various support mechanisms within 

each program, serve a range of purposes to implement the Act’s directive, varying from increasing broadband connectivity in schools 

and libraries to providing voice and Internet services to low-income 

consumers. In particular, the Rural Health Care Program (RHCP) 

provides subsidies to public and non-profit rural health care providers to reduce the cost of communications services. Under the 

Act, eligibility for RHCP funding is limited to public or non-profit 

entities. 

The 2010 National Broadband Plan (NBP) observed that there is 

a health IT broadband connectivity gap that exists, particularly in 


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rural areas, notwithstanding the RHCP. Among other things, the 

NBP recommended various reforms to the RHCP, including that 

the FCC re-examine the interpretation of ‘‘health-care provider’’ in 

light of trends in the provision of healthcare. 

In 2012, the FCC created the Healthcare Connect Fund to reform, expand, and modernize the RHCP. Although the FCC acknowledged that SNFs provide some of the ‘‘same post-acute services that are traditionally provided at hospitals,’’ it could not conclude how a SNF might qualify as a health care provider under the 

Act. Notwithstanding this conclusion, the FCC established a pilot 

program to test how it could support broadband connectivity to 

non-profit skilled nursing facilities. In 2014, the FCC announced it 

was deferring the SNF pilot program. 

H.R. 4111 expands the statutory definition of ‘‘health care provider’’ under section 254 of the Communications Act of 1934, as 

amended to include Skilled Nursing Facilities. SNFs provide a 

range of traditional health care services, such as home health, assisted living, skilled nursing care, post-acute care, and hospice 

care. Additionally, technology is being developed to connect patients in rural SNFs to doctors and specialists located in distant 

areas. The legislation will allow such facilities to request support 

from the fund to bring broadband connectivity to SNFs in rural 

communities where it might otherwise not be available to power 

the advanced technologies that can enhance patient care in rural 

areas. 

HEARINGS

On April 13, 2016, the Subcommittee on Communications and 

Technology held a hearing on H.R. 4111, and received testimony 

from Dan Holdhusen, Director of Government Relations, Good Samaritan Society, on the bill. 

COMMITTEE CONSIDERATION

On April 18 and 19, 2016, the Subcommittee on Communications 

and Technology met in open markup session and forwarded H.R. 

4111 to the full Committee, without amendment, by a voice vote. 

On April 26, 27, and 28, 2016, the full Committee on Energy and 

Commerce met in open markup session to consider H.R. 4111. Congressmen Lance and Loebsack offered a bipartisan amendment to 

the bill, which was passed by voice vote. Chairman Upton ordered 

H.R. 4111 reported to the House, as amended, by a voice vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no recorded votes taken in connection with ordering H.R. 4111 reported. 

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee held a hearing and made findings that are reflected in this report. 


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STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The goal and objective of H.R. 4111 is to increase broadband 

connectivity for skilled nursing facilities located in rural communities. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 4111 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI of the 

Rules of the House of Representatives, the Committee finds that 

H.R. 4111 contains no earmarks, limited tax benefits, or limited 

tariff benefits. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate provided by 

the Congressional Budget Office pursuant to section 402 of the 

Congressional Budget Act of 1974: 

MAY 17, 2016. 

Hon. FRED UPTON, 

Chairman, Committee on Energy and Commerce, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 4111, the Rural Health 

Care Connectivity Act of 2015. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Kathleen Gramp. 

Sincerely, 

KEITH HALL. 

Enclosure. 

H.R. 4111—Rural Health Care Connectivity Act of 2015 

Summary: H.R. 4111 would make certain skilled nursing facilities (SNFs) eligible for grants under the Universal Service Fund’s 

Rural Health Care (RHC) program. The Universal Service program 

is administered by the Federal Communications Commission (FCC) 

and is intended to promote the availability of telecommunications 

services at affordable rates. The cash flows of the fund appear in 

the budget as direct spending (for amounts distributed from the 

fund) and as revenues (for fund collections). 

CBO estimates that enacting H.R. 4111 would increase direct 

spending by $193 million and revenues by $212 million over the 


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2017–2026 period, resulting in an estimated net reduction in the 

deficit of $19 million. CBO estimates that implementing the bill 

would have no significant discretionary costs. Pay-as-you-go procedures apply because enacting the legislation would affect direct 

spending and revenues. 

CBO estimates that enacting the legislation would not increase 

net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027. 

H.R. 4111 contains no intergovernmental mandates as defined in 

the Unfunded Mandates Reform Act (UMRA). 

Because CBO expects the FCC would increase fee collections associated with the Universal Service Fund, the bill would increase 

the cost of an existing mandate on private entities required to pay 

those fees. Based on information from the FCC, CBO estimates 

that the incremental cost of the mandate would amount to no more 

than $25 million in any of the next five years. Thus, the aggregate 

cost of the mandate would fall below the annual threshold established in UMRA for private-sector mandates ($154 million in 2016, 

adjusted annually for inflation). 

Estimated cost to the Federal Government: The estimated budgetary effect of H.R. 4111 is shown in the following table. The costs 

of this legislation fall within budget function 370 (commerce and 

housing credit). 

By fiscal year, in millions of dollars— 

2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2017- 

2021 

2017- 

2026 

INCREASE IN DIRECT SPENDING 

Estimated Budget Authority 2 10 15 20 25 25 25 30 30 30 72 212 

Estimated Outlays ............... 1 6 11 17 22 24 25 28 29 30 57 193 

INCREASE IN REVENUES 

Estimated Revenues ............ 2 10 15 20 25 25 25 30 30 30 72 212 

NET DECREASE IN THE DEFICIT 

Impact on Deficit ................ ¥1 ¥4 ¥4 ¥3 ¥3 ¥1 0 ¥2 ¥1 0 ¥15 ¥19 

Basis of estimate: Current law authorizes the FCC to collect and 

spend up to $400 million a year for RHC programs, which provide 

reduced rates for telecommunications services for certain rural public and nonprofit health care providers. Expanding the eligibility 

criteria to include SNFs would increase both direct spending and 

revenues because the RHC programs currently operate below the 

statutory cap on total spending. 

CBO estimates that enacting the program would increase direct 

spending and revenues by $193 million and $212 million, respectively, over the 2017–2026 period. CBO also estimates that an average of 1,650 public and nonprofit SNFs in rural areas would be 

eligible for grants during that period and that participation rates 

and grant awards would be similar to those for existing RHC programs. Based on information from the FCC, CBO estimates that 

participation rates would reach 75 percent over a period of several 

years and that certain nonrural entities affiliated with those participants also would receive funding. Grant awards would vary in 

size depending on the recipient’s location and choice of benefits. In 

2015, most RHC grantees received an average of about $14,000 for 

telecommunications services. CBO estimates that grants would avVerDate Sep 11 2014 05:27 Jun 01, 2016 Jkt 059006 PO 00000 Frm 00005 Fmt 6659 Sfmt 6602 E:\HR\OC\HR582.XXX HR582

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erage about $18,000 a year over the next 10 years, reflecting the 

historical growth in payments for other RHC programs. 

Finally, based on information from the FCC, CBO estimates that 

the administrative activities needed to implement the new program 

would significantly increase the agency’s operating costs. Moreover, 

under current law, the FCC is authorized to collect fees sufficient 

to offset the cost of its regulatory activities each year. 

Pay-As-You-Go considerations: The Statutory Pay-As-You-Go Act 

of 2010 establishes budget-reporting and enforcement procedures 

for legislation affecting direct spending or revenues. The net 

changes in outlays and revenues that are subject to those pay-asyou-go procedures are shown in the following table. 

CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 4111, AS ORDERED REPORTED BY THE 

HOUSE COMMITTEE ON ENERGY AND COMMERCE ON APRIL 28, 2015 

By Fiscal Year, in Millions of Dollars— 

2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2016- 

2021 

2016- 

2026 

DECREASE IN THE DEFICIT 

Statutory Pay-AsYou-Go Impact ... 0 ¥1 ¥4 ¥4 ¥3 ¥3 ¥1 0 ¥2 ¥1 0 ¥15 ¥19 

Memorandum: 

Changes in 

Outlays ...... 0 1 6 11 17 22 24 25 28 29 30 57 193 

Changes in 

Revenues ... 0 2 10 15 20 25 25 25 30 30 30 72 212 

Increase in long-term direct spending and deficits: CBO estimates that enacting the legislation would not increase net direct 

spending or on-budget deficits in any of the four consecutive 10- 

year periods beginning in 2027. 

Estimated impact on state, local, and tribal governments: H.R. 

4111 contains no intergovernmental mandates as defined in 

UMRA. 

Estimated impact on the private-sector: CBO expects the FCC to 

increase fee collections to offset the costs associated with expanding 

the RHC program to cover skilled nursing facilities. As a result, the 

bill would increase the cost of an existing mandate on some telecommunications companies required to pay those fees. Based on information from the FCC, CBO estimates that the additional fees 

collected would amount to about $2 million in 2017, increasing to 

about $25 million in 2021. Therefore, the incremental cost of the 

mandate would fall below the annual threshold established in 

UMRA for private-sector mandates ($154 million in 2016, adjusted 

annually for inflation). CBO expects that telecommunications companies would generally pass most of the cost of the fee increase on 

to consumers. 

Previous estimate: On March 24, 2016, CBO transmitted a cost 

estimate for S. 1916, the Rural Health Care Connectivity Act of 

2015, as ordered reported by the Senate Committee on Commerce, 

Science, and Transportation on November 18, 2015. The differences 

between the estimates reflect the effect of a provision in H.R. 4111 

that would delay the implementation of the program by six months. 

Estimate prepared by: Federal costs: Kathleen Gramp; Impact on 

state, local, and tribal governments: Rachel Austin; Impact on the 

private sector: Logan Smith. 


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Estimate approved by: H. Samuel Papenfuss, Deputy Assistant 

Director for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office 

pursuant to section 423 of the Unfunded Mandates Reform Act. 

DUPLICATION OF FEDERAL PROGRAMS

No provision of H.R. 4111 establishes or reauthorizes a program 

of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the 

Government Accountability Office to Congress pursuant to section 

21 of Public Law 111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULE MAKINGS

The Committee estimates that enacting H.R. 4111 specifically directs to be completed 0 rule makings within the meaning of 5 

U.S.C. 551. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

This section provides the short title as the ‘‘Rural Health Care 

Connectivity Act of 2016’’. 

Section 2. Telecommunications services for skilled nursing facilities 

This section adds ‘‘skilled nursing facilities’’ to the definition of 

a Health Provider in Section 254 of the Communications Act related to Universal Service. The bill defines skilled nursing facility 

by cross-reference to the definition used in the Social Security Act. 

The section requires the changes identified in the bill be made six 

months after the legislation is enacted. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

and existing law in which no change is proposed is shown in 

roman): 


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COMMUNICATIONS ACT OF 1934 

* * * * * * * 

TITLE II—COMMON CARRIERS 

* * * * * * * 

PART II—DEVELOPMENT OF COMPETITIVE 

MARKETS 

* * * * * * * 

SEC. 254. UNIVERSAL SERVICE. 

(a) PROCEDURES TO REVIEW UNIVERSAL SERVICE REQUIRE- MENTS.— 

(1) FEDERAL-STATE JOINT BOARD ON UNIVERSAL SERVICE.— Within one month after the date of enactment of the Telecommunications Act of 1996, the Commission shall institute 

and refer to a Federal-State Joint Board under section 410(c) 

a proceeding to recommend changes to any of its regulations in 

order to implement sections 214(e) and this section, including 

the definition of the services that are supported by Federal 

universal service support mechanisms and a specific timetable 

for completion of such recommendations. In addition to the 

members of the Joint Board required under section 410(c), one 

member of such Joint Board shall be a State-appointed utility 

consumer advocate nominated by a national organization of 

State utility consumer advocates. The Joint Board shall, after 

notice and opportunity for public comment, make its recommendations to the Commission 9 months after the date of 

enactment of the Telecommunications Act of 1996. 

(2) COMMISSION ACTION.—The Commission shall initiate a 

single proceeding to implement the recommendations from the 

Joint Board required by paragraph (1) and shall complete such 

proceeding within 15 months after the date of enactment of the 

Telecommunications Act of 1996. The rules established by such 

proceeding shall include a definition of the services that are 

supported by Federal universal service support mechanisms 

and a specific timetable for implementation. Thereafter, the 

Commission shall complete any proceeding to implement subsequent recommendations from any Joint Board on universal 

service within one year after receiving such recommendations. 

(b) UNIVERSAL SERVICE PRINCIPLES.—The Joint Board and the 

Commission shall base policies for the preservation and advancement of universal service on the following principles: 

(1) QUALITY AND RATES.—Quality services should be available at just, reasonable, and affordable rates. 

(2) ACCESS TO ADVANCED SERVICES.—Access to advanced telecommunications and information services should be provided in 

all regions of the Nation. 

(3) ACCESS IN RURAL AND HIGH COST AREAS.—Consumers in 

all regions of the Nation, including low-income consumers and 

those in rural, insular, and high cost areas, should have access 

to telecommunications and information services, including 


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interexchange services and advanced telecommunications and 

information services, that are reasonably comparable to those 

services provided in urban areas and that are available at 

rates that are reasonably comparable to rates charged for similar services in urban areas. 

(4) EQUITABLE AND NONDISCRIMINATORY CONTRIBUTIONS.—All 

providers of telecommunications services should make an equitable and nondiscriminatory contribution to the preservation 

and advancement of universal service. 

(5) SPECIFIC AND PREDICTABLE SUPPORT MECHANISMS.—There 

should be specific, predictable and sufficient Federal and State 

mechanisms to preserve and advance universal service. 

(6) ACCESS TO ADVANCED TELECOMMUNICATIONS SERVICES

FOR SCHOOLS, HEALTH CARE, AND LIBRARIES.—Elementary and 

secondary schools and classrooms, health care providers, and 

libraries should have access to advanced telecommunications 

services as described in subsection (h). 

(7) ADDITIONAL PRINCIPLES.—Such other principles as the 

Joint Board and the Commission determine are necessary and 

appropriate for the protection of the public interest, convenience, and necessity and are consistent with this Act. 

(c) DEFINITION.— (1) IN GENERAL.—Universal service is an evolving level of 

telecommunications services that the Commission shall establish periodically under this section, taking into account advances in telecommunications and information technologies 

and services. The Joint Board in recommending, and the Commission in establishing, the definition of the services that are 

supported by Federal universal service support mechanisms 

shall consider the extent to which such telecommunications 

services— 

(A) are essential to education, public health, or public 

safety; 

(B) have, through the operation of market choices by 

customers, been subscribed to by a substantial majority of 

residential customers; 

(C) are being deployed in public telecommunications networks by telecommunications carriers; and 

(D) are consistent with the public interest, convenience, 

and necessity. 

(2) ALTERATIONS AND MODIFICATIONS.—The Joint Board may, 

from time to time, recommend to the Commission modifications 

in the definition of the services that are supported by Federal 

universal service support mechanisms. 

(3) SPECIAL SERVICES.—In addition to the services included 

in the definition of universal service under paragraph (1), the 

Commission may designate additional services for such support 

mechanisms for schools, libraries, and health care providers for 

the purposes of subsection (h). 

(d) TELECOMMUNICATIONS CARRIER CONTRIBUTION.—Every telecommunications carrier that provides interstate telecommunications services shall contribute, on an equitable and nondiscriminatory basis, to the specific, predictable, and sufficient mechanisms established by the Commission to preserve and advance universal service. The Commission may exempt a carrier or class of 


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carriers from this requirement if the carrier’s telecommunications 

activities are limited to such an extent that the level of such carrier’s contribution to the preservation and advancement of universal service would be de minimis. Any other provider of interstate telecommunications may be required to contribute to the 

preservation and advancement of universal service if the public interest so requires. 

(e) UNIVERSAL SERVICE SUPPORT.—After the date on which Commission regulations implementing this section take effect, only an 

eligible telecommunications carrier designated under section 214(e) 

shall be eligible to receive specific Federal universal service support. A carrier that receives such support shall use that support 

only for the provision, maintenance, and upgrading of facilities and 

services for which the support is intended. Any such support 

should be explicit and sufficient to achieve the purposes of this section. 

(f) STATE AUTHORITY.—A State may adopt regulations not inconsistent with the Commission’s rules to preserve and advance universal service. Every telecommunications carrier that provides 

intrastate telecommunications services shall contribute, on an equitable and nondiscriminatory basis, in a manner determined by the 

State to the preservation and advancement of universal service in 

that State. A State may adopt regulations to provide for additional 

definitions and standards to preserve and advance universal service within that State only to the extent that such regulations adopt 

additional specific, predictable, and sufficient mechanisms to support such definitions or standards that do not rely on or burden 

Federal universal service support mechanisms. 

(g) INTEREXCHANGE AND INTERSTATE SERVICES.—Within 6 

months after the date of enactment of the Telecommunications Act 

of 1996, the Commission shall adopt rules to require that the rates 

charged by providers of interexchange telecommunications services 

to subscribers in rural and high cost areas shall be no higher than 

the rates charged by each such provider to its subscribers in urban 

areas. Such rules shall also require that a provider of interstate 

interexchange telecommunications services shall provide such services to its subscribers in each State at rates no higher than the 

rates charged to its subscribers in any other State. 

(h) TELECOMMUNICATIONS SERVICES FOR CERTAIN PROVIDERS.— (1) IN GENERAL.— 

(A) HEALTH CARE PROVIDERS FOR RURAL AREAS.—A telecommunications carrier shall, upon receiving a bona fide 

request, provide telecommunications services which are 

necessary for the provision of health care services in a 

State, including instruction relating to such services, to 

any public or nonprofit health care provider that serves 

persons who reside in rural areas in that State at rates 

that are reasonably comparable to rates charged for similar services in urban areas in that State. A telecommunications carrier providing service under this paragraph 

shall be entitled to have an amount equal to the difference, 

if any, between the rates for services provided to health 

care providers for rural areas in a State and the rates for 

similar services provided to other customers in comparable 

rural areas in that State treated as a service obligation as 


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a part of its obligation to participate in the mechanisms to 

preserve and advance universal service. 

(B) EDUCATIONAL PROVIDERS AND LIBRARIES.—All telecommunications carriers serving a geographic area shall, 

upon a bona fide request for any of its services that are 

within the definition of universal service under subsection 

(c)(3), provide such services to elementary schools, secondary schools, and libraries for educational purposes at 

rates less than the amounts charged for similar services to 

other parties. The discount shall be an amount that the 

Commission, with respect to interstate services, and the 

States, with respect to intrastate services, determine is appropriate and necessary to ensure affordable access to and 

use of such services by such entities. A telecommunications 

carrier providing service under this paragraph shall— 

(i) have an amount equal to the amount of the discount treated as an offset to its obligation to contribute to the mechanisms to preserve and advance 

universal service, or 

(ii) notwithstanding the provisions of subsection (e) 

of this section, receive reimbursement utilizing the 

support mechanisms to preserve and advance universal service. 

(2) ADVANCED SERVICES.—The Commission shall establish 

competitively neutral rules— 

(A) to enhance, to the extent technically feasible and economically reasonable, access to advanced telecommunications and information services for all public and nonprofit elementary and secondary school classrooms, health 

care providers, and libraries; and 

(B) to define the circumstances under which a telecommunications carrier may be required to connect its network to such public institutional telecommunications 

users. 

(3) TERMS AND CONDITIONS.—Telecommunications services 

and network capacity provided to a public institutional telecommunications user under this subsection may not be sold, 

resold, or otherwise transferred by such user in consideration 

for money or any other thing of value. 

(4) ELIGIBILITY OF USERS.—No entity listed in this subsection 

shall be entitled to preferential rates or treatment as required 

by this subsection, if such entity operates as a for-profit business, is a school described in paragraph (7)(A) with an endowment of more than $50,000,000, or is a library or library consortium not eligible for assistance from a State library administrative agency under the Library Services and Technology 

Act. 

(5) REQUIREMENTS FOR CERTAIN SCHOOLS WITH COMPUTERS

HAVING INTERNET ACCESS.— (A) INTERNET SAFETY.— (i) IN GENERAL.—Except as provided in clause (ii), 

an elementary or secondary school having computers 

with Internet access may not receive services at discount rates under paragraph (1)(B) unless the school, 

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thority with responsibility for administration of the 

school— 

(I) submits to the Commission the certifications 

described in subparagraphs (B) and (C); 

(II) submits to the Commission a certification 

that an Internet safety policy has been adopted 

and implemented for the school under subsection 

(l); and 

(III) ensures the use of such computers in accordance with the certifications. 

(ii) APPLICABILITY.—The prohibition in clause (i) 

shall not apply with respect to a school that receives 

services at discount rates under paragraph (1)(B) only 

for purposes other than the provision of Internet access, Internet service, or internal connections. 

(iii) PUBLIC NOTICE; HEARING.—An elementary or 

secondary school described in clause (i), or the school 

board, local educational agency, or other authority 

with responsibility for administration of the school, 

shall provide reasonable public notice and hold at 

least one public hearing or meeting to address the proposed Internet safety policy. In the case of an elementary or secondary school other than an elementary 

school or a secondary school as defined in section 8101 

of the Elementary and Secondary Education Act of 

1965, the notice and hearing required by this clause 

may be limited to those members of the public with a 

relationship to the school. 

(B) CERTIFICATION WITH RESPECT TO MINORS.—A certification under this subparagraph is a certification that the 

school, school board, local educational agency, or other authority with responsibility for administration of the 

school— 

(i) is enforcing a policy of Internet safety for minors 

that includes monitoring the online activities of minors and the operation of a technology protection 

measure with respect to any of its computers with 

Internet access that protects against access through 

such computers to visual depictions that are— 

(I) obscene; 

(II) child pornography; or 

(III) harmful to minors; 

(ii) is enforcing the operation of such technology protection measure during any use of such computers by 

minors; and 

(iii) as part of its Internet safety policy is educating 

minors about appropriate online behavior, including 

interacting with other individuals on social networking 

websites and in chat rooms and cyberbullying awareness and response. 

(C) CERTIFICATION WITH RESPECT TO ADULTS.—A certification under this paragraph is a certification that the 

school, school board, local educational agency, or other authority with responsibility for administration of the 

school— 


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(i) is enforcing a policy of Internet safety that includes the operation of a technology protection measure with respect to any of its computers with Internet 

access that protects against access through such computers to visual depictions that are— 

(I) obscene; or 

(II) child pornography; and 

(ii) is enforcing the operation of such technology protection measure during any use of such computers. 

(D) DISABLING DURING ADULT USE.—An administrator, 

supervisor, or other person authorized by the certifying authority under subparagraph (A)(i) may disable the technology protection measure concerned, during use by an 

adult, to enable access for bona fide research or other lawful purpose. 

(E) TIMING OF IMPLEMENTATION.— 

(i) IN GENERAL.—Subject to clause (ii) in the case of 

any school covered by this paragraph as of the effective date of this paragraph under section 1721(h) of 

the Children’s Internet Protection Act, the certification 

under subparagraphs (B) and (C) shall be made— 

(I) with respect to the first program funding 

year under this subsection following such effective 

date, not later than 120 days after the beginning 

of such program funding year; and 

(II) with respect to any subsequent program 

funding year, as part of the application process for 

such program funding year. 

(ii) PROCESS.— 

(I) SCHOOLS WITH INTERNET SAFETY POLICY AND

TECHNOLOGY PROTECTION MEASURES IN PLACE.—A 

school covered by clause (i) that has in place an 

Internet safety policy and technology protection 

measures meeting the requirements necessary for 

certification under subparagraphs (B) and (C) 

shall certify its compliance with subparagraphs 

(B) and (C) during each annual program application cycle under this subsection, except that with 

respect to the first program funding year after the 

effective date of this paragraph under section 

1721(h) of the Children’s Internet Protection Act, 

the certifications shall be made not later than 120 

days after the beginning of such first program 

funding year. 

(II) SCHOOLS WITHOUT INTERNET SAFETY POLICY

AND TECHNOLOGY PROTECTION MEASURES IN

PLACE.—A school covered by clause (i) that does 

not have in place an Internet safety policy and 

technology protection measures meeting the requirements necessary for certification under subparagraphs (B) and (C)— 

(aa) for the first program year after the effective date of this subsection in which it is 

applying for funds under this subsection, shall 

certify that it is undertaking such actions, inVerDate Sep 11 2014 05:27 Jun 01, 2016 Jkt 059006 PO 00000 Frm 00013 Fmt 6659 Sfmt 6602 E:\HR\OC\HR582.XXX HR582

SSpencer on DSK4SPTVN1PROD with REPORTS
14 

cluding any necessary procurement procedures, to put in place an Internet safety policy 

and technology protection measures meeting 

the requirements necessary for certification 

under subparagraphs (B) and (C); and 

(bb) for the second program year after the 

effective date of this subsection in which it is 

applying for funds under this subsection, shall 

certify that it is in compliance with subparagraphs (B) and (C). 

Any school that is unable to certify compliance 

with such requirements in such second program 

year shall be ineligible for services at discount 

rates or funding in lieu of services at such rates 

under this subsection for such second year and all 

subsequent program years under this subsection, 

until such time as such school comes into compliance with this paragraph. 

(III) WAIVERS.—Any school subject to subclause 

(II) that cannot come into compliance with subparagraphs (B) and (C) in such second year program may seek a waiver of subclause (II)(bb) if 

State or local procurement rules or regulations or 

competitive bidding requirements prevent the 

making of the certification otherwise required by 

such subclause. A school, school board, local educational agency, or other authority with responsibility for administration of the school shall notify 

the Commission of the applicability of such subclause to the school. Such notice shall certify that 

the school in question will be brought into compliance before the start of the third program year 

after the effective date of this subsection in which 

the school is applying for funds under this subsection. 

(F) NONCOMPLIANCE.— (i) FAILURE TO SUBMIT CERTIFICATION.—Any school 

that knowingly fails to comply with the application 

guidelines regarding the annual submission of certification required by this paragraph shall not be eligible 

for services at discount rates or funding in lieu of services at such rates under this subsection. 

(ii) FAILURE TO COMPLY WITH CERTIFICATION.—Any 

school that knowingly fails to ensure the use of its 

computers in accordance with a certification under 

subparagraphs (B) and (C) shall reimburse any funds 

and discounts received under this subsection for the 

period covered by such certification. 

(iii) REMEDY OF NONCOMPLIANCE.— (I) FAILURE TO SUBMIT.—A school that has failed 

to submit a certification under clause (i) may remedy the failure by submitting the certification to 

which the failure relates. Upon submittal of such 

certification, the school shall be eligible for services at discount rates under this subsection. 


SSpencer on DSK4SPTVN1PROD with REPORTS
15 

(II) FAILURE TO COMPLY.—A school that has 

failed to comply with a certification as described 

in clause (ii) may remedy the failure by ensuring 

the use of its computers in accordance with such 

certification. Upon submittal to the Commission of 

a certification or other appropriate evidence of 

such remedy, the school shall be eligible for services at discount rates under this subsection. 

(6) REQUIREMENTS FOR CERTAIN LIBRARIES WITH COMPUTERS

HAVING INTERNET ACCESS.— (A) INTERNET SAFETY.— (i) IN GENERAL.—Except as provided in clause (ii), a 

library having one or more computers with Internet 

access may not receive services at discount rates 

under paragraph (1)(B) unless the library— 

(I) submits to the Commission the certifications 

described in subparagraphs (B) and (C); and 

(II) submits to the Commission a certification 

that an Internet safety policy has been adopted 

and implemented for the library under subsection 

(l); and 

(III) ensures the use of such computers in accordance with the certifications. 

(ii) APPLICABILITY.—The prohibition in clause (i) 

shall not apply with respect to a library that receives 

services at discount rates under paragraph (1)(B) only 

for purposes other than the provision of Internet access, Internet service, or internal connections. 

(iii) PUBLIC NOTICE; HEARING.—A library described 

in clause (i) shall provide reasonable public notice and 

hold at least one public hearing or meeting to address 

the proposed Internet safety policy. 

(B) CERTIFICATION WITH RESPECT TO MINORS.—A certification under this subparagraph is a certification that the 

library— 

(i) is enforcing a policy of Internet safety that includes the operation of a technology protection measure with respect to any of its computers with Internet 

access that protects against access through such computers to visual depictions that are— 

(I) obscene; 

(II) child pornography; or 

(III) harmful to minors; and 

(ii) is enforcing the operation of such technology protection measure during any use of such computers by 

minors. 

(C) CERTIFICATION WITH RESPECT TO ADULTS.—A certification under this paragraph is a certification that the library— 

(i) is enforcing a policy of Internet safety that includes the operation of a technology protection measure with respect to any of its computers with Internet 

access that protects against access through such computers to visual depictions that are— 

(I) obscene; or 


SSpencer on DSK4SPTVN1PROD with REPORTS
16 

(II) child pornography; and 

(ii) is enforcing the operation of such technology protection measure during any use of such computers. 

(D) DISABLING DURING ADULT USE.—An administrator, 

supervisor, or other person authorized by the certifying authority under subparagraph (A)(i) may disable the technology protection measure concerned, during use by an 

adult, to enable access for bona fide research or other lawful purpose. 

(E) TIMING OF IMPLEMENTATION.— 

(i) IN GENERAL.—Subject to clause (ii) in the case of 

any library covered by this paragraph as of the effective date of this paragraph under section 1721(h) of 

the Children’s Internet Protection Act, the certification 

under subparagraphs (B) and (C) shall be made— 

(I) with respect to the first program funding 

year under this subsection following such effective 

date, not later than 120 days after the beginning 

of such program funding year; and 

(II) with respect to any subsequent program 

funding year, as part of the application process for 

such program funding year. 

(ii) PROCESS.— 

(I) LIBRARIES WITH INTERNET SAFETY POLICY

AND TECHNOLOGY PROTECTION MEASURES IN

PLACE.—A library covered by clause (i) that has in 

place an Internet safety policy and technology protection measures meeting the requirements necessary for certification under subparagraphs (B) 

and (C) shall certify its compliance with subparagraphs (B) and (C) during each annual program 

application cycle under this subsection, except 

that with respect to the first program funding 

year after the effective date of this paragraph 

under section 1721(h) of the Children’s Internet 

Protection Act, the certifications shall be made not 

later than 120 days after the beginning of such 

first program funding year. 

(II) LIBRARIES WITHOUT INTERNET SAFETY POLICY AND TECHNOLOGY PROTECTION MEASURES IN

PLACE.—A library covered by clause (i) that does 

not have in place an Internet safety policy and 

technology protection measures meeting the requirements necessary for certification under subparagraphs (B) and (C)— 

(aa) for the first program year after the effective date of this subsection in which it is 

applying for funds under this subsection, shall 

certify that it is undertaking such actions, including any necessary procurement procedures, to put in place an Internet safety policy 

and technology protection measures meeting 

the requirements necessary for certification 

under subparagraphs (B) and (C); and 


SSpencer on DSK4SPTVN1PROD with REPORTS
17 

(bb) for the second program year after the 

effective date of this subsection in which it is 

applying for funds under this subsection, shall 

certify that it is in compliance with subparagraphs (B) and (C). 

Any library that is unable to certify compliance 

with such requirements in such second program 

year shall be ineligible for services at discount 

rates or funding in lieu of services at such rates 

under this subsection for such second year and all 

subsequent program years under this subsection, 

until such time as such library comes into compliance with this paragraph. 

(III) WAIVERS.—Any library subject to subclause 

(II) that cannot come into compliance with subparagraphs (B) and (C) in such second year may 

seek a waiver of subclause (II)(bb) if State or local 

procurement rules or regulations or competitive 

bidding requirements prevent the making of the 

certification otherwise required by such subclause. 

A library, library board, or other authority with 

responsibility for administration of the library 

shall notify the Commission of the applicability of 

such subclause to the library. Such notice shall 

certify that the library in question will be brought 

into compliance before the start of the third program year after the effective date of this subsection in which the library is applying for funds 

under this subsection. 

(F) NONCOMPLIANCE.— 

(i) FAILURE TO SUBMIT CERTIFICATION.—Any library 

that knowingly fails to comply with the application 

guidelines regarding the annual submission of certification required by this paragraph shall not be eligible 

for services at discount rates or funding in lieu of services at such rates under this subsection. 

(ii) FAILURE TO COMPLY WITH CERTIFICATION.—Any 

library that knowingly fails to ensure the use of its 

computers in accordance with a certification under 

subparagraphs (B) and (C) shall reimburse all funds 

and discounts received under this subsection for the 

period covered by such certification. 

(iii) REMEDY OF NONCOMPLIANCE.— 

(I) FAILURE TO SUBMIT.—A library that has 

failed to submit a certification under clause (i) 

may remedy the failure by submitting the certification to which the failure relates. Upon submittal 

of such certification, the library shall be eligible 

for services at discount rates under this subsection. 

(II) FAILURE TO COMPLY.—A library that has 

failed to comply with a certification as described 

in clause (ii) may remedy the failure by ensuring 

the use of its computers in accordance with such 

certification. Upon submittal to the Commission of 


SSpencer on DSK4SPTVN1PROD with REPORTS
18 

a certification or other appropriate evidence of 

such remedy, the library shall be eligible for services at discount rates under this subsection. 

(7) DEFINITIONS.—For purposes of this subsection: 

(A) ELEMENTARY AND SECONDARY SCHOOLS.—The term 

‘‘elementary and secondary schools’’ means elementary 

schools and secondary schools, as defined in section 8101 

of the Elementary and Secondary Education Act of 1965. 

(B) HEALTH CARE PROVIDER.—The term ‘‘health care provider’’ means— 

(i) post-secondary educational institutions offering 

health care instruction, teaching hospitals, and medical schools; 

(ii) community health centers or health centers providing health care to migrants; 

(iii) local health departments or agencies; 

(iv) community mental health centers; 

(v) not-for-profit hospitals; 

(vi) rural health clinics; øand¿ 

(vii) skilled nursing facilities (as defined in section 

1819(a) of the Social Security Act (42 U.S.C. 1395i– 

3(a))); and 

ø(vii)¿ (viii) consortia of health care providers consisting of one or more entities described in øclauses (i) 

through (vi)¿ clauses (i) through (vii) . (C) PUBLIC INSTITUTIONAL TELECOMMUNICATIONS USER.— The term ‘‘public institutional telecommunications user’’ 

means an elementary or secondary school, a library, or a 

health care provider as those terms are defined in this 

paragraph. 

(D) MINOR.—The term ‘‘minor’’ means any individual 

who has not attained the age of 17 years. 

(E) OBSCENE.—The term ‘‘obscene’’ has the meaning 

given such term in section 1460 of title 18, United States 

Code. 

(F) CHILD PORNOGRAPHY.—The term ‘‘child pornography’’ 

has the meaning given such term in section 2256 of title 

18, United States Code. 

(G) HARMFUL TO MINORS.—The term ‘‘harmful to minors’’ 

means any picture, image, graphic image file, or other visual depiction that— 

(i) taken as a whole and with respect to minors, appeals to a prurient interest in nudity, sex, or excretion; 

(ii) depicts, describes, or represents, in a patently offensive way with respect to what is suitable for minors, an actual or simulated sexual act or sexual contact, actual or simulated normal or perverted sexual 

acts, or a lewd exhibition of the genitals; and 

(iii) taken as a whole, lacks serious literary, artistic, 

political, or scientific value as to minors. 

(H) SEXUAL ACT; SEXUAL CONTACT.—The terms ‘‘sexual 

act’’ and ‘‘sexual contact’’ have the meanings given such 

terms in section 2246 of title 18, United States Code. 

(I) TECHNOLOGY PROTECTION MEASURE.—The term ‘‘technology protection measure’’ means a specific technology 


SSpencer on DSK4SPTVN1PROD with REPORTS
19 

that blocks or filters Internet access to the material covered by a certification under paragraph (5) or (6) to which 

such certification relates. 

(i) CONSUMER PROTECTION.—The Commission and the States 

should ensure that universal service is available at rates that are 

just, reasonable, and affordable. 

(j) LIFELINE ASSISTANCE.—Nothing in this section shall affect the 

collection, distribution, or administration of the Lifeline Assistance 

Program provided for by the Commission under regulations set 

forth in section 69.117 of title 47, Code of Federal Regulations, and 

other related sections of such title. 

(k) SUBSIDY OF COMPETITIVE SERVICES PROHIBITED.—A telecommunications carrier may not use services that are not competitive to subsidize services that are subject to competition. The Commission, with respect to interstate services, and the States, with respect to intrastate services, shall establish any necessary cost allocation rules, accounting safeguards, and guidelines to ensure that 

services included in the definition of universal service bear no more 

than a reasonable share of the joint and common costs of facilities 

used to provide those services. 

(l) INTERNET SAFETY POLICY REQUIREMENT FOR SCHOOLS AND LI- BRARIES.— 

(1) IN GENERAL.—In carrying out its responsibilities under 

subsection (h), each school or library to which subsection (h) 

applies shall— 

(A) adopt and implement an Internet safety policy that 

addresses— 

(i) access by minors to inappropriate matter on the 

Internet and World Wide Web; 

(ii) the safety and security of minors when using 

electronic mail, chat rooms, and other forms of direct 

electronic communications; 

(iii) unauthorized access, including so-called ‘‘hacking’’, and other unlawful activities by minors online; 

(iv) unauthorized disclosure, use, and dissemination 

of personal identification information regarding minors; and 

(v) measures designed to restrict minors’ access to 

materials harmful to minors; and 

(B) provide reasonable public notice and hold at least 

one public hearing or meeting to address the proposed 

Internet safety policy. 

(2) LOCAL DETERMINATION OF CONTENT.—A determination regarding what matter is inappropriate for minors shall be made 

by the school board, local educational agency, library, or other 

authority responsible for making the determination. No agency 

or instrumentality of the United States Government may— 

(A) establish criteria for making such determination; 

(B) review the determination made by the certifying 

school, school board, local educational agency, library, or 

other authority; or 

(C) consider the criteria employed by the certifying 

school, school board, local educational agency, library, or 

other authority in the administration of subsection 

(h)(1)(B). 


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20 

(3) AVAILABILITY FOR REVIEW.—Each Internet safety policy 

adopted under this subsection shall be made available to the 

Commission, upon request of the Commission, by the school, 

school board, local educational agency, library, or other authority responsible for adopting such Internet safety policy for purposes of the review of such Internet safety policy by the Commission. 

(4) EFFECTIVE DATE.—This subsection shall apply with respect to schools and libraries on or after the date that is 120 

days after the date of the enactment of the Children’s Internet 

Protection Act. 

* * * * * * * 

Æ 


SSpencer on DSK4SPTVN1PROD with REPORTS