1834 Federal Register / Vol. 89, No. 8 / Thursday, January 11, 2024 / Rules and Regulations 

billion annually, or no more than $1.33 

billion annually if certain conditions are 

met, using an updated version of the A– 

CAM. By adopting this program, the 

Commission furthered its long-standing 

goals by promoting the universal 

availability of voice and broadband 

networks, while also taking measures to 

minimize the burden on the nation’s 

ratepayers. The Commission also 

adopted requirements for the Enhanced 

A–CAM program to complement 

existing Federal, state, and local funding 

programs, so that broadband funding 

can be used efficiently to maximize the 

deployment of high-quality broadband 

service across the United States. 

To ensure that the Enhanced A–CAM 

program does not deprive rural 

consumers in high-cost areas of 

broadband service that is as secure as 

the service deployed pursuant to other 

Federal funding initiatives, the 

Commission required Enhanced A– 

CAM carriers to implement operational 

cybersecurity and supply chain risk 

management plans by January 1, 2024— 

the start of the Enhanced A–CAM 

support term. Enhanced A–CAM 

carriers must submit such plans to the 

Universal Service Administrative 

Company (USAC) and certify they have 

done so, by January 2, 2024, or within 

30 days of approval under the 

Paperwork Reduction Act, whichever is 

later. Failure to submit the plans and 

make the certification shall result in 

25% of monthly support being withheld 

until the carrier comes into compliance. 

If a carrier makes a substantive 

modification to its cybersecurity or 

supply chain risk management plan, the 

Commission requires that the carrier 

submit its updated plan to USAC within 

30 days of making that modification. 

The purpose of this information 

collection is to collect the operational 

cybersecurity and supply chain risk 

management plans required of the 

Enhanced A–CAM carriers by the start 

of the Enhanced A–CAM support term 

and address the burdens associated with 

that requirement. 

Federal Communications Commission. 

Marlene Dortch, 

Secretary, Office of the Secretary. 

[FR Doc. 2024–00417 Filed 1–10–24; 8:45 am] 

BILLING CODE 6712–01–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

47 CFR Part 54 

[WC Docket No. 17–310; FCC No. 23–110; 

FR ID 195910] 

Promoting Telehealth in Rural America 

AGENCY: Federal Communications 

Commission. 

ACTION: Final rule. 

SUMMARY: In this document, the Federal 

Communications Commission 

(Commission) seeks to provide vital 

support to assist rural health care 

providers with the costs of broadband 

and other eligible services. By offering 

discounted rates for these services, the 

Rural Health Care (RHC) Program 

enables health care providers to better 

treat patients in rural areas that often 

have fewer medical resources and 

higher service rates than in urban areas. 

DATES: Effective February 12, 2024, 

except for §§ 54.601(b) and (c) 

(amendatory instruction 2) and 

54.622(e)(1)(i) through (ii) and (i)(3)(iv) 

(amendatory instruction 4), which are 

delayed indefinitely. The Commission 

will publish a document in the Federal 

Register announcing the effective date 

for those rule sections. 

FOR FURTHER INFORMATION CONTACT: 

Philip A. Bonomo, Philip.Bonomo@

fcc.gov, Wireline Competition Bureau, 

202–418–7400 or TTY: 202–418–0484. 

Requests for accommodations should be 

made as soon as possible in order to 

allow the agency to satisfy such requests 

whenever possible. Send an email to 

fcc504@fcc.gov or call the Consumer 

and Governmental Affairs Bureau at 

(202) 418–0530 (voice), 202–418–0432 

(TTY). 

SUPPLEMENTARY INFORMATION: This is a 

synopsis of the Commission’s Third 

Report and (Third R&O) in WC Docket 

No. 17–310; FCC No. 23–110, adopted 

on December 13, 2023, and released on 

December 14, 2023.The full text of this 

document is available for public 

inspection during regular business 

hours at Commission’s headquarters 45 

L Street NE, Washington, DC 20554 or 

at the following internet address: 

https://docs.fcc.gov/public/ 

attachments/FCC-23-110A1.pdf. 

I. Introduction 

1. In the Third R&O, the Commission 

continues its efforts to improve the 

effectiveness and efficiency of the Rural 

Health Care (RHC) Program. The RHC 

Program offers discounted rates for 

broadband and other communications 

services to health care providers who 

use these increasingly essential services 

to better treat patients in rural areas that 

may have limited resources, fewer 

medical professionals, and higher rates 

for these services than in urban areas. 

Broadband-enabled telehealth and 

telemedicine services in particular have 

proven to be critical tools for the 

effective delivery of health care to 

millions of patients in rural areas, as 

demonstrated by the heightened 

dependency on these services during 

the COVID–19 pandemic. Telemedicine 

and telehealth make the provision of 

high-quality health care a reality for 

patients regardless of location or ability 

to travel. The measures adopted will 

enhance the provision of these vital 

services through the RHC Program. 

2. The Commission adopts four 

revisions to the RHC Program as 

proposed in the Second Further Notice 

of Proposed Rulemaking, 88 FR 17495, 

March 23, 2023 (Second FNPRM) (FCC 

23–6), aimed at facilitating participation 

in and improving the administration of 

the Program. First, the Commission 

revises the RHC Program rules to permit 

conditional approval of eligibility for 

health care providers that expect to be 

eligible in the near future to allow them 

to initiate competitive bidding and 

request funding. Second, to give 

participants more flexibility with 

deadlines, the Commission revises its 

rules to move back the RHC Program’s 

Service Provider Identification Number 

(SPIN) change deadline to align with the 

invoice deadline. Third, the 

Commission simplifies the rules for 

determining urban rates by eliminating 

the seldom-used ‘‘standard urban 

distance’’ component of the urban rate 

rules. Fourth, in a separate action to 

provide more flexibility with deadlines, 

the Commission revises the RHC 

Program rules to permit health care 

providers to request changes to the dates 

of their evergreen contracts following a 

funding commitment. 

3. In addition to these revisions, the 

Commission also on its own motion 

makes two programmatic improvements 

to the administration of the RHC 

Program and Universal Service Fund. 

To reduce burdens and promote 

efficiency, the Commission harmonizes 

the RHC Program eligibility 

determination process by shifting to the 

use of a single universal eligibility form 

for all program participants. Finally, to 

free up for other uses unclaimed RHC 

Program support, the Commission 

establishes a deadline by which health 

care providers must submit invoices for 

any undisbursed funding commitments 

from funding year 2019 and prior that 

do not currently have an applicable 

invoice deadline. 


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II. Discussion 

4. In the Third R&O, the Commission 

continues to improve the RHC Program 

by facilitating health care provider 

participation in and improving the 

administration of the Program. 

Specifically, the Commission revises the 

RHC Program rules to permit 

conditional eligibility for health care 

providers and eliminate the seldomused ‘‘standard urban distance’’ 

component of the urban rate rule. The 

Commission also makes two changes 

relating to RHC Program administrative 

deadlines by aligning the SPIN change 

deadline with the existing invoice 

deadline and permitting health care 

providers to request a change to 

evergreen contract dates. The 

Commission then amends the rules to 

shift to the use of the same form when 

determining Telecom and Healthcare 

Connect Fund (HCF) Program eligibility. 

Finally, the Commission establishes a 

deadline by which invoices must be 

submitted for undisbursed funding 

commitments from before funding year 

2020. 

5. Conditional Approval of Eligibility 

for Future Eligible Health Care 

Providers. The Commission first adopts 

amendments to the RHC Program rules 

to allow conditional approval of 

eligibility consistent with what the 

Commission proposed in the Second 

FNPRM. The amendments enable 

entities that do not meet all eligibility 

requirements at the time they seek 

eligibility determinations to obtain 

conditional approval of eligibility, 

conduct competitive bidding, and 

request funding prior to receiving 

formal approval of eligibility. With this 

change, entities granted such 

conditional approval may conduct 

competitive bidding and request 

funding before they receive formal 

eligibility approval, ensuring that they 

are able to participate in the RHC 

Program for the funding year in which 

they expect to receive a formal 

eligibility approval. However, entities 

with conditional approval will not 

receive funding commitments until they 

meet all eligibility requirements. The 

substantive standard used to determine 

full eligibility remains unchanged. This 

change ensures that health care 

providers that are not yet eligible during 

the application window, but expect to 

become eligible in the near future, are 

not locked out of much needed funding. 

All commenters who addressed this 

proposal supported it, and no 

commenters opposed this change. This 

change will be effective for funding year 

2025, the competitive bidding process 

for which begins in mid-2024. 

6. Eligible health care providers, as 

defined in section 254(h)(7)(B) of the 

Communications Act and implemented 

in the Commission’s rules, are limited to 

the following categories: (1) postsecondary educational institutions 

offering health care instruction, teaching 

hospitals, and medical schools; (2) 

community health centers or health 

centers providing health care to 

migrants; (3) local health departments or 

agencies; (4) community mental health 

centers; (5) not-for-profit hospitals; (6) 

rural health clinics; (7) skilled nursing 

facilities; and (8) consortia of health 

care providers consisting of one or more 

entities falling into the first seven 

categories. In addition, eligible health 

care providers must be non-profit or 

public. In the Telecom Program, only 

eligible health care providers located in 

a ‘‘rural area’’ defined in § 54.600(e) of 

the Commission’s rules can receive 

support. The HCF Program, on the other 

hand, permits rural eligible health care 

providers as well as non-rural eligible 

health care providers participating in a 

majority-rural consortium to receive 

support. 

7. To allow health care providers to 

receive RHC Program funding as soon as 

they become eligible, the Commission 

amends § 54.601 of its rules to permit 

entities that expect to meet all eligibility 

requirements before the end of a given 

upcoming funding year to request and 

receive a conditional approval of 

eligibility. The Commission also 

amends § 54.622(e)(1) of its rules to 

allow those entities to make the 

required certifications when filing a 

Request for Services to initiate 

competitive bidding. The amendments 

adopted will enable entities that receive 

conditional approval of program 

eligibility to conduct competitive 

bidding and submit funding requests 

prior to receiving formal approval of 

eligibility. However, the substantive 

standard used to determine eligibility 

remains unchanged. Entities that receive 

conditional approval of eligibility will 

not receive funding commitments until 

they actually become eligible and 

receive the formal approval of eligibility 

under the existing substantive standard. 

No RHC funding shall be committed or 

disbursed to an entity for any time 

period that is prior to the date the entity 

is formally approved as eligible. The 

Commission directs the Universal 

Service Administrative Company 

(Administrator or USAC), upon 

approval from the Wireline Competition 

Bureau (Bureau), to implement the 

conditional approval of eligibility 

mechanism. 

8. This change is warranted given the 

change to a fixed application filing 

window in the RHC Program. Before 

funding year 2016, after an initial 

application filing window, the 

Administrator accepted applications on 

a rolling basis until the last day of the 

funding year. Since funding year 2017, 

no applications have been accepted 

following the close of the initial 

application window. Beginning in 

funding year 2021, the Commission’s 

rules require the Administrator to open 

an initial filing window period with an 

end date no later than April 1 prior to 

the start of the funding year. 

9. In 2016, when applications were 

still accepted on a rolling basis and 

there were two application windows, 

the Bureau issued the Hope Community 

Order, DA 16–855, rel. July 29, 2016 

(Hope Order), which held that that if an 

entity had not demonstrated its 

eligibility at the time of its eligibility 

determination form submission for a 

funding year, it would be ineligible to 

receive RHC Telecommunications 

Program support for that funding year. 

The change the Commission makes 

eliminates this limitation and allows 

health care providers to seek 

conditional eligibility approval so they 

can participate in the program in the 

year in which they expect to become 

fully eligible, even if they receive their 

full eligibility approval after the initial 

application window closes. Based on 

experience administering the program, 

the Commission finds it appropriate to 

eliminate the Hope Order’s requirement 

that a site be eligible for RHC Program 

support, which requires that it qualifies 

as one of the eligible health care 

providers defined by section 

254(h)(7)(B) of the Communications Act, 

at the time of its request for eligibility 

determination. In funding year 2013, the 

funding year at issue in the Hope Order, 

the Administrator accepted applications 

on a rolling basis throughout the 

funding year, which permitted a health 

care provider to begin receiving funding 

for RHC Program supported services 

within a few months after it became an 

eligible entity under section 254(h)(7)(B) 

of the Communications Act. Shortly 

after meeting eligibility requirements, 

the health care provider could receive 

its eligibility determination, engage in 

competitive bidding, file a Request for 

Funding during the rolling application 

window, and start to receive funding. 

10. Absent this change with the 

current use of a fixed filing window, a 

health care provider might have to wait 

more than one year after becoming an 

eligible health care provider to receive 

RHC Program funding. For example, if 

a new medical provider is in the process 

of opening and expects to become 

eligible under section 254(h)(7)(B) of the 


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Communications Act on July 1, 2025, 

which is after the initial application 

filing window, it may not be able to 

receive RHC Program support for 

funding year 2025 because it could not 

have been approved as eligible until 

after the provider’s July 1, 2025 opening 

date. Permitting conditional approvals 

of eligibility will allow health care 

providers that are not yet eligible but 

expect to become an eligible health care 

provider in a given upcoming funding 

year to complete competitive bidding 

and file Requests for Funding so they 

are able to receive RHC Program funding 

as soon as they are fully designated as 

an eligible health care provider under 

the Commission’s rules. 

11. To protect the integrity and 

success of the RHC program and ensure 

that no RHC Program funding is 

disbursed for entities that are not yet 

fully approved as eligible, the 

Commission adopts the following 

safeguards for conditional approvals of 

eligibility. First, to request conditional 

approval of eligibility, an applicant 

must submit an eligibility determination 

form and supporting documentation to 

the Administrator, which will include 

the estimated date that it expects to 

meet all eligibility requirements. The 

documentation must show that the 

entity is or reasonably expects to qualify 

as a public or non-profit health care 

provider defined in § 54.600(b) of the 

Commission’s rules by the estimated 

eligibility date. Additionally, if applying 

for the Telecom Program or if applying 

as an individual applicant in the HCF 

Program, the entity must be located or 

reasonably expect to be located in a 

rural area defined in § 54.600(e) of the 

Commission’s rules by the estimated 

eligibility date, or, if not located in such 

a rural area, for purposes of applying for 

the HCF Program, be or plan to be a 

member of a majority-rural HCF 

Program consortium that satisfies the 

eligible rural health care provider 

composition requirement set forth in 

§ 54.607(b) of the Commission’s rules by 

the estimated eligibility date. 

12. Once the Administrator approves 

an applicant’s conditional eligibility, 

the applicant can proceed to conduct 

competitive bidding for the 

conditionally-approved site(s). In order 

to provide notice of the applicant’s 

conditional eligibility to potential 

bidders and service providers, an 

applicant engaging in competitive 

bidding with conditional eligibility 

must provide a written indication with 

its competitive bidding form indicating 

(1) that the eligibility is conditional, and 

(2) when the estimated expected 

eligibility date is. After conducting 

competitive bidding and signing a 

service contract, the applicant can 

submit a funding request during the 

application filing window for a given 

funding year, provided that the 

applicant’s estimated expected 

eligibility date is no later than the end 

of that funding year. To ensure that no 

funding is committed or disbursed for 

health care providers that are 

conditionally eligible under section 

254(h)(7)(B) of the Communications Act 

or the RHC Program rules, entities with 

conditional approval of eligibility will 

not be able to receive funding 

commitments or disbursements until 

they meet all eligibility requirements 

and are granted a formal approval of 

eligibility. This restriction is consistent 

with the Commission rule that RHC 

Program funding is provided to eligible 

health care providers for services for 

health care purposes. 

13. An applicant with conditional 

approval of eligibility is expected to 

notify the Administrator within 30 

calendar days of its actual eligibility 

date and provide documentation 

confirming that it is actually eligible. If 

the Administrator determines that the 

entity meets the requirements for a 

public or non-profit health care provider 

defined in § 54.600(b) Commission’s 

rules and the requirements for rural 

location or majority-rural HCF 

consortium membership set forth in the 

Commission’s rules, the Administrator 

shall formally approve the applicant’s 

eligibility and designate the applicant as 

an eligible health care provider. The 

Administrator will then review the 

applicant’s funding request and issue a 

funding commitment or denial in a 

timely manner. The funding 

commitment shall cover only a time 

period that starts no earlier than the 

applicant’s actual approved eligibility 

date and that is within the funding year 

for which support was requested. No 

funding shall be committed to ineligible 

entities or entities with only conditional 

approval and any support erroneously 

disbursed to ineligible entities or 

entities with only conditional approval 

must be recovered. The Commission 

directs the Administrator to implement 

these requirements in its procedures 

and delegate authority to the Bureau to 

issue further direction consistent with 

the Third R&O as necessary. 

14. Alignment of the Service Provider 

Identification Number Change Deadline 

with Invoice Deadline. The 

Commissions next amends its rules to 

move back the Service Provider 

Identification Number (SPIN) change 

filing deadline to align with the invoice 

filing deadline, rather than the service 

delivery deadline. A SPIN is a unique 

number that the Administrator assigns 

to an eligible service provider seeking to 

participate in the universal service 

support programs. An applicant under 

the HCF Program or Telecom Program 

may request either a ‘‘corrective SPIN 

change’’ (in cases not involving a 

change in the service provider 

associated with the applicant’s funding 

request number) or an ‘‘operational 

SPIN change’’ (in cases involving a 

change to the service provider 

associated with the applicant’s funding 

request number). The current filing 

deadline to submit a SPIN change 

request is no later than the service 

delivery deadline, which, with limited 

exceptions, is June 30 of the funding 

year for which program support is 

sought. The invoice deadline is 120 

days after the later of the service 

delivery deadline or the date of a 

revised funding commitment letter. In 

the Second FNPRM, the Commission 

proposed to align the SPIN change 

deadline with the invoice deadline and 

commenters supported this change. 

15. The Commission moves back the 

deadline for requesting SPIN changes 

effective funding year 2023 in response 

to program participant requests 

asserting that the nature of corrective 

SPIN changes creates a ‘‘recurring 

hardship for applicants’’ unable to meet 

the deadline, which, in turn, results in 

deadline waiver requests filed with the 

Commission. According to these 

participant comments, two commonly 

recurring situations support a change to 

the corrective SPIN change deadline: (1) 

mergers and acquisitions that can occur 

at any time during the funding year and 

(2) a service provider that assigns one of 

its multiple SPINs to a funding request 

without advising the healthcare 

provider as to the correct SPIN before 

invoicing begins, a situation that, in 

many instances, occurs after the service 

delivery deadline has passed. These 

commenters maintain that changing the 

deadline to request a corrective SPIN 

change to match the invoice deadline 

will provide the Administrator with 

sufficient time to process the change 

request without the need for applicants 

to request deadline waivers from the 

Commission. The Commission agrees 

with these commenters that the current 

deadline for requesting corrective SPIN 

changes imposes unnecessary burdens 

and challenges for program participants 

that a later-in-time deadline will largely 

eliminate. 

16. The Commission moves back the 

SPIN change deadline to align with the 

invoice deadline, which, in most cases 

is 120 days after the close of the funding 

year, to reduce the need for applicants 

to seek, and for the Commission to 

address, waivers of the current 


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corrective SPIN change deadline. This 

change facilitates participation in and 

the administration of the program, while 

still maintaining an administratively 

reasonable date by which such change 

requests must be made. Aligning the 

SPIN change deadline with the invoice 

deadline will not cause Program 

participants to miss the invoice 

deadline because a SPIN change results 

in a revised commitment letter, which 

will create a new invoice deadline 120 

days from the issuance of the revised 

commitment letter. 

17. Simplifying Urban Rate 

Calculations. In this section, the 

Commission simplifies the rules for 

calculating urban rates for the Telecom 

Program by eliminating the rarelyinvoked ‘‘standard urban distance’’ 

provision from its rules. In the Order on 

Reconsideration, 88 FR 17379, March 

23, 2023 (Order on Recon) (FCC 23–6), 

the Commission eliminated the Rates 

Database and reinstated the longstanding rules for calculating urban 

rates. These rules provide that the urban 

rate for an eligible service shall be a rate 

no higher than the highest tariffed or 

publicly-available rate charged to a 

commercial customer for a functionally 

similar service in any city with a 

population of 50,000 or more in that 

state. If, however, the service is 

provided over a distance greater than 

the standard urban distance, which is 

the average of the longest diameters of 

all cities with a population of 50,000 or 

more within a state, the urban rate is the 

rate no higher than the highest tariffed 

or publicly-available rate provided over 

the standard urban distance. In the 

Second FNPRM, the Commission 

proposed to simplify program rules by 

eliminating the distinction between 

services provided over and within the 

standard urban distance and proposed 

to base all urban rates calculations on 

rates provided in a city, rather than over 

the standard urban distance. It also 

sought comment on the extent to which 

health care providers rely on the 

standard urban distance distinction to 

calculate urban rates. 

18. Based on the record, the 

Commission finds that adopting its 

proposal to eliminate the standard 

urban distance provision from the urban 

rate rules will help simplify the 

calculation of urban rates in the 

Telecom Program. Eliminating it will 

make clearer the process for 

determining urban rates and there is no 

evidence that it will adversely impact 

health care providers because few, if 

any, Telecom Program participants 

calculate urban rates using this 

distinction. No commenters opined on 

the extent to which health care 

providers rely on the standard urban 

distance provision to calculate urban 

rates, which suggests that standard 

urban distance was not commonly 

invoked to calculate urban rates. The 

only commenter that addressed this 

proposal, the Schools, Health & 

Libraries Broadband (SHLB) Coalition, 

supported this change. Therefore, the 

Commission adopts the proposal to base 

all urban rates calculations on rates 

provided in a city rather than over the 

standard urban distance. This change 

shall be applicable for funding year 

2025. 

19. Change of Evergreen Contract 

Dates. The Commission next amends 

the RHC Program rules to permit health 

care providers to request a change in the 

evergreen contract dates following a 

funding commitment. Upon approving 

such a change, the Administrator will 

issue a revised funding commitment 

letter. This change will provide health 

care providers with the benefits of 

evergreen contract designation across 

the full length of the contract’s term 

while also reducing the need for health 

care providers to seek relief from the 

Administrator in cases where a postcommitment evergreen contract date 

change is necessary. This new rule will 

become effective for funding year 2024. 

20. Evergreen contracts are multi-year 

agreements under which covered 

services are exempt from the 

competitive bidding requirements for 

the term of the contract, which may be 

extended by up to an aggregate of five 

years. When the Administrator issues a 

funding commitment letter, it sets the 

period for an evergreen contract based 

on the estimated service start and end 

dates provided by the health care 

provider on the Request for Funding. 

However, as the Commission explained 

in the Second FNPRM, services 

sometimes start after the estimated 

service start date, which means that the 

evergreen status of the contract expires 

before it would have if the evergreen 

designation period was based on the 

actual service start date. In the Second 

FNPRM, the Commission sought 

comments on whether there should be 

a process for health care providers to 

change evergreen contract dates after a 

funding commitment has been made. 

The Commission also requested 

comments on how such a process could 

be accomplished. 

21. SHLB and New England 

Telehealth Consortium (NETC) support, 

and no party opposes, allowing health 

care providers to request changes to 

their evergreen contract dates in cases 

when the contract supports those 

changes. SHLB maintains that such 

requests should always be deemed 

timely and not precluded by expiration 

of the 60-day window for an appeal of 

the original funding commitment. SHLB 

also suggests that the Commission 

clarify that the Administrator should 

defer to the parties’ interpretation of a 

contract’s start and end date unless it is 

‘‘obviously inconsistent’’ with the 

language of the contract. 

22. The Commission agrees with 

SHLB and NETC that health care 

providers should be permitted to 

request evergreen contract changes 

following a funding commitment 

provided the contract supports a 

change. Aligning a contract’s actual 

service start date with the start date that 

determines the duration of the evergreen 

contract period will exempt health care 

providers from the competitive bidding 

process for the full length of the 

contract, thereby providing certainty to 

RHC Program participants. This change 

will not alter rules or processes for 

multi-year commitments or other 

competitive bidding exemptions. 

Accordingly, the Commission amends 

the RHC Program rules to allow health 

care providers to request changes to 

evergreen contract dates, subject to the 

following two requirements. 

23. First, the Commission requires 

that the terms of the evergreen contract 

support any requested date change. For 

example, an evergreen contract that 

specifies a start date effective upon 

signature of the contracting parties 

would not be eligible for a contract date 

change because the start date is a date 

established by the contract independent 

of the service start date. By contrast, an 

evergreen contract with terms specifying 

a start date tied to the commencement 

of services yet to be delivered would be 

eligible for a date change regardless of 

the date of signature. The Commission 

makes clear that any changes to the 

dates of the evergreen contract must be 

supported by the contract, and declines 

to adopt SHLB’s suggestion that the 

Administrator defer to the contracting 

parties’ interpretation on the contract 

timing. As in the case of ‘‘verification of 

discounts, offsets, or support amounts’’ 

as a general matter under § 54.707 of the 

Commission’s rules, it will be 

incumbent upon applicants to ensure 

that the available evidence sufficiently 

justifies a given date change. 

24. Second, the Commission requires 

that health care providers request an 

evergreen contract change within 60 

days of the date service commences. 

This 60-day window should provide 

health care providers with ample time 

to request a date change without having 

to resort to appealing the original 

funding commitment, which addresses 

the timing concern raised by SHLB and 


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NETC. The Commission declines, 

however, to adopt SHLB’s approach that 

all requests for evergreen contract 

changes be deemed timely. Such an 

open-ended option would provide no 

incentive to health care providers to 

promptly notify the Administrator of 

evergreen contract date changes. To 

memorialize the changed evergreen 

contract dates, the Commission directs 

the Administrator to issue a revised 

funding commitment letter to the health 

care provider reflecting the changed 

dates. If the Administrator denies a 

requested change, the Commission 

directs it to issue a letter to the health 

care provider explaining the basis for 

the denial. Finally, the Commission 

directs the Administrator to develop 

procedures subject to prior Bureau 

approval for accepting changes to 

evergreen contract dates consistent with 

the amended Commission’s rules 

§ 54.622(i)(3), and to publicize 

instructions on requesting changes to 

evergreen contract dates with the 

stakeholder community. 

25. Single Eligibility Form. To reduce 

burdens on Telecom Program applicants 

and improve the efficiency and 

operation of the RHC Program, the 

Commission next harmonizes the RHC 

Program eligibility determination 

process by establishing a single 

eligibility determination form for both 

the Telecom Program and the HCF 

Program that is required to be filed only 

once. Applicants must first be 

determined eligible under section 

254(h)(7)(B) of the Communications Act 

and RHC Program rules to receive 

support from the RHC Program. The 

Telecom Program and the HCF Program 

currently have different procedures for 

eligibility determinations. In the 

Telecom Program, applicants seeking 

eligibility determinations use the FCC 

Form 465 (Description of Services 

Requested and Certification Form), 

which is the same form used to initiate 

competitive bidding. Thus, even though 

most Telecom Program applicants’ 

eligibilities are very unlikely to change 

from year to year, they are required to 

provide, and the Administrator is 

required to review, information 

regarding their eligibility statuses every 

time there is a new competitive bidding 

process, which is generally every year. 

26. In contrast, when the HCF 

Program was established in 2012, the 

Commission instituted a more efficient 

process for eligibility determinations by 

separating the process for eligibility 

determination from the process for 

competitive bidding. In the HCF 

Program, applicants file an FCC Form 

460 (Eligibility and Registration Form) 

to seek a one-time eligibility 

determination that remains in place 

unless there is a material change in the 

entity’s eligibility. After receiving this 

eligibility determination, the applicant 

may file an FCC Form 461 (Request for 

Services Form) to initiate competitive 

bidding. Thus, applicants are able to 

know whether they are eligible before 

they spend time and resources planning 

competitive bidding. Because the FCC 

Form 460 is filed only once, the 

eligibility determination process in the 

HCF Program improves efficiency and 

reduces costs and time for both health 

care providers and the Administrator. 

27. Therefore, beginning funding year 

2025, the FCC Form 460 will be used for 

eligibility determinations in the 

Telecom Program and the eligibility 

determination portion will be 

eliminated from the FCC Form 465. As 

a result of this change, starting for 

funding year 2025, the FCC Form 465 

will be used solely for competitive 

bidding in the Telecom Program while 

the FCC Form 461 will continue to be 

used for competitive bidding in the HCF 

Program. Because there are certain 

differences in eligibility requirements 

between the Telecom Program and the 

HCF Program, applicants who are 

determined eligible in one program are 

not necessarily eligible in the other 

program even though one eligibility 

determination form is used for both 

programs. For example, non-rural public 

or non-profit health care providers who 

are members of majority-rural consortia 

are eligible to receive support under the 

HCF Program, but not under the 

Telecom Program. Thus, in this 

example, applicants whose FCC Form 

460s are submitted specifically for the 

HCF Program and approved on that 

basis are not automatically eligible for 

support in the Telecom Program and 

must seek eligibility determinations in 

the Telecom Program if they 

subsequently wish to demonstrate their 

eligibility for that program. The 

Commission directs the Bureau to 

amend the FCC Form 460 for eligibility 

determinations for both the Telecom 

Program and the HCF Program and 

direct the Administrator to track 

whether a health care provider is 

eligible for the Telecom Program, the 

HCF Program, or both. 

28. As part of adopting the FCC Form 

460 for the Telecom Program, the 

Commission also amends § 54.601(b) of 

its rules to extend it to the Telecom 

Program effective for funding year 2025. 

Section 54.601(b) of the Commission’s 

rules addresses the timing requirements 

for eligibility determinations in the HCF 

Program and requires health care 

providers to notify the Administrator of 

changes to their name, location, contact 

information, or eligible entity type. It 

was adopted when the Commission 

established the HCF Program in 2012 as 

a procedural rule for specifying the 

process for determining health care 

provider eligibility in the HCF Program. 

There are no corresponding rules for the 

eligibility determination process in the 

Telecom Program where applicants 

previously had to make a new eligibility 

showing every year they wished to seek 

support. Since a single eligibility 

determination form will be used for 

both programs, and thus now in the 

Telecom Program, like the HCF 

Program, applicants will be required to 

file separate forms for eligibility 

determination and request for services, 

and findings of eligibility will remain in 

place absent a material change in 

circumstances, it is reasonable to amend 

§ 54.601(b) of the Commission’s rules to 

make it apply to both programs to 

provide greater clarity to program 

participants. 

29. To further reduce unnecessary 

burdens and ease the implementation of 

this change, the Commission directs the 

Administrator to deem presumptively 

eligible for funding year 2025 and 

beyond any health care provider with an 

existing eligibility approval in the 

Telecom Program. Because the 

eligibility status of health care providers 

rarely changes, an additional up-front 

eligibility determination for funding 

year 2025 is unnecessary. This direction 

is consistent with the eligibility 

determination process in the HCF 

Program. The Commission reminds any 

health care providers with changes to 

conditions that might impact their 

eligibility status of the requirement to 

update the Administrator within 30 

days of the change. As before, health 

care providers in both the Telecom and 

HCF Programs are required to certify 

their eligibility when filing a Request for 

Services to initiate competitive bidding. 

30. The Commission emphasizes that 

its actions do not change the substantive 

requirements for determining eligibility 

in the RHC Program. It is the RHC 

Program applicants’ obligation to submit 

accurate information and certifications 

regarding their eligibility, including the 

obligation to notify the Administrator 

within 30 days of a material change in 

their eligibility information. Because 

health care provider eligibility is limited 

by the Act, the Commission does not 

have discretion to waive eligibility 

requirements, and must recover any 

support erroneously disbursed to 

ineligible entities. 

31. De-Obligation of Undisbursed, UnInvoiced Commitments. The 

Commission establishes a deadline of 

July 1, 2024, for Telecom Program 


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participants to submit invoices for 

funding years 2019 and earlier, the 

period during which there was no 

invoice deadline in the Telecom 

Program. After that date, funding 

commitments from funding year 2019 

and earlier that have not yet been 

invoiced will be de-obligated and will 

not be able to be invoiced. The 

Commission established an invoice 

deadline for the Telecom Program 

effective funding year 2020 in the 

Promoting Telehealth Report and Order, 

84 FR 54952, Oct. 11, 2019. The 

Commission explained that this 

deadline of 120 days from the service 

delivery deadline supported the 

‘‘harmonization of the invoice deadline 

for RHC programs’’ and provided 

‘‘applicants with sufficient time to 

submit their invoices and seek 

reimbursements from the 

Administrator,’’ while being ‘‘necessary 

for the efficient administration of the 

RHC program.’’ 

32. There is currently $22.2 million in 

undisbursed, un-invoiced commitments 

from funding year 2019 and earlier, 

when there was no invoice submission 

deadline. Establishing an invoice 

submission deadline of July 1, 2024, for 

Telecom Program funding requests from 

funding year 2019 and earlier and deobligating unused funding is 

appropriate for several reasons. It is 

highly unlikely, given the significant 

lapse of time, that a significant portion 

of this funding will ever be invoiced, 

and some of these commitments may be 

for services that were ultimately never 

used. At this point, the Administrator 

receives very few invoices for services 

from prior to funding year 2019. 

Further, this deadline provides ample 

time for Program participants to assess 

whether they have undisbursed 

commitments requiring invoicing and to 

complete the invoicing process for those 

funding requests. Any funding deobligated as a result of this change can 

be used for more useful purposes. 

33. Therefore, all existing Telecom 

Program commitments from funding 

year 2019 and earlier must be invoiced 

by July 1, 2024. This decision does not 

affect the invoice deadline for Telecom 

Program funding requests for funding 

year 2020 and later, which are subject 

to the invoice deadlines established in 

§ 54.627 of the Commission’s rules. In 

the event that the Administrator issues 

a funding commitment in the future for 

a funding request for funding year 2019 

or earlier, invoices for that funding 

commitment must be submitted within 

120 days of the issuance of a 

commitment letter. 

III. Procedural Matters 

A. Paperwork Reduction Act Analysis 

34. This document contains new and 

modified information collection 

requirements subject to the Paperwork 

Reduction Act of 1995 (PRA), Public 

Law 104–13. All such requirements will 

be submitted to the Office of 

Management and Budget (OMB) for 

review under section 3507(d) of the 

PRA. OMB, the general public, and 

other federal agencies will be invited to 

comment on any new or modified 

information collection requirements 

contained in this proceeding. The 

Commission will publish a separate 

document in the Federal Register at a 

later date seeking these comments. In 

addition, its noted that, pursuant to the 

Small Business Paperwork Relief Act of 

2002, Public Law 107–198, see 44 U.S.C. 

3506(c)(4), the Commission previously 

sought specific comment on how it 

might further reduce the information 

collection burden for small business 

concerns with fewer than 25 employees. 

35. In this present document, the 

Commission has assessed the effects of 

allowing conditional approvals of 

eligibility, allowing changes to 

evergreen contract dates, and adopting 

for the entire RHC Program eligibility 

form filing requirements that previously 

existed only in the HCF Program and 

finds that the additional funding and 

administrative conveniences these 

changes give health care providers 

justify these changes. 

B. Congressional Review Act 

36. The Commission has determined 

and the Administrator of the Office of 

Information and Regulatory Affairs, 

Office of Management and Budget, 

concurs that the rules are non-major 

under the Congressional Review Act, 5 

U.S.C. 804(2). The Commission will 

send a copy of the Third R&O to 

Congress and the Government 

Accountability Office pursuant to 

Congressional Review Act, see 5 U.S.C. 

801(a)(1)(A). 

37. In addition, the Commission will 

send a copy of the Third R&O, including 

the Final Regulatory Flexibility Analysis 

(FRFA), to the Chief Counsel for 

Advocacy of the Small Business 

Administration pursuant to the Small 

Business Regulatory Enforcement 

Fairness Act of 1996. 

C. Final Regulatory Flexibility Analysis 

38. The Regulatory Flexibility Act of 

1980, as amended (RFA), requires that 

an agency prepare a regulatory 

flexibility analysis for notice-andcomment rulemaking proceedings, 

unless the agency certifies that ‘‘the rule 

will not, if promulgated, have a 

significant economic impact on a 

substantial number of small entities.’’ 

Accordingly, the Commission has 

prepared an FRFA concerning the 

potential impact of the rule and policy 

changes adopted in the Third R&O. 

39. As required by the RFA, an Initial 

Regulatory Flexibility Analysis (IRFA) 

was incorporated into the Second 

FNPRM, FCC 23–6, rel. January 27, 

2023. The Commission sought written 

public comment on the proposals in the 

Second FNPRM, including comment on 

the IRFA. No comments were filed 

addressing the IRFA. This FRFA 

conforms to the RFA. 

i. Need for, and Objectives of, the Third 

R&O 

40. In the Third R&O, the Commission 

seeks to further improve the Rural 

Health Care (RHC) Program’s capacity to 

distribute telecommunications and 

broadband support to health care 

providers—especially small, rural 

healthcare providers (HCPs)—in the 

most equitable and efficient manner 

possible. Over the years, telehealth has 

become an increasingly vital component 

of healthcare delivery to rural 

Americans. Rural healthcare facilities 

are typically limited by the equipment 

and supplies they have and the scope of 

services they can offer, which ultimately 

can have an impact on the availability 

of high-quality health care. Therefore, 

the RHC Program plays a critical role in 

overcoming some of the obstacles 

healthcare providers face in delivering 

their services to rural communities. 

Considering the significance of RHC 

Program support, the Commission 

implements several measures to most 

effectively meet HCPs’ needs while 

responsibly distributing the RHC 

Program’s limited funds. 

41. Additionally, the Third R&O 

adopts proposals from the Second 

FNPRM that allow conditional 

approvals of eligibility to allow soon-tobe eligible providers to engage in 

competitive bidding, align the Service 

Provider Identification Number (SPIN) 

change deadline with the invoice 

deadline, simplify urban rate 

calculations, and allow health care 

providers to change evergreen contract 

dates. The Commission also harmonizes 

the RHC Program eligibility 

determination process by establishing a 

single eligibility determination form for 

the Telecom Program and RHC program 

and announce a new deadline for the 

de-obligation of undisbursed, uninvoiced commitments. 


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ii. Summary of Significant Issues Raised 

by Public Comments in Response to the 

IRFA 

42. There were no comments filed 

that specifically address the rules and 

policies proposed in the IRFA. 

iii. Response to Comments by the Chief 

Counsel for Advocacy of the Small 

Business Administration 

43. Pursuant to the Small Business 

Jobs Act of 2010, which amended the 

RFA, the Commission is required to 

respond to any comments filed by the 

Chief Counsel of the Small Business 

Administration (SBA), and to provide a 

detailed statement of any change made 

to the proposed rule(s) as a result of 

those comments. The Chief Counsel did 

not file any comments in response to the 

proposed rules in this proceeding. 

iv. Description and Estimate of the 

Number of Small Entities to Which the 

Rules Will Apply 

44. The RFA directs agencies to 

provide a description of and, where 

feasible, an estimate of the number of 

small entities that may be affected by 

the rules adopted herein. The RFA 

generally defines the term ‘‘small 

entity’’ as having the same meaning as 

the terms ‘‘small business,’’ ‘‘small 

organization,’’ and ‘‘small governmental 

jurisdiction.’’ In addition, the term 

‘‘small business’’ has the same meaning 

as the term ‘‘small business concern’’ 

under the Small Business Act. A ‘‘small 

business concern’’ is one that: (1) is 

independently owned and operated; (2) 

is not dominant in its field of operation; 

and (3) satisfies any additional criteria 

established by SBA. 

45. Small Businesses, Small 

Organizations, Small Governmental 

Jurisdictions. The Commission’s actions, 

over time, may affect small entities that 

are not easily categorized at present. 

The Commission therefore describes, at 

the outset, three broad groups of small 

entities that could be directly affected 

herein. First, while there are industry 

specific size standards for small 

businesses that are used in the 

regulatory flexibility analysis, according 

to data from SBA’s Office of Advocacy, 

in general a small business is an 

independent business having fewer than 

500 employees. These types of small 

businesses represent 99.9% of all 

businesses in the United States, which 

translates to 33.2 million businesses. 

46. Next, the type of small entity 

described as a ‘‘small organization’’ is 

generally ‘‘any not-for-profit enterprise 

which is independently owned and 

operated and is not dominant in its 

field.’’ The Internal Revenue Service 

(IRS) uses a revenue benchmark of 

$50,000 or less to delineate its annual 

electronic filing requirements for small 

exempt organizations. Nationwide, for 

tax year 2020, there were approximately 

447,689 small exempt organizations in 

the U.S. reporting revenues of $50,000 

or less according to the registration and 

tax data for exempt organizations 

available from the IRS. 

47. Finally, the small entity described 

as a ‘‘small governmental jurisdiction’’ 

is defined generally as ‘‘governments of 

cities, counties, towns, townships, 

villages, school districts, or special 

districts, with a population of less than 

fifty thousand.’’ U.S. Census Bureau 

data from the 2017 Census of 

Governments indicate there were 90,075 

local governmental jurisdictions 

consisting of general purpose 

governments and special purpose 

governments in the United States. Of 

this number, there were 36,931 general 

purpose governments (county, 

municipal, and town or township) with 

populations of less than 50,000 and 

12,040 special purpose governments— 

independent school districts with 

enrollment populations of less than 

50,000. Accordingly, based on the 2017 

U.S. Census of Governments data, the 

Commission estimates that at least 

48,971 entities fall into the category of 

‘‘small governmental jurisdictions.’’ 

a. Healthcare Providers 

48. Offices of Physicians (except 

Mental Health Specialists). This 

industry comprises establishments of 

health practitioners having the degree of 

M.D. (Doctor of Medicine) or D.O. 

(Doctor of Osteopathy) primarily 

engaged in the independent practice of 

general or specialized medicine (except 

psychiatry or psychoanalysis) or 

surgery. These practitioners operate 

private or group practices in their own 

offices (e.g., centers, clinics) or in the 

facilities of others, such as hospitals or 

health maintenance organization (HMO) 

medical centers. The SBA small 

business size standard for this industry 

classifies a business having annual 

receipts of $14 million or less as small. 

The 2017 Economic Census indicates 

that 137,366 firms operated in this 

industry for the entire year. Of this 

number, 126,098 firms had revenue of 

less than $10 million. Based on this 

data, the Commission concludes that a 

majority of firms operating in this 

industry are small under the SBA size 

standard. 

49. Offices of Dentists. This industry 

comprises establishments of health 

practitioners having the degree of 

D.M.D. (Doctor of Dental Medicine), 

D.D.S. (Doctor of Dental Surgery), or 

D.D.Sc. (Doctor of Dental Science) 

primarily engaged in the independent 

practice of general or specialized 

dentistry or dental surgery. These 

practitioners operate private or group 

practices in their own offices (e.g., 

centers, clinics) or in the facilities of 

others, such as hospitals or HMO 

medical centers. They can provide 

either comprehensive preventive, 

cosmetic, or emergency care, or 

specialize in a single field of dentistry. 

The SBA small business size standard 

for this industry classifies a business 

having annual receipts of $8 million or 

less as small. The 2017 Economic 

Census indicates that 113,795 firms 

operated in this industry for the entire 

year. Of that number, 112,332 firms had 

revenue of less than $5 million. Based 

on this data, the Commission concludes 

that a majority of dental businesses are 

small entities. 

50. Offices of Chiropractors. This 

industry comprises establishments of 

health practitioners having the degree of 

DC (Doctor of Chiropractic) primarily 

engaged in the independent practice of 

chiropractic. These practitioners 

provide diagnostic and therapeutic 

treatment of neuromusculoskeletal and 

related disorders through the 

manipulation and adjustment of the 

spinal column and extremities, and 

operate private or group practices in 

their own offices (e.g., centers, clinics) 

or in the facilities of others, such as 

hospitals or HMO medical centers. The 

SBA small business size standard for 

this industry classifies a business 

having annual receipts of $8 million or 

less as small. The 2017 Economic 

Census indicates that 34,414 firms 

operated in this industry for the entire 

year. Of that number, 34,366 firms 

operated with revenue of less than $5 

million per year. Based on this data, the 

Commission concludes that a majority 

of chiropractors are small. 

51. Offices of Optometrists. This 

industry comprises establishments of 

health practitioners having the degree of 

O.D. (Doctor of Optometry) primarily 

engaged in the independent practice of 

optometry. These practitioners examine, 

diagnose, treat, and manage diseases 

and disorders of the visual system, the 

eye and associated structures as well as 

diagnose related systemic conditions. 

Offices of optometrists prescribe and/or 

provide eyeglasses, contact lenses, low 

vision aids, and vision therapy. They 

operate private or group practices in 

their own offices (e.g., centers, clinics) 

or in the facilities of others, such as 

hospitals or HMO medical centers, and 

may also provide the same services as 

opticians, such as selling and fitting 

prescription eyeglasses and contact 


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lenses. The SBA small business size 

standard for this industry classifies a 

business having annual receipts of $8 

million or less as small. The 2017 

Economic Census indicates that 17,879 

firms operated in this industry for the 

entire year. Of this number, 16,792 firms 

had revenue of less than $5 million. 

Based on this data, the Commission 

concludes that a majority of firms in this 

industry are small. 

52. Offices of Mental Health 

Practitioners (except Physicians). This 

industry comprises establishments of 

independent mental health practitioners 

(except physicians) primarily engaged 

in (1) the diagnosis and treatment of 

mental, emotional, and behavioral 

disorders and/or (2) the diagnosis and 

treatment of individual or group social 

dysfunction brought about by such 

causes as mental illness, alcohol and 

substance abuse, physical and 

emotional trauma, or stress. These 

practitioners operate private or group 

practices in their own offices (e.g., 

centers, clinics) or in the facilities of 

others, such as hospitals or HMO 

medical centers. The SBA small 

business size standard for this industry 

classifies a business having annual 

receipts of $8 million or less as small. 

The 2017 Economic Census indicates 

that 19,316 firms operated in this 

industry for the entire year. Of that 

number, 13,318 firms had revenue of 

less than $5 million. Based on this data, 

the Commission concludes that a 

majority of mental health practitioners 

who do not employ physicians are 

small. 

53. Offices of Physical, Occupational 

and Speech Therapists and 

Audiologists. This industry comprises 

establishments of independent health 

practitioners primarily engaged in one 

of the following: (1) providing physical 

therapy services to patients who have 

impairments, functional limitations, 

disabilities, or changes in physical 

functions and health status resulting 

from injury, disease or other causes, or 

who require prevention, wellness or 

fitness services; (2) planning and 

administering educational, recreational, 

and social activities designed to help 

patients or individuals with disabilities, 

regain physical or mental functioning or 

to adapt to their disabilities; and (3) 

diagnosing and treating speech, 

language, or hearing problems. These 

practitioners operate private or group 

practices in their own offices (e.g., 

centers, clinics) or in the facilities of 

others, such as hospitals or HMO 

medical centers. The SBA small 

business size standard for this industry 

classifies a business having annual 

receipts of $11 million or less as small. 

The 2017 Economic Census indicates 

that 22,402 firms in this industry 

operated for the entire year. Of that 

number, 21,712 firms had revenue of 

less than $5 million. Based on this data, 

the Commission concludes that a 

majority of businesses in this industry 

are small. 

54. Offices of Podiatrists. This 

industry comprises establishments of 

health practitioners having the degree of 

D.P.M. (Doctor of Podiatric Medicine) 

primarily engaged in the independent 

practice of podiatry. These practitioners 

diagnose and treat diseases and 

deformities of the foot and operate 

private or group practices in their own 

offices (e.g., centers, clinics) or in the 

facilities of others, such as hospitals or 

HMO medical centers. The SBA small 

business size standard for this industry 

classifies a business having annual 

receipts of $8 million or less as small. 

The 2017 Economic Census indicates 

that 6,673 firms operated in this 

industry for the entire year. Of that 

number, 6,235 firms had revenue of less 

than $5 million. Based on this data, the 

Commission concludes that a majority 

of firms in this industry are small. 

55. Offices of All Other Miscellaneous 

Health Practitioners. This industry 

comprises establishments of 

independent health practitioners 

(except physicians; dentists; 

chiropractors; optometrists; mental 

health specialists; physical, 

occupational, and speech therapists; 

audiologists; and podiatrists). These 

practitioners operate private or group 

practices in their own offices (e.g., 

centers, clinics) or in the facilities of 

others, such as hospitals or HMO 

medical centers. The SBA small 

business size standard for this industry 

classifies firms having annual receipts 

of $9 million or less as small. The 2017 

Economic Census indicates that 14,194 

firms in this industry operated the 

entire year. Of that number, 10,874 

firms had revenue of less than $5 

million. Based on this data, the 

Commission concludes the majority of 

firms in this industry are small. 

56. Family Planning Centers. This 

industry comprises establishments with 

medical staff primarily engaged in 

providing a range of family planning 

services on an outpatient basis, such as 

contraceptive services, genetic and 

prenatal counseling, voluntary 

sterilization, and therapeutic and 

medically induced termination of 

pregnancy. The SBA small business size 

standard for this industry classifies 

firms having annual receipts of $16.5 

million or less as small. The 2017 

Economic Census indicates that 1,339 

firms in this industry operated for the 

entire year. Of that number, 1,014 firms 

had revenue of less than $10 million. 

Based on this data, the Commission 

concludes that the majority of firms in 

this industry is small. 

57. Outpatient Mental Health and 

Substance Abuse Centers. This industry 

comprises establishments with medical 

staff primarily engaged in providing 

outpatient services related to the 

diagnosis and treatment of mental 

health disorders and alcohol and other 

substance abuse. These establishments 

generally treat patients who do not 

require inpatient treatment. They may 

provide a counseling staff and 

information regarding a wide range of 

mental health and substance abuse 

issues and/or refer patients to more 

extensive treatment programs, if 

necessary. The SBA small business size 

standard for this industry classifies a 

firm as small if it has $16.5 million or 

less in annual receipts. The 2017 

Economic Census indicates that 5,637 

firms operated for the entire year. Of 

this number, 4,534 firms had of less 

than $10 million. Based on this data, the 

Commission concludes that a majority 

of firms in this industry are small. 

58. HMO Medical Centers. This 

industry comprises establishments with 

physicians and other medical staff 

primarily engaged in providing a range 

of outpatient medical services to the 

HMO subscribers with a focus generally 

on primary health care. These 

establishments are owned by the HMO. 

HMO establishments that both provide 

health care services and underwrite 

health and medical insurance policies 

are also included in this industry. The 

SBA small business size standard for 

this industry classifies firms having $39 

million or less in annual receipts as 

small. The 2017 U.S. Economic Census 

indicates that 17 firms in this industry 

operated for the entire year. However, 

the 2017 Economic Census does not 

provide disaggregated financial 

information for this industry, therefore 

the Commission cannot determine how 

many of the firms in this industry are 

small under the SBA small business size 

standard. 

59. Freestanding Ambulatory Surgical 

and Emergency Centers. This industry 

comprises establishments with 

physicians and other medical staff 

primarily engaged in (1) providing 

surgical services (e.g., orthoscopic and 

cataract surgery) on an outpatient basis 

or (2) providing emergency care services 

(e.g., setting broken bones, treating 

lacerations, or tending to patients 

suffering injuries as a result of 

accidents, trauma, or medical 

conditions necessitating immediate 

medical care) on an outpatient basis. 


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Outpatient surgical establishments have 

specialized facilities, such as operating 

and recovery rooms, and specialized 

equipment, such as anesthetic or X-ray 

equipment. The SBA small business size 

standard for this industry classifies 

firms having annual receipts of $16.5 

million or less as small. The 2017 U.S. 

Economic Census indicates that 3,888 

firms in this industry operated for the 

entire year. Of that number, 3,132 firms 

had revenue of less than $10 million. 

Based on this data, the Commission 

concludes that a majority of firms in this 

industry are small. 

60. All Other Outpatient Care Centers. 

This industry comprises establishments 

with medical staff primarily engaged in 

providing general or specialized 

outpatient care (except family planning 

centers, outpatient mental health and 

substance abuse centers, HMO medical 

centers, kidney dialysis centers, and 

freestanding ambulatory surgical and 

emergency centers). Centers or clinics of 

health practitioners with different 

degrees from more than one industry 

practicing within the same 

establishment (i.e., Doctor of Medicine 

and Doctor of Dental Medicine) are 

included in this industry. The SBA 

small business size standard for this 

industry classifies a business with 

annual receipts of $22.5 million or less 

as small. The 2017 U.S. Economic 

Census indicates that 5,524 firms 

operated in this industry for the entire 

year. Of this number, 4,584 firms had 

revenue of less than $10 million. Based 

on this data, the Commission concludes 

that a majority of firms in this industry 

are small. 

61. Blood and Organ Banks. This 

industry comprises establishments 

primarily engaged in collecting, storing, 

and distributing blood and blood 

products and storing and distributing 

body organs. The SBA small business 

size standard for this industry classifies 

firms having annual receipts of $35 

million or less as small. The 2017 U.S. 

Census Bureau data indicate that 293 

firms operated in this industry for the 

entire year. Of that number, 219 firms 

operated with revenue of less than $25 

million. Based on this data, the 

Commission concludes the major of 

firms that operate in this industry are 

small. 

62. All Other Miscellaneous 

Ambulatory Health Care Services. This 

U.S. industry comprises establishments 

primarily engaged in providing 

ambulatory health care services (except 

offices of physicians, dentists, and other 

health practitioners; outpatient care 

centers; medical and diagnostic 

laboratories; home health care 

providers; ambulances; and blood and 

organ banks). The SBA small business 

size standard for this industry classifies 

businesses having annual receipts of 

$18 million or less as small. 2017 U.S. 

Bureau Census data show that 2,968 

firms operated in this industry for the 

entire year. Of that number, 2,810 firms 

had revenue of less than $10 million. 

Based on this data, the Commission 

concludes that a majority of the firms in 

this industry are small. This industry 

comprises establishments known as 

medical laboratories primarily engaged 

in providing analytic or diagnostic 

services, including body fluid analysis, 

generally to the medical profession or to 

the patient on referral from a health 

practitioner. The SBA small business 

size standard for this industry classifies 

a business as small if it has annual 

receipts of $36.5 million or less. 2017 

U.S. Census Bureau data indicate that 

2,799 firms operated in this industry for 

the entire year. Of this number, 2,640 

firms had revenue of less than $25 

million. Based on this data, the 

Commission concludes that a majority 

of firms that operate in this industry are 

small. 

63. Medical Laboratories. This 

industry comprises establishments 

known as medical laboratories primarily 

engaged in providing analytic or 

diagnostic services, including body 

fluid analysis, generally to the medical 

profession or to the patient on referral 

from a health practitioner. The SBA 

small business size standard for this 

industry classifies a business as small if 

it has annual receipts of $36.5 million 

or less. 2017 U.S. Census Bureau data 

indicate that 2,799 firms operated in 

this industry for the entire year. Of this 

number, 2,640 firms had revenue of less 

than $25 million. Based on this data, the 

Commission concludes that a majority 

of firms that operate in this industry are 

small. 

64. Diagnostic Imaging Centers. This 

U.S. industry comprises establishments 

known as diagnostic imaging centers 

primarily engaged in producing images 

of the patient generally on referral from 

a health practitioner. The SBA small 

business size standard for this industry 

classifies firms having annual receipts 

of $16.5 million or less as small. The 

2017 U.S. Economic Census indicates 

that 3,556 firms operated in this 

industry for the entire year. Of that 

number, 3,233 firms had revenue of less 

than $10 million. Based on this data, the 

Commission concludes that a majority 

of firms that operate in this industry are 

small. 

65. Home Health Care Services. This 

industry comprises establishments 

primarily engaged in providing skilled 

nursing services in the home, along with 

a range of the following: personal care 

services; homemaker and companion 

services; physical therapy; medical 

social services; medications; medical 

equipment and supplies; counseling; 24- 

hour home care; occupation and 

vocational therapy; dietary and 

nutritional services; speech therapy; 

audiology; and high-tech care, such as 

intravenous therapy. The SBA small 

business size standard for this industry 

classifies a firm having annual receipts 

of $16.5 million or less as small. The 

2017 Economic Census indicates that 

19,414 firms operated in this industry 

for the entire year. Of that number, 

18,291 firms had revenue of less than 

$10 million. Based on this data, the 

Commission concludes that a majority 

of firms that operate in this industry are 

small. 

66. Ambulance Services. This 

industry comprises establishments 

primarily engaged in providing 

transportation of patients by ground or 

air, along with medical care. These 

services are often provided during a 

medical emergency but are not 

restricted to emergencies. The vehicles 

are equipped with lifesaving equipment 

operated by medically trained 

personnel. The SBA small business size 

standard for this industry classifies 

businesses having annual receipts of 

$20 million or less as small. The 2017 

U.S. Economic Census indicates that 

2,744 firms operated in this industry for 

the entire year. Of that number, 2,539 

firms had revenue of less than $10 

million. Based on this data, the 

Commission concludes that a majority 

of firms in this industry is small. 

67. Kidney Dialysis Centers. This 

industry comprises establishments with 

medical staff primarily engaged in 

providing outpatient kidney or renal 

dialysis services. The SBA small 

business size standard for this industry 

classifies firms having annual receipts 

of $41.5 million or less as small. The 

2017 U.S. Economic Census indicates 

that 378 firms operated in this industry 

for the entire year. Of that number, 271 

firms had revenue of less than $25 

million. Based on this data, the 

Commission concludes that a majority 

of firms in this industry are small. 

68. General Medical and Surgical 

Hospitals. This industry comprises 

‘‘establishments known and licensed as 

general medical and surgical hospitals 

primarily engaged in providing 

diagnostic and medical treatment (both 

surgical and nonsurgical) to inpatients 

with any of a wide variety of medical 

conditions. These establishments 

maintain inpatient beds and provide 

patients with food services that meet 

their nutritional requirements. The 


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hospitals have an organized staff of 

physicians and other medical staff to 

provide patient care services and 

usually provide other services, such as 

outpatient services, anatomical 

pathology services, diagnostic X-ray 

services, clinical laboratory services, 

operating room services for a variety of 

procedures, and pharmacy services. The 

SBA small business size standard for 

this industry classifies firms having 

annual receipts of $41.5 million or less 

as small. The 2017 U.S. Economic 

Census indicates that 2,948 firms 

operated in this industry for the entire 

year. Of that number, 705 firms had 

revenue of less than $25 million, while 

709 firms had revenue between $25 

million and $99,999,999 and 1,072 firms 

had revenue greater than $100,000,000. 

Based on this data, the Commission 

concludes that approximately onequarter of firms in this industry are 

small. 

69. Psychiatric and Substance Abuse 

Hospitals. This industry comprises 

establishments known and licensed as 

psychiatric and substance abuse 

hospitals primarily engaged in 

providing diagnostic, medical treatment, 

and monitoring services for inpatients 

who suffer from mental illness or 

substance abuse disorders. The 

treatment often requires an extended 

stay in the hospital. These 

establishments maintain inpatient beds 

and provide patients with food services 

that meet their nutritional requirements. 

They have an organized staff of 

physicians and other medical staff to 

provide patient care services. 

Psychiatric, psychological, and social 

work services are available at the 

facility. These hospitals usually provide 

other services, such as outpatient 

services, clinical laboratory services, 

diagnostic X-ray services, and 

electroencephalograph services. The 

SBA small business size standard for 

this industry classifies a business 

having annual receipts of $41.5 million 

or less as small. 2017 U.S. Census 

Bureau data indicate that 414 firms 

operated in this industry for the entire 

year. Of this number, 174 firms had 

revenue of less than $25 million. The 

Commission notes that 195 firms had 

revenue between $25 million and 

$99,999,999 but are unable to determine 

the number of firms in this group that 

have revenue of $41.5 million or less. 

Thus, based on the available data, under 

the SBA size standard slightly more 

than one-third of the businesses in this 

industry are small. 

70. Specialty (Except Psychiatric and 

Substance Abuse) Hospitals. This 

industry consists of ‘‘establishments 

known and licensed as specialty 

hospitals primarily engaged in 

providing diagnostic, and medical 

treatment to inpatients with a specific 

type of disease or medical condition 

(except psychiatric or substance 

abuse).’’ Hospitals providing long-term 

care for the chronically ill and hospitals 

providing rehabilitation, restorative, and 

adjustive services to physically 

challenged or disabled people are 

included in this industry. These 

establishments maintain inpatient beds 

and provide patients with food services 

that meet their nutritional requirements. 

They have an organized staff of 

physicians and other medical staff to 

provide patient care services. These 

hospitals may provide other services, 

such as outpatient services, diagnostic 

X-ray services, clinical laboratory 

services, operating room services, 

physical therapy services, educational 

and vocational services, and 

psychological and social work services. 

The SBA small business size standard 

for this industry classifies businesses 

having annual receipts of $41.5 million 

or less as small. 2017 U.S. Census 

Bureau data indicate that 346 firms 

operated in this industry for the entire 

year. Of that number, 119 firms had 

revenue of less than $25 million, while 

169 firms had revenue of $25 million or 

more. Based on this data, the 

Commission concludes the less than 

half of the firms in this industry are 

small. 

71. Emergency and Other Relief 

Services. This industry comprises 

establishments primarily engaged in 

providing food, shelter, clothing, 

medical relief, resettlement, and 

counseling to victims of domestic or 

international disasters or conflicts (e.g., 

wars). The SBA small business size 

standard for this industry classifies 

firms having annual receipts of $36.5 

million or less as small. The 2017 U.S. 

Economic Census indicates that 499 

firms operated in this industry for the 

entire year. Of that number, 413 firms 

had revenue of less than $25 million. 

Based on this data, the Commission 

concludes that a majority of firms in this 

industry are small. 

b. Providers of Telecommunications and 

Other Services 

(i) Telecommunications Service 

Providers 

72. The small entities that may be 

affected are Wireline Providers, 

Wireless Carriers and Service Providers, 

and Internet Service Providers. 

(ii) Vendors and Equipment 

Manufacturers 

73. Vendors of Infrastructure 

Development or ‘‘Network Buildout.’’ 

The Commission nor the SBA have 

developed a small business size 

standard specifically directed toward 

manufacturers of network facilities. 

There are two applicable industries in 

which manufacturers of network 

facilities could fall and each have 

different SBA business size standards. 

The applicable industries are ‘‘Radio 

and Television Broadcasting and 

Wireless Communications Equipment’’ 

with a SBA small business size standard 

of 1,250 employees or less, and ‘‘Other 

Communications Equipment 

Manufacturing’’ with a SBA small 

business size standard of 750 employees 

or less.’’ U.S. Census Bureau data for 

2017 show that for Radio and Television 

Broadcasting and Wireless 

Communications Equipment there were 

656 firms in this industry that operated 

for the entire year. Of this number, 624 

firms had fewer than 250 employees. 

For Other Communications Equipment 

Manufacturing, U.S. Census Bureau data 

for 2017 show that there were 321 firms 

in this industry that operated for the 

entire year. Of that number, 310 firms 

operated with fewer than 250 

employees. Based on this data, the 

Commission concludes that the majority 

of firms in this industry are small. 

74. Telephone Apparatus 

Manufacturing. This industry comprises 

establishments primarily engaged in 

manufacturing wire telephone and data 

communications equipment. These 

products may be stand-alone or boardlevel components of a larger system. 

Examples of products made by these 

establishments are central office 

switching equipment, cordless and wire 

telephones (except cellular), private 

branch exchange (PBX) equipment, 

telephone answering machines, local 

area network (LAN) modems, multi-user 

modems, and other data 

communications equipment, such as 

bridges, routers, and gateways. The SBA 

small business size standard for 

Telephone Apparatus Manufacturing 

classifies businesses having 1,250 or 

fewer employees as small. U.S. Census 

Bureau data for 2017 show that there 

were 189 firms in this industry that 

operated for the entire year. Of this 

number, 177 firms operated with fewer 

than 250 employees. Thus, under the 

SBA size standard, the majority of firms 

in this industry can be considered 

small. 

75. Radio and Television 

Broadcasting and Wireless 

Communications Equipment 


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Manufacturing. This industry comprises 

establishments primarily engaged in 

manufacturing radio and television 

broadcast and wireless communications 

equipment. Examples of products made 

by these establishments are: 

transmitting and receiving antennas, 

cable television equipment, global 

positioning system (GPS) equipment, 

pagers, cellular phones, mobile 

communications equipment, and radio 

and television studio and broadcasting 

equipment. The SBA small business size 

standard for this industry classifies 

businesses having 1,250 employees or 

less as small. U.S. Census Bureau data 

for 2017 show that there were 656 firms 

in this industry that operated for the 

entire year. Of this number, 624 firms 

had fewer than 250 employees. Thus, 

under the SBA size standard, the 

majority of firms in this industry can be 

considered small. 

76. Other Communications 

Equipment Manufacturing. This 

industry comprises establishments 

primarily engaged in manufacturing 

communications equipment (except 

telephone apparatus, and radio and 

television broadcast, and wireless 

communications equipment). Examples 

of such manufacturing include fire 

detection and alarm systems 

manufacturing, Intercom systems and 

equipment manufacturing, and signals 

(e.g., highway, pedestrian, railway, 

traffic) manufacturing. The SBA small 

business size standard for this industry 

classifies firms having 750 or fewer 

employees as small. U.S. Census Bureau 

data for 2017 show that 321 firms in this 

industry operated for the entire year. Of 

this number, 310 firms operated with 

fewer than 250 employees. Based on 

this data, the Commission concludes 

that the majority of firms in this 

industry are small. 

v. Description of Projected Reporting, 

Recordkeeping, and Other Compliance 

Requirements for Small Entities 

77. The rules adopted in the Third 

R&O will result in modified reporting, 

recordkeeping, or other compliance 

requirements for small and other 

entities. Applicants that request 

conditional approval for eligibility must 

submit an eligibility determination and 

supporting documentation, along with 

an estimated date to meet all eligibility 

requirements. They must also be located 

in a rural area as defined in § 54.600(e) 

of the Commission’s rules by the 

estimated eligibility date, or plan to be 

a member of a majority-rural Healthcare 

Connect Fund (HCF) Program 

consortium that satisfies the eligible 

rural health care provider composition 

requirement set forth in § 54.607(b) of 

the Commission’s rules by the estimated 

eligibility date. An applicant with 

conditional eligibility that plans to 

engage in competitive bidding must 

indicate that the eligibility is 

conditional, and state the estimated date 

of eligibility on its competitive bidding 

form. Applicants with conditional 

approval of eligibility must also notify 

the Universal Service Administrative 

Company (Administrator) within 30 

calendar days of its actual eligibility 

date and provide documentation 

confirming eligibility. Beginning 

funding year 2025, a single eligibility 

determination form for the RHC 

Program for both the Telecom Program 

and the HCF Program, FCC Form 469, 

will be required to be filed once. 

Applicants will use the FCC Form 460 

for eligibility determinations in the 

Telecom Program and the eligibility 

determination portion will be 

eliminated from the FCC Form 465. The 

Commission also amends § 54.601(b) of 

the Commission’s rules to require health 

care providers in both programs to 

notify the Administrator of changes to 

their name, location, contact 

information, or eligible entity type. 

Telecom Program providers with 

invoices for funding years 2019 and 

earlier, must submit invoices by July 1, 

2024, after which, any funding 

commitments for 2019 and earlier will 

be de-obligated and providers will not 

be able to invoice for services. 

78. The Commission expects the 

actions taken in the Third R&O will 

achieve the goals of improving the 

effectiveness and efficiency of the RHC 

Program without placing significant 

additional costs and burdens on small 

entities. At present, there is not 

sufficient information on the record to 

quantify the cost of compliance for 

small entities, however, the Commission 

anticipates that the compliance 

obligations for small providers will be 

outweighed by the benefits of improving 

the RHC Program’s capacity to distribute 

telecommunications and broadband 

support to rural health care providers. 

vi. Steps Taken To Minimize the 

Significant Economic Impact on Small 

Entities, and Significant Alternatives 

Considered 

79. The RFA requires an agency to 

provide ‘‘a description of the steps the 

agency has taken to minimize the 

significant economic impact on small 

entities . . . including a statement of 

the factual, policy, and legal reasons for 

selecting the alternative adopted in the 

final rule and why each one of the other 

significant alternatives to the rule 

considered by the agency which affect 

the impact on small entities was 

rejected.’’ 

80. In the Third R&O, the Commission 

takes steps to minimize the economic 

impact on small entities with the rule 

changes that are adopted. For example, 

conditional approval of eligibility for 

RHC Program funding will allow soonto-be eligible providers to begin 

competitive bidding and request 

funding so that they may receive 

support as soon as they become eligible. 

The Commission aligns the SPIN change 

deadline with the invoice filing 

deadline to give small entities more 

time to complete SPIN changes. The 

Commission simplifies urban rate 

calculations by eliminating the standard 

urban distance provision, which will 

ease administrative burdens on small 

entities. The Commission changes 

evergreen contract dates to provide 

small entities with the benefits of 

evergreen contract designation across 

the full length of the contract’s term. As 

a part of the reforms to use the same 

form for eligibility determinations in the 

Telecom and HCF Program, the 

Commission allows small entities to 

continue using their existing eligibility 

determinations. Finally, in establishing 

an invoice deadline for funding year 

2019 and earlier, the Commission 

provides ample time for small providers 

and other entities to meet that deadline. 

These actions will promote efficiency 

and promote the goals of these 

programs, while strengthening 

protections against waste, fraud and 

abuse. 

vii. Report to Congress 

81. The Commission will send a copy 

of the Third R&O, including the FRFA, 

in a report to Congress pursuant to the 

Congressional Review Act. In addition, 

the Commission will send a copy of the 

Third R&O, including the FRFA, to the 

Chief Counsel for Advocacy of the SBA. 

A copy of the Third R&O and FRFA (or 

summaries thereof) will also be 

published in the Federal Register. 

IV. Ordering Clauses 

82. Accordingly, it is ordered, 

pursuant to the authority contained in 

sections 1, 4(j), 214, and 254 of the 

Communications Act of 1934, as 

amended, 47 U.S.C. 151, 154(j), 214, and 

254 and § 1.429 of the Commission’s 

rules, 47 CFR 1.429, that the Third R&O 

is adopted. 

83. It is further ordered, that pursuant 

to § 1.103 of the Commission’s rules, the 

provisions of the Third R&O will 

become effective February 12, 2024, 

unless indicated otherwise herein. 

84. It is further ordered, that pursuant 

to the authority contained in sections 1– 


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4, 201 through 205, 254, 303(r), and 403 

of the Communications Act of 1934, as 

amended, 47 U.S.C. 151–154, 201–205, 

254, 303(r), and 403, and section 706 of 

the Telecommunications Act of 1996, 47 

U.S.C. 1302, part 54 of the 

Commission’s rules, 47 CFR part 54, is 

amended, and such rule amendments 

shall be effective February 12, 2024, 

except for §§ 54.601(b) and (c) and 

54.622(e)(1)(i) through (ii) and (i)(3)(iv), 

which may contain new or modified 

information collection requirements, 

will not become effective until the 

Office of Management and Budget 

completes any required review under 

the Paperwork Reduction Act. The 

Commission directs the Wireline 

Competition Bureau to publish a 

document in the Federal Register 

announcing completion of such reviews 

and the relevant effective dates. 

List of Subjects in 47 CFR Part 54 

Communications common carriers, 

Health facilities, Infants and children, 

Internet, Puerto Rico, Reporting and 

recordkeeping requirements, 

Telecommunications, Telephone, Virgin 

Islands. 

Federal Communications Commission. 

Marlene Dortch, 

Secretary. 

Final Rules 

For the reasons discussed in the 

preamble, the Federal Communications 

Commission amends 47 CFR part 54 as 

follows: 

PART 54—UNIVERSAL SERVICE 

■ 1. The authority citation for part 54 

continues to read as follows: 

Authority: 47 U.S.C. 151, 154(i), 155, 201, 

205, 214, 219, 220, 229, 254, 303(r), 403, 

1004, 1302, 1601–1609, and 1752, unless 

otherwise noted. 

■ 2. Delayed indefinitely, amend 

§ 54.601 by revising paragraph (b) and 

adding paragraph (c) to read as follows: 

§ 54.601 Health care provider eligibility. 

* * * * * 

(b) Determination of health care 

provider eligibility for the Rural Health 

Care Program. (1) Before funding year 

2025, health care providers in the 

Healthcare Connect Fund Program may 

certify to the eligibility of particular 

sites at any time prior to, or 

concurrently with, filing a request for 

services to initiate competitive bidding 

for the site. Applicants who utilize a 

competitive bidding exemption must 

provide eligibility information for the 

site to the Administrator prior to, or 

concurrently with, filing a request for 

funding for the site. Health care 

providers must also notify the 

Administrator within 30 days of a 

change in the health care provider’s 

name, site location, contact information, 

or eligible entity type. 

(2) Effective for funding year 2025, 

applicants in the Rural Health Care 

Program may certify to the eligibility of 

particular sites prior to, or concurrently 

with, filing a request for services to 

initiate competitive bidding for the site. 

Applicants who utilize a competitive 

bidding exemption must provide 

eligibility information for the site to the 

Administrator prior to, or concurrently 

with, filing a Request for Funding for 

the site. Health care providers must 

notify the Administrator within 30 days 

of a change in the health care provider’s 

name, site location, contact information, 

or eligible entity type. 

(c) Conditional approval of eligibility. 

Effective for funding year 2025: 

(1) An entity that does not yet meet 

all eligibility requirements under the 

Rural Health Care Program may request 

and receive a conditional approval of 

eligibility from the Administrator if the 

entity provides documentation showing 

that it satisfies the following 

requirements: 

(i) The entity is or reasonably expects 

to qualify as a public or non-profit 

health care provider as defined in 

§ 54.600(b) by an estimated eligibility 

date; 

(ii) The entity is or reasonably expects 

to be physically located in a rural area 

defined in § 54.600(e) by the estimated 

eligibility date or, for the Healthcare 

Connect Fund Program only, is not 

located in a rural area but is or plans to 

be a member of a majority-rural 

Healthcare Connect Fund Program 

consortium that satisfies the eligible 

rural health care provider composition 

requirement set forth in § 54.607(b) by 

the estimated eligibility date; and 

(iii) The estimated eligibility date is in 

the same funding year as or in the next 

funding year of the date that the entity 

requests the conditional approval of 

eligibility. 

(2) An entity that receives conditional 

approval of eligibility may conduct 

competitive bidding for the site. An 

entity engaging in competitive bidding 

with conditional approval of eligibility 

must provide a written notification to 

potential bidders that the entity’s 

eligibility is conditional and specify the 

estimated eligibility date. 

(3) An entity that receives conditional 

approval of eligibility may file a request 

for funding for the site during an 

application filing window opened for a 

funding year that ends after the 

estimated eligibility date. The 

Administrator shall not issue any 

funding commitments to applicants that 

have received conditional approval of 

eligibility only. Funding commitments 

may be issued only after such applicants 

receive formal approval of eligibility as 

described in paragraph (c)(4) of this 

section. 

(4) An entity that receives conditional 

approval of eligibility is expected to 

notify the Administrator, along with 

supporting documentation for the 

eligibility, within 30 days of its actual 

eligibility date. The actual eligibility 

date is the date that the entity qualifies 

as a public or non-profit health care 

provider as defined in § 54.600(b) and 

meets the requirements under paragraph 

(c)(1)(ii) of this section. The actual 

eligibility date may be a different date 

from the estimated eligibility date. The 

Administrator shall formally approve 

the entity’s eligibility if the entity meets 

the requirements for a public or nonprofit health care provider defined in 

§ 54.600(b) and the requirements under 

paragraph (c)(1)(ii) of this section. Upon 

the entity receiving a formal approval of 

eligibility, the Administrator may issue 

funding commitments covering a time 

period that starts no earlier than the 

entity’s actual eligibility date and that is 

within the funding year for which 

support was requested. 

■ 3. Revise § 54.604 to read as follows: 

§ 54.604 Determining the urban rate. 

(a) Effective funding year 2024: 

(1) If a rural health care provider 

requests support for an eligible service 

to be funded from the 

Telecommunications Program that is to 

be provided over a distance that is less 

than or equal to the ‘‘standard urban 

distance,’’ as defined in paragraph (a)(3) 

of this section, for the state in which it 

is located, the ‘‘urban rate’’ for that 

service shall be a rate no higher than the 

highest tariffed or publicly-available 

rate charged to a commercial customer 

for a functionally similar service in any 

city with a population of 50,000 or more 

in that state, calculated as if it were 

provided between two points within the 

city. 

(2) If a rural health care provider 

requests an eligible service to be 

provided over a distance that is greater 

than the ‘‘standard urban distance,’’ as 

defined in paragraph (a)(3) of this 

section, for the state in which it is 

located, the urban rate for that service 

shall be a rate no higher than the highest 

tariffed or publicly-available rate 

charged to a commercial customer for a 

functionally similar service provided 

over the standard urban distance in any 

city with a population of 50,000 or more 

in that state, calculated as if the service 


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were provided between two points 

within the city. 

(3) The ‘‘standard urban distance’’ for 

a state is the average of the longest 

diameters of all cities with a population 

of 50,000 or more within the state. 

(4) The Administrator shall calculate 

the ‘‘standard urban distance’’ and shall 

post the ‘‘standard urban distance’’ and 

the maximum supported distance for 

each state on its website. 

(b) As of funding year 2025, if a rural 

health care provider requests support 

for an eligible service to be funded from 

the Telecommunications Program the 

‘‘urban rate’’ for that service shall be a 

rate no higher than the highest tariffed 

or publicly-available rate charged to a 

commercial customer for a functionally 

similar service in any city with a 

population of 50,000 or more in that 

state, calculated as if it were provided 

between two points within the city. 

■ 4. Delayed indefinitely, amend 

§ 54.622 by revising paragraphs (e)(1)(i) 

and (ii) and adding paragraph (i)(3)(iv) 

to read as follows: 

§ 54.622 Competitive bidding requirements 

and exemptions. 

* * * * * 

(e) * * * 

(1) * * * 

(i) The entity seeking supported 

services is a public or nonprofit health 

care provider that falls within one of the 

categories set forth in the definition of 

health care provider listed in § 54.600, 

or expects to be such a public or 

nonprofit health care provider before 

the end of the funding year for which 

the supported services are requested 

provided that the entity has received a 

conditional approval of eligibility 

pursuant to § 54.601(c); 

(ii) The health care provider seeking 

supported services is physically located 

in a rural area as defined in § 54.600 or 

is a member of a Healthcare Connect 

Fund Program consortium which 

satisfies the rural health care provider 

composition requirements set forth in 

§ 54.607(b). If an entity seeks supported 

services under a conditional approval of 

eligibility set forth in § 54.601(c), the 

entity expects to be located in a rural 

area defined in § 54.600 before the end 

of the funding year for which the 

supported services are requested, or 

plans to be a member of a Healthcare 

Connect Fund Program consortium 

which satisfies the rural health care 

provider composition requirements set 

forth in § 54.607(b) before the end of the 

funding year for which the supported 

services are requested; 

* * * * * 

(i) * * * 

(3) * * * 

(iv) As of funding year 2024, if the 

date that services start under an 

evergreen contract differs from the date 

services were estimated to start, 

participants may request a change of the 

start date and end date of their 

evergreen contract within 60 days of the 

actual service start date provided the 

terms of the evergreen contract support 

such a change. Upon approving a 

requested change, the Administrator 

will issue a revised funding 

commitment letter to the health care 

provider reflecting the changed dates. If 

the Administrator denies a requested 

change, it will issue a letter to the health 

care provider explaining the basis for 

the denial. 

* * * * * 

■ 5. Amend § 54.625 by revising 

paragraph (c) to read as follows: 

§ 54.625 Service Provider Identification 

Number (SPIN) changes. 

* * * * * 

(c) Filing deadline. An applicant must 

file its request for a corrective or 

operational SPIN change with the 

Administrator no later than the invoice 

filing deadline as defined by § 54.627. 

[FR Doc. 2024–00415 Filed 1–10–24; 8:45 am] 

BILLING CODE 6712–01–P 


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