[Federal Register Volume 70, Number 24 (Monday, February 7, 2005)]
[Proposed Rules]
[Pages 6390-6393]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-2268]


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FEDERAL COMMUNICATIONS COMMISSION

47 CFR Part 54

[WC Docket No. 02-60; FCC 04-289]


Rural Health Care Support Mechanism

AGENCY: Federal Communications Commission.

ACTION: Notice of proposed rulemaking.

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SUMMARY: In this document, we modify our rules to improve the 
effectiveness of the rural health care universal service support 
mechanism. In the Further Notice of Proposed Rulemaking (FNPRM), we 
seek comment on whether we should increase the percentage discount that 
rural health care providers receive for Internet access and whether 
infrastructure development should be funded. Additionally, we seek 
comment on whether to modify our rules specifically to allow mobile 
rural health care providers to use services other than satellite.

DATES: Comments are due on or before April 8, 2005. Reply comments are 
due on or before May 9, 2005.

FOR FURTHER INFORMATION CONTACT: Regina Brown at (202) 418-0792 or Dana 
Bradford at (202) 418-1932, Wireline Competition Bureau, 
Telecommunications Access Policy Division, TTY (202) 418-0484.

SUPPLEMENTARY INFORMATION: This is a summary of the Commission's 
Further Notice of Proposed Rulemaking, in WC Docket No. 02-60 released 
on December 17, 2004. A companion Report and Order and Order on 
Reconsideration was also released on December 17, 2004. The full text 
of this document is available for public inspection during regular 
business hours in the FCC Reference Center, Room CY-A257, 445 12th 
Street, SW., Washington, DC 20554.

I. Further Notice of Proposed Rulemaking

A. Internet Access

    1. In the 2003 Report and Order, 68 FR 74492, December 24, 2003, 
the Commission concluded that support equal to 25 percent of the 
monthly cost for any form of Internet access reasonably related to the 
health care needs of the facility should be provided to rural health 
care providers. The Commission specifically noted that it was acting 
conservatively by choosing a 25 percent flat discount initially. 
Because requests for Internet access discounts have remained at low 
levels, to seek comment on whether a 25 percent flat discount off the 
cost of monthly Internet access for eligible rural health care 
providers is sufficient. We continue to believe that a flat discount 
will lead to greater predictability and fairness among health care 
providers. We encourage commenters to be specific as to the level of 
support that we should offer, and to provide us with the facts that 
they rely upon in advocating a level of support.
    2. Further, to accurately gauge the demand for support under the 
rural health care mechanism, we seek comment on the effect that an 
increase in Internet access support would have on the demand for 
support from rural health care providers. We therefore seek comment 
from rural health care providers on the demand for Internet access, and 
from service providers on the cost of such services. We seek comment on 
whether demand for Internet access is likely to reach the $400 million 
cap on the amount of support to be provided by the rural health care 
mechanism, and how increased demand would affect the operation of the 
rural health care mechanism.
    3. We also seek comment on the positive or negative effects that a 
decision to increase Internet access support will have on the rural 
health care support mechanism, from the perspective of the health care 
providers, the service providers, and USAC. We encourage parties to 
discuss any issues relevant to whether we should provide increased 
support for Internet access, what level of support to provide, what 
restrictions, if any, we should place on such support, what 
administrative problems and concerns may arise if we provide increased 
support, and the impact of an increase in support on the mechanism's 
ability to support other services. Specifically, we seek comment on 
whether an increase of support would have positive or negative effects 
on facilities-based broadband deployment in rural areas.

B. Support for Other Telecommunications Services for Mobile Rural 
Health Care Providers

    4. In the companion Report and Order, we revise our policy to allow 
mobile rural health care clinics to receive discounts for satellite 
services calculated by comparing the actual cost of the satellite 
service to the rate for an urban wireline service with a similar 
bandwidth. We recognize that not only satellite services but other 
telecommunications platforms, such as terrestrial wireless, may provide 
the most cost-effective means of providing the telemedicine link. 
Because we want to encourage mobile health care providers to consider 
all available telecommunications services when determining which 
service best suits the needs of the telemedicine project, we seek 
comment on whether to modify our rules specifically to allow mobile 
rural health care providers to use services other than satellite. We 
seek comment on what other telecommunications services might be 
available to support mobile rural telemedicine projects. We ask 
commenters to address how such service may be a more cost-effective 
method of providing service than a satellite connection. We also 
request whether services other than satellite services would require 
different rules, different eligibility criteria or any other changes 
from the rules we establish today.

C. Support for Infrastructure Development

    5. In the 1997 Universal Service Order, 62 FR 32862, June 17, 1997, 
the Commission requested comment on whether and how to support 
infrastructure development or ``network buildout'' needed to enhance 
public and not-for-profit health care providers' access to advanced 
telecommunications and information services. At the time, the 
Commission noted that the record contained anecdotal evidence regarding 
the need for support for infrastructure development. We now seek to 
refresh the record on this issue.
    6. In the 1997 Universal Service Order, the Commission agreed with 
MCI that infrastructure development is not a ``telecommunications 
service'' within the scope of section 254(h)(1)(A) and concluded that 
the Commission has the discretionary authority to establish rules to 
implement a program of universal

[[Page 6391]]

service support for infrastructure development as a method to enhance 
access to advanced telecommunications and information services under 
section 254(h)(2)(A), as long as such a program is competitively 
neutral, technically feasible, and economically reasonable. Section 
254(h)(2)(A) directs the Commission to establish competitively neutral 
rules ``to enhance, to the extent technically feasible and economically 
reasonable, access to advanced telecommunications and information 
services for all * * * health care providers.'' Extending or upgrading 
existing telecommunications infrastructure could enhance access to the 
advanced services that may be offered over that infrastructure. 
Alternatively, in the schools and libraries context, the Commission has 
recognized that some carrier infrastructure costs may be passed on as a 
component of monthly service charges.
    7. Should the Commission authorize support for upgrades to the 
public switched or backbone networks? How would the program be 
structured so that it is competitively neutral, technically feasible 
and economically reasonable? If so, how should the Commission limit 
such support so that funds are only provided when such upgrades can be 
shown to be necessary to deliver services to eligible health care 
providers? Should certifications or other evidence of necessity 
attesting to the use of such support be required from the rural health 
care provider or the service provider? Are other safeguards required to 
ensure that no waste, fraud or abuse occurs? Should these charges be 
prorated over a specified number of years? Commenters should provide 
specific information on the probable costs, advantages, and 
disadvantages of supporting such upgrades. Commenters should also 
provide information regarding the effect on the fund's resources.

II. Procedural Matters

A. Initial Regulatory Flexibility Analysis

    8. As required by the Regulatory Flexibility Act of 1980, as 
amended (RFA), the Commission has prepared the present Initial 
Regulatory Flexibility Analysis (IRFA) of the possible significant 
economic impact on a substantial number of small entities by the 
policies and rules proposed in this FNPRM. Written public comments are 
requested on this IRFA. Comments must be identified as responses to the 
IRFA and must be filed by the deadlines for comments on the FNPRM. The 
Commission will send a copy of the FNPRM, including this IRFA, to the 
Chief Counsel for Advocacy of the Small Business Administration. In 
addition, the FNPRM and IRFA (or summaries thereof) will be published 
in the Federal Register.

B. Need for, and Objectives of, the Proposed Rules

    9. The Commission is required by section 254 of the Act to 
promulgate rules to implement the universal service provisions of 
section 254. On May 8, 1997, the Commission adopted rules that reformed 
its system of universal service support mechanisms so that universal 
service is preserved and advanced as markets move toward competition. 
Among other programs, the Commission adopted a program to provide 
discounted telecommunications services to public or non-profit health 
care providers that serve persons in rural areas. Important changes in 
the rural health community over the past few years, such as 
technological advances and the variety of needs of the rural health 
care community, prompt us to review the rural health care universal 
service support mechanism.
    10. In this FNPRM, we seek comment on whether we should increase 
the percentage discount that rural health care providers receive for 
Internet access. To the extent that we were concerned, in the 2003 
Report and Order, that demand for Internet access support would exceed 
the annual funding cap, to date, those concerns have not come to 
fruition at this time. Therefore, we take this opportunity to seek 
comment on whether a 25 percent flat discount off the cost of monthly 
Internet access for eligible rural health care providers is sufficient. 
We also seek comment, in the FNPRM, on whether infrastructure 
development should be funded. In the 1997 Universal Service Order, the 
Commission requested comment on whether and how to support 
infrastructure development or ``network buildout'' needed to enhance 
public and not-for-profit health care providers' access to advanced 
telecommunications and information services. At the time, the 
Commission noted that the record contained anecdotal evidence regarding 
the need for support for infrastructure development. We now seek to 
refresh the record on this issue. Additionally, in the FNPRM, we seek 
comment on whether to modify our rules specifically to allow mobile 
rural health care providers to use services other than satellite. In 
the companion Report and Order, we revise our policy to allow mobile 
rural health care providers to receive discounts for satellite services 
calculated by comparing the actual cost of the satellite service to the 
rate for an urban wireline service with a similar bandwidth. However, 
we recognize that not only satellite services but other 
telecommunications platforms, such as terrestrial wireless, may provide 
the most cost-effective means of providing the telemedicine link. 
Therefore, because we want to encourage mobile health care providers to 
consider all available telecommunications services when determining 
which service best suits the needs of the telemedicine project, we seek 
comment on whether to allow mobile rural health care providers to use 
telecommunications services other than satellite.

C. Legal Basis

    11. This FNPRM is adopted pursuant to sections 1, 4(i), (4j), 201, 
202, 254, and 303 of the Communications Act of 1934, as amended, 47 
U.S.C. 151, 154(i), (j), 201, 202, 254, and 303.

D. Description and Estimate of the Number of Small Entities to Which 
Rules Will Apply

    12. The RFA directs agencies to provide a description of and, where 
feasible, an estimate of the number of small entities that will be 
affected by the proposed rules, if adopted. 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 which: (1) Is independently owned 
and operated; (2) is not dominant in its field of operation; and (3) 
satisfies any additional criteria established by the Small Business 
Administration (SBA).
    13. We have described in detail in the Final Regulatory Flexibility 
Analysis (FRFA) to the companion Report and Order the categories of 
entities that may be directly affected by any rules or proposals 
adopted in our efforts to reform the universal service rural health 
care support mechanism. For this IRFA, we hereby incorporate those 
entity descriptions by reference.

E. Description of Projected Reporting, Recordkeeping, and Other 
Compliance Requirements

    14. This FNPRM seeks comment on whether we should increase the 
percentage discount that rural health care providers receive for 
Internet access and whether infrastructure development should be 
funded. These potential changes will not impact

[[Page 6392]]

reporting or recordkeeping requirements. They may, however, increase 
the number of applicants. Additionally, the FNPRM seeks comment on 
whether to modify our policy specifically to allow mobile rural health 
care providers to use services other than satellite services, such as 
terrestrial wireless. If this proposal is adopted, mobile rural health 
care providers could potentially be required to submit additional 
information regarding their mobile services, if they choose to seek 
discounts. Any reporting and/or recordkeeping requirements adopted as 
part of this modification would only minimally impact both small and 
large entities. However, any minimal impact of such requirements would 
be outweighed by the benefit of providing support necessary to make 
mobile telemedicine economical for rural health care providers to 
provide high-quality health care to rural and remote areas, and to make 
telecommunications rates for public and non-profit rural health care 
providers comparable to those paid in urban areas. Further, such 
requirement/s may be necessary to ensure that the statutory goals of 
section 254 of the Telecommunications Act of 1996 are met without 
waste, fraud, or abuse.

F. Steps Taken To Minimize Significant Economic Impact on Small 
Entities, and Significant Alternatives Considered

    15. The RFA requires an agency to describe any significant, 
specifically small business, alternatives that it has considered in 
reaching its proposed approach, which may include the following four 
alternatives (among others): (1) The establishment of differing 
compliance or reporting requirements or timetables that take into 
account the resources available to small entities; (2) the 
clarification, consolidation, or simplification of compliance or 
reporting requirements under the rule for small entities; (3) the use 
of performance, rather than design, standards; and (4) an exemption 
from coverage of the rule, or any part thereof, for small entities.
    16. In the FNPRM, we seek comment on whether we should increase the 
percentage discount that rural health care providers receive for 
Internet. We also seek comment on whether infrastructure development 
should be funded by the universal service fund. Further, in the Further 
Notice, we seek comment on whether to modify our rules specifically to 
allow mobile rural health care providers to use services other than 
satellite, such as terrestrial wireless, to provide support to mobile 
rural health care providers. If these proposals are adopted, we believe 
the proposed changes will help small businesses by providing additional 
support under the rural health care mechanism than is currently 
available and provide rural health care providers with greater 
flexibility in choosing the services that best suit their needs. These 
proposed changes could potentially increase the number of applicants, 
including small entities, seeking support under the rural health care 
support mechanism. Affected small businesses could include rural health 
care providers and small companies serving those rural health care 
providers. In seeking to minimize any burdens imposed on small 
entities, where doing so does not compromise the goals of the universal 
service mechanism, we invite comment on alternative ways to minimize 
any significant economic impact of our proposals on small entities and 
on any alternatives to these proposals that may be more beneficial to 
small entities.

G. Federal Rules That May Duplicate, Overlap, or Conflict With the 
Proposed Rules

    17. None

H. Filing Procedures

    18. We invite comment on the issues and questions set forth in the 
FNPRM and IRFAs contained herein. Pursuant to sections 1.415 and 1.419 
of the Commission's rules, comments are due on or before April 8, 2005, 
and reply comments on or before May 9, 2005. In order to facilitate 
review of comments and reply comments, parties should include the name 
of the filing party and the date of the filing on all pleadings. 
Comments may be filed using the Commission's Electronic Comment Filing 
System (ECFS) or by filing paper copies.
    19. Comments filed through the ECFS can be sent as an electronic 
file via the Internet to http://www.fcc.gov/cgb/ecfs. Generally, only 
one copy of an electronic submission must be filed. If multiple docket 
or rulemaking numbers appear in the caption of this proceeding, 
however, commenters must transmit one electronic copy of the comments 
to each docket or rulemaking number referenced in the caption. In 
completing the transmittal screen, commenters should include their full 
name, U.S. Postal Service mailing address, and the applicable docket or 
rulemaking number. Parties may also submit an electronic comment by 
Internet e-mail. To get filing instructions for e-mail comments, 
commenters should send an e-mail to <a href="/cdn-cgi/l/email-protection#d0b5b3b6a390b6b3b3feb7bfa6"><span class="__cf_email__" data-cfemail="395c5a5f4a795f5a5a175e564f">[email protected]</span></a>, and should include 
the following words in the body of the message, ``get form.'' A sample 
form and directions will be sent in reply. Or you may obtain a copy of 
the ASCII Electronic Transmittal Form (FORM-ET) at http://www.fcc.gov/e-file/email.html.
    20. Parties that choose to file by paper must file an original and 
four copies of each filing. Filings can be sent by hand or messenger 
delivery, by commercial overnight courier, or by first-class or 
overnight U.S. Postal Service mail (although we continue to experience 
delays in receiving U.S. Postal Service mail). The Commission's 
contractor, Natek, Inc., will receive hand-delivered or messenger-
delivered paper filings for the Commission's Secretary at a new 
location in downtown Washington, DC. The address is 236 Massachusetts 
Avenue, NE., Suite 110, Washington, DC 20002. The filing hours at this 
location will be 8 a.m. to 7 p.m. All hand deliveries must be held 
together with rubber bands or fasteners. Any envelopes must be disposed 
of before entering the building.
    21. Commercial overnight mail (other than U.S. Postal Service 
Express Mail and Priority Mail) must be sent to 9300 East Hampton 
Drive, Capitol Heights, MD 20743. U.S. Postal Service first-class mail, 
Express Mail, and Priority Mail should be addressed to 445 12th Street, 
SW., Washington, DC 20554. All filings must be addressed to the 
Commission's Secretary, Office of the Secretary, Federal Communications 
Commission.

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    If you are sending this type of
 document or using this delivery method     It should be addressed for
                 . . .                          delivery to . . .
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Hand-delivered or messenger-delivered    236 Massachusetts Avenue, NE.,
 paper filings for the Commission's       Suite 110, Washington, DC
 Secretary.                               20002 (8 a.m. to 7 p.m.).
Other messenger-delivered documents,     9300 East Hampton Drive,
 including documents sent by overnight    Capitol Heights, MD 20743 (8
 mail (other United States Postal         a.m. to 5:30 p.m.).
 Service Express Mail and Priority
 Mail).

[[Page 6393]]

 
United States Postal Service first-      445 12th Street, SW.,
 class mail, Express Mail, and Priority   Washington, DC 20554.
 Mail.
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    22. Parties who choose to file by paper should also submit their 
comments on diskette. These diskettes, plus one paper copy, should be 
submitted to: Sheryl Todd, Telecommunications Access Policy Division, 
Wireline Competition Bureau, Federal Communications, at the filing 
window at 236 Massachusetts Avenue, NE., Suite 110, Washington, DC 
20002. Such a submission should be on a 3.5-inch diskette formatted in 
an IBM compatible format using Word or compatible software. The 
diskette should be accompanied by a cover letter and should be 
submitted in ``read only'' mode. The diskette should be clearly labeled 
with the commenter's name, proceeding (including the docket number, in 
this case WC Docket No. 02-60, type of pleading (comment or reply 
comment), date of submission, and the name of the electronic file on 
the diskette. The label should also include the following phrase ``Disk 
Copy--Not an Original.'' Each diskette should contain only one party's 
pleadings, preferably in a single electronic file. In addition, 
commenters must send diskette copies to the Commission's copy 
contractor, Best Copy and Printing, Inc., Portals II, 445 12th Street, 
SW., Room CYB402, Washington, DC 20554 (see alternative addresses above 
for delivery by hand or messenger).
    23. Regardless of whether parties choose to file electronically or 
by paper, parties should also file one copy of any documents filed in 
this docket with the Commission's copy contractor, Best Copy and 
Printing, Inc., Portals II, 445 12th Street SW., CY-B402, Washington, 
DC 20554 (see alternative addresses above for delivery by hand or 
messenger) (telephone (202) 488-5300; facsimile (202) 488-5563) or via 
e-mail at <a href="/cdn-cgi/l/email-protection#9dece8fcf1f8e5f4f3e9ddfcf2f1b3fef2f0"><span class="__cf_email__" data-cfemail="ed9c988c818895848399ad8c8281c38e8280">[email protected]</span></a>.
    24. The full text of this document is available for public 
inspection and copying during regular business hours at the FCC 
Reference Information Center, Portals II, 445 12th Street, SW., Room 
CY-A257, Washington, DC, 20554. This document may also be purchased 
from the Commission's duplicating contractor, Best Copy and Printing, 
Inc., Portals II, 445 12th Street, SW., Room CY-B402, Washington, DC, 
20554, telephone (202) 488-5300, facsimile (202) 488-5563, or via e-
mail <a href="/cdn-cgi/l/email-protection#b2c3c7d3ded7cadbdcc6f2d3ddde9cd1dddf"><span class="__cf_email__" data-cfemail="6d1c180c0108150403192d0c0201430e0200">[email protected]</span></a>.

I. Further Information

    25. Alternative formats (computer diskette, large print, audio 
recording, and Braille) are available to persons with disabilities by 
contacting Brian Millin at (202) 418-7426 voice, (202) 418-7365 TTY, or 
<a href="/cdn-cgi/l/email-protection#bad8d7d3d6d6d3d4fadcd9d994ddd5cc"><span class="__cf_email__" data-cfemail="0c6e6165606065624c6a6f6f226b637a">[email protected]</span></a>. This FNPRM can also be downloaded in Microsoft Word 
and ASCII formats at http://www.fcc.gov/ccb/universalservice/highcost.
    26. For further information, contact Regina Brown at (202) 418-0792 
or Dana Bradford at (202) 418-1932 in the Telecommunications Access 
Policy Division, Wireline Competition Bureau.

III. Ordering Clauses

    27. Pursuant to the authority contained in Sec. Sec.  1, 4(i), 
4(j), 201-205, 214, 254, and 403 of the Communications Act of 1934, as 
amended, 47 U.S.C. 151, 154(i), 154(j), 201-205, 214, 254, and 403, 
this Further Notice of Proposed Rulemaking is adopted.
    28. The Commission's Consumer and Governmental Affairs Bureau, 
Reference Information Center, shall send a copy of this Further Notice 
of Proposed Rulemaking, including the Initial Regulatory Flexibility 
Analysis, to the Chief Counsel for Advocacy of the Small Business 
Administration.

Federal Communications Commission.
Marlene H. Dortch,
Secretary.
[FR Doc. 05-2268 Filed 2-4-05; 8:45 am]
BILLING CODE 6712-01-P


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