Seeking your feedback: FCC Rural Health Care Program Improvements

Date: March 29, 2022

Earlier this month, the Federal Communications Commission (FCC Commission) released a further notice of proposed rulemaking (FNPRM) to seek input to improve the Rural Health Care (RHC) Program. As you know, the RHC Program provides funding to health care providers for telecommunications and broadband services necessary to provide health care services. With the advancement of telehealth flexibilities in recent years, the National Rural Health Association (NRHA) understands the importance of the RHC Program when it comes to building out broadband services and wants to ensure member concerns are reflected.

NRHA is working its way through the FNPRM but requests member input to determine whether comments are necessary on some of the issues the Commission is seeking comment on. NRHA has identified these areas for potential comment:

Defining “rural area” for the purposes of program participation.

Currently, the RHC Program employs a definition of “rural area” that relies upon a health care provider’s location relative to the Census Bureau’s Core Based Statistical Area designation. However, until 2004, the Commission followed the definition used by the Federal Office of Rural Health Policy (FORHP) located within the Health Resources and Services Administration (HRSA).

NRHA asks, has the definition of rural been too limiting for program participation? Is it necessary to adopt a different definition? Perhaps the one used by FORHP should be implemented once again? Alternatively, NRHA has heard significant concerns that the amount of funding in the program has caused issues historically. Would expanding the program to include other entities cause further dilution of the funds?

Applying geographic cost factors to rurality tiers.

In particular, the Commission asks whether it would be beneficial to use the Rural Urban Commuting Area (RUCA) codes to determine rurality tiers? ¬†Further, the Commission seeks comment on whether to eliminate rurality tiers altogether and establish rates based on an applicant’s census tract information. How do to properly apply geographic cost factors to rurality tiers?

Funding prioritization.

Adopted in 2019, the rates database lists eligible services in the program, median urban and rural rates for services by state, and underlying rate data used to determine the median rates. But the use of the database was waived in funding years 2021 and 2022 due to anomalies and inconsistencies. Now, the FCC is asking for comment on how best to fix those anomalies, which include examples of lower median rates in more rural tiers as compared with less rural tiers. If the Commission adopt a new rurality tier system, or an alternative to rurality tiers altogether, should the new system be used for funding prioritization as well?

Application processing, funding decisions, and appeals of decisions.

The Commission seeks comment on any additional measures beyond those already taken that could further enhance the efficiency of application processing and the speed at which funding commitment decisions are made. NRHA has heard significant feedback that the time from application to award is of significant concern. That said, are there suggestions providers have that would improve this process?

Digital equity and inclusion.

The Commission also seeks comment on how the proposals may promote or inhibit advances in diversity, equity, inclusion, and accessibility?

Your input will be helpful in crafting the direction of NRHA’s comments. If you have thoughts, please reach out to Josh Jorgensen (jjorgensen@ruralhealth.us) to discuss further. Comments are due to the FCC by April 14, 2022.