WASHINGTON, January 26, 2023 – The Federal Communications Commission unanimously adopted a proposal to require operators of the 988 mental health crisis line to report outages, which would “hasten service restoration and enable officials to inform the public of alternate ways to contact the 988 Lifeline.”

The proposal would ensure providers give “timely and actionable information” on 988 outages that last at least 30 minutes to the Health and Human Services’s Substance Abuse and Mental Health Service Administration, the Department of Veteran Affairs, the 988 Lifeline administrator, and the FCC.

The commission is also asking for comment on whether cable, satellite, wireless, wireline and interconnected voice-over-internet protocol providers should also be subject to reporting and notification obligations for 988 outages.

Other questions from the commission include costs and benefits of the proposal and timelines for compliance, it said.

The proposal would align with similar outage protocols that potentially affect 911, the commission said.

The notice comes after a nationwide outage last month affected the three-digit line for hours. The line received over two million calls, texts, and chat messages since it was instituted six months ago, the FCC said.

The new line was established as part of the National Suicide Hotline Designation Act, signed into law in 2020.

WASHINGTON, January 26, 2023 – The Federal Communications Commission adopted a measure Thursday to eliminate the use of a database that determined the differences in telecommunications service rates in urban and rural areas that was used to provide funding to health care facilities for connectivity.

The idea behind the database, which was adopted by the commission in 2019, was to figure out the cost difference between similar broadband services in urban and rural areas in a given state so the commission’s Telecom Program can subsidize the difference to ensure connectivity in those areas, especially as the need for telehealth technology grows.

But the commission has had to temporarily provide waivers to the rules due to inconsistencies with how the database calculated cost differences. The database included rural tiers that the commission said were “too broad and did not accurately represent the cost of serving dissimilar communities.”

FCC Chairwoman Jessica Rosenworcel gave an example at Thursday’s open meeting of the database calculating certain rural services being cheaper than in urban areas, when the denser latter areas are generally less expensive.

As such, the commission Thursday decided to revert the methods used to determine Telecom Program support to before the 2019 database order until it can determine a more sustainable method. The database rescission also applies to urban cost determinations.

“Because the Rates Database was deficient in its ability to set adequate rates, we find that restoration of the previous rural rate determination rules, which health care providers have continued to use to determine rural rates in recent funding years under the applicable Rates Database waivers, is the best available option pending further examination in the Second Further Notice, to ensure that healthcare providers have adequate, predictable support,” the commission said in the decision.

Healthcare providers are now permitted to reuse one of three rural rates calculations before the 2019 order: averaging the rates that the carrier charges to other non-health care provider commercial customers for the same or similar services in rural areas; average rates of another service provider for similar services over the same distance in the health care provider’s area; or a cost-based rate approved by the commission.

These calculations are effective for the funding year 2024, the commission said. “Reinstating these rules promotes administrative efficiency and protects the Fund while we consider long-term solutions,” the commission said.

The new rules are in response to petitions from a number of organizations, including Alaska Communications; the North Carolina Telehealth Network Association and Southern Ohio Health Care Network; trade association USTelecom; and the Schools, Health and Libraries Broadband Coalition.

“The FCC listened to many of our suggestions, and we are especially pleased that the Commission extended the use of existing rates for an additional year to provide applicants more certainty,” John Windhausen Jr., executive director of the SHLB Coalition, said in a statement.

Comment on automating rate calculation

The commission is launching a comment period to develop an automated process to calculate those rural rates by having the website of the Universal Service Administrative Company – which manages programs of the FCC – “auto-generate the rural rate after the health care and/or service provider selects sites that are in the same rural area” as the health care provider.

The commission is asking questions including whether this new system would alleviate administrative burdens, whether there are disadvantages to automating the rate, and whether there should be a challenge process outside of the normal appeals process.

The Telecom Program is part of the FCC’s Rural Health Care program that is intended to reduce the cost of telehealth broadband and telecom services to eligible healthcare providers.

Support for satellite services

The commission is also proposing that a cap on Telecom Program funding for satellite services be reinstated. In the 2019 order, a spending cap on satellite services was lifted because the commission determined that costs for satellite services were decreasing as there were on-the-ground services to be determined by the database.

But the FCC said costs for satellite services to health care service providers has progressively increased from 2020 to last year.

“This steady growth in demand for satellite services appears to demonstrate the need to reinstitute the satellite funding cap,” the commission said. “Without the constraints on support for satellite services imposed by the Rates Database, it appears that commitments for satellite services could increase to an unsustainable level.”

Soon-to-be health care providers funding eligibility

The FCC also responded to a SHLB request that future health care provider be eligible for Rural Health Care subsidies even though they aren’t established yet.

The commission is asking for comment on a proposal to amend the RHC program to conditionally approve “entities that are not yet but will become eligible health care providers in the near future to begin receiving” such program funding “shortly after they become eligible.”

Comments on the proposals are due 30 days after it is put in the Federal Register.

A pacesetter among municipal broadband owners, the City of Chattanooga is giving away 1,000 free telehealth appointments that also brings broadband into low-income homes. Vistabeam, a Nebraska Wireless ISP, is bringing telehealth to rural towns through Community Empowerment Centers that increase broadband as well as improve residents’ health. 

“The Enterprise Center works hard at the intersection of technology and inequality, whether it’s using technology to work efficiency, for learning, or improving personal health,” states CEO Deb Socia. The center is partnering with residents, community organizations and the Parkridge Medical System to identify needs and bring in resources to combat high levels of diabetes, stroke, heart disease, and asthma. 

Vistabeam owner Matt Larsen says, “You can’t just lay down some fiber and routers, then call this a broadband success. Rural areas often lack the human and tech resources necessary for broadband to thrive.” So Vistabeam is designing Community Empowerment Centers to offer communities private telehealth consultation rooms, digital skills and telehealth training, full-time digital navigators and inventory rooms with shared computing devices and equipment.

These and other communities are finding that telehealth increases broadband adoption as well as improves the physical and economic health of residents. Telehealth is the “killer app” that can harness and focus broadband investments into digital inclusions advancements for urban and rural communities.  

A perfect storm for telehealth

Chattanooga’s public broadband network, through a city electric power board that offers both electricity and broadband, is an advantage to telehealth. Socia says, “EPB has a deep connection to the community, and they invest money, technology in public spaces, and energy upgrades in the homes. EPB cares about the health of our community.” (EPB, formerly known as the Electric Power Board of Chattanooga, provides broadband in the city.) Communities without public broadband may have to work harder to find large ISPs with similar levels of commitment.

Communities wanting to leverage telehealth likely will need new strategies for winning and managing grants. You can’t have telehealth without broadband, but the integration of broadband to facilitate telehealth delivery may involve a myriad of people, organizations, and resources besides the network builder. 

For years Chattanooga has had a culture of cooperation among its many civic groups. The nonprofit Orchard Knob had a preexisting collaborative, so when the telehealth opportunity came up as part of a larger “healthy community” initiative, it was it much easier to create a grant of the size that the group currently has.

The community created the Orchard Knob Collaborative, which includes Parkridge Medical Center with their 1000 telehealth appointments, the Orchard Knob Neighborhood Association, Habitat for Humanity of Greater Chattanooga Area and United Way of Greater Chattanooga. EPB contributed money, energy upgrades, and public WiFi. Green Spaces is another nonprofit and the Center provides project management plus various Tech Goes Home digital inclusion programs.

Telehealth opens the door for larger grants. “I think the anticipated grant-raising outcomes are quite specific when you’re producing social determinants of health,” Socia says. “Projects that involve telehealth are a much tougher ‘ask’ for funders and everyone else involved. But at the same time, you can leverage other additional dollars and other partners for a much better healthcare outcome.” 

Telehealth and the ‘human element’

Every state is developing a digital equity plan. How important is telehealth to the success of a digital equity plan? Quite important! But remember that telehealth deployment strategy in rural communities likely could take shape differently than urban deployment. Vistabeam’s Centers represent one approach.

Digital equity in telehealth is just one component of a giant ecosystem of social services that good societies use to help take care of people. The challenge is the need to successfully coordinate scarce resources to get maximum impact from the resources. However, in rural communities there can be a real lack of coordination between a lot of these resources.

“It makes sense to start out by focusing on getting telehealth into some smaller communities at locations where people can come in and access telehealth in an environment that develops trust and familiarity with the technology,” says Larsen. “To do that, we’re going to need a ‘human element’, facilitators such as digital navigators to plug community telehealth into the ecosystem. A lot of rural communities have trust issues with government programs.”

Using surplus office space to create customer service centers

There are plenty of large incumbents’ mobile device showrooms in communities. But these employees tend to be sales-oriented with scripted content. Vistabeam happens to have surplus office space they are using to create true customer service centers.

“We figured out how to train people to be digital navigators, we get customers comfortable with telehealth and our staff connects people with complementary social services and other resources,” says Larsen. For the last few months, Vistabeam has been promoting exclusively the FCC’s Affordable Connectivity Program of free Internet access and subsidized computing devices. There’s a complex enrollment process residents have to complete that’s confusing for many, so Vistabeam trained staff to walk people through the process, get them qualified, and connected.  

As for the potential of telehealth deployment to the home, Larsen believes the technology represents a tremendous amount of potential utility and value for both rural and urban broadband deployments. Though broadband is currently underutilized for telehealth, in large part because communities are just beginning to plan for it, the pandemic revealed a burning need for strong video streaming capacities to bridge doctors and patients.

“What’s missing is a telehealth killer app or device,” says Larsen. “I believe preventive healthcare will be the answer – technology that detects or prevents things from happening before they become big problems. This app could be a way to check vital statistics and watch for health or illness markers. Maybe we’ll see a device connected to the Internet that accesses research data to help you and your health professional with health planning.”  

Just about everybody gets sick or hurt, or they are responsible for others when those loved ones aren’t doing well. Telehealth and its many iterations are designed for people to use when they’re sick or hurt or for preventative healthcare. The universality of telehealth and its symbiotic relationship with broadband technologies give communities great potential for expanding digital inclusion. Together with the bezillion grant dollars coming out the ying yang, what we’re seeing is the perfect digital storm. 

Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.

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