Mountain Connect 2015 USAC and the Rural Health

Mountain. Connect 2015 USAC and the Rural Health Care Program 1

Agenda • USAC Overview • RHC Program Overview – HCF Program Overview – Telecom Program Overview – Service Provider Overview • Resources Available Rural Health Care Program | Program Overview 2

USAC and the Rural Health Care Program USAC Overview Rural Health Care Program | Program Overview 3

USAC Overview What is the Universal Service Fund? • The USF is money collected from telecommunications companies dedicated to fulfilling the universal service goals; and helps make telecom access available to all U. S. consumers • The FCC’s universal service programs provide support to: – Telecom companies serving remote and rural areas; – Low-income consumers; – Health care providers; and – Schools and libraries Rural Health Care Program | Program Overview 4

USAC Overview The Universal Service Administrative Company (USAC) USAC is the neutral, not-for-profit corporation established pursuant to FCC direction that: Administers four universal service programs Collects universal service contributions Authorized Disbursements of $7. 8 billion in 2014 Rural Health Care Program | Program Overview 5

USAC Overview USAC and the FCC • The Federal Communications Commission (FCC), among other things, oversees USAC’s administration of the four Universal Service Programs, including the Rural Health Care Program. • The FCC’s functions and responsibilities include: - Establishing and modernizing the universal service programs in accordance with applicable statutory provisions; - Adopting and modifying program rules; - Issuing policy and rule guidance; and - Acting on appeals of USAC decisions. Rural Health Care Program | Program Overview 6

USAC Overview USAC and the FCC • USAC’s functions and responsibilities include: – Administering each of the USF programs, including processing of applications; – Billing contributors, collecting, contributions, an disbursing universal service support; – Reporting quarterly to the FCC on disbursement of USF support; and – Estimating improper payments and conducting audits. Rural Health Care Program | Program Overview 7

USAC Overview USAC, the Universal Service Fund (USF), and the FCC The Universal Service Administrative Company (USAC) administers the universal service fund (USF) on behalf of and under the auspices of the FCC. High Cost $3. 75 billion Lifeline $1. 60 billion Rural Health Care Program | Program Overview Rural Health Care $192 million Schools and Libraries $2. 27 billion 8

Rural Health Care Program Overview USAC Confidential and Proprietary I Rural Health Care Program Audit Training 9

Program Overview Rural Health Care Programs USAC Confidential and Proprietary I Rural Health Care Program Audit Training 10

Program Overview RHC Program Basics • The RHC Program provides discounts for telecommunications services, broadband services, and equipment for health care providers (HCPs). • The program is authorized to disburse up to $400 M annually. USAC Confidential and Proprietary I Rural Health Care Program Audit Training 11

Program Overview • Telecommunications Program – Funds urban/rural rate difference for telecom services for rural HCPs – Remains in place after Healthcare Connect Fund Program implementation • Pilot Program – Supports 50 state-wide and regional broadband HCP networks (not open to new applicants – Participants may transition to Healthcare Connect Fund as Pilot funds are exhausted • Healthcare Connect Fund Program – Supports broadband connectivity and broadband networks for eligible HCPs – Provides 65 percent discount on eligible services and equipment Rural Health Care Program | Program Overview 12

Program Overview Telecommunications Program Basics • Funds the difference between the urban and rural rates for telecommunications services • Only rural HCPs are eligible to participate • HCPs must conduct a fair and open competitive bidding process USAC Confidential and Proprietary I Rural Health Care Program Audit Training 13

Program Overview Pilot Program Basics • Established by the FCC to help deploy state or regional dedicated broadband health care networks • 50 Pilot Projects in 38 states, with over 3, 800 affiliated health care providers • Closed to new funding, but Pilot Projects may seek funding under the Healthcare Connect Fund and may add new sites. Invoicing under the Pilot Program continues until 2017. USAC Confidential and Proprietary I Rural Health Care Program Audit Training 14

Program Overview Healthcare Connect Fund (HCF) Basics • Encourages growth or formation of statewide or regional broadband health care networks. • Funds a uniform 65% subsidy for all eligible broadband services and infrastructure. • HCPs subject to competitive bidding where not exempt. • HCPs can be rural or urban. If urban, HCPs must participate as members of consortia. USAC Confidential and Proprietary I Rural Health Care Program Audit Training 15

Program Comparison Feature HCF Pilot Program Telecom or Internet Access Programs Discount on telecom services 65 percent 85 percent Urban-rural difference or mileage based Discount on Internet services 65 percent 85 percent 25 percent (ends on 6/30/2014) Connections to off-site administrative offices and data centers Eligible: Off-site data centers; Not Eligible: Not eligible Off-site admin offices Customized networks Eligible Not eligible Equipment Eligible Not eligible Rural Health Care Program | Program Overview 16

Program Overview Filing Process Determine Eligibility FCC Form 465 FCC Form 460 Request for Services FCC Form 465 FCC Form 461 Request for Funding Invoice FCC Form 466 FCC Form 462 FCC Form 467 (triggers invoicing) FCC Form 463 USAC Confidential and Proprietary I Rural Health Care Program Audit Training 17

Program Eligibility criteria: Telecom Program • Rural • Non-profit or public • Eligible organization type FCC Form 465 Pilot Program • Rural or urban • Non-profit or public • Eligible organization type FCC Form 465 USAC Confidential and Proprietary I Rural Health Care Program Audit Training HCF • Rural or urban • Non-profit or public • Eligible organization type FCC Form 460 18

Program Eligibility Eligible Organization Types • • • Not-for-profit hospitals Rural health clinics Community mental health centers Local health departments or agencies Post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools Community health centers or health centers providing health care to migrants Dedicated emergency departments of rural for-profit hospitals Consortia of HCPs consisting of rural not-for-profit hospitals Part-time eligible entities located in facilities that are ineligible USAC Confidential and Proprietary I Rural Health Care Program Audit Training 19

HCF Program Overview Rural Health Care USAC Confidential and Proprietary I Rural Health Care Program Audit Training 20

HCF Program Overview Goals of the HCF Program • FCC’s Performance Goals for Healthcare Connect Fund Program: – Increase access to broadband for HCPs, especially those serving rural areas – Foster development and deployment of broadband health care networks – Maximize cost-effectiveness of the program • FCC and USAC will collect data through the application process to help measure progress toward achieving these goals. Rural Health Care Program | Program Overview 21

HCF Program Overview Key Features of the HCF Program • Support for broadband connectivity and broadband networks for eligible HCPs • Both consortium and individual HCPs may apply • 35 percent HCP contribution required • Covers both broadband services and HCP-owned infrastructure • Non-rural HCPs can participate if in majority-rural consortia • Multi-year funding commitments available • Connections to off-site administrative offices and data centers covered Rural Health Care Program | Program Overview 22

HCF Program Overview Key Features of the HCF Program • Administrative benefits include: – Flat-rate discount (65%), which simplifies the calculation of discount level – Consortia can use a single application • Healthcare Connect Fund Program provides options: – HCPs can apply as individuals – HCPs can join an existing consortium, either now or after participating as an individual HCP in the HCF Program – HCPs also can band together and form a new consortium Rural Health Care Program | Program Overview 23

HCF Program Overview Benefits of the Consortium Approach • Creation and growth of broadband HCP networks • Lower administrative costs • Sharing of medical, administrative, and technical expertise • Lower prices, higher bandwidth, and better quality connections • Non-rural sites may participate in consortia and receive the discount, as long as they are in a consortium with a majority rural sites. • Consortia can include ineligible health care provider sites, who pay their “fair share” but can be part of the network and benefit from negotiated rates • Improved quality and reduced cost of healthcare through leveraging broadband connections in consortia Rural Health Care Program | Program Overview 24

HCF Program Overview Application Process 1. Determine Eligibility Must meet the three initial program criteria and make sure requested services are eligible 2. Develop Evaluation Criteria and Request Services • Develop scoring criteria to evaluate bids and describe service needs (posted on USAC website) 3. Evaluate Bids & Select a Service Provider • • Choose the “most cost-effective” service provider Rural Health Care Program | Program Overview 25

HCF Program Overview Application Process 4. Submit Funding Requests Provide information about services and selected service provider 5. Invoice • • Initiate invoicing process and submit to service provider for review Rural Health Care Program | Program Overview 26

HCF Program Overview Four FCC Forms: • FCC Form 460 – Registering and Determining Eligibility • FCC Form 461 – Requesting Services • FCC Form 462 – Requesting Funding Commitment • FCC Form 463 – Submitting Invoice Rural Health Care Program | Program Overview 27

HCF Program Overview FCC Form 460 Eligibility and Registration Form • Certifies that the applicant meets eligibility requirements • Eligibility must be determined before an FCC Form 461 (Requests for Services Form) can be reviewed. What is on the FCC Form 460? • Site information • Contact information • Eligibility information • Certifications and signatures Rural Health Care Program | Program Overview 28

HCF Program Overview FCC Form 461: Request for Services Form • Initiates the competitive bidding process, • Must be posted on USAC’s website for at least 28 days, • Provides information about requested services and network equipment to enable an effective competitive bidding process, and • Can be submitted starting 180 days before the beginning of the funding year. Rural Health Care Program | Program Overview 29

HCF Program Overview FCC Form 462: Funding Request Form • Provides USAC with information necessary to evaluate an applicant’s funding request • Applicants can seek a multi-year funding commitment • Applicants can file for multiple services on a single form Rural Health Care Program | Program Overview 30

HCF Program Overview FCC Form 463: Invoice and Request for Disbursement • Serves as a request to USAC for disbursement of funding from the HCF Program for services and equipment. • Filing the FCC Form 463 is a joint process between the applicant and service provider. • The applicant initiates the submission of the form and submits the form to the service provider who approves or rejects the form. Rural Health Care Program | Program Overview 31

RHC Program Telecommunications Program Overview Rural Health Care Program | Program Overview 32

Telecom Program Overview Application Process 1. Determine Eligibility Must meet the three initial program criteria and make sure requested services are eligible 2. Develop Evaluation Criteria and Request Services • Develop scoring criteria to evaluate bids and describe service needs (posted on USAC website) 3. Evaluate Bids & Select a Service Provider • • Choose the “most cost-effective” service provider Rural Health Care Program | Program Overview 33

Telecom Program Overview Application Process 4. Submit Funding Requests Provide information about services and selected service provider 5. Review, Approve, Submit • • Review HCP support schedule and submit last application form certifying that the service was turned on and dates of service Rural Health Care Program | Program Overview 34

Telecom Program Overview Three FCC Forms • FCC Form 465 – Description of Services Requested and Certification Form • FCC Form 466 – Funding Request and Certification Form • FCC Form 467 – Connection Certification Form Rural Health Care Program | Program Overview 35

Telecom Program Overview FCC Form 465 Eligibility, Registration and Request for Services Form • Eligibility must be determined before the FCC Form 465 can be posted • Initiates the competitive bidding process • Must be posted on USAC’s website for at least 28 days • Provides information about requested services to enable an effective competitive bidding process • Can be submitted starting 180 days before the beginning of the funding year Rural Health Care Program | Program Overview 36

Telecom Program Overview FCC Form 466 • Provides information about the service agreement and certifies that the applicant selected the most costeffective offer. • USAC uses the information provided on this form to calculate and issues a funding decision. Rural Health Care Program | Program Overview 37

Telecom Program Overview FCC Form 467 • Confirms service start and end dates or notifies USAC that a service was never turned on. Rural Health Care Program | Program Overview 38

Telecom Program Overview FCC Form 467: Who Must Submit • All applicants must submit one FCC Form 467 for each FCC Form 466. Rural Health Care Program | Program Overview 39

Telecom Program Overview Invoicing in the Telecom Program • The service provider completes the invoicing process in the telecom program. • Once the service provider has received and reviewed the HCP Support Schedule (HSS), the service provider should credit the applicant's account, then log in to My Portal and submit an online invoice to USAC. • After the online invoice is submitted, it will be processed within 24 hours. Rural Health Care Program | Program Overview 40

Telecom Program Overview Invoicing in the Telecom Program • Service providers may submit online invoices to USAC on a rolling basis. • The first invoice may be cumulative (beginning of approved funding up to the previous month), but service providers may not invoice ahead. Rural Health Care Program | Program Overview 41

RHC Program Service Providers Rural Health Care Program | Program Overview 42

Service Providers Process • Step 1: Determine Eligibility • Step 2: Respond to Service Requests • Step 3: Sign Service Agreement • Step 4: Invoice Rural Health Care Program | Program Overview 43

Service Providers Step 1: Determine Eligibility • To participate in the Healthcare Connect Fund (HCF) Program, service providers may be any provider of equipment, facilities, or services that are considered to be eligible for support. • To be considered eligible, service providers must also make sure they have a Service Provider Identification Number (SPIN). A SPIN is obtained by submitting the FCC Form 498. Rural Health Care Program | Program Overview 44

Service Providers Step 2: Search Posted Services • The Search Posted Services tool allows service providers to search applicant requests for services from a posted FCC Form 465, Request for Services Form. • The service provider should review an applicant's FCC forms and accompanying supporting documentation before submitting a bid for services. Rural Health Care Program | Program Overview 45

Service Providers Step 3: Sign Service Agreement • A service provider can sign a contract or service agreement with an applicant once the ACSD has been reached. Rural Health Care Program | Program Overview 46

Service Providers Step 4: Invoice USAC • Telecom – Upon crediting the HCP’s account, the service provider may log in to My Portal and submit the invoice to USAC directly. – After the online invoice is submitted, it will be processed within 24 hours with payments made twice a month. • HCF – Applicant initiates the invoicing process and submit the invoice to the service provider for approval via My Portal. – After the online invoice is submitted, it will be processed, and payments are made twice a month. Rural Health Care Program | Program Overview 47

RHC Programs Colorado Participation Rural Health Care Program | Program Overview 48

What’s in it for You • Receive support for Telecom and/or Internet access services at 65% of monthly cost in HCF Program • Receive support for Telecom services at the urban-rural difference of monthly cost in Telecom Program

Telecom Program Commitments Funding Year 1998 $ 59, 471 1999 $ 80, 962 2000 $ 93, 711 2001 $ 143, 968 2002 $ 140, 658 2003 $ 142, 852 2004 $ 155, 686 2005 $ 129, 832 2006 $ 113, 145 2007 $ 116, 154 2008 $ 246, 011 2009 $ 251, 624 2010 $ 300, 694 2011 $ 283, 292 2012 $ 211, 174 2013 $ 237, 052 2014 $ 223, 487 Totals $ 2, 929, 773 Through 5/26/15

HCF Program Funding Year Commitments 2013 $ 7. 4 Million 2014 $ Totals $ 8. 0 Million 0. 6 Million Through 5/26/15

Pilot Program Committed $5. 50 Million Disbursed $5. 45 Million

Questions? Rural Health Care Program | Program Overview 53

Contact Us! Rural Health Care Program (800) 453 -1546 RHC-Assist@usac. org Rural Health Care Program | Program Overview 54