[Federal Register: December 24, 2003 (Volume 68, Number 247)]
[Proposed Rules]
[Page 74538-74541]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr24de03-32]
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FEDERAL COMMUNICATIONS COMMISSION
47 CFR Part 54
[WC Docket No. 02-60; FCC 03-288]
Rural Health Care Support Mechanism
AGENCY: Federal Communications Commission.
ACTION: Notice of proposed rulemaking.
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SUMMARY: In this document, the Commission seeks comment on
modifications to the definition of ``rural area'' for the rural health
care support mechanism, whether additional modifications to our rules
are appropriate to facilitate the provision of support to mobile rural
health clinics for satellite services, and additional outreach efforts
and measures to streamline further the application process.
DATES: Comments are due on or before February 23, 2004. Reply comments
are due on or before April 7, 2004. Written comments on the proposed
information collection(s) must be submitted by the public, Office of
Management and Budget (OMB), and other interested parties on or before
February 23, 2004.
ADDRESSES: All filings must be sent to the Commission's Secretary,
Marlene H. Dortch, Office of the Secretary, Federal Communications
Commission, 445 12th Street, SW., Washington, DC 20554. In addition to
filing comments with the Secretary, a copy of any Paperwork Reduction
Act (PRA) comments on the information collection(s) contained herein
should be submitted to Judith B. Herman, Federal Communications
Commission, Room 1-C804, 445 12th Street, SW., Washington, DC 20554, or
via the Internet to Judith-B.Herman@fcc.gov, and to Kim A. Johnson, OMB
Desk Officer, Room 10236 NEOB, 725 17th Street, NW., Washington, DC
20503, or via the Internet to Kim_A._Johnson@omb.eop.gov or by fax to
202-395-5167. Parties should also send three paper copies of their
filings to Sheryl Todd, Telecommunications Access Policy Division,
Wireline Competition Bureau, Federal Communications Commission, 445
Twelfth Street, SW., Room 5-B540, Washington, DC 20554. See
Supplemental Information for further filing instructions.
FOR FURTHER INFORMATION CONTACT: Shannon Lipp, Attorney, (202) 418-7400
or Regina Brown, Attorney, (202) 418-7400, Wireline Competition Bureau,
Telecommunications Access Policy Division. For additional information
concerning the information collection(s) contained in this document,
contact Judith B. Herman at 202-418-0214, or via the Internet at
Judith-B.Herman@fcc.gov.
SUPPLEMENTARY INFORMATION: This is a summary of the Commission's
Further Notice of Proposed Rulemaking in WC Docket No. 02-60 released
on November 17, 2003. A companion Report and Order and Order on
Reconsideration was also released in WC Docket No. 02-60 on November
17, 2003. The full text of this document is available for public
inspection during regular business hours in the FCC Reference Center,
Room CY-A257, 445 Twelfth Street, SW., Washington, DC 20554.
This Further Notice of Proposed Rulemaking (FNPRM) contains
proposed information collection(s) subject to the Paperwork Reduction
Act of 1995 (PRA). It has been submitted to the Office of Management
and Budget (OMB) for review under the PRA. OMB, the general public, and
other Federal agencies are invited to comment on the proposed
information collections contained in this proceeding.
Paperwork Reduction Act
The FNPRM contained proposed information collections. The
Commission, as part of its continuing effort to reduce paperwork
burdens, invites the general public and the Office of Management and
Budget (OMB) to comment on the information collection(s) contained in
this FNPRM, as required by the Paperwork Reduction Act (PRA) of 1995,
Public Law 104-13. Public and agency comments on the proposed
information collections discussed in this FNPRM are due on or before
February 23, 2004. PRA comments should address: (a) Whether the
proposed collection of information is necessary for the proper
performance of the functions of the Commission, including whether the
information shall have practical utility; (b) the accuracy of the
Commission's burden estimates; (c) ways to enhance the quality,
utility, and clarity of the information collected; and (d) ways to
minimize the burden of the collection of information on the
respondents, including the use of automated collection techniques or
other forms of information technology.
OMB Control Number: 3060-0804.
Title: Universal Service--Health Care Providers Universal Service
Program.
Form No.: FCC Forms 465, 466, 466-A, and 467.
Type of Review: Proposed revised collection.
Respondents: Business or other for-profit; not for profit
institutions.
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Number of Frequency of Total annual
Title respondents response burden
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1. FCC Form 465--Description of Service Requested and 1,600 1.5 96,000
Certification.................................................
2. FCC Form 466--Funding Request And Certification............. 1,600 2 192,000
3. FCC Form 466-A--Internet Toll Charge Discount Request....... 5 1 200
4. FCC Form 467--Connection Certification...................... 1,600 1 81,000
[[Page 74539]]
Total Annual Burden: .............. ............... 369,200
Total Annual Costs: $0
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Needs and Uses: In the FNPRM, we seek comment on ways to streamline
further the application process and expand outreach efforts. In the
companion Report and Order, we note that USAC has implemented many
steps to streamline the application process and has increased its
outreach efforts, since the NPRM, 67 FR 34653, May 15, 2002, was
released in 2002. Among other things, USAC has implemented on-line
application filing and has arranged for electronic forms to be filled
automatically with the previous year's information for repeat on-line
filers. Nevertheless, we seek comment on what additional steps the
Universal Service Administrative Commission (USAC) could take to ease
further the burdens associated with the application process. For
example, what would be the advantages and disadvantages of implementing
multi-year applications, so that beneficiaries would not need to apply
every funding year? We also seek comment on whether there are
additional outreach efforts that USAC could take to inform eligible
applicants of the benefits of the program. For instance, should USAC
conduct focus groups among rural health care providers to develop ideas
on how to identify providers that operate only on a part-time basis?
Should USAC contact service providers in rural areas to solicit
suggestions for potential eligible users in the area? All rural health
care providers applying for discounts on eligible telecommunications
and information services must currently file FCC Forms 465, 466, 466-A,
and 467. The purpose of these forms is for rural health care providers
to certify their eligibility, describe program needs so that service
providers are able to bid on the services, indicate that they have
selected the most cost-effective methods, apply for discounts, and
inform the program's administrator that they have begun to receive or
stopped receiving services for which support was allocated.
I. Further Notice of Proposed Rulemaking
A. Definition of ``rural area''
1. In this FNPRM, we seek comment on modifications to the
definition of ``rural area'' for the rural health care universal
service support mechanism. Currently, an area qualifies as rural if it
is located in a non-metropolitan county as defined by the Office of
Management and Budget or is specifically identified in the Goldsmith
Modification to 1990 Census data published by the Office of Rural
Health Care Policy (ORHP). In response to the NPRM, several commenters
state that ORHP no longer utilizes the definition adopted by the
Commission in 1997 and that there will be no Goldsmith Modification to
the most recent 2000 Census data. Several commenters suggest that the
Commission adopt the rural designation system currently utilized by
ORHP, the Rural Urban Commuting Area (RUCA) system. Others propose to
define rural as non-urbanized areas, as specified by the Census Bureau.
Finally, some commenters assert that if the Commission adopts a new
definition of rural, it should grandfather existing areas that
currently qualify as rural, if they would no longer qualify under the
new definition.
2. We seek comment on whether we should adopt a new definition of
rural area for the rural health care program, and, if so, what that new
definition should be. We seek comment on whether there are any
definitions for rural areas used by other government agencies or
medical organizations that would be appropriate for the rural health
care program. In addition to describing any proposed new definitions,
we ask commenters to address the specific proposals that have already
been raised in the record. Commenters are encouraged to describe the
effects of any new definition to the program, e.g. how many existing
rural areas would become non-rural and vice versa. We also seek comment
on whether there are reasons we should or should not use the same
definition of ``rural'' for both the rural health care and schools and
libraries support mechanisms.
B. Support for Satellite Services for Mobile Rural Health Clinics
3. We also seek comment on whether additional modifications to our
rules are appropriate to facilitate the provision of support to mobile
rural health clinics for satellite services. Satellite services may be
used by mobile rural health clinics that operate in vans or boats to
deliver telemedical services via satellite to residents in rural areas.
For example, one non-profit entity is launching the first mobile
telemammography van to diagnose breast cancer in women in four rural
tribal lands in North and South Dakota early next year. This van will
conduct mammograms and deliver results to rural American Indian women
while they wait. The van's clinician will send the mammogram via
satellite, which is contained in sixty-four megabytes of data, to
doctors at the University of Colorado, who will diagnose any
abnormalities and email the van with the patient's results. The van
will serve approximately 12,000 women among the four tribes, at a rate
of ten to twelve women a day. The van will be stationed at each
reservation for approximately two weeks at a time and will travel
approximately 200-300 days a year, depending on travel time and
maintenance and repairs to the van. Satellite service for the van will
cost approximately $10,000 a month.
4. In the companion Report and Order, we conclude that support for
satellite services should be capped at the amount a provider would
receive if it received functionally-similar terrestrial-based services.
We seek comment on whether it is appropriate to apply this rule to
mobile rural health care providers, which by their very nature, are
unlikely to be able to utilize terrestrially-based services
effectively. In particular, due to the mobile nature of a telemedical
unit and the large volume of data it will likely send, would a
satellite connection be the most cost-effective method of providing
service, even if a terrestrial alternative is available? Should a
terrestrial alternative be deemed available and ``functionally
similar,'' if by its nature it is tied to a fixed location? We seek
comment on how mobile health care providers should make a cost-
effective determination for satellite services and whether they should
consider the installation and disconnection charges that would be
incurred if the mobile rural health clinic were to order a wireline
connection at each docking location. Commenters should also discuss
whether mobile rural health clinics should be required to service a
specific number of locations before satellite services are deemed cost-
effective.
5. In the event we conclude that the cap on the provision of
support for satellite services where terrestrial service is available
should not apply in
[[Page 74540]]
these circumstances, how should support be provided (i.e., how should
discounts be calculated) for satellite services? Commenters are
encouraged to discuss whether rural satellite services for mobile rural
health clinics should be compared to urban terrestrial services and
under what circumstances. We note that two other commenters in this
proceeding proposed to provide support for satellite services for
mobile health care providers. Commenters should discuss these
commenters' proposals. We also ask commenters to estimate the amount of
support a mobile rural health clinic would likely receive and the
number of mobile units that would likely be eligible. The non-profit
entity associated with the telemammography van states that distance-
based charges will not apply to satellite services in the continental
United States. We seek comment on whether other similarly situated
mobile rural health clinics would be subject to distance-based charges
using satellite services and, if so, how the revised Maximum Allowable
Distance (MAD) would impact support levels.
6. We seek comment on how we should determine whether a mobile
health clinic serves rural areas. In particular, should that
determination depend on the principal place of business of the provider
(such as its mailing address), or should it depend on where the mobile
health clinic actually provides service? We also seek comment on
whether support for a mobile rural health clinic should be prorated if
it also serves non-rural locations.
C. Administrative Matters
7. In addition, we seek comment on ways to streamline further the
application process and expand outreach efforts. In the companion
Report and Order, we note that USAC has implemented many steps to
streamline the application process and has increased its outreach
efforts, since the NPRM was released in 2002. Among other things, USAC
has implemented on-line application filing and has arranged for
electronic forms to be filled automatically with the previous year's
information for repeat on-line filers. Nevertheless, we seek comment on
what additional steps USAC could take to ease further the burdens
associated with the application process. For example, what would be the
advantages and disadvantages of implementing multi-year applications,
so that beneficiaries would not need to apply every funding year? We
also seek comment on whether there are additional outreach efforts that
USAC could take to inform eligible applicants of the benefits of the
program. For instance, should USAC conduct focus groups among rural
health care providers to develop ideas on how to identify providers
that operate only on a part-time basis? Should USAC contact service
providers in rural areas to solicit suggestions for potential eligible
users in the area?
II. Procedural Matters
A. Initial Regulatory Flexibility Act Analysis
8. As required by the Regulatory Flexibility Act of 1980, as
amended (RFA), the Commission has prepared this 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 deadline for comments on the FNPRM. The Commission will
send a copy of this FNPRM, including this IRFA, to the Chief Counsel
for Advocacy of the Small Business Administration (SBA). In addition,
the FNPRM and IRFA (or summaries thereof) will be published in the
Federal Register.
1. 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 things, the Commission adopted a mechanism to provide
discounted telecommunications services to public or non-profit health
care providers that serve persons in rural areas. Over the last few
years, important changes in the rural health community prompt us to
review the rural health care universal service support mechanism.
10. In this FNPRM, we seek comment on whether and how to modify the
definition of rural area as utilized in the rural health care support
mechanism. We also seek comment on whether additional modifications to
our rules are appropriate to facilitate the provision of support to
mobile rural health clinics for satellite services. Lastly, we seek
comments on ways to streamline further the application process and
expand outreach efforts.
2. Legal Basis
11. This FNPRM is adopted pursuant to sections 1, 4(i), (4j), 201-
205, 251, 252, and 303 of the Communications Act of 1934, as amended,
47 U.S.C. 151, 154(i), (j), 201-205, 251, 252, and 303.
3. 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 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, unless the Commission has developed one or more definitions that
are appropriate to its activities. 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) meets
any additional criteria established by the Small Business
Administration (SBA).
13. We have described in detail, supra, in the FRFA, 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.
4. Description of Projected Reporting, Recordkeeping, and Other
Compliance Requirements
14. The FNPRM seeks comment on potential changes to the definition
of ``rural area'' for the rural health care support mechanism. This
potential change will not impact reporting or recordkeeping
requirements, however, it could impact the overall pool of eligible
applicants. The FNPRM also seeks comment on whether additional support
should be provided to mobile rural health clinics that utilize
satellite services. If changes are adopted, mobile rural health
clinics, including small rural health clinics, could potentially be
required to submit additional information regarding their mobile
services, if they choose to seek discounts. Lastly, the FNPRM seeks
comment on ways to streamline further the application process. If the
application process is streamlined further, this would eliminate some
of the paperwork associated with the application process.
[[Page 74541]]
5. Steps Taken To Minimize Significant Economic Impact on Small
Entities, and Significant Alternatives Considered
15. The RFA requires an agency to describe any significant
alternatives that it has considered in reaching its proposed approach
impacting small business, which may include the following four
alternatives (among others): (1) The establishment of differing
compliance and 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 part thereof, for small entities.
16. In this FNPRM, we seek comment on a new definition of rural
area. If a new definition is adopted, this could change the size of the
overall pool of eligible applicants for universal service support for
rural health care providers. We also seek comment on whether to provide
additional support to mobile rural health clinics that utilize
satellite services. In seeking to minimize the burdens imposed on small
entities where doing so does not compromise the goals of the universal
service mechanism, we invite comment on definitions and proposals for
additional support for mobile rural health clinics that might be made
less burdensome for small entities. In addition, we seek comment on
ways to streamline further the application process and expand outreach
efforts. If the application process is streamlined further, this could
ease the burden on small entities associated with the application
process. Additionally, outreach efforts would better inform such
businesses about the benefits of the rural health care program and
potentially increase small business participation in the program.
6. Federal Rules That May Duplicate, Overlap, or Conflict With the
Proposed Rules
17. None.
B. Initial Paperwork Reduction Act of 1995 Analysis
18. This FNPRM contained proposed information collections. The
Commission, as part of its continuing effort to reduce paperwork
burdens, invites the general public and the Office of Management and
Budget (OMB) to comment on the information collections contained in
this FNPRM, as required by the Paperwork Reduction Act (PRA) of 1995,
Public Law 104-13. Public and agency comments are due February 23,
2004. It will be submitted to the Office of Management and Budget (OMB)
for review under the PRA. PRA comments should address: (a) Whether the
proposed collection of information is necessary for the proper
performance of the functions of the Commission, including whether the
information shall have practical utility; (b) the accuracy of the
Commission's burden estimates; (c) ways to enhance the quality,
utility, and clarity of the information collected; and (d) ways to
minimize the burden of the collection of information on the
respondents, including the use of automated collection techniques or
other forms of information technology.
C. Comment Filing Procedures
19. We invite comment on the issues and questions set forth in the
FNPRM and Initial Regulatory Flexibility Analysis contained herein.
Pursuant to applicable procedures set forth in sections 1.415 and 1.419
of the Commission's rules, interested parties may file comments on or
before February 23, 2004, and reply comments on or before April 7,
2004. All filings should refer to WC Docket No. 02-60. Comments may be
filed using the Commission's Electronic Comment Filing System (ECFS) or
by filing paper copies.
20. Comments filed through the ECFS can be sent as an electronic
file via the Internet to http://www.fcc.gov/e-file/ecfs.html.
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 ecfs@fcc.gov, and
should include the following words in the body of the message, ``get
form .'' A sample form and directions
will be sent in reply.
21. Parties who choose to file by paper must file an original and
four copies of each filing. If more than one docket or rulemaking
number appears in the caption of this proceeding, commenters must
submit two additional copies for each additional docket or rulemaking
number. 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 236 Massachusetts Avenue,
NE., Suite 110, Washington, DC 20002. The filing hours at this location
are 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. 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, Marlene H. Dortch, Office of
the Secretary, Federal Communications Commission.
22. Parties also must send three paper copies of their filing to
Sheryl Todd, Telecommunications Access Policy Division, Wireline
Competition Bureau, Federal Communications Commission, 445 12th Street,
SW., Room 5-B540, Washington, DC 20554. In addition, commenters must
send diskette copies to the Commission's copy contractor, Qualex
International, Portals II, 445 12th Street, SW., Room CY-B402,
Washington, DC 20054.
III. Ordering Clauses
23. Pursuant to the authority contained in sections 1, 4(i), 4(j),
201-205, 214, 254, and 403 of the Communications Act of 1934, as
amended, this Further Notice of Proposed Rulemaking is adopted.
24. 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.
List of Subjects in 47 CFR Part 54
Libraries, Reporting and recordkeeping requirements, Schools,
Telecommunications, Telephone.
Federal Communications Commission.
Marlene H. Dortch,
Secretary.
[FR Doc. 03-31684 Filed 12-23-03; 8:45 am]
BILLING CODE 6712-01-P