Federal Agencies and Grant Programs

Office for the Advancement of Telehealth (OAT)

OAT administers its own rural telemedicine grants as well as those that were awarded by the Office of Rural Health Policy before August 1998.  OAT program objectives are to demonstrate how telemedicine can be used as a tool in developing integrated systems of health care, thereby improving access to health services for rural residents; and to evaluate the feasibility, costs, appropriateness, and acceptability of rural telemedicine services and technologies.  <http://telehealth.hrsa.gov>

Applicant Network Participation Requirements: Applicants must be a multi-specialty entity (e.g., hub) located in an urban or rural area that can provide 24-hour access to a minimum range of specialty health care services (see below).  For the purpose of this grant program, a multi-specialty entity may be a tertiary care hospital, a multi-specialty clinic, or a collection of facilities that, combined, could provide 24-hour specialty consultations. Applicants should have at least two rural health facilities (e.g., spokes), which may include small rural health facilities (fewer than 100 staffed beds), rural physician offices, rural health clinics, rural community health centers, or rural nursing homes. 

Clinical Network Service Requirements: Applicants must provide a minimum of seven clinical telemedicine services over the network, one of which must be used to stabilize patients in emergency situations.  Not all services need to be provided to all sites. The applicant and its network members must select the other six services to be provided.  These services must be based on the documented needs of communities to be served. In addition to emergency stabilization services, at least two of the grant-funded services provided by the telemedicine network must include consultant services of physician specialists.  All services provided with funding from this grant program must be available from the multi-specialty entity on a 24-hour basis unless there is strong justification for more limited availability.  An entity is considered capable of providing 24-hour specialty consultations if it has specialists on call.

Permissible Use of Grant Funds: Operating costs of the telemedicine system, including compensation for consulting and referring practitioners.  Transmission costs and clinician compensation payments; costs incurred in rural communities, including rural staff salaries and equipment maintenance; and equipment placed in rural communities, regardless of where purchased (50% or more of grant award must be spent in these combined areas) Equipment for clinical services and to serve a variety of nonclinical purposes, including didactic education, administrative meetings, etc.  Grant dollars may not be used to support didactic distance education activities.  Transmission costs such as the cost of satellite time or the use of phone lines.  However, those applicants who anticipate high transmission rates for all or some of their sites should consider activities to achieve more sustainable rates.

Clinical compensation payments up to a maximum of $60 per practitioner per consult.  If a third payer, including Medicaid or Medicare, can be billed for a consult, the grantee may not provide the practitioner with an OAT/ORHP-funded compensation payment.

Equipment purchase, lease, or installation inside the health care facility for providing telemedicine services, such as codecs, cameras, monitors, computers, multiplexers, etc.  (No more than 40 percent of the total grant award may be used for this purpose each year.)

Statutory Funding Preferences for Networks: Networks with the majority of health care providers serving in the rural areas or regions within their service areas. Any federally qualified health centers, rural health clinics, and local public health departments serving in the rural area or region. Outpatient mental health providers serving in the rural area or region.  Appropriate social service providers (e.g., agencies on aging, school systems and providers under the Women, Infants, and Children [WIC] program to improve access to and coordination of health care services).

Office of Rural Health Policy (ORHP)  

ORHP is the former agency that administered rural telemedicine projects prior to the formation of the Office for the Advancement of Telehealth in August 1998.  The program had funded eleven projects in FY 1994 for a 3-year period and 18 projects in FY 1998 for a 3-year period.  It operates a rural health outreach grant program that focuses on service delivery through creative strategies requiring the grantee to form a network of with at least two additional partners.  It also has a network development grant program designed to develop organizational capacity in the rural health sector through formal collaborative partnerships involving shared resources and possible risk-taking. <http://www.ruralhealth.hrsa.gov>

Rural Utilities Service's Distance Learning Telemedicine Program

The DLT program is designed to meet educational and health care needs of Rural America.  RUS is engineering based agency and since 1949, it has worked with over 900 small phone companies to start or improve services. Since 1993, the DLT program has funded 306 projects in 44 states and two U.S. territories totaling $83 million. The DLT Program offers grants, a combined loan/grant, or a loan only.  For FY 2000, RUS had available $13 million for grants, $130 million for loans, and $70 million in combined loans and grants. and loans/grants. <http://www.usda.gov/rus/telecom/dlt/dlt.htm> 

Competitive DLT grants are available annually with a 30 percent local match requirement. The program has a $50,000 minimum and $350,000 maximum award levels. Eligible purposes are: equipment purchases; computer hardware and software; audio and video equipment; computer network components; terminal equipment; data terminal equipment; inside wiring; interactive video equipment; any other facilities that further DLT services; acquiring instructional programming; and providing technical assistance and instructions for using eligible equipment.

Loan/Grant Combination packages are accepted year-round and processed as received.  It is a noncompetitive process, no matching requirement, and $50,000 minimum project level.  This program funds medical equipment; links between medical professionals in the same facility; site development and alteration of building; purchasing land; purchasing or constructing buildings; and acquiring telecommunications transmission facilities provided that no facilities exist.

Loan Program Features are similar to the combined loan/grant program except that it covers project-operating costs during the first two years and educational broadcasting for distance learning purposes.

National Telecommunications Infrastructure Administration Technology Opportunity Program (formerly TIIAP)

Since 1993, NTIA has awarded 456 grants totaling $149.7 million with 42 projects identified as telemedicine / telehealth.  NTIA has a robust grant program web site that provides the abstracts for the nearly 700 applicants which apply each year.  In addition, helpful information is provided on past grant reviews.  NTIA guidelines vary slightly each year but in general an applicant can request up to $600,000 in total federal support with a 50% match.  Hardship cases need only provide a 25% match.

TOP grants support four application areas — community networking and services, lifelong learning and the arts, health, and public safety.  Each application is compared against applications representing the same area.  Examples of qualifying health projects include, but are not limited to: systems that improve the social and medical models of care to consumers in their place of residence; telemedicine system that offer integrated approaches to extending and integrating medical and dental expertise to rural or underserved urban areas or non-traditional settings; projects designed to improve communication, collaboration and knowledge among and between health care; project to improve access and timeliness of care for those in emergency situations; and explore various methods to extend services beyond the emergency room; projects that integrate technology to asses community needs and develop innovative health technology models of care delivery across the care continuum; projects that integrate triage mechanism into improving care delivery to the uninsured, and low income populations; and networks or information services aimed at disease prevention and health promotion.  The annual grant announcement and guidelines provide more specific information on allowable costs.  See <http://www.ntia.doc.gov/otiahome/top/>