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/>
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