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Copayment System?

Rural Healthcare Groups Seek More Competition in Rates Methodology

Rural healthcare program (RHC) participants and industry continued to back the FCC's efforts to modify the program's rate methodologies, in reply comments posted Tuesday in docket 17-310 (see 2304250074). Some urged the FCC to facilitate competitive bidding and a copayment structure in the telecom program and Healthcare Connect Fund (HCF) rather than revert to the commission's previous rates database.

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The telecom program "has been a major success in Alaska" and "is mission critical" to tribal healthcare providers, said the Alaska Native Tribal Health Consortium. The group opposed calls to implement a copayment for healthcare providers, saying it would "likely discourage the most remote" providers from obtaining services. The FCC should "recognize where competition exists and, like everywhere else in the country, let competition set rates," it said.

Alaska Communications disagreed, saying a copayment structure "could be adapted to offer an efficient, streamlined, less burdensome approach for disciplining rural rates." The FCC should also direct the Universal Service Administrative Co. to accept rural rates that result from the competitive bidding process "where sufficient competition exists," the provider said. Advanced Data Services also opposed the use of copayments for rural healthcare providers. Copays "are not consistent with the concept of 'reasonable comparability' with urban rates," ADS said.

Ensure that discounts are "available only where they are required," said USTelecom, saying the telecom program "no longer makes sense in its current form outside of Alaska." The telecom program "as it exists now should be an Alaska program," it said, and the FCC should adopt a "rebuttable presumption that the non-mileage-based rates for telecommunications services outside Alaska are reasonably comparable between urban and rural areas."

Rural rate methodologies "should be simplified where possible by relying on rates set through the competitive bidding process in areas where competition exists," said the Schools, Health & Libraries Broadband Coalition. The group suggested the FCC "move to mirror the approach taken in the HCF or E-rate programs," saying eliminating the rate-setting methods would also reduce the cost of administering the telecom program. SHLB also backed allowing funding to support last-mile special construction as a way to increase competition.

Competitive bidding with a copayment system as a "guardrail" would "ultimately facilitat[e] the merger of" the telecom program and HCF to "create efficiencies for participants, USAC, and the commission," said NCTA. The group also backed allowing HCF support to be used for network equipment purchases, saying the "modest increase in equipment support" would "lead to greater efficiency."

The New England Telehealth Consortium raised concerns about the National Rural Health Association's request to prioritize rural-only multi-year contracts for the HCF, saying the group "misunderstands the role non-rural health care providers play" in the program. Multiyear funding requests from consortiums "typically include both rural and non-rural" healthcare providers, the group said, making it "practically impossible" to separately fund rural providers and "detrimental to consortia as a whole." NETC backed calls for the FCC to release how much HCF support goes to urban providers, noting there is "no current mechanism to reflect program expenditures that are nominally associated" with non-rural locations.