FCC ASKED TO BROADEN MEANING OF ‘RURAL’ FOR HEALTH CARE PROGRAM

The comments Mon. came as the FCC is looking for ways to improve the universal service program for rural health care providers. The Commission last year adopted rules to increase participation in the program and raise the level of spending to make it closer to the $400 million funding cap (CD Nov 14 p7). FCC Chmn. Powell then expressed concern that of $400 million annually set aside by the Commission, in the first 5 years of the 6-year-old program only $30 million was used by rural facilities. In 2000 and 2001, demand for the program averaged $14 million per year -- only 3.5% of available discounts.

Rep. Boucher (D-Va.), who represents a district with 49 telemedicine sites, strongly criticized the current definition of “rural,” saying it needed to be expanded to cover communities that were “distressed, mountainous, have low population density and suffer from shortages in health professional services notwithstanding their inclusion in federally drawn metropolitan statistical areas (MSAs).” Currently, an area qualifies as rural if it’s located in a non-metropolitan county as defined by the Office of Management & Budget (OMB) or is specifically identified in the Goldsmith Modification to 1990 Census data published by the Office of Rural Health Policy.

However, Boucher said the FCC “mistakenly” relied “solely” on the Census Bureau and OMB’s definition of rural, which he said was “outdated and was never particularly well- suited to the needs of the universal service rural healthcare support mechanism.” He said the Census Bureau and OMB “never intended for the Commission to adopt its rural/urban methodology” and had warned against potential problems that could “result when an agency relies on a definition that was originally designed for demographic measurement and projection.” For example, he said the OMB had warned against using MSAs as a measurement for program needs because they didn’t necessarily equate to urban-rural classification. It said its measurements shouldn’t serve as a framework for nonstatistical activities and may not be suitable for use in program funding formulas. Nevertheless, Boucher acknowledged that the non-MSA provision of the Census Bureau’s order provided “a solid basis for a component of the Commission’s newly expanded definition.”

Boucher said the FCC should expand its definition of rural by “considering definitions used by other agencies and by taking into account population density and health shortage.” He said the current definition was “flawed,” because it disqualified communities considered rural under other well-established state and federal agency programs. He expressed concern some communities in his district classified as rural by the U.S. Dept. of Agriculture and the Appalachian Regional Commission, paid more than their urban counterparts for telecom service under the current Commission regime: “This outcome clearly frustrates Congressional intent.”

Boucher said the Commission should “supplement its MSA- related definition with a test” focusing on additional factors, such as: (1) Defining communities with fewer than 20,000 people as rural following the standard used by the U.S. Dept. of Agriculture’s (USDA) Rural Utilities Service, using a population-density measure as a safeguard against program abuse. (2) “Irrespective of population density,” defining areas with fewer than 20,000 people as rural if they have “a health-care facility that meets the definition of a ‘community health center’ or ‘critical access hospital.'” (3) “Authorizing states to designate additional areas as rural based on unique circumstances that fall outside these general standards.”

Boucher urged the FCC to adopt a definition under which an area eligible for support under the universal service program would be: “(1) Any non-MSA county, or (2) Any incorporated or unincorporated town, village, borough or other area of fewer than 20,000 persons in a county with a population density of less than 250 persons per square mile, or (3) Any incorporated or unincorporated town, village, borough or other area of fewer than 20,000 persons that includes a community health center or critical access hospital, or (4) Any community designated as rural by a state health planning and development agency.”

In a separate filing, the American Telemedicine Assn. (ATA) expressed concern that a variety of definitions used by the federal govt. created an “unnecessary and confusing element for potential rural applicants.” It urged the FCC to adopt a definition used by the USDA Rural Broadband Grant & Loan program, which defines an eligible rural community as “any area of the United States that is not contained in an incorporated city or town with a population in excess of 20,000 inhabitants.”

Meanwhile, Verizon said there was “no perfect definition that clearly divides the country between rural and urban areas” and urged the Commission to “weigh the relative advantages and disadvantages of each proffered definition” available. It said the definition of “rural” must be “accurate, easy to administer, consistent, and transparent.”

The National Rural Health Assn. (NRHA) said there was “no one rural definition that works to define the diversity and complexity of America’s rural communities.” It urged the FCC to “allow organizations to use whatever state or federal rural definition best fits their unique circumstances.” It said to encourage broad participation in the rural healthcare program, the Commission should “not force a ‘one-size-fits- all’ definition of rural.” The National Organization of State Offices of Rural Health recommended that the FCC adopt a “multiple method” of defining rural, while keeping its previous definition utilizing either OMB or Goldsmith and adding RUCA as a “third alternative.”

ATA also said it was “concerned” that recent changes to the adopted definition of “rural” would “adversely affect” the eligibility of sites previously considered rural: “Using the current FCC rules for eligibility, 28% of the counties previously classified as rural will not be considered metropolitan statistical areas and 12% of counties formerly classified as rural will be considered metropolitan statistical areas by OMB classification.”

ATA also recommended there be a provision to “grandfather” existing providers currently receiving benefits from the program under the new definition. Verizon disagreed: “Even if a new definition is adopted, there is no basis under the [Telecom] Act to provide grandfathered status to areas that formerly qualified as ‘rural.'”