Telehealth Series #2: Advance Guidance on Connected Care Pilot Application Released

What a difference a year (and a global pandemic) can make. Back in July 2019 we published an article outlining the opportunities available through telehealth and telemedicine, particularly for rural communities and as another tool in combatting the opioid epidemic. At that time, we necessarily focused on the barriers associated with the expanded adoption of telehealth. We introduced Congress’s efforts to address these challenges through its establishment and funding of the Connected Care Pilot (Pilot) program under the Federal Communications Commission (FCC).

Today, the Pandemic and the need for social distancing have engendered a rapid and exponential uptick in the use of telehealth services.  The Connected Care Pilot Program has thus taken on increased importance and earned greater recognition, both as a tool in the federal toolbox and as a resource available to providers responding to the acute and chronic challenges of our fragmented health care system. Last week, the FCC released important guidance in preparation for the upcoming Pilot program application process. While the Pilot application is not yet available, interested health care providers can use this time to assess whether they are eligible, engage in conversations with potential local partners, and begin to pull together the materials they will need to meet the requirements, as described below.

The purpose of this article is, therefore, threefold. First, we intend to remind our readers of the Pilot as an available resource for providers serving low-income populations. Second, we aim to help prepare potential applicants for submission by reviewing the key programmatic elements of the Pilot and explaining the FCC’s rationale behind the requirements. Finally, we hope to aid in understanding the goals and the expectations of the Commission, as that understanding will be critical to developing a winning application.

Recent Background

In response to the Coronavirus outbreak, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act into law on March 27, 2020. Among other actions, the CARES Act appropriated $200 million to establish the COVID-19 Telehealth Program to enable the FCC to support health care providers in the fight against the virus. The Telehealth Program was designed to provide immediate support by fully funding qualified health care provider telecommunications services, information services, and devices necessary to provide critical connected care services in response to the restrictions created by the pandemic.

Shortly thereafter, the FCC published a Report & Order on April 2, 2020, outlining the rules for both the emergency COVID-19 Telehealth Program and the Connected Care Pilot Program. It is worth noting that, despite the consolidation of their operations under the umbrella of “promoting telehealth for low-income consumers,” these two programs were established to serve very different purposes. The former was a quick cash infusion to support the rapid adoption of telehealth in the face of a public health emergency. The Pilot Program, on the other hand, is a long-term program intended to serve as a framework for more systemic change and investment in the necessary infrastructure. Specifically, the Pilot Program will provide meaningful data to support the broader study of the benefits, including cost savings of connected care and whether there are obstacles to connected care that could be addressed by the Commission’s universal service programs.

A Checklist of Key Programmatic Requirements

Eligible Health Care Providers

While the FCC received numerous comments from stakeholders regarding the Pilot’s proposed definition for eligible health care providers, the final rule maintains the limited definition as enumerated in the Telecommunications Act of 1996. This includes:

1. Post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools;
2. Community health centers or health centers providing health care to migrants;
3. Local health departments or agencies;
4. Community mental health centers;
5. Not-for-profit hospitals;
6. Rural health clinics;
7. Skilled nursing facilities; or
8. A consortium of health care providers consisting of one or more entities falling into any of the first seven categories.

This definition draws a bright line excluding for-profit in favor of nonprofit and public health care providers. While commentators advocated for the FCC to expand the eligible pool and utilize the broad definition of health care provider established under the Medicare program (Section 1171(3) of the Social Security Act), the FCC declined, noting that the limited categories were designated by Congress. The Commission further reasoned that the narrow definition will ensure that the funds will go to the types of health care providers that are more likely to have a greater need and include provider types that are familiar with other FCC programs, allowing the FCC to leverage existing processes and procedures for determining program eligibility.

In addition to meeting the above definition, the Commission is seeking applicants that have previous experience providing telehealth services. Experience must go beyond using electronic health records (EHRs) to include more sophisticated, clinical interactions such as remote patient monitoring, store-and-forward imaging, or video conferencing.

A lack of direct experience does not preclude eligible providers from participating in the Pilot. Such providers are, instead, encouraged to partner with another health care provider, government agency, or designated telehealth resource center in order to meet this criterion. However, partnerships with a service provider (e.g., a vendor of connected care services or a provider of broadband) are not sufficient to meet this preference. The FCC views partnerships as an important path forward for expanding access to telehealth services for providers that have experienced barriers to the implementation of telehealth.

Priority Populations and Conditions

The Pilot program was established to improve access to connected care for low-income Americans and veterans because these populations are more likely to have complex, high-cost conditions, reside in areas with physician shortages, and may not have mobile or residential internet access. Recognizing the limited resources available to address this broad objective, the Commission also identified a subset of prioritized health conditions to further narrow the focus of the Pilot. These include opioid dependency, mental health conditions, high-risk pregnancy, or chronic or recurring conditions that typically require at least several months to treat, including (but not limited to) diabetes, cancer, kidney disease, heart disease, and stroke recovery. The final rule expanded these prioritized conditions to include an additional focus area for Pilot programs that are designed to treat public health epidemics, such as the current Coronavirus pandemic.

These conditions were selected because they impact large segments of the population and, due to the length of required treatments, will provide more meaningful data to track progress towards the Pilot Program goals of improving health outcomes and reducing costs.

Geographic Area

While the greatest need and opportunity for telehealth services are generally associated with more rural areas, the Pilot program support is available to health care providers in both rural and non-rural areas. This decision was made in recognition of the fact that “underserved communities exist in both rural and non-rural settings and broadband access is a concern to low-income communities generally,” regardless of geography. As we will discuss in the following section (“How to Get Started…”) since eligibility is not restricted by geography, it will be important for successful applicants to demonstrate (with data):

1. How patients in their area of practice (either based on geography or area of practice) face access barriers and;
2. The projected impact that Pilot investment will have on the target population.

Eligible Services and Equipment

The Pilot Program will fund 85% of the qualifying costs incurred by eligible health care providers. These costs include:

1. Patient broadband Internet access services;
2. Health care provider broadband data connections;
3. Other connected care information services; and,
4. Certain network equipment.

As many commentators noted, a significant barrier to telehealth is the lack of broadband internet for some while, for others, the internet that is available is insufficient to facilitate connected care services. In light of these facts, the final rules allow funding to be used by participating health care providers to purchase mobile or fixed broadband Internet access service for participating patients who do not already have broadband Internet access or who lack sufficient broadband Internet access service necessary to participate in the specific Pilot project.

The Pilot Program will also provide support for eligible, participating health care providers to purchase the broadband data connections needed in their practices to provide connected care services under the Pilot Program. This includes those who already have connectivity but may need additional services to fully participate in the Pilot.

The Commission received an extensive comment on the other significant costs providers incur to provide connected care services. For example, providers use “store-and-forward” technology or remote patient monitoring capabilities to monitor expecting mothers or to treat mental health conditions. These information services are necessary to retrieve and store the information that is being transmitted. Costs for these services are typically not reimbursable through health care payors, which can present an obstacle to connected care services. Funding information services for health care providers through the Pilot program, therefore, could enhance health care providers’ access to such information services and encourage innovation.

How to Get Started…

If you have been thinking that your practice/organization and your patients would benefit from access or improved access to telehealth services, this funding opportunity may provide the financing needed to overcome barriers to implementation. We have outlined three simple (3) steps below to begin assessing your eligibility and participation in the Pilot.  

1. Request an Eligibility Determination
To determine whether a health care provider meets the established criteria, applicants must request an eligibility determination by filing an FCC Form 460 with the Universal Service Administrative Company (USAC) and obtain a Health Care Provider Number (HCP Number) for each health care provider site where they intend to use Pilot Program funding to provide connected care services. We recommend this as the first step in assessing the viability of the Pilot for your organization. Because these forms are available now, you can get a jump start on the process. Providers that have already applied for other FCC programs, including the Rural Health Care (RHC) Program or the COVID-19 Telehealth Program, may rely on that eligibility determination for the Pilot program.

2. Review Data & Identify Gaps
While the Commission has yet to identify evaluation measures for the Pilot program, data integration remains an integral part of the program. The FCC expects that applicants will use data to demonstrate need and define both the geographic area to be served as well as the target population and conditions. We recommend that organizations considering applying for the Pilot program review their existing data to identify answers to the following questions:

1. How many patients meet the target population criteria (i.e., low-income or veteran)?
2. Of those patients, how many are being treated for one of the preferred conditions?
3. What types of connected care services have proven to improve outcomes for these populations/conditions?

Reviewing this data will help not only to plan for potential Pilot program development but will also identify gaps and areas where potential partners may improve the program design.

There may be additional data points required by the application that providers do not have easy access to, such as broadband connectivity among the target patient population. The Commission indicates that if an applicant is seeking funds to pay for patient broadband internet access, they must demonstrate how they will determine patient need. We recommend reaching out to the designated telehealth resource center in your region. These centers are funded by the Office of Advancement of Telehealth to assist in expanding the availability of health care to rural and underserved populations in local communities. They provide technical assistance, education, and information to organizations that are actively providing or interested in providing health care at a distance and their support is generally free of charge.

3. Consider Partnerships
Often the barriers to telehealth adoption (e.g., lack of broadband access) are experienced regionally. This fact would suggest that taking a regional approach to designing a Pilot program will not only have a greater impact on the community but will also allow providers to share the administrative responsibilities associated with the Pilot. Additionally, Pilots that involve a larger geographic area or patient population are more likely to be chosen given the Commission’s goal of leveraging meaningful data to demonstrate the benefits of telehealth.

Even more so, entities that have traditionally not been considered a part of the medical model of healthcare (e.g., public health departments and community mental health centers) and, therefore, have not been engaged in telehealth efforts to date, have a great opportunity to partner with local providers that are more experienced with telehealth. Such partnerships can benefit both parties and leverage existing skill sets (i.e., non-profit hospital expertise in telehealth and public health department expertise in maternal health and patient engagement) to quickly ramp up Pilot programs.

Ready, set, GO!

We believe the public notice provides sufficient detail of the Pilot program to begin conversations with potential partners and identify opportunities to work together in support of a Pilot application. The past six months have demonstrated to many the opportunities created by telehealth to expand access and to improve quality and patient satisfaction. However, significant barriers persist, and regional and demographic disparities create further challenges for many providers. This Pilot Program, although limited, provides an important resource to help establish the infrastructure to better deliver on the aspirational goal of the right care, at the right time – in the right place.

As always, should your organization be considering participation in this Pilot Program, Atrómitos is available to help you assess readiness, identify partners, and develop a compelling application for this program. You can get in contact with us here.