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March 2021

Charter announces broadband investment in Bamberg County

By News

Special to The T&D

Charter Communications Inc. has announced plans to deliver gigabit high-speed broadband to approximately 98,600 unserved South Carolina small businesses and homes, including properties in Bamberg County.

Today, 60% of Bamberg County’s more than 14,000 residents cannot access high-speed broadband.

As a result of Charter’s investment in South Carolina, an additional FCC-estimated 2,853 Bamberg County homes and small businesses will have access to gigabit connections from Spectrum Internet.

More than $362 million will be invested in South Carolina, which includes an expected private investment of at least $250 million by Charter and more than $112 million in support won by Charter in the FCC’s Rural Digital Opportunity auction.
Aiken Electric, CarolinaConnect partner to bring high-speed internet to rural areas
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Aiken Electric, CarolinaConnect partner to bring high-speed internet to rural areas

The effort is part of the company’s recently announced expected investment of approximately $5 billion — offset by $1.2 billion in RDOF support — to expand Charter’s network to what the FCC estimates to be more than 1 million homes and small businesses in lower-density, mostly rural communities across 24 states that do not have access to broadband service of at least 25/3 Mbps.

The new initiative is in addition to Charter’s existing network expansion.

100Mbps uploads and downloads should be US broadband standard, senators say

By News

Four US senators called on the Biden administration Thursday to establish a “21st century definition of high-speed broadband” of 100Mbps both upstream and downstream. This would be a big upgrade over the Federal Communications Commission broadband standard of 25Mbps downstream and 3Mbps upstream, which was established in 2015 and never updated by former President Trump’s FCC chair, Ajit Pai.

Today’s letter was sent to FCC Acting Chairwoman Jessica Rosenworcel and other federal officials by two Democrats, one independent who caucuses with Democrats, and one Republican. Noting that “the pandemic has reinforced the importance of high-speed broadband and underscored the cost of the persistent digital divide in our country,” they wrote:

Going forward, we should make every effort to spend limited federal dollars on broadband networks capable of providing sufficient download and upload speeds and quality, including low latency, high reliability, and low network jitter, for modern and emerging uses, like two-way videoconferencing, telehealth, remote learning, health IoT, and smart grid applications. Our goal for new deployment should be symmetrical speeds of 100 megabits per second (Mbps), allowing for limited variation when dictated by geography, topography, or unreasonable cost.

“We should also insist that new networks supported with federal funds meet this higher standard, with limited exceptions for truly hard-to-reach locations,” the senators wrote later in the letter. “For years, we have seen billions in taxpayer dollars subsidize network deployments that are outdated as soon as they are complete, lacking in capacity and failing to replace inadequate broadband infrastructure.”

The letter was written by Sens. Michael Bennet (D-Colo.), Angus King (I-Maine), Rob Portman (R-Ohio), and Joe Manchin (D-W.Va.). In addition to Rosenworcel, it was sent to Secretary of Commerce Gina Raimondo, Secretary of Agriculture Tom Vilsack, and Director of the National Economic Council Brian Deese.

“Ask any senior who connects with their physician via telemedicine, any farmer hoping to unlock the benefits of precision agriculture, any student who receives livestreamed instruction, or any family where both parents telework and multiple children are remote learning, and they will tell you that many networks fail to come close to ‘high-speed’ in the year 2021,” they wrote. “For any of these functions, upload speeds far greater than 3Mbps are particularly critical. These challenges will not end with the pandemic.”

Rosenworcel pushed for higher speeds

Rosenworcel already supports a standard above the FCC’s current one. “With so many of our nation’s providers rolling out gigabit service, it’s time for the FCC to adjust its baseline upward, too,” she said in April 2020, calling for a 100Mbps download standard and an upload standard that’s higher than 3Mbps. “At present, our standard [for uploads] is 3 megabits per second,” she said at the time. “But this asymmetrical approach is dated. We need to recognize that with extraordinary changes in data processing and cloud storage, upload speeds should be rethought.”

The FCC standard is important for the commission’s annual broadband deployment report that determines how many Americans are “unserved” and grades the country’s progress toward universal availability. Adopting a higher speed standard would make it more likely that the FCC will find that broadband deployment is not happening fast enough and take more aggressive action to speed up deployment.

The FCC isn’t as active as it could be right now because there is a 2-2 split between Democrats and Republicans. President Joe Biden can fix that by nominating a new Democratic commissioner, but he hasn’t done so yet.

100Mbps a big upgrade for uploads

Going from 25/3Mbps to 100/100Mbps would be an especially large upgrade on the upload side. Today’s offerings from cable companies would not meet the 100Mbps threshold for uploads, as even gigabit-download cable plans from Comcast and Charter come with only 35Mbps upload speeds. The cable industry for years has been promising faster upload speeds powered by upgrades to DOCSIS, the Data Over Cable Service Interface Specification. But cable’s speeds are still unbalanced, providing much greater download speeds than upload speeds.

By contrast, AT&T and Verizon’s fastest fiber plans come with 940Mbps download speeds and 880Mbps upload speeds. Even the cheaper, lower-tier plans offered by fiber-to-the-home ISPs meet the senators’ proposed 100/100Mbps standard.

Cable is far more widespread than fiber in the US. The eight biggest cable companies combined have 72.8 million Internet subscribers, according to Leichtman Research Group. The top eight wireline phone companies have 33 million Internet subscribers, but that includes both fiber-to-the-home and DSL, and those copper-line DSL networks are severely outdated and poorly maintained.

A serious commitment to symmetrical 100Mbps broadband may require a lot more fiber construction across the US. The senators’ letter didn’t quite take a fiber-or-bust stand, but they do want federal funding in rural areas to support higher upload speeds than what you normally get with cable:

While we recognize that in truly hard-to-reach areas, we need to be flexible in order to reach unserved Americans, we should strive to ensure that all members of a typical family can use these applications simultaneously. There is no reason federal funding to rural areas should not support the type of speeds used by households in typical well-served urban and suburban areas (e.g., according to speedtest.net’s January 2021 analysis, average service is currently 180Mbps download/65Mbps upload with 24 millisecond latency.

The senators are also frustrated by differing standards across agencies. “We now have multiple definitions across federal agencies for what constitutes an area as served with broadband, resulting in a patchwork without one consistent standard for broadband,” they wrote. “For example, the FCC defines high-speed broadband as download speeds of up to 25 megabits per second and upload speeds of up to 3 megabits per second (25/3Mbps). Alternatively, the US Department of Agriculture (USDA) defines it as just 10/1Mbps.”

FCC deployment data

The FCC is already supporting networks faster than the 25/3Mbps standard. The commission’s Rural Digital Opportunity Fund (RDOF) tentatively awarded $9.2 billion over 10 years to 180 entities to deploy broadband to 5.2 million unserved homes and businesses. The FCC said that “99.7 percent of these locations will be receiving broadband with speeds of at least 100/20Mbps, with an overwhelming majority (over 85 percent) getting gigabit-speed broadband.” The funding is going to a mix of cable, fiber, and fixed wireless providers, plus SpaceX’s Starlink satellite network.

The most recent FCC broadband deployment report said that, as of year-end 2019, 95.6 percent of Americans had access to fixed broadband with speeds of at least 25Mbps downstream and 3Mbps upstream. Deployment at higher speeds is more limited, especially in rural and tribal areas. For example, the report said that 250/25Mbps speeds are available to 87.2 percent of people nationwide, 55.6 percent of people in rural areas, and 49.6 percent of tribal residents.

Those data points likely undercount the number of unserved Americans because the FCC lets ISPs count an entire census block as served even if it can serve just one home in the block. The commission plans to collect geospatial maps from ISPs to make the data more accurate.

FCC commissioner wants more bandwidth, more jobs in Mississippi

By News

GULFPORT, Miss. (WLOX) – Federal Communications Commissioner Brendan Carr was in South Mississippi Thursday, working with state community college leaders and Southern District PSC Commissioner Dane Maxwell on creating more internet-broadband based jobs for that expanding industry.

“How do we have the workforce in place to build out the next generation of internet infrastructure which is 5G which is the fastest newest service?” Carr said. “Right now, we can almost double the amount of tower tech workers. We can hire 20,000 almost overnight.”

The current pool is 27,000 tower technicians and other broadband/internet based employees. He and others would like to expand that workforce through Mississippi’s community college system.

“We came up with an idea because we have such good community colleges, so we put them together and put everybody together and build a curriculum,” Maxwell said. “Build an apprentice program and get them trained and get them out.”

When they are out, they go to businesses like Millerco, a company based here in South Mississippi that has nine locations in four states.

“People don’t realize it takes a lot to make your cell phone work. It’s not magic and it’s not pixie dust. It’s hard, tough, dangerous work that these tower techs are doing and nationwide we’re looking at needing to fill about 20,000 positions,” said Jordyn Ladner, Millerco operations manager.

Carr and others also toured MGCCC’s Harrison County Campus and other areas of the Coast.

“We need to make sure that every community in this country has a fair shot and next gen internet,” Carr added. “It’s so critical whether it’s for distance learning, telehealth, or working remotely.”

Copyright 2021 WLOX. All rights reserved.

Deep dive: Tracking the past 12 months of telehealth at Yale New Haven Health

By News

By Bill Siwicki

12:03 PM

With a collaborative spirit and a drive to provide the virtual care patients wanted, the health system has grown its program by leaps – it now sees in 10 minutes the number of patients it used to see via telemedicine in a month.

ale New Haven Health in Connecticut is a five-hospital, seven-campus health system that includes a large physician practice, numerous ambulatory centers and a home care agency. It is affiliated with the Yale School of Medicine and its clinical faculty practice, Yale Medicine, which provides a depth and breadth of clinical expertise to support much of the health system’s telemedicine programs and provides existing infrastructure that supports joint development of telehealth programs.

All Yale New Haven Health entities are on a single instance of the Epic EHR that spans Connecticut into western Rhode Island and Westchester County, New York. The health system has developed tele-stroke, tele-ICU and on-demand video visit programs.

The crisis sets in

The COVID-19 crisis presented several challenges to the health system that amplified the need and impact of telehealth services.

To safely care for patients and provide additional safeguards for clinical staff, Yale New Haven Health had three clear needs to address:

  1. Rapidly expand the tele-ICU services to support a ballooning ICU census.
  2. Provide supportive services in med/surg units to allow nursing staff to cluster care activities to reduce utilization of PPE and potential staff exposure.
  3. Rapidly scale ambulatory telehealth to provide ongoing access to medical care for patients.

“The northeast U.S. was among the regions of the country affected early in the pandemic when little was known about transmission and when treatment was largely supportive care,” said Dr. L. Scott Sussman, physician executive director telehealth at Yale New Haven Health. “Additionally, since the availability of COVID testing was limited, patients who were suspected of having COVID needed the same isolation precautions and PPE as those patients who had already been diagnosed while we were awaiting test results.”

Early in the pandemic, Yale New Haven Health, like the rest of the nation, faced significant shortages of essentials including PPE, negative pressure rooms and testing supplies. These limitations had a direct impact on patient care and posed several problems:

  • Patients were cared for behind closed doors and with no visitors allowed, adding to their feeling of isolation.
  • Clinicians were anxious for the safety of the patient, themselves and their families.
  • PPE was in short supply.
  • Yale New Haven Health needed to maximize the safety and efficiency of care teams.

“To address these issues, we turned to telehealth to increase connections between patients and the families, to enable the care team to provide care while minimizing exposure risk,” Sussman explained. “We were fortunate to have enough PPE to see our patients, and innovative stewardship efforts and our telehealth equipment helped ensure our supply lasted, though we did not have excess.”

Challenges for physicians and nurses

These obstacles created a challenging environment for nursing and physician staff.

“The impact of our telehealth intervention is demonstrated by just one example: One of our ICU nurses was caring for a COVID-positive patient in March 2020,” Sussman recalled. “She heard the ventilator start to alarm because the tube became disconnected and ran into the room to care for the patient, without concern for her own risk of exposure.”

This level of commitment is not unique among frontline caregivers, and it was exactly the reason Yale New Haven Health put telehealth in place to monitor and intervene with patients remotely, he added.

“Not surprisingly, between lockdowns, limited PPE, visitor restrictions and concern about virus transmission, in-person outpatient care was not an option for most patients,” he noted. “We recognized that delaying important ambulatory care would be detrimental to health and could result in emergency department visits, which would put additional strain on those resources.”

Ambulatory video visits

Yale New Haven Health needed a solution that would connect clinicians with patients to provide care for both acute and chronic diseases. It leveraged and rapidly scaled its ambulatory video visit platform to meet the need for ambulatory care.

“In the past, we would have relied heavily on our vendor partners to provide these technical solutions,” Sussman observed. “Given the need to work quickly and at scale, the team looked to internalize these solutions, leveraging commercial computer and AV equipment along with software provided by our telehealth partner, InTouch, now part of Teladoc.”

“We see telehealth as a great opportunity to provide increased access to care, enhanced convenience, and to enrich the relationship between patients and their care teams. With that opportunity, though, are other challenges, including ensuring patient access to technology, broadband and digital literacy.”

Dr. L. Scott Sussman, Yale New Haven Health

Over the course of around a month, the team was able to support an expansion of tele-ICU services from 94 monitored rooms across three hospital locations to more than 200 rooms across the health system.

“This was done in conjunction with the expansion of clinical services from a 7 p.m. to 7 a.m. model to full 24/7 remote monitoring through the tele-ICU,” Sussman explained. “From a med/surg perspective, more than 1,000 telehealth carts were delivered to inpatient units throughout Connecticut and Rhode Island to ensure that nurses had the capability to interact with COVID-positive patients through real-time audio-visual solutions.

“The size of this effort and the time in which it was completed was nothing short of amazing,” he continued. “While Yale New Haven Health recognizes and appreciates the assistance offered by the FCC through its multimillion-dollar telehealth grant, we are equally as appreciative for the outpouring of support that allowed this to happen.”

Everyone pitched in

For several weeks, Yale New Haven Health had staff from across all aspects of the organization participating in this process – through the construction of equipment, testing and validation, and coordination of deliveries to inpatient units. This collaboration not only rapidly allowed the health system to meet patient care needs, it also resulted in more than $3 million in savings.

In-hospital telehealth, a combination of hardwired rooms in select ICUs and mobile carts in other units, facilitated care for admitted patients at each of Yale New Haven Health’s delivery networks and promoted PPE preservation.

This would allow two-way audio and video communication for patients who were admitted to the hospital. The InTouch platform allowed the care team to access patients who were admitted using audio and video technology, while decreasing the amount of PPE needed and minimizing exposure to COVID-19.

“For the tele-ICU, the telemedicine technology was expanded in conjunction with efforts from our clinical engineering team to integrate physiological monitoring into the proposed solution,” Sussman said. “In conjunction with the rapid construction of a new tele-ICU bunker to accommodate additional clinical support staff, the integrated team designed and built the capacity to monitor more than 200 simultaneous locations directly through our EHR.”

As a result of this work, Yale New Haven Health was able to:

  • Reduce the burden on intensivists to cover extended shifts.
  • Allow patients to remain at the local hospital location and receive medical care from a tertiary care hospital, which was especially important since many of the ICUs were full.
  • Reduce the need for direct patient/provider contact for COVID-positive patients.
  • Improve the overall safety and efficiency of services provided by allowing for an additional set of eyes and ears to support these critically ill patients.

“From the med/surg perspective, the primary focus was to address nursing needs around the preservation of PPE and the reduction of direct patient contact,” Sussman said. “Our implementation plan included rapid deployment of telehealth carts, as well as communication and education of nursing staff on the appropriate utilization of the new technology.”

Bi-directional communication with patients

All clinical staff were granted access to the telehealth platform through both mobile devices and desktop workstations in the units. The bi-directional communication with patients allowed the caregivers to remotely visit with the patients to assess care and answer any questions.

As an added benefit, the team was also able to develop a support model for virtual consults. This enabled specialty providers to meet with patients virtually when not available on site and is a care pathway that the health system intends to develop well past COVID-19 to improve both the efficiency and timeliness of care.

“In the ambulatory space, we set up telehealth visits for every department and section, which involved tremendous work by the Epic team,” Sussman noted. “They designed new workflows, created training for patients and clinicians, and provided support for patients who were new to telehealth, and set up a team of volunteers to convert patient visits to video and support patients on the download of necessary applications.”

The Vidyo platform was integrated into Epic and the MyChart patient portal, which facilitated patient video visits. This infrastructure allowed visits to occur virtually, since large numbers of face-to-face visits were not feasible.

“Telehealth technology allowed us to care for patients who were admitted to the hospital in a new and meaningful way,” Sussman observed.

“By facilitating connections between patients and the care team – nurses, trainees, nurse practitioners, physician assistants, therapists, physicians, etc. – we were able to provide care in ways that simply were not feasible without video technology. For example, our workforce, which at times was limited in seeing patients in person due to health restrictions, could care for patients remotely.”

New models of providing care

This also allowed the team to use new models of providing care – including assigning virtual advanced practice providers to provide care for groups of patients overseen by multiple attendings, who would use PPE and see the patient in person, and perhaps follow up in the afternoon via telehealth.

“Rounding on patients across multiple units became more straightforward, and taking the shuttle between campuses became optional, as we could see patients via telehealth as a supplement to in-person visits,” Sussman said.

“PPE preservation was another key factor, especially early in the pandemic. It is largely because we were able to use video technology to care for patients that we were able to maintain adequate supplies of PPE that our supply chain team worked hard to secure.”

In the ambulatory setting, telehealth facilitated care that otherwise would not have been possible.

“Initially, we used Vidyo and ultimately transitioned to Zoom,” Sussman recalled. “We provided individualized patient support for video visits – assistance with downloading software, logging in to the patient portal – and provided extensive training for clinicians on how to use the software effectively in order to connect with patients in meaningful ways.”

Zoom is integrated directly into Epic and allows links to be texted and emailed to patients and their family members so they can easily join visits. In addition, it incorporates interpreter services directly into the video visit to help ensure access to patients who might speak languages other than English.

The results

Since expansion of tele-ICU services, Yale New Haven Health has had more than 3,500 distinct video assessments performed by tele-ICU staff and more than 14,000 interventions ranging from ventilator management to restraint order compliance.

In addition, the tele-ICU staff are responsible for best practice rounding to ensure that patients have appropriate orders in place based on systemwide ICU patient management policies. While overall compliance goals are still being developed, the tele-ICU team has established greater than 90% compliance in management of CVAD, Foley Catheter and DVT prophylaxis order management.

“Overall, there have been thousands of inpatient consults completed using telehealth, which otherwise might not have been able to occur since some specialists were not able to see patients in the hospital due to their own health restrictions,” said Sussman.

“The technology helped mitigate burnout, since clinicians were able to care for patients across greater geographies without needing to travel, and allowed more clinicians to participate in care than would have otherwise been able to.”

Since March 2020, clinicians, nurses, therapists, chaplains and many other members of the team connected with patients and have spent more than 9,500 hours with admitted patients using telehealth.

“In 2019, we performed 316 ambulatory video visits across our health system, and in 2020 we completed more than 516,000, which is growth of more than 100,000%,” Sussman said. “Put another way, the number of patients we used to see per month now happens in 10 minutes. This unprecedented growth in video visits allowed patients to access care in ways that were meaningful to them, while keeping patients and clinicians safe.”

Taking care of patients at home

There was hesitancy to seek medical care in-person early in the pandemic, and telehealth provided a way for patients to receive medical care without leaving their homes.

“In two surveys of our patients and the public, we measured the adoption of and satisfaction with video visits,” Sussman said. “From greater than 3,000 responses, 72% of patients indicated they had participated in a video visit, 75% reported the quality was excellent or good, and 74% said they might or would do it again. Sixty-four percent of people responded that the ability to do video visits is a primary consideration in their selection of a provider or hospital.

“These are important indicators for us,” Sussman continued, “that telehealth is a durable and important mode of care.”

The FCC bequeaths $2.9 million

In May 2020, the FCC’s telehealth funding program awarded Yale New Haven Health a $2,875,781 grant to expand telemedicine during the COVID-19 crisis.

“These funds allowed us to understand how to effectively use telehealth technologies to support our clinical operations,” Sussman said. “Based on our experience through COVID, we are now redesigning our approach to telehealth services including significant investment in both technology solutions as well as staff to ensure that the program continues to grow to support the needs of our patients and caregivers.”

In addition to supporting the hardware acquisition to perform video visits, the FCC funds also covered the costs of software licensing with vendors. The combination of these created the infrastructure to complete more than 500,000 patient visits during COVID-19 and sets Yale New Haven Health up to meet the growing consumer demand for high-quality and accessible telehealth far beyond the pandemic and public health emergency, Sussman said.

“It is a silver lining of COVID, since it quickly accelerated our program to provide a service that our patients have clearly indicated they want,” he said. “We now offer telehealth visits in all specialties and are expanding our offerings outside of traditional hours to include evening and weekend appointments.”

Answering patient questions virtually

In addition, the telemedicine team has partnered with the patient access center to connect patients with medical questions, initially related to COVID-19, though now any topic, to facilitate telehealth visits on-demand.

“We see telehealth as a great opportunity to provide increased access to care, enhanced convenience, and to enrich the relationship between patients and their care teams,” Sussman said. “With that opportunity, though, are other challenges, including ensuring patient access to technology, broadband and digital literacy.”

Future federal funding may help address some of these issues, he added.

“Regardless, our system will continue to promote and deliver equitable access to healthcare through telehealth technology,” he concluded. “The infrastructure that now exists, due in part to the FCC funds, provides the foundation upon which our telehealth program can grow to extend health into our local communities and beyond by facilitating connections and making it easier to do the right thing.”

FCC PUBLIC NOTICE RE: Milestones for the Emergency Broadband Benefit Program

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PUBLIC NOTICE

DA 21-265

Released:  March 4, 2021

WIRELINE COMPETITION BUREAU Announces Initial Milestones for the Emergency Broadband Benefit Program
WC Docket No. 20-445

By this Public Notice, the Wireline Competition Bureau (Bureau) announces upcoming milestone dates for the Emergency Broadband Benefit Program (EBB Program), a $3.2 billion federal initiative created by Congress in the Consolidated Appropriations Act of 2021,[1] to help lower the cost of high-speed internet for eligible households during the on-going COVID-19 pandemic.[2]

On February 25th, the Federal Communications Commission (Commission) unanimously adopted a Report and Order that established the EBB Program.  The EBB Program Order directed the Bureau within seven days of adoption to announce a timeline for submission of information by broadband providers required by the Consolidated Appropriations Act to participate in the EBB Program.[3]

As adopted in the EBB Program Order and required by the Consolidated Appropriations Act, to participate in the EBB Program, broadband providers must submit information to the Bureau and the Universal Service Administrative Company (USAC) depending on the regulatory status of the broadband provider.[4]  Eligible telecommunications carriers (ETCs) and their affiliates in the states or territories where the ETC is designated can elect to participate in the EBB Program by filing the appropriate information with USAC and do not need to seek approval from the Bureau in those states.[5]  All other broadband providers need to seek approval from the Bureau to participate in the EBB Program.[6]  Additionally, any provider seeking to use an alternative verification process to make household eligibility determinations in the EBB Program must seek approval from the Bureau.[7]

In establishing these review processes, the Commission directed the Bureau to designate a priority application deadline by which non-ETC providers seeking approval to participate in the EBB Program will have the opportunity to obtain that approval prior to commencement of household enrollments.[8]  Applications received after the priority application deadline will be expeditiously reviewed on a rolling basis.[9]  Accordingly, the Bureau announces the following milestone dates for the provider application and election processes.

EBB Program MilestoneFiling LocationDate
Non-ETC Provider Application & Alternative Eligibility Verification Process Portal OpensBureauMarch 8, 2021
Provider Election Notice Inbox OpensUSACMarch 11, 2021
Non-ETC Provider Priority Application & Alternative Eligibility Verification Process DeadlineBureauMarch 22, 2021

 

As discussed in the EBB Program Order, the priority application deadline allows time for prospective providers to evaluate the rules of the EBB Program and prepare applications while at the same time also encouraging providers “to accelerate their consideration consistent with the need to quickly begin providing these supported broadband services.”[10]  The Bureau anticipates a large number of provider applications and elections, and these deadlines reflect the time needed for the Bureau and USAC to review the filings and provide sufficient notice to providers prior to the start of the EBB Program.  The Commission also directed the Bureau to announce at a later date other administrative deadlines or milestones, such as when the EBB Program will begin and when providers may begin enrolling households in the program.  The Commission expects that the EBB Program and enrollment process will begin in less than 60 days after the adoption of the EBB Program Order.[11]  The Bureau will announce in a future public notice the official commencement.

Providers seeking to participate in the EBB Program or receive approval of an alternative eligibility verification process must review all applicable program requirements and procedures as set forth in the EBB Program Order and any subsequent guidance for compliance with the EBB Program’s requirements.  To assist, the Bureau has created a webpage providing additional information about these approval processes and how to submit an application: https://www.fcc.gov/emergency-broadband-benefit-program.  Providers should use the same online application portal for non-ETC provider applications and requests for approval of an alternative eligibility verification process.  This online application portal will be available on the Bureau’s webpage under the “Provider FCC Approvals” section beginning March 8, 2021.  Non-ETCs that file complete applications for approval meeting the necessary criteria by the priority application deadline will know of their status prior to the start date for the EBB Program.[12]  These providers should obtain Bureau approval prior to filing their elections with USAC.[13]

Further information about the EBB Program, USAC’s role, and the provider election process can be found on the USAC webpage: https://www.usac.org/about/emergency-broadband-benefit-program/.  Providers seeking to file election notices should review the instructional information found on the USAC webpage for details about required information and how to submit the election.  Beginning March 11, providers can submit their forms and required attachments via email to [email protected]. The form and directions will be available soon at https://www.usac.org/about/emergency-broadband-benefit-program/system-resources/get-started.

– FCC –

[1] Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, div. N, tit. IX, § 904, 134 Stat. 1182, 2130 (2020), available at https://www.congress.gov/bill/116th-congress/house-bill/133/text (Consolidated Appropriations Act).

[2] See Emergency Broadband Benefit Program, WC Docket No. 20-445, Report and Order, FCC 21-29 (2021) (EBB Program Order).

[3] EBB Program Order, at para. 11.

[4] Id. at para. 15.

[5] Id.

[6] Id. at para. 25.

[7] Id. at para. 62.

[8] Id. at para. 15.

[9] Id. at para. 25.

[10] Id. at para. 15.

[11] Id. at para. 11.

[12] Id. at para. 15.

[13] Id.

USDA invests $2.8M in S.C. distance learning, telemedicine

By News

As part of a U.S. Department of Agriculture $24.3 million COVID-19 relief package extended to rural areas across the country, two Palmetto State school systems, a college and medical center will expand their telemedicine and distance learning platforms.

A $499,950 grant to Clinton College will go toward the establishment of a distance learning network linking libraries, churches and adult learning centers for residents in 12 rural counties in South Carolina. Funding will be used to back the school’s workforce certificate and college degree programs for adult learners, while the platform also will be used to offer pre-law and free virtual legal clinics from the North Carolina Central University School of Law.

The McLeod Regional Medical Center of the Pee Dee will make use of a $697,674 USDA grant to provide telehealth services to rural residents in Clarendon, Chesterfield, Marlboro and Florence counties, according to the release. Telehealth platforms will be installed at primary care offices in Manning and Cheraw for patients with lung ailments, as well as at public schools in the area to aid students with primary care visits and medication prescriptions.

The Pickens County School District received $845,291 to develop a distance learning and digital resource system for seven rural communities in the county through community support, dual-credit and foreign language courses, virtual field trips and professional development opportunities, as well as additional science, technology, engineering and mathematics classes, according to the release. The network is expected to serve 19,000 students.

Williamsburg County School District will create a distance learning system for dual enrollment students at third level institutions across the county with its $792,411 grant.

“The Distance Learning and Telemedicine program helps rural communities use the unique capabilities of telecommunications to connect to each other and to the world, overcoming the effects of remoteness and low population density,” USDA South Carolina Acting State Director for Rural Development Marty Bright-River said in the release.  “USDA is committed to working with the local communities to provide services which allows rural America equal access to quality health care and education, because we know when we work together, America prospers.”

Overall, the $42.3 million national investment, including $24 million sourced from the Coronavirus Aid, Relief and Economic Security Act, will benefit an estimated 5 million rural residents, according to the release.

South Carolina electric cooperatives press for rural internet access

By News

COLUMBIA, S.C. (WSAV) — As some school districts begin implementing hybrid learning options, many students are still learning remotely.

Experts say the need for better internet access in rural communities is becoming clear as the digital divide worsens.

South Carolina electric cooperatives are urging federal regulators to ensure internet providers bring high-speed access to rural areas.

Members of Electric Cooperatives of South Carolina (ECSC) say the lack of broadband connectivity, compared to urban areas, is deepening disparities in education and the workforce.

“What we see is unemployment, underachievement in our schools,” ECSC President and CEO Mike Couick said. “So many of these things are tied to the lack of quality broadband access.”

The push comes after some providers won a portion of $20.4 billion in federal grants that included new requirements to meet the needs of unserved and underserved areas.

The funding, called the Rural Digital Opportunity Fund, was established by the Federal Communications Commission to encourage the expansion of high-speed internet access to underserved areas to bridge the digital divide.

Electric cooperatives are urging regulators to build for the future, not the present.

“As co-ops, we look at the need for this connectivity. It’s not an eight or 10-year need. It’s an eight to 10-month need,” Couick said. “Our economy is changing. Our home is going to be a schoolhouse. A home is going to be a place of business for a lot longer. Let’s make sure we get it gigged-up to do both of those things.”

Couick says the state of WiFi connection for many rural counties is not enough to sustain continued remote learning for students.

“The teachers want the students to download the homework,” Couick said. “They don’t have adequate broadband in their home to do it. There’s no communication of work being done, assigned and graded between the student and the teacher. And they just get further and further behind.”

“We’re taking a sub-generation of children and taking years out of their educational opportunities,” he added.

Co-op leaders note that there is little they can do for consumers in areas where they fail to receive adequate broadband service.

“If you’re in a location where you can’t get quality — quality being that you and your children can both be in your home and do your business and have your school — let your local leaders know,” Couick said.

Lawmakers Resubmit Telehealth Bills Targeting Kids’ Health, COVID-19 Effects

By News

By Eric Wicklund

Two more telehealth bills have returned to Capitol Hill after failing to make it through last year’s session. One takes on kids’ health and other calls for an HHS study of how telehealth has effected care delivery.

– Two more telehealth bills have resurfaced on Capitol Hill, joining a growing package of legislation aimed at improving connected health coverage and access after the coronavirus pandemic.

US Reps. Lisa Blunt Rochester (D-DE) and Michael Burgess, MD (R-TX) last week reintroduced the Telehealth Improvement for Kids’ Essential Services (TIKES) Act (HR 1397), which aims to boost telehealth coverage through state Medicaid and Children’s Health Insurance Program (CHIP) services.

While no text is available for this bill, Rochester and Burgess, who first submitted the bill last October, said last year that it would “provide guidance and strategies” to help states integrate telehealth in Medicaid and CHIP programs and mandate telehealth studies from both the Government Accountability Office (GAO) and the Medicaid and CHIP Payment and Access Commission (MACPAC). It would build upon a 25-page CMS toolkit unveiled in April 2020 that’s designed to help states expand telehealth coverage under Medicaid and CHIP to deal with the pandemic.

“Amidst the pain and suffering that our nation has endured throughout the COVID-19 pandemic, a major takeaway has been the advantage of telehealth,” Burgess said then. “There is a convenience factor to not having to take time to physically transport yourself to the doctor’s office and have your child sit in a waiting room with other potentially sick patients. This bipartisan legislation will improve utilization of telehealth by requiring the Centers for Medicare and Medicaid Services (CMS) to provide guidance to states on how to make the most of telehealth options in their Medicaid and CHIP programs. Additionally, it directs studies to gather data that can help inform future telehealth policy.”

Also making a return appearance in Washington is the COVID-19 Emergency Telehealth Impact Reporting Act (HR 1406), which would have the Health and Human Services Department collect data on telehealth use during the pandemic and analyze how these technology platforms have affected care delivery.

“Telehealth is undoubtedly the future of health care, especially for the rural communities that I am privileged to represent,” US Rep. John Curtis (R-UT), who co-sponsored the bill submitted last July and this year’s version with US Reps. Peter Welch (D-VT) and Doris Matsui (D-CA), said in a press release last year. “Ultimately, Congress’ objective should be to make many – if not at all – of these regulatory changes permanent. Our bill is a significant step in that direction because it will ensure we are keeping patients’ health and reducing the costs of care through value-based medicine as our top priorities as we consider expanding telehealth services throughout the country.”

With the COVID-19 pandemic in full force last year, Congress saw several bills aimed at improving coverage for and access to telehealth services both during the after the public health emergency, but none of those bills made it out to a vote. With a new administration and Congress in place this year, the hope is that some – if not all – of these bills making a return will be approved, either individually or in some sort of package.

Just last week, the Senate saw the reintroduction of the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act (S 340) and the Telehealth Modernization Act (S 368 and HB 1332).

Scott, Schatz, Shaheen Introduce Bipartisan Legislation to Increase Access to Telehealth in the Midst of the Pandemic

By News

The Telehealth Modernization Act codifies crucial flexibilities for telehealth coverage to increase access to high-quality health care services, particularly for seniors.

WASHINGTON— Today, Senators Tim Scott (R-S.C.), Brian Schatz (D-HI), and Jeanne Shaheen (D-N.H.) reintroduced the bipartisan Telehealth Modernization Act that would update coverage restrictions that have long prevented life-saving telehealth services for many of the nation’s roughly 61 million Medicare beneficiaries. They are joined by Senators Blackburn (R-TN), Marshall (R-KS), Tester (D-MT), and Wicker (R-MS).

“As Ranking Member on the Senate Aging Committee, I know how important telehealth is to our nation’s seniors. Telehealth has been a godsend for millions of Americans receiving health care services during the pandemic, while ensuring the spread of the virus stays at a minimum,” said Senator Scott. “Updating our laws to solve today’s challenges through commonsense and practical approaches will ensure more access to health care and a safer aging population.”

“Telehealth has been a critical lifeline for millions of patients who need care during this pandemic. Now we need to make sure that the emergency expansions of telehealth coverage for Medicare beneficiaries are made permanent,” said Senator Schatz. “This new bill works hand in hand with the CONNECT for Health Act by removing unnecessary barriers in Medicare and making it easier to keep using telehealth moving forward.”

While these Medicare access gaps predated the pandemic, the spread of COVID-19 highlighted the urgency of updating telehealth coverage rules, prompting Congress to provide authority for temporary emergency waivers designed to ensure safe access to care for seniors and other vulnerable populations. As the pandemic raged, Medicare beneficiaries turned to telehealth services to minimize exposure risk and receive medically necessary care in safe and accessible settings. In April 2020, more than two-fifths (43.5%) of Medicare FFS primary care visits were provided through telehealth, and from mid-March through early July of that year, more than 10.1 million beneficiaries accessed telehealth services. 

Without further congressional action, however, these emergency flexibilities will expire at the end of the public health emergency, creating chaos for tens of millions of Medicare beneficiaries, including many who have come to rely on telehealth for critically needed care. Our nation’s seniors deserve better. The Telehealth Modernization Act would help to support their needs through necessary updates to coverage policies.

The Telehealth Modernization Act makes permanent two changes: 

•Ensures that patients can access telehealth anywhere by permanently removing Medicare’s so-called “geographic and originating site” restrictions, which required both that the patient live in a rural area and use telehealth at a doctor’s office or certain other clinical sites.

•Protects access to telehealth for patients in rural areas.

And gives the U.S. Secretary of Health and Human Services new authority to do these three things:

•Help patients continue to access telehealth from physical therapists, speech language pathologists, and other health care providers.

•Help give Medicare recipients many more telehealth services.

•Help Medicare hospice and home dialysis patients use telehealth to keep receiving necessary care.

Supporting Organizations: ACT | The App Association, Alliance for Aging Research, Alliance for Connected Care, American Academy of Neurology, American Association for the Study of Liver Diseases, American Clinical Neurophysiology Society, American Heart Association, American Medical Association, American Nurses Association, American Telemedicine Association, American Urological Association, College of Healthcare Information Management Executives, Connected Health Initiative, eHealth Initiative, Endocrine Society, Health Innovation Alliance, HIMSS, Infectious Diseases Society of America, Medical University of South Carolina, National Association of ACOs, National Hospice and Palliative Care Organization, National Multiple Sclerosis Society, National Organization for Rare Disorders, Palmetto Care Connections, Personal Connected Health Alliance, Prisma Health, Society of General Internal Medicine, South Carolina Hospital Association

Is This the Worst Medicare Telehealth Law of 2020?

By News

 

The Public Health Emergency introduced a myriad of changes to federal and state telemedicine and digital health laws and rules. There were expansions to telehealth coverage and reimbursement, suspension of enforcement on HIPAA security for digital health, expedited FDA review processes, DEA exemptions of controlled substance prescribing rules, and state waivers of medical licensure requirements. Nearly all these changes, whether permanent or temporary, were telemedicine-friendly and promoted the use of digital health technology to deliver medical care.

But one change, signed into law in the last days of December 2020, has raised confusion (and eyebrows) in the telemental health provider community. It is a single sentence, contained in Section 123 of the Consolidated Appropriations Act of 2021. It reads:

“Payment may not be made under this paragraph for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth …” (emphasis added).

In short, the Act changes the Medicare telehealth coverage statute, expanding Medicare payment beyond substance use disorder treatment (already required under the SUPPORT Act) to more broadly cover treatment of mental health disorders. Most telemedicine industry stakeholders would support expanded Medicare coverage of telehealth-based mental health services. The need for access to mental health care is high, considering the well-documented shortage of mental health practitioners nationwide, particularly in rural areas. However, under this new law, Medicare will cover the telehealth mental health service only if the practitioner has conducted an in-person consult with the patient in the prior six months and subsequently continues to conduct in-person exams (at such a frequency to be determined by HHS). Otherwise, Medicare will not pay for the telehealth service.

Here is the language of Section 123 in its entirety.

SEC. 123. EXPANDING ACCESS TO MENTAL HEALTH SERVICES FURNISHED THROUGH TELEHEALTH.

(a) TREATMENT OF MENTAL HEALTH SERVICES FURNISHED THROUGH TELEHEALTH.—Paragraph (7) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended—

(1) by striking ‘‘DISORDER SERVICES FURNISHED THROUGH TELEHEALTH.—The geographic’’ and inserting ‘‘DISORDER SERVICES AND MENTAL HEALTH SERVICES FURNISHED THROUGH TELEHEALTH.—

‘‘(A) IN GENERAL.—The geographic’’;

(2) in subparagraph (A), as added by paragraph (1), by inserting ‘‘or, on or after the first day after the end of the emergency period described in section 1135(g)(1)(B), subject to subparagraph (B), to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder, as determined by the Secretary,’’ after ‘‘as determined by the Secretary,’’; and

(3) by adding at the end the following new subparagraph: ‘

‘(B) REQUIREMENTS FOR MENTAL HEALTH SERVICES FUR- NISHED THROUGH TELEHEALTH.—

“(i) IN GENERAL.—Payment may not be made under this paragraph for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this title (or would have been made under this title if such individual were entitled to, or enrolled for, benefits under this title at the time such item or service is furnished)—

“(I) within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and

“(II) during subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

‘‘(ii) CLARIFICATION.—This subparagraph shall not apply if payment would otherwise be allowed—

‘‘(I) under this paragraph (with respect to telehealth services furnished to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or cooccurring mental health disorder); or

‘‘(II) under this subsection without application of this paragraph.’’.

(b) IMPLEMENTATION.—Notwithstanding any other provision of law, the Secretary may implement the provisions of, or amendments made by, this section by interim final rule, program instruction, or otherwise.

This is not the first time restrictions have been imposed on Medicare reimbursement for telehealth or virtual care services. For example, certain CPT service codes are limited to established patients, select items of durable medical equipment have had a “face-to-face encounter” requirement, and the geographic and originating site restrictions on telehealth have been in place for nearly 20 years. Yet, this law may very well be the first and only instance of a federal statute expressly mandating an in-person exam as a prerequisite for Medicare coverage of a telehealth-based service.

Little legislative history is readily available that reflects Congressional lawmakers discussing the merits of Section 123’s requirement for an in-person exam. To be fair, at 5,593 pages and $2.3 Trillion, this legislation is the longest bill ever passed by Congress and one of the largest spending measures ever enacted. But the in-person exam requirement is at odds with the direction that telehealth policy has moved over the last decade. It disrupts Medicare’s historical approach, which is to defer to state laws on professional practice requirements and clinical standards of care.

State laws vary on their specific requirements and practice standards, but at this point generally allow the creation of valid doctor-patient relationships via telemedicine without an in-person exam, assuming the standard of care is met. Additionally, 43 States now have telehealth coverage laws requiring commercial health plans to cover services delivered via telehealth. Some states, like Massachusetts’ recent telemedicine law, even take extra steps to ensure reimbursement of telehealth-based mental health care, and CMS itself includes new patient evaluation/management (E/M) service codes (e.g., CPT Codes 99201-99205) among the Medicare-covered telehealth services.

Moreover, Section 123’s new prerequisite for an in-person visit applies only to mental health treatment. Medicare beneficiaries seeking medical services via telehealth are not subject to this requirement. It is only those patients seeking treatment of mental health disorders who are required to “mask up” and head to their practitioner for an in-person exam. It prompts consideration as to why mental health care is being held to different payment restrictions than medical care, despite years of efforts on mental health parity and the passage of the Mental Health Parity and Addiction Equity Act.

While expansion of Medicare coverage for telehealth services can increase access to care, particularly as the Public Health Emergency continues, the policy implications of Section 123’s in-person exam requirement may leave patients and practitioners wondering if the Act actually gives as much as it takes.

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