5 - 1 5. Rural Health Care Support The portion of the 1996 Telecommunications Act that covers universal service support for rural health care providers states that “[a] telecommunications carrier shall . . . provide telecommunications services . . . to any public or non-profit health care provider . . . at rates that are reasonably comparable to rates charged for similar services in urban areas in that state.” 1 The Commission's universal service rules permit eligible health care providers 2 to receive support for any telecommunications service. 3 In December 2004, the Commission released a Second Order 4 that modified the Commission’s rules for rural health care support. In this Second Order, the Commission changed its definition of rural for the purposes of the rural health care support mechanism. Now a “rural area” is an area that is not located within or near a large population base. Specifically, a “rural area” is an area that (a) is entirely outside of a Core Based Statistical Area (CBSA); (b) is within a CBSA that does not have any urban area with a population of 25,000 or greater; or (c) is in a CBSA that contains an urban area with a population of 25,000 or greater, but is within a specific census tract that itself does not contain any part of a place or urban area with a population of greater than 25,000. This new definition was effective as of Funding Year 2005 (July 1, 2005 – June 30, 2006). Several other rules also were changed. The Commission expanded funding for mobile rural health care providers by subsidizing the difference between the rate for the satellite service and the rate for an urban wireline service with a similar bandwidth. June 30 is now the final deadline for applications for support for health care providers seeking discounts for a specific funding year under the rural health care support mechanism. In addition, a rural health care provider in a state that is entirely rural may now receive support for advanced telecommunications and information services. 1 47 U.S.C. § 254(h)(1)(A). 2 47 C.F.R. § 54.601. 3 A 1.544 Mbps (T1) maximum bandwidth cap was employed in Funding Years 1 and 2. See Federal-State Joint Board on Universal Service, CC Docket No. 96-45, Report and Order, 12 FCC Rcd 8776, 8952-94 (1997). The Commission removed the bandwidth cap for year three and beyond. See Federal-State Joint Board on Universal Service, CC Docket Nos. 97-21 and 96-45, Sixth Order on Reconsideration in CC Docket No. 97-21, Fifteenth Order on Reconsideration in CC Docket No. 96-45, 14 FCC Rcd 18756 (1999) (Fifteenth Order on Reconsideration). 4 See Rural Health Care Support Mechanism, WC Docket No. 02-60, Second Report and Order, Order on Reconsideration, and Further Notice of Proposed Rulemaking, 19 FCC Rcd 24613 (2004) (Second Order). 5 - 2 To receive funding under the Rural Health Care Program, an eligible rural health care provider seeking funding must first submit FCC Form 465 (description of services requested and certification form) to the Rural Health Care Division (RHCD). 5 If the RHCD determines that the health care provider is eligible, it posts the Form 465 on its website. 6 Twenty-eight days thereafter, the rural health care provider may contract with the most cost-effective bidder. The health care provider then fills out FCC Form 466 (Funding Request and Certification Form) and/or 466-A (Internet Service Funding Request and Certification Form), and submits it to the RHCD. Upon receipt and approval of FCC Form 466, the RHCD sends a Funding Commitment Letter to the rural health care provider. The letter explains that the request has received preliminary approval, and provides an estimate of the amount of support that can be expected. The rural health care provider must respond by submitting FCC Form 467 (receipt of service confirmation form) to verify that the service has begun. RHCD then sends a Support Schedule to the carrier and the health care provider. The carrier provides service to the rural health care provider, and then invoices the RHCD for the support amount. Upon approval of the invoice, USAC reimburses the carrier. In September 2006, the FCC established the Rural Health Care Pilot Program to provide funding to stimulate deployment of the broadband infrastructure necessary to support innovative telehealth and telemedicine services to those areas of the country where the need for these benefits is most acute. 7 Specifically, the Pilot Program will provide funding to support the design and construction of state or regional broadband networks dedicated to health care and the advanced services provided over those networks, as well as connecting those networks to Internet2, National LambdaRail, Inc. (both dedicated nationwide backbones), or the public Internet. 8 On November 19, 2007, the Commission released the Rural Health Care Pilot Program Selection Order, which selected 69 applicants covering 42 states and three U.S. territories 5 The Rural Health Care Corporation merged into the Universal Service Administrative Company (USAC) and became the Rural Health Care Division on January 1, 1999. See Changes to the Board of Directors of the National Exchange Carrier Association, Inc., Federal-State Joint Board on Universal Service, CC Docket Nos. 97-21 and 96-45, Third Report and Order in CC Docket No. 97-21 and Fourth Order on Reconsideration in CC Docket No. 97-21 and Eighth Order on Reconsideration in CC Docket No. 96-45, 13 FCC Rcd 25058, 25064-65, para. 12 (1998). 6 The forms may be viewed at www.rhc.universalservice.org/telecomcarriers/searchpostings/default.asp. 7 Rural Health Care Support Mechanism, WC Docket No. 02-60, Order, 21 FCC Rcd 11111 (2006) (Rural Health Care Pilot Program Order). 8 Rural Health Care Support Mechanism, WC Docket No. 02-60, Order on Reconsideration, 22 FCC Rcd 2555 (2007). 5 - 3 to participate in the Pilot Program. 9 The Rural Health Care Pilot Program Selection Order makes available to these participants approximately $139 million in rural health care support per funding year for three years, beginning with Funding Year 2007 of the existing Rural Health Care program. 10 The Rural Health Care Pilot Program Selection Order further provides instructions to selected participants concerning submission of FCC forms to the RHCD and on Pilot Program administration. 11 For more information on the Pilot Program, visit the Pilot Program website. 12 By rule, the Commission has established a $400 million per funding year cap for the rural health care mechanism. 13 For more information on the Universal Service Program for Rural Health Care providers, visit the RHCD website. 14 USAC supplied the Commission with funding commitments and disbursements information as of June 30, 2007. 15 Table 5.1 summarizes funding disbursements for all funding years by service speed. Tables 5.2 through 5.4 show details for Funding Years 2004 through 2006. For details on the preceding funding years, see the previous editions of the Monitoring Report. 16 Table 5.2 summarizes funding commitments and disbursements on a state-by-state basis. Funding Year 2004 was July 1, 2004, through June 30, 2005. USAC reports that 2,999 FCC Forms 465 have been posted and that it received 4,667 Form 466 and 466-A packets, including 810 packets from applicants seeking support for Internet access only. USAC estimates Funding Year 2004 demand will be $31.65 million. 17 9 Rural Health Care Support Mechanism, WC Docket No. 02-60, Order, FCC 07-198 (rel. Nov. 19, 2007) (Rural Health Care Pilot Program Selection Order). 10 See id. at para. 33. 11 See id. at paras. 22 to 123. 12 See Rural Health Care Pilot Program at http://www.fcc.gov/cgb/rural/rhcp.html . 13 47 C.F.R. § 54.623(a). 14 See Rural Health Care at http://www.universalservice.org/rhc/ . 15 Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 16 Earlier editions of the Monitoring Reports are available at www.fcc.gov/wcb/iatd/monitor.html. 17 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2007, 5 - 4 Funding Year 2005 was July 1, 2005, through June 30, 2006. USAC reports that 3,482 FCC Forms 465 have been posted and that it received 5,487 Form 466 and 466-A packets. 18 Of the 5,487 packets, 4,774 were completely processed, six were complete and ready to process, 535 were withdrawn by the applicant, 98 were denied, and the rest were incomplete or required clarification. 19 As of June 30, 2007, over $41.7 million had been committed, and nearly $34.4 million had been disbursed. 20 USAC estimates Funding Year 2005 demand will be approximately $40.69 million. Funding Year 2006 was July 1, 2006, through June 30, 2007. USAC reports that it received 3,043 Form 466 and 466-A packets. Of these packets, 1,611 have been completely processed, 120 are awaiting supervisory approval only, 199 are complete and ready to process, 162 have been withdrawn by the applicant, 12 have been denied, and 939 were incomplete or require clarification. 21 As of June 30, 2007, more than $27.4 million had been committed, and more than $10.3 million had been disbursed. 22 USAC estimates Funding Year 2006 demand will be $100 million. The increase in funding commitments from Funding Year 2005 is due to the pilot program described above. 23 Table 5.3 shows state-by-state disbursements by service speed for Funding Years 2004 through 2006. In some instances, such as with frame relay service, the service speed was not clearly identifiable. Whenever possible, the most likely speed for each service was assumed. For example, Frame Relay theoretically could be provided at voice grade speeds, but the vast majority of it is provided at broadband speeds (200K to 1.49Mb), so Frame Relay was assumed to be broadband at that level. http://www.universalservice.org/about/governance/fcc-filings/2007/ at 16. 18 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2007, at 16. 19 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2007 at 17. 20 See Table 5.2. 21 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2007, at 18. 22 See Table 5.2. 23 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2007, at 18. 5 - 5 Table 5.4 shows, for Funding Years 2004 and 2006, state-by-state disbursements from the Rural Health Care Support Mechanism, the population of the rural areas, and the disbursements per person in rural areas. Table 5.1 Rural Health Care Funding Disbursements by Funding Year Voice Grade Broadband Other Service Funding 56K to 200K to 1.5Mb or Speed Year 199K 1.49Mb and faster Unknown Total 1998 $202,778 $880,375 $2,292,252 $0 $3,375,405 1999 452,992 1,073,816 2,719,619 58,132 4,304,559 2000 613,595 3,015,004 6,685,573 0 10,314,172 2001 319,539 8,110,537 10,125,267 0 18,555,343 2002 428,506 10,660,185 10,528,679 0 21,617,369 2003 477,146 11,353,665 13,572,815 7,559 25,411,185 2004 588,599 11,798,524 16,997,168 117,111 29,501,402 2005 805,153 15,266,288 17,965,181 362,936 34,399,557 2006 114,931 4,681,973 5,508,965 54,021 10,359,890 Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. 5 - 6 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2004: July 1, 2004 through June 30, 2005 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $18,693 5 $17,243 5 Alaska 20,555,405 229 16,312,290 186 American Samoa 0 0 0 0 Arizona 1,207,764 73 1,016,322 55 Arkansas 163,213 34 103,876 26 California 564,724 76 527,222 72 Colorado 155,686 16 136,171 15 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 351,825 53 166,461 12 Georgia 216,861 21 207,353 16 Guam 0 0 0 0 Hawaii 305,536 21 242,690 19 Idaho 136,905 28 116,374 27 Illinois 597,529 68 541,580 59 Indiana 175,949 9 134,993 9 Iowa 218,683 53 205,127 47 Kansas 547,697 73 491,574 64 Kentucky 919,990 202 839,753 156 Louisiana 7,536 6 7,536 6 Maine 42,258 11 37,716 10 Maryland 0 0 0 0 Massachusetts 1,638 1 1,638 1 Michigan 835,089 75 660,623 62 Minnesota 1,030,301 139 982,738 133 Mississippi 175,424 25 164,365 16 Missouri 124,185 29 86,101 16 Montana 582,426 62 505,879 55 Nebraska 857,484 76 740,221 69 Nevada 64,099 10 35,353 6 New Hampshire 5,388 2 5,103 2 New Jersey 0 0 0 0 New Mexico 276,523 55 205,718 41 New York 41,782 8 7,274 1 North Carolina 199,975 22 190,241 17 North Dakota 577,294 89 551,066 86 Northern Mariana Is. 4,938 7 0 0 Ohio 196,045 10 178,257 10 Oklahoma 168,105 35 157,412 30 Oregon 40,054 11 37,903 11 Pennsylvania 80,716 17 57,618 12 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 45,433 11 38,528 9 South Dakota 574,325 76 510,834 65 Tennessee 97,352 29 82,213 20 Texas 451,913 37 437,176 36 Utah 661,538 36 641,212 35 Vermont 35,336 9 31,970 8 Virgin Islands 113,841 12 111,881 12 Virginia 364,973 50 350,736 50 Washington 88,533 31 70,642 26 West Virginia 131,324 20 97,714 13 Wisconsin 1,459,699 170 1,348,233 152 Wyoming 109,001 9 108,468 8 Totals $35,580,991 2,141 $29,501,402 1,786 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 7 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2005: July 1, 2005 through June 30, 2006 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Commitments Disbursed Support Alabama $339,679 121 $299,451 97 Alaska 21,747,418 237 19,814,812 217 American Samoa 0 0 0 0 Arizona 1,451,093 71 990,613 38 Arkansas 118,644 24 31,216 10 California 538,387 74 358,908 35 Colorado 131,810 15 107,569 11 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 181,718 15 104,955 8 Georgia 550,062 60 438,924 40 Guam 3,642 1 0 0 Hawaii 237,388 20 184,004 17 Idaho 123,670 28 93,739 20 Illinois 562,103 50 388,188 32 Indiana 195,019 11 101,297 7 Iowa 310,607 55 251,434 40 Kansas 504,173 78 165,695 30 Kentucky 244,242 87 193,693 53 Louisiana 853,489 45 738,256 33 Maine 47,358 19 3,883 2 Maryland 418 1 0 0 Massachusetts 35,487 2 35,375 2 Michigan 789,641 62 710,776 50 Minnesota 1,493,255 162 1,247,711 141 Mississippi 208,293 25 195,618 17 Missouri 90,996 21 76,890 14 Montana 526,640 59 439,589 50 Nebraska 1,632,066 93 1,133,386 77 Nevada 37,478 7 0 0 New Hampshire 4,873 2 4,816 1 New Jersey 0 0 0 0 New Mexico 404,849 45 232,056 24 New York 41,876 15 27,062 8 North Carolina 152,304 16 145,615 12 North Dakota 760,284 88 673,456 79 Northern Mariana Is. 0 0 0 0 Ohio 167,869 9 80,087 2 Oklahoma 232,458 26 91,098 7 Oregon 11,868 9 0 0 Pennsylvania 85,746 11 55,857 7 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 57,699 16 51,051 15 South Dakota 995,541 80 832,671 60 Tennessee 178,764 40 166,560 34 Texas 1,631,984 65 895,902 21 Utah 752,228 36 437,145 31 Vermont 82,653 12 82,653 12 Virgin Islands 101,021 11 41,465 7 Virginia 344,120 57 262,524 45 Washington 82,778 27 35,954 11 West Virginia 138,870 21 92,172 14 Wisconsin 2,436,036 223 2,010,774 186 Wyoming 125,409 13 74,656 9 Totals $41,744,006 2,265 $34,399,557 1,626 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 8 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2006: July 1, 2006 through June 30, 2007 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $2,051 1 $0 0 Alaska 17,082,480 154 6,880,041 74 American Samoa 0 0 0 0 Arizona 776,218 40 133,711 8 Arkansas 48,495 15 1,472 4 California 164,756 49 38,709 15 Colorado 26,448 7 377 1 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 142,844 13 11,519 2 Georgia 552,745 47 226,967 7 Guam 0 0 0 0 Hawaii 214,309 18 0 0 Idaho 74,010 19 26,389 7 Illinois 309,335 32 143,659 15 Indiana 264,093 17 22,737 5 Iowa 207,217 36 44,126 11 Kansas 311,768 51 15,450 12 Kentucky 110,161 26 7,779 11 Louisiana 58,354 16 36,377 9 Maine 1,341 1 0 0 Maryland 0 0 0 0 Massachusetts 52,751 2 43,443 2 Michigan 506,243 32 45,318 6 Minnesota 955,234 114 322,944 51 Mississippi 43,036 13 15,220 8 Missouri 105,734 16 53,335 4 Montana 386,290 42 144,473 16 Nebraska 781,635 55 487,548 41 Nevada 6,308 5 0 0 New Hampshire 0 0 0 0 New Jersey 0 0 0 0 New Mexico 137,073 38 11,736 2 New York 64,545 16 36,979 7 North Carolina 15,924 7 1,931 1 North Dakota 492,457 66 278,353 51 Northern Mariana Is. 0 0 0 0 Ohio 51,829 5 17,930 1 Oklahoma 297,803 28 2,363 1 Oregon 52,866 6 0 0 Pennsylvania 13,085 4 1,323 1 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 39,030 12 29,170 10 South Dakota 709,740 43 549,697 36 Tennessee 76,283 10 54,915 6 Texas 282,901 43 0 0 Utah 257,815 23 162,517 21 Vermont 114,031 19 76,357 13 Virgin Islands 46,584 10 42,702 10 Virginia 654,900 113 110,335 17 Washington 31,498 17 2,012 1 West Virginia 77,785 11 3,531 1 Wisconsin 784,997 102 232,996 49 Wyoming 99,989 7 43,448 4 Totals $27,484,990 1,401 $10,359,890 541 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 9 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2004: July 1, 2004 through June 30, 2005 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $0 $1,360 $15,883 $0 $17,243 Alaska 27,138 9,019,547 7,265,606 0 16,312,290 American Samoa 0 0 0 0 0 Arizona 0 134,580 881,742 0 1,016,322 Arkansas 3,160 23,983 76,734 0 103,876 California 175,792 42,919 308,511 0 527,222 Colorado 16,168 11,639 108,365 0 136,171 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 7,819 158,642 0 166,461 Georgia 0 33,460 173,894 0 207,353 Guam 0 0 0 0 0 Hawaii 0 6,586 236,103 0 242,690 Idaho 0 41,220 75,154 0 116,374 Illinois 0 69,847 471,732 0 541,580 Indiana 0 586 134,407 0 134,993 Iowa 24,432 29,716 150,979 0 205,127 Kansas 23,000 279,121 189,453 0 491,574 Kentucky 0 346,133 493,620 0 839,753 Louisiana 0 2,017 5,519 0 7,536 Maine 21,565 11,750 4,401 0 37,716 Maryland 0 0 0 0 0 Massachusetts 0 139 0 1,500 1,638 Michigan 8,395 53,684 598,544 0 660,623 Minnesota 2,952 155,658 788,516 35,612 982,738 Mississippi 0 15,009 149,356 0 164,365 Missouri 0 15,960 70,141 0 86,101 Montana 0 42,871 463,007 0 505,879 Nebraska 0 66,653 673,568 0 740,221 Nevada 0 0 35,353 0 35,353 New Hampshire 207 0 4,896 0 5,103 New Jersey 0 0 0 0 0 New Mexico 0 113,521 92,197 0 205,718 New York 1,975 1,200 4,099 0 7,274 North Carolina 0 9,022 181,219 0 190,241 North Dakota 10,715 243,338 297,013 0 551,066 Northern Mariana Is. 0 0 0 0 0 Ohio 148 0 158,550 19,560 178,257 Oklahoma 0 95,598 57,812 4,002 157,412 Oregon 0 12,842 25,061 0 37,903 Pennsylvania 6,911 10,310 40,398 0 57,618 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 23,990 14,538 0 38,528 South Dakota 4,859 50,582 455,393 0 510,834 Tennessee 0 38,505 43,708 0 82,213 Texas 0 193,150 244,026 0 437,176 Utah 0 121,019 520,192 0 641,212 Vermont 0 18,478 13,492 0 31,970 Virgin Islands 1,987 15,412 94,481 0 111,881 Virginia 0 155,750 194,987 0 350,736 Washington 0 13,076 57,566 0 70,642 West Virginia 4,095 13,578 80,041 0 97,714 Wisconsin 255,101 207,643 829,052 56,438 1,348,233 Wyoming 0 49,255 59,214 0 108,468 Totals $588,599 $11,798,524 $16,997,168 $117,111 $29,501,402 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 10 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2005: July 1, 2005 through June 30, 2006 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $9,617 $272,164 $17,669 $0 $299,451 Alaska 29,522 11,803,472 7,981,818 0 19,814,812 American Samoa 0 0 0 0 0 Arizona 0 55,676 934,938 0 990,613 Arkansas 0 14,621 16,594 0 31,216 California 159,546 19,648 179,714 0 358,908 Colorado 11,261 6,422 89,886 0 107,569 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 2,654 102,302 0 104,955 Georgia 7,944 68,970 347,466 14,544 438,924 Guam 0 0 0 0 0 Hawaii 0 3,768 180,236 0 184,004 Idaho 0 24,256 69,483 0 93,739 Illinois 5,099 15,680 367,409 0 388,188 Indiana 0 0 101,297 0 101,297 Iowa 58,045 22,593 140,169 30,627 251,434 Kansas 3,600 19,550 142,544 0 165,695 Kentucky 0 21,156 172,537 0 193,693 Louisiana 0 722,293 15,962 0 738,256 Maine 0 3,265 618 0 3,883 Maryland 0 0 0 0 0 Massachusetts 0 1,497 33,878 0 35,375 Michigan 12,051 58,767 639,958 0 710,776 Minnesota 2,702 101,344 1,079,056 64,610 1,247,711 Mississippi 6,375 135,946 53,298 0 195,618 Missouri 0 13,994 62,896 0 76,890 Montana 0 40,410 399,179 0 439,589 Nebraska 0 58,212 1,075,175 0 1,133,386 Nevada 0 0 0 0 0 New Hampshire 0 4,816 0 0 4,816 New Jersey 0 0 0 0 0 New Mexico 0 109,622 122,434 0 232,056 New York 5,701 2,648 18,713 0 27,062 North Carolina 0 0 145,615 0 145,615 North Dakota 24,405 223,542 425,509 0 673,456 Northern Mariana Is. 0 0 0 0 0 Ohio 0 0 60,527 19,560 80,087 Oklahoma 0 88,503 0 2,595 91,098 Oregon 0 0 0 0 0 Pennsylvania 4,846 12,233 38,778 0 55,857 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 23,036 25,418 2,597 51,051 South Dakota 1,687 24,137 806,614 233 832,671 Tennessee 0 6,700 159,860 0 166,560 Texas 0 879,592 16,310 0 895,902 Utah 0 118,935 318,209 0 437,145 Vermont 0 22,120 60,533 0 82,653 Virgin Islands 0 41,465 0 0 41,465 Virginia 0 8,090 254,434 0 262,524 Washington 0 3,574 32,381 0 35,954 West Virginia 3,662 12,720 75,790 0 92,172 Wisconsin 459,091 183,097 1,140,415 228,170 2,010,774 Wyoming 0 15,102 59,554 0 74,656 Totals $805,153 $15,266,288 $17,965,181 $362,936 $34,399,557 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 11 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2006: July 1, 2006 through June 30, 2007 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $0 $0 $0 $0 $0 Alaska 0 4,194,974 2,685,066 0 6,880,041 American Samoa 0 0 0 0 0 Arizona 0 750 132,961 0 133,711 Arkansas 0 1,472 0 0 1,472 California 0 27,213 11,496 0 38,709 Colorado 0 377 0 0 377 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 1,036 10,483 0 11,519 Georgia 4,299 3,343 209,358 9,968 226,967 Guam 0 0 0 0 0 Hawaii 0 0 0 0 0 Idaho 0 480 25,909 0 26,389 Illinois 0 8,308 135,351 0 143,659 Indiana 10,672 784 11,281 0 22,737 Iowa 0 6,209 37,917 0 44,126 Kansas 0 10,754 4,696 0 15,450 Kentucky 1,067 4,408 2,304 0 7,779 Louisiana 0 16,019 20,358 0 36,377 Maine 0 0 0 0 0 Maryland 0 0 0 0 0 Massachusetts 0 2,063 41,380 0 43,443 Michigan 0 5,974 39,344 0 45,318 Minnesota 3,300 36,792 282,852 0 322,944 Mississippi 8,139 5,040 2,040 0 15,220 Missouri 0 2,735 50,600 0 53,335 Montana 0 758 143,715 0 144,473 Nebraska 0 3,535 484,013 0 487,548 Nevada 0 0 0 0 0 New Hampshire 0 0 0 0 0 New Jersey 0 0 0 0 0 New Mexico 0 1,007 10,729 0 11,736 New York 0 3,837 33,142 0 36,979 North Carolina 221 1,710 0 0 1,931 North Dakota 0 193,345 85,007 0 278,353 Northern Mariana Is. 0 0 0 0 0 Ohio 0 0 0 17,930 17,930 Oklahoma 0 2,363 0 0 2,363 Oregon 0 0 0 0 0 Pennsylvania 0 1,323 0 0 1,323 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 17,178 0 11,992 29,170 South Dakota 0 402 549,295 0 549,697 Tennessee 0 0 54,915 0 54,915 Texas 0 0 0 0 0 Utah 0 45,001 117,517 0 162,517 Vermont 0 17,308 59,049 0 76,357 Virgin Islands 0 42,702 0 0 42,702 Virginia 0 4,642 91,563 14,131 110,335 Washington 0 2,012 0 0 2,012 West Virginia 0 0 3,531 0 3,531 Wisconsin 87,233 16,119 129,644 0 232,996 Wyoming 0 0 43,448 0 43,448 Totals $114,931 $4,681,973 $5,508,965 $54,021 $10,359,890 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 12 USAC Disbursements Disbursements State or on Behalf of Rural Population in Per Person in Jurisdiction Health Care Providers Rural Areas 1 Rural Areas Alabama $17 1,407 $0.01 Alaska 16,312 367 44.49 American Samoa 0 57 0.00 Arizona 1,016 954 1.07 Arkansas 104 1,435 0.07 California 527 2,521 0.21 Colorado 136 777 0.18 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 166 1,427 0.12 Georgia 207 2,520 0.08 Guam 0 155 0.00 Hawaii 243 335 0.72 Idaho 116 862 0.14 Illinois 542 1,878 0.29 Indiana 135 1,691 0.08 Iowa 205 1,600 0.13 Kansas 492 1,193 0.41 Kentucky 840 2,069 0.41 Louisiana 8 1,111 0.01 Maine 38 854 0.04 Maryland 0 385 0.00 Massachusetts 2 335 0.00 Michigan 661 1,769 0.37 Minnesota 983 1,594 0.62 Mississippi 164 1,821 0.09 Missouri 86 1,799 0.05 Montana 506 705 0.72 Nebraska 740 811 0.91 Nevada 35 305 0.12 New Hampshire 5 380 0.01 New Jersey 0 0 NA New Mexico 206 856 0.24 New York 7 1,537 0.00 North Carolina 190 2,612 0.07 North Dakota 551 367 1.50 Northern Mariana Islands 0 69 0.00 Ohio 178 2,139 0.08 Oklahoma 157 1,378 0.11 Oregon 38 977 0.04 Pennsylvania 58 1,893 0.03 Puerto Rico 0 3,859 0.00 Rhode Island 0 55 0.00 South Carolina 39 1,205 0.03 South Dakota 511 503 1.02 Tennessee 82 1,827 0.04 Texas 437 3,280 0.13 Utah 641 531 1.21 Vermont 32 448 0.07 Virgin Islands 112 109 1.03 Virginia 351 1,503 0.23 Washington 71 1,136 0.06 West Virginia 98 1,043 0.09 Wisconsin 1,348 1,757 0.77 Wyoming 108 354 0.31 Totals $29,501 58,795 $0.50 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Population in entirely rural counties as of April 1, 2000 from the Census Bureau. Some commitments were allowed in non- rural counties in areas affected by the Goldsmith Modification. See 47 C.F.R. § 54.5. For those counties, the 2000 rural population has been estimated. Table 5.4 Disbursements per Person for Rural Health Care Support Mechanism, by State Values in Thousands, Except Disbursements per Person in Rural Areas Funding Year 2004: July 1, 2004 through June 30, 2005 5 - 13 USAC Disbursements Disbursements State or on Behalf of Rural Population in Per Person in Jurisdiction Health Care Providers Rural Areas 1 Rural Areas Alabama $299 1,407 $0.21 Alaska 19,815 367 54.04 American Samoa 0 57 0.00 Arizona 991 954 1.04 Arkansas 31 1,435 0.02 California 359 2,521 0.14 Colorado 108 777 0.14 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 105 1,427 0.07 Georgia 439 2,520 0.17 Guam 0 155 0.00 Hawaii 184 335 0.55 Idaho 94 862 0.11 Illinois 388 1,878 0.21 Indiana 101 1,691 0.06 Iowa 251 1,600 0.16 Kansas 166 1,193 0.14 Kentucky 194 2,069 0.09 Louisiana 738 1,111 0.66 Maine 4 854 0.00 Maryland 0 385 0.00 Massachusetts 35 335 0.11 Michigan 711 1,769 0.40 Minnesota 1,248 1,594 0.78 Mississippi 196 1,821 0.11 Missouri 77 1,799 0.04 Montana 440 705 0.62 Nebraska 1,133 811 1.40 Nevada 0 305 0.00 New Hampshire 5 380 0.01 New Jersey 0 0 NA New Mexico 232 856 0.27 New York 27 1,537 0.02 North Carolina 146 2,612 0.06 North Dakota 673 367 1.83 Northern Mariana Islands 0 69 0.00 Ohio 80 2,139 0.04 Oklahoma 91 1,378 0.07 Oregon 0 977 0.00 Pennsylvania 56 1,893 0.03 Puerto Rico 0 3,859 0.00 Rhode Island 0 55 0.00 South Carolina 51 1,205 0.04 South Dakota 833 503 1.66 Tennessee 167 1,827 0.09 Texas 896 3,280 0.27 Utah 437 531 0.82 Vermont 83 448 0.18 Virgin Islands 41 109 0.38 Virginia 263 1,503 0.17 Washington 36 1,136 0.03 West Virginia 92 1,043 0.09 Wisconsin 2,011 1,757 1.14 Wyoming 75 354 0.21 Totals $34,400 58,795 $0.59 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2007. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Population in entirely rural counties as of April 1, 2000 from the Census Bureau. Some commitments were allowed in non- rural counties in areas affected by the Goldsmith Modification. See 47 C.F.R. § 54.5. For those counties, the 2000 rural population has been estimated. Table 5.4 Disbursements per Person for Rural Health Care Support Mechanism, by State Values in Thousands, Except Disbursements per Person in Rural Areas Funding Year 2005: July 1, 2003 through June 30, 2006 5 - 14