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. 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) of the Universal Service Administrative Company 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 (USAC). 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 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 5 The Rural Health Care Corporation merged into 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). 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). 5 - 3 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, 2008. 15 Table 5.1 summarizes funding disbursements for all funding years by service speed. Tables 5.2 and 5.3 show details for Funding Years 2005 through 2007. Table 5.4 shows details for Funding Years 2005 and 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 2005 was July 1, 2005, through June 30, 2006. USAC reports that 4,821 Form 466 and 466-A packets have been completely processed. As of June 30, 2008, over $41.69 million had been committed, and over $38.34 million had been disbursed. 17 USAC also reports that more than 200 applicants representing more than $3 million of commitments have yet to file their connection certification form (Form 467), and that it will begin sending pending denial letters to applicants and 10 See id. at para. 33. USAC did not issue a Pilot Program funding commitment for the first funding year (Funding Year 2007 of the existing Rural Health Care program). Unused Pilot Program support, however, is carried over to the next Pilot Program funding year. See Letter from Dana Shaffer, FCC, to Scott Barash, USAC, CC Docket No. 02-60 (Jan. 17, 2008). 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 See Table 5.2. 5 - 4 service providers with such outstanding commitments. USAC states that Funding Year 2005 demand will be $41.11 million. 18 Funding Year 2006 was July 1, 2006, through June 30, 2007. USAC reports that it completely processed 5,218 Form 466 and 466-A packets. 19 Additionally, 529 packets were withdrawn by the applicant and 59 were denied. USAC estimates Funding Year 2006 demand will be approximately $45.56 million. 20 As of June 30, 2008, over $46.3 million had been committed, and over $39.4 million had been disbursed. 21 Funding Year 2007 was July 1, 2007, through June 30, 2008. As of June 30, 2008, more than $34.5 million had been committed, and more than $13.8 million had been disbursed. 22 USAC estimates Funding Year 2007 demand will be $52.39 million. 23 Table 5.3 shows state-by-state disbursements by service speed for Funding Years 2005 through 2007. 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. Table 5.4 shows, for Funding Years 2005 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. 18 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2008, http://www.universalservice.org/about/governance/fcc-filings/2007/ at 16. 19 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2008, at 18. 20 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2008 at 18. 21 See Table 5.2. 22 See Table 5.2. 23 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2008 at 19. 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 10,662,943 10,528,679 0 21,620,128 2003 477,657 11,392,783 13,643,255 7,559 25,521,254 2004 591,118 11,929,440 17,320,262 117,730 29,958,551 2005 880,642 15,901,091 21,062,479 501,266 38,345,478 2006 965,980 12,740,519 22,244,606 3,501,086 39,452,190 2007 167,538 7,930,713 5,374,031 347,150 13,819,432 Note: Disbursements through June 30, 2008. 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 - 5 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 Support Disbursed Support Alabama $339,679 121 $307,686 98 Alaska 21,747,418 237 21,320,135 234 American Samoa 0 0 0 0 Arizona 1,451,093 71 1,165,603 53 Arkansas 118,644 24 42,501 13 California 538,387 74 465,542 66 Colorado 131,810 15 125,040 13 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 181,718 15 112,285 10 Georgia 550,062 60 524,274 58 Guam 7,134 1 0 0 Hawaii 237,388 20 187,889 17 Idaho 123,670 28 108,285 24 Illinois 562,103 50 462,861 35 Indiana 195,019 11 102,116 8 Iowa 310,607 55 274,787 42 Kansas 504,173 78 437,074 63 Kentucky 244,242 87 201,315 62 Louisiana 854,652 45 746,886 35 Maine 47,358 19 39,243 12 Maryland 418 1 0 0 Massachusetts 35,487 2 35,375 2 Michigan 789,641 62 729,946 54 Minnesota 1,493,255 162 1,360,668 149 Mississippi 208,293 25 203,395 22 Missouri 90,996 21 85,218 15 Montana 528,308 60 495,833 55 Nebraska 1,571,077 93 1,492,801 88 Nevada 37,478 7 36,254 7 New Hampshire 4,873 2 4,816 1 New Jersey 0 0 0 0 New Mexico 404,849 45 329,430 41 New York 41,876 15 27,370 9 North Carolina 152,304 16 150,044 15 North Dakota 760,284 88 694,532 85 Northern Mariana Is. 0 0 0 0 Ohio 167,869 9 84,776 4 Oklahoma 232,458 26 128,532 23 Oregon 11,868 9 11,868 9 Pennsylvania 85,746 11 57,600 8 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 57,699 16 51,051 15 South Dakota 995,541 80 963,607 75 Tennessee 178,764 40 166,560 34 Texas 1,631,984 65 958,439 22 Utah 752,228 36 745,798 35 Vermont 82,653 12 82,653 12 Virgin Islands 101,021 11 41,465 7 Virginia 344,120 57 312,037 54 Washington 83,248 28 68,175 24 West Virginia 138,870 21 119,147 14 Wisconsin 2,442,590 223 2,169,135 208 Wyoming 125,409 13 115,431 10 Totals $41,696,365 2,267 $38,345,478 1,940 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 6 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 Commitments Disbursed Support Alabama $45,236 52 $40,828 45 Alaska 25,701,518 231 23,589,804 219 American Samoa 0 0 0 0 Arizona 1,629,416 77 1,039,651 42 Arkansas 196,430 61 42,220 11 California 600,623 91 383,768 68 Colorado 113,145 15 87,450 12 Connecticut 0 0 0 0 Delaware 63 1 63 1 District of Columbia 0 0 0 0 Florida 427,978 30 195,261 16 Georgia 940,688 88 817,207 74 Guam 83,109 2 0 0 Hawaii 220,430 19 177,809 16 Idaho 164,258 28 123,920 25 Illinois 630,777 62 424,984 47 Indiana 376,327 37 307,659 25 Iowa 427,728 63 344,661 54 Kansas 556,401 67 550,399 61 Kentucky 187,868 63 141,155 31 Louisiana 69,923 25 57,931 17 Maine 52,398 10 34,984 8 Maryland 0 0 0 0 Massachusetts 57,633 2 56,601 2 Michigan 866,751 74 475,217 59 Minnesota 1,796,409 194 1,520,277 165 Mississippi 87,922 22 79,556 16 Missouri 144,860 23 131,528 18 Montana 541,848 60 509,670 55 Nebraska 1,721,642 89 1,646,166 87 Nevada 56,256 11 26,273 1 New Hampshire 6,765 2 6,510 1 New Jersey 0 0 0 0 New Mexico 372,985 50 248,349 22 New York 74,216 22 48,414 11 North Carolina 176,423 23 155,708 19 North Dakota 761,618 88 451,518 78 Northern Mariana Is. 0 0 0 0 Ohio 117,919 8 95,536 6 Oklahoma 303,394 31 205,826 28 Oregon 84,064 12 72,296 12 Pennsylvania 71,867 8 58,421 5 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 47,842 14 36,930 11 South Dakota 1,081,124 78 1,053,095 75 Tennessee 193,532 37 155,112 20 Texas 297,827 47 8,060 4 Utah 756,866 37 646,440 32 Vermont 131,685 20 123,658 20 Virgin Islands 48,678 11 46,584 10 Virginia 773,090 125 736,413 122 Washington 67,313 32 48,857 26 West Virginia 109,141 20 78,513 12 Wisconsin 3,006,430 238 2,181,709 215 Wyoming 191,649 12 189,198 11 Totals $46,372,065 2,412 $39,452,190 1,915 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. 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 2007: July 1, 2007 through June 30, 2008 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $77,629 11 $37,510 5 Alaska 21,613,868 185 9,752,526 105 American Samoa 108,400 1 0 0 Arizona 767,811 51 83,661 7 Arkansas 17,483 11 1,942 5 California 366,799 37 79,683 15 Colorado 22,728 5 6,189 3 Connecticut 0 0 0 0 Delaware 413 2 0 0 District of Columbia 0 0 0 0 Florida 214,328 21 27,792 3 Georgia 924,903 22 436,076 11 Guam 0 0 0 0 Hawaii 111,971 9 81,415 7 Idaho 150,490 29 70,530 19 Illinois 482,795 36 109,051 13 Indiana 353,784 24 57,679 5 Iowa 236,509 43 98,866 14 Kansas 163,191 23 109,642 10 Kentucky 285,283 49 41,812 13 Louisiana 55,690 11 29,960 5 Maine 0 0 0 0 Maryland 0 0 0 0 Massachusetts 86,969 1 77,590 1 Michigan 700,196 56 25,970 8 Minnesota 1,269,332 107 269,252 45 Mississippi 138,504 22 38,099 12 Missouri 231,513 26 97,735 8 Montana 540,589 54 292,594 33 Nebraska 1,368,987 83 632,443 51 Nevada 31,598 10 0 0 New Hampshire 0 0 0 0 New Jersey 0 0 0 0 New Mexico 296,925 33 84,093 11 New York 65,208 13 18,691 2 North Carolina 91,868 18 17,850 5 North Dakota 335,134 66 150,000 31 Northern Mariana Is. 0 0 0 0 Ohio 144,942 14 72,657 9 Oklahoma 5,812 2 1,575 1 Oregon 96,100 5 86,867 4 Pennsylvania 36,280 6 1,350 1 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 20,014 7 1,050 1 South Dakota 713,363 44 447,195 25 Tennessee 312,689 27 54,210 7 Texas 189,874 21 37,806 3 Utah 111,896 7 0 0 Vermont 141,861 20 109,166 17 Virgin Islands 48,618 11 20,238 11 Virginia 704,375 123 94,286 18 Washington 42,249 10 9,698 4 West Virginia 91,281 12 15,492 6 Wisconsin 645,920 49 72,658 7 Wyoming 103,407 6 66,532 3 Totals $34,519,581 1,423 $13,819,432 564 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 8 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 $275,095 $22,973 $0 $307,686 Alaska 29,522 11,836,898 9,453,715 0 21,320,135 American Samoa 0 0 0 0 0 Arizona 0 62,851 1,100,489 2,262 1,165,603 Arkansas 0 14,621 27,879 0 42,501 California 159,546 27,041 250,179 28,775 465,542 Colorado 22,522 8,413 94,105 0 125,040 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 7,330 112,285 Georgia 7,944 68,970 432,816 14,544 524,274 Guam 0 0 0 0 0 Hawaii 0 3,768 184,122 0 187,889 Idaho 0 28,348 79,877 60 108,285 Illinois 5,099 15,680 442,082 0 462,861 Indiana 0 819 101,297 0 102,116 Iowa 58,045 36,479 149,636 30,627 274,787 Kansas 4,704 289,826 142,544 0 437,074 Kentucky 0 28,778 172,537 0 201,315 Louisiana 0 730,923 15,962 0 746,886 Maine 21,418 16,384 1,442 0 39,243 Maryland 0 0 0 0 0 Massachusetts 0 1,497 33,878 0 35,375 Michigan 12,051 60,661 657,234 0 729,946 Minnesota 2,702 119,922 1,162,994 75,050 1,360,668 Mississippi 6,375 141,335 55,686 0 203,395 Missouri 0 22,322 62,896 0 85,218 Montana 0 46,595 428,681 20,557 495,833 Nebraska 0 58,801 1,434,000 0 1,492,801 Nevada 0 0 36,254 0 36,254 New Hampshire 0 4,816 0 0 4,816 New Jersey 0 0 0 0 0 New Mexico 0 183,758 145,672 0 329,430 New York 5,701 2,809 18,713 147 27,370 North Carolina 0 4,429 145,615 0 150,044 North Dakota 24,405 229,392 436,989 3,746 694,532 Northern Mariana Is. 0 0 0 0 0 Ohio 0 1,258 63,957 19,560 84,776 Oklahoma 0 88,503 18,443 21,587 128,532 Oregon 0 7,271 3,000 1,597 11,868 Pennsylvania 4,846 13,218 39,537 0 57,600 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 31,809 908,108 22,003 963,607 Tennessee 0 6,700 159,860 0 166,560 Texas 0 942,129 16,310 0 958,439 Utah 0 118,935 626,863 0 745,798 Vermont 0 22,120 60,533 0 82,653 Virgin Islands 0 41,465 0 0 41,465 Virginia 0 16,077 295,960 0 312,037 Washington 0 9,886 54,325 3,964 68,175 West Virginia 3,662 12,720 102,765 0 119,147 Wisconsin 500,798 226,976 1,198,827 242,534 2,169,135 Wyoming 0 15,102 96,002 4,327 115,431 Totals $880,642 $15,901,091 $21,062,479 $501,266 $38,345,478 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. 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 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 $40,828 $0 $0 $40,828 Alaska 0 10,569,475 10,623,596 2,396,734 23,589,804 American Samoa 0 0 0 0 0 Arizona 0 23,496 984,002 32,152 1,039,651 Arkansas 0 21,909 20,311 0 42,220 California 83,833 63,338 210,402 26,195 383,768 Colorado 14,296 7,328 65,827 0 87,450 Connecticut 0 0 0 0 0 Delaware 0 63 0 0 63 District of Columbia 0 0 0 0 0 Florida 0 7,373 187,888 0 195,261 Georgia 10,822 54,040 686,340 66,005 817,207 Guam 0 0 0 0 0 Hawaii 0 6,806 171,003 0 177,809 Idaho 0 22,237 101,247 435 123,920 Illinois 1,320 18,518 350,185 54,961 424,984 Indiana 23,806 13,059 270,794 0 307,659 Iowa 76,885 20,443 203,486 43,848 344,661 Kansas 6,120 357,909 186,370 0 550,399 Kentucky 18,599 41,491 81,064 0 141,155 Louisiana 0 27,931 30,000 0 57,931 Maine 21,418 13,566 0 0 34,984 Maryland 0 0 0 0 0 Massachusetts 0 2,063 54,538 0 56,601 Michigan 11,182 52,289 398,214 13,531 475,217 Minnesota 4,544 91,981 1,274,863 148,889 1,520,277 Mississippi 8,139 21,116 47,278 3,023 79,556 Missouri 4,704 40,319 86,505 0 131,528 Montana 0 36,233 430,711 42,727 509,670 Nebraska 0 52,203 1,592,567 1,395 1,646,166 Nevada 0 2,091 24,182 0 26,273 New Hampshire 0 6,510 0 0 6,510 New Jersey 0 0 0 0 0 New Mexico 0 137,934 110,415 0 248,349 New York 0 5,845 37,607 4,962 48,414 North Carolina 2,628 23,450 129,630 0 155,708 North Dakota 20,521 234,315 179,741 16,941 451,518 Northern Mariana Is. 0 0 0 0 0 Ohio 157 75 65,858 29,446 95,536 Oklahoma 0 139,134 2,655 64,038 205,826 Oregon 0 12,668 20,569 39,059 72,296 Pennsylvania 8,845 26,693 22,883 0 58,421 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 17,395 6,454 13,082 36,930 South Dakota 1,515 4,853 928,994 117,733 1,053,095 Tennessee 0 1,375 153,737 0 155,112 Texas 0 8,060 0 0 8,060 Utah 0 113,824 532,617 0 646,440 Vermont 0 27,208 78,586 17,864 123,658 Virgin Islands 0 46,584 0 0 46,584 Virginia 0 32,855 627,797 75,762 736,413 Washington 0 10,343 25,212 13,302 48,857 West Virginia 14,262 30,118 34,132 0 78,513 Wisconsin 632,383 251,549 1,022,882 274,895 2,181,709 Wyoming 0 1,627 183,466 4,106 189,198 Totals $965,980 $12,740,519 $22,244,606 $3,501,086 $39,452,190 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. 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 2007: July 1, 2007 through June 30, 2008 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $10,416 $1,416 $25,678 $0 $37,510 Alaska 0 7,456,997 2,295,528 0 9,752,526 American Samoa 0 0 0 0 0 Arizona 0 4,359 79,303 0 83,661 Arkansas 0 1,942 0 0 1,942 California 0 32,971 27,513 19,200 79,683 Colorado 0 376 5,813 0 6,189 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 8,370 19,422 0 27,792 Georgia 17,063 16,367 228,252 174,395 436,076 Guam 0 0 0 0 0 Hawaii 0 0 81,415 0 81,415 Idaho 0 15,643 54,887 0 70,530 Illinois 1,485 6,352 101,215 0 109,051 Indiana 0 1,668 56,010 0 57,679 Iowa 0 11,338 87,528 0 98,866 Kansas 0 9,767 99,875 0 109,642 Kentucky 17,090 16,016 8,706 0 41,812 Louisiana 0 9,076 20,884 0 29,960 Maine 0 0 0 0 0 Maryland 0 0 0 0 0 Massachusetts 74,196 0 3,394 0 77,590 Michigan 1,714 5,643 18,612 0 25,970 Minnesota 470 5,316 263,466 0 269,252 Mississippi 14,556 11,191 12,351 0 38,099 Missouri 0 5,779 91,956 0 97,735 Montana 0 5,023 281,049 6,523 292,594 Nebraska 0 14,506 617,937 0 632,443 Nevada 0 0 0 0 0 New Hampshire 0 0 0 0 0 New Jersey 0 0 0 0 0 New Mexico 0 48,291 35,802 0 84,093 New York 0 150 18,541 0 18,691 North Carolina 5,300 12,551 0 0 17,850 North Dakota 0 101,479 48,521 0 150,000 Northern Mariana Is. 0 0 0 0 0 Ohio 1,429 16,879 3,887 50,463 72,657 Oklahoma 0 1,575 0 0 1,575 Oregon 0 630 39,797 46,440 86,867 Pennsylvania 0 1,350 0 0 1,350 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 1,050 0 0 1,050 South Dakota 0 12,127 435,068 0 447,195 Tennessee 0 818 53,392 0 54,210 Texas 6,241 1,395 15,351 14,819 37,806 Utah 0 0 0 0 0 Vermont 0 17,177 56,679 35,309 109,166 Virgin Islands 0 20,238 0 0 20,238 Virginia 0 4,600 89,686 0 94,286 Washington 0 400 9,298 0 9,698 West Virginia 8,832 2,696 3,964 0 15,492 Wisconsin 8,747 47,190 16,720 0 72,658 Wyoming 0 0 66,532 0 66,532 Totals $167,538 $7,930,713 $5,374,031 $347,150 $13,819,432 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 11 USAC Disbursements Disbursements State or on Behalf of Rural Population in Per Person in Jurisdiction Health Care Providers Rural Areas 1 Rural Areas Alabama $308 1,407 $0.22 Alaska 21,320 367 58.15 American Samoa 0 57 0.00 Arizona 1,166 954 1.22 Arkansas 43 1,435 0.03 California 466 2,521 0.18 Colorado 125 777 0.16 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 112 1,427 0.08 Georgia 524 2,520 0.21 Guam 0 155 0.00 Hawaii 188 335 0.56 Idaho 108 862 0.13 Illinois 463 1,878 0.25 Indiana 102 1,691 0.06 Iowa 275 1,600 0.17 Kansas 437 1,193 0.37 Kentucky 201 2,069 0.10 Louisiana 747 1,111 0.67 Maine 39 854 0.05 Maryland 0 385 0.00 Massachusetts 35 335 0.11 Michigan 730 1,769 0.41 Minnesota 1,361 1,594 0.85 Mississippi 203 1,821 0.11 Missouri 85 1,799 0.05 Montana 496 705 0.70 Nebraska 1,493 811 1.84 Nevada 36 305 0.12 New Hampshire 5 380 0.01 New Jersey 0 0 NA New Mexico 329 856 0.38 New York 27 1,537 0.02 North Carolina 150 2,612 0.06 North Dakota 695 367 1.89 Northern Mariana Islands 0 69 0.00 Ohio 85 2,139 0.04 Oklahoma 129 1,378 0.09 Oregon 12 977 0.01 Pennsylvania 58 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 964 503 1.92 Tennessee 167 1,827 0.09 Texas 958 3,280 0.29 Utah 746 531 1.41 Vermont 83 448 0.18 Virgin Islands 41 109 0.38 Virginia 312 1,503 0.21 Washington 68 1,136 0.06 West Virginia 119 1,043 0.11 Wisconsin 2,169 1,757 1.23 Wyoming 115 354 0.33 Totals $38,345 58,795 $0.65 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. 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, 2005 through June 30, 2006 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 $41 1,407 $0.03 Alaska 23,590 367 64.34 American Samoa 0 57 0.00 Arizona 1,040 954 1.09 Arkansas 42 1,435 0.03 California 384 2,521 0.15 Colorado 87 777 0.11 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 195 1,427 0.14 Georgia 817 2,520 0.32 Guam 0 155 0.00 Hawaii 178 335 0.53 Idaho 124 862 0.14 Illinois 425 1,878 0.23 Indiana 308 1,691 0.18 Iowa 345 1,600 0.22 Kansas 550 1,193 0.46 Kentucky 141 2,069 0.07 Louisiana 58 1,111 0.05 Maine 35 854 0.04 Maryland 0 385 0.00 Massachusetts 57 335 0.17 Michigan 475 1,769 0.27 Minnesota 1,520 1,594 0.95 Mississippi 80 1,821 0.04 Missouri 132 1,799 0.07 Montana 510 705 0.72 Nebraska 1,646 811 2.03 Nevada 26 305 0.09 New Hampshire 7 380 0.02 New Jersey 0 0 NA New Mexico 248 856 0.29 New York 48 1,537 0.03 North Carolina 156 2,612 0.06 North Dakota 452 367 1.23 Northern Mariana Islands 0 69 0.00 Ohio 96 2,139 0.04 Oklahoma 206 1,378 0.15 Oregon 72 977 0.07 Pennsylvania 58 1,893 0.03 Puerto Rico 0 3,859 0.00 Rhode Island 0 55 0.00 South Carolina 37 1,205 0.03 South Dakota 1,053 503 2.09 Tennessee 155 1,827 0.08 Texas 8 3,280 0.00 Utah 646 531 1.22 Vermont 124 448 0.28 Virgin Islands 47 109 0.43 Virginia 736 1,503 0.49 Washington 49 1,136 0.04 West Virginia 79 1,043 0.08 Wisconsin 2,182 1,757 1.24 Wyoming 189 354 0.53 Totals $39,452 58,795 $0.67 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2008. 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 2006: July 1, 2006 through June 30, 2007 5 - 13