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 Additionally, the 1996 Act directs the Commission to establish competitively neutral rules – to enhance, to the extent technically feasible and economically reasonable, access to advanced telecommunications and information services for all public and nonprofit … health care providers. 4 In December 2004, the Commission released a Second Report and Order 5 that modified the Commission’s rules for rural health care support. In this Second Report and Order, the Commission changed its definition of “rural” for the purposes of the rural health care support mechanism. 6 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. 7 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 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, 9101-04 (1997), paras. 620-624. 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, 18767-72 paras. 17 – 24 (1999) (Fifteenth Order on Reconsideration). 4 47 U.S.C. § 254(h)(2)(A). 5 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 Report and Order). 6 See Second Report and Order at 24619-20, paras. 11-12. 7 47 C.F.R. § 54.5. 5 - 2 rate for a functionally similar urban wireline service. 8 June 30 became 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. 9 In addition, rural health care providers in states that are entirely rural were granted increased support for advanced telecommunications and information services. 10 Also, in 2003 the Commission authorized a 25% discount on advanced telecommunications services for RHC providers. 11 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 (USAC). 12 If the RHCD determines that the health care provider is eligible, it posts the Form 465 on its website. 13 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 8 See Second Report and Order at 24626, para. 28. 9 Id. at 24629, para. 34. 10 Id. at 24631, para. 38. 11 See Rural Health Care Support Mechanism, WC Docket No. 02-60, Report and Order, Order on Reconsideration, and Further Notice of Proposed Rulemaking, 18 FCC Rcd 24546, 24557-62, paras 22 - 29 (2003). 12 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). 13 The forms may be viewed at https://www.rhc.universalservice.org/serviceproviders/searchpostings/default.asp. 5 - 3 telemedicine services to those areas of the country where the need for these benefits is most acute. 14 Specifically, the Pilot Program provides 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. 15 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. 16 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. 17 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. 18 For more information on the Pilot Program, visit the Pilot Program website. 19 By rule, the Commission has established a $400 million per funding year cap for the rural health care mechanism. 20 For more information on the Universal Service Program for Rural Health Care providers, visit the RHCD website. 21 14 Rural Health Care Support Mechanism, WC Docket No. 02-60, Order, 21 FCC Rcd 11111 (2006) (Rural Health Care Pilot Program Order). 15 Rural Health Care Support Mechanism, WC Docket No. 02-60, Order, 22 FCC Rcd 20360, 20361 (2007) (Rural Health Care Pilot Program Selection Order). 16 Rural Health Care Pilot Program Selection Order. Following mergers, there are now 61 projects in the Pilot Program. See http://www.fcc.gov/cgb/rural/rhcp.html. 17 See RHCPP Selection Order at 20372-73, paras. 32-33. 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). USAC reported that it rolled forward the Funding Year 2007 demand estimate and commitment cap of $139.26 million to Funding Year 2008, except for $0.53 million, which was committed and invoiced for Funding Year 2007. Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Fourth Quarter 2009 at 21. 18 See RHCPP Selection Order at 20395-411, paras. 70-98. 19 See Rural Health Care Pilot Program at http://www.fcc.gov/cgb/rural/rhcp.html. 20 47 C.F.R. § 54.623(a). 5 - 4 USAC supplied the Commission with funding commitments and disbursements information as of June 30, 2010. 22 Table 5.1 summarizes funding disbursements for all funding years by service speed. As of June 30, 2010, USAC had disbursed more than 53.2 million of Funding Year 2007 funds. USAC had also disbursed nearly 48.9 million of Funding Year 2008 funds and disbursed nearly 20.6 million of Funding Year 2009 funds. 23 For more information on individual Funding Years, such as the number of packets processed, withdrawn or denied, see Federal Universal Support Mechanisms Fund Size Projections. 24 Funding Years 2007 through 2009 are shown in Tables 5.2 and 5.3. Table 5.4 shows details for Funding Years 2007 and 2008. For details on the preceding funding years, see the previous editions of the Monitoring Report. 25 Table 5.2 summarizes funding commitments and disbursements on a state-by- state basis. Table 5.3 shows state-by-state disbursements by service speed. 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 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. 21 See Rural Health Care at http://www.usac.org/rhc/ . 22 Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 23 See Table 5.1. 24 http://www.usac.org/about/governance/fcc-filings/2010/. USAC files the information each quarter. 25 Earlier editions of the Monitoring Reports are available at www.fcc.gov/wcb/iatd/monitor.html. 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 $693,226 $287,396 $2,394,783 $0 $3,375,405 1999 1,127,232 238,191 2,881,005 58,132 4,304,559 2000 1,857,586 652,036 7,804,550 0 10,314,172 2001 2,056,690 948,470 15,550,184 0 18,555,343 2002 2,375,518 1,072,799 18,171,811 0 21,620,128 2003 1,532,448 2,012,706 22,321,996 5,033 25,872,184 2004 1,481,533 2,899,293 26,611,638 9,321 31,001,784 2005 1,354,195 3,419,777 35,332,417 2,739 40,109,127 2006 868,640 3,618,646 40,570,106 0 45,057,391 2007 681,542 2,908,614 49,632,343 0 53,222,499 2008 593,017 1,787,799 46,507,546 0 48,888,362 2009 55,136 409,726 20,128,268 0 20,593,130 Note: Disbursements through June 30, 2010. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. For purposes of this analysis, broadband was defined to include 200k to 1.49 Mbps. 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 2007: July 1, 2007 through June 30, 2008 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Commitments Disbursed Support Alabama $169,200 60 $156,403 58 Alaska 30,142,687 236 29,600,007 235 American Samoa 116,650 1 108,400 1 Arizona 1,746,587 81 1,511,066 72 Arkansas 289,156 59 228,713 56 California 793,113 109 637,643 100 Colorado 119,758 19 102,295 16 Connecticut 0 0 0 0 Delaware 413 2 413 2 District of Columbia 0 0 0 0 Florida 487,546 33 402,244 21 Georgia 1,399,127 73 1,369,597 71 Guam 54,179 2 12,014 1 Hawaii 192,524 20 183,884 19 Idaho 245,511 40 232,885 36 Illinois 858,119 77 707,275 68 Indiana 630,677 52 504,321 42 Iowa 534,195 69 526,932 68 Kansas 225,193 39 216,022 36 Kentucky 521,298 79 510,858 76 Louisiana 68,995 24 55,307 15 Maine 51,128 7 51,128 7 Maryland 0 0 0 0 Massachusetts 128,955 3 128,955 3 Michigan 1,282,522 108 968,537 97 Minnesota 2,282,787 190 2,215,059 186 Mississippi 166,638 28 165,752 27 Missouri 358,423 53 337,986 50 Montana 696,706 67 655,793 66 Nebraska 1,581,960 95 1,478,891 94 Nevada 71,135 13 69,048 13 New Hampshire 0 0 0 0 New Jersey 0 0 0 0 New Mexico 509,364 55 410,020 52 New York 75,081 20 49,504 13 North Carolina 236,228 41 229,861 38 North Dakota 687,102 97 526,876 96 Northern Mariana Is. 0 0 0 0 Ohio 293,630 21 221,548 19 Oklahoma 470,851 45 324,686 43 Oregon 202,682 19 197,561 18 Pennsylvania 132,086 16 97,100 13 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 47,633 15 29,819 9 South Dakota 1,188,929 89 1,183,097 87 Tennessee 395,552 35 363,486 35 Texas 275,151 42 266,599 40 Utah 540,804 48 459,479 45 Vermont 146,417 23 140,853 21 Virgin Islands 56,804 12 51,318 12 Virginia 1,033,533 148 887,305 147 Washington 79,233 34 77,108 33 West Virginia 208,092 26 187,978 26 Wisconsin 4,440,644 259 4,178,441 252 Wyoming 212,408 11 202,433 10 Totals $56,447,403 2,695 $53,222,499 2,545 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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 2008: July 1, 2008 through June 30, 2009 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $292,149 73 $264,508 69 Alaska 34,960,820 232 24,262,949 217 American Samoa 141,191 1 141,191 1 Arizona 1,351,112 68 712,184 38 Arkansas 625,143 68 417,735 34 California 1,041,457 117 769,497 55 Colorado 256,696 24 164,347 17 Connecticut 0 0 0 0 Delaware 350 2 0 0 District of Columbia 0 0 0 0 Florida 477,243 22 208,314 16 Georgia 1,720,183 99 1,226,013 91 Guam 87,800 2 71,528 2 Hawaii 148,487 18 134,469 15 Idaho 303,596 32 172,088 20 Illinois 1,176,600 74 968,897 62 Indiana 885,715 60 589,033 44 Iowa 559,794 72 474,028 66 Kansas 289,699 56 235,181 41 Kentucky 520,653 77 474,811 62 Louisiana 70,440 24 14,690 8 Maine 21,865 7 1,453 1 Maryland 0 0 0 0 Massachusetts 151,250 3 145,789 2 Michigan 1,559,394 110 1,176,582 91 Minnesota 2,723,473 200 2,245,815 183 Mississippi 179,100 24 161,292 20 Missouri 551,944 65 443,412 48 Montana 876,754 80 753,418 71 Nebraska 1,528,465 113 1,435,905 102 Nevada 91,924 14 0 0 New Hampshire 14,658 2 14,658 2 New Jersey 0 0 0 0 New Mexico 756,947 60 361,099 28 New York 70,059 23 17,559 6 North Carolina 335,257 53 260,237 45 North Dakota 1,230,480 103 916,653 91 Northern Mariana Is. 0 0 0 0 Ohio 389,297 36 311,932 32 Oklahoma 627,662 49 449,294 19 Oregon 300,256 21 263,688 9 Pennsylvania 103,740 14 62,430 9 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 11,453 5 5,137 3 South Dakota 1,408,740 90 1,209,647 68 Tennessee 205,404 21 177,949 19 Texas 1,040,762 63 998,930 57 Utah 756,173 54 461,903 39 Vermont 108,390 22 107,700 20 Virgin Islands 46,404 10 46,404 10 Virginia 770,336 145 675,753 142 Washington 68,045 33 27,028 8 West Virginia 213,666 23 165,200 18 Wisconsin 4,953,272 291 4,617,118 265 Wyoming 113,786 14 72,915 8 Totals $66,118,083 2,869 $48,888,362 2,274 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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 2009: July 1, 2009 through June 30, 2010 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $326,998 83 $133,632 25 Alaska 20,609,324 157 11,233,960 88 American Samoa 220,158 1 0 0 Arizona 915,831 54 285,398 19 Arkansas 496,903 38 358,993 17 California 847,810 70 281,934 22 Colorado 184,206 16 43,647 6 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 152,635 19 86,950 9 Georgia 1,744,684 117 1,072,964 85 Guam 14,333 1 0 0 Hawaii 114,271 13 78,402 10 Idaho 165,166 27 8,796 5 Illinois 1,000,152 61 504,508 29 Indiana 614,082 58 297,481 27 Iowa 265,725 44 66,424 11 Kansas 258,516 53 78,533 16 Kentucky 482,155 58 226,477 23 Louisiana 38,548 10 20,970 2 Maine 50,821 4 25,524 1 Maryland 0 0 0 0 Massachusetts 116,346 1 116,346 1 Michigan 669,702 53 214,795 20 Minnesota 2,134,653 154 568,122 62 Mississippi 139,067 20 93,760 12 Missouri 343,165 40 74,607 13 Montana 702,742 79 390,258 40 Nebraska 1,336,545 100 769,356 53 Nevada 45,405 11 3,466 2 New Hampshire 9,000 1 0 0 New Jersey 0 0 0 0 New Mexico 448,593 28 6,687 1 New York 16,311 7 12,384 5 North Carolina 241,568 41 47,500 10 North Dakota 937,042 77 481,891 43 Northern Mariana Is. 0 0 0 0 Ohio 379,636 33 265,209 11 Oklahoma 416,117 23 10,605 2 Oregon 269,108 9 191,696 5 Pennsylvania 33,157 9 10,055 3 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 3,941 4 491 3 South Dakota 673,865 37 155,920 8 Tennessee 368,887 36 17,737 4 Texas 1,537,387 73 888,982 41 Utah 422,813 25 303,242 8 Vermont 38,242 14 630 1 Virgin Islands 44,541 10 39,692 9 Virginia 623,163 127 154,827 23 Washington 60,162 15 13,610 4 West Virginia 177,324 18 113,381 11 Wisconsin 2,611,020 209 784,450 75 Wyoming 99,880 13 58,839 7 Totals $43,401,699 2,151 $20,593,130 872 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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 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 $2,579 $88,262 $65,562 $0 $156,403 Alaska 158,938 1,620,537 27,820,531 0 29,600,007 American Samoa 0 0 108,400 0 108,400 Arizona 25,458 13,388 1,472,220 0 1,511,066 Arkansas 0 70,204 158,509 0 228,713 California 4,837 75,130 557,675 0 637,643 Colorado 0 13,522 88,773 0 102,295 Connecticut 0 0 0 0 0 Delaware 0 413 0 0 413 District of Columbia 0 0 0 0 0 Florida 764 17,680 383,800 0 402,244 Georgia 5,769 101,442 1,262,386 0 1,369,597 Guam 0 0 12,014 0 12,014 Hawaii 0 6,208 177,676 0 183,884 Idaho 0 7,593 225,292 0 232,885 Illinois 0 49,467 657,808 0 707,275 Indiana 6,331 49,890 448,100 0 504,321 Iowa 1,810 17,253 507,869 0 526,932 Kansas 0 50,590 165,432 0 216,022 Kentucky 1,397 45,879 463,582 0 510,858 Louisiana 4,346 16,867 34,095 0 55,307 Maine 5,625 6,438 39,065 0 51,128 Maryland 0 0 0 0 0 Massachusetts 425 2,953 125,577 0 128,955 Michigan 9,607 55,047 903,883 0 968,537 Minnesota 2,434 62,513 2,150,112 0 2,215,059 Mississippi 11,450 30,862 123,439 0 165,752 Missouri 0 13,484 324,502 0 337,986 Montana 4,192 9,704 641,896 0 655,793 Nebraska 354 11,965 1,466,571 0 1,478,891 Nevada 0 0 69,048 0 69,048 New Hampshire 0 0 0 0 0 New Jersey 0 0 0 0 0 New Mexico 7,957 75,950 326,113 0 410,020 New York 0 12,649 36,855 0 49,504 North Carolina 6,664 33,604 189,593 0 229,861 North Dakota 3,704 1,829 521,343 0 526,876 Northern Mariana Is. 0 0 0 0 0 Ohio 12,839 15,185 193,523 0 221,548 Oklahoma 691 10,501 313,495 0 324,686 Oregon 2,813 14,941 179,807 0 197,561 Pennsylvania 0 13,843 83,257 0 97,100 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 12,024 17,795 0 29,819 South Dakota 2,960 1,182 1,178,955 0 1,183,097 Tennessee 0 9,450 354,035 0 363,486 Texas 2,965 17,248 246,385 0 266,599 Utah 2,911 16,627 439,941 0 459,479 Vermont 0 28,802 112,050 0 140,853 Virgin Islands 0 0 51,318 0 51,318 Virginia 0 27,743 859,562 0 887,305 Washington 5,196 7,903 64,009 0 77,108 West Virginia 0 49,102 138,876 0 187,978 Wisconsin 386,524 122,274 3,669,643 0 4,178,441 Wyoming 0 464 201,969 0 202,433 Totals $681,542 $2,908,614 $49,632,343 $0 $53,222,499 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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 2008: July 1, 2008 through June 30, 2009 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $0 $106,669 $157,839 $0 $264,508 Alaska 169,088 561,235 23,532,626 0 24,262,949 American Samoa 0 0 141,191 0 141,191 Arizona 2,460 4,151 705,573 0 712,184 Arkansas 0 18,888 398,847 0 417,735 California 104 74,087 695,305 0 769,497 Colorado 0 6,225 158,122 0 164,347 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 20,551 187,763 0 208,314 Georgia 5,769 80,513 1,139,731 0 1,226,013 Guam 0 0 71,528 0 71,528 Hawaii 0 5,812 128,657 0 134,469 Idaho 0 22,209 149,879 0 172,088 Illinois 0 46,834 922,063 0 968,897 Indiana 1,228 48,356 539,449 0 589,033 Iowa 320 22,154 451,554 0 474,028 Kansas 0 53,489 181,692 0 235,181 Kentucky 0 49,079 425,732 0 474,811 Louisiana 0 5,653 9,037 0 14,690 Maine 0 0 1,453 0 1,453 Maryland 0 0 0 0 0 Massachusetts 0 1,831 143,958 0 145,789 Michigan 780 55,314 1,120,489 0 1,176,582 Minnesota 612 63,885 2,181,318 0 2,245,815 Mississippi 0 37,001 124,291 0 161,292 Missouri 0 46,742 396,670 0 443,412 Montana 1,538 12,961 738,920 0 753,418 Nebraska 262 22,558 1,413,085 0 1,435,905 Nevada 0 0 0 0 0 New Hampshire 0 14,658 0 0 14,658 New Jersey 0 0 0 0 0 New Mexico 0 8,038 353,062 0 361,099 New York 0 5,421 12,138 0 17,559 North Carolina 0 68,116 192,121 0 260,237 North Dakota 0 3,751 912,902 0 916,653 Northern Mariana Is. 0 0 0 0 0 Ohio 7,887 21,851 282,194 0 311,932 Oklahoma 0 20,808 428,486 0 449,294 Oregon 0 1,230 262,458 0 263,688 Pennsylvania 0 12,716 49,714 0 62,430 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 548 4,588 0 5,137 South Dakota 0 540 1,209,107 0 1,209,647 Tennessee 0 22,559 155,390 0 177,949 Texas 0 53,708 945,222 0 998,930 Utah 2,570 15,529 443,803 0 461,903 Vermont 0 29,766 77,934 0 107,700 Virgin Islands 0 0 46,404 0 46,404 Virginia 0 19,504 656,248 0 675,753 Washington 248 4,469 22,311 0 27,028 West Virginia 0 39,575 125,625 0 165,200 Wisconsin 400,150 76,732 4,140,236 0 4,617,118 Wyoming 0 2,086 70,829 0 72,915 Totals $593,017 $1,787,799 $46,507,546 $0 $48,888,362 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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 2009: July 1, 2009 through June 30, 2010 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $0 $14,494 $119,138 $0 $133,632 Alaska 1,234 53,475 10,877,649 301,602 11,233,960 American Samoa 0 0 0 0 0 Arizona 806 4,959 242,052 37,581 285,398 Arkansas 0 5,724 318,502 34,766 358,993 California 0 3,359 229,376 49,200 281,934 Colorado 0 2,155 41,492 0 43,647 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 4,164 82,786 0 86,950 Georgia 0 35,233 852,001 185,730 1,072,964 Guam 0 0 0 0 0 Hawaii 0 0 78,402 0 78,402 Idaho 0 175 4,027 4,594 8,796 Illinois 0 20,578 139,144 344,786 504,508 Indiana 0 16,353 232,558 48,569 297,481 Iowa 0 3,589 62,835 0 66,424 Kansas 0 10,076 28,999 39,458 78,533 Kentucky 0 22,190 122,201 82,086 226,477 Louisiana 0 150 20,820 0 20,970 Maine 0 0 0 25,524 25,524 Maryland 0 0 0 0 0 Massachusetts 0 0 3,747 112,599 116,346 Michigan 0 11,795 132,249 70,751 214,795 Minnesota 60 9,218 336,228 222,616 568,122 Mississippi 0 22,139 71,621 0 93,760 Missouri 0 15,957 58,650 0 74,607 Montana 0 4,621 349,607 36,030 390,258 Nebraska 0 14,880 752,411 2,065 769,356 Nevada 0 0 3,466 0 3,466 New Hampshire 0 0 0 0 0 New Jersey 0 0 0 0 0 New Mexico 0 0 0 6,687 6,687 New York 0 4,353 8,031 0 12,384 North Carolina 0 22,177 25,323 0 47,500 North Dakota 0 0 217,720 264,171 481,891 Northern Mariana Is. 0 0 0 0 0 Ohio 0 7,729 41,302 216,178 265,209 Oklahoma 0 2,363 8,243 0 10,605 Oregon 0 750 0 190,946 191,696 Pennsylvania 0 0 10,055 0 10,055 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 491 0 0 491 South Dakota 0 450 155,470 0 155,920 Tennessee 0 4,770 12,967 0 17,737 Texas 0 27,542 208,801 652,639 888,982 Utah 0 0 303,242 0 303,242 Vermont 0 630 0 0 630 Virgin Islands 0 0 39,692 0 39,692 Virginia 0 7,629 123,677 23,520 154,827 Washington 0 4,818 8,792 0 13,610 West Virginia 0 28,898 54,004 30,480 113,381 Wisconsin 53,036 17,613 550,286 163,515 784,450 Wyoming 0 4,230 54,609 0 58,839 Totals $55,136 $409,726 $16,982,174 $3,146,094 $20,593,130 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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 $156 1,407 $0.11 Alaska 29,600 367 80.73 American Samoa 108 57 1.90 Arizona 1,511 954 1.58 Arkansas 229 1,435 0.16 California 638 2,521 0.25 Colorado 102 777 0.13 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 402 1,427 0.28 Georgia 1,370 2,520 0.54 Guam 12 155 0.08 Hawaii 184 335 0.55 Idaho 233 862 0.27 Illinois 707 1,878 0.38 Indiana 504 1,691 0.30 Iowa 527 1,600 0.33 Kansas 216 1,193 0.18 Kentucky 511 2,069 0.25 Louisiana 55 1,111 0.05 Maine 51 854 0.06 Maryland 0 385 0.00 Massachusetts 129 335 0.39 Michigan 969 1,769 0.55 Minnesota 2,215 1,594 1.39 Mississippi 166 1,821 0.09 Missouri 338 1,799 0.19 Montana 656 705 0.93 Nebraska 1,479 811 1.82 Nevada 69 305 0.23 New Hampshire 0 380 0.00 New Jersey 0 0 NA New Mexico 410 856 0.48 New York 50 1,537 0.03 North Carolina 230 2,612 0.09 North Dakota 527 367 1.43 Northern Mariana Islands 0 69 0.00 Ohio 222 2,139 0.10 Oklahoma 325 1,378 0.24 Oregon 198 977 0.20 Pennsylvania 97 1,893 0.05 Puerto Rico 0 3,859 0.00 Rhode Island 0 55 0.00 South Carolina 30 1,205 0.02 South Dakota 1,183 503 2.35 Tennessee 363 1,827 0.20 Texas 267 3,280 0.08 Utah 459 531 0.87 Vermont 141 448 0.31 Virgin Islands 51 109 0.47 Virginia 887 1,503 0.59 Washington 77 1,136 0.07 West Virginia 188 1,043 0.18 Wisconsin 4,178 1,757 2.38 Wyoming 202 354 0.57 Totals $53,222 57,962 $0.92 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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. Total population includes only those areas with RHC disbursements. 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 2007: July 1, 2007 through June 30, 2008 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 $265 1,407 $0.19 Alaska 24,263 367 66.17 American Samoa 141 57 2.48 Arizona 712 954 0.75 Arkansas 418 1,435 0.29 California 769 2,521 0.31 Colorado 164 777 0.21 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 208 1,427 0.15 Georgia 1,226 2,520 0.49 Guam 72 155 0.46 Hawaii 134 335 0.40 Idaho 172 862 0.20 Illinois 969 1,878 0.52 Indiana 589 1,691 0.35 Iowa 474 1,600 0.30 Kansas 235 1,193 0.20 Kentucky 475 2,069 0.23 Louisiana 15 1,111 0.01 Maine 1 854 0.00 Maryland 0 385 0.00 Massachusetts 146 335 0.44 Michigan 1,177 1,769 0.67 Minnesota 2,246 1,594 1.41 Mississippi 161 1,821 0.09 Missouri 443 1,799 0.25 Montana 753 705 1.07 Nebraska 1,436 811 1.77 Nevada 0 305 0.00 New Hampshire 15 380 0.04 New Jersey 0 0 NA New Mexico 361 856 0.42 New York 18 1,537 0.01 North Carolina 260 2,612 0.10 North Dakota 917 367 2.49 Northern Mariana Islands 0 69 0.00 Ohio 312 2,139 0.15 Oklahoma 449 1,378 0.33 Oregon 264 977 0.27 Pennsylvania 62 1,893 0.03 Puerto Rico 0 3,859 0.00 Rhode Island 0 55 0.00 South Carolina 5 1,205 0.00 South Dakota 1,210 503 2.41 Tennessee 178 1,827 0.10 Texas 999 3,280 0.30 Utah 462 531 0.87 Vermont 108 448 0.24 Virgin Islands 46 109 0.43 Virginia 676 1,503 0.45 Washington 27 1,136 0.02 West Virginia 165 1,043 0.16 Wisconsin 4,617 1,757 2.63 Wyoming 73 354 0.21 Totals $48,888 57,880 $0.84 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2010. 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. Total population includes only those areas with RHC disbursements. 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 2008: July 1, 2008 through June 30, 2009 5 - 13