May 27, 2021 FCC FACT SHEET* Connected Care Pilot Program Second Report and Order  WC Docket No. 18-213 Telehealth has assumed an increasingly critical role in health care delivery, enabling patients to access health care services without needing to visit a health care provider s physical location. Among other benefits, connected care services, delivered via a broadband Internet access connection directly to the patient s home or mobile location, also can help contain and treat health conditions during public health emergencies, such as the ongoing COVID-19 pandemic. The Commission created the Connected Care Pilot Program (Pilot Program) in April 2020 to evaluate how the Universal Service Fund (USF or Fund) can promote telehealth by supporting the adoption of connected care services among patients and their health care providers. The Commission accepted applications for the Pilot Program from November 6 to December 7, 2020. In January 2021, the Commission announced the selection of an initial set of 14 Pilot Program projects from 23 applications. What the Second Report and Order Would Do: " Provide guidance on eligible services, including offering clarifications on the eligibility of certain network equipment. " Provide details for Pilot Program participants about the competitive bidding process, requesting funding, receiving funding commitments, making changes to projects, and seeking reimbursement through submitting invoices. " Allow Pilot Program participants to begin their three-year Pilot Program projects. * This document is being released as part of a  permit-but-disclose proceeding. Any presentations or views on the subject expressed to the Commission or its staff, including by email, must be filed in WC Docket No. 18-213, which may be accessed via the Electronic Comment Filing System (https://www.fcc.gov/ecfs/). Before filing, participants should familiarize themselves with the Commission s ex parte rules, including the general prohibition on presentations (written and oral) on matters listed on the Sunshine Agenda, which is typically released a week prior to the Commission s meeting. See 47 CFR § 1.1200 et seq. Federal Communications Commission FCC-CRIC2106-05 Before the Federal Communications Commission Washington, D.C. 20554 In the Matter of ) ) Promoting Telehealth for Low-Income Consumers ) WC Docket No. 18-213 ) SECOND REPORT AND ORDER* Adopted: [ ] Released: [ ] By the Commission: TABLE OF CONTENTS Heading Paragraph # I. INTRODUCTION .................................................................................................................................. 1 II. BACKGROUND .................................................................................................................................... 3 III. DISCUSSION ........................................................................................................................................ 7 A. Connected Care Pilot Project Selection Evaluation Criteria ............................................................ 8 B. Connected Care Pilot Program Requirements ............................................................................... 11 1. Program Administration and Budget ....................................................................................... 12 2. Eligible Services ...................................................................................................................... 14 C. Connected Care Pilot Program Rules and Procedures ................................................................... 19 1. Funding Request Process Overview ........................................................................................ 20 2. Competitive Bidding  FCC Form 461 ................................................................................... 21 3. Requests for Funding  FCC Form 462 .................................................................................. 26 4. Funding Commitments ............................................................................................................ 28 5. Changes to Projects ................................................................................................................. 29 6. Seeking Reimbursement  FCC Form 463 .............................................................................. 32 7. Wind Down Period and Project Conclusion ............................................................................ 35 D. Additional Pilot Program Requirements ........................................................................................ 36 1. Data Reporting and Bureau Report on Pilot ............................................................................ 36 2. USAC Outreach ....................................................................................................................... 39 3. Document Retention, Audits, and Protection Against Waste, Fraud, and Abuse ................... 40 4. Payment Administration .......................................................................................................... 44 5. Appeals of USAC Decisions ................................................................................................... 47 * This document has been circulated for tentative consideration by the Commission at its June 17, 2021 open meeting. The issues referenced in this document and the Commission s ultimate resolution of those issues remain under consideration and subject to change. This document does not constitute any official action by the Commission. However, the Acting Chairwoman has determined that, in the interest of promoting the public s ability to understand the nature and scope of issues under consideration, the public interest would be served by making this document publicly available. The FCC s ex parte rules apply and presentations are subject to  permit-but-disclose ex parte rules. See, e.g., 47 C.F.R. §§ 1.1206, 1.1200(a). Participants in this proceeding should familiarize themselves with the Commission s ex parte rules, including the general prohibition on presentations (written and oral) on matters listed on the Sunshine Agenda, which is typically released a week prior to the Commission s meeting. See 47 CFR §§ 1.1200(a), 1.1203. Federal Communications Commission FCC-CRIC2106-05 6. Delegations of Authority ......................................................................................................... 48 IV. PROCEDURAL MATTERS ................................................................................................................ 50 V. ORDERING CLAUSES ....................................................................................................................... 51 APPENDIX A  Previous Connected Care Pilot Program Selections I. INTRODUCTION 1. Through this Second Report and Order, we continue our efforts to implement the Commission s Connected Care Pilot Program (Pilot Program) created pursuant to the Commission s authority under section 254(h)(2)(A) of the Communications Act.1 We offer further guidance on the administration of the Pilot Program, including guidance on eligible services, competitive bidding, invoicing, and data reporting for selected participants. 2. The Commission received more than 200 Pilot Program applications from many health care providers whose patients lack Internet connections sufficient to transmit a video visit or receive health care through connected care and providers who indicate that their systems and bandwidth are inadequate to carry the new and significantly increased loads. The projects we expect to announce in the future, as well as those announced in January,2 will directly benefit thousands of low-income patients and veterans facing a wide variety of health challenges, such as diabetes, hypertension, stroke recovery, opioid dependency, high-risk pregnancy, pediatric heart disease, mental health conditions, and cancer. Through these projects, we will develop a better understanding of how the Universal Service Fund (USF or Fund) can help support the adoption of connected care services among patients and their health care providers. II. BACKGROUND 3. To limit transmission of COVID-19, patients and providers have adopted and expanded use of telehealth systems and processes with great rapidity.3 The Centers for Medicare and Medicaid Services estimates that Medicare patients telehealth activity increased from 15,000 beneficiaries a week pre-pandemic, to 24.5 million beneficiaries receiving a telehealth service between mid-March and mid- October 2020.4 Telehealth is expected to remain in demand even after the COVID-19 pandemic abates. As noted by the Centers for Disease Control and Prevention (CDC),  [w]ith expanded access and improved reimbursement policies in place, as well as ongoing acceptability by patients and health care providers, telehealth might continue to serve as an important modality for delivering care during and after the pandemic. 5 4. The Pilot Program will make available up to $100 million over a three-year funding period for selected projects and will provide universal service support for 85% of the cost of eligible 1 See 47 U.S.C. § 254(h)(2)(A); Promoting Telehealth for Low-Income Consumers; COVID-19 Telehealth Program, Report and Order, 35 FCC Rcd 3366 (2020) (Connected Care Report and Order). 2 Federal Communications Commission Announces Initial Projects Selected for the Connected Care Pilot Program, Public Notice, 36 FCC Rcd 593 (2021) (January Selection Public Notice). 3 See, e.g., Judd Hollander, M.D. & Aaron Neinstein, M.D., Maturation from Adoption-Based to Quality-Based Telehealth Metrics, NEJM Catalyst (Sept. 9, 2020), https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0408. 4 Press Release, Centers for Medicare & Medicaid Services, Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients, (Dec. 1, 2020), https://www.cms.gov/newsroom/press-releases/trump-administration-finalizes-permanent-expansion-medicare- telehealth-services-and-improved-payment. 5 Centers for Disease Control and Prevention, Trends in the Use of Telehealth During the Emergence of the COVID- 19 Pandemic  United States, January-March 2020 (Oct. 30, 2020), https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm. 2 Federal Communications Commission FCC-CRIC2106-05 connected care services and equipment.6 In the Connected Care Report and Order in April of last year, the Commission identified  connected care services as a subset of telehealth that uses broadband Internet access service-enabled technologies to deliver remote medical, diagnostic, patient-centered, and treatment-related services directly to patients outside of traditional brick and mortar medical facilities including specifically to patients at their mobile location or residence.7 The Pilot Program is open to eligible non-profit or public health care providers that fall within the statutorily-enumerated categories in section 254(h)(7)(B) of the Act.8 For purposes of the Pilot Program, eligible health care providers and their patients may be located in rural or non-rural areas, and eligible non-rural health care providers are not required to be part of a majority rural consortium.9 5. Selected Pilot Program participants will receive universal service support to offset 85% of the cost of eligible services and equipment funded by the Pilot Program.10 The remaining 15% share of the costs of eligible services and equipment must be paid by the selected Pilot Program participants from eligible sources, which include the applicant or eligible health care provider participants, participating patients, or state, federal, or Tribal funding or grants.11 Selected Pilot Program participants must also pay the costs of any ineligible expenses associated with their respective projects,12 and must seek competitive bids for the eligible services for which they intend to seek Pilot Program support.13 6. On November 5, 2020, the Wireline Competition Bureau (Bureau) announced that the application filing window for the Pilot Program would open on Friday, November 6, 2020, at 12:00 PM 6 See Connected Care Report and Order, 35 FCC Rcd at 3397-3402, paras. 56-64 (describing eligible costs as costs for (1) patient broadband Internet access services, (2) health care provider broadband data connections, (3) other connected care information services, and (4) certain network equipment). 7 See id. at 3375, 3385, paras. 14, 39. Examples of connected care services delivered to patients at their residence or mobile location rather than a health care provider s physical location include, but are not limited to, remote patient monitoring (e.g., use of patient reporting outcome platforms, glucometers, pulse oximeters, sphygmomanometers, chest straps, wearables, passive sensors, or other devices to consistently monitor patient vitals), patient health education, store and forward services (e.g., asynchronous transfer of patient images and data for interpretation by a physician), and synchronous video consultations and visits. See id. at 3375, para. 14. 8 See id. at 3390, para. 47 (noting that the categories of eligible nonprofit and public health care providers are: (1) post-secondary educational institutions offering health care instruction; teaching hospitals, and medical schools; (2) community health centers or health centers providing health care to migrants; (3) local health departments or agencies; (4) community mental health centers; (5) not-for-profit hospitals; (6) rural health clinics; (7) skilled nursing facilities; and (8) consortia of health care providers consisting of one or more entities falling into the first seven categories). 47 U.S.C. § 254(h)(7)(B). 9 See Connected Care Report and Order, 35 FCC Rcd. at paras. 49, 67 & n.171, 3391-92, 3404. 10 See id. at 3388, para. 43. 11 See id. at 3388-89, para. 43. See also 47 CFR § 54.611(b)(1) ( Eligible sources include the applicant or eligible health care provider participants, state grants, appropriations, or other sources of state funding; federal grants, loans, appropriations except for federal universal service funding, or other sources of federal funding; Tribal government funding; and other grants, including private grants. ); 47 CFR § 54.611(b)(2) ( Ineligible sources include (but are not limited to) in-kind or implied contributions from health care providers; direct payments from service providers, including contractors and consultants to such entities; and for-profit entities. ). For purposes of the Pilot Program, participating patients can also be a source of the required 15% share of the costs. Additionally, all participants in the Connected Care Pilot Program are subject to the Commission prohibition on gifts from service providers. See Connected Care Report and Order, 35 FCC Rcd at 3412, para. 76. 12 See id. at 3402-3404, paras. 65-66 (describing ineligible expenses for the Pilot Program). 13 Id. at 3411-13, paras. 75-76. Note also, these paragraphs describe limited exemptions to the competitive bidding requirements. 3 Federal Communications Commission FCC-CRIC2106-05 ET and would close on Monday, December 7, 2020, at 11:59 PM ET.14 Health care providers submitted 220 applications seeking Pilot Program funding to treat a variety of patients and conditions nationwide. On January 15, 2021, the Commission announced that an initial tranche of 23 applications had been selected, and that the remainder of the selected applications would be announced thereafter.15 III. DISCUSSION 7. We now provide selected Pilot Program participants with additional information on the rules and requirements for participation so that they can begin their projects. A. Connected Care Pilot Project Selection Evaluation Criteria 8. In reviewing applications, we sought to identify projects that would serve a high number of patients in the target populations, in areas most in need of USF support for connected care, treating many of the targeted conditions, and using products and services eligible for purchase with USF support. To do so, we used the evaluation criteria set out in the Connected Care Report and Order and reviewed applications in accordance with these criteria. For instance, we considered whether an application would serve low-income or veteran patients, as the Connected Care Report and Order established a strong preference for Pilot projects that can demonstrate that they will primarily benefit these patient groups.16 For purposes of the Pilot Program, a patient is considered low-income by determining whether (1) the patient is eligible for Medicaid or (2) the patient s household income is at or below 135% of the U.S. Department of Health and Human Services Federal Poverty Guidelines, and a patient is considered a veteran if they qualify for health care through the U.S. Department of Veterans Affairs Veterans Health Administration (VHA).17 9. Pursuant to the Connected Care Report and Order, we also considered whether an application is primarily focused on treating certain conditions, such as public health epidemics, opioid dependency, mental health conditions, high-risk pregnancy/maternal health, or chronic or recurring conditions that typically require at least several months to treat, including, but not limited to, diabetes, cancer, kidney disease, heart disease, and stroke recovery.18 Further, we gave particular emphasis to health care providers that have either experience with providing telehealth or connected care services to patients, or a partnership with another health care provider, government agency, or designated telehealth resource center with such experience.19 10. In addition, the Commission stated a desire in the Connected Care Report and Order to select a diverse set of projects and target Pilot Program funds to geographic areas and populations most in need of USF support for connected care.20 Consistent with this directive, we considered whether applications would serve rural or Tribal areas or patients, or would serve patients in Health Professional Shortage Areas or Medically Underserved Areas.21 We also considered whether applications would 14 Wireline Competition Bureau Announces Connected Care Pilot Program Application Filing Window Opening, Public Notice, 35 FCC Rcd 12751 (WCB Nov. 5, 2020) (Bureau Application Filing Window Public Notice). 15 See January Selection Public Notice. The initial selection notice was for 14 applicants, filing 23 separate Pilot project applications. Id. Selections from the January Selection Public Notice are listed in Appendix A. 16 Connected Care Report and Order, 35 FCC Rcd at 3393-94 para. 51. 17 Id. at 3394-95 paras. 52-53. 18 Id. at 3385-86, 3407, paras. 39, 68. 19 Id. at 3392-93, para. 50. 20 Id. at 3406-08, para. 68. 21 Id. at 3405-08, para. 68. 4 Federal Communications Commission FCC-CRIC2106-05 promote the goals of the Pilot Program.22 Lastly, we reviewed applications to determine whether they sought funding for eligible products and services, to ensure that the Pilot Program would use its limited funding efficiently. B. Connected Care Pilot Program Requirements 11. This section summarizes the requirements of the Connected Care Report and Order, and provides additional instructions and procedures about the administration, budget, and eligible services for the Connected Care Pilot Program.23 We remind all Pilot Program participants to review the Pilot Program s eligible services information prior to procuring services. 1. Program Administration and Budget 12. As a general matter, the traditional funding year period (e.g., July 1 to June 30 of each year) for the Rural Health Care Program will not apply to the Pilot Program. Because of the nature of the Pilot Program, and given the funding request submission deadline and ramp-up period deadlines, we will not require selected Pilot Program participants to follow the traditional funding year process for the Rural Health Care Program. Pilot Program participants should therefore pay careful attention to any dates contained in official Pilot Program correspondence and on the Commission and USAC webpages to ensure compliance with all applicable dates and deadlines. 13. We direct USAC to commit no more than the total amount associated with each project over a three-year period not to exceed the duration of the Pilot Program. This will ensure that total disbursements remain under the program budget. Further, to fund the Pilot Program, we direct USAC to collect only the total amount associated with the actual commitments for each selected project.24 Because maximum expenditures based on each Pilot project budget were tracked before selection, selected participants will be able to request funding and receive funding commitments for multiple funding years.25 Allowing funding requests and commitments to cover multiple years will reduce administrative burdens on Pilot Program participants by reducing the number of FCC Forms 462 they file and will allow them to know what their total funding commitment for the Pilot Program will be. 2. Eligible Services 14. The Pilot Program will provide Pilot Program participants funding to cover up to 85% of the cost of eligible services, which fall under the following categories: (1) patient broadband Internet access services; (2) health care provider broadband data connections; (3) connected care information services; and (4) certain network equipment.26 We provide two clarifications on services eligible for support in the Pilot Program. First, we clarify that the Pilot Program will reimburse network equipment purchases necessary to make broadband services functional, even if the Pilot Program is not directly 22 Id. at 3405, para. 68. The Commission established three specific goals for the Pilot Program: to determine how USF support can be used to (1) improve health outcomes through connected care; (2) reduce health care costs for patients, facilities and the health care system; and (3) support the trend towards connected care everywhere. Id. at 3415, para. 83. 23 See id. at 3411, para. 74 (stating that the Commission will provide additional instructions and procedural information regarding the Pilot Program, including requests for funding, invoicing, and the specific data to be reported and reporting format); Promoting Telehealth for Low-Income Consumers, Notice of Proposed Rulemaking, 34 FCC Rcd 5620, 5650, para. 63 (2019) (Connected Care Notice). 24 See Connected Care Report and Order, 35 FCC Rcd at 3387-88, para. 42 (directing USAC to collect funds quarterly for the Pilot Program beginning in the fourth quarter of 2020 and collecting necessary funds up to the amount of the budget over the entire three-year period in order to minimize any impact to the contribution factor). We direct USAC to collect only the aggregate amount associated with the projects that have been selected to date or will be selected in the future, not to exceed the $100 million budget. 25 See id. at 3413, para. 77; see also infra Section III.C.3. 26 Connected Care Report and Order, 35 FCC Rcd at 3397-3404, paras. 55-66. 5 Federal Communications Commission FCC-CRIC2106-05 supporting the costs of those broadband services. The Connected Care Report and Order states that the Pilot Program will fund  network equipment that is necessary to make Pilot Program funded broadband services for connected care services functional, or to operate, manage, or control such services. 27 However, Pilot Program applicants have also indicated a need for network equipment to make a supported broadband service functional even if they do not require new or upgraded broadband from the Pilot Program as part of their Pilot project, and a need for network equipment to make the connected care services they are providing through their Pilot project functional. Accordingly, some Pilot projects do not require upgraded or new broadband service to participate in the Pilot Program but do require upgraded network equipment (e.g., switches) to make existing broadband services functional given the increased volume of network traffic associated with connected care services. To ensure these projects have the network equipment they need to provide broadband-enabled connected care services, the Pilot Program will provide funding to eligible, participating health care providers for necessary network equipment to make a broadband service functional for providing connected care services through the Pilot Program. 15. Second, we clarify that the Pilot Program will reimburse network equipment purchases necessary to make a connected care information service functional (e.g., a server necessary for storing video conferences or facilitating video transmissions). Although the Connected Care Report and Order stated that equipment necessary to make a broadband service functional was supported,28 it did not specifically address eligibility of equipment necessary to make a connected care service functional. Many applicants requested funding for this type of network equipment and explained that this equipment was necessary, for example, to handle the increased volume of network traffic or storage needs associated with connected care services. Funding this additional network equipment for the limited purposes of the Pilot Program is consistent with the Commission s decision to fund connected care information services through the Pilot Program and is critical to the successful operation of the participating Pilot projects that requested such equipment. Further, funding this equipment for the limited purposes of the Pilot Program is within the scope of the Commission s statutory authority consistent with the legal rationale that the Commission relies on in the Healthcare Connect Fund to fund network equipment necessary to make a supported broadband service functional.29 To ensure these additional types of funded network equipment are within the scope of our statutory authority and Pilot Program purpose, where projects requested network equipment necessary to make a connected care service functional, the equipment must be purchased either because of the increase in Internet traffic caused by the connected care services, or because the equipment would be primarily used for connected care information services. While our approach today to fund network equipment necessary to make a broadband service functional even if the Pilot Program is not funding the broadband service and to fund network equipment necessary to make a connected care information service function is more expansive than the Rural Healthcare Program s reimbursement for network equipment purchases,30 we believe it is appropriate in this time-limited Pilot Program effort, focused on determining how USF funds can best support the trend towards connected care to be slightly more inclusive to ensure the success of selected Pilot Program participants. 16. The Pilot Program will not fund devices, including end-user connected devices (e.g., tablets, smart phones, or remote patient monitoring equipment), medical equipment, health care provider administrative costs, personnel costs (including, but not limited to medical professional costs), or other miscellaneous expenses.31 The Pilot Program also will not fund network deployment, the construction of networks between health care providers, internal connections for health care providers, or connectivity 27 Id. at 3401, para. 63. 28 Id. at 3401, para. 63. 29 See id. at 3401, para. 63 & n.155. 30 See Rural Health Care Support Mechanism, WC Docket No. 02-60, Report and Order, 27 FCC Rcd 16678, 16751-53, paras. 157-163 (2012) (Healthcare Connect Fund Order) (articulating what equipment is eligible for reimbursement as part of the Healthcare Connect Fund). 31 See Connected Care Report and Order, 35 FCC Rcd at 3402-04, paras. 65-66. 6 Federal Communications Commission FCC-CRIC2106-05 services between health care provider sites.32 Pilot Program participants must cost allocate all ineligible services and/or equipment that are included in bundles, packages, or suites of services used in Pilot Program projects.33 Funding for Pilot Program participants is limited to three years.34 As a reminder, patient broadband Internet access service funded through the Pilot Program is intended for patients who lack broadband or have an internet connection insufficient to receive connected care, and the funded patient broadband connection must be  primarily used for activities that are integral, immediate, and proximate to the provision of connected care services to participating patients.35 17. During application review, Bureau reviewers identified clearly ineligible services and equipment when they were apparent on the application, but USAC reviewers will review FCC Form 462s in order to take further steps to ensure that no funding will be committed for ineligible services or equipment. Pilot Program participants that seek competitive bids and submit requests for funding (discussed more fully below) should refer to the Bureau s previously published guidance on eligible services and equipment36 to ensure that they are only requesting funding for eligible items. Pilot Program participants should be aware that selection does not guarantee that all items in an application are eligible and will be funded upon request. 18. Finally, we remind Pilot Program participants that they are prohibited from using Universal Service support to purchase or obtain any equipment or services produced or provided by a covered company posing a national security threat to the integrity of communications networks or the communications supply chain.37 In addition, Pilot Program participants are prohibited from using Federal subsidies to purchase, rent, lease, or otherwise obtain any covered communications equipment or service, or maintain any covered communications equipment or service previously purchased, rented, leased, or otherwise obtained.38 A list of covered equipment and services was posted on the Commission s website on March 12, 2021 and will be updated to reflect any future determinations.39 32 See Connected Care Report and Order, 35 FCC Rcd at 3340-41, para. 60; see also Bureau Application Filing Window Public Notice; Federal Communications Commission, Connected Care Eligible Services Chart, https://www.fcc.gov/connect-care-eligible-services (last visited May 21, 2021). Additionally, the Connected Care Pilot Program seeks to avoid duplication with the Healthcare Connect Fund, and otherwise has eligibility rules consistent with the Healthcare Connect Fund. See Healthcare Connect Fund Order, 27 FCC Rcd at 16727-16756, paras. 105-170. 33 See Connected Care Report and Order, 35 FCC Rcd at 3397, n.131. 34 See id. at 3389, para. 46. 35 Id. at 3398-99, para. 58. 36 See Bureau Application Filing Window Public Notice; see also Federal Communications Commission, Connected Care Eligible Services Chart, https://www.fcc.gov/connect-care-eligible-services (last visited May 21, 2021). 37 47 CFR § 54.9; Connected Care Report and Order, 35 FCC Rcd at 3401-02, para. 64. See also Protecting Against National Security Threats to the Communications Supply Chain Through FCC Programs, WC Docket No. 18-89, Report and Order, Further Notice of Proposed Rulemaking, and Order, 34 FCC Rcd 11423, 11433, para. 26 (2019), appeal pending in Huawei Technologies USA v. FCC, No. 19-60896 (5th Cir.). See also Protecting Against National Security Threats to the Communications Supply Chain Through FCC Programs  Huawei Designation, PS Docket No. 19-351, Order, 35 FCC Rcd 6604 (PSHSB 2020); Protecting Against National Security Threats to the Communications Supply Chain Through FCC Programs  ZTE Designation, PS Docket No. 19-352, Order, 35 FCC Rcd 6633 (PSHSB 2020). 38 47 CFR § 54.10; Protecting Against National Security Threats to the Communications Supply Chain Through FCC Programs, Second Report and Order, 35 FCC Rcd 14284, 14286, para. 4 (2020). 39 See Federal Communications Commission, List of Equipment and Services Covered by Section 2 of the Secure Networks Act, https://www.fcc.gov/supplychain/coveredlist (last visited May 21, 2021). 7 Federal Communications Commission FCC-CRIC2106-05 C. Connected Care Pilot Program Rules and Procedures 19. This section provides details for Pilot Program participants about the competitive bidding process, requesting funding, receiving funding commitments, making changes to their projects, and seeking reimbursement through submitting invoices.40 To ensure efficient and predictable administration, the Pilot Program will use rules and procedures for the RHC Healthcare Connect Fund Program to the extent feasible.41 For purposes of the Connected Care Pilot Program, the Commission directs USAC to develop new versions of FCC Form 461 (Request for Services Form), FCC Form 462 (Request for Funding Form), and FCC Form 463 (Invoice and Request for Disbursement Form) and make them publicly available. These forms should be clearly marked to indicate their association with the Connected Care Pilot Program and avoid confusion with other versions. Pilot Program participants may now begin the competitive bidding process and, if a competitive bidding exemption applies, may file a Request for Funding. 1. Funding Request Process Overview 20. Following selection by the Commission, Pilot Program participants can begin to follow the process outlined below. Generally, Pilot projects are to operate using Pilot Program funds for no more than three years from the first date of service.42 Expenses for which Pilot Program funding is requested and invoiced must be incurred within three years from the first date of service for the respective project, and by no later than June 30, 2025. " Conduct Competitive Bidding. The FCC Form 461 initiates the competitive bidding process for all products and services for which competitive bids are required. The Pilot Program participant will describe the required services and equipment for its project, develop scoring criteria to evaluate bids,43 and post the resulting request for services to USAC s website for at least 28 days. Following the 28-day posting, the Pilot Program 40 These post-selection processes, together with the FCC Form 461, FCC Form 462, and FCC Form 463, are described in graphic form on USAC s website. See USAC, Connected Care Pilot Program Health Care Provider (HCP) Application Process, https://www.usac.org/wp-content/uploads/rural-health-care/documents/connected- care/Connected_Care_Process_Infograph.pdf (last visited May 21, 2021). 41 See Connected Care Notice, 34 FCC Rcd 5620, 5638, para. 41 ( We also propose to borrow additional administrative procedures from the RHC programs in implementing the Pilot Program. ). RHC Healthcare Connect Fund rules requiring proration for certain types of funding requests and limiting funding for certain health care provider and applicant types do not apply to the Pilot Program because the Pilot Program is of a limited duration and has a proscribed funding amount for each Pilot Program participant. See, e.g., 47 CFR § 54.607(c); (limiting funding available to non-rural hospitals with 400 or more patient beds); 47 CFR § 54.616(b)(2) (limiting support for upfront payments to consortium applicants); 47 CFR § 54.616(c) (requiring that a request for support for upfront payments that exceeds, on average, $50,000 per eligible site in the consortium be prorated over three years and be part of a multi-year contract). 42 Pilot projects may continue to operate using non-Pilot Program funding after the end of their Pilot Program funding period. 43 Pilot Program participants must  develop weighted evaluation criteria (e.g., a scoring matrix) that demonstrates how the applicant will choose the most cost-effective bid before submitting its request for services, must  specify on its bid evaluation worksheet and/or scoring matrix the requested services for which it seeks bids, the information provided to bidders to allow bidders to reasonably determine the needs of the applicant, its minimum requirements for the developed weighted evaluation criteria, and each service provider s proposed service levels for the criteria , and must  specify the disqualification factors, if any, that it will use to remove bids or bidders from further consideration. 47 CFR § 54.622(d). A Request for Proposal (RFP) is required  if required under applicable State, Tribal, or local procurement rules or regulations and for consortium  seeking more than $100,000 in program support [for a Pilot Program year], including applications that seek more than $100,000 in program support for a multi-year commitment. 47 CFR § 54.622(e)(5)(ii)(A and B). If an RFP is issued it must contain the information outlined in 47 CFR § 54.622(e)(5)(iii)(A-E) as applicable. 8 Federal Communications Commission FCC-CRIC2106-05 participant must choose the most cost effective44 service provider and may then enter into a contract. This requirement does not apply to any products or services for which the Pilot Program participant is exempt from seeking competitive bids pursuant to a competitive bidding exemption, as outlined below. " Request Funding. Pilot Program participants must request funding by submitting the FCC Form 462 to USAC.45 Note that for Pilot Program participants in Appendix A, the submission of the FCC Form 462 to USAC must occur no later than six months after the effective date of this Report and Order. Any future Pilot Program selections must submit their respective FCC Form 462 to USAC no later than six months after the announcement of their selection.46 " Receive a Funding Commitment. USAC will review the FCC Form 462 and, if approved, issue funding commitment letters (FCLs) to the Pilot Program participants (and vendors, if necessary), indicating the amount committed under the Pilot Program for the FCC Form 462. The FCL contains other important information such as the service delivery deadline, and Pilot Program participants are reminded to read their FCLs closely. " Begin the Pilot Project. Pilot Program participants must begin their Pilot projects no later than six months after receipt of their Funding Commitment Letter from USAC. " Make Project Modifications, if Needed. Pilot Program participants may request site or service substitutions or contract modifications pursuant to the procedures outlined in this Report and Order.47 " Request Reimbursement. After equipment or services have been delivered, Pilot Program participants may seek reimbursement by submitting the FCC Form 463 to USAC. Pilot Program participants are encouraged to seek reimbursement on a monthly basis, if possible. Note that certain vendors, for instance, Internet Service Providers enrolled with the Rural Health Care Program, will submit the FCC Form 463 directly to USAC, upon request by the health care provider (or consortium).48 2. Competitive Bidding  FCC Form 461 21. In the Connected Care Report and Order, the Commission adopted, to the extent feasible, the competitive bidding requirements for the Healthcare Connect Fund Program for participants in the Pilot Program.49 Unless a competitive bidding exemption applies, Pilot Program participants must 44 47 CFR § 54.622(c); see also Connected Care Report and Order, 35 Rcd at 3411, para. 75. Accordingly, for the Pilot Program, the most cost-effective service means the method that  costs the least after consideration of the features, quality of transmission, reliability, and other factors that the health care provider (HCP) deems relevant to choosing a method of providing the required health care services. 47 CFR § 54.622(c). Further,  when choosing the most  cost-effective bid, price must be a primary factor, but need not be the only primary factor. A non-price factor may receive an equal weight to price, but may not receive a greater weight than price. Id. Finally,  after reviewing the bid submissions and identifying the bids that satisfy the applicant s specific needs, the applicant must then select the service provider that offers the most cost-effective service. 47 CFR § 54.622(d). 45 47 CFR § 54.623. 46 See Connected Care Report and Order, 35 FCC Rcd at 3413, para. 77. 47 See 47 CFR § 54.624. See also Connected Care Report and Order, 35 FCC Rcd at 3413, para. 78 (requiring that USAC be notified of changes to projects, including site closures). 48 See Connected Care Report and Order, 35 FCC Rcd at 3413-14, para. 77-79; see generally 47 CFR § 54.627(d). 49 Connected Care Report and Order, 35 FCC Rcd at 3411-12, paras. 75-76; Connected Care Notice, 34 FCC Rcd 5620, 5651, para. 66 (2019); 47 CFR § 54.622; see also Universal Service Administrative Company, Step 2: Develop Bid Evaluation Criteria and Select Services, https://www.usac.org/rural-health-care/healthcare-connect- (continued& .) 9 Federal Communications Commission FCC-CRIC2106-05 participate in a competitive bidding process, follow any additional applicable state, local or other procurement requirements, and select the most cost-effective option for services and equipment eligible for Connected Care Pilot Program support. Below, we provide further guidance on these requirements. 22. To satisfy the competitive bidding requirements, Pilot Program participants must submit an FCC Form 461 for USAC to post. In some circumstances, Pilot Program participants will be required to prepare a formal Request for Proposal (RFP) to be posted along with their FCC Form 461.50 The FCC Form 461 should include a description of the services and equipment for which the Pilot Program participant is seeking support. 23. The Pilot Program participant must wait at least 28 days from the date on which the Form 461 is posted on USAC s website before selecting a service provider.51 After seeking bids from potential service providers, Pilot Program participants should conduct a bid evaluation to select the most cost- effective means of meeting their needs, and thereafter participants may enter into a legally binding agreement with the selected service provider. Pilot Program participants may enter into a service agreement or sign a contract with the selected provider on or after the Allowable Contract Selection Date (ACSD), the day after the required number of days the FCC Form 461 is posted on the USAC website. If Pilot Program participants enter into a new contract or service agreement before the ACSD, funding will be denied for services covered under that contract or service agreement. Pilot Program participants will also be required to make certain certifications regarding the competitive bidding process before submitting the FCC Form 461.52 The FCC Form 461 will be made available to Pilot Program participants fund-program/step-2-develop-evaluation-criteria-select-services/ (last visited May 21, 2021); Universal Service Administrative Company, Step 3: Evaluate Bids and Select Service Provider, https://www.usac.org/rural-health- care/healthcare-connect-fund-program/step-3-evaluate-bids-select-service-provider/ (last visited May 21, 2021). 50 A Request for Proposal (RFP) is required  if required under applicable State, Tribal, or local procurement rules or regulations and for consortium  seeking more than $100,000 in program support in a single Pilot Program year,  including applications that seek more than $100,000 in program support for a multi-year commitment. 47 CFR § 54.622(e)(5)(ii)(A- B). If a Request for Proposal is issued, it must contain the information outlined in 47 CFR § 54.622(e)(5)(iii)(A-E) as applicable. 51 47 CFR § 54.622(g). 52 The Form 461 requires the following certifications under penalty of perjury from the individual submitting the Form 461 for the Pilot project: (1) I am authorized to act on behalf of the healthcare provider or consortium; (2) I have examined the request and all attachments, and to the best of my knowledge all statements contained in the request and in attachments are true; (3) the selected Pilot Program participant is seeking supported services and has complied with any applicable state, Tribal, or local procurement rules; (4) the selected Pilot Program participant satisfies all of the requirements under section 254 of the Communications Act, 47 U.S.C. § 254, and applicable Commission rules; (5) I understand all documentation associated with the request, including a copy of the signed Request for Services (FCC Form 461), any bids/contracts resulting from the FCC Form 461 posting, scoring sheet, and other information that was used in the decision making process, must be retained for a period of at least five years pursuant to 47 CFR § 54.631, or as otherwise prescribed by the Commission s rules; (6) the selected Pilot Program participant seeking supported services is a nonprofit or public entity that falls within one of the seven categories set forth in the definition of health care provider listed in 47 CFR §54.600 of the Commission s rules; (7) the services will not be sold, resold, or transferred in consideration for money or any other thing of value; (8) the selected Pilot Program participant or consortium will comply with all applicable Connected Care Pilot Program rules, requirements and procedures, including the requirement to pay 15% of the costs for supported items from eligible sources, and will comply with all applicable federal and state laws, including the Americans with Disabilities Act, the Rehabilitation Act, the False Claims Act, the Anti-Kickback Statute, and the Civil Monetary Penalties Law; (9) the selected Pilot Program participant or consortium will comply with the applicable Health Insurance Portability and Accountability Act (HIPAA) requirements and other applicable privacy and reimbursement laws and regulations, and applicable medical licensing laws; (10) the selected Pilot Program participant or consortium is not already receiving or expecting to receive other funding (from any source, private, state, or federal) for the exact same services and/or equipment eligible for support under the Connected Care Pilot Program; and (11) all requested equipment and services funded under the Connected Care Pilot Program will be used for their intended purposes. 10 Federal Communications Commission FCC-CRIC2106-05 in USAC s online My Portal system53 with additional information provided to Pilot Program participants by USAC during outreach. 24.  Fair and Open Competitive Bidding Process. Pilot Program participants must conduct a fair and open competitive bidding process. To satisfy the  fair and open standard, all potential bidders must have access to the same information and be treated in the same manner during the competitive bidding period to ensure that the process is  fair and open. Further, service providers who intend to bid on supported services may not simultaneously help the Pilot Program participant to complete its RFP or Request for Services form.54 Service providers who have submitted a bid to provide supported services, equipment, or facilities to a health care provider may not simultaneously help the health care provider evaluate submitted bids or choose a winning bid.55 Pilot Program participants must respond to all service providers that have submitted questions or proposals during the competitive bidding process.56 All Pilot Program participants and service providers must comply with any applicable state, Tribal, or local procurement laws, in addition to the Commission s competitive bidding requirements.57 The competitive bidding requirements in this section are not intended to preempt such state, Tribal, or local requirements.58 Additionally the Commission s prohibitions against gifts from service providers apply to the Connected Care Pilot Program.59 Although service providers may make charitable contributions to Pilot Program participants, such gifts may not be directly or indirectly related Connected Care Pilot Program procurement activities.60 Further, Pilot Program participants are reminded that services 53 Applicants utilized My Portal to submit Forms 460 and were required to submit their applications via the My Portal link on the USAC website. See https://forms.universalservice.org/portal/login. 54 47 CFR § 54.622(b)(1)(ii); see also Universal Services Administrative Company, Step 2: Develop Bid Evaluation Criteria & Select Services, https://www.usac.org/rural-health-care/healthcare-connect-fund-program/step-2-develop- evaluation-criteria-select-services/ (last visited May 21, 2021). 55 47 CFR § 54.622(b)(1)(iii). 56 47 CFR § 54.622(b)(1)(iv). 57 47 CFR § 54.622(b)(1)(v). 58 Id. 59 See Connected Care Report and Order, 35 FCC Rcd at 3412, para. 76; 47 CFR § 54.622(h)(1-4). The Bureau s limited waivers of the prohibition on gifts to allow service providers to offer, and for program participants to solicit and accept, improved broadband connections or equipment for telehealth do not apply to the Pilot Program. See Rural Health Care Universal Service Support Mechanism; Schools and Libraries Universal Service Support Mechanism, WC Docket No. 02-60, CC Docket No. 02-6, Order, 35 FCC Rcd 2741, 2741-42, para. 1 (WCB 2020) (COVID-19 Gift Rules Waiver Order) (initially waiving the RHC and E-Rate Programs gift rules through September 30, 2020); Rural Health Care Universal Service Support Mechanism; Schools and Libraries Universal Service Support Mechanism, WC Docket No. 02-60, CC Docket No. 02-6, Order, 35 FCC Rcd 9416, 9416, para. 1 (WCB 2020) (COVID-19 Gift Rules Waiver Extension Order) (extending the waivers of the RHC and E-Rate Programs gift rules through December 31, 2020); Rural Health Care Universal Service Support Mechanism; Schools and Libraries Universal Service Support Mechanism, WC Docket No. 02-60, CC Docket No. 02-6, Order, 35 FCC Rcd 14544, 14544, para. 1 (WCB 2020) (extending the waivers of the RHC and E-Rate Programs gift rules through June 30, 2021). The limited duration gift rule waivers were a response to the COVID-19 pandemic that coincided with funding year 2020 and created unprecedented connectivity needs for health care providers, schools, and libraries. In contrast to the E-Rate and Rural Health Care Programs, which are designed to address eligible entities general connectivity needs, the Pilot Program is targeted specifically towards connected care services. Further, Pilot projects generally require a ramp up-period, therefore, it is unlikely that the projects will start before the limited duration gift rule waivers are set to expire, and most of the participating Pilot projects sought funding for multiple years. Given the distinct nature of the Pilot Program and these timing considerations, extending the limited duration of the gift rule restrictions to the Pilot Program would unnecessarily complicate compliance with and the enforcement of Pilot Program rules. 60 See 47 CFR § 54.622(h)(4). 11 Federal Communications Commission FCC-CRIC2106-05 purchased pursuant to universal support mechanisms shall not be sold, resold, or transferred in consideration for money or any other thing of value.61 25. Competitive Bidding Exemptions. Pilot Program participants are not required to engage in competitive bidding if a competitive bidding exemption applies. All of the competitive bidding exemptions under the Healthcare Connect Fund Program, plus an additional exemption, apply to the Pilot Program:62 " Government Master Services Agreement. The eligible health care provider seeks support for services and equipment purchased from Master Services Agreements (MSAs) negotiated by federal, state, Tribal, or local government entities on behalf of such health care providers and others, if such MSAs were awarded pursuant to applicable federal, state, Tribal, or local competitive bidding requirements;63 " Pre-approved Master Services Agreement. The eligible health care provider opts into an existing MSA approved under the Rural Health Care Pilot Program or Healthcare Connect Fund Program and seeks support for services and equipment purchased from the MSA, if the MSA was developed and negotiated in response to an RFP that specifically solicited proposals that included a mechanism for adding additional sites to the MSA;64 " Evergreen contract. The eligible health care provider has a multi-year contract designated as  evergreen by USAC and seeks to exercise a voluntary option to extend an evergreen contract without undergoing additional competitive bidding;65 " E-Rate contract. The eligible health care provider is in a consortium with participants in the schools and libraries universal service support program (E-Rate program) and a party to the consortium s existing contract, if the contract was approved in the E-Rate program as a master contract;66 " Annual undiscounted cost of $10,000 or less. The eligible health care provider seeks support for $10,000 or less of total undiscounted eligible expenses for a single year, if the term of the contract is one year or less;67 or " Pre-existing contract (Connected Care Pilot Program only). The eligible health care provider already has entered into a legally binding agreement with a service provider for services or equipment eligible for support in the Pilot Program and that legally binding agreement itself was the product of competitive bidding. We clarify that this exemption 61 47 CFR § 54.629(a); see also 47 U.S.C. § 254(h)(3) ( Telecommunications services and network capacity provided to a public telecommunications user under this section may not be sold, resold, or transferred by such user in consideration for money or any other thing of value. ). Also, in the Connected Care Report and Order, the Commission explained that this does not prohibit health care providers from providing broadband to patients participating in their Pilot project, 35 FCC Rcd at 3397, n.130. 62 See 47 CFR § 54.622(i). 63 See 47 CFR § 54.622(i)(1). 64 See 47 CFR § 54.622(i)(2). 65 See 47 CFR § 54.622(i)(3)(i)-(iii). Although selected Connected Care Pilot participants may use a contract already designated as evergreen by USAC in the Healthcare Connect Fund Program, contracts negotiated for the Connected Care Pilot are not eligible for an evergreen designation because many services eligible in the Connected Care Pilot are not eligible for support in the Healthcare Connect Fund Program. 66 See 47 CFR § 54.622(i)(4). 67 See 47 CFR § 54.622(i)(5). Very few selected projects have annual undiscounted costs of $10,000 or less, so we expect that this exemption will not be widely invoked. 12 Federal Communications Commission FCC-CRIC2106-05 applies only when the contract was signed before the applicant was selected to participate in the Pilot Program and the contract was not entered into solely for purposes of the Pilot Program. The prior competitive bidding process must have included public solicitation of bids or the applicant must have evaluated multiple quotes or bids before signing the contract.68 3. Requests for Funding  FCC Form 462 26. In the Connected Care Pilot Program Report and Order, the Commission indicated that additional information on filing a request for funding would be forthcoming.69 We now lay out the process for requesting funding. Pilot Program participants must request funding from USAC by filing the FCC Form 462, a formal request for funding that provides specific information on pricing and services.70 Pilot Program participants in Appendix A must file their initial FCC Form 462(s) no later than six months after the effective date of this Report and Order, and any subsequent Pilot Program selections must file their initial FCC Form 462(s) within six months of the announcement of their selection.71 As discussed above, Pilot Program participants must wait at least 28 days from the date of posting the FCC Form 461 before signing a contract or service agreement with a service provider and filing the Form 462. The 28- day period does not apply to those Pilot Program participants that are exempt from seeking competitive bids for certain products or services. Pilot Program participants that are exempt from seeking competitive bids for some but not all, of the Pilot-supported products and services, are encouraged to seek competitive bids as necessary, and file one Form 462 seeking funding for all requested products and services, being sure to wait 28 days as necessary. 27. Requests for Multi-Year Commitments. Pilot Program participants may seek bids for multi-year or single-year contracts during the competitive bidding process. If a project only seeks bids for a single-year contract, it will need to conduct a new competitive bidding process for each year of the Pilot Program, unless an exemption applies. Pilot Program participants may then submit multi-year or single-year funding requests to USAC. Also, as noted above, the competitive bidding requirements for the Pilot Program are in addition to and do not supplant any applicable state or local procurement requirements. 4. Funding Commitments 28. After USAC reviews the FCC Form 462 and makes funding determinations, USAC will issue a Funding Commitment Letter (FCL) for each FCC Form 462 filed for the Pilot Program that details 68 See Connected Care Report and Order, 35 FCC Rcd at 3412, para. 76, n.204. See also Wireline Competition Bureau Announces Application Deadline for the E-Rate Deployed Ubiquitously (EDU2011) Pilot Program, Public Notice, 25 FCC Rcd 15834, 15837-38 (WCB 2010) (waiving the E-Rate program competitive bidding requirements, to the extent necessary, for EDU2011 Pilot Program applicants that have already entered into legally-binding agreements with service providers for the off-premises connectivity for portable wireless devices). 69 Connected Care Report and Order, 35 FCC Rcd at 3411, para. 74; Connected Care Notice, 34 FCC Rcd at 5652- 53, paras. 70-72. 70 Connected Care Report and Order, 35 FCC Rcd at 3413, para. 77. 71 Pilot Program participants selected in January may file additional FCC Form 462s more than six months from the effective date of this Second Report and Order, and any future selections can file additional FCC Forms 462 more than six months from the announcement of their respective selection. We also acknowledge that Pilot Program participants in Appendix A who were notified of selection in the January Selection Public Notice will have longer than six months from the date of notification to the deadline to file an FCC Form 462. As noted in the January Selection Public Notice, to avoid confusion and ensure smooth operation of the Pilot Program, selections in the January Selection Public Notice would not trigger the various submission deadlines, including the deadline for the FCC Form 462. January Selection Public Notice, para. 12 & n.13. 13 Federal Communications Commission FCC-CRIC2106-05 the amount of committed funding and contains other important information.72 The amount of funding specified in the FCL is the total amount for which a Pilot Program participant may request reimbursement. Pilot Program participants may begin to receive supported recurring services on the start date of their Pilot project. To ensure that projects start in a timely manner, Pilot Program participants may install equipment or pay for other supported non-recurring services before the start date, but may not invoice for this equipment and services until after the start date. Services must be delivered by the service delivery deadline applicable to the funding year of the last day of the funding commitment.73 To aid in administration of the Pilot Program, all funding commitments shall end three years from the first date of service for the respective Pilot project, and by no later than June 30, 2025.74 Participants that seek one- year funding commitments may access unused funds in future years of the Pilot Program s three year period. Pilot Program participants may request site and service substitutions as necessary pursuant to the process detailed below in Section III.C.5. 5. Changes to Projects 29. Pilot Program participants are required to report to the Commission any material change in the participating health care providers or Pilot projects status (e.g., the health care provider site has closed, or the pilot project has ceased operations) within 30 days of such material change in status.75 In instances where a Pilot Program participant is unable to participate in the Pilot Program for their proposed project period, a successor may be designated by the Bureau.76 Further, to facilitate the tracking and monitoring of the Pilot Program budget and guard against potential waste, fraud and abuse, Pilot Program participants must notify USAC within 30 days of any decrease of 5% or more in the number of patients participating in their respective Pilot projects.77 Pilot Program participants can notify USAC of these changes via My Portal. We direct USAC to advise the Bureau of project changes that could impact committed funding (e.g., changes to the cost of patient broadband or decrease in service quantities). 30. Site and Service Substitutions. To provide flexibility to Pilot Program participants, the Pilot Program will permit site and service substitutions within a project, consistent with the site and 72 See Connected Care Report and Order, 35 FCC Rcd at 3413, para. 77 (stating that USAC will review funding requests and issue funding commitment letters); Connected Care Notice, 34 FCC Rcd at 5653, para. 71. 73 See 47 CFR § 54.626(a) (requiring the delivery of all recurring and non-recurring services by the end of the funding year for which services were sought). 74 The beginning of the Pilot project is the first day that supported services are provided. Pilot projects that have an end date earlier than June 30, 2025, can seek an extension of the service delivery deadline for non-recurring services consistent with Healthcare Connect Fund procedures, but extensions shall not go beyond June 30, 2025. See 47 CFR § 54.626(b) (permitting an extension of the service delivery deadline for non-recurring services when (1) funding commitment letters were issued on or after March 1 of the funding year for which discounts are authorized, (2) applicants receive service provider change authorizations or site and service authorizations from the USAC on or after March 1 of the funding year for which discounts are authorized, (3) the service provider is unable to complete implementation for reasons beyond its control, or (4) the service provider is unwilling to complete delivery and installation because the applicant s funding request is under review by the Administrator for program compliance). We do not expect to issue service delivery deadline extensions beyond June 30, 2025, but will consider requests on a case-by-case basis. 75 Connected Care Report and Order, 35 FCC Rcd at 3413, para. 78. 76 Id. 77 Id. For purposes of reporting, participating patients are measured as the number of patients enrolled in the Pilot project on the first day that supported services are provided. After the first year of the Pilot Program, participating patients will be measured as the number of patients enrolled, as reported in the Pilot Program participant s annual report to the Commission. Participants should notify USAC within 30 days of any decrease of 5% or more from those reported numbers. 14 Federal Communications Commission FCC-CRIC2106-05 service substitution rules in the Rural Health Care Program.78 Both individual and consortium projects may make service substitutions. USAC shall approve a site or service substitution for the Pilot Program if: (1) the substitution is provided for in the contract, within the change clause, or constitutes a minor modification; (2) the site is an eligible HCP and the service is an eligible service under the Pilot Program; (3) the substitution does not violate any contract provision or state or local procurement laws; and, (4) the requested change is within the scope of the controlling FCC Form 461, including any applicable Request for Proposal.79 A site or service substitution cannot increase the total funding commitment.80 Pilot Program participants may request site and service substitutions via My Portal. 31. Contract Modifications. Contract modifications are permissible if they would be considered minor and therefore exempt from state, local, or tribal competitive bidding requirements.81 If the jurisdiction s laws are silent or otherwise inapplicable on whether a modification would be permitted without rebidding, the Commission adheres to the  cardinal change doctrine, which looks at whether the modified terms are essentially the same as in the original contract.82 To qualify for reimbursement, any items provided pursuant to a minor contract modification must also be eligible services under the rules of the Pilot Program. 6. Seeking Reimbursement  FCC Form 463 32. We provide additional details on invoicing requirements and processes.83 The Pilot Program will provide universal service support for 85% of the cost of eligible services and equipment. 84 Consistent with the Commission s existing rules for the Healthcare Connect Fund Program, Pilot Program participants must contribute the other 15% of the cost of eligible services or equipment.85 Only funds from eligible sources, including the applicant or eligible health care provider participants, participating patients, or state, federal, or Tribal funding or grants, may be applied toward the health care provider s required contribution.86 Health care providers cannot use ineligible sources (e.g., direct payments from vendors or service providers) to pay their required share of requested services or equipment. 87 78 See 47 CFR § 54.624. See also Connected Care Report and Order, 35 FCC Rcd at 3413, para. 78 (requiring that USAC be notified of changes to projects, including site closures). 79 47 CFR § 54.624. See also USAC, Site and Service Substitutions, https://www.usac.org/rural-health- care/additional-program-guidance/site-and-service-substitutions/ (last visited May 20, 2021). 80 See Healthcare Connect Fund Order, 27 FCC Rcd at 16807, para. 315 ( Once USAC has issued a funding commitment letter, support under the letter is capped at the amount provided in the letter. Therefore, support for a qualifying site and service substitution is only guaranteed if the substitution will not cause the total amount of support under the funding commitment letter to increase. ). 81 These are the contract modification rules of the Healthcare Connect Fund. See Healthcare Connect Fund Order, 27 FCC Rcd at 16804-06, paras. 306-12. 82 The concept of a  cardinal change is discussed in the Federal-State Joint Board on Universal Service Fourth Order on Reconsideration. Federal-State Joint Board on Universal Service; Access Charge Reform, Price Cap Performance Review for Local Exchange Carriers, Transport Rate Structure and Pricing, End User Common Line Charge, CC Docket Nos. 96-45; 96-262; 94-1; 91-213; 95-72, Fourth Order on Reconsideration in CC Docket No. 96-45, 13 FCC Rcd 5318, 5448-50, paras. 223-28 (1997). 83 Connected Care Report and Order, 35 FCC Rcd at 3411, para. 74; Connected Care Notice, 34 FCC Rcd at 5654, paras. 73-74. 84 Connected Care and Report and Order, 35 FCC Rcd at 3384-406, paras. 38, 43, 55, 68. 85 See 47 CFR § 54.611(a) (requiring that health care providers receiving support are required to contribute the non- discount portion of all eligible expenses). 86 See Connected Care Report and Order, 35 FCC at 3388-89, para. 43; see also 47 CFR § 54.611(b). 87 Connected Care Report and Order, 35 FCC Rcd at 3389-90, para. 43. 15 Federal Communications Commission FCC-CRIC2106-05 33. After eligible equipment or services have been delivered, service providers, in conjunction with the participating health care providers, will be required to make certain certifications and submit invoicing forms, i.e., FCC Form 463 (Invoice and Request for Disbursement Form), with supporting documentation to USAC.88 USAC will review the invoicing forms and supporting documentation and issue disbursements to the applicable service providers or vendors.89 So that the Pilot Program can operate easily with existing invoicing systems, service providers will receive reimbursement directly, rather than through the health care provider, consistent with the standard practice in the Healthcare Connect Fund Program.90 Both broadband service providers and other vendors must have a valid Service Provider Identification Number from USAC, also known as a 498 ID, to receive payments.91 34. Finally, we waive the procedural rule established in the Connected Care Report and Order that invoices be submitted monthly.92 While the Commission strongly encourages Pilot Program participants to submit invoices on a monthly basis when possible, requiring invoices to be submitted on a monthly basis may pose an undue administrative burden for some Pilot Program participants and would be difficult to enforce. Because we are tracking the expenditures for each project to ensure that total disbursements remain under the $100 million cap, and because the Pilot Program has a number of reporting requirements to further monitor the progress of projects, requiring monthly invoicing is not necessary to ensure that total disbursements will be under the cap. We therefore find good cause under section 1.3 of our rules to not require invoices to be submitted on a monthly basis, but still encourage participants to submit their invoices promptly upon incurring an expense. All invoices must be submitted to USAC by the invoice deadline for the RHC Program,93 which is 120 days after the service delivery deadline, but no later than six months following the conclusion of each project. 7. Wind Down Period and Project Conclusion 35. As discussed above, Pilot Program participants may begin receiving service and eligible network equipment upon receipt of an FCL from USAC and must begin receiving service no later than six months following receipt of the FCL. Projects are to last for three years from the first date of service, and no later than June 30, 2025. Following the conclusion of the three-year period, Pilot Program participants will have an additional six months to wind down their projects or transition to a funding source other than the Pilot Program. During this period, Pilot Program participants may submit any remaining invoices for expenses incurred during the three-year Pilot project period, submit final data reporting (discussed in 88 Pilot Program participants will use a new version of Form 463, to be released in coming months by USAC, which will be available in My Portal. The new form will be based on Healthcare Connect Fund invoicing rules at 47 CFR § 54.627, adapted for the requirements of the Pilot Program. 89 Connected Care Report and Order, 35 FCC Rcd at 3413-14, para. 79. 90 Id. 91 Id. at 3413, n.213. The 498 ID (formerly known as the Service Provider Identification Number) can be obtained by filing FCC Form 498. Additional information on the form and the process for filing is available on the USAC website at the following links: https://www.usac.org/rural-health-care/service-providers/fcc-form-498/, https://www.usac.org/service-providers/participating-in-a-usf-program/register-for-a-498-id/. 92 The Commission may waive its rules upon good cause shown, See 47 CFR § 1.3; see also ICO Global Commc ns (Holdings) Ltd. v. FCC, 428 F.3d 264 (D.C. Cir. 2005); Northeast Cellular Tel. Co. v. FCC, 897 F.2d 1164, 1166 (D.C. Cir. 1990) (stating that in granting a waiver, an agency must explain why deviation from the general rule better serves the public interest than would strict adherence to the rule); WAIT Radio v. FCC, 418 F.2d 1153, 1157 (D.C. Cir. 1969) (stating that even though the overall objectives of a general rule have been adjudged to be in the public interest, it is possible that application of the rule to a specific case may not serve the public interest). Good cause may be found  where particular facts would make strict compliance inconsistent with the public interest. Northeast Cellular, 897 F.2d at 1166. 93 See 47 CFR § 54.627. 16 Federal Communications Commission FCC-CRIC2106-05 Section III.D.1, below), and conclude any administrative tasks. Additional guidance may be provided by the Bureau regarding project conclusion. D. Additional Pilot Program Requirements 1. Data Reporting and Bureau Report on Pilot 36. The Commission established the Pilot Program to examine how the Fund can help support the trend towards connected care services, particularly for low-income Americans and veterans. In particular, we expect that the Pilot Program will benefit many low-income and veteran patients who are responding to a wide variety of health challenges such as infectious diseases, diabetes, opioid dependency, high-risk pregnancies, pediatric heart disease, mental health conditions, and cancer. We also expect that the Pilot Program will provide meaningful data that will help us better understand how USF funds can support health care provider and patient use of connected care services.94 To this end, the Commission established three specific goals for the Pilot Program: to determine how USF support can be used to (1) improve health outcomes through connected care; (2) reduce health care costs for patients, facilities and the health care system; and (3) support the trend towards connected care everywhere.95 37. To help evaluate the Pilot Program, the Commission directed the Bureau to issue a report detailing the results of the Pilot Program after it has been completed. To assist with this report, we will require Pilot Program participants to submit anonymized, aggregated data to the Bureau regarding their Pilot project. Pilot Program participants are required to submit three total reports: an annual report after their first year of funding, after their second year of funding, and a final report after their third year of funding that contains data for the third year of funding, summarizes final results, and explains whether goals of the Pilot project were met and how the Pilot project served the Commissions goals for the program.96 The Bureau will draw on the data from individual Pilot projects to prepare a final report upon the conclusion of the Pilot Program. 38. We direct the Bureau to develop a form template for Pilot Program participants to use in reporting data annually and at the Pilot project s conclusion.97 We direct the Bureau to make the template available as close to the start of the Pilot projects as possible to ensure that each project can gather data while the project is underway and be in position to report to the Commission at the conclusion of each year of the Pilot project. We further direct the Bureau to provide guidance on how Pilot Program participants can access the template, and how participants can submit the report to the Bureau, as well as establish deadlines as necessary. We expect that Pilot Program participants will be asked to report data such as: the number of patients served and percentage of those who were low-income and veteran patients; changes from the estimated patient population; progress in meeting the project s goals and objectives; impact of funding on number of patients treated with connected care; patient satisfaction with connected care and with health status; changes in treatment adherence; reductions in emergency room or urgent care visits; decreases in hospital admissions, re-admissions or lengths of stay; reductions or improvements in condition-specific outcomes or acute incidents among those who suffer from a chronic illness;98 impact of funding patient broadband connections; decreases in missed appointments; estimated cost-savings for health care providers and patients; reduced patient travel or time (e.g., reduction in travel time or time missed from work); and other metrics that may demonstrate progress toward achieving the 94 Connected Care Report and Order, 35 FCC Rcd at 3368-69, para. 5. 95 Id. at 3415, para. 83. 96 Id. at 3414, para. 81. 97 We further direct the Bureau to obtain necessary approvals for the use of this form, including Paperwork Reduction Act approval from the Office of Management and Budget, as needed. 98 Illustrative examples of condition specific outcomes include, but are not limited to, changes in A1c levels for diabetic patients, or changes in blood pressure for patients with hypertension. See, e.g., Connected Care Report and Order, 35 FCC Rcd at 3414-16, paras. 80, 84. 17 Federal Communications Commission FCC-CRIC2106-05 Pilot Program s goals, and general feedback on program administration. We expect that the final report from Pilot Program participants will, at a minimum, include an overall summary of the information in the annual reports, an explanation of how the project helped advance the goals and objectives of the Pilot Program, an explanation of whether the Pilot project met its specific goals and objectives, information on any lessons learned concerning the provision and utilization of connected care services, and, particularly for low-income patients and veterans, lessons learned concerning patient retention, patient training, and how best to address digital literacy challenges. Pilot projects must collect data sufficient to provide substantive responses for the required reports. Failure to provide the data may result in either the elimination of the selected participant from the Pilot Program, loss or reduction of support, or recovery of prior distributions.99 2. USAC Outreach 39. All Pilot Program participants listed in Appendix A have 14 calendar days from the effective date of this Order to provide or update, as needed, contact information for the lead project coordinator to USAC, including the lead project coordinator s name, mailing address, e-mail address, and telephone number.100 Any future selections will need to provide or update this information within 14 calendar days of the announcement of their selection. Within 30 days of the effective date of this Order, USAC will conduct an initial coordination meeting with Pilot Program participants identified in Appendix A. For any future selections, we direct USAC to conduct an initial coordination meeting with additional selected Pilot Program participants within 30 days of their selection. USAC will also conduct a targeted outreach program, such as a webinar or similar outreach, to educate and inform selectees about the Pilot Program administrative process, including filing requirements and deadlines.101 In addition to the structured outreach, participants are encouraged to contact USAC support staff, who will be available to respond to individual questions about how to file forms or submit proper supporting documents. Pilot Program participants can also find information on USAC s website for the Connected Care Pilot Program.102 And as noted above, most program forms and other program documents can be found in My Portal. 3. Document Retention, Audits, and Protection Against Waste, Fraud, and Abuse 40. As in the Healthcare Connect Fund, health care providers and selected participants, in addition to maintaining records related to their Pilot projects to demonstrate their compliance with the Pilot Program rules and requirements, must also keep supporting documentation for these reports for at least five years after the conclusion of their Pilot project and must present that information to the 99 See Connected Care Notice, 34 FCC Rcd at 5654, para. 75 (proposing to tie data reporting requirements to the reimbursement of Pilot Program support); Rural Health Care Support Mechanism, WC Docket No. 02-60, Report and Order, 22 FCC Rcd 20360, 20424, para. 128 (2007) (2007 RHC Pilot Program Selection Order) (establishing quarterly reporting requirement for 2007 RHC Pilot Program participants, and stating that  failure to provide the data will result in either the elimination of the selected participant from the Pilot Program, loss or reduction of support, or recovery of prior distributions ). 100 Pilot Program participants provided this information as part of their initial applications. To the extent additions or updates to this contact information is needed, selected Pilot Program participants in Appendix A should make those changes within 14 days of the effective date of this Report and Order, and any future selections shall make these changes within 14 days of the announcement of their selection. 101 Connected Care Report and Order, 35 FCC Rcd at 3414-15, para. 82. 102 Universal Service Administrative Company, Connected Care Pilot Program, https://www.usac.org/rural-health- care/connected-care-pilot-program (last visited May 21, 2021). 18 Federal Communications Commission FCC-CRIC2106-05 Commission or USAC upon request. Pilot projects will also be subject to random compliance audits to ensure compliance with the Pilot Program rules and requirements.103 41. One indicator of the Pilot Program s success will be the avoidance of waste, fraud, and abuse and the careful stewardship of Universal Service Fund resources. Pilot Program participants must carefully adhere to program rules, file timely and accurate reports, and promptly consult with USAC when questions regarding Pilot Program rules or processes arise. We retain the discretion to evaluate the uses of monies disbursed through the USF programs and to determine on a case-by-case basis that waste, fraud, or abuse of program funds occurred, and that recovery is warranted. Additionally, in the event we discover any improper activity resulting from the Pilot Program, we will subject the offending party to all available penalties at our disposal, and will direct USAC to recover funds, assess retroactive fees and/or interest, or both. We remain committed to ensuring the integrity of the USF programs and will continue to aggressively pursue instances of waste, fraud, or abuse under our own procedures and in cooperation with law enforcement agencies. 42. Further, consistent with the Commission s existing rules for the Healthcare Connect Fund Program, Pilot Program participants must contribute their 15% share of the eligible costs from eligible sources (e.g., the applicant, patient charges, an eligible health care provider, or state, federal, or Tribal funding or grants)104 and cannot apply funds from ineligible sources (including other FCC programs, such as the Universal Service Fund and the COVID-19 Telehealth Program, or direct payments from vendors or service providers).105 Pilot Program participants are also reminded that on their program application, they certified that no funds from any source  private, state, or federal  have been received or are expected to be received for the exact same services or equipment that are claimed as eligible for support under the Pilot Program.106 All Pilot Program participants are strongly encouraged to review their active certification commitments, including those related to HIPAA compliance, document retention, and proper use of funds. 43. Finally, we remind Pilot Program participants that Pilot projects are prohibited from receiving duplicative funding from the Pilot Program and the COVID-19 Telehealth Program, or any other source, for those exact same items.107 If a Pilot Program participant is also selected for participation in the COVID-19 Telehealth Program, it must ensure that it does not request disbursements for the same services or equipment from both programs.108 If any Pilot Program participant is also selected to participate in the COVID-19 Telehealth Program, the participant shall notify the Administrator immediately, and we direct the Administrator to compare that participant s Pilot Program funding request(s) against its COVID-19 Telehealth Program application to ensure that participants do not receive duplicative funding. 103 See Connected Care Report and Order, 35 FCC Rcd at 3408-09 para. 69; Connected Care Notice, 34 FCC Rcd 5620, 5655-56, paras. 76-77. 104 See 47 CFR § 54.611(b)(1) ( Eligible sources include the applicant or eligible health care provider participants, state grants, appropriations, or other sources of state funding; federal funding, grants, loans or appropriations except for other federal universal service funding, or other sources of federal funding; Tribal government funding; and other grants, including private grants. ); 47 CFR § 54.611(b)(2) ( Ineligible sources include (but are not limited to) in-kind or implied contributions from health care providers; direct payments from service providers, including contractors and consultants to such entities; and for-profit entities. ). 105 47 CFR § 54.611(b)(2) ( Ineligible sources include (but are not limited to) in-kind or implied contributions from health care providers; direct payments from service providers, including contractors and consultants to such entities; and for-profit entities. ). 106 Connected Care Report and Order, 35 FCC Rcd at 3401, para. 64. 107 See id. at 3409, n.186. 108 See id. 19 Federal Communications Commission FCC-CRIC2106-05 4. Payment Administration 44. FCC Red Light Rule. To implement the requirements of the Debt Collection Improvement Act of 1996, the Commission established what is commonly referred to as the  red light rule. 109 Under the red light rule, the Commission will not take action on applications or other requests by an entity that is found to owe debts to the Commission until full payment or resolution of that debt.110 If the delinquent debt remains unpaid or other arrangements have not been made within 30 days of being notified of the debt, the Commission will dismiss any pending applications.111 If a Pilot Program participant or service provider is currently on red light status, it will need to satisfy or make arrangements to satisfy any debts that it owes to the Commission before its application can be processed. 45. System for Award Management Registration. All Pilot Program participants and service providers must also register with the System for Award Management (SAM). SAM is a web-based, government-wide application that collects, validates, stores, and disseminates business information about the federal government s partners in support of federal awards, grants, and electronic payment processes. Registration in SAM provides the Commission with an authoritative source of information necessary to provide funding to Pilot Program participants and to ensure accurate reporting pursuant to the Federal Funding Accountability and Transparency Act of 2006, as amended by the Digital Accountability and Transparency Act of 2014.112 Only those applicants and service providers that are actively registered in SAM will be able to receive reimbursement from the Pilot Program. Pilot Program participants and service providers that are already registered with SAM do not need to re-register with that system in order to receive payment from the Pilot Program. Pilot Program participants who are not already registered with SAM may still participate in the Pilot Program, apply for funding, and receive program commitments, but Pilot Program participants and service providers must be registered in SAM before any payments can be issued for the Pilot Program.113 To assist participants who are not registered with SAM, we direct USAC to provide information and guidance to participants regarding the SAM registration process. To the extent that pilot program participants subaward the payments they receive from the Pilot Program, as defined by FFATA/DATA Act regulations, pilot program participants may be required to submit data on those subawards.114 46. Do Not Pay. Pursuant to the requirements of the Payment Integrity Information Act of 2019, the Commission is required to ensure that a thorough review of available databases with relevant information on eligibility occurs to determine program or award eligibility and prevent improper 109 Amendment of Parts 0 and 1 of the Commission s Rules; Implementation of the Debt Collection Improvement Act of 1996 and Adoption of Rules Governing Applications or Requests for Benefits by Delinquent Debtors, MD Docket No. 02-339, Report and Order, 19 FCC Rcd 6540 (2004). 110 47 CFR § 1.1910(b)(2). 111 47 CFR § 1.1910(b)(3). 112 Pub. L. No. 109-282, 120 Stat. 1186 (2006) and Pub. L. No. 113-101, 128 Stat. 114 (2014), codified at 31 U.S.C. § 6101 note. In August 2020, OMB updated the rules governing compliance with the Transparency Act as part of wider ranging revisions to title 2 of the Code of Federal Regulations. Guidance for Grants and Agreements, 85 Fed. Reg. 49506, 49506 (Aug. 13, 2020) (to be codified at 2 CFR pt. 25, 170, 183, and 200). OMB explained that the SAM registration requirements were expanded  beyond grants and cooperative agreements to include other types of financial assistance to ensure compliance with FFATA. Guidance for Grants and Agreements, 85 Fed. Reg. at 49517. 113 It is strongly recommended that unregistered applicants and service providers that will submit requests for reimbursement start the SAM registration process immediately because it may take up to 20 days for the registration to become active and an additional 24 hours before that registration information is available in other government systems. To register with the system, go to https://www.sam.gov/SAM/ and provide the requested information. 114 2 CFR pt. 170, App. A. 20 Federal Communications Commission FCC-CRIC2106-05 payments before the release of any federal funds.115 To meet this requirement, the Commission and USAC will make full use of the Do Not Pay system administered by the U.S. Treasury s Bureau of the Fiscal Service.116 If a check of the Do Not Pay system results in a finding that a Pilot Program participant or service provider should not be paid, the Commission will withhold issuing commitments and payments. The Pilot Program participant or service provider is responsible for working with the relevant agency to correct its information in the Do Not Pay system before payment can be issued.117 5. Appeals of USAC Decisions 47. Affected parties may seek review of a USAC decision pursuant to the rules and procedures outlined in sections 54.719 to 54.725 of the Commission s rules.118 Specifically, an affected party may seek review of a decision by USAC by filing a request for review with USAC within 60 days of the date of the decision.119 An affected party may seek Commission review of a USAC decision, only after first seeking review of the decision with USAC, and may file a request for review with the Commission within 60 days after USAC s decision on appeal.120 An affected party may only request a waiver of the Commission s rules, or a waiver of a decision by USAC, by filing such request with the Commission, within 60 days of USAC s decision.121 All other requirements for appeals and requests for waiver, including the form the filings must take, can be found in sections 54.719 to 54.725 of the Commission s rules. 6. Delegations of Authority 48. In order to ease program administration, the Commission delegates to the Bureau, consistent with the goals of the Pilot Program, the authority to waive certain program deadlines, clarify any inconsistencies or ambiguities in the Pilot Program rules, adjust Pilot project funding commitments, or to perform other administrative tasks as may be necessary for the smooth operation of the Pilot Program. The Commission also delegates to the Bureau the authority to grant limited extensions of deadlines to Pilot projects, and other authority as may be necessary to ensure a successful Pilot Program.122 49. We delegate financial oversight of this program to the Commission s Managing Director and direct the Office of the Managing Director (OMD) to work in coordination with the Bureau to ensure that all financial aspects of the program have adequate internal controls. These duties fall within OMD s current delegated authority to ensure that the Commission operates in accordance with federal financial statutes and guidance.123 OMD performs this role with respect to USAC s administration of the 115 Payment Integrity Information Act (PIIA), Pub. L. No. 116-117, 134 Stat. 113 (2020). PIAA codifies and amends the prior improper payment statutes (i.e., Improper Payments Information Act of 2002, Pub. L. No. 107-300; Improper Payments Elimination and Recovery Act of 2010, Pub. L. No. 111-204; Improper Payments Elimination and Recovery Improvement Act of 2012, Pub. L. No. 112-248; and Fraud Reduction and Data Analytics Act of 2015, Pub. L. No. 114-186. 116 For additional information, please see: https://fiscal.treasury.gov/DNP/. 117 For additional information, please see: https://fiscal.treasury.gov/dnp/privacy-program.html#data-correction- process. 118 47 CFR § 54.719-725. 119 47 CFR § 54.719(a); 54.720(b). 120 47 CFR § 54.719(b); 54.720(a). 121 47 CFR § 54.719(c); 54.720(a). 122 See also Connected Care Report and Order, 34 FCC Rcd at 3390, para. 46. 123 47 CFR § 0.11(a)(3)-(4) (stating that OMD will  [a]ssist the Chairman in carrying out the administrative and executive responsibilities and  [a]dvise the Chairman and Commission on management, administrative, and related matters; review and evaluate the programs and procedures of the Commission; initiate action or make (continued& .) 21 Federal Communications Commission FCC-CRIC2106-05 Commission s Universal Service programs124 and we anticipate that OMD will leverage existing policies and procedures, to the extent practicable and consistent the Connected Care Pilot Program, to ensure the efficient and effective management of the program. Finally, we note that OMD is required to consult with the Bureau on any policy matters affecting the program, consistent with section 0.91(a) of the Commission s rules. IV. PROCEDURAL MATTERS 50. Paperwork Reduction Act Analysis. This document contains new information collection requirements. The Commission, as part of its continuing effort to reduce paperwork burdens, invites the general public and the Office of Management and Budget (OMB) to comment on the information collection requirements contained in this document, as required by the Paperwork Reduction Act of 1995 (PRA), Public Law 104-13. In addition, pursuant to the Small Business Paperwork Relief Act of 2002, Public Law 107-198, see 44 U.S.C. § 3506(c)(4), we seek specific comment on how we might further reduce the information collection burden for small business concerns with fewer than 25 employees. V. ORDERING CLAUSES 51. Accordingly, IT IS ORDERED that, pursuant to the authority contained in sections 201, 254, and 303(r) of the Communications Act of 1934, as amended, 47 U.S.C. §§ 201, 254, and 303(r) this Order IS ADOPTED and SHALL BECOME EFFECTIVE 30 days after publication of this Report and Order in the Federal Register, pursuant to 47 U.S.C. § 408, with the exception of those portions containing information collection requirements that have not been approved by the Office of Budget and Management (OMB). 52. IT IS FURTHER ORDERED that, pursuant to the Paperwork Reduction Act of 1995, Section 3507(d), the Connected Care Pilot Program information collection requirements not yet approved SHALL BECOME EFFECTIVE after announcement in the Federal Register of OMB approval of the information collection requirements. 53. IT IS FURTHER ORDERED that, pursuant to the authority contained in sections 201, 254, and 303(r) of the Communications Act of 1934, as amended, 47 U.S.C. §§ 201, 254, and 303(r), and section 1.3 of the Commission s Rules, 47 CFR § 1.3, the monthly invoice submission requirement IS WAIVED, to the extent discussed herein. FEDERAL COMMUNICATIONS COMMISSION Marlene H. Dortch Secretary recommendations as may be necessary to administer the Communications Act most effectively in the public interest ); 47 CFR § 0.11(a)(8) (stating that OMD s current responsibility is to  [p]lan and manage the administrative affairs of the Commission with respect to the functions of . . . budget and financial management ); 47 CFR § 0.5(e) (requiring Bureau and Office coordination with OMD on recommendations  that may affect agency compliance with Federal financial management requirements ). 124 See, e.g., Memorandum of Understanding Between the Federal Communications Commission and the Universal Service Administrative Company (Dec. 19, 2018), https://www.fcc.gov/sites/default/files/usac-mou.pdf (stating that the Commission is responsible for the effective and efficient management and oversight of the USF, including USF policy decisions, and USAC is responsible for the effective administration of the programs). 22 Federal Communications Commission FCC-CRIC2106-05 APPENDIX A Previous Connected Care Pilot Program Selections The Commission selected the following 14 projects filing 23 separate applications for the Connected Care Pilot Program on January 15, 2021:1 " Banyan Community Health Center, Inc., Coral Gables, FL2  $911,833 " Duke University Health System, Durham, NC3  $1,464,759 " Geisinger, consortium with sites in Lewiston, PA; Danville, PA; Jersey Shore, PA; Bloomsburg, PA; Coal Township, PA; and Wilkes-Barre, PA4  $1,739,100 " Grady Memorial Hospital Corporation, dba Grady Health System, Atlanta, GA5  $635,596 " Intermountain Centers for Human Development, consortium with sites in Casa Grande, AZ; Nogales, AZ; Coolidge, AZ; and Eloy, AZ6  $237,150 " MA FQHC Telehealth Consortium, consortium with 76 sites in Massachusetts7  $3,121,879 " Mountain Valley Health Center, consortium with 7 sites in Northeastern California8  $550,800 " Neighborhood Healthcare  Escondido, Escondido, CA, Neighborhood Healthcare - Valley Parkway, Escondido, CA, Neighborhood Healthcare - El Cajon, El Cajon, CA, Neighborhood Healthcare  Temecula, Temecula, CA, Neighborhood Healthcare - Pauma Valley, Pauma Valley, CA9  $129,744 1 See January Selection Public Notice. 2 See Banyan Community Health Center, Application No. CCPP20200000052 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214136007638. 3 See Duke University Health System, Application No. CCPP20200000384 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214103875023. 4 See Geisinger, Application No. CCPP20200000006 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214796000692. 5 See Grady Memorial Hospital Corporation, dba Grady Health System, Application No. CCPP20200000090 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214223786663. 6 See Intermountain Centers for Human Development, Application No. CCPP20200000270 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214149169812. 7 See MA FQHC Telehealth Consortium C-19, Application No. CCPP20200000256 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/12142862406316. 8 See Mountain Valley Health Center, Application No. CCPP20200000338 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214062604214. 9 See Neighborhood Healthcare  Escondido, Application No. CCPP20200000274 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214899013936; Neighborhood Healthcare - Valley Parkway, Application No. CCPP20200000408 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214398228691; Neighborhood Healthcare - El Cajon, Application No. CCPP20200000417 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/121462450067; Neighborhood Healthcare  Temecula, Application No. CCPP20200000419 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214196400745; Neighborhood Healthcare - Pauma Valley, Application No. CCPP20200000414 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/121417768437. 23 Federal Communications Commission FCC-CRIC2106-05 " OCHIN, Inc., consortium with 15 sites in Ohio, 16 sites in Oregon, and 13 sites in Washington10  $5,834,620 " Phoebe Worth Medical Center - Camilla Clinic, Camilla, GA; Phoebe Physicians Group Inc. - PPC of Buena Vista, Buena Vista, GA; Phoebe Physicians Group - Ellaville Primary Medicine Center, Ellaville, GA; Phoebe Physicians dba Phoebe Family Medicine & Sports Medicine, Americus, GA; Phoebe Putney Memorial Hospital, Albany, GA; Phoebe Putney Memorial Hospital dba Phoebe Family Medicine  Sylvester, Sylvester, GA11  $673,200 " Summit Pacific Medical Center, Elma, WA12  $169,977 " Temple University Hospital, Inc., Philadelphia, PA13  $4,254,250 " The University of Mississippi Medical Center, Jackson, MS14  $2,377,875 " University of Virginia Health System, Charlottesville, VA15  $4,462,500 10 See OCHIN, Inc., Application No. CCPP20200000030 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/12142890418016. 11 See Phoebe Worth Medical Center - Camilla Clinic, Application No. CCPP20200000364 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/12141693806859; Phoebe Physicians Group Inc. - PPC of Buena Vista, Application No. CCPP20200000373 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/121471598310; Phoebe Physicians Group - Ellaville Primary Medicine Center, Application No. CCPP20200000396 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214245457559; Phoebe Physicians dba Phoebe Family Medicine & Sports Medicine, Application No. CCPP20200000400 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214626826276; Phoebe Putney Memorial Hospital, Application No. CCPP20200000416 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214038814551; Phoebe Putney Memorial Hospital dba Phoebe Family Medicine  Sylvester, Application No. CCPP20200000421 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/121445259327. 12 See Summit Pacific Medical Center, Application No. CCPP20200000004 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/12142635321948. 13 See Temple University Hospital, Inc., Application No. CCPP20200000205 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214310504229. 14 See UMMC RHC Consortium, Application No. CCPP20200000375 (submitted Dec. 7, 2020), https://www.fcc.gov/ecfs/filing/1214264014334. 15 See University of Virginia Health System, Application No. CCPP20200000149 (submitted Dec. 6, 2020), https://www.fcc.gov/ecfs/filing/12141571415964. 24