5 - 1 5. Rural Health Care Support The portion of the 1996 Telecommunications Act that covers universal service support for rural health care providers states that “[a] telecommunications carrier shall ... provide telecommunications services . . . to any public or non-profit health care provider ... at rates that are reasonably comparable to rates charged for similar services in urban areas in that state.” 1 The Commission's universal service rules permit eligible health care providers 2 to receive support for any telecommunications service. 3 In December 2004, the Commission released a Second Order 4 that modified the Commission’s rules for rural health care support. In this Second Order, the Commission changed its definition of “rural” for the purposes of the rural health care support mechanism. 5 Now a “rural area” is an area that is not located within or near a large population base. Specifically, a “rural area” is an area that (a) is entirely outside of a Core Based Statistical Area (CBSA); (b) is within a CBSA that does not have any urban area with a population of 25,000 or greater; or (c) is in a CBSA that contains an urban area with a population of 25,000 or greater, but is within a specific census tract that itself does not contain any part of a place or urban area with a population of greater than 25,000. 6 This new definition was effective as of Funding Year 2005 (July 1, 2005 – June 30, 2006). Several other rules also were changed. The Commission expanded funding for mobile rural health care providers by subsidizing the difference between the rate for the satellite service and the rate for an urban wireline service with a similar bandwidth. 7 June 30 is now the final deadline for applications for support for health care providers seeking discounts for a specific funding year under 1 47 U.S.C. § 254(h)(1)(A). 2 47 C.F.R. § 54.601. 3 A 1.544 Mbps (T1) maximum bandwidth cap was employed in Funding Years 1 and 2. See Federal-State Joint Board on Universal Service, CC Docket No. 96-45, Report and Order, 12 FCC Rcd 8776, 9101-04 (1997), paras. 620-624. The Commission removed the bandwidth cap for year three and beyond. See Federal-State Joint Board on Universal Service, CC Docket Nos. 97-21 and 96-45, Sixth Order on Reconsideration in CC Docket No. 97-21, Fifteenth Order on Reconsideration in CC Docket No. 96-45, 14 FCC Rcd 18756, 18767-72 (1999) (Fifteenth Order on Reconsideration). 4 See Rural Health Care Support Mechanism, WC Docket No. 02-60, Second Report and Order, Order on Reconsideration, and Further Notice of Proposed Rulemaking, 19 FCC Rcd 24613 (2004) (Second Order). 5 See Second Order at 24619-20, paras. 11-12. 6 47 C.F.R. § 54.5. 7 See Second Order at 24626, para. 28. 5 - 2 the rural health care support mechanism. 8 In addition, a rural health care provider in a state that is entirely rural may now receive support for advanced telecommunications and information services. 9 To receive funding under the Rural Health Care Program, an eligible rural health care provider seeking funding must first submit FCC Form 465 (description of services requested and certification form) to the Rural Health Care Division (RHCD) of the Universal Service Administrative Company (USAC). 10 If the RHCD determines that the health care provider is eligible, it posts the Form 465 on its website. 11 Twenty-eight days thereafter, the rural health care provider may contract with the most cost- effective bidder. The health care provider then fills out FCC Form 466 (Funding Request and Certification Form) and/or 466-A (Internet Service Funding Request and Certification Form), and submits it to the RHCD. Upon receipt and approval of FCC Form 466, the RHCD sends a Funding Commitment Letter to the rural health care provider. The letter explains that the request has received preliminary approval, and provides an estimate of the amount of support that can be expected. The rural health care provider must respond by submitting FCC Form 467 (receipt of service confirmation form) to verify that the service has begun. RHCD then sends a Support Schedule to the carrier and the health care provider. The carrier provides service to the rural health care provider, and then invoices the RHCD for the support amount. Upon approval of the invoice, USAC reimburses the carrier. In September 2006, the FCC established the Rural Health Care Pilot Program to provide funding to stimulate deployment of the broadband infrastructure necessary to support innovative telehealth and telemedicine services to those areas of the country where the need for these benefits is most acute. 12 Specifically, the Pilot Program will provide funding to support the design and construction of state or regional broadband networks dedicated to health care and the advanced services provided over those networks, as well as connecting those networks to Internet2, National LambdaRail, Inc. (both dedicated nationwide backbones), or the public Internet. 13 8 Id. at 24629, para. 34. 9 Id. at 24631, para. 38. 10 The Rural Health Care Corporation merged into USAC and became the Rural Health Care Division on January 1, 1999. See Changes to the Board of Directors of the National Exchange Carrier Association, Inc., Federal-State Joint Board on Universal Service, CC Docket Nos. 97-21 and 96-45, Third Report and Order in CC Docket No. 97-21 and Fourth Order on Reconsideration in CC Docket No. 97-21 and Eighth Order on Reconsideration in CC Docket No. 96-45, 13 FCC Rcd 25058, 25064-65, para. 12 (1998). 11 The forms may be viewed at www.rhc.universalservice.org/telecomcarriers/searchpostings/default.asp. 12 Rural Health Care Support Mechanism, WC Docket No. 02-60, Order, 21 FCC Rcd 11111 (2006) (Rural Health Care Pilot Program Order). 13 Rural Health Care Support Mechanism, WC Docket No. 02-60, Order, 22 FCC Rcd 20360 5 - 3 On November 19, 2007, the Commission released the Rural Health Care Pilot Program Selection Order, which selected 69 applicants covering 42 states and three U.S. territories to participate in the Pilot Program. 14 The Rural Health Care Pilot Program Selection Order makes available to these participants approximately $139 million in rural health care support per funding year for three years, beginning with Funding Year 2007 of the existing Rural Health Care program. 15 The Rural Health Care Pilot Program Selection Order further provides instructions to selected participants concerning submission of FCC forms to the RHCD and on Pilot Program administration. 16 For more information on the Pilot Program, visit the Pilot Program website. 17 By rule, the Commission has established a $400 million per funding year cap for the rural health care mechanism. 18 For more information on the Universal Service Program for Rural Health Care providers, visit the RHCD website. 19 USAC supplied the Commission with funding commitments and disbursements information as of June 30, 2009. 20 Table 5.1 summarizes funding disbursements for all funding years by service speed. Tables 5.2 and 5.3 show details for Funding Years 2006 through 2008. Table 5.4 shows details for Funding Years 2006 and 2007. For details on the preceding funding years, see the previous editions of (2007) (Rural Health Care Pilot Program Selection Order), para. 2. 14 Rural Health Care Pilot Program Selection Order. Due to mergers, there are now 62 projects in the Pilot Program. See http://www.fcc.gov/cgb/rural/rhcp.html. 15 See id. at para. 33. USAC did not issue a Pilot Program funding commitment for the first funding year (Funding Year 2007 of the existing Rural Health Care program). Unused Pilot Program support, however, is carried over to the next Pilot Program funding year. See Letter from Dana Shaffer, FCC, to Scott Barash, USAC, CC Docket No. 02-60 (Jan. 17, 2008). USAC reported that it rolled forward the Funding Year 2007 demand estimate and commitment cap of $139.26 million to Funding Year 2008, except for $0.53 million, which was committed and invoiced for Funding Year 2007. Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Fourth Quarter 2009 at 21. 16 See id. at paras. 22 to 123. 17 See Rural Health Care Pilot Program at http://www.fcc.gov/cgb/rural/rhcp.html . 18 47 C.F.R. § 54.623(a). 19 See Rural Health Care at http://www.universalservice.org/rhc/ . 20 Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 4 the Monitoring Report. 21 Table 5.2 summarizes funding commitments and disbursements on a state-by- state basis. Funding Year 2006 was July 1, 2006, through June 30, 2007. USAC reports that 5,225 Form 466 and 466-A packets have been completely processed. 22 As of June 30, 2009, over $46.34 million had been committed, and nearly $43.53 million had been disbursed. 23 USAC states that Funding Year 2006 demand will be $45.38 million. 24 Funding Year 2007 was July 1, 2007, through June 30, 2008. USAC reports that it completely processed 5,919 Form 466 and 466-A packets. Additionally, 484 packets were withdrawn by the applicant and 237 were denied. USAC estimates Funding Year 2007 demand will be approximately $54.99 million. 25 As of June 30, 2009, over $55.92 million had been committed, and nearly $50.16 million had been disbursed. 26 Funding Year 2008 was July 1, 2008, through June 30, 2009. As of June 30, 2009, more than $42.56 million had been committed, and more than $22.65 million had been disbursed. 27 USAC estimates Funding Year 2008 demand will be $60.95 million. 28 Table 5.3 shows state-by-state disbursements by service speed for Funding Years 2006 through 2008. In some instances, such as with frame relay service, the service speed was not clearly identifiable. Whenever possible, the most likely speed for each service was assumed. For example, Frame Relay theoretically could be provided at voice grade speeds, but the vast majority of it is 21 Earlier editions of the Monitoring Reports are available at www.fcc.gov/wcb/iatd/monitor.html. 22 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Fourth Quarter 2009, http://www.universalservice.org/about/governance/fcc-filings/2009/ at 20. 23 See Table 5.2. 24 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Fourth Quarter 2009 at 20. 25 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Fourth Quarter 2009 at 21. 26 See Table 5.2. 27 Id.. 28 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Fourth Quarter 2009 at 22. 5 - 5 provided at broadband speeds (200K to 1.49Mb), so Frame Relay was assumed to be broadband at that level. Table 5.4 shows, for Funding Years 2006 and 2007, state-by-state disbursements from the Rural Health Care Support Mechanism, the population of the rural areas, and the disbursements per person in rural areas. Table 5.1 Rural Health Care Funding Disbursements by Funding Year Voice Grade Broadband Other Service Funding 56K to 200K to 1.5Mb or Speed Year 199K 1.49Mb and faster Unknown Total 1998 $202,778 $880,375 $2,292,252 $0 $3,375,405 1999 452,992 1,073,816 2,719,619 58,132 4,304,559 2000 613,595 3,802,601 5,897,976 0 10,314,172 2001 319,539 13,256,841 4,978,963 0 18,555,343 2002 428,506 14,222,035 6,969,587 0 21,620,128 2003 477,657 15,917,701 9,469,267 7,559 25,872,184 2004 611,101 17,511,205 12,733,212 141,133 30,996,651 2005 899,135 23,270,642 14,956,523 520,114 39,646,414 2006 1,006,698 21,707,378 16,746,517 4,066,979 43,527,572 2007 1,231,390 25,740,082 22,590,045 596,518 50,158,034 2008 426,472 11,626,702 10,597,776 0 22,650,950 Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. 5 - 6 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2006: July 1, 2006 through June 30, 2007 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $45,236 52 $41,951 49 Alaska 25,701,518 231 25,250,712 231 American Samoa 0 0 0 0 Arizona 1,636,053 78 1,323,213 68 Arkansas 196,430 61 143,268 56 California 593,986 90 526,927 83 Colorado 113,145 15 92,441 14 Connecticut 0 0 0 0 Delaware 63 1 63 1 District of Columbia 0 0 0 0 Florida 432,008 31 311,015 19 Georgia 950,569 89 925,289 88 Guam 83,109 2 77,955 2 Hawaii 220,430 19 198,046 18 Idaho 164,258 28 130,776 27 Illinois 630,777 62 585,112 59 Indiana 376,327 37 360,569 36 Iowa 427,728 63 365,296 59 Kansas 556,401 67 550,552 65 Kentucky 187,868 63 174,509 51 Louisiana 69,923 25 57,966 17 Maine 52,398 10 51,057 9 Maryland 0 0 0 0 Massachusetts 57,633 2 56,601 2 Michigan 866,751 74 579,373 66 Minnesota 1,761,088 194 1,621,807 185 Mississippi 87,922 22 86,152 21 Missouri 143,817 20 136,373 19 Montana 541,848 60 515,740 57 Nebraska 1,721,642 89 1,655,242 88 Nevada 56,256 11 55,266 11 New Hampshire 6,765 2 6,510 1 New Jersey 0 0 0 0 New Mexico 372,985 50 320,416 45 New York 74,216 22 48,414 11 North Carolina 176,423 23 172,993 22 North Dakota 761,618 88 502,685 86 Northern Mariana Is. 0 0 0 0 Ohio 112,135 7 108,676 7 Oklahoma 303,394 31 208,806 29 Oregon 84,064 12 72,296 12 Pennsylvania 69,356 7 61,021 7 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 47,842 14 40,768 13 South Dakota 1,081,124 78 1,067,826 77 Tennessee 193,532 37 193,196 35 Texas 297,827 47 18,825 6 Utah 756,866 37 684,607 35 Vermont 131,685 20 123,658 20 Virgin Islands 48,678 11 48,678 11 Virginia 773,090 125 743,486 122 Washington 67,313 32 57,797 29 West Virginia 109,141 20 96,524 19 Wisconsin 3,005,380 238 2,885,469 233 Wyoming 191,649 12 191,649 12 Totals $46,340,267 2,409 $43,527,572 2,233 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 7 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2007: July 1, 2007 through June 30, 2008 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Commitments Disbursed Support Alabama $169,200 60 $151,248 57 Alaska 29,608,303 235 28,772,216 232 American Samoa 116,650 1 108,400 1 Arizona 1,743,822 81 1,211,070 55 Arkansas 370,081 59 184,300 45 California 793,113 109 500,567 53 Colorado 119,758 19 91,139 14 Connecticut 0 0 0 0 Delaware 413 2 413 2 District of Columbia 0 0 0 0 Florida 487,546 33 400,933 20 Georgia 1,402,319 73 1,364,205 70 Guam 54,179 2 6,860 1 Hawaii 192,524 20 183,884 19 Idaho 245,511 40 227,804 34 Illinois 874,489 77 684,471 67 Indiana 630,677 52 498,271 41 Iowa 534,195 69 460,226 66 Kansas 225,193 39 201,314 29 Kentucky 521,298 79 510,098 76 Louisiana 68,995 24 48,193 11 Maine 51,128 7 39,314 2 Maryland 0 0 0 0 Massachusetts 128,955 3 128,530 2 Michigan 1,282,522 108 803,500 81 Minnesota 2,282,787 190 2,093,296 174 Mississippi 166,638 28 151,279 23 Missouri 358,423 53 327,428 44 Montana 696,706 67 609,686 63 Nebraska 1,581,960 95 1,469,575 91 Nevada 71,135 13 6,784 2 New Hampshire 0 0 0 0 New Jersey 0 0 0 0 New Mexico 494,634 54 302,944 36 New York 75,081 20 38,614 11 North Carolina 236,228 41 200,974 26 North Dakota 687,102 97 457,375 84 Northern Mariana Is. 0 0 0 0 Ohio 293,630 21 213,978 18 Oklahoma 470,851 45 251,258 19 Oregon 202,682 19 167,100 8 Pennsylvania 132,086 16 97,100 13 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 47,633 15 29,819 9 South Dakota 1,188,929 89 1,107,370 75 Tennessee 395,552 35 359,271 35 Texas 275,151 42 246,713 36 Utah 540,804 48 413,713 41 Vermont 146,417 23 137,770 18 Virgin Islands 56,804 12 51,318 12 Virginia 957,847 148 580,040 68 Washington 79,233 34 39,999 13 West Virginia 208,092 26 184,496 25 Wisconsin 4,440,644 259 3,917,585 243 Wyoming 212,408 11 125,596 7 Totals $55,920,328 2,693 $50,158,034 2,172 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 8 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2008: July 1, 2008 through June 30, 2009 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $247,093 61 $94,003 7 Alaska 21,123,773 196 12,713,417 148 American Samoa 141,191 1 141,191 1 Arizona 564,688 43 254,605 18 Arkansas 117,202 18 47,658 7 California 728,778 95 240,106 20 Colorado 197,348 20 113,041 9 Connecticut 0 0 0 0 Delaware 350 2 0 0 District of Columbia 0 0 0 0 Florida 354,243 21 196,277 14 Georgia 1,465,613 83 863,169 42 Guam 1,084 1 0 0 Hawaii 112,630 15 55,288 10 Idaho 208,806 29 52,677 8 Illinois 820,179 55 567,340 25 Indiana 671,396 56 152,453 15 Iowa 530,306 67 287,491 37 Kansas 247,160 49 176,315 16 Kentucky 369,671 72 190,991 31 Louisiana 53,482 19 8,892 3 Maine 20,195 6 0 0 Maryland 0 0 0 0 Massachusetts 149,419 2 28,304 1 Michigan 771,906 70 194,773 24 Minnesota 2,136,315 179 1,054,836 99 Mississippi 118,816 21 59,709 6 Missouri 470,152 62 43,503 7 Montana 766,760 73 364,244 39 Nebraska 1,221,686 104 947,133 65 Nevada 49,027 13 0 0 New Hampshire 5,658 2 1,839 1 New Jersey 0 0 0 0 New Mexico 474,255 46 44,795 11 New York 42,967 12 15,003 5 North Carolina 291,428 48 79,313 16 North Dakota 1,060,412 101 554,219 49 Northern Mariana Is. 0 0 0 0 Ohio 334,783 35 160,161 19 Oklahoma 533,067 45 66,753 2 Oregon 271,512 17 192,076 5 Pennsylvania 67,676 12 10,536 3 Puerto Rico 0 0 0 0 Rhode Island 0 0 0 0 South Carolina 6,842 4 4,982 1 South Dakota 1,344,870 84 1,075,450 58 Tennessee 176,544 20 127,883 8 Texas 823,736 59 456,732 20 Utah 422,237 25 3,560 3 Vermont 108,355 22 32,680 10 Virgin Islands 46,404 10 46,404 10 Virginia 760,274 144 295,769 32 Washington 52,215 31 18,680 5 West Virginia 172,320 18 115,638 14 Wisconsin 1,821,742 177 458,446 57 Wyoming 83,292 13 42,615 6 Totals $42,559,858 2,358 $22,650,950 987 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 9 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2006: July 1, 2006 through June 30, 2007 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $204 $41,045 $703 $0 $41,951 Alaska 0 19,039,312 3,814,666 2,396,734 25,250,712 American Samoa 0 0 0 0 0 Arizona 0 60,256 1,154,658 108,299 1,323,213 Arkansas 2,124 80,586 60,558 0 143,268 California 92,558 65,883 297,150 71,336 526,927 Colorado 14,296 12,318 65,827 0 92,441 Connecticut 0 0 0 0 0 Delaware 0 63 0 0 63 District of Columbia 0 0 0 0 0 Florida 0 27,707 283,309 0 311,015 Georgia 19,524 135,065 704,694 66,005 925,289 Guam 0 74,339 3,616 0 77,955 Hawaii 0 7,190 190,856 0 198,046 Idaho 0 29,094 101,247 435 130,776 Illinois 1,320 23,480 505,350 54,961 585,112 Indiana 23,806 24,322 295,936 16,505 360,569 Iowa 76,885 41,078 203,486 43,848 365,296 Kansas 6,120 358,062 186,370 0 550,552 Kentucky 18,599 59,538 96,372 0 174,509 Louisiana 0 27,966 30,000 0 57,966 Maine 21,418 13,566 0 16,073 51,057 Maryland 0 0 0 0 0 Massachusetts 0 2,063 54,538 0 56,601 Michigan 11,182 55,908 494,451 17,832 579,373 Minnesota 4,544 101,372 1,360,268 155,623 1,621,807 Mississippi 8,139 21,413 53,578 3,023 86,152 Missouri 4,704 43,016 88,652 0 136,373 Montana 0 36,767 436,247 42,727 515,740 Nebraska 0 58,625 1,595,221 1,395 1,655,242 Nevada 0 2,091 27,592 25,582 55,266 New Hampshire 0 6,510 0 0 6,510 New Jersey 0 0 0 0 0 New Mexico 0 207,395 113,021 0 320,416 New York 0 5,845 37,607 4,962 48,414 North Carolina 2,628 23,450 146,915 0 172,993 North Dakota 20,521 246,435 218,788 16,941 502,685 Northern Mariana Is. 0 0 0 0 0 Ohio 157 75 78,998 29,446 108,676 Oklahoma 0 142,114 2,655 64,038 208,806 Oregon 0 12,668 20,569 39,059 72,296 Pennsylvania 8,845 29,293 22,883 0 61,021 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 21,232 6,454 13,082 40,768 South Dakota 1,659 4,853 939,882 121,432 1,067,826 Tennessee 0 1,375 191,821 0 193,196 Texas 0 8,060 10,765 0 18,825 Utah 0 123,168 550,843 10,597 684,607 Vermont 0 27,208 78,586 17,864 123,658 Virgin Islands 0 48,678 0 0 48,678 Virginia 0 34,045 633,679 75,762 743,486 Washington 0 11,209 33,285 13,302 57,797 West Virginia 14,262 32,938 49,324 0 96,524 Wisconsin 653,202 274,624 1,321,634 636,009 2,885,469 Wyoming 0 4,077 183,466 4,106 191,649 Totals $1,006,698 $21,707,378 $16,746,517 $4,066,979 $43,527,572 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 10 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2007: July 1, 2007 through June 30, 2008 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $23,283 $89,678 $38,287 $0 $151,248 Alaska 0 21,717,566 7,054,650 0 28,772,216 American Samoa 0 108,400 0 0 108,400 Arizona 1,723 52,126 1,157,221 0 1,211,070 Arkansas 0 84,876 99,424 0 184,300 California 5,350 66,820 409,198 19,200 500,567 Colorado 2,919 2,365 85,854 0 91,139 Connecticut 0 0 0 0 0 Delaware 0 413 0 0 413 District of Columbia 0 0 0 0 0 Florida 0 17,680 383,254 0 400,933 Georgia 103,770 103,194 913,966 243,275 1,364,205 Guam 0 0 6,860 0 6,860 Hawaii 0 6,208 177,676 0 183,884 Idaho 0 34,994 192,809 0 227,804 Illinois 10,468 92,698 581,305 0 684,471 Indiana 17,860 85,533 394,878 0 498,271 Iowa 81,580 43,411 335,235 0 460,226 Kansas 6,120 40,983 154,211 0 201,314 Kentucky 32,150 205,258 272,690 0 510,098 Louisiana 0 16,867 31,326 0 48,193 Maine 361 36,849 2,103 0 39,314 Maryland 0 0 0 0 0 Massachusetts 0 2,953 125,577 0 128,530 Michigan 14,051 63,111 726,338 0 803,500 Minnesota 3,616 207,643 1,856,593 25,444 2,093,296 Mississippi 23,847 22,323 105,109 0 151,279 Missouri 2,300 37,511 287,616 0 327,428 Montana 0 41,073 560,785 7,828 609,686 Nebraska 0 37,966 1,431,609 0 1,469,575 Nevada 0 0 6,784 0 6,784 New Hampshire 0 0 0 0 0 New Jersey 0 0 0 0 0 New Mexico 0 209,476 93,468 0 302,944 New York 144 6,283 32,187 0 38,614 North Carolina 8,190 25,158 167,627 0 200,974 North Dakota 8,130 233,223 216,021 0 457,375 Northern Mariana Is. 0 0 0 0 0 Ohio 14,572 89,194 35,831 74,380 213,978 Oklahoma 0 248,758 2,500 0 251,258 Oregon 0 61,293 59,367 46,440 167,100 Pennsylvania 7,821 13,843 75,435 0 97,100 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 27,960 1,859 0 29,819 South Dakota 1,920 60,083 1,045,367 0 1,107,370 Tennessee 0 13,050 346,220 0 359,271 Texas 37,017 123,299 71,578 14,819 246,713 Utah 311 19,011 394,391 0 413,713 Vermont 0 25,720 69,679 42,371 137,770 Virgin Islands 0 51,318 0 0 51,318 Virginia 0 90,760 366,521 122,760 580,040 Washington 0 7,903 32,096 0 39,999 West Virginia 20,815 68,676 95,005 0 184,496 Wisconsin 803,071 1,146,112 1,968,402 0 3,917,585 Wyoming 0 464 125,133 0 125,596 Totals $1,231,390 $25,740,082 $22,590,045 $596,518 $50,158,034 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 11 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2008: July 1, 2008 through June 30, 2009 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $20,498 $4,327 $69,178 $0 $94,003 Alaska 0 9,508,454 3,204,963 0 12,713,417 American Samoa 0 141,191 0 0 141,191 Arizona 0 1,151 253,453 0 254,605 Arkansas 0 2,804 44,853 0 47,658 California 0 11,858 228,248 0 240,106 Colorado 0 3,956 109,085 0 113,041 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 17,998 178,279 0 196,277 Georgia 86,577 314,878 461,713 0 863,169 Guam 0 0 0 0 0 Hawaii 0 0 55,288 0 55,288 Idaho 0 5,162 47,516 0 52,677 Illinois 16,261 24,364 526,714 0 567,340 Indiana 8,429 23,602 120,422 0 152,453 Iowa 69,755 13,644 204,092 0 287,491 Kansas 7,541 22,166 146,609 0 176,315 Kentucky 20,547 21,031 149,413 0 190,991 Louisiana 0 4,725 4,167 0 8,892 Maine 0 0 0 0 0 Maryland 0 0 0 0 0 Massachusetts 0 0 28,304 0 28,304 Michigan 11,460 50,302 133,012 0 194,773 Minnesota 3,336 22,796 1,028,704 0 1,054,836 Mississippi 5,158 11,371 43,181 0 59,709 Missouri 13,381 26,183 3,939 0 43,503 Montana 0 53,993 310,252 0 364,244 Nebraska 0 22,142 924,990 0 947,133 Nevada 0 0 0 0 0 New Hampshire 0 1,839 0 0 1,839 New Jersey 0 0 0 0 0 New Mexico 0 42,589 2,206 0 44,795 New York 0 5,421 9,582 0 15,003 North Carolina 447 29,696 49,170 0 79,313 North Dakota 0 154,105 400,114 0 554,219 Northern Mariana Is. 0 0 0 0 0 Ohio 11,539 113,772 34,851 0 160,161 Oklahoma 0 0 66,753 0 66,753 Oregon 0 144,474 47,602 0 192,076 Pennsylvania 0 3,600 6,936 0 10,536 Puerto Rico 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 394 4,588 0 4,982 South Dakota 0 38,940 1,036,510 0 1,075,450 Tennessee 0 5,636 122,247 0 127,883 Texas 18,249 401,062 37,421 0 456,732 Utah 0 3,560 0 0 3,560 Vermont 0 32,680 0 0 32,680 Virgin Islands 0 46,404 0 0 46,404 Virginia 0 142,815 152,954 0 295,769 Washington 0 288 18,392 0 18,680 West Virginia 17,289 57,248 41,101 0 115,638 Wisconsin 116,006 92,856 249,584 0 458,446 Wyoming 0 1,224 41,391 0 42,615 Totals $426,472 $11,626,702 $10,597,776 $0 $22,650,950 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 12 USAC Disbursements Disbursements State or on Behalf of Rural Population in Per Person in Jurisdiction Health Care Providers Rural Areas 1 Rural Areas Alabama $42 1,407 $0.03 Alaska 25,251 367 68.87 American Samoa 0 57 0.00 Arizona 1,323 954 1.39 Arkansas 143 1,435 0.10 California 527 2,521 0.21 Colorado 92 777 0.12 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 311 1,427 0.22 Georgia 925 2,520 0.37 Guam 78 155 0.50 Hawaii 198 335 0.59 Idaho 131 862 0.15 Illinois 585 1,878 0.31 Indiana 361 1,691 0.21 Iowa 365 1,600 0.23 Kansas 551 1,193 0.46 Kentucky 175 2,069 0.08 Louisiana 58 1,111 0.05 Maine 51 854 0.06 Maryland 0 385 0.00 Massachusetts 57 335 0.17 Michigan 579 1,769 0.33 Minnesota 1,622 1,594 1.02 Mississippi 86 1,821 0.05 Missouri 136 1,799 0.08 Montana 516 705 0.73 Nebraska 1,655 811 2.04 Nevada 55 305 0.18 New Hampshire 7 380 0.02 New Jersey 0 0 NA New Mexico 320 856 0.37 New York 48 1,537 0.03 North Carolina 173 2,612 0.07 North Dakota 503 367 1.37 Northern Mariana Islands 0 69 0.00 Ohio 109 2,139 0.05 Oklahoma 209 1,378 0.15 Oregon 72 977 0.07 Pennsylvania 61 1,893 0.03 Puerto Rico 0 3,859 0.00 Rhode Island 0 55 0.00 South Carolina 41 1,205 0.03 South Dakota 1,068 503 2.12 Tennessee 193 1,827 0.11 Texas 19 3,280 0.01 Utah 685 531 1.29 Vermont 124 448 0.28 Virgin Islands 49 109 0.45 Virginia 743 1,503 0.49 Washington 58 1,136 0.05 West Virginia 97 1,043 0.09 Wisconsin 2,885 1,757 1.64 Wyoming 192 354 0.54 Totals $43,528 58,285 $0.75 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Population in entirely rural counties as of April 1, 2000 from the Census Bureau. Some commitments were allowed in non- rural counties in areas affected by the Goldsmith Modification. See 47 C.F.R. § 54.5. For those counties, the 2000 rural population has been estimated. Total population includes only those areas with RHC disbursements. Table 5.4 Disbursements per Person for Rural Health Care Support Mechanism, by State Values in Thousands, Except Disbursements per Person in Rural Areas Funding Year 2006: July 1, 2006 through June 30, 2007 5 - 13 USAC Disbursements Disbursements State or on Behalf of Rural Population in Per Person in Jurisdiction Health Care Providers Rural Areas 1 Rural Areas Alabama $151 1,407 $0.11 Alaska 28,772 367 78.47 American Samoa 108 57 1.90 Arizona 1,211 954 1.27 Arkansas 184 1,435 0.13 California 501 2,521 0.20 Colorado 91 777 0.12 Connecticut 0 334 0.00 Delaware 0 157 0.00 District of Columbia 0 0 NA Florida 401 1,427 0.28 Georgia 1,364 2,520 0.54 Guam 7 155 0.04 Hawaii 184 335 0.55 Idaho 228 862 0.26 Illinois 684 1,878 0.36 Indiana 498 1,691 0.29 Iowa 460 1,600 0.29 Kansas 201 1,193 0.17 Kentucky 510 2,069 0.25 Louisiana 48 1,111 0.04 Maine 39 854 0.05 Maryland 0 385 0.00 Massachusetts 129 335 0.38 Michigan 803 1,769 0.45 Minnesota 2,093 1,594 1.31 Mississippi 151 1,821 0.08 Missouri 327 1,799 0.18 Montana 610 705 0.87 Nebraska 1,470 811 1.81 Nevada 7 305 0.02 New Hampshire 0 380 0.00 New Jersey 0 0 NA New Mexico 303 856 0.35 New York 39 1,537 0.03 North Carolina 201 2,612 0.08 North Dakota 457 367 1.24 Northern Mariana Islands 0 69 0.00 Ohio 214 2,139 0.10 Oklahoma 251 1,378 0.18 Oregon 167 977 0.17 Pennsylvania 97 1,893 0.05 Puerto Rico 0 3,859 0.00 Rhode Island 0 55 0.00 South Carolina 30 1,205 0.02 South Dakota 1,107 503 2.20 Tennessee 359 1,827 0.20 Texas 247 3,280 0.08 Utah 414 531 0.78 Vermont 138 448 0.31 Virgin Islands 51 109 0.47 Virginia 580 1,503 0.39 Washington 40 1,136 0.04 West Virginia 184 1,043 0.18 Wisconsin 3,918 1,757 2.23 Wyoming 126 354 0.35 Totals $50,158 57,962 $0.87 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2009. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Population in entirely rural counties as of April 1, 2000 from the Census Bureau. Some commitments were allowed in non- rural counties in areas affected by the Goldsmith Modification. See 47 C.F.R. § 54.5. For those counties, the 2000 rural population has been estimated. Total population includes only those areas with RHC disbursements. Table 5.4 Disbursements per Person for Rural Health Care Support Mechanism, by State Values in Thousands, Except Disbursements per Person in Rural Areas Funding Year 2007: July 1, 2007 through June 30, 2008 5 - 14