Last month, we summarized the Federal Communications Commission's draft Third Further Notice of Proposed Rulemaking (FNPRM) and Order in its long-running Promoting Telehealth in Rural America proceeding (WC Docket No. 17-310). The Federal Communications Commission adopted that item on August 6, 2026, and released the final version on August 7. The bulk of what we wrote last month still holds. This update covers what changed between the draft and the adopted item.

The Vote

FCC Chairman Brendan Carr and Commissioner Olivia Trusty each issued separate statements. Both statements are supportive; there are no dissents or partial concurrences. Chairman Carr highlights the Mescalero Indian Hospital on the Mescalero Apache Reservation in New Mexico as an example of what the Rural Health Care (RHC) Program enables, describing how community members "can now have one-on-one video sessions with mental and behavioral health specialists that are located over 200 miles away in Albuquerque, thanks to a high-speed Internet connection supported by the FCC's Rural Health Care (RHC) Program." Commissioner Trusty describes telehealth as "the modern house call" and cites visits to health care providers in Alaska, Kansas, Nebraska, and New Mexico.

Three New Sets of Questions Added to the FNPRM

The adopted FNPRM expands on the draft's questions in three areas. 

1. Capacity, latency, and security for health care networks

The adopted item adds a new paragraph in the secondary-services section asking "What level of capacity, latency, and security is necessary to support healthcare providers and networks?" and whether there are "special considerations around network resiliency, latency, capacity, etc. for health care when it comes to support for secondary services." The FCC also asks how the competitive bidding process is affected when an applicant seeks bids for secondary services, and how a service provider responding to a request for proposal qualifies that its services meet the applicant's needs in terms of network resiliency and safety.

2. Clarifying the scope of eligible entities

Responding to the Ad Hoc Broadband for Rural Health Group's suggestion, the FCC directs the Wireline Competition Bureau to "look for opportunities to further clarify the scope of eligible entities in the course of acting on RHC Program issues in the future." The FCC also seeks comment on which of "the seven types of eligible health care providers require specific clarification and whether the Commission should adopt more formal definitions of each entity type."¹ This addition was not in the draft version we summarized in July.

3. Alternatives to a September 1 processing target

The performance-metrics section gains a new paragraph asking whether there are "alternative measures to establishing a September 1 target (or any other specific deadline) that would more clearly define and track USAC's administrative procedures during an application review." The FCC also asks what other ways it can "streamline the application process, clarify program rules, ensure effective and timely communication between USAC and applicants, and promote efficient program administration," and whether there is specific information that would be "particularly helpful to publish in the RHC Open Data datasets."

A Softened Position on Processing Exceptions

The draft version tentatively concluded that "any applications that are subject to a pending information request from USAC to the applicant" would be exempt from a processing deadline. That tentative conclusion is gone in the adopted item. In its place, the FCC "seek[s] comment on whether there are RHC Program-specific exceptions that should be considered in determining what is a 'workable' funding request." The description of the E-Rate program's September 1 metric was also softened—the adopted item describes it as "directing USAC to aim to issue funding commitments or denials for all 'workable' funding requests by September 1," whereas the draft described it as "establishing a September 1 deadline."

A Change in the Proposed Rule Text

The proposed new section 54.634 governing the eligible services list was rewritten. The draft's version began: "The Commission shall provide a list of all supported services eligible for Telecommunications Program and Healthcare Connect Fund Program support." The adopted version explicitly delegates that work: "The Wireline Competition Bureau shall issue a Public Notice seeking comment on a list of all supported services eligible for Telecommunications Program and Healthcare Connect Fund Program support. The Wireline Competition Bureau shall publish the final list of services eligible for support at least 60 days prior to the opening of the application filing window for the following funding year." The 60-day publication timeline is now written into the rule itself.

What Did Not Change

We flagged two mismatches in the draft's Appendix B—the Initial Regulatory Flexibility Analysis (IRFA). Both survived into the adopted version.

• The IRFA still describes the Notice as seeking comment on "whether to increase the RHC Program funding cap" and on "how the RHC Program prioritizes support in the event that demand exceeds the program funding cap." The body of the adopted item, like the draft, contains no such proposal.
• The IRFA still describes the Notice as seeking comment on "the elimination of the evergreen contract competitive bidding exemption." The body of the adopted item, like the draft, seeks comment on eliminating USAC's approval requirement for evergreen contracts — not the exemption itself.

The three cost study alternatives drawn from GCI Communication Corp.'s comments (wholesale rates, previously approved rates, and rate projections) are all in the adopted item as they were in the draft. The FY2027 waiver of section 54.605(b) is adopted as proposed. The proposal to eliminate the Healthcare Connect Fund Program's annual report requirement—including the FCC's characterization of the report as "a hurdle that HCF Program applicants must clear"—is unchanged. The questions about the 30 percent "similar services" threshold, "comparable rural areas," and the possible shift from a functional to a technological definition of similar services are all unchanged.

What Happens Next

Publication of the adopted item does not set the deadline for filing comments in this proceeding. Comments on the adopted FNPRM will be due 30 days after publication in the Federal Register, with reply comments due 60 days after. The proceeding is subject to "permit-but-disclose" ex parte rules; presentations to FCC commissioners or staff must be filed in WC Docket No. 17-310 via the Electronic Comment Filing System.

Notes

1. The Telecommunications Act of 1996 defined a "health care provider" as: post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools; community health centers or health centers providing health care to migrants; local health departments or agencies; community mental health centers; not-for-profit hospitals; rural health clinics; and skilled nursing facilities.

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