Illinois Broadband Advisory Council Meeting: Telehealth and Economic Development

1. Balanced scorecard slide 1 Illinois Broadband Advisory Council Special Meeting: Tuesday, October 1, 2019

2. Balanced scorecard slide 2 WORKING GROUPS TECHNOLOGY & INFRASTRUCTURE ECONOMIC DEVELOPMENT ACCESS TELEHEALTH EDUCATION

3. Balanced scorecard slide 3 TELEHEALTH OVERVIEW What is Telehealth? • Telehealth refers to a collection of means for enhancing health care and education delivery using telecommunications technologies. • Telehealth as a modality can provide a variety of services. • Modalities: store-and-forward, video-conferencing, remote-patient-monitoring • Examples: telestroke, telepsychiatry, telebehavioral health in schools, specialist services

4. Balanced scorecard slide 3 TELEHEALTH OVERVIEW The Need for Telehealth • Shortage of primary care physicians and mental health professionals in IL • Patient access to infrastructure is lacking both in-the-home and at local healthcare anchor institutions • Access and equity issue • More and more companies or private payers are looking at opportunities to provide access to care via telehealth for their employees or beneficiaries • Lack of access to broadband is one of the contributors to low telehealth use in certain Illinois communities • Broad interest in the issue at the federal level – numerous funding opportunities • Telehealth is the wave of the future in healthcare.

5. Balanced scorecard slide 3 TELEHEALTH BARRIERS • Limited to no broadband connectivity in small or safe-net hospitals and other healthcare locations • Digital divide between urban and rural residents • Expense of telehealth equipment and high-speed internet access • Lack of public education and orientation on telehealth opportunities

6. Balanced scorecard slide 3 TELEHEALTH RECOMMENDATIONS • Prioritize and incentivize applications that expand telehealth • Allow applicants to partner with anchor institutions in the community (schools, hospitals, local governments) on the grant application • Integrate affordable pricing structures into the grant proposals • Leverage existing technical assistance programs to aid applicants • Maximize federal funding opportunities available and other matching opportunities from private and local partners • Explore including healthcare anchor institutions on the Illinois Century Network (ICN)

7. Balanced scorecard slide 3 TELEHEALTH IMMEDIATE POSSIBILITIES Telehealth incubators in DHS facilities and DOC? Federal Funding Opportunities • Health Resources and Services (HRSA)’s Telehealth Network Grant Program - $8.5 billion • Focuses on bringing telehealth to hard-to-reach places • FCC Connected Care Pilot – 3-year program, $100 million • Supports brining telehealth services directly to low-income patients and veterans

8. Balanced scorecard slide 3 ECONOMIC DEVELOPMENT IMPORTANCE OF BROADBAND • Broadband is increasingly necessary for business attraction and growth in the current and future economy. • Broadband reduces transaction costs and improves access to on-line resources, boosting sales and reducing costs of inputs. • Multiple studies find rural broadband causes or is positively correlated with: • GDP growth • Median household incomes • Share of non-farm rural businesses • Farm revenues • Faster broadband has greater impact. • Largest rural impact for companies with high transaction costs or high labor intensity such as financial services, wholesale trade, health, & tourism. • Broadband for households is an important business attraction tool, providing quality of life for workers and local customers.

9. Balanced scorecard slide 3 ECONOMIC DEVELOPMENT SPECIFIC BROADBAND APPLICATIONS Agriculture • Real-time pricing for products • Ability to update firmware and use some software for technologies that increase productivity Industrial Parks • Require higher upload and download speeds, and more reliable connections (redundancy) • Proximity to infrastructure can make running lines difficult Manufacturers • Connections to clients, suppliers, and other operations centers • Like agriculture, ability to update and use some technologies that increase productivity Remote Work and Home-Based Businesses • Broadband provides the ability to operate a business at home and can help diversify income • Remote work one of the best ways to give residents who enjoy quality of life of rural or exurban areas opportunity to make a living there

10. Balanced scorecard slide 3 ECONOMIC DEVELOPMENT BROADBAND SPEED • Many businesses need higher speeds than households • Applications that require teleconference or uploading large files (many office operations; remote work) now require symmetric 100/100 speeds, at minimum • Many businesses value reliability over speed • While not ideal, reliable 25/3 speeds would represent significant improvement for economic viability for remote areas where businesses need better contact with clients and suppliers

11. Balanced scorecard slide 3 ECONOMIC DEVELOPMENT METRICS • Track broadband speeds and reliability for businesses as well as households • Other Metrics: • Employment by sector and occupation • Earnings by sector and occupation • Expect to see more sector and occupation diversification following broadband implementation • Property assessed values • Prevalence of remote workers • Number of start-ups • Exports • Worker productivity

12. Balanced scorecard slide 3 ECONOMIC DEVELOPMENT RECOMMENDATIONS Broadband is necessarybut not sufficient. • Will have greater impact if deployed as part of larger plan to develop a regional hub and address other barriers to business, including infrastructure. • Communities need tools and skillsets to take advantage. Do K-12 students have laptops? Do small and mid-sized business get support in adopting new technologies? Does workforce get trained on in-demand tech skills? Tailor speeds to needs. At least some deployment will require high speeds (at least 100/100; maybe even some gigabit) to be impactful on economy. Not only about connecting businesses. Broadband also important for quality of life for employees, and ability to work remotely or start a business at home. Also, connecting local governments gives them access to federal and state resources and improves the services they provide to their constituents. Provide a certification that recognizes most connected communities and market this to prospective companies. Leverage federal and nonprofit funds that are available for broadband and other economic development purposes.

13. Balanced scorecard slide 3 EDUCATION OPPORTUNITIES • Solid access to fiber in most school districts, colleges, and universities. • Focus resources on school districts without broadband access (leverage Illinois Century Network and ISBE E-Rate State Matching Grant initiatives). • Entice carriers to bring access to underserved rural communities through grant opportunities. • Equity in grant distribution based on geographical needs and income. • Research wi-fi, hot spots on school buses, and creation of cyber-hubs in central gathering locations open in the evenings and on weekends (i.e. community centers, YMCA’s, etc.). • Transportation opportunities to cyber-hubs. • In communities without broadband, education is needed on the benefits of expanded access to promote support from educators, administrators, school boards, and residents. • Utilize schools, colleges, and universities as community anchors and encourage expansion of partnerships to expand access to resources (eg. schools, libraries, disaster recovery). • Share positive examples of uses of broadband in education. • Conduct further research on activities in other states.

14. Balanced scorecard slide 4 EDUCATION BARRIERS • Lack of access to fiber for students and staff when they are not on school grounds, creating a homework access gap for K-12 and higher education. • Access to wireless may not provide enough bandwidth afforded by fiber connections. • Affordability of and access to fiber to homes, especially in rural areas. • Bandwidth constraints in K-12 impacts utilization of full transformation opportunities. • Lack of resource lists and maps of availability limits options and awareness. • Limits to upstream capabilities limits availability to deliver video. • Lack of equipment and devices also limits access. Some observing an increase in demand for checkouts of laptops. K-12 schools with 1:1 programs may not always allow students to take laptops home. 14

15. Balanced scorecard slide 3 ACCESS RIGHT-OF-WAY EASEMENTS – ROADWAYS & POWER POLES • Discussion • Timeframe for notification of landowners and road districts utilizing existing standard practices. • Notification to include information on the Connect Illinois program. • Property damages caused by installation will be remediated and not time limited. • Financial compensation to landowners. • Expedited right-of-way process for providers when no easement agreement is reached. • Standard easement template for all projects under Connect Illinois. • Use of power poles for broadband projects to ensure proper height clearances using National Electric Safety Code. • Areas of Disagreement • Scope of financial compensation, if any, to landowners. • Need for expedited right-of-way process for providers when no easement agreement is reached. • Timeframe for access to right-of-way easement agreement for Connect Illinois projects regardless of notification procedures. • Potential of litigation for any process which accesses private property without landowner approval. • Providers express willingness to establish notification procedures and property damage remediation guarantees only in the event of expedited access to rights-of-way.

16. Balanced scorecard slide 3 ACCESS RIGHT-OF-WAY EASEMENTS - RAILROADS • Discussion • Legislation governing ICC and Railroad Rights-of-Way (PA100-251) may be updated to specifically include broadband projects. • Easement Agreement process for railroad-owned rights-of-way. • Areas of Disagreement • Providers prefer a standard Easement Agreement for all railroad-owned rights-of-way. • Railroads prefer the current process of negotiating Easement Agreements with individual providers. • Providers request the Crossing of Railroad Right-of-way Act (220ILCS 70) be amended to include all railroad companies (not just land management companies).

17. Balanced scorecard slide 3 ACCESS MUNICIPALITIES & LOCAL UNITS OF GOVERNMENT STATE PROPERTY • Discussion & Consensus • The Telecommunication Municipal Maintenance Fee Act (35ILCS 635/30) must be strictly enforced. • Legislation may be necessary to further clarify what fees municipalities can and cannot charge for provider access. • Further clarify no additional fees may be charged by other units of government. • Discussion and Consensus • Amend procurement code governing concessions and leases of State property and no-cost contracts (30 ILCS 500/53-10) to ensure the State can enter into contracts for broadband access on State property without going through the procurement process.

18. Balanced scorecard slide 3 TECHNOLOGY & INFRASTRUCTURE OVERVIEW • Barriers to Access and Adoption • Capital, right of way, poles and facilities • Adoption • Mapping Unserved and Underserved • FCC data inaccurate • Federal, state and private pilots • Investments • Infrastructure grant program • State’s vision and goals • Funding Schedule and Project Timeline • Construction season • 3-4 year timeline • Matching Funds • Leverage federal and private funds • Clawback clause • Evaluation Criteria • Collaborations • Affordable service offerings

19. Balanced scorecard slide 3 TECHNOLOGY & INFRASTRUCTURE RECOMMENDATIONS • Vision and Broadband Plan • Technology Neutral Infrastructure Grant Program • Challenge Process • Mapping • Broadband Adoption Programs and Strategies

20. Balanced scorecard slide 3 PAST PUBLIC BROADBAND INVESMENT: THE ARRA ERA

21. Balanced scorecard slide 3 RESOURCES • Federal Communications Commission • US Department of Commerce | NTIA |BroadbandUSA • US Department of Agriculture | ReConnect • Pew Charitable Trusts |Broadband Research Initiative

22. Balanced scorecard slide 3 BROADBAND PROGRAMS • Office • Task Force • Mapping • Plan • Promotional

23. Balanced scorecard slide 3 COMPETITION & REGULATION • Municipal Broadband • Cooperatives • Regulatory Authority • Service Provision - Other

24. Balanced scorecard slide 3 DEFINITIONS • Broadband • Unserved • Underserved

25. Balanced scorecard slide 3 FUNDING & FINANCE • Fund • Fund - Other • State USF • Tax Incentives • Financing - Other

26. Balanced scorecard slide 3 INFRASTRUCTURE & ACCESS • Pole attachments • Permitting • Right of way • Dig Once • Railroad • ROW – Other • Wireless facilities • Small cell facilities • Open access

27. Balanced scorecard slide 3 BEST PRACTICES IN STATE BROADBAND: MINNESOTA AND BEYOND

28. Balanced scorecard slide 3 MINNESOTA • Governor-Appointed Task Force (2008 - present) • Goals • Ubiquitous service of 25/3 Mbps by 2022 • Competitive access of 100/20 Mbps by 2026 • Office of Broadband Development (2013 - present) • “Border to Border Broadband” Competitive Grant Fund (2014 - present) • Definitions • Broadband: 25/3 Mbps • Unserved: 25/3 Mbps • Underserved: 100/20 Mbps

29. Balanced scorecard slide 3 NEW YORK • Broadband Program Office (2015 - present) • New NY Broadband Program ($500M; 2015 - present) • Definitions • Broadband: N/A • Unserved: <25 Mbps download (wireline) • Underserved: <100 Mbps download (wireline) • “The Program provides State grant funding through an innovative ‘reverse auction’ method to support projects that deliver high-speed Internet access to Unserved and Underserved areas of New York State at speeds of 100 Mbps in most areas, and 25 Mbps in the most remote areas.” • https://nysbroadband.ny.gov/

30. Balanced scorecard slide 3 CALIFORNIA • California Broadband Council (2010 – present) • Office of Broadband | Department of Technology • Public Utilities Commission | Advanced Services Fund • Broadband Infrastructure Grants ($300M) • Rural & Urban Regional Broadband Consortia Grants ($10M) • Broadband Adoption Account ($20M) • Goals • At least 98% with service of 25/3 Mbps by 2023 • At least 90% adoption by 2023 • Definitions • Broadband: 25/3 Mbps • Unserved: 6/1 Mbps • Underserved: 100/20 Mbps

31. Balanced scorecard slide 7 CONTACT • Matt Schmit | Deputy Director for Broadband • Department of Commerce & Economic Opportunity • matt.schmit@Illinois.gov | 773.497.3001

32. Balanced scorecard slide 10 NEXT MEETING MONDAY, OCTOBER 21

33. Balanced scorecard slide 10 ADJOURNMENT