Good afternoon and welcome to the webinar, Caption Telephone Eligibility, What the FCC Wants Providers to Know. We're so glad you could be here today to learn more about the ins and outs of Internet Protocol Caption Telephone Service, also called IPCTS, and how to operate within the law. Your moderators today are me, Diana Cheryvel, Associate Director of Marketing, and me, Fran Vincent, Director of Membership and Marketing. Our expert presenters today are Deputy Chief Elliot Greenwald and Attorney Advisor Michael Scott, both from the Disability Rights Office at the Federal Communications Commission. Elliot began his career at the FCC in 1977, working in the former Common Carrier Bureau until 1982. After practicing at various law firms, he rejoined the FCC in 2011, where he participates in proceedings involving telecommunications relay services, television closed captioning, real-time text, and implementation of the 21st Century Communications and Video Accessibility Act of 2010, including Internet captioning, hearing aid compatibility, and the National Deaf-Blind Equipment Distribution Program. Michael Scott joined the Disability Rights Office in 2016 and primarily works on issues concerning telecommunications relay services and real-time text. Prior to joining the FCC, he was a hearing officer for the Massachusetts Department of Telecommunications and Cable, which oversees all telecommunications and cable business in Massachusetts. We are very excited to have Michael and Elliot as our presenters today, but before we get started, just a few housekeeping items to keep in mind. Please note that we're recording today's presentation so that we may offer it on demand through the IHS website in the future. Also, this webinar is available for one continuing education credit through the International Hearing Society. We've uploaded the CE quiz to the handout section of the webinar dashboard, and you may download it at any time. You can also find the quiz and more information about receiving continuing education credit at our website, ihsinfo.org. Click on the webinar banner on the homepage or choose webinars from the navigation menu. You'll find a CE quiz along with information on how to submit your quiz to IHS for credit. If you'd like a copy of the slideshow from today's presentation, you can download that as well from the handout section of the webinar dashboard, or you can access it from the webinar page on the IHS website. Feel free to download them now. Tomorrow, you'll receive an email with a link to a survey on this webinar. It is brief, and your feedback will help us create valuable content for you moving forward. Today, we'll be covering the following topics. Internet Protocol Caption Telephone Service, also called IPCTS and its background, IPCTS User Eligibility Assessment, and important considerations for evaluating and certifying an individual to use IPCTS. At the end, we'll move on to a Q&A session. You can send a question for Elliot and Michael at any time by entering your question in the question box on your webinar dashboard, usually located to the right or top of your webinar screen. We'll take as many questions as we can in the time we have available. And now, I'm going to turn it over to Elliot, who will start us off for today's presentation. Elliot? Okay. Well, thank you, and I'll start out with a little bit of background on the FCC, and particularly what is the FCC's regulatory authority. The Communications Act gives the FCC regulatory authority to regulate, among other things, radio and television, including distribution by cable and satellite, other uses of radio spectrum, and interstate telecommunications services, which includes communications between the U.S. and foreign countries. And what is Telecommunications Relay Service, also known as TRS? TRS are telephone transmission services that provide the ability for an individual who is deaf, hard of hearing, deafblind, or who has a speech disability to engage in communication by wire or radio with one or more individuals in a manner that is functionally equivalent to the ability of a hearing individual who does not have a speech disability to communicate using voice communication service by wire or radio. The Americans with Disabilities Act gives the FCC regulatory authority over TRS, including oversight over the state TRS programs, and the FCC exercises exclusive regulatory authority over the internet-based forms of TRS. And a little bit further background, does the FCC have regulatory authority over hearing aids or providers of hearing aids? This is just a little bit of bonus information, just for your information. The FCC does not have authority to regulate providers of hearing aids. The FCC's authority to regulate hearing aids is limited to regulating the radio frequency emissions emitted by hearing aids and regulating telecommunications and voice-over internet protocol service providers and manufacturers of telephones, including mobile and VOIP telephones in regard to hearing aid compatibility, which we often refer to as HAC. As discussed below, the FCC regulates IPCTS providers and the eligibility of consumers to use internet protocol captioned telephone service, known as IPCTS. So what is IPCTS? IPCTS is a form of TRS that allows people with hearing loss to speak during a phone call and read captions on a specialized device when the other person responds. In IPCTS, the consumer is therefore using a combination of residual hearing and the captioning to understand the other parties to the call. With IPCTS, a communications assistant, which we often refer to as a CA, listens to the other call participant and re-voices everything the caller says into a speech automation program that is trained to that CA's voice to provide captions to the IPCTS user, and the CA can also correct the captioning. Alternatively, stenographers, rather than re-voicers, can produce the captions. And so how is IPCTS delivered? IPCTS can be delivered in different ways. One is via a specialized telephone with a screen that is connected to a telephone line and the internet, and the other way is via web-based or mobile-based applications. And there are currently five IPCTS providers, CaptionCall, ClearCaptions, HamiltonCaptail, NoCaption, and SprintCaptail. How are IPCTS providers compensated? IPCTS users are not directly charged to receive IPCTS. IPCTS providers seek reimbursement for minutes of service provided from the Interstate TRS Fund. Telephone and VOIP service providers contribute a percentage of revenues received from subscribers of Interstate Telecommunication Service to the TRS Fund. IPCTS is the most widely used form of TRS and represents almost 80% of the total minutes compensated by the TRS Fund. And what are the FCC's current concerns with IPCTS? Annual TRS Fund expenditures have grown dramatically to over $1.4 billion annually, of which approximately $900 million is for IPCTS. Because the presence of the Communications Assistant, or CA, is not intrusive and often unknown to the other party to the call, the FCC is concerned that the ease and convenience of using IPCTS can lead to the risk of IPCTS use when it is not needed. Evidence suggests that the marketing of IPCTS has been aggressive and is not limited to only those who need the service for effective communications. How is the FCC addressing its current concern with IPCTS? In 2018, the FCC adopted a Report and Order Declaratory Ruling and Further Notice of Proposed Rulemaking, also known as an FNPRM, and Notice of Inquiry, which takes a multifaceted approach to ensure that the TRS program, and especially IPCTS, is sustainable so that relay services remain available for those who need them. We discussed below those reforms addressing use of automatic speech recognition, or ASR, programs without the assistance of the CA, incentives to use IPCTS, informational materials made available by IPCTS providers, and user registration and eligibility assessments. So what is automatic speech recognition, also known as ASR? The FCC recently authorized the use of ASR without a CA to provide captions. ASR can achieve near-simultaneous communication at a lower cost than CA-assisted captions. ASR enhances call privacy and seamless communications, and ASR is approaching comparable levels of accuracy to CA-assisted captions. The FCC has received three applications from new market entrants to provide IPCTS using ASR. The FCC will determine whether each applicant is able to provide IPCTS in accordance with the FCC's mandatory minimum standards designed to ensure functionally equivalent telephone conversations for IPCTS users. Does the FCC prohibit incentives to use IPCTS? An IPCTS provider, and the answer is yes, an IPCTS provider shall not offer or provide to any person or entity any form of direct or indirect incentives, financial or otherwise, to register for or use IPCTS. And an IPCTS provider shall not offer or provide to a hearing health professional any direct or indirect incentives, financial or otherwise, that are tied to a consumer's decision to register for or use IPCTS. Where an IPCTS provider offers or provides IPCTS equipment directly or indirectly to a hearing health professional, and such professional makes or has an opportunity to make a profit on the sale of the equipment to consumers, such IPCTS provider shall be deemed to be offering or providing a form of incentive tied to a consumer's decision to register for or use IPCTS. Joint marketing arrangements between IPCTS providers and hearing health professionals, even if there's no exchange of cash, are prohibited. Does the FCC require IPCTS providers to include any specific information on IPCTS devices and with IPCTS software? IPCTS equipment must contain a conspicuous label stating, Federal law prohibits anyone but registered users with hearing loss from using this device with the captions turned on. For software applications on mobile phone, laptops, tablets, and computers, the same notice must be provided in a conspicuous location on the device screen immediately after login. Does the FCC require providers to include any information with informational materials distributed by providers? IPCTS providers must ensure that their informational materials, both printed and websites, used to market, advertise, educate, or otherwise inform consumers and professionals about IPCTS include the following language in a prominent location in a clearly legible font. Federal law prohibits anyone but registered users with hearing loss from using IPCTS with the captions turned on. IPCTS may use a live operator. The operator generates captions of what the other party to the call says. These captions are then sent to your phone. This portion of the notice may be eliminated if the IPCTS providers does not make any use of live CAs. And thirdly, there is a cost for each minute of captions generated paid for from a federally administered fund. Has the FCC proposed any new marketing requirements for IPCTS providers? The FCC proposes in the 2018 FNPRM to require that all IPCTS-provided distributed online print and orally delivered materials used to market IPCTS be complete and accurate, make clear that IPCTS may not be necessary for everyone with hearing loss, and that to qualify for IPCTS use, consumers with hearing loss must be able to certify that captioning is needed to enable them to understand telephone conversations. This would prohibit statements suggesting that any amount of hearing loss causing any degree of difficulty will qualify consumers for IPCTS. Has the FCC stated any concern with marketing of free IPCTS phones? The FCC is concerned that advertised offers of a free phone for anyone with hearing loss could encourage consumers to sign up for IPCTS to obtain the phone, even if they do not need IPCTS, and give the misimpression that the associated IPCTS services are also free. The FCC proposes to eliminate from IPCTS provider promotional materials, including print materials and websites, promises of a free phone for anyone with hearing loss without specifying that IPCTS and the associated phone are only intended for individuals who have a hearing loss that makes it difficult to use the phone. How does a user register for IPCTS? For a consumer to register for IPCTS, the consumer must submit full name, date of birth, last four digits of the social security number, residential address, and telephone number. Under new rules adopted by the FCC, the FCC's TRS user registration database administrator will verify the user's identity and residency, although that rule is not in effect yet. It will be in effect soon. And also, the registration must include a self-certification of eligibility. And we will discuss this requirement in detail in an upcoming slide. Does the FCC currently require third-party certification of user eligibility? The short answer is no at this time. In 2013, the FCC adopted rules requiring consumers to either pay $75 for an IPCTS device or obtain certification of eligibility from an independent third-party professional qualified to evaluate an individual's hearing loss in accordance with applicable professional standards. This rule was later changed to require payment of $75 for the device with no option for third-party certification. The Court of Appeals subsequently overturned the $75 rule. As a result, there is no current FCC requirement for third-party certification. Some IPCTS providers continue to require users to obtain third-party certification of eligibility when registering for service. And now I will turn the floor over to Michael, who will discuss IPCTS user eligibility assessment. Hi. Good afternoon. This is Michael. So to begin with, we'll talk a little bit about the IPCTS user self-certification process. So when an IPCTS user or someone looking to become a user seeks to self-certify, that user has to state that they have a hearing loss that necessitates the use of captioned telephone service, that they understand that the captioning is provided by a live CA who listens to the other party on the line and provides the text on the captioned phone, that they understand that the cost of captioning each IPCTS call is funded through a federal program, which is known as the TRS fund, and that they will not permit, to the best of the user's ability, persons who have not registered to use IPCTS to make captioned telephone calls on a consumer's registered IP captioned telephone service or device. These certifications are kind of twofold. They are to create transparency for the user to understand how the program exists, what it's for, and to remind them that as the individual eligible, they're the only ones who should be using their IPCTS device with the captions on or using the app or the web browser functions and providing that, that's providing them the text to facilitate their call use because of the cost of providing those services. So the SEC's prior independent eligibility assessments require, and this is when we had a third-party assessment requirement, which was typically done by a hearing health professional and now are optionally done at the request of providers to users to have a hearing health professional provide an evaluation. So our rules require that independent eligibility assessments from the third-party professional providing certification be qualified to evaluate an individual's hearing loss in accordance with applicable professional standards, it must either be a physician, audiologist, hearing aid specialist, or other hearing-related professional. The professional has not been referred to the IPCTS user either directly or indirectly by any TRS provider, affiliate, or employee therein, nor is the professional allowed to have any business, family, or social relationship with the TRS provider or any affiliate of the TRS provider from which the consumer is receiving or will receive service. So the third-party professional requirement also requires the third-party professional providing certification to provide his or her name, title, contact information, including address, telephone number, and email address. And they also have to certify in writing under penalty of perjury that the IPCTS user is an individual with hearing loss that necessitates use of captioned telephone service and that the third-party professional understands that the captioning on captioned telephone service is provided by the live CA and is funded through a federal program. Again, that federal program is known as the TRS Fund. And because it is a limited source of funding, we want to ensure that only individuals who truly need the service are being registered for the service. And these steps were taken to help ensure that hearing health professionals understood those limitations and that they were expressing to potential users that they needed to meet certain qualifications in order to qualify. So what are our proposed new independent eligibility assessments? So in that 2018 Further Notice proposed rulemaking, the FCC proposed to consider re-establishing requirements for third-party certification of eligibility to use IPCTS and address concerns that past user assessments have not been sufficiently complete or objective leading to program weight. The FCC, we thought, comment on whether to require each prospective IPCTS user to undergo an objective assessment by a qualified and independent entity that would determine whether the individual has a hearing loss that necessitates the use of captioned telephone service. So in putting forward this Further Notice of proposed rulemaking, the FCC expressed concern that the extent to which an individual's hearing loss affects that person's ability to understand telephonic speech can depend on a number of factors. That includes the individual's specific decibel level of hearing loss as affected by different sound frequencies, environmental and background noises, and device distortion. This means that there are variations in when a person might need to use captioned telephone. This even includes the ability for someone to qualify to meet IPCTS, but the suggestion that they may not need to use it on every phone call, depending upon their familiarity with the speaker, for example, the background noise that's going on either on the caller's end or around them. Issues like that, that we want taken into consideration, that we mentioned as part of that full spectrum of understanding whether or not captions are appropriate. The FCC was also concerned about that effective assessment of an individual's need for IPCTS should be based on a more specific evaluation than a generalized hearing test or a previously recorded audiogram. It's really a full assessment of the user based on their stated concerns. If they're coming in to talk to you, you're talking about how their hearing loss is affecting them, if they're talking about issues hearing over the telephone, we want certain assessments of how that exists and what can help them. The FCC proposed that assessments of the user's need for IPCTS must be specifically focused on a consumer's ability to hear and understand speech over the telephone and to consider whether the consumer's communication needs can be addressed by other assisted technologies, such as an amplified telephone or an inductive coupling or Bluetooth connection between the consumer's hearing aids and the mobile phone. It's all part of understanding how that hearing loss is affected, what current technology is available to help, and whether or not this funded program is the best option for the consumer to have phone conversation. Because the FCC cannot require a consumer to purchase hearing aids or a new mobile phone in lieu of using IPCTS, this type of assessment would be limited to consumers with hearing aids or planning on purchasing hearing aids or who have a mobile phone with Bluetooth or inductive capabilities or planning on purchasing such phones. Because a consumer would be obtaining a new phone or equipment-based IPCTS, the alternative of an amplified phone can be considered as part of an assessment, whether that consumer has an amplified phone or is planning to obtain one. So, again, it's really about understanding how that person is able to communicate on the phone, what options are available for them to communicate on the phone, and have they considered the full spectrum of available options to address any type of hearing loss they're experiencing. So, the FCC proposed two alternative approaches for the eligibility assessment. One approach is to have the existing state relay service program handle IPCTS user eligibility assessment. This would be having those existing state programs conduct eligibility tests. There are certain programs in place where they're able to do that and assess what type of equipment is best for consumers, and we would simply be expanding this program in that area. The other is having an independent third-party hearing health professional who would be subject to specific safeguards to affirm a user's eligibility. So, for assessments by state TRS or equipment distribution programs, so many states currently have such programs where an individual may obtain information about IPCTS and alternative technologies. These programs may have information available to help with the assessment of appropriate technology, and these programs often have equipment available for consumers to test to help individuals learn what technology may be best and help them have telephone conversations. Now, there is a TRS program in every state and territory. There is not an equipment distribution program in every state and territory. So, depending upon what state you're located in, these options may or may not be fully available. For the independent third-party assessment, the FCC thought comment on whether to require IPCTS providers to only accept assessments of certification signed by specific hearing health professionals. Physicians specializing in certain types of hearing loss, audiologists, hearing aid specialists, and other state-certified or licensed hearing health professionals qualify to evaluate an individual's hearing loss in accordance with applicable professional standards. That third-party professional assessment would need to be in writing and submitted under penalty of perjury. The FCC also thought comment on prohibiting providers from accepting a certification from any professional with a business, family, or social relationship with the TRS provider or any affiliate of the TRS provider, and also thought comment on prohibiting IPCTS providers from facilitating or otherwise playing a role in the acquisition of professional certifications by arranging, sponsoring, hosting, conducting, or promoting seminars, conferences, meetings, or other activities within community centers, nursing homes, apartment buildings, or any location, really, where a hearing health professional offers free hearing screening. So, simply something to not, to kind of avoid the appearance or the actual, like, unnecessary influence of IPCTS providers in that hearing evaluation. So, for the third-party independent assessments, the FCC also thought comment on whether to include an attestation from the hearing professional that the, an evaluation of the individual has been conducted in accordance with applicable professional standards and the FCC's rules, and whether, in a professional's opinion, the applicant has a hearing loss that necessitates use of IPCTS for the individual to achieve effective telephone communication, and the professional understands and has explained to the individual that, one, that captions used for IPCTS may be generated by a CA who listens to the other party on the line and provides the captions received by the IPCTS driver, and two, there is a permanent cost to provide captioning on each IPCTS call, which is funded for a federal program. Again, it's giving that transparency to the consumer about what the program's about, how it functions, what, and how there are costs for the programs, even if that user won't be seeing an individual cost on their phone bill. So, continuing, for these third-party assessments, the FCC also thought comment on requiring IPCTS providers to maintain a copy of each third-party professional certification for a minimum of 10 years after termination of service to the individual receiving IPCTS and to make such records available to the TRS Fund Administrator or the FCC upon request. This is primary for auditing purposes and other review that the FCC might find appropriate. So, what are some appropriate assessment considerations now? As a hearing health professional, what should you be thinking about when someone comes to you and expresses their hearing loss needs, problems talking on the telephone, or specifically ask you about IPCTS service and whether it might be good for them? So, we currently believe that, you know, professionals providing such eligibility assessments should know that, one, IPCTS is not for everyone with a hearing loss. We've said this a couple of times now. You need a full type of assessment, and that individuals seeking assessment and eligibility, you know, they're often inquiring about IPCTS based on marketing materials without prior knowledge of all the options for improving their ability to hear over the telephone. And a hearing health professional should endeavor to recommend a solution for telephonic communication that best meets the individual's needs and not just the service that the individual is requesting. We're really hoping to say that you should start a conversation with the user about their hearing loss, understand how it affects them, and recommend alternatives or give them an opportunity to try out certain alternatives that may be best for them, whether that's getting a hearing aid, whether that's trying out a hearing aid with Bluetooth functionality, whether that's an amplified phone, just there might be those other options we've mentioned that are out there. So, a hearing health professional should also know that we consider a functional assessment of an individual communication need to include an understanding of the extent to which that individual will be able to use that amplified telephone or other existing technology, and that the captions used for IPCTS may be generated by a CA who listens to the other party on the line and provides the captions received by the IPCTS subscriber, and there is a permanent cost to provide captions for each IPCTS call, which is funded through a federal program. Again, you know, the federal program is the TRS Fund, and it's something we've again mentioned a few times here because we want that transparency in the consumer program. We want them to be able to have a full understanding of these costs. So, what are some of the other points we want to make sure you're aware of? That there are five IPCTS providers, you know, in terms of marketing opportunities or just industry opportunities, you may hear of one. We want you to know that there are currently five out there, and they all offer slightly different services, and, you know, one may work better for a consumer than the other, and we hope that you take the time to learn about them. So, an IPCTS provider may not enter into a joint marketing arrangement with a hearing health professional. That's something we mentioned a little bit earlier, and then under the FCC's proposal for third-party certification of eligibility, a hearing health professional with an exclusive arrangement or other relationship with an IPCTS provider would be prohibited from providing such certification to users of that provider. Hearing health professionals should also know about and may have outreach materials about IPCTS and other assistive technologies to improve telephonic communication. You know, we know you have a lot of webinars such as this one, a lot of professional opportunities, and we want to just make sure that you're, when it comes to telephone communications, you're aware of those options and that they're part of the conversation you're having with your clients, your customers, to help them understand what will work best for them. And we encourage hearing health professionals to make any of these outreach materials available to the public. We also just want to make sure that, as hearing health professionals, that you're aware that you can reach out to us at the FCC at any time with questions concerning IPCTS in general, or any other aspects of the TRS program, or really generally how we make communication accessible for people with hearing loss. You can ask us about marketing materials from IPCTS providers, whether they're appropriate, whether there's anything you should know about, and whether there are any concerns. We certainly stress concerns about marketing materials that mention free phones. We don't want consumers to be picking IPCTS because they have an option for a free phone. We want them to find the best solution available to them. For states that have them, we also want you to be aware of the equipment distribution programs that are available to individuals who are deaf or hard of hearing. It is a great resource, if your state has one, for information about IPCTS, other TRS programs, other ways to help individuals who are deaf or hard of hearing, and generally about assisted technologies. Many of these programs have outreach materials. They have an opportunity for consumers to test out equipment. If there's ever a need, you can often refer consumers directly there, and these states have individuals trained to help individuals assess what works best for them. They will often set up to go to senior centers or other places where individuals who might have hearing loss might gather. They have a lot of great staff and resources that are available to them. All right. At this point, I think we'll turn it back over to see if there are any questions out there for us at this point. Thank you. Hi, everyone. This is Fran. First, thank you, Elliot and Michael, for being on with us today. Everybody, we're super excited that more than 100 of our colleagues and followers have joined us today on the webinar. We do have time for questions. Feel free to enter your questions into the question box now for Elliot and Michael. We'll take as many questions as we have time available. First, guys, we have a question from Janice. She wants to know, should a hearing health professional inform individual patients about captioning only if the patient asks about the service specifically, or can we bring up captioning anytime we think it will improve the patient's ability to hear over the telephone? Sure. Certainly. Well, this is Michael. No, you can, as a hearing health professional, you can certainly inform consumers about IPC-TS as an option available. I mean, we want you to be conducting that full assessment of their hearing loss and inform them of the options available to them. IPC-TS is certainly a great option for certain consumers who need that captioning on their phone, and we want that to be available to them, and they won't always hear about it from other sources. And we think, you know, hearing health professionals are a great place for consumers to get complete information, whether that's about IPC-TS or about amplified telephones or about hearing aid options that can improve communications over the phone, whether that's Bluetooth or another technology. You know, we want all those options to be on the table, and we want you to be fully informed about all the options, including IPC-TS. Thank you, Michael. So, you guys talked about the TRS Fund. Could you just take a brief moment to tell listeners how that the use of that fund has grown over recent years? Because we do have several questions where people are wanting to know, A, is your evidence showing that people without hearing loss are using IPC-TS, and is the fund in danger of running out? All right. This is Elliot. I'll answer this question. The TRS, I mean, there has been fairly expansive growth of the use of the TRS Fund for IPC-TS. There have been a number of marketing materials and other aggressive marketing techniques used by some of the IPC-TS providers, which leads us to believe that people have been signed up for the service who may not need it. Yes, there are lots of people who may need some assistive technology to use the telephone, but these other assistive technologies may actually better serve the individual, because if somebody can be served by an amplified phone or Bluetooth connection to the hearing aid or even inductive coupling between the hearing aid and the phone, that may give the user good clarity and volume for that user's needs on the telephone, and without having to both read the captions and listen at the same time, particularly since there is an inherent delay in the captioning, that the user needing to deal with that inherent delay is therefore not a problem if the user doesn't need the captioning. That is really what the concern is. Although the way the TRS fund is set up by the statute that sets it up, which is part of the Communications Act, there's no cap on how the amount of the TRS fund would grow. What we are concerned about is that the way it's funded is that the telephone and VOIP providers are paying into this fund based on what their interstate telephone revenues are, and eventually, even though consumers are not directly charged for the TRS fund contribution, it is a cost of doing business for the telephone and VOIP providers. As that cost of business increases, that increases basically the cost of what could get passed on to the consumer in terms of higher telephone and VOIP charges. We are concerned about making sure that consumers in general are well-served and not paying to something that's not needed. That is really what the concern is. Elliot, we had a couple of listeners ask, where do consumers see these charges on their phone bills? What is it called? Is it on just landline bills? Is it on also cell phone bills and VOIP system bills? How are consumers paying into this TRS fund? The consumers do not see, for interstate TRS, the consumers do not see, which is what is covered by IPCTS, the consumers do not see charges for that on their phone bill. If they see a TRS charge, it's for state TRS, whereas states may, those are usually small charges because the state TRS programs are generally small. They may see a charge for that. But what it is, it's a cost of doing business for the telephone and VOIP providers and rates are often determined by cost of doing business does affect phone rates. In that sense, consumers are indirectly paying for it. This is Michael. That does include wireless phones, in addition to traditional telephones and VOIP phones. Those companies providing those services, they are paying in at a contribution rate based on their interstate revenues. As those services transition, we see changes in the amounts available in the funds. The FCC, certainly part of the rulemaking we were, the FNPRM we were discussing is exploring alternatives of potentially expanding sources of revenue within the fund. But those are questions we're asking and part of our mandate is to make sure that the TRS fund is being used properly and there's no misuse within that fund, whether it's intentional or not. It's our goal to make sure that consumers are fully informed and that people are exploring the best options available to them. Thank you, guys. Another listener, and this kind of goes to what you were talking about, whose responsibility is it to make sure the TRS fund stays efficient? Does that fall mostly on the hearing healthcare provider or on the provider telephone company, the IPCTS providers? Sally, I want to make sure, to make sure the fund is efficient, is that what you were asking? Yes. That was the question. Right. Well, the FCC has oversight over the interstate TRS fund, and so through that oversight, the FCC has adopted various rules and regulations to ensure that money is not misspent within the fund, and one of the obligations of the TRS providers is to provide the service to those who need the service, but not provide the service to those who do not need it. That is an obligation that the providers have, and that's embedded in our rules in terms of eligibility rules, as we discussed some of the IPCTS eligibility rules, including the self-certification by the consumer that they need the service. Yes. Good point. This is Michael. Yes. The involvement of the hearing health professional is really another step to try to help the consumer know about all their options and to have a kind of a proper hearing assessment so that they understand whether or not IPCTS is really right for them, and it's also to help the provider know that an individual is, you know, it gives us another avenue for the potential user and the provider to know that this user is eligible for the service and it would benefit them, because, I mean, individuals are primarily responsible for their accessibility needs. They're in the best position to make that determination, but we want to make sure that they can get professional advice as to what their hearing loss is and what might help them. Great. Thank you, guys. Tammy wants to know, is there a specific speech discrimination percent score benchmark we should use to determine whether a patient with hearing loss is a potential candidate for the IPCTS service, or are there other parameters you suggest? Yeah. This is Elliot. I'll answer that one. Back in 2013, when the FCC was considering various rule proposals, the FCC considered and rejected either specific decibel level loss or specific or other quantitative numbers, because hearing loss, as most people on this call recognize, is a fairly complex question, and so many factors go into what it takes to correct somebody's hearing. The idea that having a specific quantitative measurement, we were concerned, and a number of consumer organizations and other hearing loss experts brought to our attention, that it can't be quantified in a definitive way, because it would be both over-inclusive and under-inclusive. They were concerned that it would exclude people who, maybe based on quantitative values, it would seem that they didn't need IPCTS, but in reality did, based upon various other factors. It would also include people who, quantitatively, may seem like they needed it, but in reality, they were to understand phone conversations. That's why there are no quantitative values. Got you. Thank you. A couple of listeners, Donna, Margaret, asked questions relating to, has there been any known litigation regarding fraudulent use, or has any over-marketing or inappropriate assessments, et cetera, resulted in any fines against companies or individuals? Yeah, Celia, I'll answer that one, too. The general approach is that, very often, when we hear people bring marketing materials to our attention, where we think that they may be inconsistent with our requirements and may be promoting use of IPCTS when it's not needed, very often, we start out by just informally discussing it with the providers about such marketing materials. We do have an enforcement bureau here at the FCC who can bring an action against a provider if they saw a systemic problem, but we don't have, actually, any decisions right now that have actually fined providers for over-aggressive marketing at this point. We are vigilant as to what's going on in terms of that. Okay. Thank you, Elliot. What additional details can you provide on your advice to limit exclusive relationships between a hearing healthcare professional and a provider? Carlos is asking, he wants to know, is he prohibited from recommending one company over another? Even if he's not specifically prohibited from doing so, if he were to have an exclusive relationship with one phone provider, would he be precluded from providing a third-party certification of eligibility? How does that work? Okay. Well, this is Michael. I'll answer that question. With our proposed rules, there would be some limitations to entering into an exclusive relationship that would affect a hearing health professional's ability to sign a certification for that provider. That's something that's still under consideration here at the Commission. As the rules currently exist, there's certainly no prohibition on a hearing health professional recommending one IPC-ETS provider over another. But we would encourage that you explain your reasoning to the user. We don't encourage relationships where you agree to simply recommend a company at the expense of all the other companies. We recognize that there might be situations where a particular IPC-ETS service might be the best for that particular user. For example, there are certain IPC-ETS providers that are mobile only, and that might be preferential to that user, and it might be good to recommend that company or one of the companies that has a mobile solution as opposed to one of the companies that doesn't, even if that is the company the consumer came in asking about. Okay, thank you. Well, Carlos did have a follow-up question, though. He wanted to know, should he then turn away a provider that wants to inform him about their product and services to provide a demo model of their equipment, or is that okay? So, this is Michael, yeah. As a hearing health professional, you can certainly receive marketing materials, talk to IPC-ETS providers, learn about their equipment, and you can even receive a demo model and make it available. We're encouraging you to not be exclusive in that relationship. If someone else wants to come in and you say they need IPC-ETS, you can either allow them to look at all of their options, or if they have a specific company in mind and you think they qualify and you want to provide certification for that company, we'd encourage you to just go forward with doing that as opposed to necessarily steering them away from that provider because of some relationship you've entered into with a provider. Gotcha. So, Frederick wants to know, he says, if I don't have any formal agreement or understanding with a phone provider, can I refer patients to a specific IPC-ETS provider as long as I don't refuse to provide an assessment for a patient seeking service with a different provider? Yeah, so this is Michael. So, yes, again, you can certainly refer a consumer to a specific company. You're not prohibited from doing that. We encourage you to be aware of all five providers, of how their services differ to the extent that they do, but you don't have to tell a consumer about all five every time. If there's one that, for whatever reason, you say, you know, this is a good company, like some of my other clients have used them, and so you feel comfortable saying that this is a good company for them to choose, that is perfectly all right within our rules. And, Cecilia, I would just like to emphasize that not all five providers are offering, are identical in terms of what they offer, and therefore, it's good to know what the offerings are of each of the providers so that, to ensure that the consumer, you know, gets what they need. So, more of a personalized approach as opposed to a blanket, this is the phone that we offer everybody regardless of what your needs are. That's what I hear you saying. Yeah, exactly. Gotcha. So, Jonathan is asking, are there specific types of marketing materials that FCC recommends hearing health professionals avoid displaying? Well, this is Michael. It will depend on the marketing materials. We certainly suggest avoiding marketing materials that are very prominent about displaying, you know, get a free captioned telephone or a free device, because that is, you know, that shouldn't be what's driving the consumer's interest in the program. Certainly, the equipment is very nice equipment. It usually amplifies the telephone. It's a very nice product, and we don't want that to be the driving factor. We want it to be an assessment of the consumer's needs and their understanding that this will improve their ability to have a phone conversation. Okay, great. Thank you. Okay, our last question is from Gerald. He wants to know, do hearing health professionals have an obligation to reassess whether a new assistive technology is able to alleviate the patient's need for IPC-TS, and if so, how frequently should a hearing health care professional reassess? And should we periodically reassess such other technologies? You know, how often should that be done? Yeah. This is Elliot. We would encourage hearing health professionals to work with their clients to consider new technologies that they think will help those clients. So, for example, you may have a client with an older hearing aid that does not have Bluetooth connectivity, and you may conclude that that client would do very well, you know, that client's getting ready for a new hearing aid, and that a hearing aid with Bluetooth technology might help that client with understanding on the telephone and being able to better participate in phone conversations. And so that would be an example of where a new technology could be very useful for a particular client because, as we all know, technology is changing so rapidly. And it really, you know, if you think something would better serve your client's needs, then we, of course, encourage you to consider that. But we have no requirements to do that once the, you know, once a consumer has been certified as eligible for IPCTS, they don't need to get another certificate. You know, they don't need, right now it's only self-certification, but once a consumer has been deemed eligible for IPCTS, there's no process to make them ineligible. It's just that an eligible IPCTS user may find a new assistive technology may mean they don't need IPCTS anymore, and that would be up to the, you know, the hearing health professional and the consumer to figure that out. And that 2018 Further Notice of Proposed Rulemaking that we've mentioned a couple times, there is a request for comment on whether or not we should require some sort of reassessment by the provider every two years. But in those instances, we only ask questions about the consumer self-re-certifying, even if they previously had a third-party assessment. We didn't ask about necessarily needing to go back to a hearing health professional and have their, have a complete re-evaluation of anything like that. And just, Elliot, let me add that the purpose of asking that question is not that somebody might, hearing might get better, but rather, you know, rather there's, you know, a lot of the, you know, a lot of the IPCTS users are elderly people, and it's one way to find out whether somebody's even still alive or they may have cognitive decline, that they're not even involved in phone conversations anymore so that, let's say, you know, they may have had an IPCTS phone given to them by a provider, and that person isn't using it anymore, and somebody else may have appropriated the phone, and that's really just to make sure that that type of misuse doesn't happen. And we try to make, you know, so the proposal is really just a self-certification because that's something the consumer can do without a lot of trouble as opposed to getting a, as opposed to proposing a third-party certification, just to make sure the consumer is still alive and around and using the phone. Gotcha. Okay, thank you so much, and I just want to thank everyone. First, Elliot and Michael, thank you for an excellent presentation, and I want to thank everyone joining us today on the IHS webinar, Caption Telephone Eligibility, What the FCC Wants Providers to Know. If you'd like to get in touch with either of our speakers at the FCC Disability Rights Office, you may email Elliot at Elliot.Greenwald at FCC.gov, and you'll see both email addresses up there for Elliot and Michael, and Michael says Michael.Scott at FCC.gov, and they are happy to answer your questions directly should you have concerns or just need some feedback on marketing materials or just have questions about the fund and your role. They are wonderful resources, so we really are so glad to have them stay, you know, speaking with all of us. For more information about receiving and continuing education credit for this webinar through IHS, please visit the IHS website at IHSinfo.org. You can click on that webinar banner, find more information on the webinar tab on the navigation menu. IHS members receive a substantial discount on CE credit, so if you're not already an IHS member, you'll find more information on IHSinfo.org. Please keep an eye out for the feedback survey you'll receive tomorrow via email. We ask that you take just a few moments to answer some brief questions about the quality of today's presentation. Thank you again for being with us today, and we'll catch you at the next IHS webinar.

Internet Protocol Caption Telephone Service

IPCTS

eligibility requirements

FCC

aggressive marketing

misuse of service

reforms

sustainability

self-certification

third-party certification