Hill-Burton Facilities Compliance

Frequently Asked Questions about Compliance and Recovery

42 CFR Part 124, Subpart are the regulations to the Hill-Burton Act. The “Provider’s Guide to the Hill-Burton Uncompensated Services Regulations” provides guidance to grantees on how to operate an uncompensated services program in compliance with the regulations. Some grantees have been approved to operate under a compliance alternative to the Hill-Burton regulations. The general Hill-Burton regulations require that grantees provide a specific amount of free or below cost health care services to persons unable to pay. The uncompensated services obligation lasts approximately 20 years for Title VI facilities and for Title XVI facilities in perpetuity.

Compliance Alternatives

The uncompensated services regulations have been amended several times to provide compliance alternatives for qualified facilities. These alternatives allow for facilities to reduce much of the procedural and reporting requirements. These facilities operate their own programs of discounted health services in lieu of operating under the general Hill-Burton requirements:

• Public Facility Compliance Alternative (PFCA): publicly or quasi-publicly owned and operated facilities. In support of their discounted health services programs, eligible facilities must receive over a 3 year period, an average of 10 percent of their revenues from State and local governments.
• Section 124.515 Compliance Alternative (515): Community Health Centers (CMC), Migrant Health Centers (MHC) and certain National Health Service Corps (NHSC) Sites that are current recipients of funds under Sections 329, 330 and 334 of the Public Health Service Act.
• Charitable Facility Compliance Alternative (CFCA): facilities whose mission and purpose are substantially supported by charitable and state and local governmental entities at an average level for the past 3 years equal to ten percent of total revenues: or which provide all of their services to all persons seeking services with incomes up to double (triple, if nursing home) the poverty guidelines.
• Unrestricted Availability Compliance Alternative (UACA): Title VI facilities which offer all of their services to all eligible individuals who request uncompensated services with incomes up to double (triple, if nursing home) the poverty guidelines.

If you have questions about the operation of your uncompensated services program or would like to apply for a compliance alternative, please contact the Project Officer assigned to your grant. If you do not know the Project Officer assigned to your grant, please call 301-443-5656 or email DFCRCOMM@hrsa.gov.

About Hill-Burton, Titles VI & XVI

• $4.6 billion total grants and $1.5 billion total loans between 1946 and 1997
• 6,800 health care facilities in more than 4,000 U.S. communities

Title VI

In 1946, Congress passed P.L. 79-725, the Hospital Survey and Construction Act, sponsored by Senators Lister Hill and Harold Burton and widely known as the Hill-Burton Act. It was designed to provide Federal grants to modernize hospitals that had become obsolete due to lack of capital investment throughout the period of the Great Depression and World War II (1929 to 1945). Hill-Burton hospitals were required to provide uncompensated services for 20 years after receiving funds.

Title XVI

In 1975, Congress enacted an amendment to the Hill-Burton Program, Title XVI of the Public Health Service Act. Facilities assisted under Title XVI were required to provide uncompensated services in perpetuity. Title XVI transferred the enforcement responsibilities from States to the Federal government, and required more stringent investigation, monitoring and compliance standards. In 1979, regulations established compliance levels, eligibility, record maintenance, and reporting requirements.