Frequently Asked Questions

What are uncompensated services?
Uncompensated Services is the term applied to health services made available at no charge or at reduced charges under Titles VI (Hill-Burton) and XVI of the Public Health Service (PHS) Act to eligible persons unable to pay.

Who must provide uncompensated services?
All health facilities which received grants, loans or loan guarantees for construction, modernization, or equipment under Titles VI or XVI of the PHS Act, or any assistance supplementary to the title VI or XVI assistance.

How long does the obligation last?
Facilities which received grants under Title VI are obligated to provide uncompensated services for 20 years from the opening date. Facilities which received loans are obligated until the loan is repaid. These periods of obligation may be shortened or lengthened because of the excess and deficit provisions of the regulations. Facilities which received grant funds under Title XVI are obligated indefinitely.

What are the requirements for public notice?
A facility must publish notice of its uncompensated services obligation in a local newspaper. The plan can take effect no earlier than 60 days following the date of publication. The notice must contain:

• A description of the services intended to be provided and how they will be distributed throughout the year
• The financial criteria used to make eligibility determinations, including, if applicable, the methodology used to provide services on a discounted basis
• The dollar amount of uncompensated services to be provided
• A statement inviting comment on the plan.

What are the requirements for Individual Notice?
Each facility must prepare and distribute a notice to each person who is seeking services on behalf of themselves or another. The notice must be provided to everyone even if an individual is over income, is seeking services not covered in your published allocation plan, is covered by insurance, or has not made a request for uncompensated services. A facility found in noncompliance with the individual notice requirement is subject to losing all of its uncompensated services credit for the period of noncompliance. The individual notice must:

• Explain that the facility is required by law to provide a reasonable amount of care without or below charge to people who cannot afford care
• Set forth the criteria the facility uses for determining eligibility for uncompensated services (be sure to include the income figures from the poverty guidelines), the types of services covered in your published allocation plan, and the sliding scale or other method used for Category B and C patients, if applicable
• State where in the facility people can request uncompensated services
• State that the facility will make a written determination of eligibility within a specified time frames.

What are the requirements for Posted Notice?
Signs provided by HRSA must be conspicuously posted in your admissions areas, business office, emergency room (if you have one), and in any other areas you believe are appropriate. The signs are in English and Spanish and both must be posted at all times that uncompensated services are available. You must also translate the signs into other languages and post them if 10 percent or more of the population in your service area (based on census reports) speaks other than English or Spanish and make efforts to communicate the contents of the signs to people you believe may not be able to read them.

What is a request?
A request is any indication that a person is unable to pay for services. At all times that uncompensated services are available, the facility must make a written determination of eligibility in response to each request for uncompensated services.

When may a request be made?
A request may be made at any time - before, during, or after services are received, including after institution of a collection action.

What are the time frames for making a determination of eligibility?
All facilities except nursing homes: For requests prior to discharge or prior to receipt of outpatient services, determinations must be made within 2 working days following the request. For requests made after discharge or after receipt of outpatient services, determinations must be made no later than the end of the first full billing cycle following the request.

Nursing homes: For requests made prior to admission, determinations must be made within 10 working days of the request, but no later than 2 working days after admission. For requests made after admission, determinations must be made no later than the end of the first full billing cycle following the request.

Are undocumented immigrants eligible for Hill-Burton assistance?
Yes. Eligibility is not based on citizenship or residency status.

What is a substantial compliance review?
A substantial compliance review is conducted by HRSA to determine a facility's compliance with the uncompensated services regulations. HRSA will contact you when an audit has been scheduled. They will let you know what documentation you must provide to document compliance.

How long must records be kept?
A facility shall retain the records for three years after submission of the Uncompensated Services Assurance Report or 180 days following the close of HRSA's assessment investigation, whichever is less.

What are the compliance alternatives?
Compliance alternatives are designed to accommodate facilities providing significant amounts of uncompensated services.

How is uncompensated services credit determined?
At least once every 2 years, HRSA will conduct a substantial compliance review to determine a facility's compliance with the uncompensated services regulations. The facility will be contacted regarding the records needed:

• a copy of each published notice, including proof of publication date;
• a copy of each individual notice used during the period to be assessed, along with a description of the method used for distribution of the individual notice;
• written policies and procedures concerning the Hill-Burton program;
• supporting documentation for calculating the 3 percent compliances, if applicable, and the allowable credit factors;
• log or listing of Hill-Burton accounts and total dollar amounts written off each year supported by ledgers or journals;
• patient account information, including the determination of eligibility, income and family size information, and billing information for Hill-Burton approved accounts; for denied accounts, maintain the determination of eligibility, including the reason for denial.