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Hill-Burton Facilities Compliance and Recovery

About Hill-Burton Free Care Program, 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, which established Federal grants, loan guarantees and interest subsidies for health facilities. 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. The Act also empowered the Government to recover grant funds in certain situations when the facility is sold, transferred to an ineligible entity, or ceases to be used for an eligible purpose within the 20-year obligation period. In 1979, regulations established compliance levels (adjusted by the change in the Consumer Price Index for medical care) eligibility (based solely on the Federal Poverty Guidelines), record maintenance, and reporting requirements.

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