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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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