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.

Program Policy Notices are issued each year to grantees also providing guidance in the operation of their uncompensated services program.

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.