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Medical Treatment in Hill-Burton Funded Healthcare Facilities

Woman standing at clinic reception desk 

The Hill-Burton Act authorizes assistance to public and other nonprofit medical facilities such as acute care general hospitals, special hospitals, nursing homes, public health centers, and rehabilitation facilities.

The Community Service Assurance under Title VI of the Public Health Service Act requires recipients of Hill-Burton funds to make services provided by the facility available to persons residing in the facility's service area without discrimination on the basis of race, color, national origin, creed, or any other ground unrelated to the individual's need for the service or the availability of the needed service in the facility. 

These requirements also apply to persons employed in the service area of the facility if it was funded under Title XVI of the Public Health Service Act. Please note that the community service obligation is different from the uncompensated care provision. The community service obligation does not require the facility to make non-emergency services available to persons unable to pay for them. It does, however, require the facility to make emergency services available without regard to the person's ability to pay.

There are several basic requirements that every Hill-Burton hospital or other facility must comply with to fulfill the community service obligation:

  • A person residing in the Hill-Burton facility's service area has the right to medical treatment at the facility without regard to race, color, national origin or creed.
  • Hill-Burton facilities must participate in the Medicare and Medicaid programs unless they are ineligible to participate.
  • Hill-Burton facilities must make arrangements for reimbursement for services with principal State and local third-party payors that provide reimbursement that is not less than the actual cost of the services.
  • A Hill-Burton facility must post notices informing the public of its community service obligations in English and Spanish. If 10 percent or more of the households in the service area usually speak a language other than English or Spanish, the facility must translate the notice into that language and post it as well.
  • A Hill-Burton facility may not deny emergency services to any person residing in the facility's service area on the grounds that the person is unable to pay for those services.
  • A Hill-Burton facility may not adopt patient admissions policies that have the effect of excluding persons on the basis of race, color, national origin, creed or any other ground unrelated to the patient's need for the service or the availability of the needed service.

The regulation is 42 CFR Part 124, Subpart G.