Administration of the Hill-Burton Program

The Hill-Burton Program is the nation's major health facility construction program providing construction grants, direct loans, and loan guarantees. Certain conditions must be met for facilities to receive funds, including: (1) providing a reasonable volume of uncompensated medical care; and (2) making medical services available to all persons residing in the service area. Recently implemented regulations altered the way facilities establish compliance levels, determine eligibility, maintain records, and report on levels of uncompensated care. However, the Department of Health and Human Services (HHS) is experiencing difficulty monitoring compliance, obtaining accurate compliance data from facilities, and investigating and resolving complaints in a timely manner. The large number of facilities, the limited staff resources, and the enormous workload generated by the regulations raise questions as to whether HHS can conduct the required compliance assessments necessary to release facilities from their 20-year obligations or obtain up-to-date compliance information. Although HHS is adequately addressing the program monitoring problem, improvements in its efforts can still be made.