How to be an Effective Board Jennifer Genua

 Federally Qualified Health Center (FQHC)  Federally Qualified Health Center Look-Alike (FQHC LAL)  Community Health Centers  Section 330 Grantee  Non-federal entity  HRSA/Bureau of Primary Health Care (Bureau) Special Population Funding  Section 330(g)-Migrant/Seasonal Health Centers  Section 330(h)-Healthcare for the Homeless  Section 330(i)-Public Housing Primary Care

 The Duty to Care ◦ Be careful and prudent when making decisions  The Duty to be Loyal ◦ Never purposely do ANYTHING that could harm the center/board conflict of interest  The Duty to be Obedient ◦ Opening voice opinions, but then back the decision of the board ◦ Try to seek consensus

 Like any business; governs the corporation ◦ Notice of Award (NoA) is a legal document  A requirement of receiving HRSA funding ◦ HRSA 19 Program Requirements

 Policy Information Notice ◦ “Health Center Program Governance” pg. 8  Hold monthly meetings and maintain records/minutes that verify and document the board functioning  Approve applications related to the health center project, including grants/designation application and other HRSA requests including scope of project  Approve the annual health center budget and audit  Long term strategic planning (including regular updating of the health center’s mission, goals and plans as appropriate)  Evaluate the health center’s progress in meeting its annual and long- term goals

 Selecting services beyond those required in law to be provided by the health center, as well as the location and mode of delivery of those services  Determining hours during which services are provided at the health center sites that are appropriate and responsive to the community’s needs  Approving the selection/dismissal and evaluating the performance of the health center’s CEO/Executive Director  Establishing general policies and procedures for the health center that are consistent with the health center program and applicable grants management requirements.  Privileging of health center providers

Board Composition  51% of members of the board must be individuals who are served by the health center  Patient board members must be a current registered patient of the health center and must have accessed the health center in the past 24 months to receive at least one or more in-scope service(s) that generated a health center visit  Visits are defined as “documented, face-to-face contacts between a patient and a provider who exercises independent professional judgment in the provision of services to the patient”  Must reasonably represent the individuals who are served by the health center in terms of race, ethnicity and sex. Can also consider factors such as socioeconomic status, age and other relevant demographic factors  Legal guardian of a patient who is a dependent child or adult, or a legal sponsor of an immigrant, may also be considered a patient for purposes of board representation  No more than ½ of the non-patient representatives may derive more than 10% of their annual income from the health care industry

Board Composition for Special Populations Section 330(g),(h),(i)-[PIN ; pg.6]  Must have patient representation on board from the populations targeted and served by the health center  Must have a least one board member that is representative of the special population that the health center receives Section 330 funding/designation ◦ Advocates who have personally experienced being a member/work closely or have expertise with that special population would meet the requirement to have representation BUT these individuals would NOT be counted as a patient unless they were also health center patients.

Board Composition for Special Populations Section 330(g),[PIN ; pg.6]  For Migrant Health Centers ONLY (no other Section 330 funding): ◦ 51% must be migrant and/or seasonal agricultural workers (current or retired due to age) and/or members of their families who are served by the health center ◦ No more than 2/3rds of the non-patient representatives may derive more than 10% of their annual income from the health care industry

 1. Define and Preserve the Mission ◦ Mission statement  Do you understand, commit to and clarify the mission  Do you set goals and objectives to carry out the mission?  2. Make Policy ◦ Board sets the policy; staff carry out the procedures  Personnel  Financial  Clinical  Operations

 3. Safeguard the Assets of the Community Health Center ◦ Fiduciary Responsibility ◦ Center Finances, Budget, Annual Audit, Facility ◦ Personnel (CEO/ED)  4. Select and Evaluate the CEO ◦ Responsible for day to day operations (delegate) ◦ Clear concise job description (signed) ◦ Evaluate according to the document

 5. Monitor and Evaluate Center and Board Performance ◦ Is the health center meeting the mission? ◦ How does the center know whether its meeting the mission? ◦ What reports does board receive that can base whether the center is meeting the mission?  Annual Board Self-Evaluation ◦ Look at board meeting responsibilities ◦ Does the board of directors interact with the CEO/ED, community and each other? ◦ What are the board goals? What are the health center goals?

 6. Strategic Planning ◦ 1-3 year plan ◦ Keep an eye on the future and preparing for it?  Expansion of Medicaid? Payment changes? ◦ Written goals and objectives WITH timelines ◦ Implement the plan ◦ Evaluate the plan and report out  “Effective and Realistic Plans Enable the Board to Successfully Face and Make the Tough Decisions”

 President/Board Chair ◦ Promote the teamwork and decision by consensus ◦ Act as liaison between CEO/ED and board ◦ Major resource for the CEO/ED in all aspects of planning ◦ Chairs board meetings ◦ Assigns other members to committees and delegates tasks effectively ◦ Part of the Executive Committee ◦ Can be ex-officio of committees

 Vice President/Vice Chair ◦ Acts as a back-up for President/Chair in absence ◦ Can take on special assignments, such as projects/ad hoc committees ◦ Stays on top of current issues and operations ◦ Part of the Executive Committee

 Secretary ◦ In charge of the minutes of the board meeting  Sign the board minutes with date ◦ Attendance-can monitor attendance of board members to make sure following health center policy and Bylaws ◦ Meeting reminders ◦ Part of the Executive Committee

 Treasurer ◦ Ensure accurate financial records are kept  Reviews annual audit  Assists with annual budget  With the CFO, provides the monthly financial report to the board  Part of the Executive Committee  Chair of the Finance Committee

 Standing Committees? ◦ Executive  If stated in the Bylaws, this committee has the authority to act on behalf of the full board  Must specify the circumstances in which the health center board authorizes this committee to act on behalf of the full board  ALL actions must be reported to the full board and full board must vote and record them in the board minutes ◦ Finance ◦ Quality Improvement (QI) ◦ Personnel ◦ Nominating  Ad Hoc (Temporary) ◦ Established for a specific purpose/project  CEO evaluation, bylaws review, facilities

 Save time and streamline effort  The work of the board is done WITHIN the committees ◦ Study the report and issues and then report recommendations to the full board  Committees have NO power to make policy ◦ Full board needs to discuss recommendations before voting  Committees are a great way to recruit board members  NO RUBBER STAMPING

 Ability to request a waiver of the 51% patient majority governance requirement ◦ Any Section 330 funded health center or Look-Alike that is serving a sparsely populated rural area (entire service area would have seven or fewer people per square mile at the time of the waiver application) ◦ Section 330 health centers that ONLY receive special population funding and not Section 330 (e) funding

 Must: ◦ Demonstrate good cause as to why the health center cannot meet the statutory requirement ◦ Present alternative strategies detailing how the health center intends to meet the statue to ensure that patient participation is represented in the organization, direction and ongoing governance of the center

 Good Cause ◦ Based upon the unique situation of the health center’s service area of undue hardship and unable to establish a patient majority  Description of the population to be served and characteristics of the service area  Description of the health center’s attempts to meet the requirement to date  Why attempts have not been successful **Sparsely populated means if the entire service area has seven or fewer people per square mile at the time of the waiver application**

 Alternative Mechanism Plan for Addressing Patient Representation ◦ Present an acceptable plan on how the health center will comply with the intent of the statue  Clear description of the alternative mechanism for gathering patient input  Specifics on the type of patient input to be collected  Process for formally communicating the input to the board  Specifics on how patient input will be used to determine:  services, hours of operations, budget priorities, patient satisfaction, meeting organizational goals etc.

 Sample Alternative Mechanism Plan for Addressing Patient Representation ◦ Various alternatives to meet that patient population voice:  Patient Advisory Council-have a significant number of special population patients  Must meet regularly (at least quarterly)  Clear line of authority and communication with health center’s governing board  Advisory councils are not expected to meet board requirements and not recognized as fulfilling requirements  Form 6A-list only BOARD members NOT advisory council

 Must Meet MONTHLY with minutes kept ◦ Monthly meetings can be conducted by telephone or other means of communication ◦ All parties must be able to listen and speak to other parties ◦ Must check with state requirements on non-profit laws  Annual meeting usually days after fiscal year end ◦ Review of the year, annual report, nomination of officers  Board agenda in consonance with committee chairs and senior staff  Clear expectations and engagement  Benchmark setting  Transparence is key

Board RoleCEO’s Role Develop Mission StatementCommunicate Mission Statement Guide Strategic/Long-Range PlanningImplement Strategic/Long-Range Planning Establish/Approve PolicyImplement Policy Select and Evaluate Qualified Chief Executive Officer Ensure Timely and Accurate Reporting to Board on Achievement of Organizational Goals and Objectives Evaluate Center OperationsManage Center Operations Review Quality of CareMonitor Quality of Care Represent Community InterestRepresent Health Center Needs

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 Jennifer A. Genua-McDaniel, BA (Hons), CHCEF, Consultant   (928)