1. CEO versus Board of Directors
Who Does What in a Community Health Center?
Jennifer Genua

2. Definitions and Acronyms Used
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
Jennifer Genua

3. Statutory Requirements for Governance
As a recap:
Holding monthly meetings and maintaining records/minutes that verify and document the board’s functioning
Approving applications related to the health center project, including grants/designation applications and other HRSA requests regarding scope of project
Approving the annual health center budget, audit and sliding fee discount program (nominal fee)
Long-term strategic planning, which would include regular updating of the health center’s mission, goals, and plans, as appropriate
Jennifer Genua

4. Statutory Requirements for Governance
Evaluating the health center’s progress in meeting its annual and long-term goals
Selecting services, location and mode of delivery of those services (Form 5, A, B, C)
Determining the hours during which services are provided at health center sites that are appropriate and responsive to the community’s needs
Approving the selection/dismissal/evaluation of the health center’s CEO/Executive Director
Establishing general policies and procedures for the health center that are consistent with Health Center Program and applicable grants management requirements
Privileging and Credentialing unless by board resolution delegated (Per PIN )
Jennifer Genua

5. Delineation Between CEO & Board
Board Role
CEO’s Role
Develop Mission Statement
Communicate Mission Statement
Guide Strategic/Long-Range Planning
Implement Strategic/Long-Range Planning
Establish/Approve Policy
Implement Policy
Select and Evaluate Qualified Chief Executive Officer
Ensure Timely and Accurate Reporting to Board on Achievement of Organizational Goals and Objectives
Evaluate Center Operations
Manage Center Operations
Review Quality of Care
Monitor Quality of Care
Represent Community Interest
Represent Health Center Needs
Jennifer Genua

6. The Board’s Role With: Budget and Finance:
Board members approve the budget
Generally prepared by the Chief Financial Officer (CFO), and reviewed by the CEO and Senior Management
Monitoring program expenditures and determine sound fiscal policy and internal control practices
“Stoplight dashboards”; Statement of Operations etc.
Assume the responsibility for the fiscal accountability of the health center
Notice of Award (NoA) is legal document that HRSA provides
Jennifer Genua

7. The Board’s Role With: Health Center Program Evaluation:
Monitor program effectiveness
Review of program evaluation reports on a regular basis
Reports can come through committees
Trending reports for fiscal and clinical measures
Other goals the board sets through the strategic plan
What did you tell HRSA you would do?
Through the grant application and quarterly calls with Project Officer
Advise staff on the health center’s self-evaluation activities
Jennifer Genua

8. The Board’s Role With: Planning:
Participation in and approve the strategic plans of the center, including the program’s goals and objectives
Regular monitoring of goals?
“What is the status of the goal? Are there restrictions to achieving this goal?”
May assist staff in the development of these plans and set organizational priorities for action
Through the CEO/Executive Director, allow staff to operationalize priorities
Jennifer Genua

9. The Board’s Role With: Personnel:
Board of Directors hires the CEO/Executive Director
Monitors the effectiveness of the Director’s performance and removes Director if performance is unsatisfactory
Based on job description and mutually agreed upon objectives
Determining personnel salary ranges (and benefits) and develop personnel policies.
Staff members are hired, evaluated, and, if necessary, removed by the CEO/ED, not the Board
This includes the Chief Medical Officer (CMO)
Jennifer Genua

10. The Board’s Role With: Board Development:
Determining the structure of the Board and committee membership (Based on PIN )
Nominate and selects new board members and set standards for its own periodic self-evaluation
Self-evaluation by board members is an important process as it provides feedback to the Board
Can assist to identify potential training opportunities and other opportunities for improvement at the Board level
Jennifer Genua

11. The Board’s Role With: Public Relations:
When appropriate, the Board of Directors communicates with funders, community leaders, and other interested parties about the health center’s activities
Can include fundraising/board development
More typically, Board members advise the staff in the development of public relations responses to community and/or health center issues as appropriate.
Jennifer Genua

12. The Board’s Role With: Policy:
Board determines the health center’s policies
Policies: Broad guidelines that provide a framework for future decision making
Procedures: Clarify what steps must be taken, what rules must be followed, and who must be included in the process.
Generally formulated by the staff rather than by the Board
Organizational Policies and Procedures are routinely brought to the Board for review and approval on a regular basis
Jennifer Genua

13. The CEO’s Role With: Planning:
Works with the board to develop and gains Board approval on the goals, objectives and priorities
Usually completed through the strategic plan
Will delegate responsibility to staff to carry out and operationalize the plan
Regular report back to the board on the progress
Jennifer Genua

14. The CEO’s Role With: Budget and Finance:
Works in conjunction with the CFO/Finance Director to prepare the budget
If a health center has a finance committee- all preparation work can be done within the committee
The health center budget is brought before the full board for approval
Monthly financials prepared for the board with discussion
Financial indicators, statement of operations, balance sheet, profit & loss, productivity etc.
Jennifer Genua

15. The CEO’s Role With: Administration & Staff:
Responsible for the day to day administration of the activities of the health center
Duties are clearly defined in the job description and at times health center bylaws
Delegation and supervision of staff in carrying out the plans and programs of the health center
Determines responsibilities and authority among staff and assures that high standards of performance are being met
Jennifer Genua

16. The CEO’s Role With: Program Evaluation:
Assists board in evaluation of the progress and outcomes of health center programs (strategic plan), and recommends revisions of goals/objectives when needed in order to improve organizational performance
Works with the board to secure adequate resources to carry out the center’s programs and monitors the allocation of these resources to insure they are used effectively and efficiently
Report back to the board on the status
Jennifer Genua

17. The CEO’s Role With: Public Relations:
Works with the board to ensure community awareness of the health center’s goals, mission, objectives and programs, and obtaining community support for the Center.
The CEO, or his/her delegate, is the chief spokesperson for the health, unless otherwise directed by the board of directors
Jennifer Genua

18. Boards of Directors & Health Center Staff Interactions
Board members must not use their positions to obtain employment in the health center, or for preferential medical treatment for themselves, family members or close associates
Program Requirement #19-Conflict of Interest
Also addressed in the bylaws usually address
Board members should not attempt to resolve staff complaints
Jennifer Genua

19. Boards of Directors & Health Center Staff Interactions
When confronted with a staff complaint, Board members will:
Express concern and desire that the complaint be handled appropriately as outlined in the Personnel Policy
Explain that an individual board member has no authority to deal with staff complaints; therefore, the Board member will not attempt to mediate or resolve their complaint
Explain that the Board has delegated staff, including complaints, to administration and the staff person should address their concern with the Chief Executive Officer or his/her delegate
Jennifer Genua

20. Resources
atlagreement.html (Updated Health Center Governing Board Workbook)
Jennifer Genua

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