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Federally Qualified Health Center Program Expectations

and the Board’s Role in Strategic Planning

Erin SologaistoaFlorida Association of Community

Health Centers

Susan KnoxPresident, SEK Consulting

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FQHC Fundamentals

Serve a medically underserved area or population (MUA/MUP) Operate a Sliding Fee Schedule Serve Everyone, regardless of ability to pay Have a Community Governing Board made up of at least 51%

regular users of health center services Offer comprehensive primary and preventative healthcare

services Comply with Federal Program Expectations outlined in HRSA

Policy Information Notice (PIN) 98-23

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FQHC Program Expectations (Policy Information Notice 98-23)

To receive federal 330 funding or an FQHC Look Alikedesignation a community health center (CHC) must meet the Program Expectations of the U.S.Public Health Service which are divided into thefollowing four categories:

Mission and Strategy Clinical Services Governance Management and Finance

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FQHC Required Services (Across All Age Groups)

Required Services Primary medical care Health screenings Prenatal/Perinatal care Family planning Pediatrics Immunizations Emergency medical After Hours Coverage Vision services Diagnostic X-ray Diagnostic Lab services Preventative Dental Mental health/substance abuse Referrals to specialty and sub-specialty care Case management

“Typical Enabling Services”•Language services•Pharmacy•Transportation•Outreach•Case management•Eligibility Assistance•Education •Support services

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FQHC Board Composition

9-25 members Represent the service area’s demographics Majority are regular users of the FQHC’s services Non-users should be selected for expertise in a variety of

areas No more than half of the non-users can derive more than

10% of their income from the healthcare industry No board member may be an employee of the center or be

an immediate family member of an employee

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Role of the Board Govern the FQHC Ensure Compliance with State and Federal Laws Serve as a Link to the Community

Representing Community Needs Promote the FQHC and it’s Mission to the Community

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Core Functions of CHC Board

1. Establish and Preserve the CHCs Mission2. Set Policy3. Safeguard CHC Assets4. Select/Evaluate/Support the CEO5. Monitor/Evaluate Performance6. Plan for the Future

* From HRSA’s Governing Board Handbook

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Core Functions of CHC Board

The Board does not OPERATE or MANAGE the health center

The board makes policy

The CEO and STAFF implements their policy

The board supports the CEO in this endeavor

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The Board Operates the CHC - NOT!

The board’s job is to make sure the organization is well managed, not to

manage the organization.

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Board Function 1Establish, Preserve and Communicate

the Mission Establish the mission Clarify and Ensure broad understanding of the Mission Ensure that all goals and objectives flow from the mission Continuously assess the degree to which the program is

accomplishing the mission Assess resources available to meet those needs Work closely with other safety net providers to carry out the

mission

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Board Function 2Set Policy

Four Types of Policy1. Operations2. Personnel 3. Clinical4. Fiscal

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Operations Policy (Board Function 2: Set Policy)

Ensure compliance with federal, state and local laws

Ensure efficient and effective operations Determine scope of services offered Determine hours of operation Ensure availability of appropriate facilities,

equipment and personnel

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Personnel Policy (Board Function 2: Set Policy)

Selection & Dismissal Procedures Employee Compensation Position Descriptions Performance Review and Evaluation Procedures Employee Grievance Procedures Equal Opportunity Practices

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Fiscal Policy (Board Function 2: Set Policy)

Ensure management that is guided by mission and goals

Ensure team process with well-defined lines of authority and responsibility

Ensure sound management & control systems Develop & Approve Annual Budget Establish a fee schedule to cover reasonable costs

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Clinical Policy (Board Function 2: Set Policy)

Board Ensures.. Health services are available & accessible Clinical quality and continuity of care Providers are qualified and culturally competent Services are culturally competent and accessible in

appropriate languages Systems for maintaining confidentiality are HIPAA Compliant Primary care services are coordinated with other levels of

care Support services are appropriate and accessible Community has opportunities to participate with the center

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Board Function 3 Safeguard CHC Assets

Review and Approve annual budget Compare real state of finances (actuals) to what was

planned in the budget (projections) Ensure annual audit by independent CPA Pay attention to changes in the law, policies of fiscal

situation of funding sources Pay attention to increased costs, particularly in personnel

and contractual services (which are the bulk of CHC expenditures)

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Board Function 3 Safeguard CHC Assets

Ask Where is the money coming from and in what proportions

(grant, patient revenue, insurance, contracts etc)? How is it Being Spent? Are We Within Budget Month to Month? Are We Meeting Payroll? Are We Up to Date In Our Taxes? Are We Using Grant Monies According to Budget? Does the budget Need Modification?

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Board Function 3 Safeguard CHC Assets

At least one board member should have financial expertise Board needs understandable, timely, accurate information Should receive a monthly fiscal status report Should be reviewed by finance committee prior to each

meeting

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Board Function 4 Select/Evaluate/Support the CEO

CEO Evaluation The board should conduct an annual review They should also know what the CEO is doing on an ongoing

basis Positive and negative feedback should be given on an

ongoing basis Interim steps should be taken to improve any deficiencies

noted in the CEO evaluation

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Board Function 5 Monitor/Evaluate CHC and Board

Performance

Measuring Health Center Performance How well is FQHC measuring up to the mission? How effective are the CHC’s programs Are they reaching everyone they were intended for? What is the quality of the programs? Are they affordable to the target population? Would the needs of the community be better served by

revising, replacing or discarding some programs or services?

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Board Function 5 Monitor/Evaluate CHC and Board

Performance

Measuring Board Performance Is the board in compliance with federal requirements? Does the board meet monthly? Is there a quorum at each meeting? What are the board’s strengths and weaknesses? How well does it meet it’s responsibilities? Are appropriate committee and CEO reports provided

regularly? Does the board have credibility in the community? Do board members receive appropriate orientation and

training? Does the board receive skill building in areas of weakness?

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Board Function 6Plan for Future

Strategic Planning Is a team effort that should include senior staff Defines (3-5 year) plan for CHC services and growth Addresses critical issues and potential obstacles Considers the CHCs role within the local, state and

national healthcare marketplace Looks at trends and how they will impact the operation Seeks to capitalize opportunities and minimize risks

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Disclaimer

The copyrights to this presentation belong to the Florida Association of Community Health Centers. This presentation may not be shared or duplicated without the organization’s

express permission.

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Contact InformationErin Sologaistoa

Florida Association of Community Health Centers (FACHC)433 Hansen Lane

Tallahassee, Florida 32301(850) 942-1822erin@fachc.org