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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Alabama Primary Health Care Association

2013 Annual Conference and Trade Show

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

Presented byWilliam W. Rice

HRSA ConsultantAlexandria, Virginia

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

Session Objectives• Determine Board Authority For a FQHC• Describe How to Demonstrate and

Document Board Authority• Best Practices in Board Oversight• Discuss Related Issues

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

Determine Board Authority For a FQHC•Relationship to the 19 Program Requirements•How to Survive a HRSA Operational Site Visit

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Need•Needs Assessment (PR #1)• The Needs Assessment: What is the

Board’s Role?• How Is the Needs Assessment Used?• How Often Is a Needs Assessment Done?

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Services•Required and Additional Services (PR #2)• Services of the Health Center: Board Role

and Responsibilities– Selection of Services– Written Agreements

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Services•Staffing Requirement (PR #3)• Staffing for the Health Center: Board Role

and Responsibilities– Budgeting for Staff– Privileging and Credentialing– Personnel Policies

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Services•Hours of Operation (PR #4)• Accessible Hours of Operation/Locations:

Board Role and Responsibilities– Approval of Operational Plan– Relationship to Patient Satisfaction– Changes in Scope of Project

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Services•After Hours Coverage (PR #5)• After Hours Coverage: Board Role and

Responsibilities– Defined Arrangements– Delegation to Management

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Services•Hospital Admitting (PR #6)• Hospital Admitting Privileges and

Continuum of Care: Board Role – Formal Arrangements for Referral– Staff Qualifications/Standards (Relationship

to PR #3)

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Services•Sliding Fee Discounts (PR #7)• Sliding Fee Discounts: Board Role – Board Approval of the SFD Policy– Annual Revision Based on Federal Poverty

Guidelines (FPL)

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Services•QI/QA Plan (PR #8)• Quality Improvement/Assurance Plan:

Board Role and Responsibilities– Monitoring the Ongoing QI/QA Program– Providing Clinical Leadership

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Key Management (PR #9)• Key Management Staff: Board Role and

Responsibilities– Selection/Dismissal of the CEO– Annual Evaluation of the CEO– CFO and Medical Director

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Contracts/Agreements (PR #10)• Contracts/Affiliation Agreements: Board

Role and Responsibilities– Oversight of Contracted Services– Contracts/Agreements/MOU’s and MOA’s– Delegation to Management Where

Appropriate14

Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Collaborative Relationships (PR #11)• Collaborative Relationships: Board Role

and Responsibilities– Indirect Primarily – Related Aspects: Strategic and Operational

Plans; i.e. Mission Statement

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Financial Management (PR #12)• Financial Management and Control

Policies: Board Role and Responsibilities– Selection of Auditor – Acceptance of Annual Audit– Approval of Financial Policies – Oversight of Control

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Billing and Collections (PR #13)• Billing and Collection: Board Role – Written Billing, Credit and Collection Policies– Monitoring Financial Indicators; i.e. Days

Outstanding in Accounts Receivable

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Budget (PR #14)• Budget: Board Role and Responsibilities – Approval of The Annual Operating Budget– 330 Grant Budget – Board Review of Budget Variences

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Information Systems (PR #15)• Program Data Reporting System: Board

Role and Responsibilities – Data for the Strategic Plan– Monitoring of HRSA Reporting Requirements

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The 19 Program Requirements: Mgt./Fin.•Scope of Project (PR #16)• Scope of Project: Board Role – Sites– Services– Target Population and the Service Area

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The Program Requirements: Governance•Board Authority (PR #17)• Board Authority: Board Role and

Responsibilities – Monthly Meetings & Minutes– 330 Grant Application and Budget– CEO Position Oversight

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The Program Requirements: Governance•Board Authority (PR #17 Cont.)• Board Authority: Board Role and

Responsibilities – Measuring and Evaluating Progress– Developing Plans– Ongoing Reviews– Monitoring Assets and Performance

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The Program Requirements: Governance•Board Composition (PR #18)• Board Composition: Board Role and

Responsibilities– Board Size– The User Majority– Other Board Composition Requirements– Special Populations

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

The Program Requirements: Governance•Conflict of Interest (PR #19)• Conflict of Interest Policy: Board Role and

Responsibilities– Board By-laws– Conflict of Interest Policy– Conflicts: Nepotism, Business Relationships,

Dual Loyalties

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

How Board Actions Are Demonstrated• Meeting Minutes• Board Approved Policies

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

How Board Actions Are Demonstrated• Meeting Minutes– Level of Detail– Format–Approval Process– Importance

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

How Board Actions Are Demonstrated• Policies–Board Approval Process– Frequency of Review/Approval–Policy Format Issues

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review:Board Authority

Best Practices• Board/Management Calendar• Committee Functions• Corporate Compliance Program

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review: Board Authority

Board Authority Issues•The Operational Site Visit–Process–Documentation

•By-laws–Compliance

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review: Board Authority

Discussion/Questions and Answers

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Beyond Change: Transforming Culture, Care and Communities

APHCA’s 28th Annual Conference and Trade Show

Governance Compliance Review: Board Authority

Conclusion

It has been an honor to have been a part of your conference.

William Rice

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