Public Entities: Applying Health Center Program Requirements

1
Public Entities Applying Health Center Program
Requirements

• Presenter Patricia Fairchild,
• Vice President, John Snow Inc.
• pfairchild_at_jsi.com

2
Public Health Service Act

• Enables grant awards to Public or Non-profit
  private entities
• Limits funding for Public Entities to 5 of
  appropriation in any fiscal year (doesnt apply
  to homeless or public housing grants)
• Does not distinguish requirements for public
  entities vs. non-profits except
• In section discussing governing board
  responsibilities, gives public entities the
  authority to establish general policies.

3
Key Requirements in Law

• Specifies Required and Additional Health Services
• Specifies serving a medically underserved
  population
• List of specific requirements including
  continuity, collaboration, quality improvement,
  financial responsibility, billing and
  collections, sliding scale, hospital referral
  relationship(s), overall plan and budget,
  reporting to HHS, language-appropriate services,
  enrollment of patients in coverage, assurance of
  compliance with federal, state and local laws.

4
Key Requirements in Law

• Governance
• Consumer majority that represents population
  being served
• Monthly meetings, selects services, determines
  hours, approves annual budget, approves the
  selection of the director, and except in the
  case of a governing board of a public entity
  establishes general policies.

5
Code of Regulations Title 42 Part 51c

• Provides additional requirements on size,
  composition and responsibilities of governing
  boards, sliding fee scale and other issues
• Apply only to 330 (e) and (g)
• Does not separately discuss public entities

6
Program Expectations

• Two options for meeting governing board
  requirements
• Public entity board fulfills board composition
  and function requirements including user majority
• Co-applicant board that meets composition and
  function requirements
• Prefers the co-applicant board be incorporated
• Requires a written agreement between the boards

7
PINS 99-09 Definition of FQHC Look-alike for
Public Entities

• Public entity structured to meet all section 330
  regs or,
• Public entity and co-applicant together meet
  requirements
• As with Expectations states the under the
  co-applicant option, board must meet composition
  and responsibility requirements except for
  establishing general policies.
• States that Board should be given responsibility
  to manage the health center to the extent
  allowed by the public entities charter.
• States preference for incorporated co-applicant
  board with by-laws that define the relationship
  but acknowledges that may not always be possible.
• Acknowledges that many responsibilities may be
  shared
• Again requires a written agreement

8
Memo of Agreement

• Specifies role of each party (Public Entity and
  Co-Applicant).
• Required roles for Consumer majority board are
  those specified in the legislation and
  regulations. Some, such as budget approval or
  selection of the Director may be shared.

9
Required Co-applicant roles for MOA

• Selection of the services to be provided by the
  health center
• Approval of the health center's annual budget,
  with the overall plan and budget prepared under
  its direction
• Approval of the selection and dismissal of the
  Executive Director for the center
• Approval of the application for a second or
  subsequent grant or FQHC recertification
• Adopt health care policies, including scope and
  availability of services, location and hours of
  services and quality of care audit procedures
• Assure that the health center is operated in
  compliance with applicable Federal, State and
  local laws and regulations and
• Evaluate center activities including services
  utilization patterns, productivity of the center,
  patient satisfaction, achievement of project
  objectives, and development of a process for
  hearing and resolving patient grievances.

10
Making the MOA Work

• Key is clarity, communication and trust between
  co-applicant and public entity
• Be precise on what must be retained by public
  entity due to charter (vs. preference)
• Develop operational guidelines for sharing roles
  and responsibilities

11
Key Areas of Shared Responsibility

• Hiring/Evaluating/Dismissing CEO
• Approving annual grant application and budget
• Setting fee schedule and sliding scale
• Determining policies like hours and location(s)

12
Example Selecting Director

• Co-applicant board approves selection and
  dismissal of the Executive Director
• Public entity establishes personnel policies and
  employs the staff including the ED
• Handout with sample shared process

13
Example Approval of Annual Application

• Co-applicant must approve the annual budget and
  grant application
• Depending on charter, Public Entity may not be
  able to relinquish budget responsibility
• Handout with sample shared process