Strategies for Effective Board Governance in PHPC’s.

Strategies for Effective Board Governance in PHPC’s. David Vincent, National Center for Health and Public Housing Allan Cintron, Consejo de Puerto Rico/Med Centro, Ponce, P.R. Karen Williams, WestEnd Medical Centers, Atlanta, GA

What is Governance Governance is the process in which consumers and non-consumers participate in the oversight of health center operations.

The Federal Mandate – Board Composition • Health center’s must have a governing board that consist of “a majority (at least 51%) of individuals (“consumers” or “patients”). * • Majority must represent the individuals being served by the organization in terms of race, ethnicity and gender.* • Must have a minimum of 9 and a maximum of 25 members. * • No more than 50% of the non-patient governing board members may derive more than 10% of their income from the health care industry. * • There must be at least one consumer from each of the funded special population. • Does not apply to those from Indian tribes, tribal or Indian organizations.

Is There Any Flexibility, And If So Where? • “Portions of program requirements notated by an asterisk “*” indicate regulatory requirements that are recommended but not required for grantees that receive funds solely for Health Care for the Homeless (section 330(h)) and/or the Public Housing Primary Care (section 330(i)) Programs”. • This means, if you have 330(e) funding and are interested in receiving 330(h) or (i), you must meet the governance requirement on board composition.

What about waivers • While 51% consumer representation is a mandate, it is possible to obtain a waiver. • Waivers are not granted automatically. • Health centers must demonstrate why they are unable to meet the requirements and what part of the statutory requirement they are requesting the waiver.

What about waivers (cont’d) • Typically only granted for two issues: unable to meet the 51% consumer representation and/or they are unable to meet the monthly meeting requirement. • A detailed plan on how they plan to obtain consumer feedback is required. • Historically, waivers are only granted to 330(g) migrant and seasonal farmworkers • Health centers who receive 330 (e) Community Health Center funding must meet the 51% consumer requirement and have monthly meetings.

Governing Board Requirements • Meet at least once a month; • Select the servicesthat are to be provided by the health center; • Determine the hours of operations in which services are to be provided; • Measure and evaluate the health center’s progress in meeting its annual and long-term programmatic and financial goals; • Develop and approve the health center’s strategic plan; • Review of the health center’s mission and by-laws on an on-going basis;

Governing Board Requirements (cont’d) • Evaluate patient satisfaction annually; • Approve the health center’s annual budget; • Approve the health center grant applications; • Approve the selection/dismissal of the health center’s Executive Director/CEO • Review the performance of the health center’s Executive Director/CEO; and • Establish general policies for the organization (this requirement does not apply to public health centers e.g. county health clinics).

Conflict of Interest Policy • Bylaws must have a board approved conflict of interest policy. • This policy must “prohibit conflict of interest by board members, employees, consultants and those who furnish goods or services to the health center.” • Board member can not be an employee of the health center. • They can also not be an immediate family member of a health center employee. • The Executive Director or CEO may serve only as an ex-officio member of the board of directors.

Is There Any Flexibility, And If So Where? • “In the case of public centers (also referred to as public entities) with co-applicant governing boards, the public center is permitted to retain authority for establishing general policies (fiscal and personnel policies) for the health center.” • “Upon a showing of good cause the Secretary may waive, for the length of the project period, the monthly meeting requirement in the case of a health center that receives a grant pursuant to subsection (g), (h), (i), or (p).’

Eligible Public Housing Residents According to HRSA, “public housing residents” are defined based on section 3(b)(1) of the Housing Act, which includes low-income housing developed, acquired, or assisted by a public housing agency including dwelling units in a mixed finance project that are assisted by a public housing agency with capital or operating assistance other than support under section 8 of the Housing Act (section 8 vouchers). A facility that accepts Section 8 vouchers and receives no assistance under any other section of the Housing Act does not fall under the definition of “public housing.”

Member Outreach • Recruiting members is typically a board driven process. • The Executive Director is helpful in identifying a public housing resident who might be interested • Constantly be on alert for patients who might be good board members. • Referrals from PHPC program staff or other health center staff for recommendations.

Member Outreach (cont’d) • Using the local housing authorityas a referral source (Resident Advisory Councils) • Using affiliated programming such as Head Start programs. • Consider having more than one public housing representative especially if you serve more than one public housing community.

Retention of Members • Incentives increase public housing resident’s participation • Providing monetary incentives is not permitted. • Incentives used include: • Food • Childcare • Conference Calls • Reimbursement for transportation • Translation services during the meeting • Use of Technology to stay in communication

Consejo de Puerto Rico/Med Centro, Ponce, P.R. • Allan Cintron • History of Consejo de Puerto Rico/Med Centro, Ponce, P.R. • Experience with Board of Directors • Success/Challenges • Commitment of the Executive Director

Making it work • Choosing the right public housing resident and what to do if they aren’t a match. • The average term of a board member is approximately 6 – 10 years. • New members may require up to 2 years for full integration. • Training efforts for many health centers are limited, because funding constraints.

WestEnd Medical Centers, Atlanta, GA • Karen Williams • History of WestEnd Medical Centers • Experience with Board of Directors • Success/Challenges • Recruitment of Board Members • Training of Board Members

Best Practices • Trial Board Membership - Have potential public housing residents attend a minimum of 3 meetings as an observer, can help with selection and retention process. • Take Advantage of other Grant - Related Programming Requirements

Changing Landscape • Challenges in identifying public housing residents for Board of Director’s membership. • Impact of Hope VI, Section 8 and Housing Choice Vouchers. • Residents and health center confusion on public housing status. • Need to inform Project Officer of changing landscape.

Resources HRSA Policy Information Notice (PIN) – Governance Requirements: • http://bphc.hrsa.gov/policiesregulations/policies/pdfs/pin199812.pdf HRSA Governing Board Handbook: http://www.fachc.org/pdf/cd_Governing%20board%20handbook.pdf National Association of Community Health Centers - Governance: • http://www.nachc.com/hc-info-governance.cfm US Housing Act of 1937: • http://hud.gov/offices/ogc/usha1937.pdf

Contact Information David Vincent National Center for Health and Public Housing dvincent@gmail.com Allan Cintron Consejo de Puerto Rico/Med Centro, Ponce, P.R. Allanbucana@aol.com Karen Williams WestEnd Medical Centers, Atlanta, GA kwwill@comcast.net

Strategies for Effective Board Governance in PHPC’s.