Maine Primary Care Association Board Governance Training MPCA Annual Conference Bar Harbor Club October 22, 2014.

Maine Primary Care AssociationBoard Governance Training

MPCA Annual ConferenceBar Harbor Club

October 22, 2014

Your Presenters Today:

Darcy Shargo, COO

Jeb Murphy, Director of Communication and Data Coordination

Dan Washburn, CFO

Becky Colella, Risk Management/Emergency Preparedness

Coordinator

We’re Here to Help Health Centers!

The Maine Primary Care Association works to assist health centers in multiple ways:• Advocacy• Informational Resource• Training and Technical

Assistance

Our Training and Technical Assistance isn’t just targeted at employees of health centers; we can also engage Community Health Center boards, mainly through two offerings:

• Tailored Board Governance Trainings (Tell Us What You Need Covered)

• Annual Compliance Trainings (Covering board and staff expectations)

Our Programs

• Communication and Data Coordination• Outreach and Enrollment (with focus on the Affordable Care Act)• Behavioral and Dental Health Integration• Advocacy• Health Information Technologies (HIT)

• Quarterly Regional Roundtables• Heath Center Controlled Network (HCCN)

• Quality Improvement• Patient Navigation Network• Emergency Preparedness/Risk Management (You’ll hear about

today!)

Interested in learning more about the work being done or looking for a place to sit in and learn about the “boots on the ground” work? Check out our Events Calendar on the MPCA Website

(www.mepca.org)

For the most up to date information about MPCA and Our Health Centers

Like us on Facebook at Facebook.com/MainePCA

Follow us on Twitter @MainePCA

Community Health Center Board Roles and Responsibilities

A Brief History…..• Community Health Center (CHC) model emerged in

the 1960s to target roots of poverty with local focus, incl. local governance and accountability

• CHC funding called “Section 330 funding” and refers to $$ for health centers to serve community, homeless, public housing, or migrant populations

• Program oversight from the Health Services and Resources Administration (HRSA)

Community Governance is Hallmark of CHCs• No other health care provider has the level of

community governance or guidance that CHCs do

• Creates another layer of responsibility to align with program requirements

• Need guidance and governance to help CHC do what it supposed to do• Need linkage to the community and a way to ensure that the CHC is meeting the local needs in the towns it serves• Community members are an essential part of promoting the mission of the CHC and the great work that it does• Your CHC is a non-profit business and needs a governing board to hold it accountable-state and federal laws require that for 501 © 3 status (duty of care, loyalty and obedience)

Why Have a Board?

What else is unique about CHCs?

• 100% of Maine CHCs are currently meeting or exceeding Healthy People 2020 Goal metrics

• Certified Application Counselors at Maine CHCs helped Maine become the #1 State for Enrollments per capita (with a Federally Facilitated Marketplace) in the nation

• Currently 95% of Maine’s CHCs are PCMH Recognized, while the national average is 54%

Maine is

actually 94%!

What are core needs for good CHC governance?

• Define and preserve mission• Make policies (aligning with federal

program priorities and community needs)• Safeguard the assets of the CHC• Select, Evaluate, and Support CEO• Monitor and Evaluate the BOD itself• Plan for the future

• Know the CHC mission, strengths, and weaknesses

• Participate at BOD meetings• Support CEO and staff and understand they

are operating with limited resources• Avoid conflict of interest• Understand CHC financials and help the BOD

plan accordingly

CHC Board Best Practices

• Don’t lose your sense of humor-this work can be very hard!

• Don’t forget the CHC program requirements-many of which demand Board attention and review on a regular basis

CHC Board-Things to Watch Out For

CHC Program Requirements• Part of overall compliance strategy (think

“duty of care.”)• 19 requirements that make up the CHC

program-covering areas such as “key management staff” to “conflict of interest” for BOD members

• Represent areas of risk to CHC funding because of increased scrutiny on CHC program

• Sets standards that represent HRSA/BPHC position on issues ranging from internal operations to third party arrangements

• Interprets, explains, expands and updates rules that may be too broad, unclear, vague or out of date

• 19 Health Center Program Requirements:Legal standards mandated by health center statute/regulationsGrouped into four sections that generally reflect the core components of the health center program: need, services, management & finance, and governance

Program Information Notices (PINs) & Program Assistance Letters (PALs)

High Risk Areas-Program Requirements

What’s at stake?

Special award conditions“High-risk” designation (triggered by 5 conditions):- Cost disallowances- Draw-down restrictions- Suspension/termination of funding- Re-Competition of your grant.- Any other remedies legally available and appropriate

What are the Program Requirements Causing the Most Challenge for CHCs?

Scope of ProjectRequired and Add’l Services

Board AuthorityBoard CompositionSliding Fee Scale

Collaboration/Affiliations

Program Requirement 7: Sliding Fee

MUST …approve general health center policies…

For Example: • Sliding Fee Discount Program• Patient Centered• Improves Access• No patient denied health care due to

an inability to pay

Must…• Periodically review evaluations• Assess their effectiveness• Assess their appropriateness• Organizational training

Risk Management and Emergency Preparedness:

A deeper dive into an emerging topic for

Community Health Center Boards

MPCA EP Offerings

Health Center Emergency

Preparedness Task Force

Shared Learning &

Program Development

Webinars

Weekly Emergency

Preparedness Updates

1:1 Training & Technical

Assistance

Health Center Responsibilities for Emergency Preparedness

• Emergency Management Planning

• Linkages & Collaborations

• Communications & Information Sharing

• Maintaining Financial & Operational Stability

HRSA PIN 2007-15

HRSA PIN 2007-15: Maintaining Financial & Operational Stability

• Effort within an organization to ensure the continuity of essential functions

Continuity of Operations

Maintaining Financial & Operational Stability

Business Interrupti

on

Managing and

insuring against…

Business

Continuity

Equipment

Failure/ Loss/

Damage

Health Center Responsibilities for Risk Management

• Communication—reporting and tracking test results, physician-to-physician communication, and patient education

• Special patient concerns—newborns, minors, elderly, and pregnant patients

• Obstetrical risk management

HRSA

Health Center Responsibilities for Risk Management

• Corporate Compliance– Jacqueline Leifer, Esq. highlighted this as a Board

responsibility

“Section 330 implementing regulations require a health center’s Board of Directors to ensure that the health center is operated

in compliance with applicable Federal, State & Local laws & regulations”

FTLF highly recommends that health centers have an

integrated compliance program

Team Based Approach

Health Center Board’s Role in Compliance

•Review & update compliance program policies

•Review & evaluate compliance program work plan

•Monitor investigations via reports from compliance officer

•Evaluate overall effectiveness

Bright Idea!

Compliance Committee of the Health Center Board

Action Steps

For CHCs who have not yet established a compliance program:

• Pass resolution to establish the program & approve policies• Consider establishing a committee of the Board• Request regular reports on Compliance Program development

For CHCs with an established Compliance Program

• Request annual compliance program evaluation• Ensure sufficient funds are made available for the program• Modify and/or approve policies• Request regular reports from Compliance officer(s)

MPCA’s Risk Management Program

4 Buckets

Clinical

Operational

Financial

Legal & Regulatory

Corporate Compliance touches on all 4 buckets

Next Steps

Determine health center risk

management needs & priorities

• Direct feedback• Survey Data

Maine Primary Care AssociationBoard Governance TrainingMPCA Annual Conference

Bar Harbor ClubOctober 22, 2014

Questions?