Passage
of the Health Centers Consolidation Act of 1996
(P.L. 104-299) resulted in a number of revisions
to section 330 of the Public Health Service
(PHS) Act. The new section 330(j)(3)(H) of the
PHS Act requires that all organizations which
receive health center funding under section
330 have a governing body which assumes full
authority and oversight responsibility for the
health center. The governing board must maintain
an acceptable size, composition, and meeting
schedule. Furthermore, the responsibilities
of the board include the authority to control
the health center's budget and major resource
decisions, set center policies, and approve
the selection and dismissal of the health center
program director or chief executive officer.
Community and migrant health centers were subject
to governing board requirements under previous
legislation. This statute includes, for the
first time, governing body requirements for
section 330(h) health care for the homeless
and section 330(i) health services for residents
of public housing grantees.
II.
SECTION 330 GOVERNANCE REQUIREMENTS |
Section
330(j)(3)(H) stipulates that, in order to receive
a health center grant, the applicant must demonstrate
that "...the center has established a governing
body which...
-
is composed of individuals, a majority of
whom are being served by the center and who,
as a group, represent the individuals being
served by the center;
-
meets at least once a month, selects the services
to be provided by the center, schedules the
hours during which services will be provided,
approves the center's annual budget, approves
the selection of a director for the center,
and, except in the case of a public center
(as defined in the second sentence of this
paragraph), establishes general policy for
the center; and
- in
the case of the application for a second or
subsequent grant for a public center, has
approved the application or, if the governing
body has not approved the application, the
failure of the governing body to approve the
application was unreasonable."
These requirements of the governing body do
not apply to an entity operated by an Indian
tribe or tribal organization.
Most health centers are private, non-profit
corporations. Public entities operating health
center programs may meet the governance requirement
in either of two ways. The public entity's board
may meet health center board composition requirements
including having a consumer majority. In this
case, no special considerations are needed.
When
the public entity's board does not meet health
center composition requirements, a separate
health center governing board may be established.
The health center board must meet all the membership
requirements and perform all the responsibilities
expected of governing boards except that the
public entity may retain the responsibility
of establishing fiscal and personnel policies.
The
health center board can be a formally incorporated
entity and it and the public entity board are
co-applicants for the health center program.
When there are two boards, each board's responsibilities
must be specified in writing so that the responsibilities
for carrying out the governance functions are
clearly understood.
The
statute allows for a waiver by the Secretary
for any of the requirements stipulated in section
330(j)(3)(H) of the PHS Act for health centers
receiving funds pursuant to subsections 330(g),
(h), (i), or (p). Specifically, the statute
stipulates: "upon showing of good cause
the Secretary shall waive, for the length of
the project period, all or part of the requirements
of this subparagraph in the case of a health
center that receives a grant pursuant to subsections
(g), (h), (i), or (p)."
Thus,
the waiver authority applies to grants under
the Migrant Health, Health Care for the Homeless,
and Health Services for Residents of Public
Housing programs, as well as, for programs funded
under subsection 330(p) in sparsely populated
rural areas.
Regulations regarding governing board requirements
are set forth in 42CFR§51c.304. These regulations
have been and are applicable to Community and
Migrant Health Center programs, but not to Health
Care for the Homeless and Health Services for
Residents in Public Housing programs. However,
the regulations serve as a useful framework
for all health center programs. Statutory and
regulatory requirements are described in further
detail in the BPHC Health Center Program Expectations
for the cluster.
Governance requirements for all health center
programs will continue to be evaluated and monitored
through the Primary Care Effectiveness Review
process, the annual review of continuation applications,
and other review mechanisms.
A.
Section 330(e) Community Health Centers
The Health Centers Consolidation Act of 1996
includes no legislative changes to governance
requirements for section 330(e) as community
health centers. For those community health center
grantees which also receive funding designated
to serve a special population (i.e., section
330(g), (h), or (i)) representation among the
consumer members of the governing body should
be reasonably proportional to the percentage
of consumers the special population group represents.
Community health center governing boards without
special population representation should add
such consumers or representatives with the next
available vacancy(ies). The intent is not to
impose quotas on board membership, but to ensure
that boards are sensitive to the needs of all
of their consumers.
In addition, implementation of one or more of
the following options can assist the health
center in its assessment of the health service
needs of special populations:
-
inclusion on the governing body of persons
who previously have been health center consumers,
but no longer receive services;
- use
of a formal advisory board;
-
regularly-constituted focus groups comprised
of health center consumers who
-
are migrants, homeless, or residents of public
housing which advise the
governance body on a routine basis; or
-
inclusion on the governing body of representatives
of other service
provider organizations and/or local advocacy
groups that have experience in
serving these special populations.
B.
Section 330(g) Migrant Health Centers
The Health Centers Consolidation Act of 1996
includes no legislative changes to governance
requirements for section 330(g) migrant health
centers, although it does permit section 330(g)
grantees to request "good cause" waivers
of the governance requirements. However, the
Secretary will only consider a request to waive
all or part of the governance requirements from
section 330(g) grantees that do not additionally
receive funding under section 330 (e) as community
health centers. This is because community health
centers, with or without funding to provide
health services to a special population, are
not eligible for a waiver. In addition, migrant
health centers that previously complied with
governing board requirements will have a heavy
burden to satisfy the good cause requirement
for a waiver.
Migrant
Health Programs (formerly known as migrant voucher
programs) do not have to meet the requirements
in 42CFR§56.601 for governing board composition.
These entities may meet consumer participation
for migrant/seasonal agricultural worker representation
through advisory councils. Please refer to PIN
#94-7, issued February 7, 1994, and PIN # 98-07,
issued March 6, 1998, for more information regarding
governance activities for the Migrant Health
Programs.
C. Section 330(h) Health Care for the Homeless
Section 330(i) Health Services for Residents
of Public Housing
As stated previously, the Health Centers Consolidation
Act of 1996 includes governance requirements
for all section 330(h) health care for the homeless
and section 330(i) health services for residents
of public housing grantees. Grantees which do
not currently meet the governance requirements
must immediately come into compliance with the
requirements, unless granted a waiver.
The
statute permits section 330(h) and section 330(i)
grantees to request good cause waivers of the
governance requirements. However, the Secretary
will only consider a request to waive all or
part of the governance requirements from section
330(g) grantees that do not additionally receive
funding under section 330 (e) as community health
centers. This is because community health centers,
with or without funding to provide services
to a special population, are not eligible for
a waiver.
All Section 330(h) and 330(i) grantees must
provide the BPHC with a status report describing
governance arrangements and, where necessary,
a time frame for coming into compliance with
the section 330 governance requirements. Any
request for a waiver of all or any of the specific
governance requirements must include a compelling
argument as to why the program cannot meet the
statutory requirements, as well as, alternative
strategies detailing how the program intends
to meet the intent of the statute for appropriate
user input.
The status report (including any waiver requests)
from each health care for the homeless and health
services to residents of public housing grantee
and any waiver request from migrant health center
grantees must be submitted no later than June
30, 1998 to:
Lawrence Poole
Grants Management Officer
Bureau of Primary Health Care
4350 East West Highway, 11th floor
Bethesda, Maryland 20814
Programs should indicate "Governance Status
Report" prominently on the first page of
their submission, as well as include the grant
number for their health care for the homeless,
health services to residents of public housing,
and/or migrant health center program.
Any questions regarding this Policy Information
Notice should be addressed to Jean Hochron,
Chief, Health Care for the Homeless program
at (301) 594-4437.
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