Fee Agreement, Sliding Scale

							Public Entities: Applying
 Health Center Program
     Requirements
 Presenter: Patricia Fairchild,
Vice President, John Snow Inc.
      pfairchild@jsi.com
  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 (doesn’t 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”.
  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.
 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.
 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
    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
    PINS: 99-09 – Definition of
   FQHC Look-alike for Public
•
                          Entities 330 regs; or,
  Public entity structured to meet all section
• 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
      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.
    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.
    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
       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)
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
 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