Board Authorities and Responsibilities
Mountain Park's documents and agreements with other entities confirm that no other individual, entity, or committee reserves or has approval/veto power over the health center Board.
TRUE. Mountain Park's bylaws and other documents confirm no other individual or entity or committee has approval or veto power over the Board.
Mountain Park takes attendance and keeps minutes for its Board meetings because it is good practice, but this is not a HRSA requirement.
FALSE. HRSA requires health centers keep monthly minutes of each Board meeting which indicate Board quorum.
The Board can have as few as 5 members and still conduct business.
FALSE. A health center Board must have at least 9 and not more than 25 members.
The Board is required to hold at least 9 Board meetings each year.
FALSE. The Board must hold monthly meetings (12 meetings per year). This is a HRSA requirement and stated in our Bylaws.
The Board does not approve Federal grant applications.
FALSE. The Board must approve federal grant applications.
The Board approves our Federal 330 grant application each summer (including the grant budget for how we will spend federal and non-federal funds)
Board members should apply for employment with Mountain Park if they are looking for a job and should encourage their immediate family members to do the same.
FALSE. Board members and their immediate family members may not be current employees of the health center.
The Board is responsible for the selection and evaluation of the CEO.
TRUE.
The Board Resource Library contains a link to ALL Board-approved policies.
TRUE.
Mountain Park employees and immediate family members of employees may be Board members.
FALSE. Employees and their immediate family members may NOT be health center Board members.
The annual budget must be presented to the Board but does not require a Board vote.
FALSE. The Board is required to approve the health center's annual budget.
The bylaws specify an ongoing selection and removal process for Board members.
TRUE. Elections, terms and duties of officers are all outlined in the health center's bylaws.
At least 25% of the Board's members must be patients of Mountain Park and seen for a clinical visit within the past 2 years.
FALSE. 51% need to be registered patients with a documented visit within the past 2 years.
The Board must approve all health center SERVICES, SITES, and HOURS of operation.
TRUE. Any additions or changes to services, sites, and hours require a Board vote. This is also referred to as our "Scope of Services." Examples of changes our Board has approved:
-MFM service added (a new service)
-Extending hours for pediatrics at Baseline (new hours)
-Adding 303 E. Baseline Rd. for Women's Health (a new location/site).
The Board is responsible to assure compliance with applicable laws and regulations. What are some of the external and internal audits that help the Board assure compliance?
EXTERNAL: annual financial audit, Joint Commission survey every 3 years, HRSA OSV every 3 years
INTERNAL: Compliance Audit Work Plan, Annual Risk Management Plan
No more than 50% of the non-patient board members can earn more than 10% of their income from the health care industry.
TRUE. This is a direct HRSA requirement. Mountain Park tracks the Board composition requirements very closely and works with the Board Development Committee to ensure our members fulfill the composition requirements from HRSA.
Per Mountain Park's bylaws, the Board is required to adopt all policies, procedures and Clinical Practice Guidelines for the health center.
FALSE. The Board is only required to adopt all policies.
The Quality Management II Committee adopts procedures and CPGs.
The Board is required to evaluate the performance of Mountain Park. Name 3 different ways the Board does this.
EXAMPLES:
1. Clinical performance - peer review reports, UDS clinical results, annual risk report to the Board of all incident reports by category (including clinical errors), quality assessment reports
2. Financial Performance - monthly financial statements, annual financial audit review
3. Customer Service Performance - customer service survey results, annual diversity assessment presentation, annual presentation of incident reports by category (including patient complaints)
Mountain Park requires Board members to review and sign a Conflict of Interest Disclosure Form every 2 years.
FALSE. This is an ANNUAL requirement. P.S. We are still missing a few, so please turn them in :)
The Board must conduct long-range/strategic planning at least once every 3 years.
TRUE. The planning should address financial management and capital expenditure needs.
HRSA specifies which policies require Board approval.
TRUE. HRSA requires the Board adopt and evaluate every 3 years policies in the following areas:
-Sliding Fee Discount Program
-Quality Improvement/Assurance
-Billing and Collections
-Financial Management and Accounting Systems
-Personnel
Mountain Park has a Conflict of Interest Policy in place that covers Board member conflicts in addition to organizational conflicts.
TRUE. Mountain Park's policy also covers Board members and there is a procedure for the full Board to review a situation and determine a course of action for potential and actual conflicts.