CHC Board Roles & Responsibilities  

Community Health Center Boards have a complex set of roles and responsibilities for governing their health centers. The following tools and resources will help your Board of Directors function effectively and with an understanding of its obligations.

Note: Legal liability is governed by state corporation law. Please seek legal advice to learn about the laws in your state.

Please click or scroll down for:
Federal Regulations
10 Non-Profit Board Responsibilities
Duties of Care and Loyalty
CHAMPS Archived Board Webcast: Legal Roles & Responsibilities
Sample CHC Bylaws
Other Online Resources

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FEDERAL REGULATIONS

FQHC Governing Board Functions and Responsibilities

• The governing board for the center has the authority for establishing policy regarding the conduct of the center.
• The governing board will hold regularly scheduled meetings, at least once a month. Minutes will be kept.
• The governing board has specific responsibility for:
  • Selection and dismissal of a project director or chief executive officer for the center
  • Establishing personnel policies and procedures including:
    • selection and dismissal
    • salary and benefit scales
    • employee grievance
    • equal opportunity practices
  • Adopting policy for financial management practices including:
    • system to assure accountability for center resources
    • approval of annual project budget
    • center priorities
    • eligibility for services including criteria for partial payment schedules
    • long-range financial planning
  • Evaluating center activities including:
    • services utilization patterns
    • center productivity
    • patient satisfaction
    • achievement of project objectives
    • development of process for hearing and resolving patient grievances
  • Assuring the center is operated in compliance with applicable Federal, State, and local laws and regulations
  • Adopting health care policies including:
    • scope and availability of services
    • location and hours of services
    • quality-of-care audit procedures

For more information about FQHC governance regulations, visit these online resources:

Electronic Code of Federal Regulations (e-CFR)
Public Health Regulations Governing Grants for Operating Community Health Centers, Specifically § 51c.304: Governing Board

Health Resources and Services Administration (HRSA)
Governing Board Handbook
Excerpt: Health Center Board Members Do's and Don'ts

National Association Of Community Health Centers (NACHC)
Reference Document: "So You Want to Start a Health Center: a Practical Guide for Starting a Federally Qualified Health Center"

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NON-PROFIT BOARD RESPONSIBILITIES

BoardSource (formerly the National Center for Nonprofit Boards) has identified ten basic responsibilities for nonprofit boards:

• Determine Mission and Purpose
• Select the Executive Director
• Support the Executive Director and Review His/Her Performance
• Ensure Effective Organizational Planning
• Ensure Adequate Resources
• Manage Resources Effectively
• Determine and Monitor Programs and Services
• Enhance Public Image
• Serve as a Court of Appeal
• Assess its Own Performance

For more information about Non-Profit Board Responsibilities, view the following CHAMPS article:
Ten Basic Responsibilities of Nonprofit Boards

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DUTIES OF CARE AND LOYALTY

Board members, while carrying out their governance function, act as fiduciaries (persons to whom property or power is entrusted for the benefit of another) on the organization's behalf. This role subjects directors to two obligations: the Duty of Care, and the Duty of Loyalty.

• The Duty of Care requires that directors act in a reasonable and informed manner, using the same degree of care as a prudent person in a like position would believe approrpiate under similar circumstances.
• The Duty of Loyalty requires that directors place the organization's interest above their own personal interests.

For more information and details about the Duties of Care and Loyalty, view the following resources:

American Bar Association (ABA)
Tax Exempt Tool Kit

CHAMPS Archived Webcast Materials
CHC Boards: Legal Roles & Responsibilities

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CHAMPS ARCHIVED BOARD WEBCAST

CHC Boards: Legal Roles & Responsibilities

Presented by Henry Granger, MEd
July 2005

Topics: Self-assessment of suitability to serve on a CHC Board; General rights, roles, and responsibilities of the Executive Board of Directors and those of the Chief Executive Officer; Administrative roles of the Executive Board of Directors; Legal roles of the Executive Board of Directors; Ways the Executive Board of Directors can make its collective voice heard; Q & A

CD-ROM:

• Link to CHAMPS Archived Webcasts Volume 4 to borrow or purchase a copy of this webcast on CD-ROM.

SLIDE COPIES:

• Click HERE to download a printable version of the handouts, including slide text, for this webcast.

SPEAKER'S NOTES:

• Click HERE to download a printable version of the speaker's presentation notes for this webcast.

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SAMPLE CHC BYLAWS

Several Region VIII CHCs have graciously provided their bylaws as reference for other CHCs. If your CHC is willling to share your bylaws on this site, please contact andrea@champsonline.org.

Sample CHC Bylaws:

• Bylaws - Central Montana Community Health Center, MT - 12/07
• Bylaws - Family HealthCare Center, ND - 09/25/08
• Bylaws - Valley Community Health Center, ND - 02/23/09
• Checklist for Health Center Bylaws - Health Resources and Services Administration

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OTHER ONLINE RESOURCES

BoardSource
The Source: Twelve Principles of Governance that Power Exceptional Boards
Book defining governance as a creative and collaborative process, addresses twelve principles including constructive partnership, culture of inquiry, sustaining resources, and more (publication available for purchase; overview available for free download)
www.boardsource.org/Bookstore.asp?Item=171 
www.boardsource.org/files/thesource.pdf

Colorado Community Health Network (CCHN)
Patient Centered Medical Home (PCMH) Toolkit
Toolkit of resources regarding leaders in the PCMH process, as well as resources about the National Committee for Quality Assurance (NCQA) PCMH Recognition process; these tools have been specifically designed for use by CHC leadership
www.champsonline.org/assets/files/ToolsProducts/CHCBoardResources/BoardDocs/board_of_directors_toolkit.zip

Colorado Nonprofit Association
Principles and Practices for Nonprofit Excellence in Colorado
A document developed with the input of leaders of Colorado's nonprofit, government, and private sectors, detailing principles and practices based on the fundamental values of efficiency, transparency, and accountability; focus areas include operations, governance, human resources, advocacy, financial management, and fundraising
http://www.coloradononprofits.org/help-desk-resources/principles-practices/

Community Health Association of Mountain/Plains States (CHAMPS)
Agency Functions and the Delineation of Board/Staff Roles and Responsibilities
A useful tool in discussing the definition of board and staff roles
www.champsonline.org/assets/files/ToolsProducts/CHCBoardResources/BoardDocs/BODvsStaffRolesTool.doc

Guidestar
The IRS View of Nonprofit Governance
Article addressing the increased focus that the IRS will be giving to good governance practices and internal controls.
www2.guidestar.org/rxa/news/articles/2009/the-irs-view-of-nonprofit-governance.aspx?source=dec09nwsltr

Independence Sector
Principles for Good Governance and Ethical Practice: a Guide for Charities and Foundations 
A list of 33 principles including six required by law and another 27 that charities should consider adopting if they make sense based on their legal status, operational structure, and purpose
www.independentsector.org/principles_guide_summary
GuideStar.org article discussing the above document
www2.guidestar.org/rxa/news/articles/2008/principles-from-the-panel-on-the-nonprofit-sector.aspx?articleId=1190#1

National Associtaion of Community Health Centers (NACHC)
Information Bulletin #10: Translating Corporate "Responsibility" Legislation and Guidance into Good Governance
Helping health centers understand the specific implications of corporate responsibility legislation on health centers.
http://iweb.nachc.com/Purchase/ProductDetail.aspx?Product_code=GOV_10_05

Lisa A. Runquist
Responsibilities and Duties of a Director of a Nonprofit Organization 
Article addressing the questions that should be asked by directors in determining the scope of their responsibilities
www.runquist.com/article_director.htm

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