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Management and Finance


Key Management Staff

Key Management Staff: Health center maintains a fully staffed health center management team as appropriate for the size and needs of the center. Prior approval by HRSA of a change in the Project Director/Executive Director/CEO position is required.

Sample job descriptions for various HCH positions are available, as well as peer-to-peer mentoring for new HCH administrators. If you are interested in the Council’s mentoring program either and a mentor or mentee, please email staff with your requests,

Contractual/ Affiliation Agreements

Health center exercises appropriate oversight and authority over all contracted services, including assuring that any subrecipient(s) meets Health Center program requirements.

Definitions: Subrecipient and Sub-contractors

This document includes HRSA language for the definition of ‘sub-recipient’, and offers additional information around sub recipients versus contractors, as well as guidance on developing Memorandums of Understanding/ Agreements (MOU/MOA).

Sample Memorandums of Understanding/ Agreement (MOU/MOAU) are available. Please email staff with your requests,


If a health center (“Health Center A”) provides services through a sub-award to another health center (“Health Center B,” a sub-recipient of Health Center A), how are patients, utilization, costs, and revenues counted in the UDS reports for the two organizations?

If the two organizations are both Health Center Program grantees and/or Look-Alikes, this can make for complex reporting based on the arrangement delineated in the sub- recipient agreement. It is possible that the two organizations will independently report UDS data (patients, utilization, costs, and revenues) for care provided to the same patients. This may occur in cases where Health Center B, as the sub-recipient of Health Center A, is providing some services to a patient under the Health Center A sub- recipient arrangement (medical care) and other services under its own scope of project (dental care). Furthermore, the site where Health Center B is providing services to Health Center A patients under the sub-recipient arrangement would be recorded in its own scope of project as well as the scope of project of Health Center A.

In cases where Health Center B, as a sub-recipient of Health Center A, is providing care to a defined/limited patient population on behalf of Health Center A, and providing no care independently to these patients, the UDS data for patients, utilization, costs, and revenues for care provided to these patients should be included in the UDS report ONLY for Health Center A. Health Center B, as sub-recipient, should not be including these patients and related data in their UDS report because they are only patients of Health Center A. In this scenario, the site where Health Center B is seeing patients strictly on behalf of Health Center A would only be recorded in Health Center A’s scope of project.

Collaborative Relationships

Health center makes effort to establish and maintain collaborative relationships with other health care providers, including other health centers, in the service area of the center. The health center secures letter(s) of support from existing health centers (section 330 grantees and Look-Alikes) in the service area or provides an explanation for why such letter(s) of support cannot be obtained.

Pages from So You Want to Start A Health Center

(2011) Pages on partnering and collaborations from the National Association of Community Health Centers publication So You Want to Start a Health Center.

Clinical Services for Permanent Supportive Housing

(2013) Health Care for the Homeless grantees are encouraged to partner with their local permanent supportive housing programs. Providing clinical care in these settings create challenges address in this document featuring two case studies from the field. More information about permanent supportive housing can be found here.

Collaborations Between Veterans Affairs and Health Care for the Homeless Programs

(2013) The purpose of this quick guide is to assist health care for the homeless (HCH) grantees with their efforts to establish and strengthen collaborations with local Veterans Affairs Medical Centers (VAMCs). The guide discusses the federal goal to end veteran homelessness and how HCH grantees can contribute to this cause. There are sections on federal priorities for collaboration that involve community partners, the current state of HCH-VA partnerships, and promising practices for HCH-VA collaborations that are currently being used by some HCH grantees.

Collaborations Between Academic Institutions and Health Care for the Homeless Programs

(2013) The purpose of this guide is to assist Health Care for the Homeless (HCH) grantees with their efforts to establish and strengthen collaborations with academic institutions, which include medical and allied health professional training schools. A large number of HCH grantees already collaborate with academic entities in providing education to students and residents; however, many are not accredited and/or do not receive additional funding for providing these educational opportunities. This resource guide will be useful for administrators interested in learning the potential benefits of having students and/or residents serve patients and learn at their sites. This guide will provide the resources needed to assist in developing meaningful relationships with academic partners and information on how to seek accreditation as a Teaching Health Center (THC) to provide Graduate Medical Education (GME). 

Webinar: Collaborations Between Veterans Affairs and Health Care for the Homeless Programs

(2012) This webinar will feature the experiences of two HCH providers, detailing how they established meaningful and productive collaborations with the VA Medical Centers in their communities.

Collaborations Between HUD Continua of Care and Health Care for the Homeless Programs

(2013) This webinar will address the dynamic role of local Continuum of Care (CoC) programs in addressing homelessness while defining the array of services available to vulnerable populations. The presenters will describe the many opportunities to learn, communicate, collaborate, and integrate CoC and HCH training, planning, services, and programs to better serve people experiencing homelessness and other underserved populations.

Find a HRSA Health Center

Use this tool to identify local community health centers. 

Nationwide Directory for Health Care for the Homeless Grantees

Use this page to identify programs, services and contacts in and near your community.

Financial Management and Control Policies

Health center maintains accounting and internal control systems appropriate to the size and complexity of the organization reflecting Generally Accepted Accounting Principles (GAAP) and separates functions appropriate to organizational size to safeguard assets and maintain financial stability. Health center assures an annual independent financial audit is performed in accordance with Federal audit requirements, including submission of a corrective action plan addressing all findings, questioned costs, reportable conditions, and material weaknesses cited in the Audit Report.

Module 4: The Definition of Homelessness & Eligibility for HCH Services

(2010) HCH administrators discuss satisfying A-133 and auditors’ requirements while maintaining accessibility; the 12 month eligibility rule; the 25% rule; documentation of homelessness; residency status.

Financial System and Risk Management

(2001) Pages from Organizing Health Services for Homeless People in Part V. Organizational Tools.

Billing and Collections

Health center has systems in place to maximize collections and reimbursement for its costs in providing health services, including written billing, credit and collection policies and procedures.

Please review the HRSA Policy Information Notice on Sliding Fee Discount Scales released October 2014. Page 13-15 address issues related to Billing and Collections.

Sample policies and procedures are available. Please email staff with your requests,


Health center has developed a budget that reflects the costs of operations, expenses, and revenues (including the Federal grant) necessary to accomplish the service delivery plan, including the number of patients to be served.

Webinar: Costing Tool for Health Care for the Homeless

(2014) Health Care for the Homeless health centers include diverse patient populations, services, projects, programs, and communities. The wide variation in patients and services can cause difficulty in measuring costs, outputs, and outcomes. However, health and cost outcomes data are critical as programs plan how best to use limited resources and seek additional funding. Webinar presenters from Brandeis University will share a tool they developed to help programs conduct basic cost analyses of homeless services to measure costs and benefits. The preliminary results may be used to inform planning and policy, improve program operations, apply for funding, compare programs’ performance, or to help justify a broader cost study. Results can also help supporters, funders, policy-makers and community stakeholders to understand a program’s performance and the value of its services.

Resource Development – Financing, Fundraising, and Friendraising

(2001) Pages from Organizing Health Services for Homeless People in Part V. Organizational Tools, Resource Development.

Program Data Reporting Systems

Health center has systems which accurately collect and organize data for program reporting and which support management decision-making.

HRSA Uniform Data System (UDS) Webpage

The Uniform Data System (UDS) is a core set of information appropriate for reviewing the operation and performance of health centers. The UDS tracks a variety of information, including patient demographics, services provided, staffing, clinical indicators, utilization rates, costs, and revenues. UDS data are collected from health center programs and due February 15 of each year. Information and assistance on reporting and categories of homelessness can be found in the UDS Manual updated annually, here.

Information Systems in Health Care for Homeless

(2001) Pages from Organizing Health Services for Homeless People in Part V. Organizational Tools.

Scope of Project

Health center maintains its funded scope of project (sites, services, service area, target population, and providers), including any increases based on recent grant awards.

Homelessness – Definition and Eligibility

(2015) This TA paper addresses the definition of homelessness, how homelessness is defined and categorized in UDS, suggestions for how a grantee can determine an individual’s eligibility for homeless services, and HRSA’s 12-month rule and the 25% rule.

Policy Advisory: Clarification of the 12-month Rule

Eligibility for Health Care for the Homeless services is extended to consumers living in permanent supportive housing past the 12-month rule that is in place for newly housed individuals in regular permanent housing.

Module 7: Scope of Project and Site Issues

(2010) HCH administrators discuss the two specific Policy Information Notices (PIN) from HRSA that focus on Scope of Project and Site issues and the 25% Rule.

Peer-to-peer technical assistance is available for grantees considering a change in scope, including issues around adding regular community health center populations (e) to the (h)—homeless grant. Please email staff with your requests,

You may request in-depth or personalized technical assistance on any of these topics. Visit our Get Assistance page.

This website is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,625,741 with 20 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit

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