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The Federal Deposit Insurance Corporation (FDIC) recently issued its second quarter 2024 Quarterly Banking Profile. The report provides financial information based on call reports filed by 4,539 FDIC-insured commercial banks and savings institutions. The report also contains a section specific to community bank performance. In the second quarter of 2024, this section included the financial information of 4,104 FDIC-insured community banks. BerryDunn’s key takeaways from the report are as follows:

Second quarter of 2024 resulted in community banks’ quarterly net income increasing $72.6 million from the previous quarter.

Quarterly net income for community banks increased 1.1% in second quarter 2024, resulting in $6.4 billion in quarterly net income. This increase was the result of higher net interest and noninterest income, which more than exceeded the increase in noninterest expense. Despite the increase in quarterly net income, full year net income declined. Compared to second quarter 2023, net income had decreased $568.9 million, or 8.2%. More than half (61.6%) of all community banks reported an increase in net income compared to first quarter 2024.

Net interest margin (NIM) sees its first quarterly increase to 3.30% since fourth quarter 2022, but continues to remain below the average quarterly NIM of 3.51% over the past 10 years.

Community banks’ NIM increased 7 basis points from the prior quarter. However, NIM was down 9 basis points from the year-ago quarter. The yield on earning assets increased 54 basis points while the cost of funds increased 63 basis points from the year-ago quarter. Community banks’ NIM performance continued to prevail over the overall banking industry’s NIM of 3.16%, which declined 1 basis point in second quarter 2024. Community banks have only shown quarter-over-quarter NIM growth while the overall banking industry showed a decline once over the past five years.

Loan and lease balances continued to grow in second quarter 2024, with 75.7% of community banks reporting quarterly loan growth. 

Loan and lease balances continued to see widespread growth in second quarter 2024. Community banks saw loan growth in all major portfolios. Nonfarm, nonresidential commercial real estate (CRE) loans exhibited the most growth from first quarter ($7.9 billion or 1.4%), followed closely by residential real estate ($7.8 billion, 1.7%). Total loans and leases grew 6.3% from one year ago. This year-over-year growth was also driven by residential real estate and nonfarm, nonresidential CRE loans, which showed growth year-over-year of $30.5 billion (7.0%) and $33.9 billion (6.3%), respectively. The largest loan growth year-over-year, percentage-wise, was with farm loans, which saw a 7.2% increase.

The gap between the quarterly net charge-off rate for community banks and all other banks continues to build. 

Community banks witnessed a 2 basis point increase from the prior quarter and a 5 basis point increase from the prior year. However, the ratio remains 1 basis point lower than the pre-pandemic average of 0.15%. The increase was significantly impacted by the nearly 39% annual increase in net charge-off volume in the moderately sized loan portfolio of commercial and industrial loans (represents 12.8% of total loan balances for community banks). The net charge-off rate for commercial and industrial loans increased 16 basis points from one year earlier to 0.37%. The industry’s net charge-off rate increased 3 basis points to 0.68% from the prior quarter and was 20 basis points higher than one year earlier and the pre-pandemic average. The industry banks’ net charge-off rate for the quarter was the highest reported rate since second quarter 2013.

In September, the Federal Reserve cut interest rates by 50 basis points, the first time the Federal Reserve has cut interest rates since 2020. Although most were speculating that a rate cut was imminent, there was some dissent as to the magnitude of the rate cut and whether it would be 50 basis points or a more modest 25 basis points. Even with the more aggressive 50 basis point cut, the Federal Reserve has signaled that more rate cuts in 2024 are likely. With the reduction in rates, and the expectation this will only bolster bank profitability in the long run, attention has returned to bank merger and acquisition (M&A) activity. As indicated in the second quarter Quarterly Banking Profile, in quarter 2 alone, community banks declined to 4,104, down 27 from the previous quarter. This decline was primarily due to M&A, with 22 out of the 27 community banks having merged out of existence during the quarter. Many believe this is just the beginning. As the need for cutting-edge technology becomes more prevalent to remain competitive, some banks are being squeezed out of the industry as the upfront technology investment needed to remain competitive is too steep.

Another notable trend from quarter 1 to quarter 2 2024 was an increase in the number of institutions on the FDIC’s “Problem Bank List,” which increased from 63 to 66 (this stat is for all banks, not just community banks). This jives with the increases in the net charge-off ratios, as noted above. The consensus we’ve received from those with “boots on the ground” is that regulators are laser-focused on well-defined weaknesses in credits and are being more stringent and unwavering on ratios that are indicative of a needed downgrade. For instance, if debt service coverage ratio is below 1, unless liquidity and/or guarantor strength is a mitigant to downgrade and there is clear support for this mitigant, that relationship should be downgraded to a classified risk rating category. If anything, this is a sign of the regulators’ concerns about credit quality, even with the possibility of a “soft landing” seemingly on the rise. As always, please don’t hesitate to reach out to your BerryDunn’s Financial Services team should you have any questions.

In April 2024, the Governmental Accounting Standards Board (GASB) issued GASB Statement No. 103, Financial Reporting Model Improvements. The objective of this statement is to improve key components of the financial reporting model to enhance its effectiveness in providing information that is essential for decision-making and assessing a government’s accountability.

The biggest news about GASB Statement No. 103 is that it did not change the basis of accounting or presentation of governmental fund financial statements as we all had anticipated. For the past 10 years, GASB was reexamining the effectiveness of GASB Statement No. 34 Basic Financial Statements – and Management’s Discussion and Analysis – For State and Local Governments. Through this re-examination, they found the guidance was working well, but there were opportunities to make targeted improvements.

Previously, BerryDunn issued an article that, at a high level, summarized GASB Statement No. 103. In this article, we are going to focus specifically on the impact that GASB Statement No. 103 has on your Management's Discussion and Analysis (MD&A).

GASB Statement No. 103 reestablished a full set of requirements for the MD&A. This encourages governments to take a fresh look at the effectiveness of their MD&A. The new guidance directs governments not to just describe what changed during the reporting period, and by how much, but to also explain why those changes occurred. The guidance now requires greater description and detail about items discussed as currently known facts, decisions, or conditions expected to have a significant financial impact in the subsequent reporting period.

What makes a good MD&A and what your organization should focus on

The MD&A should be a story of your financial statements and an explanation of the significant changes in your entity’s finances from the prior year. When well written, the MD&A provides readers of the financial statements highly valuable information.

GASB Statement No. 103 emphasizes the following:

• The MD&A should be written for a reader who may not have a detailed knowledge of governmental accounting and financial reporting and may not be from the government’s geographical area.
• The MD&A should assist the reader in understanding why finances changed from the prior year, NOT just present the amount of the change.
• Encourage governments to avoid repetitive explanations in multiple sections of the MD&A.
• Clarify that the MD&A should discuss significant long-term financing activity during the year, not just debt, but leases, subscription-based information technology arrangements, and all other forms of long-term borrowing.

GASB states that the information presented in the MD&A should be confined to the following five sections:

1. Overview of the Financial Statements
2. Financial Summary
3. Detailed Analyses
4. Significant Capital Asset and Long-Term Financing Activity
5. Currently Known Facts, Decisions, or Conditions

Helpful tips when preparing your MD&A

To assist your entity in preparing the MD&A, we’ve laid out some helpful tips below.

• Write in a manner that is easily readable and can be understood by users who may not have a detailed knowledge of governmental accounting and financial reporting.
• Use charts, graphs, and tables to enhance the understandability of the information.
• Avoid unnecessary duplication.
• Avoid “boilerplate” discussion.
• Focus on the “why” and explanations.

The MD&A should include explanations and interpretations that explain the why. Some specific examples include:

• Increase in intergovernmental grant revenues
• Growth in revenues due to specific economic circumstances
• Increases in specific programs and functions
• Transfers to other funds
• Expenditures due to specific events

Use visuals to make information clear

To make the MD&A more visual and help the reader understand critical information, you can incorporate charts, graphs, and tables.

Below are a few examples that could be incorporated:

Contents of the Basic Financial Statements

Governmental Activities Revenues by Source

Governmental Activities Expenses by Source

If your organization follows the above tips, you will have an impactful MD&A that will be beneficial to the readers of your financial statements. Be sure to check out Exhibit 1 that is included in GASB Statement No. 103 for an example MD&A.

Be on the lookout for future GASB Statement No. 103 articles and how this new standard impacts your entity. When it comes to writing an impactful MD&A, BerryDunn’s Governmental Accounting Team can be a resource to your organization.

Read this if you work within a State Medicaid Agency (SMA). This is the fifth and final article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC) 2024. Prior articles highlighted industry MES trends, the value of the CMS and SMA MES partnership, the roles outcomes play in supporting enterprises, how SMAs can embrace Artificial Intelligence (AI), and further support their teams in achieving organizational excellence. 

If you attended the Medicaid Enterprise Systems Conference (MESC) back in August, you likely had the opportunity to join one of the many exciting workshops on day one of the conference. One of those workshops was focused on leading people through change. Facilitators guided attendees through an interactive exercise that replicated the chaos and confusion experienced during change. This exercise quickly became a frequent topic of conversation among MESC attendees because it demonstrated the importance of building and executing a plan that attends to communication, education, and motivation during times of change. The workshop, along with a handful of sessions throughout the week, highlighted the importance of having a people-focused strategy, and the resulting power from doing so. These refreshing conference topics gave meaningful insight into the pain points of invested MES parties, as well as practical solutions to help support them. 

So how can we all maintain focus on the people? 

• Be in tune with the energy (positive or negative) and engagement (high or low) of the group. If you’re not, find someone who is, and then build and maintain high energy and positive engagement through open communication, milestone celebration, collaboration, support, and recognition.  
• Identify resistance and address it quickly. Ask people about their concerns to help you understand their resistance. 
• Tactfully involve resistors in helping solve the problems they see. 
• Remember your "why" and find the reasoning. Why are we here? Why do we do what we do, and why are we changing? What are the benefits associated with this change? 
• Focus on the areas where you have influence. 
• Be sure team members have clarity and are committed to the project and its approach before jumping in. 
• Identify how you as a project team will be flexible: Flexibility is knowing the approach that was previously successful might not work the next time. 
• Collaborate with invested parties to identify and integrate lessons learned from prior efforts into existing ones. 
• Strategically identify and leverage your change catalysts as influencers to early adopters.  
• Consider how to contain and support the ‘fervent resistors’ to prevent increasing the resistance of the late adopters. 
• When leading, designing, and driving change, create a strategy and plan that pays attention to communication, education, and motivation. 

Other insights to help support your team, help ensure people come first, and help achieve success in your multimodule multivendor environment include the following: 

What’s Your North Star? Establish a vision that is the product of your agency and the people it serves. To establish a vision, SMAs should engage leadership and other invested parties to identify and align on long-term goals. This typically involves conducting a situational analysis (i.e., SWOT), clarifying the mission and values, and facilitating collaborative workshops to generate ideas on the agency’s vision. Once established, speak it, maintain it, and discuss how you’re achieving it. If you really want to be an all-star, identify your vision’s goals, outcomes, and metrics…then track against it! 

Workload: Be mindful of your SMA capacity. Measuring an organization’s capacity involves assessing its ability to deliver services, manage resources, and achieve goals. Key areas to evaluate include human resources, operational efficiency, technology, financial health, and strategic alignment. Tools like capacity assessments, KPIs, and process analysis help identify gaps and measure performance, while regular evaluation of these areas helps ensure the organization can be well positioned for growth, resilience, and effective decision-making.  

Portfolio, Program, and Project Management: Establish consistent processes (risk and issue management, change request process, etc.) across all invested parties (i.e., vendors and staff) and educate them during onboarding. Typically, MES organizational layers like a portfolio, program, and/or project management office can help establish, implement, and maintain these processes. Consistent processes are vital for ensuring the successful execution and governance of projects across an SMA. This uniformity not only reduces risks and operational inefficiencies but also supports scalability and continuous improvement, ensuring that the portfolio of initiatives delivers maximum value to the organization. 

Governance: Governance is critical for MES projects within an SMA involving multiple vendors because it ensures accountability, alignment, and oversight across all project activities. A strong governance framework provides clear decision-making structures, establishes performance metrics, and enforces compliance with state and federal regulations. This helps manage risks, streamlines communication, and ensures that vendors work collaboratively toward the SMA’s strategic goals, ultimately improving project outcomes and service delivery for Medicaid beneficiaries. 

Organizational Change Management (OCM): OCM is crucial for SMA initiatives (technology or otherwise) as it helps ensure that the change brought about by an initiative aligns with the needs and concerns of the people impacted by the change. By prioritizing activities such as communication, training, and support, OCM helps ease the transition for invested parties, facilitating buy-in and reducing resistance. This focus on the human element not only enhances user adoption of new programs, policies, systems, and processes but also promotes a positive organizational culture, ensuring that the implementation leads to sustainable improvements in service delivery and overall agency effectiveness. 

Collaboration: Effective collaboration within an SMA for MES projects involves establishing clear roles and responsibilities, using centralized communication tools, and following standardized project management practices. Engaging invested parties early, focusing on data-driven decision-making, and fostering transparency are key to helping ensure alignment and continuous improvement.  

Timely Issue Identification, Resolution, and Communication: Early identification allows for timely resolution, minimizes disruptions, and helps maintain project momentum. It also fosters transparency and trust within teams, ensuring that all invested parties are informed and can collaborate on effective solutions. Swift issue escalation promotes better decision-making and reduces the risk of missed deadlines or budget overruns. Be sure to also communicate the root cause and solution in place to address issues in order to further foster buy-in and credibility.  

Leading through change isn’t just about managing tasks—it’s about guiding people. By focusing on communication, education, and motivation, we help ensure our teams are not only prepared for change but empowered by it. As we navigate the complexities of our work, let’s remember that real progress comes from putting people first, fostering collaboration, and maintaining a clear vision. With these principles at the forefront, we’re not just managing change—we’re driving meaningful transformation. 

Although MESC 2024 has come to a close, conference presentations, innovative discussions, and the work of the industry’s brightest minds live on. Conferences like MESC and the upcoming Information Technology Solutions Management for Human Services (ISM) reaffirm the importance of collaboration, adaptability, and putting people first in our journey toward modernizing HHS programs and the technology needed to support them. As we move ahead, let's remain focused on building strong relationships, staying adaptable in the face of change, and continuously aligning our efforts with the ultimate goal: Better serving the country’s most vulnerable populations. Together, through thoughtful leadership and strategic partnership, we can transform challenges into opportunities for meaningful impact. 

Previous articles in this series: 

CMS is your enterprise partner: Are you leaning in yet?

MITA 4.0, APDs, and more: Clearer guidance and helpful templates are coming!

Medicaid outcomes, measures, and metrics are here to stay

Practical Approaches to Using Artificial Intelligence in State Medicaid Agencies

Read this if you work within a State Medicaid Agency (SMA). This is the fourth article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC) 2024. Prior articles highlighted industry trends, the value of the CMS and SMA MES partnership, and forthcoming guidance on APDs, SMC, and MITA 4.0, while future articles will discuss how SMAs can further support their teams in achieving organizational excellence.

Artificial Intelligence (AI) continues to dominate tech innovation headlines and Medicaid industry partners continue to express both fear and excitement over its potential to tactically support the enterprise. State Medicaid Agencies (SMAs) and their industry partners have been tactfully integrating Artificial Intelligence—whether generative, predictive, analytical, automated, or assisted—into Medicaid discussions and initiatives...and generating positive results!

Below are a few examples of SMAs testing the AI waters and getting favorable results:

• Tennessee is using AI to rapidly locate policy answers to address constituent questions and expedite eligibility determinations.
• Kentucky is using a chat knowledge bot to help eligibility workers search for policy and process information.
• New York is leveraging docAI to match EOBs to claims and identify potential mismatches for human review.
• Louisiana is using a chatbot for non-MAGI call centers to answer basic questions and allow customer service representatives to focus on other work and calls. (Spoiler: Constituents love it!)
• Wisconsin is using a chatbot to examine existing policies and help team members find answers needed to support their responsibilities.

At the Medicaid Enterprise Systems Conference (MESC) in August, SMAs and industry leaders also discussed and provided advice for interested parties looking to start the AI conversation:

• Identify clear objectives for AI—through defined use cases and measurable goals—to help ensure AI initiatives align with your agency’s overall mission, vision, and goals.
• Build a strong data foundation and clear boundaries through data quality, governance, and interoperability.
• Start small with pilot projects.
• Invest in upskilling staff and establish teams to help them understand AI technologies, how to work with them, and how to interpret AI-driven insights. Don’t forget to test your AI technologies!
• Draft and implement agency policies and protocols to monitor AI systems, create transparency, and help ensure ethical and responsible AI use.
• Collaborate with federal and industry partners to share knowledge, resources, and best practices.
• Focus on the scalability of solutions, the need to continuously improve AI technologies, and how teams are using them.

As an industry leader who is partnering with SMAs nationwide, BerryDunn is often called upon to be at the forefront of helping SMAs design innovative solutions for their Medicaid programs. AI provides SMAs the unique opportunity to address operational challenges as well as existing business processes in areas such as program integrity, care management, member engagement, and data analytics and reporting. In addition to the great points industry leaders shared at MESC, below are some additional considerations for Medicaid innovators looking to get started:

Understand the opportunities for AI: Each Medicaid program is unique, and understanding where there may be opportunities for efficiency or enhanced effectiveness is a good first step to identifying where AI may be able to support your program. Typically, the areas of program integrity, provider enrollment, member enrollment, care management, and data analytics and reporting are some of the more typical business areas where AI-related opportunities may exist. An SMA’s Medicaid Information Technology Architecture (MITA) State Self-Assessment (SSA) may be a great document to reference when looking for those opportunities for AI.

Assess the current state: Assessing the current state of an SMA does not just entail focusing on the program’s policy- or technology-related needs. It also entails understanding the organizational capacity for change and its understanding of AI. Change and AI have a tendency to bring about excitement and apprehension, and understanding your SMA's readiness for change and AI is essential part of gaining SMA buy-in.

Define your AI use cases: As an output from your analysis of those opportunities for AI and your assessment of the current state, consider those areas where AI could make the most immediate impact. Maybe it’s in program integrity where predictive analytics and AI-based fraud detection could identify anomalies in billing, or maybe it’s in care management where assistance identifying high-risk patients is needed. As mentioned earlier, start small!

Build a cross-functional team: Successful AI requires collaboration across the agency and more specifically within those areas impacted by your use cases. Typically, AI teams are comprised of a sponsor, more technical resources familiar with the SMA’s technology and infrastructure, your business leads, and AI experts. Your federal partners are also an invaluable resource for you on your AI journey.

Invest in data governance and infrastructure: AI thrives in high-quality data environments, so SMAs will need data governance and its supporting infrastructure to help ensure AI solutions can be effective. Prioritize clean, standardized, and accessible data, and ensure appropriate safeguards (i.e. policy) are in place to support AI usage.

Plan for long-term AI integration (and change!): AI is here to stay. Investing in your agency’s AI roadmap is one effective way to help establish an AI plan and infrastructure that can improve operational efficiency, enhance program effectiveness, and enhance rates of adoption.

By starting with a focused, methodical approach, SMAs can leverage AI to enhance service delivery, improve operational efficiency, and better serve their constituents. Embracing AI is an existing SMA challenge. Let’s continue the conversation on how we can help today!

Previous articles in this series: 

CMS is your enterprise partner: Are you leaning in yet?

MITA 4.0, APDs, and more: Clearer guidance and helpful templates are coming!

Medicaid outcomes, measures, and metrics are here to stay

It seems these days as though there’s a policy or some fine print for everything. As I grow older, I find myself more and more ensconced in reading the fine print on things—be it a food ingredient label, a contract, or the Apple user agreement (ok, maybe I just skim that one). Just last week, I went to return some school clothes my son had already grown out of and was asked if I had reviewed the store’s return/refund policy (I hadn’t). There’s no question that a review of applicable policies is a best practice for everyone—including exempt organizations.

If it’s been a while since your nonprofit organization last conducted a review of its governing documents and policies, worry not, you’re not alone! This article will highlight a few of the most critical documents applicable to nonprofits to ensure you remain in compliance and good standing.

Conflict of interest policy

If I were playing a rather nerdy version of nonprofit Family Feud, and the category was “Most Important Policies,” I would be shocked if the conflict of interest policy wasn’t the number one answer. It is vital that any potential conflict, either real or perceived, be identified and addressed in a manner consistent with the organization’s policy.

This policy is so important the IRS devotes several questions to it on the Form 990, including a required written narrative detailing how the organization consistently monitors and enforces compliance with said policy. Further, there is a requirement for potential disclosure of certain transactions with “interested persons” on Schedule L of Form 990. Transactions include loans as well as business transactions over a specified dollar threshold. It’s important to note that for Form 990 disclosure, the term “interested persons” includes family members of any officers, directors, trustees, or key employees of the organization, as well as any business entity more than 35% owned or controlled by any of the folks mentioned above.

For these reasons, distribution of a questionnaire to applicable organizational members on an annual basis is a baseline standard.

Gift acceptance policy

The gift acceptance policy is one that often goes overlooked or underappreciated until it’s needed; but when it is needed, it can be a lifesaver. This policy can help to navigate and dictate a myriad of issues, including what sort of gifts the organization is willing to accept and how long the organization is required to retain the gift, as well as provide guidance for board or staff members who are on either the asking or receiving end of contributions. And, perhaps most importantly, the policy can help manage the expectations of donors while maintaining a level of courtesy and respect.

The policy most comes into play when it comes to gifts of something other than cash. For example, if a donor wishes to gift the organization with their interest in a partnership, there could be all sorts of potential tax impacts and complications, including unrelated business income and foreign filing compliance. Another more recent example is the proliferation of cryptocurrency. Having a policy in place that addresses these sorts of non-standard contributions can help mitigate potentially awkward or difficult conversations with donors.

Written whistleblower and document retention and destruction policies

Like the aforementioned conflict of interest policy, the whistleblower and document retention/destruction policies have dedicated questions on the Form 990 asking if the organization has these in place. The key word for both policies is "written." Often times, we will hear that a client follows a policy, but it’s not in writing. Unfortunately, this would warrant a “no” response on the Form 990. Potential donors, members of the media, regulators, and careful job seekers will have greater confidence when you respond “yes” to the policy questions on the Form 990.

While there have not been any sweeping changes or recent regulations on either, it is still a good idea to review these policies on an annual basis to ensure they are still in lockstep with the organization. The IRS does consider these policies to be best practices for any organization (large or small) to have in place.

In addition to reviewing policies of the organization, we also recommend reviewing the governing documents of the organization on a regular basis, especially as IRS guidance or tax laws change.

Dissolution clause

It’s a sad reality that all things must come to an end, including business entities. Historically, nonprofit organizations were able to rely upon Revenue Procedure 82-2. This procedure identified states where a Section 501(c)(3) charity could rely on state law to satisfy the requirement that its organizing documents require that, upon dissolution, the charity must distribute all of its assets for IRC Section 501(c) tax-exempt purposes. However, the IRS recently issued Revenue Procedure 2024-22, which now makes Rev. Proc. 82-2 obsolete. Said in simpler terms, organizations can no longer simply rely upon applicable state law to satisfy dissolution requirements at the federal level.

For this reason, we strongly encourage all organizations to review this particular clause and consult with legal counsel as needed to ensure the wording and procedures followed are in line with current law. It may be necessary in some cases to amend governing documents and/or bylaws to add the required dissolution wording to remain in compliance. 

Sample policies for nonprofits

Policies and governing documents are critical in ensuring the organization and its decision-makers protect themselves from wrongdoing and criticism that could undermine the ability to promote the organization’s mission. Organizations will be better protected if there are sound policies and procedures in place that can be adequately followed. There are a number of various outlets that provide sample policies, including the Internal Revenue Service, among others. Links to sample policies and additional guidance can be found below:

• IRS Sample Conflict of Interest Policy
• Gift Acceptance Policies – National Council of Nonprofits
• Sample Whistleblower Policy – National Council of Nonprofits
• Recordkeeping – Internal Revenue Service
• Document Retention and Destruction Policy – National Council of Nonprofits

If you have any questions about the applicability of certain policies, we are here to help! Please do not hesitate to contact a member of your tax engagement team for further guidance.

Now, what to do with these undersized school clothes… perhaps I can donate them to charity? I better check their gift acceptance policy first!

How should a business owner, management team, or investor estimate the value of its company? There are a variety of methods available in the world of business valuation. Let’s discuss the pros and cons of using a common financial metric in the assessment of a business’s value: Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA).

Pros of using EBITDA for business valuation:

• EBITDA targets the core operations of the business, focusing on revenue from operations and the necessary costs to generate revenue. Typically, nonrecurring income and expenses are also excluded.
• EBITDA removes depreciation and amortization, which can be significant non-cash expenses. This provides a better indication of the company’s cash flow from operations compared to other financial metrics, such as operating income or net income.
• EBITDA is useful as a reflection of operating profitability. It drills down on revenue and ongoing operating expenses, which results in a clearer measure to compare the performance of two companies.

Cons of using EBITDA for business valuation:

• EBITDA is not an exact snapshot of cashflow from operations, as it does not account for changes in working capital. Also, it includes certain non-cash expenses, such as stock option compensation and bad debt expense.
• EBITDA ignores cash outlays for capital expenditures. Warren Buffet once said, “Does management think the tooth fairy pays for capital expenditures?” Many businesses must incur costs annually for upgrading and maintaining capital assets (machinery, equipment, etc.). The normalized level of capital expenditures can vary significantly depending on which industry the company operates in.
• EBIDTA disregards debt and interest expense. The metric can distort the financial well-being of a business if it carries significant debt and pays substantial interest costs to service the debt each year.

EBITDA is one measure to value a business. Other financial metrics to consider are the discounted cash flow method, free cash flow, and others. Certain metrics may be more meaningful for different industries and at different points in a company’s life cycle. Despite some flaws, when it comes to valuing a company, EBITDA is a go-to metric that is a focal point of many deals.

If you have questions about assessing the value of your business, please contact our business valuation professionals.

Read this if you work within a State Medicaid Agency (SMA). This is the third article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC) 2024. A prior article highlighted industry MES trends and the value of the CMS and SMA MES partnership, while future articles will discuss how SMAs can embrace Artificial Intelligence (AI), and how SMAs can further support their teams in achieving organizational excellence.

If there’s one thing that was clear at the recent Medicaid Enterprise Systems Conference (MESC) in Louisville, it is that CMS is focused on meaningful enterprise planning, meaningful outcome definitions, and meaningful data from State Medicaid Agencies (SMAs) to illustrate trends throughout every phase of the IT life cycle and the benefit to Medicaid beneficiaries.

In support of this theme, the Data Systems group (DSG) Division of State Systems (DSS) Director Eugene Gabrielov has also proclaimed this to be the “year of metrics,” and strongly encouraged SMAs to fulfill their obligation to be actively reporting on the outcomes and metrics for all solutions that have received enhanced Federal Financial Participation (FFP).  

CMS also continues to make operational reporting requirements a part of everyday conversations and remains available to SMAs for support in their enterprise planning and outcome management efforts. The partnerships between SMAs, CMS, and other industry partners are more frequently leading to discussions on how to make operational outcomes more meaningful. More often than not, CMS is questioning SMAs about the value attained from SMA outcomes and encouraging them to revisit outcomes to help ensure they are assisting in the management of the enterprise.   

At MESC this year, CMS also reiterated key operational reporting requirements and underscored the importance of SMA adoption of outcomes and adherence to their related reporting requirements:  

• Any Medicaid solution receiving enhanced FFP for M&O should be submitting metrics to CMS.
• Although a draft ORW is required for the Streamlined Modular Certification (SMC) Operational Readiness Review (ORR), SMAs should begin submitting ORWs to CMS and posting ORW information to the Box subsequent to the ORR.   
• In alignment with requirements for SMC-certified solutions, legacy systems must submit ongoing ORWs with data for each metric at least annually; however, CMS encourages this data be produced, reviewed, acted upon (if necessary), and submitted to CMS monthly.  
• Annual OAPD submissions should include 12 months of data and be submitted by the annual OAPD submission deadline (typically in the month of August if not sooner).  
• ORWs submitted with an Operations Advanced Planning Document (OAPD) are expected to include 12 months of data.  

For additional details on operational reporting requirements, refer to this CMCS informational bulletin, the ORW template, the ORW procedure manual, and metrics-related FAQs.  

As SMAs embark on MES journeys and are developing an APD, building an RFP, or merely defining a business challenge, CMS encourages SMAs to reach out to each other, CMS, or the vendor community for support with outcomes definition, adoption, and management. Similarly, several innovative portfolio-management-focused SMAs like Tennessee and Vermont are also looking to technology and supporting services, such as our own HHS investment management suite, tHHS, to plan for change, manage their enterprise, and fulfill federal partners' guidance. These solutions can provide you with valuable insight into the industry data needed to inform strategic planning and related procurement initiatives while also helping you manage the implementation and operations phases of your enterprise.  

The focus on outcomes, measures, and metrics is not a passing trend; it’s the foundation for effective enterprise planning and outcomes management in the Medicaid space. CMS’s emphasis on meaningful data and transparency underscores the need for SMAs to embrace these practices and integrate them into their IT planning life cycle. By leaning on each other, collaborating closely with CMS, and leveraging innovative technologies, SMAs can not only meet these requirements but also drive significant improvements in service delivery and beneficiary outcomes.

As we move forward, let's commit to a metrics-driven approach that helps ensure every decision, every investment, and every effort aligns with the ultimate goal of enhancing the lives of those we serve.  

Previous articles in this series:

• MITA 4.0, APDs, and more: Clearer guidance and helpful templates are coming!
• CMS is your enterprise partner: Are you leaning in yet?

Read this if your parks and recreation agency is thinking about AI integration opportunities.

For decades, park and recreation agencies have been challenged to “do more with less.” Is that tall order becoming easier? Imagine a world where managing parks and recreation becomes not just easier, but also more innovative and efficient. Some would argue this vision is becoming reality, thanks to advancements in Artificial Intelligence (AI). Long perceived as a domain reserved for tech giants and futuristic films, AI is now an accessible, transformative tool that has become part of everyday life for many people. It’s more than a buzzword; AI is a technology capable of analyzing vast data, automating routine tasks, and unlocking insights.

Recent developments in Generative AI tools, such as ChatGPT, have brought the power of AI to the forefront, dominating news and becoming a practical tool for the masses. With these advancements in text- and image-based AI, the way we manage parks, market programs, and engage with the public will be going through a transformative shift. While early, this change isn’t speculative; it’s already impacting our field. These tools simplify creating compelling narratives for grant proposals, designing eye-catching promotional materials, and more, transforming tasks that once required extensive manual effort.

This article will shed light on how AI can enhance your parks and recreation services, making them more efficient, engaging, and sustainable.

Opportunities and benefits of generative AI: Content creation

When it comes to writing content for websites, newsletters, or press releases, AI writing assistants are transforming the process. These tools can generate anything from social media posts to detailed reports, suggest improvements, and even tailor the language to different audience segments. Similarly, routine communications, such as newsletters or event descriptions, can be generated quickly and efficiently, allowing staff to focus on more creative and strategic tasks. In addition to speeding up content creation, these tools ensure messages are clear, engaging, and aligned with your brand voice.

Tools like Grammarly have been around for years and can be used as a stand-alone application, browser plug-in, or word processor add-on to provide grammatical corrections and feedback on style and tone. Over the past year, generative AI tools from OpenAI, Google, Microsoft, and others have provided significantly more functionality—instantly generating draft documents based on user prompts or completely rewriting existing content for new audiences. These tools have become so mainstream that they are being incorporated into products you use every day, such as Copilot for Microsoft Office and the latest smartphones.

Park and recreation professionals are using these tools to increase creativity and efficiency for everything from program descriptions and social media posts to drafting contracts and grant applications.

Research and information synthesis
Generative AI is transforming the way people gather and synthesize information. Imagine leveraging AI to quickly compile historical information, best practices, and case studies relevant to park management and recreational program development. While inaccuracies and hallucinations remain a concern at this time, AI tools can scour a wide range of sources, from academic journals to industry reports, extracting pertinent information and presenting it in a concise, easily digestible format. In addition to scanning PDFs and websites, generative AI tools can also quickly synthesize information from lengthy videos by scanning their transcripts. Otter.ai is one example of applications that listen to virtual and in-person meetings and provide transcripts and meeting summaries to share with participants.

Brainstorming and creativity
Park and recreation professionals can use AI as a collaborative partner and idea generator. These tools can generate a plethora of topics, from innovative park programs to unique visitor engagement strategies. Imagine an AI that suggests new event themes based on trending topics or environmental concerns or offers creative solutions for park maintenance and conservation challenges. This technology doesn’t replace human creativity but rather enhances it, providing a springboard for brainstorming sessions and helping teams think outside the box. It’s a partnership where AI provides the seeds of ideas, and human ingenuity cultivates them into fully realized projects.

Enhancing marketing with AI-driven graphic design
Imagine creating stunning, custom visuals for marketing campaigns, brochures, and social media posts in a fraction of the time it used to take. Image-based generative AI tools enable the creation of visual content, from posters and brochures to digital advertisements, tailored to specific themes, events, or seasons in our parks. With AI, creating visually appealing designs is not only faster but also more accessible to teams without professional graphic designers. This means that even small-scale events or announcements can have high-quality, engaging visuals, significantly enhancing the overall appeal and reach of marketing efforts. Image-generation tools such as MidJourney and Dall-E have exponentially increased in quality and sophistication over the last few years. ChatGPT now supports image generation by Dall-E, and popular design tools such as Canva and Adobe Photoshop offer several AI tools within their software.

Streamlining communication and design processes
The integration of AI tools promises to streamline communication and design processes significantly. The marketplace is flooded with new tools tailored to specific tasks, like Beautiful.ai for creating presentations, or to serving a variety of organization-wide functions within one platform, such as Jasper.ai. Used well, these tools reduce the time and resources needed to produce high-quality content, allowing park and recreation departments to respond quickly to emerging trends and visitor feedback. This agility ensures that parks remain relevant and engaging to their visitors, adapting swiftly to changing needs and preferences.

Practical steps to implement AI in your parks and recreation organization

The first step in embracing generative AI within your parks and recreation organization is to identify where these technologies can have the greatest impact. Is it in creating more engaging marketing materials, enhancing visitor communication, or streamlining administrative tasks?

Selecting the right AI tools
Look for tools that are user-friendly, cost-effective, and provide reliable support. Ensure these tools are compatible with your existing systems and can effectively handle your specific needs. For instance, some AI platforms excel in text generation for marketing or administrative purposes, while others are more adept at creating dynamic visual content.

Engaging leadership for support and guidance
Involve leadership, information technology, and legal professionals in your organization regarding the AI tools and uses you plan to pursue, as there is security, legal, and ethical concerns with many of these tools and how they may be used (see the next section for more on challenges and concerns).

Planning for implementation
A phased implementation approach is recommended. Start with pilot projects in areas where AI can show quick wins. This could be as simple as using an AI tool to design a new flyer or draft social media posts. These initial projects will offer valuable insights and help fine-tune your approach before a broader roll-out.

Training and empowering staff
Provide your team with the resources and training they need to effectively use these new tools. Encourage a culture where staff feel comfortable experimenting with AI and suggesting innovative applications.

Data management and privacy
Handling data responsibly is a key aspect of implementing AI. Ensure that your use of AI tools complies with privacy laws and ethical standards, especially when processing visitor information. Establish clear guidelines on data usage and privacy to maintain trust and integrity in your operations.

Evaluating and adjusting your AI strategy
Regularly evaluate the effectiveness of your AI implementations. Are they meeting your objectives? Solicit feedback from staff and visitors to understand the impact of these tools. Be open to adjusting based on this feedback and evolving needs, ensuring your AI strategy remains effective and relevant.

Scaling AI implementation
Once you’ve seen success with initial AI projects, consider how you can expand these tools to other areas of your organization. Gradual scaling allows for a more controlled integration, minimizing disruptions while maximizing the benefits. 

Staying informed on AI developments
The field of AI is rapidly evolving. Stay informed about new tools, techniques, and best practices. This continuous learning will help keep your organization at the forefront of AI applications in parks and recreation, ensuring ongoing efficiency and innovation.

Generative AI challenges and considerations

Understanding and managing limitations
While generative AI offers remarkable capabilities, it’s not without limitations. There’s potential for inaccuracies or contextually misaligned content. Crucial to successful implementation is human oversight, ensuring AI-generated content aligns with your specific needs and values.

Navigating data privacy and security
A paramount concern in using AI is data privacy, especially when handling visitor information. Adhering to privacy laws and ensuring data security is essential. It’s important to establish stringent protocols and consider AI tools that prioritize data protection.

Balancing human creativity and AI efficiency
AI should be viewed as a complement to, not a replacement for, human creativity and intuition. The challenge lies in leveraging AI to enhance efficiency while preserving the unique creative input that only humans can provide.

Dealing with technical challenges and integration
Integrating AI with existing systems can present technical challenges, requiring data input and maintenance. To mitigate these issues, collaborating with IT experts to select AI tools with robust support is advisable.

Cost and budget considerations
Implementing many AI tools involves initial investment and ongoing costs. You can get started with tools like ChatGPT and many others for no cost, but more robust features require monthly fees.

Keeping up with rapid technological changes
The rapid evolution of AI technology necessitates continuous learning and adaptation. Staying informed through industry resources and professional networks is crucial for keeping your AI applications current and effective.

Ethical considerations in AI usage
Lastly, the responsible use of AI demands consideration of ethical implications. It’s important to ensure that AI tools are used in a manner that is ethical and align with your organization’s values. This includes understanding how various models are trained, and potential legal or ethical considerations based on your use of those models.

Beyond data sources, one of the main ethical concerns is algorithmic bias, where AI systems can inadvertently perpetuate or amplify existing human biases. For instance, if an AI tool is trained on historical data that reflects past inequities in park access or resource allocation, it might suggest strategies that continue these patterns. It’s vital to critically assess and regularly update AI models to ensure they reflect equitable and inclusive practices.

Another ethical concern is the potential for AI to replace human judgment in sensitive areas. While AI can assist in decision-making, it’s essential to maintain human oversight, especially in matters affecting community well-being or environmental stewardship. Relying solely on AI can lead to decisions that lack empathy or fail to consider the nuances of human experience and the natural world. Ensuring a balanced approach where AI supplements human insight is key to ethical and effective use of these technologies in parks and recreation.

Conclusion

Integrating AI tools into park and recreation practices holds the potential to streamline operations and infuse a new energy into our content and how we interact with visitors. Yet, as we navigate this promising landscape, we must also be prudent. It’s important to proceed with a blend of optimism and caution, recognizing that each step forward comes with its own challenges and learning opportunities. Adopting these tools necessitates a willingness to explore and adapt, and to critically evaluate and refine our approaches.

The road ahead invites us to not only embrace the efficiencies and enhancements that AI offers but also to guard against the complacency that can come with reliance on technology. It’s a journey that calls for a thoughtful blend of human insight and artificial intelligence, ensuring that the services we offer and the spaces we manage are not only improved but also respectfully and sustainably preserved.

Ryan Hegreness originally authored this article in collaboration with ChatGPT and Grammarly AI tools in January 2024. Ryan updated the article for this publication in August 2024.

Read this if you work within a State Medicaid Agency (SMA). This is the second article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC). A prior article highlighted industry MES trends and the value of the CMS and SMA MES partnership, while future articles will include guidance on SMA MES outcomes, how SMAs can embrace Artificial Intelligence (AI), and how SMAs can further support their teams in achieving organizational excellence.

At MESC in Louisville this year, CMS announced it would be publishing new Advanced Planning Document (APD) and testing guidance as well as seven required templates. Through these publications, CMS is acknowledging feedback and lessons learned from SMAs and vendors while also enabling standardization and connections across Medicaid Enterprise Systems (MES). This guidance is also sure to help further data standardization and MES integration within SMAs.

The seven required MES templates, identified below, are coming to you in the very near future:

1. MES APD: Used for Planning-Advanced Planning Documents (PAPDs), Implementation Advanced Planning Documents (IAPDs), Advanced Planning Document Updates (APDUs), and as-needed submissions. Used for both Medicaid Management Information System (MMIS) and Eligibility and Enrollment (E&E) APD submissions. 
2. MES Operations Advanced Planning Document (OAPD): Used to seek funding for system maintenance and operating costs.
3. Analysis of Alternatives (AOA) Template: Used to standardize submission of the CFR-required statement of alternative considerations detailed in the IAPD and other APDs (as applicable). CMS also noted that AOAs and reuse plans serve as a compelling factor in determining CMS support of SMA FFP requirements.
4. MES Medicaid Detailed Budget Table (MDBT): Used to provide a structure for submitting required detailed budget data within an APD.
5. Operations Reporting Workbook (ORW): Used for documenting metric definitions and values that show you are meeting applicable outcomes and benefits to Medicaid.
6. Certification Eligibility Triage Form: Used to determine whether Streamlined Modular Certification (SMC) applies to the project.
7. Monthly Project Status Report Template: Used to monitor, oversee, and manage risks associated with achieving APD-established project outcomes.

CMS also highlighted the next evolution of MITA 4.0, which promises to reduce the burden on SMAs in fulfilling their MITA obligations and aids in streamlining strategic planning efforts and implementation, as well as maintenance and operations (M&O) reporting. Learn more about how Alejandra Johnson, technical director of the Division of State Systems at CMS, and the MITA industry workgroup are moving MITA forward.

Keeping with the theme of furthering CMS and SMA’s partnership, two CMS state officers (SOs)—Jessica Dunlap and Dion Summerville—provided attendees with insight into the day in the life of a CMS SO. They highlighted the SO team structure, operational statistics, and some notable do’s and don’ts. Below are some of my personal favorites:

• The SOs are organized into five color teams and an operations team that spans all 56 SMAs.
• SOs are primarily responsible for reviewing procurement/APD documentation, conducting certification reviews, serving as a strategic partner for the SMA, participating in workgroups, and providing meeting support and technical assistance for SMAs.
• In FY2023, CMS SOs reviewed more than 675 APDs, 500 contracts, 90 SOWs and RFPs, and one audit. That’s a whole lot of documents!
• Other notable APD do’s and don’ts:
  • Do schedule meetings with your SO prior to APD submission.
  • Do clearly define outcomes and metrics.
  • Do forecast and schedule future APD submissions.
  • Do list all contracts and contract costs in the contractor resource section.
  • Do begin cost allocation discussions early.
  • Don’t forget your vendor and personnel resource statements.
  • Don’t forget to include procurement, testing, and implementation schedules.
  • Don’t forget that CMS has a 60-day review window.
  • Don’t skimp on writing your alternatives analysis.

CMS also highlighted the ongoing importance of SMAs building reuse plans into their APDs and announced forthcoming guidance—a testing framework—for SMAs to use in support of their modernization efforts.

CMS’s commitment to providing clearer guidance and standardized templates marks a pivotal step toward simplifying and enhancing SMA MES operations. CMS listened to the needs of SMAs and vendors and is fostering greater connectedness across the Medicaid landscape. As we prepare to adopt these templates and guidance, the message is clear: Success lies in collaboration, standardization, and proactive engagement with CMS. Let’s embrace these changes and continue building stronger, more efficient systems for those we serve.

Please contact our Medicaid consulting team if you have any questions or would like to learn more. We're here to help.