Effective onboarding to improve employee retention 

Read this if you are at a rural health clinic or are considering developing one.

Section 130 of H.R. 133, the Consolidated Appropriations Act of 2021 (Covid Relief Package) has become law. The law includes the most comprehensive reforms of the Medicare RHC payment methodology since the mid-1990s. Aimed at providing a payment increase to capped RHCs (freestanding and provider-based RHCs attached to hospitals greater than 50 beds), the provisions will simultaneously narrow the payment gap between capped and non-capped RHCs.

This will not obtain full “site neutrality” in payment, a goal of CMS and the Trump administration, but the new provisions will help maintain budget neutrality with savings derived from previously uncapped RHCs funding the increase to capped providers and other Medicare payment mechanisms.

Highlights of the Section 130 provision:

• The limit paid to freestanding RHCs and those attached to hospitals greater than 50 beds will increase to $100 beginning April 1, 2021 and escalate to $190 by 2028.
• Any RHC, both freestanding and provider-based, will be deemed “new” if certified after 12/31/19 and subject to the new per-visit cap.
• Grandfathering would be in place for uncapped provider-based RHCs in existence as of 12/31/19. These providers would receive their current All-Inclusive Rate (AIR) adjusted annually for MEI (Medicare Economic Index) or their actual costs for the year.

If you have any questions about your specific situation, please contact us. We’re here to help.

Read this if your agency is planning to procure a services vendor.

In our previous article, we looked at three primary areas we, or a potential vendor, consider when responding to a request for services. In this follow-up, we look at additional factors that influence the decision-making process on whether a potential vendor decides to respond to a request for services.

• Relationship with this state/entity―Is this a state or client that we have worked with before? Do we understand their business and their needs?
  
  A continuing relationship allows us to understand the client’s culture and enables us to perform effectively and efficiently. By establishing a good relationship, we can assure the client that we can perform the services as outlined and at a fair cost.
• Terms and conditions, performance bonds, or service level agreements―Are any of these items unacceptable? If there are concerns, can we request exceptions or negotiate with the state?
  
  When we review a request for services our legal and executive teams assess the risk of agreeing to the state’s terms and compare them against our existing contract language. States might consider requesting vendors provide exceptions to terms and conditions in their bid response to open the door for negotiations. Not allowing exceptions can result in vendors assuming that all terms are non-negotiable and may limit the amount of vendor bid responses received or increase the cost of the proposal.
  
  The inclusion of well-defined service level agreements (SLAs) in requests for proposals (RFPs) can be an effective way to manage resulting contracts. However, SLAs with undefined or punitive performance standards, compliance calculations, and remedies can also cause a vendor to consider whether to submit a bid response.
  
  RFPs for states that require performance bonds may result in significantly fewer proposals submitted, as the cost of a performance bond may make the total cost of the project too high to be successfully completed. If not required by law that vendors obtain performance bonds, states may want to explore other effective contractual protections that are more impactful than performance bonds, such as SLAs, warranties, and acceptance criteria.
• Mandatory requirements―Are we able to meet the mandatory requirements? Does the cost of meeting these requirements keep us in a competitive range?
  
  Understanding the dichotomy between mandatory requirements and terms and conditions can be challenging, because in essence, mandatory requirements are non-negotiable terms and conditions. A state may consider organizing mandatory requirements into categories (e.g., system requirements, project requirements, state and federal regulations). This can help potential vendors determine whether all of the mandatory requirements are truly non-negotiable. Typically, vendors are prepared to meet all regulatory requirements, but not necessarily all project requirements.
• Onsite/offsite requirements―Can we meet the onsite/offsite requirements? Do we already have nearby resources available? Are any location requirements negotiable?
  
  Onsite/offsite requirements have a direct impact on the project cost. Factors include accessibility of the onsite location, frequency of required onsite participation, and what positions/roles are required to be onsite or local. These requirements can make the resource pool much smaller when RFPs require staff to be located in the state office or require full-time onsite presence. And as a result, we may decide not to respond to the RFP.
  
  If the state specifies an onsite presence for general positions (e.g., project managers and business analysts), but is more flexible on onsite requirements for technical niche roles, the state may receive more responses to their request for services and/or more qualified consultants.
• Due date of the proposal―Do we have the available proposal staff and subject matter experts to complete a quality proposal in the time given?
  
  We consider several factors when looking at the due date, including scope, the amount of work necessary to complete a quality response, and the proposal’s due date. A proposal with a very short due date that requires significant work presents a challenge and may result in less quality responses received.
• Vendor available staffing―Do we have qualified staff available for this project? Do we need to work with subcontractors to get a complete team?
  
  We evaluate when the work is scheduled to begin to ensure we have the ability to provide qualified staff and obtain agreements with subcontractors. Overly strict qualifications that narrow the pool of qualified staff can affect whether we are able to respond. A state might consider whether key staff really needs a specific certification or skill or, instead, the proven ability to do the required work.
  
  For example, technical staff may not have worked on this particular type of project, but on a similar one with easily transferable skills. We have several long-term relationships with our subcontractors and find they can be an integral part of the services we propose. If carefully managed and vetted, we feel subcontractors can be an added value for the states.
• Required certifications (e.g., Project Management Professional^® (PMP^®), Cybersecurity and Infrastructure Security Agency (CISA) certification)―Does our staff have the required certifications that are needed to complete this project?
  
  Many projects requests require specific certifications. On a small project, maybe other certifications can help ensure that we have the skills required for a successful project. Smaller vendors, particularly, might not have PMP®-certified staff and so may be prohibited from proposing on a project that they could perform with high quality.
• Project timeline―Is the timeline to complete the project reasonable and is our staff available during the timeframe needed for each position for the length of the project?
  
  A realistic and reasonable timeline is critical for the success of a project. This is a factor we consider as we identify any clear or potential risks. A qualified vendor will not provide a proposal response to an unrealistic project timeline, without requesting either to negotiate the contract or requesting a change order later in the project. If the timeline is unrealistic, the state also runs the risk that the vendor will create many change requests, leading to a higher cost.

Other things we consider when responding to a request for services include: is there a reasonable published budget, what are the minority/women-owned business (M/WBE) requirements, and are these new services that we are interested in and do they fit within our company's overall business objectives?

Every vendor may have their own checklist and/or process that they go through before making a decision to propose on new services. We are aware that states and their agencies want a wide-variety of high-quality responses from which to choose. Understanding the key areas that a proposer evaluates may help states provide requirements that lead to more high-quality and better value proposals. If you would like to learn more about our process, or have specific questions, please contact the Medicaid Consulting team.

Read this if your agency is planning to procure a services vendor. 

Every published request for services aims to acquire the highest-quality services for the best value. Requests may be as simple as an email to a qualified vendor list or as formal as a request for proposal (RFP) published on a state’s procurement website. However big or small the request, upon receiving it, we, or a potential vendor, triages it using the following primary criteria:

1. Scope of services―Are these services or solutions we can provide? If we can’t provide the entire scope of services, do we have partners that can?
   As a potential responding vendor, we review the scope of services to see if it is clearly defined and provides enough detail to help us make a decision to pursue the proposal. Part of this review is to check if there are specific requests for products or solutions, and if the requests are for products or solutions that we provide or that we can easily procure to support the scope of work. 
2. Qualifications―What are the requirements and can we meet them?
   We verify that we can supply proofs of concept to validate experience and qualification requirements. We check to see if the requirements and required services/solutions are clearly defined and we confirm that we have the proof of experience to show the client. Strict or inflexible requirements may mean a new vendor is unable to propose new and innovative services and may not be the right fit.
3. Value―Is this a service request that we can add value to? Will it provide fair compensation?
   We look to see if we can perform the services or provide the solution at a rate that meets the client’s budget. Sometimes, depending upon the scope of services, we can provide services at a rate typically lower than our competitors. Or, conversely, though we can perform the scope of services, the software/hardware we would have to purchase might make our cost lower in value to the client than a well-positioned competitor.

An answer of “no” on any of the above questions typically means that we will pass on responding to the opportunity. 

The above questions are primary considerations. There are other factors when we consider an opportunity, such as where the work is located in comparison to our available resources and if there is an incumbent vendor with a solid and successful history. We will consider these and other factors in our next article. If you would like to learn more about our process, or have specific questions, please contact the Medicaid Consulting team.
 

Read this if you are planning for, or are in the process of implementing a new software solution.

User Acceptance Testing (UAT) is more than just another step in the implementation of a software solution. It can verify system functionality, increase the opportunity for a successful project, and create additional training opportunities for your team to adapt to the new software quickly. Independent verification through a structured user acceptance plan is essential for a smooth transition from a development environment to a production environment. 

Verification of functionality

The primary purpose of UAT is to verify that a system is ready to go live. Much of UAT is like performing a pre-flight checklist on an aircraft. Wings... check, engines... check, tires... check. A structured approach to UAT can verify that everything is working prior to rolling out a new software system for everyone to use. 

To hold vendors accountable for their contractual obligations, we recommend an agency test each functional and technical requirement identified in the statement of work portion of their contract. 

It is also recommended that the agency verify the functional and technical requirements that the vendor replied positivity to in the RFP for the system you are implementing. 

Easing the transition to a new software

Operational change management (OCM) is a term that describes a methodology for making the switch to a new software solution. Think of implementing a new software solution like learning a new language. For some employees, the legacy software solution is the only way they know how to do their job. Like learning a new language, changing the way business and learning a new software can be a challenging and scary task. The benefits outweigh the anxiety associated with learning a new language. You can communicate with a broader group of people, and maybe even travel the world! This is also true for learning a new software solution; there are new and exciting ways to perform your job.

Throughout all organizations there will be some employees resistant to change. Getting those employees involved in UAT can help. By involving them in testing the new system and providing feedback prior to implementation, they will feel ownership and be less likely to resist the change. In our experience, some of the most resistant employees, once involved in the process, become the biggest champions of the new system.  

Training and testing for better results

On top of the OCM and verification benefits a structured UAT can accomplish, UAT can be a great training opportunity. An agency needs to be able to perform actions of the tested functionality. For example, if an agency is testing a software’s ability to import a document, then a tester needs to be trained on how to do that task. By performing this task, the tester learns how to login to the software, navigate the software, and perform tasks that the end user will be accomplishing in their daily use of the new software. 

Effective UAT and change management

We have observed agencies that have installed software that was either not fully configured or the final product was not what was expected when the project started. The only way to know that software works how you want is to test it using business-driven scenarios. BerryDunn has developed a UAT process, customizable to each client, which includes a UAT tracking tool. This process and related tool helps to ensure that we inspect each item and develop steps to resolve issues when the software doesn’t function as expected. 

We also incorporate change management into all aspects of a project and find that the UAT process is the optimal time to do so. Following established and proven approaches for change management during UAT is another opportunity to optimize implementation of a new software solution. 

By building a structured approach to UAT, you can enjoy additional benefits, as additional training and OCM benefits can make the difference between forming a positive or a negative reaction to the new software. By conducting a structured and thorough UAT, you can help your users gain confidence in the process, and increase adoption of the new software. 

Please contact the team if you have specific questions relating to your specific needs, or to see how we can help your agency validate the new system’s functionality and reduce resistance to the software. We’re here to help.   
 

The BerryDunn Recovery Advisory Team has compiled this guide to COVID-19 consulting resources for state and local government agencies and higher education institutions.

We have provided a list of our consulting services related to data analysis, CARES Act funding and procurement, and legislation and policy implementation. Many of these services can be procured via the NASPO ValuePoint Procurement Acquisition Support Services contract.

READ THE GUIDE NOW

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If you have any questions, please contact us at info@berrydunn.com

BerryDunn’s Healthcare/Not-for-Profit Practice Group members have been working closely with our clients as they navigate the effect the COVID-19 pandemic will have on their ability to sustain and advance their missions.

We have collected several of the questions we received, and the answers provided, so that you may also benefit from this information. We will be updating our COVID-19 Resources page regularly. If you have a question you would like to have answered, please contact Sarah Belliveau, Not-for-Profit Practice Area leader, at sbelliveau@berrydunn.com.

The following questions and answers have been compiled into categories: stabilization, cash flow, financial reporting, endowments and investments, employee benefits, and additional considerations.

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Please contact the BerryDunn not-for-profit team if you have any questions, or would like to discuss your specific situation.

Editor’s note: Please read this if you are a not-for-profit board member, CFO, or any other decision maker within a not-for-profit.

In a time where not-for-profit (NFP) organizations struggle with limited resources and a small back office, it is important not to overlook internal audit procedures. Over the years, internal audit departments have been one of the first to be cut when budgets are tight. However, limited resources make these procedures all the more important in safeguarding the organization’s assets. Taking the time to perform strategic internal audit procedures can identify fraud, promote ethical behavior, help to monitor compliance, and identify inefficiencies. All of these lead to a more sustainable, ethical, and efficient organization. 

Internal audit approaches

The internal audit function can take on many different forms, depending on the size of the organization. There are options between the dedicated internal audit department and doing nothing whatsoever. For example:

• A hybrid approach, where specific procedures are performed by an internal team, with other procedures outsourced. 
• An ad hoc approach, where the board or management directs the work of a staff member.

The hybrid approach will allow the organization to hire specialists for more technical tasks, such as an in-depth financial analysis or IT risk assessment. It also recognizes internal staff may be best suited to handle certain internal audit functions within their scope of work or breadth of knowledge. This may add costs but allows you to perform these functions otherwise outside of your capacity without adding significant burden to staff. 

The ad hoc approach allows you to begin the work of internal audit, even on a small scale, without the startup time required in outsourcing the work. This approach utilizes internal staff for all functions directed by the board or management. This leads to the ad-hoc approach being more budget friendly as external consultants don’t need to be hired, though you will have to be wary of over burdening your staff.

With proper objectivity and oversight, you can perform these functions internally. To bring the process to your organization, first find a champion for the project (CFO, controller, compliance officer, etc.) to free up staff time and resources in order to perform these tasks and to see the work through to the end. Other steps to take include:

1. Get the audit/finance committee on board to help communicate the value of the internal audit and review results of the work
2. Identify specific times of year when these processes are less intrusive and won’t tax staff 
3. Get involved in the risk management process to help identify where internal audit can best address the most significant risks at the organization
4. Leverage others who have had success with these processes to improve process and implementation
5. Create a timeline and maintain accountability for reporting and follow up of corrective actions

Once you have taken these steps, the next thing to look at (for your internal audit process) is a thoughtful and thorough risk assessment. This is key, as the risk assessment will help guide and focus the internal audit work of the organization in regard to what functions to prioritize. Even a targeted risk assessment can help, and an organization of any size can walk through a few transaction cycles (gift receipts or payroll, for example) and identify a step or two in the process that can be strengthened to prevent fraud, waste, and abuse.  

Here are a few examples of internal audit projects we have helped clients with:

• Payroll analysis—in-depth process mapping of the payroll cycle to identify areas for improvement
• Health and education facilities performance audit—analysis of various program policies and procedures to optimize for compliance
• Agreed upon procedures engagement—contract and invoice/timesheet information review to ensure proper contractor selection and compliant billing and invoicing procedures 

Internal audits for companies of all sizes

Regardless of size, your organization can benefit from internal audit functions. Embracing internal audit will help increase organizational resilience and the ability to adapt to change, whether your organization performs internal audit functions internally, outsources them, or a combination of the two. For more information about how your company can benefit from an internal audit, or if you have questions, contact us.