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The US Department of the Treasury and the Internal Revenue Service released guidance on February 13, 2023, providing taxpayers with information and timelines on the program under Section 48C(e)(1) for the allocation of $10 billion of Section 48C credits under the recently passed Inflation Reduction Act. Of that total, $4 billion of the Section 48C credits must be allocated to projects located in certain energy communities. The Section 48C(e)(1) program aims to increase US manufacturing capacity and quality jobs for clean energy technologies, reduce greenhouse gas emissions in the industrial sector, and secure domestic supply chains for critical materials and components used in the production of clean energy technologies.

The publication of Notice 2023-18 provides the initial program guidance, similar to the program implemented in 2009 as part of a joint effort between the Treasury, the IRS, and the Secretary of Energy, which allocated $2.3 billion of credits to qualifying advanced energy projects. The notice provides that additional guidance will be issued by May 31, 2023.

The period for taxpayers to submit their initial concept papers, discussed below, is from May 31, 2023, to July 31, 2023. This is a time-sensitive application period for taxpayers if they want to be eligible for consideration of an award of Section 48C credits.

Qualifying advanced energy project credit

Several categories of projects may qualify for the 30% investment tax credit under Section 48C. The 30% credit rate is contingent on whether the taxpayer's project meets prevailing wage and apprenticeship requirements; if it does not, the credit rate is 6%. 

Notice 2023-18 defines the term “qualifying advanced energy project” as a project, any portion of the qualified investment in which is certified by the Department of Energy (DOE) under the submission program as eligible for a credit. Projects focused on the following activities may qualify:

• Re-equipping, expanding, or establishing an industrial or manufacturing facility for the production or recycling of:
  • Property designed to be used to produce energy from the sun, water, wind, geothermal deposits, or other renewable resources
  • Fuel cells, microturbines, or energy storage systems and components
  • Electric grid modernization equipment or components
  • Property designed to capture, remove, use, or sequester carbon oxide emissions
  • Equipment designed to refine, electrolyze, or blend any fuel, chemical, or product that is renewable or low-carbon and low-emission
  • Property designed to produce energy conservation technologies
  • Electric or fuel cell vehicles, as well as technologies, components, or materials for such vehicles, and associated charging or refueling infrastructure
  • Hybrid vehicles subject to weight limitations, as well as technologies, components, or materials for such vehicles
  • Other advanced energy property designed to reduce greenhouse gas emissions as may be determined by the Secretary of Energy
• Re-equipping an industrial or manufacturing facility with equipment designed to reduce greenhouse gas emissions by at least 20 percentage points through installation of:
  • Low- or zero-carbon process heat systems
  • Carbon capture, transport, or utilization of storage systems 
  • Energy efficiency and reduction in waste of industrial process
  • Any other industrial technologies designed to reduce greenhouse gas emissions as determined by the Secretary of Energy
• Re-equipping, expanding, or establishing an industrial facility for the processing, refining, or recycling of critical materials 

New guidance

The Section 48C(e) program will have at least two allocation rounds and Notice 2023-18 provides details regarding the first allocation round, for which the submission period will begin May 31, 2023, and end July 31, 2023. The IRS anticipates that it will allocate $4 billion of qualifying advanced energy credits in this round, with approximately $1.6 billion of credits reserved for projects located in energy communities, and the remaining $2.4 billion for projects with no specific location requirement. The notice states that the designation for energy communities will be determined using a mapping tool that will be referenced in future guidance. 

Section 5 of the notice outlines the round one allocation process discussed below.

Stage 1: Concept paper

1. A taxpayer must submit for each project that it sponsors a concept paper for DOE review by July 31, 2023, through the online application portal, the eXCHANGE portal. More information on the concept paper can be found in Appendix B of the notice. 
2. The DOE will review the concept paper and will send the taxpayer a letter encouraging or discouraging the submission of a Section 48C(e) application. All taxpayers who submit concept papers are eligible to submit Section 48C(e) applications regardless of the DOE’s response.

Stage 2: Section 48C(e) application

1. The taxpayer will then evaluate the DOE’s response letter on their submitted concept paper and determine if they want to submit a Section 48C(e) application. 
2. The DOE will review all applications submitted through the eXCHANGE portal for compliance with eligibility and other threshold requirements; if the application is compliant, the DOE will then conduct a technical review of the application and the DOE will form a recommendation.
3. The DOE will provide a recommendation to the IRS based on that review to either accept or reject the application, and a ranking of the applications. 
4. The IRS will then review the ranking of projects and the DOE’s recommendations and issue either a denial letter or an allocation letter. Taxpayers that receive a denial letter will have an opportunity to request a debriefing. Taxpayers that receive an allocation letter must notify the DOE—through the eXCHANGE portal—within two years from the date the letter is received that the certification requirements have been met. Appendix B of the notice provides more information regarding this notification process. 
5. The DOE will then notify the IRS that it has received notification from an eligible taxpayer that the requirements have been met and the IRS will issue a certification letter.
6. The taxpayer must notify the DOE that the project has been placed in service by submitting information through the eXCHANGE portal within two years of receiving a certification letter. More information on the details of the place in service notification is included in Appendix B of the notice.
7. The DOE then notifies the IRS that it has received confirmation that the taxpayer has placed the project in service. The taxpayer may then claim a Section 48C credit on its income tax return for the taxable year in which the project is placed in service. 

Key observations

• Notice 2023-18 provides examples of qualifying projects for purposes of claiming Section 48C credits in Appendix A.
• An initial concept paper will need to make a compelling case for the DOE to provide an encouragement recommendation. While this notice doesn’t specifically address key considerations outside of the definitions for qualified advanced energy projects, we can look to the previous program implemented in 2009 for guidance. Projects that qualified for that previous allocation of Section 48C credits factored in considerations for a project’s commercial viability (project timeline), domestic job creation, net impact on reducing emissions, levelized cost of energy, and technological innovation. 
• The Section 48C credits are subject to prevailing wage and apprenticeship requirements. Taxpayers should consider this in the project’s planning and feasibility stages.
• Notice 2023-18 notes that taxpayers will be able to identify energy community census tracts using a mapping tool that will be referenced in further guidance. If a project is determined to be within an energy community, it may have an impact on the DOE’s recommendation to the IRS to accept the project for Section 48C credits. 
• Recapture rules apply to Section 48C credits. Taxpayers should be aware and plan carefully through this multiphase application process to ensure these rules are not triggered. 
• Taxpayers should also be aware that if they receive a Section 48C credit, they will be unable to claim the Section 45X Advanced Manufacturing Production Credit on components produced at a facility where the basis of any property was included in a Section 48C credit after August 16, 2022.  Forthcoming guidance will address the interplay between the Section 45X and the Section 48C credits.

As always, if you have any questions about the credits or your specific situation, please contact our Renewable Energy team. We’re here to help.

Written by Gabe Rubio, Courtney Sandifer, and Logan Munson. Copyright © 2023 BDO USA, LLP. All rights reserved. www.bdo.com

Healthcare system conversions are risky endeavors. But what is the alternative? Stay with a system you’ve outgrown and no longer meets your organizational needs? At BerryDunn, our healthcare consulting teams have worked with a substantial number of organizations as they’ve transitioned to new enterprise systems such as Electronic Health Records (EHR) systems and Enterprise Resource Planning (ERP) systems. Based on our experience, there are 10 key areas to focus on in order to have a successful conversion.   

1. Start preparing early 

If you know you’ll be bringing in a success partner like BerryDunn to help you through the conversion, bring them early in the planning as possible. The success of the entire project depends on how well you’ve planned and if you've brought in a strong methodology to approach the implementation.   

2. Assess your needs before you make a decision to change systems 

Before you even decide that you need a new EHR or ERP system, the first step is to conduct a thorough assessment of your current system and determine if you actually need a new system.  It’s possible that your current system could and will meet your needs if set up correctly.  

If you determine that you do need a new system, the next step is to conduct a thorough needs assessment that details exactly what your organization needs out of the system. It’s important not to think in terms of what your old system was capable of, but to focus on the problems that you want the new system to solve. Talking to other organizations or consultants like BerryDunn, who are solely focused on and have experience in this work, can help you determine what best-in-class systems can do.  

3. Understand and mitigate the risks 

There are risks at every stage of the process, from not identifying your needs correctly, not assessing the facility’s readiness for change, choosing a subpar vendor, having an incomplete contract, not monitoring the implementation very closely to meet the deadlines, and not addressing the risks as they appear. It’s important to manage the steps correctly at each phase, beginning with: 

• Documenting detailed requirements for the EHR or ERP system 
• Initiating a formal RFP process to include the system requirements in writing 
• Thoroughly vetting and evaluating vendors consistently 
• Negotiating a solid contract that holds the vendor accountable for support and a timeline 
• Assessing what staffing changes and training are needed 
• Providing sufficient time for testing pre- and post-go-live 
• Understanding and planning for the impacts to your revenue cycle 

4. Manage the vendor 

The vendor may be managing the project, but who is managing the vendor? Whether you hire a consultant like BerryDunn or have in-house resources, managing the vendor can be a full-time job. In our experience, the vendor wants to have a successful implementation as much as you do, and they also want to go live on time so they can move on to their next project. You will need to advocate for your organization and be able to hold the vendor accountable to what was agreed on, even if that means taking more time. If your contract was thorough, you should have enough leverage to do so. The bottom line: Don’t feel rushed to go live until you know you are ready. 

Insist on a detailed implementation plan from the vendor that shows realistic timelines for the tasks needed to be accomplished to meet the go-live date. The project should include weekly communication meetings with the vendor to ensure any problems and delays identified can be addressed quickly. 

5. Make sure your internal project team is ready 

Just as it’s important to ensure your vendor is well-staffed, prepared, and held accountable, these factors are equally important for your internal project team. Take the time at the beginning of the project to create a plan for success that takes into account roles, communication, and contingency plans. A good plan will include:  

• Establishing a project charter to formalize governance, teams, and roles and responsibilities 
• Communicating and reinforcing the project as a mission-critical effort 
• Establishing regular project meetings to follow up on and manage risks, actions, issues, and decisions 
• Monitoring competing priorities and alleviating non-project efforts for staff where possible  
• Anticipating project team turnover and having a plan for backfilling team members in advance 

6. Help your staff adopt the new system 

Even if you implement the best system in the world, if your nurses, doctors, and billing staff don’t use it (or don’t use it correctly), it won’t be effective. You need to be able to manage the people side of change, starting with building the case for why you are switching systems and how it will benefit the working staff. Having a thorough training plan and making sure people are ready for the conversion is a key step that shouldn’t be neglected. 

7. Allocate enough time and the right resources for testing 

Before you go live, you need to know the system is going to work for specific scenarios in every department that uses it. For EHR systems, that is every department that touches a patient. A solid testing plan begins with identifying the key, critical scenarios in each area and assigning the right people to be involved in testing – ideally, those who will be using the new system and have a firm grasp on the typical workflows. The plan should “follow” a patient from the point of registration to treatment, discharge, billing, and patient follow-up. A good testing plan will confirm if the system functions as intended and will drive issue resolution and any needed configuration changes. Ultimately, the result of testing will be to determine if you’re ready for go-live.  

8. Get your accounting systems in order  

Many healthcare organizations implement new accounting ERP systems at the same time they convert their EHR. It is important to determine concurrently how the operational and financial data from the EHR will be integrated into the general ledger and reporting dashboards. A study will need to be made on the ease with which the payroll information from the outside software application can be accurately uploaded. Your chart of accounts likely will need to be revamped.  Electronic invoice routing and approvals have become very sophisticated and can improve efficiency with the proper setups. Your new accounting ERP system should not be a “last minute thought” but carefully selected and planned as the EHR is being implemented to ensure accurate and state-of-the-art reporting to deliver to your internal and external audiences.   

9. Don’t neglect your revenue cycle 

Launching a new system is not business as usual. Most new EHRs introduce new complexity to the clinically driven revenue cycle. This requires different management skills and tighter coordination across the organization. Success requires advance planning around charge master structure changes, patient access, and other workflows that will heavily change. Attention needs to be paid to leveraging clearinghouse functionality, and testing plans should incorporate all charging and payor scenarios.  

In addition, no matter how prepared you thought you were, your clinicians are just not going to be able to do things as fast as usual when using a new tool. It takes time to build proficiency in any new system. When launching a new EHR, you’ll need to schedule lighter patient loads in the weeks after your go-live, allowing flexibility for fixing problems and for taking into account learning curves.  

Because of this lighter load, your revenue cycle will be impacted. Fewer patients will be cared for, and fewer patients will be billed. You need to consider these cash flow impacts and plan around legacy receivables well before launch day (ideally as much as two years prior) so you can plan for it and ensure that you’re accounting for, and finding ways around, any shortfalls.  

10. Manage the post-go-live transition 

So you went live with your new system. Congratulations! But this isn’t the end. The two weeks after your go-live date are very important. Are you meeting with the vendor to track defects? Are you getting everything out of the system that you dreamed of? Do you have a plan for addressing deficiencies and adding more functionality? Most vendors have a two-week window to help you post-go-live. You need to take advantage of that while you still have their attention. Once you transition to help desk support, you’re just not going to get the attention that you were before. Having a plan and a system in place for these post-go-live weeks is crucial.  

Is it time to bring in a success partner?  

To be successful, you need a partner who can address all of your needs and be your advocate, and expert, providing the support – and the answers – to questions you might not even know to ask. BerryDunn’s Healthcare team works with healthcare organizations every day, all year long, guiding them through EHR and ERP selection, vendor management, system implementation, testing, and beyond to mitigate risks and help ensure your investment pays off. We’re happy to discuss how we can help you with project and change management, interim or project staffing assistance, system report creation and dashboarding, and revenue cycle optimization. Contact a member of our team.                                                              

Read this if you are looking to improve anti-fraud controls within your government agency. 

According to a 2022 report by the Association of Certified Fraud Examiners, occupational fraud is the most common form of financial crime in the world and costs government agencies a median loss of $138,000 per case. 

Black's Law Dictionary defines fraud as "all multifarious means which human ingenuity can devise, and which are resorted to by one individual to get an advantage over another by false suggestions or suppression of the truth. It includes all surprise, trick, cunning, or dissembling, and any unfair way by which another is cheated." 

Occupational fraud, a subset of fraud, is defined as the use of an employee’s occupation for personal gain by misusing or misapplying their employer’s resources or assets. 

What are the consequences of government fraud? 

Fraud significantly impacts organizations of any size. The greatest consequence of government fraud is the loss of public trust and taxpayer money. The misappropriation and misuse of government funds and property can: 

• Delay the delivery of government services and programs 
• Increase the cost of government services and programs 
• Reduce organizational compliance and performance 

In order to address government occupational fraud, you first need to understand why it occurs.  

Why do people commit fraud?  

People may commit fraud for several reasons: 

1. They rationalize the act or decision. They may think: “I deserve a raise” or “I’ll return the money” or “Someone else is getting away with it. 
2. They feel significant financial or social pressure. They may be overwhelmed by personal debt or feel insecure about their future with the agency.  
3. They have an opportunity for financial or personal gain. They recognize that the department or organization lacks internal controls or management oversight and seek to take advantage of this weakness. 

What are the most common government fraud schemes? 

One common example of government occupational fraud would be obtaining or disclosing personal or government data for personal gain. 

Other common types of government fraud schemes include, but are not limited to: 

• Public corruption 
• Procurement fraud 
• Fraudulent claims and statements 
• Healthcare fraud 
• Grants fraud 

What are the signs to look for of fraud in local and state government? 

There are some commonalities among most types of government fraud. The following circumstances are often red flags for fraud: 

• Large government budgets and expenditures 
• Lax monitoring and oversight  
• Poorly defined roles and responsibilities 
• Poor inventory management and recordkeeping 
• Poor vendor management 
• Undisclosed conflicts of interest 
• Lack of segregation of duties 

Identifying red flags and mitigating risk can renew public trust and confidence in government agencies and employees. We encourage management to conduct a risk assessment to determine if an environment is susceptible to fraud. 

To help you assess your current risks, the complimentary fraud vulnerability checklist is a quick self-assessment tool for any government agency or department to gauge if your organization would benefit from a comprehensive risk assessment.   

For more information on how to identify and mitigate fraud, waste, and abuse in your government agency, please contact our compliance and risk management consulting team. We’re here to help. 

Read this if you are considering an EHR system implementation.

Recently, we were working with a client project team on an electronic health record (EHR) system implementation across multiple locations. We were reviewing the results of integrated and unit testing and it was apparent that more testing was needed—but not enough timeline remained before the go-live. The decision was made to delay the go-live. It was the right decision to make as now the team had the time to have a more fully tested and ready system. However, the CIO was concerned that a delay in the go-live would reduce the urgency and effort the project team had been putting in.

We told the client that they needed to go the same speed, and just needed more road. “Same speed, more road” became our battle cry for the remainder of the project, and after a two-month delay, we had a successful go-live.

Organizations are often hesitant to think about changing the schedule or delaying a go-live. It is an understandable hesitation as many things are tied to the schedule including conference room reservations, vendor travel, reduced patient schedules, and even vacation blackouts. However, using the project schedule should be at the forefront of an organization’s project management toolkit. 

The Iron Triangle of project management has three primary variables: scope, schedule, and resources. And in the center of them is the quality of the project. 

In the current healthcare environment, hospitals, nursing homes, and health systems may find it challenging to consider scope or resources as primary tools. 

• Scope
  Whether you are a hospital replacing multiple EHRs with one, or a nursing home replacing paper charts with an integrated EHR, the foundational scope needed is large and expansive and with few items that you can pare back. The required scope limits your ability to use a reduction in scope to improve project outcomes.
• Resources
  Between the significant staffing shortages across healthcare and the financial headwinds health systems are facing, resources are scarce. In the face of these challenges, using resources as a primary tool to keep a project on track presents its own challenge.
• Schedule
  A schedule is the most available tool to use to keep an EHR project on track. While this is a tool not without limits, challenges, or problems, planning for it from the onset of an EHR project is key to successful implementation. 

EHR system implementation schedule flexibility tactics

To have schedule flexibility as a readily available tool for your EHR project, here are tactics to set you up for maximum success:

• Realistic timeline
  EHR vendors often provide you with timelines that may be realistic to achieve under ideal conditions but may fall short when reality sets in. Reviewing and planning an EHR implementation timeline with your preferred vendor in advance of contract signing is beneficial. You should look to incorporate known constraints, known risks, and sufficient contingency time to keep the project on track when issues arise. For example, if a vendor provides you with a six-month implementation time frame that starts in October and concludes in April, it may not account for the disruption the fall and winter holidays could have in shrinking the actual number of project weeks within that six-month window. 
  
  If you anticipate a survey window during a particular point in the project and have no contingency time to redo a project even if the surveyor shows up, that could cause problems. Also, when reviewing the timeline, look at the time between each testing event and the scheduled go-live. If there is not sufficient time between each of these important project milestones, you will not leave yourself enough time for defect resolution or an additional testing event without having to change your go-live date. By setting a realistic timeline with sufficient slack time between major events, you increase your likelihood to address issues and maintain your planned go-live date.  
• Effective contracts
  Negotiate contract provisions with your preferred EHR vendor to give you schedule options that are not overly punitive to your health system. Contract provisions that allow you to delay if the vendor has challenges that warrant the delay without financial penalty are essential. You will need clear acceptance criteria that must be achieved in order to go live and set expectations for how schedule changes would be addressed if you need to delay for your own resources. Without planning the options in advance of the project, schedule changes and delays can become overly contentious with the vendor and costly to your health system.
• Set priorities
  Work with your senior leadership, medical staff, and board to understand how the schedule may be used as a tool for project success. Describe how, why, and when a project delay may be used. Get everyone on the same page with the go-live criteria that will be used, conditions that would warrant a delay, and how the timeline will be used to bring about a successful go-live. 
• Know why
  No EHR go-live is perfect or risk-free. It is all about acceptable levels of risk in order to proceed to go-live. Be clear and differentiate between being nervous and needing to delay. Use your go-live criteria, your risk and issues logs, and the input from senior leadership and staff to establish if you are just nervous or are actually at a risk level that warrants a delay. 
• Be better
  Delaying and doing nothing differently can make you run later and more expensive, but no more successful than had you gone live on the original date. At a minimum, embracing the “same speed, more road” battle cry is warranted with a delay. There is no slowing down, taking a break, or stepping back. If anything, depending on your situation, it may warrant “faster speed, more road” to be successful. This can come in the form of daily project huddles, repeated pulse surveys, dedicated events focused on resolving project issues, additional testing events, and any recurring meetings between your leadership and the EHR vendor’s leadership team. When you delay, have a clear plan of attack for improving the project.
• Try not to kick the can
  If you are facing a project delay, it can be very tempting to want to delay it as little as possible. This is understandable as everyone has been working hard and wants to reach the go-live date. Be cautious and confirm your delay is sufficient to address the risks, issues, and tasks needed to improve the project. Medical staff and colleagues will be tolerant of a delay to achieve a successful EHR go-live but will grow wary if you must delay repeatedly. When you make a delay call, build a plan and schedule with sufficient time, including contingency time, built in. It is better to be ready and confident early than have to face the challenge of a repeated delay.

EHR implementations are hard, stressful, and intense endeavors. They overturn nearly every process in your health system. By the time you approach go-live, people are ready to get there and hesitant to make changes. However, you may not be ready to go live successfully. The scope of the project may not be able to be reduced and additional resources may not be available. Using schedule flexibility to your advantage may be your best option for a successful go-live. Know why, how, and when to use this tool—and communicate clearly and broadly to your organization—and success can follow. 

Read this if you are looking to find balance with digital usage at your organization.

The current digital well-being environment

Over the last few decades, there has been a major shift in the use of smartphones, laptops, tablets, and other devices. Technology has become an integral part of people’s private and professional lives and the constant innovations and improvements in technology have made information much more accessible than ever before. Some people are finding themselves to be too reliant on technology, however, and the transition to a technology-driven environment and constant exposure to screens have led to a serious dilemma for employees and employers: finding a healthy work-life balance. 

Studies have consistently shown the detrimental effects of excessive technology use, which include:

• Physical health concerns, such as vision problems, neck strain, and even heart complications due to extended periods of sedentary behavior.
• Mental health concerns, such as increased stress, anxiety, depression, and a general sense of dissatisfaction with life.
• Social isolation and feelings of loneliness, as digital interactions may not fully substitute for meaningful face-to-face connections.
• Disrupted sleep patterns, as the use of technology before bedtime makes it harder to obtain quality sleep and can lead to sleep disorders.
• Reduced engagement and performance in the workplace, potentially impacting productivity and job satisfaction.

What is digital well-being? 

The negative impacts of excessive technology use can prevent employees from maximizing their potential. This has paved the way for digital well-being, which is an emerging concept designed to help manage some of the inherent risks of increased technology use and help employees find an ideal work-life balance. 

Digital well-being is about creating and maintaining a healthy relationship with technology. It is a subjective and individual experience of understanding the optimal balance between the benefits and drawbacks obtained from technology. A common example of how technology can have a negative impact on employees is the overuse of social media during the workday. This can quickly lead to employee disengagement and decrease work performance. Although many workers rely on technology to perform their jobs, digital well-being is about using technology in such a way that helps employees. Objectives for increasing digital well-being include:

• Developing a clear understanding of the advantages and potential risks associated with technology usage.
• Striking a balance between professional commitments and personal life responsibilities. 
• Cultivating and maintaining meaningful connections with coworkers, family members, and friends. 
• Efficiently managing workload and minimizing digital distractions.
• Actively participating in social and community events and activities.

Why is digital well-being important?

With the shift to a technology-driven environment, the ability to concentrate without distraction is becoming increasingly valuable among employers. An individual’s technological dependencies and habits may decrease their ability to focus for prolonged periods of time, especially if they are constantly interrupted by incoming communications and notifications. Technology should help individuals achieve their private and professional goals, rather than distract them or get in the way.

Digital well-being enables employees to be more engaged and productive, as well as maintain healthier lives outside of the workplace. Adopting leading digital well-being practices can help employees focus on their work and cause less exhaustion and distraction. For example, an employee who checks their smartphone four to five times a day will likely be more productive than someone who regularly checks their device every few minutes. This can result in improved individual performance over time and a greater contribution to team and company performance.

Finding balance in the workplace

As remote work gains popularity and flexible work arrangements become the norm, technology can be both helpful and intrusive. Collaboration tools, such as Zoom and Microsoft Teams, can help keep employees digitally connected but can also be distracting for team members being bombarded with communications and requests. Additionally, employees may be tempted (or expected) to answer communications and continue to work after the workday is over. This makes it hard for employees to separate their work life from their private life. But employers can help their workforce find this balance. 

The National Day of Unplugging, celebrated on the first Friday of March, has been followed by many organizations for several years and encourages people to disconnect from technology for 24 hours and engage in activities that promote well-being. 

Best practices for digital well-being

Ultimately, employees are responsible for their digital well-being. Simple changes made consistently over time can make a big impact. Some best practices for individuals to follow include:

• Be mindful of the information and media you consume online. By engaging with reliable sources, fact-checking information, and balancing digital experiences with offline activities, you can increase your digital well-being.
• Focus on positive aspects and achievements of others online. When you avoid negative social comparisons online, you develop healthier relationships and interactions online.
• Understand and manage your digital identity and footprint. Our online habits and activity can shape how others perceive us and can impact our personal and professional lives. This is especially true for social media. By being mindful of the impact our words and actions can have, we can contribute to a more supportive digital community.
• Express yourself and be creative. It is important to engage in creative activities online that promote mental well-being, boost self-esteem, and enable you to explore your passions and talents.
• Address digital clutter. The accumulation of unnecessary and disorganized digital files, emails, and applications can have a negative impact on productivity and stress levels.
• Optimize workspaces. Whether you are in the office or at home, an optimal workspace can improve productivity and reduce distractions. 
• Distinguish between intentional and passive use of technology. Intentional use involves purposeful engagement, while passive use can lead to mindless scrolling and excessive screen time, which can negatively impact your overall well-being.
• Set boundaries and take breaks. Engaging in offline activities, practicing mindfulness, and setting boundaries with technology allows individuals to recharge, reduce stress, and maintain a healthy balance between digital engagement and self-care.
• Develop a healthy pre-sleep routine. Getting sufficient and quality sleep is essential for overall well-being. Excessive use of digital devices, particularly before bedtime, can disrupt sleep patterns and negatively impact physical health.
• Consider a digital detox. Sometimes we just need a break from digital devices and social media platforms. A digital detox is a period when you disconnect from digital devices and technology, typically for a temporary duration, to reduce screen time and digital distractions and promote overall well-being.

To encourage and help workers find a healthy work-life balance, employers should:

• Foster a positive digital culture. Encourage collaboration, enhance employee engagement, and prioritize well-being. This type of culture can promote effective communication, reduce misunderstandings, and enhance productivity.
• Train employees on how to use digital tools and platforms. Being familiar with technology allows your team to adapt to new tools and stay updated in a fast-paced digital environment.
• Help employees stay focused and limit distractions. You should not only focus on training your team on how to use technology, but also provide guidance on how to concentrate on tasks, be more efficient, minimize interruptions, and achieve goals. 
• Educate employees on privacy and security. This can help your employees feel more confident and empowered in their use of technology and can help reduce the risk of cyberattacks, such as data breaches and ransomware attacks.
• Provide ergonomic support and help optimize workspaces. Whether your team members are in the office or at home, it is important to help create workspaces that support proper posture, comfort, and overall well-being. 
• Collaborate and communicate strategically. Collaboration and communication are critical for teams, particularly for hybrid and remote workforces. At the same time, excessive emails and chats can be distracting and lead to disengagement. Too many meetings, particularly virtual meetings, can also lead to physical and mental fatigue. When possible, find ways to meet face-to-face.
• Support employees on their digital journey. You should provide resources to help your team develop healthy digital habits, manage stress levels, avoid burnout, reduce feelings of isolation, and find a healthy work-life balance.
• Develop a sense of connection and community. This can help create a supportive and inclusive environment that allows team members to share common interests, receive support, engage in collaborative activities, and foster a sense of belonging.
• Check in with employees on a regular basis to verify that their digital needs are being met. Managers should ask targeted questions such as: Are you finding it difficult to disconnect from work after hours? Are there tools you feel that are hindering your productivity or well-being? Do you feel a sense of fulfillment, satisfaction, and purpose in your work?
• Encourage breaks and physical activity throughout the workday. By decreasing the amount of screen time and allowing the brain to rest and recharge throughout the workday, team members can reduce eye strain, fatigue, and other physical discomforts, improve productivity, reduce stress levels, elevate mood, and enhance creativity. Your organization may consider implementing activity challenges to promote physical activity and encourage healthy behaviors.  
• Encourage employees to disconnect. Managers should set clear expectations for when employees need to be available and advise them only to contact one another after hours with urgent matters. Additionally, when possible, employees should have the ability to turn off notifications on personal devices after workday hours.

Conclusion

It is important for organizations to recognize the impact of technology on employee health and happiness. In today's current environment, technology is an essential part of daily operations, and its overuse can quickly lead to burnout, stress, and decreased productivity. 

Being proactive about employee digital well-being leads to a more supportive work environment that benefits both employees and the organization. This can lead to higher productivity, increased job satisfaction, and reduced turnover rates. Additionally, it sends a clear message to current and potential employees that the organization cares about their well-being, which can help to attract and retain top talent. 

Digital well-being resources

If you would like more information about digital well-being or have questions about your specific situation, please contact our Well-being Consulting team. We’re here to help.

Read this if you are a State Medicaid Agency (SMA).

On April 27, 2023, the Centers for Medicare & Medicaid Services (CMS) published a proposed new rule titled “Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality,” intended to address the most critical elements of access and person-centered care. The COVID-19 Public Health Emergency (PHE) tested states’ abilities to connect individuals to quality care, stabilize the workforce, and monitor Medicaid managed care programs. Leveraging the proposed changes in this rule, CMS aims to provide guidance to states to help advance CMS efforts to improve access to care, quality, and health outcomes, and better address health equity consistent with the CMS Framework for Health Equity 2022 – 2032.

This summary is intended to offer a glimpse of the proposed provisions for which CMS is seeking feedback. Below are some highlights of the significant changes:

Enrollee experience

To enhance state monitoring of network access, CMS is proposing that states take on a qualitative and quantitative approach to monitoring service access. Specifically, CMS proposes to revise regulations to explicitly include “enrollee experience” and require states to use the results from the annual enrollee experience survey and secret shopper surveys that offer a person-centered view to understanding network deficiencies.

Transparency

In an effort to promote transparency and empower enrollee choice, CMS proposed several requirements that would make states' websites easier to use. The proposed rules require states to post up-to-date information on their websites, including making available a one-stop location for enrollees to compare health plans.

State Directed Payments (SDPs)

Given the growing number of SDP preprints submitted for approval, proposed changes in this area are focused on strengthening vague contractual, procedural, and monitoring requirements to help ensure access to care and implement proper fiscal and program integrity guardrails.

Medical Loss Ratio (MLR) standards

CMS aims to establish consistency in MLR methodology across multiple markets (private, Medicare, Medicaid, and CHIP) to improve administrative efficiency for the states regulating insurance and Medicaid/CHIP and for the collection and measurement of data to calculate an MLR and provide reports. The proposed changes include revisions to requirements for clinical or quality improvement standards for provider incentive arrangements, prohibited administrative costs in quality improvement activity reporting, and additional requirements for expense allocation methodology reporting

In Lieu of Services (ILOS) and settings

ILOS offers states the flexibility in managed care to substitute a service or setting for a service or setting covered under the state plan, when medically appropriate and cost effective, to enrollees. This proposed rule looks at ILOS as a mechanism for addressing Social Determinants of Health (SDoHs) and health-related social needs, proposes that states evaluate the impact ILOS has on health equity, and evaluates whether ILOS is an appropriate and efficient use of Medicaid and CHIP resources. There are several requirements based on helping to ensure fiscal protections are in place for investments in ILOS.

Medicaid managed care quality rating system

CMS is proposing changes to how states monitor quality of services delivered and aimed at promoting member choice. The goals of quality improvements are intended to make quality reporting more transparent and meaningful for driving quality improvement, reduce burden on certain quality reporting requirements, and establish a rating system for Medicaid and CHIP health plans.

CMS is seeking feedback on these proposed rules. Public comments are due by July 3, 2023, and can be submitted at the following link: Regulations.gov.

If you would like more information or have questions about the proposed rule and guidance on assessing, developing, or implementing changes to your managed care program, please contact our Medicaid consulting team. We are here to help.

Key employees, as their name suggests, are integral to the success of the companies they lead, as they are responsible for the direction of their company and many of the fundamental decisions that must be made. Given the weight of the decisions that are made by people in these roles, it is important to attract and retain the highest-quality leaders in your organization. Employment contracts are an effective tool companies can use to attract, support, and retain their key employees, as they formally outline terms that both parties agree on, and protect both parties’ interests. Some elements of an employment contract include:  

• Outlining job responsibilities and schedule
  Setting clear expectations and goals for all employees, including leadership, can help to keep the company focused on its overall mission. These expectations can include individual performance goals, as well as strategic goals relating to the vision of the company. The contract can also set the expectation of what type of time commitment is required, if there will be a lot of traveling, and who the key employee should be regularly communicating with about business decisions and results. 
• Duration of employment
  Outlining the duration and conditions of employment is another expectation that can be set early on. This can include considerations such as how many years the employee will serve in the position, if there is an opportunity to renew and extend the relationship, and other important timeline details. Giving this clarity to leaders can help them appropriately frame their timelines when they are deciding their vision for the company and what they can reasonably accomplish during their tenure. 
• Compensation and benefits
  The responsibilities owned by key employees are often directly linked to the increase in compensation and benefits they receive. Employment contracts allow employers to state clearly how key employees will be compensated and demonstrate to prospective employees how they will be compensated for the position they are accepting. This also provides an opportunity to discuss bonuses or performance-linked compensation, including nonqualified deferred compensation, which ties in with the above-outlined responsibilities and goals, as well as who will be determining those goals. Like compensation, strong benefits can entice talented prospects to not only join your company, but to remain. It is important to maintain a competitive edge if you want to attract key leaders and retain them going forward. Establishing these incentives and benefits is a promise to your key employees that you value their hard work and want to recognize and reward their commitment. 
• Non-compete and confidentiality agreements
  There are many other clauses, conditions, and perks that can be included in these contracts. One to consider is a non-compete agreement, which bars an employee from competing with the company for a specified duration of time during and/or after employment. The contents of the agreement can differ depending on the company, but can include various stipulations such as prohibiting employees, for a period of time, from leaving the company to work for a competitor or starting their own business selling competing products or services. A confidentiality agreement can give employers protection by asking their employees not to share any confidential or proprietary information the employee has access to during employment. 

An appropriate employment contract can protect both the key employee and the company by defining important terms of employment and setting expectations from the start. It offers legal protection and can be referenced when evaluating performance or deciding who is responsible for certain decisions and actions. Without an employment contract, both the employee and the company are left open to misunderstandings. For additional perspective on employee considerations, please reach out to a BerryDunn professional.

Read this if you are at a state agency looking to implement or improve your 988 Suicide & Crisis Lifeline. 

The 988 Suicide & Crisis Lifeline offers numerous opportunities to improve crisis response. The National Suicide Hotline Designation Act enables states to pass legislation to support planning and implementation of the 988 Suicide & Crisis Lifeline. As of September 2022, 23 states¹ have passed legislation to facilitate the implementation of the 988 Suicide & Crisis Lifeline. Colorado, Nevada, Washington, and Virginia enacted legislation with 988 telecommunication fees to support 988 operations and to provide financial sustainability for the system. The fees range from $0.18 to $0.40 in these states, who plan to use the revenue for crisis outreach and stabilization services, 988 call routing, and establishing mobile crisis teams². Several states such as Connecticut, Indiana, Maryland, and Virginia have introduced a 988 fund to protect 988 fees, appropriations, and other funding sources. These legislations can be a model for many other states who are still in the planning phase of 988 Suicide & Crisis Lifeline implementations. 

Many states are utilizing federal funding sources to implement the 988 Suicide & Crisis Lifeline. Texas received an $8 million dollar Substance Abuse and Mental Health Services Administration (SAMHSA) 988 State and Territory Cooperative Agreements grant. Texas is utilizing the grant to improve state response to 988 contacts by supporting workforce capacity building and unification of 988 responses statewide³. Washington received $2 million to improve state and territory response to 988 contacts and California received $14 million to support 988 implementations⁴. Maryland received a $2 million federal grant, which will be used to increase staffing within the state’s call centers, improve workforce, integrate 988 and 911, and enhance behavioral health preventive services⁵. 

Click here to view various funding sources along with the eligibility and usage of the available funds that states can leverage for the implementation of 988 Suicide & Crisis Lifeline. 

If you have any questions about implementing a 988 Suicide & Crisis Lifeline, or have questions about your specific situation, please contact act BerryDunn’s behavioral health consulting team. We’re here to help.

¹https://www.nashp.org/state-legislation-to-fund-and-implement-988-for-the-national-suicide-prevention-lifeline/  
²https://www.nasmhpd.org/sites/default/files/988_Convening_Playbook_States_Territories_and_Tribes.pdf
³https://www.hhs.texas.gov/sites/default/files/documents/9-8-8-implementation-study-rider-58.pdf 
⁴https://www.samhsa.gov/grants/grants-dashboard?f%5B0%5D=by_award_fy%3A2022&f%5B1%5D=by_nofo_number%3ASM-22-015#awards-tab 
⁵https://conduitstreet.mdcounties.org/2022/05/05/maryland-receives-2-million-to-implement-9-8-8-suicide-prevention-lifeline/

What every free-standing Skilled Nursing Facility (SNF) and chains with five or more facilities needs to know to avoid civil money penalties and regulatory compliance survey F895, F867, and F946 findings. 

The US Department of Health and Human Services, Office of the Inspector General (OIG) released its Compliance Program Guidance for Nursing Facilities in 2000. Additional Program Guidance was introduced in 2008, to reflect the OIG’s continued focus on quality of care and address specific risk areas related to quality of care, claims submissions, the federal anti-kickback statute, and other emerging areas.

Section 11281(b) of the Patient Protection and Affordable Care Act (PPACA, also known as Obamacare) amended regulations pertaining to the Medicare and Medicaid programs, requiring long-term care facilities to implement a compliance and ethics program to effectively prevent and detect criminal, civil, and administrative violations, and to promote quality of care as of November 28, 2019.

As defined in the 42 CFR §483.85, a facility’s compliance and ethics program, at a minimum, must have eight required components: 

1. Written compliance and ethics standards, policies, and procedures
2. Assigned specific high-level personnel within the organization (such as the chief executive officer, members of the board of directors, or directors of major divisions) to oversee the compliance program
3. Sufficient resources and authority to the specific individuals, designated above in Item 2, to assure compliance with such standards, policies, and procedures
4. Due care to not delegate substantial authority to individuals who had a propensity to engage in criminal, civil, and administrative violations under the Social Security Act.
5. Procedures for effective communication of the compliance and ethics program elements to the entire staff, contractors, and volunteers
6. Reasonable steps to achieve compliance with the program's elements, such as:
   •    Monitoring and auditing systems designed to detect violations 
   •    A reporting system to report violations anonymously
   •    A process in place for ensuring the integrity of any reported data
7. Consistent enforcement of the program through appropriate disciplinary mechanisms, including discipline for the failure to detect and report a violation
8. Steps to respond to the reported violations and to prevent further violations, such as modification to the organization's program to prevent and detect criminal, civil, and administrative violations under the Act

Additional compliance and ethics program requirements for skilled nursing facility (SNF) chains with five or more facilities

Organizations operating five or more nursing facilities must also include, at a minimum, the following components in their compliance and ethics program:

1. A designated compliance officer for whom the organization’s compliance and ethics program is a major responsibility. This individual must report directly to the operating organization’s governing body and not be subordinate to the general counsel, chief financial officer, or chief operating officer.
2. Designated compliance liaisons located at each of the organization’s facilities        
3. A mandatory annual training on the organization’s compliance and ethics program, meeting the requirements of 42 CFR §483.95: 

• Effective communications—mandatory training for direct care staff 
• The rights of the facility’s residents and the responsibilities of the facility to properly care for its residents, per 42 CFR §483.10
• Freedom from abuse, neglect, and exploitation, per 42 CFR §483.12
• The elements and goals of the facility’s quality assurance and performance improvement (QAPI) program, per 42 CFR §483.75
• The written standards, policies, and procedures for the facility’s infection prevention and control program, per 42 CFR §483.80(a)(2)
• Explanation of the compliance and ethics program standards, policies, and procedures
• Minimum annual 12-hour in-service training for nurse aides, including dementia management and resident abuse prevention training, as well as training in any areas of weakness as determined by the nurse aides’ performance reviews and assessments of the facility, per 42 CFR §483.70
• Completion of a state-approved paid feeding assistant training program, per 42 CFR §483.160
• Behavioral health training consistent with 42 CFR §483.40 and as determined by the facility’s assessment based on 42 CFR Section 483.70(e)

Evaluation of a corporate compliance program

Each facility must review its compliance and ethics program annually and revise its program as needed to reflect changes in all applicable laws or regulations. If you are not sure how to approach your review, the US Department of Justice sets forth three fundamental questions to ask when assessing the effectiveness of a corporate compliance program:  

1. Is the corporation’s program well-designed?
2. Is the program being applied earnestly and in good faith?
3. Does the corporation’s compliance program work in practice?

Need help assessing your compliance program? BerryDunn can help. 

BerryDunn’s SNF operations and compliance experts can answer your questions regarding compliance and ethics program requirements and provide an external review. Please contact Robyn Hoffmann or Olga Gross-Balzano.

Resource
US Department of Health and Human Services, Center for Clinical Standards and Quality/Quality, Safety & Oversight Group. Ref: QSO-22-19-NH (June 29, 2022). Revised Long-Term Care Surveyor Guidance | CMS