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Procurement is often described as “ground zero” for audit findings—and for good reason. In single audits and other compliance reviews, procurement files are one of the first places auditors look. Not because organizations are acting in bad faith, but because procurement is where documentation, judgment, and regulatory requirements collide. 

The Governmental Accounting Standards Board (GASB) issued Statement No. 105, Subsequent Events to enhance the transparency, consistency, and value of financial reporting related to events that occur after the financial statement date, but before the financial statements are issued. The statement realigns existing guidance by clearly describing the subsequent events' time frame, distinguishing between recognized and non-recognized subsequent events, and providing specific disclosure requirements. 

Does every audit feel like a rescue mission? Do you often feel like each year is the same as the last? You’re not alone. Many nonprofit and governmental agencies experience turbulence along the way and no audit is perfect. In this article, we’ll outline a strategic approach to help your audit journey progress to planned readiness. 

No one likes to be caught off guard, especially when it comes to an audit. Being “audit ready” isn’t about checking a box; it’s about building confidence, protecting your reputation, and making sure your team can carry out its daily responsibilities with minimal disruption. It’s also important to know when to seek help. 

Artificial Intelligence (AI) is no longer a futuristic concept reserved for research labs or tech giants in Silicon Valley. Today, AI is becoming a practical and powerful tool for local governments across the country—helping to boost efficiency, reduce costs, and elevate the quality of public services. 

Credit, purchase, and debit cards each offer convenience for small-dollar purchases, but carry varying levels of risk. Strong internal controls are essential to prevent fraud, misuse, and compliance violations.

Digital accessibility is more than a legal requirement—it’s about ensuring everyone can access public services, regardless of ability. As government agencies increasingly move services online, compliance with accessibility standards like the ADA’s Web Content Accessibility Guidelines (WCAG), EAA regulations, and Section 508 is essential. 

In today's data-driven world, the ability to share information between Medicaid and Public Health Agencies (PHAs) is crucial for efficiently using limited resources to serve both individual patient and population health goals and priorities. Often, states already have the needed technology, but they don’t have the partnerships or workforce infrastructure to leverage existing investments across different agencies.

Public health is at a crossroads. With the lessons learned from COVID-19 and a workforce on the brink of burnout, now is the time for transformative action. By reimagining operations, infrastructure, and health equity, we can shape a system that’s responsive to future challenges.

Law enforcement, courts, prosecutors, and corrections personnel provide many complex, seemingly limitless services. Seemingly is the key word here, for in reality these personnel provide a set number of incredibly important services.

Your government agency just signed the contract to purchase and implement a shiny new commercial off-the-shelf (COTS) software to replace your aging legacy software. The project plan and schedule are set; the vendor is ready to begin configuration and customization tasks; and your team is eager to start the implementation process.

State governments regularly negotiate contracts with vendors. Unfortunately, these negotiations are often prolonged, which can have major downstream effects on projects, procurements, and implementations—including skewed timelines, delayed milestones, and increased costs. 

Modernization means different things to different people—especially in the context of state government. For some, it is the cause of a messy chain reaction that ends (at best) in frustration and inefficiency. For others, it is the beneficial effect of a thoughtful and well-planned series of steps. 

Artificial Intelligence, or AI, is no longer the exclusive tool of well-funded government entities and defense contractors, let alone a plot device in science fiction film and literature. Instead, AI is becoming as ubiquitous as the personal computer. 

When an organization wants to select and implement a new software solution, the following process typically occurs:

People are naturally resistant to change. Employees facing organizational change that will impact day-to-day operations are no exception, and they can feel threatened or fearful of what that change will bring. Even more challenging are multiyear initiatives where the project’s completion is years away.

The day-to-day work of providing government services involves collecting, using, and storing large amounts of data. The data that government agencies accumulate is a critical asset — it holds answers about which programs perform best, which interventions are most effective, and how to improve service delivery. 

While new software applications help you speed up processes and operations, deciding which ones will work best for your organization can quickly evolve into analysis paralysis, as there are so many considerations.

Over the course of its day-to-day operations, every organization acquires, stores, and transmits Protected Health Information (PHI), including names, email addresses, phone numbers, account numbers, and social security numbers.

Success is slippery and can be evasive, even on the simplest of projects. Grasping it grows harder during lengthier and more complex undertakings, such as enterprise-wide technology projects—and requires incorporating a variety of short- and long-term strategies. 

The Merriam-Webster Dictionary defines leadership as having the capacity to lead. Though modest in theory, the concept of leadership permeates all industries and is a building block for every organization’s success. 

As more state and local government workers enter retirement, state and local agencies are becoming more dependent on millennial workers — the largest and most educated generation of workers in American history. But there is a serious gap between supply and demand.

Some days, social media seems nothing more than a blur of easily forgettable memes. Yet certain memes keep reappearing to the point where we have no choice but to remember them. 

In July 2016, we wrote about how the booming microbrewery scene in Maine is shaking up the three-tier system of alcohol distribution, which dates back to the 1930s.

Government projects conducted in challenging conditions require trust, collaboration, communication, and project management acumen to succeed. Here are five recommendations for project success.

Electronic accessibility in every aspect of modern life has increased ten-fold, but government — and courts in particular — has been slow to follow.

There is plenty of media coverage of Maine’s, and specifically Portland’s, burgeoning microbrew scene. It’s good economic development and complements the already established “foodie” scene Portland is renowned for.

There has been a recent flurry of proposals surrounding payment stablecoin regulation. In March and April 2026, the Office of the Comptroller of the Currency (OCC) and Federal Deposit Insurance Corporation (FDIC) issued Notices of Proposed Rulemaking (NPR) to implement major provisions of the Guiding and Establishing National Innovation for US Stablecoins (GENIUS) Act. While this article focuses on the OCC and FDIC proposals, the US Department of the Treasury, the Financial Crimes Enforcement Network, and the Office of Foreign Assets Control have also issued recent proposals on implementing the GENIUS Act.  

The OCC and FDIC proposals, among other reforms, establish regulatory frameworks for the issuance of payment stablecoins. While the OCC proposal is broader and more prescriptive, reflecting its role as the primary regulator for national banks, federal savings associations, nonbank federal issuers, and foreign payment stablecoin issuers, the FDIC proposal is narrower and more bank-centric, focusing on FDIC-supervised insured depository institutions (IDI) and their payment stablecoin subsidiaries. The FDIC proposal also clarifies deposit insurance treatment for stablecoin reserve deposits and affirms how tokenized deposits are treated under existing deposit insurance rules.

While many community banks may not be planning to issue payment stablecoins in the near term, the proposed rules remain relevant because they: 

  • Define the permissible role of community banks in the digital asset ecosystem 
  • Signal how stablecoins and tokenized deposits may coexist with traditional banking 
  • Clarify deposit insurance boundaries, reducing regulatory ambiguity

Key takeaways from the NPRs 

There are five main considerations from the NPRs. Comments on the OCC’s proposal are due by May 1, 2026, and comments on the FDIC’s proposal are due by June 9, 2026. 

1. A new federal framework for payment stablecoin issuance 

The proposed rules operationalize the GENIUS Act by creating detailed standards for Permitted Payment Stablecoin Issuers (PPSIs)—entities approved to issue payment stablecoins. For FDIC-supervised institutions, a PPSI must be a subsidiary of an IDI and is subject to full FDIC supervision. 

Key policy guardrails include: 

  • Narrowly defined activities limited largely to issuing and redeeming payment stablecoins, managing required reserves, and providing related custody services 
  • Strict one-to-one reserve backing, requiring each outstanding stablecoin to be fully supported by highly liquid assets
  • Explicit prohibitions against paying interest or yield to stablecoin holders, preventing payment stablecoins from functioning as deposit substitutes
  • Under the FDIC’s NPR, PPSIs are prohibited from providing credit to their customers to purchase payment stablecoins. The OCC’s NPR does not explicitly prohibit this activity. 
  • PPSIs are generally required to redeem a payment stablecoin within two business days. 

For community banks, the structure reinforces that stablecoin issuance is not a casual extension of deposit-taking, but rather a regulated, capital-sensitive activity requiring governance, systems, and risk management comparable to other significant lines of business. 

2. Reserve assets: Conservative by design 

One of the most consequential aspects of the proposals is their treatment of reserve assets backing payment stablecoins. The OCC and FDIC propose a conservative list of eligible reserve assets, including: 

  • Cash and balances at Federal Reserve Banks 
  • Demand deposits at insured institutions 
  • Short-term US Treasury securities (93 days or less) 
  • Certain Treasury-backed repurchase and reverse repurchase agreements 
  • Certain securities issued by registered investment companies invested solely in otherwise permitted reserve assets 

Reserve assets must be: 

  • Valued at fair value (with cash at par)
  • Identifiable and segregated, particularly if multiple stablecoin “brands” are issued
  • Continuously monitored to ensure reserves never fall below outstanding issuance
  • Published on the PPSI’s website monthly, with the report examined by a registered public accounting firm. Under the FDIC’s NPR, the registered public accounting firm will issue a written report of findings to the PPSI’s audit committee, or board of directors, if there is no audit committee. Both proposals also require confidential reporting on reserve assets, among other information, weekly, as well as quarterly reports of financial condition.

For community banks, this matters even if the bank does not issue stablecoins. Banks may be asked to hold reserves on behalf of PPSIs, creating potentially large, volatile deposit balances with specific operational and liquidity considerations. Both proposals explicitly seek comment on whether various limits should apply to stablecoin reserve deposits to mitigate safety and soundness risks.

3. Deposit insurance clarified: No pass-through coverage 

The FDIC’s NPR squarely addresses an area of confusion by proposing amendments to the FDIC’s deposit insurance rules. Under the proposal: 

  • Deposits held as reserve assets for payment stablecoins are insured only to the PPSI, as corporate deposits 
  • Payment stablecoin holders do not receive pass-through FDIC insurance 
  • Reserve deposits are aggregated with other deposits of the PPSI at the same bank and insured up to the standard $250,000 limit 

This clarification reinforces an important principle for banks: payment stablecoins are not insured deposits, and banks must avoid marketing or structuring arrangements that imply otherwise. The proposal aligns deposit insurance treatment with the GENIUS Act’s prohibition against representing stablecoins as FDIC-insured.

4. Tokenized deposits remain deposits 

Separately, the FDIC uses this rulemaking to confirm that tokenized deposits are still deposits for purposes of the Federal Deposit Insurance Act. The form of recordkeeping—whether traditional or distributed ledger-based—does not change the legal status of a deposit. 

This is a significant assurance for community banks exploring: 

  • Distributed ledger technology for internal settlement 
  • Tokenized representations of deposit balances 
  • Real-time or programmable payment innovations 

As long as the product meets the statutory definition of a “deposit,” it remains eligible for FDIC insurance and depositor preference, regardless of the technology used. 

5. Capital, governance, and operational expectations 

The proposals set meaningful expectations around: 

  • Capital planning, including a $5 million minimum for de novo PPSIs and ongoing capital commensurate with risk 
  • An operational backstop equal to 12 months of expenses, separate from reserve assets 
  • Robust risk management, IT security, AML, and audit requirements, many modeled on existing banking standards 

Importantly, the OCC and FDIC also propose to deconsolidate PPSI subsidiaries for regulatory capital purposes, ensuring that parent banks are not required to hold capital in excess of what the PPSI itself must maintain—while reserving supervisory authority to prevent “capital arbitrage.” 

What community banks should do now 

Even if stablecoin issuance is not imminent, community banks should: 

  • Assess potential exposure to stablecoin reserve deposits and custodial activities 
  • Monitor how peers and core providers are engaging with tokenization and stablecoin infrastructure 
  • Ensure marketing and disclosures clearly distinguish deposits from non-deposit digital assets 

The proposals make clear that stablecoins will coexist with the banking system—but firmly within traditional prudential boundaries. For community banks, the rule offers clarity, guardrails, and opportunity, while underscoring that innovation must be anchored in safety, soundness, and transparency. As always, please don’t hesitate to reach out to your BerryDunn team if you have any questions.

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What proposed payment stablecoin rules mean for community banks

Maine’s recent housing legislation, including LD 1829, changes how municipalities regulate housing and where growth can occur. This article explains how the law affects comprehensive plans and zoning, why alignment between planning documents and ordinances now matters more than ever, and what Maine communities can do to stay compliant while still shaping development outcomes locally. 

What is LD 1829 and how does it change housing regulation? 

LD 1829 is a Maine housing reform law, which aims to increase housing supply by reducing local regulatory barriers. It establishes statewide minimum housing allowances, reduces barriers to developing ADUs, and raises the threshold for Planning Board and subdivision review while preserving local authority through planning and zoning decisions. 

Under the law, municipalities must allow at least three dwelling units on any residential lot statewide, and up to four units in designated growth areas or areas served by public water and sewer. 

Why this matters now for Maine communities 

Across the country, states are taking action to address housing shortages by easing zoning restrictions and streamlining development rules. Maine is no exception. 

LD 1829 directly affects local zoning ordinances, development review processes, and dimensional standards. Municipalities that rely on outdated comprehensive plans may find their policies in conflict with state law—creating confusion, delays, and missed opportunities to guide housing and growth to appropriate locations. 

Considerations for municipalities

  • Does your community have a current comprehensive plan and defined growth area?
  • Do growth areas reflect current community goals and values?
  • Does your community have public water and sewer service areas and do service areas align with growth areas?
  • Does your community have concerns about future public water and sewer infrastructure capacity?
  • How does your community regulate residential density?
  • What are your community’s housing goals?

How comprehensive plans shape outcomes under LD 1829 

Comprehensive plans—especially future land use plans and growth area designations—now carry direct regulatory consequences. Future land use plans and growth areas defined in comprehensive plans will now carry more weight in determining growth potential in a community.

Communities with clear, current plans are better positioned to: 

  • Direct housing to locations with existing or planned infrastructure 
  • Coordinate zoning updates with water, sewer, and transportation capacity 
  • Invest strategically in growth rather than enabling sprawl 

Plans adopted before recent housing reforms may lack clear growth area definitions or include policies that no longer align with state requirements. 

Aligning zoning with comprehensive plans 

LD 1829 does not eliminate local zoning authority, but it changes how municipalities can regulate housing. 

Effective zoning updates should: 

  • Reflect adopted comprehensive plan policies 
  • Address dimensional standards, definitions, and review thresholds affected by state law 
  • Clearly define residential density allowances
  • Balance neighborhood context with compliance requirements 

When planning and zoning are aligned, communities reduce friction during project review and implementation. 

What municipalities should do next 

Municipalities can take practical steps now to respond proactively: 

  • Review comprehensive plans for alignment with current housing laws 
  • Clarify growth areas and future land use priorities 
  • Evaluate infrastructure capacity to support growth
  • Identify zoning provisions affected by LD 1829 
  • Engage boards, officials, and residents on what the law does—and does not—require 
  • Coordinate planning, zoning, and infrastructure decisions together 

Key takeaways 

  • Understand how LD 1829 changes housing regulation statewide. 
  • Recognize that comprehensive plans now play a direct regulatory role. 
  • Align zoning ordinances with updated planning policies and planned infrastructure investments. 
  • Use planning tools to guide growth—not just respond to it. 
  • Act proactively to reduce confusion and implementation challenges. 

How BerryDunn helps Maine communities navigate change 

BerryDunn works with municipalities across Maine to align community vision with evolving state requirements. Our planning and advisory services support communities through: 

  • Comprehensive plan updates that integrate housing, infrastructure, and economic goals 
  • Housing plans that provide clear strategies for addressing community housing needs
  • Land use and zoning analysis, including legislative compliance and best‑practice benchmarking 
  • Community and board engagement to build understanding and transparency 
  • Development process improvement and system modernization 

With a national perspective in all aspects of operating, growing, and maintaining community development organizations, we work collaboratively with clients to establish a clear vision, develop actionable strategies, and manage plan implementation. From comprehensive planning to digital transformation to fee studies, we can help you improve your operations to better serve your community. Learn more about our services and team.

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How Maine's housing law changes affect comprehensive plans

The FDIC's Quarterly Banking Profile for quarter four 2025 reports the performance for the 3,909 community banks evaluated. Here are the key highlights: 

Note: Graphs are for all FDIC-insured institutions unless the graph indicates it is only for FDIC-insured community banks. 

Financial Performance 

  • Quarterly net income decreased $307.6 million (3.8%) from the previous quarter to $7.9 billion, with 53.4% of community banks reporting a decrease. 

  • Pretax return on assets decreased to 1.35%, down 11 basis points quarter over quarter; however, overall increased by 28 basis points year over year. 

  • Net interest margin rose to 3.77%, up 4 basis points from the prior quarter and 33 basis points year over year.

Costs and Efficiency 

  • Noninterest expense increased by $841 million (4.8%) from the previous quarter and has increased 7.7% year over year. 

  • Provision expenses decreased by 0.1% quarter over quarter and have increased 8.1% year over year, signaling consistent concern over potential credit losses. 

  • Efficiency ratio increased to 62.46%, up 1.87% from the prior quarter, indicating declining cost control relative to revenue. 

Loan and Deposit Trends  

  • Loan and lease balances increased by $26.8 billion (1.4%) quarter over quarter and 5.4% year over year, led by nonfarm nonresidential CRE, 1–4 family residential loans, and commercial and industrial loans. 

  • Domestic deposits rose 1.5% quarter over quarter and 5.0% year over year, with stronger growth in interest-bearing vs. noninterest-bearing accounts. 

  • Nearly 70% of community banks reported loan growth, and about 65% reported deposit growth during the quarter. 

Asset Quality 

  • Past-due and nonaccrual loans (PDNA) increased 10 basis points to 1.36% from the previous quarter. 

  • Net charge-off ratio increased six basis points from the prior quarter to 0.29%, continuing to be above the pre-pandemic average of 0.15%. 

  • Reserve coverage ratio continued to decline to 154.3%, indicating that allowance growth lagged increases in noncurrent.

Capital and Structural Stability 

  • Capital ratios remained stable across the board: CBLR rose to 14.30%, and the leverage capital ratio remained at 11%. 

  • Unrealized losses on securities fell by $3.2 billion (9.8%) from the prior quarter to $30.0 billion in total. 

  • Community bank count declined by 44 during the quarter due to transitions, sales, and mergers and acquisitions. 

Conclusion and Outlook 

The fourth quarter of 2025 presented a more mixed performance for community banks, as earnings softened modestly while core balance sheet growth remained steady. Quarterly net income declined $307.6 million (3.8%) from the prior quarter to $7.9 billion, with slightly more than half of institutions reporting lower earnings. Pretax return on assets decreased 11 basis points quarter over quarter to 1.35%, though it remained 28 basis points higher than the same period a year earlier. Net interest margin continued to improve, rising to 3.77%, up 4 basis points from the previous quarter and 33 basis points year over year, reflecting the ongoing benefits of repricing assets in a higher-rate environment. 

Cost pressures, however, weighed on operating efficiency. Noninterest expenses increased by $841 million (4.8%) during the quarter and are now 7.7% higher than a year ago. This contributed to a higher efficiency ratio, which rose to 62.46%, up 1.87 percentage points from the prior quarter, indicating weaker cost control relative to revenue generation. Provision expenses remained relatively stable quarter over quarter but increased 8.1% year over year, signaling that institutions continue to prepare for potential credit deterioration. 

From a capital and structural standpoint, the community banking sector remained stable. Regulatory capital ratios held steady, with the community bank leverage ratio rising slightly to 14.30% and the leverage capital ratio remaining at 11%. Unrealized losses on securities declined by $3.2 billion (9.8%) during the quarter to $30.0 billion, reflecting modest improvements in securities valuations. Meanwhile, consolidation within the sector continued, as the number of community banks declined by 44 during the quarter due to mergers, acquisitions, and other structural transitions. 

Looking ahead, community banks enter 2026 with solid capital positions and continued loan and deposit growth, but with growing attention on operating costs and credit quality trends. As economic conditions evolve and consolidation persists, institutions will need to balance growth opportunities with disciplined risk management and operational efficiency. As the regulatory environment is ever-evolving, BerryDunn has a Federal Impacts page, where we are frequently posting updates on the federal landscape. Check out this page for timely information that may impact your institution or your institution’s borrowers. We wish you all the best in 2026 and, as always, your BerryDunn team is here to help! 

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FDIC Issues its Fourth Quarter 2025 Quarterly Banking Profile

Read this if you are a business owner or individual taxpayer in Maine. 

On April 10, 2026, Maine’s governor signed into law the supplemental budget for the fiscal year. The supplemental budget includes several significant changes to the state’s income tax regime. The law updates Maine’s conformity to the Internal Revenue Code and outlines key provisions from which Maine tax law will decouple from federal treatment. The supplemental budget also introduces a 2% high-income tax surcharge and creates a Pass-Through Entity Tax (PTET) whereby electing flow-through businesses can pay income tax on behalf of their owners. 

High-income surcharge 


Effective date: Tax years beginning on or after January 1, 2026 

A new 2% income tax surcharge will apply to Maine taxable income exceeding the following thresholds: 

  • $1,000,000 for single filers 
  • $1,500,000 for joint filers and heads of household 
  • $750,000 for married individuals filing separately 

These thresholds will be indexed for inflation for tax years after 2026. The surcharge also applies to the taxable income of estates and trusts. High-net-worth individuals and fiduciaries should review projected income and consider timing strategies for large transactions to manage the impact of this new surcharge.

Federal conformity and decoupling 


IRC update: Maine will conform to the Internal Revenue Code as of December 31, 2025, with targeted exceptions and phased implementation.

Key provisions

  • Standard deduction: Maine’s standard deduction will increase in phases, matching the federal standard deduction by 2027. 
  • R&D expensing: Maine will phase in conformity to federal immediate expensing for domestic R&D expenditures, with a delayed full deduction for large businesses through 2030. Small businesses (gross receipts ≤ $31 million) will receive immediate conformity. 
  • Bonus depreciation: Maine continues to decouple from federal 100% bonus depreciation and the new 100% expensing for certain real property used in production. 
  • Opportunity zones: Maine decouples from the federal gain exclusion for investments in Qualified Opportunity Funds made after December 31, 2026. 
  • Dependent exemption tax credit: For tax years beginning in 2026, eligibility for the $300 dependent exemption tax credit will be based on the federal personal exemption, not the child tax credit. 
  • Employer credit for family and medical leave: This credit is repealed for tax years beginning after January 1, 2026. 

Businesses and individuals should carefully review these conformity and decoupling provisions to avoid surprises on Maine returns and to optimize tax planning strategies. 

New Pass-Through Entity Tax 


Effective date: Tax years beginning on or after January 1, 2026 

Maine has established an elective PTET for partnerships and S corporations, designed as a workaround to the federal state and local tax (SALT) deduction limitation.  

Key features

  • Electing PTEs pay tax at Maine’s highest individual marginal income tax rate on their taxable income. 
  • Qualified members of the electing PTE receive a refundable income tax credit equal to 90% of their share of the tax paid by the entity. 
  • Maine resident individuals may also claim a credit for their share of substantially similar PTET paid to other states. 
  • The election is made annually. 

This “SALT cap workaround” can provide significant federal tax benefits for owners of Maine-based PTEs. Entities should evaluate the benefits of making the PTET election for 2026 and beyond.

Next steps for taxpayers and advisors
 

  • Review entity structures: PTEs should assess the potential benefits of the new PTET election. 
  • Monitor federal conformity: Stay alert to Maine’s ongoing conformity and decoupling from federal tax law, especially for depreciation, R&D, and capital gains. 
  • Plan for surcharge: High-income individuals and trusts should consider the impact of the new surcharge on future transactions and income recognition. 

BerryDunn’s tax consultants offer expertise for large corporations and small businesses alike. We keep abreast of the latest updates, laws, and regulations to make sure our clients are in compliance with all reporting obligations, while executing planning opportunities to minimize adverse tax consequences. Learn more about our team and services. 

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Maine's 2026-2027 supplemental budget enacts key income tax changes

Read this if you are a medical director, practice/hospital administrator, compliance officer, risk manager, or clinical quality director. 

Early in my first year as a surgical resident, while taking my first night call, I was assigned a simple task: See the patients scheduled for surgery the next day and “get them to sign the consent.” At the time, elective patients were routinely admitted the night before surgery. 

I remember telling my senior resident that I wasn’t yet prepared to have a meaningful conversation about risks, benefits, or alternatives. The response was immediate: “Don’t worry—the surgeon already went through everything in the office. The hospital just needs the form signed.” 

That moment stayed with me. While common back in the day, it reflects a mindset that still surfaces today: Consent as documentation rather than consent as understanding. 

—Alan Weintraub

Whether on paper or via electronic means, patients are asked to sign an ever-increasing number of forms—procedural consents, treatment permissions, privacy notices—often written in dense, legalistic language and presented during stressful or time-pressured moments. While these documents serve important regulatory and legal purposes, they do not, by themselves, ensure informed consent. Just as many of us scroll through an app’s conditions of use before downloading and checking the box to agree without reading, many patients sign a consent without fully understanding what they are agreeing to or feeling comfortable enough to ask questions.

In an environment of increasing comfort with ‘check the box’ agreements, consent can become a transactional exercise—an administrative checkpoint focused on signatures rather than comprehension. The emphasis shifts to ensuring paperwork is completed, rather than ensuring patients understand what is being proposed, what alternatives exist, what risks matter most to them, and whether they genuinely agree. 

Informed consent: More than a form 

The Joint Commission has been clear that informed consent is not simply a form, but a process of communication—one that ensures patients receive information in a manner they can understand, are informed of material risks, benefits, and alternatives, and are given the opportunity to participate meaningfully in decisions about their care. View the Joint Commission statement. 

When consent is reduced to a throughput-driven task, organizations increase the risk of patient dissatisfaction, quality complaints, and adverse events linked to misunderstanding. Conversely, consent processes that emphasize clarity, dialogue, and comprehension support patient rights, safety, and trust. 

Strategies for a patient-centered consent process 

The challenge for healthcare leaders is balancing legitimate regulatory, legal, and accreditation requirements with patient-centered care that respects autonomy and promotes understanding. Consent should be a process done with patients, not one done to them. Informed consent is not about forms—it is about conversation. 

For hospital leaders, the question is not whether consent forms are signed, but whether consent is truly informed. A few practical strategies for designing more meaningful, patient-centered consent processes include: 

  • Clear, accessible educational materials that focus on what patients need to know—not everything an organization wants to disclose. Materials should be written at an appropriate reading level, avoid medical jargon, and use analogies or visuals, where helpful. These support compliance with regulatory and accreditation requirements, including those pertaining to accessibility and non-discrimination. 
  • Streamlined consent forms that reinforce, rather than replace, clinician/patient conversations. Well-designed documents can meet regulatory and legal standards while supporting—not substituting for—discussion. 
  • Processes that allow time for questions, especially when risks, outcomes, or alternatives are significant. Allowing space for dialogue reduces the likelihood of surprise, dissatisfaction, and quality-of-care complaints, and may also reduce malpractice exposure. 

None of this is easy in busy clinical environments. Time pressures, staffing constraints, and throughput demands are real. Even small changes, however, in how consent is framed and operationalized can make a meaningful difference. 

Ultimately, consent is not a piece of paper. It is a moment of trust. When we treat it as such, we move closer to the experience patients deserve—and the care we aspire to deliver. 

BerryDunn can help 

Our healthcare compliance team can help. We incorporate deep, hands-on knowledge with industry best practices to help your organization manage compliance and revenue integrity risks. Learn more about BerryDunn’s healthcare compliance consulting team and services.   

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Consents: It's all about the conversation