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Leveraging industry standards to optimize Offender Management Systems (OMS)

08.28.20

Read this if you use, manage, or procure public safety and corrections technology. 

In our previous post, we discussed the link between developing a technology RFP with meaning, structure, and clarity to enhance the competitive nature of the solicitation. In this article, we ask: How can your agency synthesize and unify existing business processes with industry standards to attract modern OMS providers? The answer? Your agency crosswalks. 

Industry standards, such as those set by the Corrections Technology Association (CTA) and American Probation and Parole Association (APPA), establish the benchmark for modern operations. However, legacy correction software limitations often blur the one-to-one relationship with industry standards. For that reason, crosswalk tools help agencies map current process into industry-wide standards.

CTA Functional Areas

Corrections Technology Association Functional Areas

Agencies crosswalk in preparation for a corrections technology procurement to help align system requirements with commercial-off-the-shelf (COTS) corrections management systems. In revisiting the topics of clarity, meaning, and structure, the crosswalk helps technology vendors understand your current operations, the tools your currently use to support the operations, and the way in which those operations relate to industry functional areas.

In an iterative fashion, the CTA crosswalk first helps you understand your agency’s technology and operational structure, and then communicates system requirements to correction technology providers in an industry-led framework. The approach helps you transition from your legacy processes to your new operational environment.

Although your agency can engage the market with a meaningful, structured, and clear RFP, prequalification and contract vehicles provide a viable alternative of enhancement to procuring a new offender management system. The following advantages and disadvantages can inform your agency’s decision to use a prequalification vehicle.

Advantages:

  1. Non-competitive procurement can often be accomplished more quickly given the absence of the timeframe usually dedicated to the development of the RFP, posting to potential vendors, and evaluation of proposals.
  2. Reduced uncertainties in terms of what a vendor is able to provide since an open dialog starts immediately.
  3. Competitive procurement (secondary competition) under a contract vehicle is limited to the vendors who proposed and were awarded. Only higher performing vendors are likely to be able to respond, particularly if only certain vendors are selected from the list.
  4. Potentially better pricing as a vendor can eliminate unknowns through open communication, so less risk is priced into the proposal.
  5. A better environment around requested changes, as a vendor that has maintained a certain margin in their pricing may be more amenable to no-cost change orders.

Disadvantages:

  1. The agency loses some negotiating advantage when a vendor knows they are the only ones in the procurement conversation. 
  2. A vendor may have less incentive to “put their best foot forward” and offer higher levels of service and functionality.
  3. Competitive cost may not be obtained because the vendor doesn’t have to worry about beating a competitor.
  4. Secondary competition may take a somewhat similar timeframe because the solicitation, evaluation, and award processes take a similar amount of time to an RFP for larger projects.

The trajectory to develop an RFP for new corrections management software spans assessing existing operations and technology to including mapping current operations into industry standards clarity. At the same time your agency should consider the driving and constraining factors for using a prequalification or contract vehicle.

BerryDunn has experience with cross-walking agencies into industry-leading practices, and we also understand the need for non-standard RFPs that extend beyond CTA and APPA guidelines. Reach out to our public safety consultants if you have questions, or look out for our next blog providing insight on adapting to and overlapping challenges in non-standard corrections technology procurements.

Related Industries

Related Professionals

Read this if you use, manage, or procure public safety and corrections technology.

Recently we discussed the benefits of developing a strong, succinct Request for Proposal (RFP) that attracts Offender Management Systems (OMS) vendors through a competitive solicitation. Conversely, we explored the advantages and disadvantages of leading a non-competitive solicitation. Industry standards and best practices serve as the common thread between competitive and non-competitive solicitations for standard implementations. So, how does an agency prepare to navigate the nuances and avoid the “gotchas” of a non-standard implementation in the corrections realm?

Functional areas in the corrections industry exist in an ever-evolving state. The ongoing functional area refinements serve to overcome potential gaps between standardizing organizations (e.g., CTA, APPA) and your agency’s operations. For example, CTA does not distinguish incidents from disciplines as distinct functional areas. While merging workflows for incidents and disciplines may align with one agency’s practice, your agency may not always correlate the two functions (e.g., disciplinary action might not always result from an incident). Moreover, your agency may not have a need for every functional area, such as community corrections, depending on the scale of your operation.

Your agency should view the industry standards as a guide rather than the source of truth, which helps you cultivate a less parochial approach driven solely by standards and follow instead a more pragmatic plan, comprised of your unique operations and best practices. CTA and APPA specifications alone will result in comprehensive solicitation. For that reason, agencies can enhance an OMS modernization initiative by enhancing solicitation requirements to include jurisdictional specifications resulting from interviews with end-users and policy research. 

Upcoming OMS webinar

On Thursday, November 5, our consulting team will host a webinar on navigating a solicitation for a new OMS. During the webinar, our team will revisit the benefits of an independent third-party on your solicitation and review industry standards, and will discuss:

  1. Crafting requirements that address common OMS functions, as well as jurisdiction-specific functions (i.e., those that address the unique statutes of the state). Crafting requirements helps your agency to ensure a replacement system addresses core business functions, provides a modern technical infrastructure, and complies with local, state, and federal regulations.
  2. Thriving with a collaborative approach when acquiring and implementing an OMS system, helping to ensure all stakeholders not only participate in the project but also buy into the critical success factors.

If you have questions about your specific situation with OMS implementations, or would like to receive more information about the webinar, please contact one of our public safety consultants.
 

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Managing non-standard Offender Management System (OMS) implementations

Read this if you use, manage, or procure public safety and corrections technology. 

When initiating the selection of a new technology platform to replace legacy software, how does an agency ensure the new system addresses functional and technical requirements while also complying with procurement standards? Request for Proposals (RFP) serve as an effective purchasing vehicle, particularly when agencies seek to identify modern technology with professional services to implement the software. While correctional agencies may use an RFP to engage a new Offender Management System (OMS) provider, the complexities of the industry and vast range of best practices complicate the planning, scoping, issuance, and evaluation process. 

With the long-term vision set to complete projects on time, under budget, and within scope, independent third-parties write technology RFPs to enhance traceability and accountability during implementation.

An independent third-party can help your agency:

  1. Define a meaningful project scope to scale the vendor market and guide quality proposals
  2. Develop effective forms, worksheets, and attachments to supplement RFP requirements to support compliance and meet proposal standards
  3. Build a balanced evaluation committee with impartial scoring criteria to represent agency-wide needs and fairly rank vendors
  4. Craft a structured procurement package that attracts multiple vendors to find the solution that best fits your needs
  5. Design a reasonable and achievable RFP schedule of events to finish the project in a timely manner
  6. Reduce ambiguity and increase clarity of RFP terms to streamline the process

If your agency incorporates a sound strategy to craft a meaningful RFP, then a lengthy, meandering procurement journey will become a well-defined, objective, and seamless process to identify new software. Furthermore, you can enhance competitive responses with an RFP free from ambiguity―and full of clarity.

If your corrections agency does engage outside help to facilitate development of an RFP for new OMS software, you should ensure that the third party you engage has experience supporting a meaningful, balanced, and structured purchasing process. BerryDunn injects best practices from the Corrections Technology Association (CTA) and American Probation and Parole Association (APPA). Pairing CTA and APPA standards with an RFP tailored to the technology markets will help an agency boost vendor responses to ultimately improve critical operations.

Reach out to our public safety consultants directly for questions, or look out for our next blog providing insight on leveraging industry standards (e.g., CTA, APPA) when crafting an RFP for corrections technology.
 

Article
Sourcing new IT systems: Third-party advantages

Read this if you or your government agency may be interested in project management or a project management office.

You may think that PMO stands for Project Management Office, Program Management Office, or Portfolio Management Office, and you would be correct. However, when establishing your PMO priorities, think:
1.    P – Planning and Processes
2.    M – Motivation
3.    O – Operations

Determining where your organization will focus your efforts is fundamental to the successful functioning of the PMO, whether the PMO is well established or just getting started. With multiple competing projects and initiatives, spending some time planning and developing your PMO priorities in the short term will save you time and effort moving forward. 

According to the Project Management Institute’s (PMI’s) research, they reported that "aligning projects and strategic objectives has the greatest potential to add value to an organization.” 

The “value” here must be determined by each organization, but through establishing your PMO priorities early, you promote a culture of project management in order to gain greater experience in project management practices and personnel. This allows for more efficient processes, more focused and flexible project managers, greater scope, schedule, and budgetary control, and ultimately more successful projects implemented.

Planning and processes

The first step in establishing the priorities for your PMO requires planning and evaluating existing processes. Identifying all projects for the upcoming year is an excellent place to start. For each project or initiative, you will want to pull together information that will assist you in the prioritization process. This may include items such as type of project, expected outcomes, aligned strategic objective(s), targeted length of the project, targeted start date, funding sources, types of approvals needed, resource capacity, and risk versus reward analysis. Each organization can make the determination of what kind of information is necessary in this step to make prioritization more streamlined and specific to their current structure and processes.

As new team members enter and exit project work, there is a risk that knowledge transfer of the PMO processes get lost, or deviations in processes begin to occur. PMI notes “high-performing organizations succeed through a strategic focus on people, processes, and outcomes” and 74% of these high-performing organizations are supported by a PMO. Taking the opportunity for continuous process improvement―to review and share the PMO processes and templates with the organization on a reoccurring basis―helps to ensure consistency across programs within the organization. With consistency comes efficiency, allowing your project teams to focus on the work at hand, and not recreate processes. Consistency and efficiency will help streamline administrative activities, improve resource estimates, and increase the likelihood that projects will come in on time and on budget.

Motivation 

The second step in establishing PMO priorities is motivation. Having a working knowledge of your organization will help in this step―knowing what excites or drives them to succeed. Motivating factors may vary for different organizations. For example, if you’re a government entity, the deciding factor in priority may be a legislative mandate. Early identification of your organization’s motivating factors allows you to expedite the prioritization efforts and increase planning time for high-priority projects, including aligning resources sooner. Here are a few ideas to consider when thinking about finding what motivates people in your organization:

  • Durations/meeting timeframes
  • Legislation/mandates
  • Strategic plans and goals
  • Recognition
  • Policy
  • Outcomes/potential impacts
  • Level of risk
  • Return on Investment (ROI)

Operations

The third step in establishing PMO priorities is operations. By outlining operational aspects of the projects before establishing your PMO priorities, you can see the big picture and organizational strategy. Per PMI, organizations which “align their PMO to strategy report 38% more projects meet the original goals and business intent, while 33% fewer projects are deemed as failures.” This allows you to understand dependencies between projects, identify possible duplication or gaps, and plan for resources earlier. Below are a few examples to consider with this step:

  • High-level strategy (will the work be delivered in phases or at the end of the project)
  • Approximate Full-Time Equivalents (FTEs) required
  • Skill level needed for the resources
  • Organizational charts and reporting relationships
  • Approximate cost for the project/initiative

Now that you are aware of the three steps―planning and processes, motivation, and operations, you are ready to begin establishing your PMO priorities. Evaluating all three steps helps ensure you’ve considered everything before prioritizing the work, although some items may clearly have more weight than others. There is no magic formula for establishing PMO priorities, and given the same projects, different organizations would have different priorities. One organization may define and identify project work as high, medium, or low, while another PMO may number projects, with number one being the first project to start. Either way is right. 

The important take-away is for your PMO to develop a consistent methodology as you are establishing priorities now and in the future. 

Does your organization need help establishing your PMO processes, prioritizing, or developing strategic plans? Contact our Medicaid Consulting team for more information on how we can help.

Resources cited

Project Management Institute. PMI’s Pulse of the Profession: The High Cost of Low Performance. PMI.org. Accessed July 8, 2020. https://www.pmi.org/-/media/pmi/documents/public/pdf/learning/thought-leadership/pulse/pulse-of-the-profession-2014.pdf?v=eb9b1ac0-8cad-457f-81ec-b09dbb969a38 
Project Management Institute. PMI’s Pulse of the Profession – 9th Global Project Management Survey: Success Rates Rise – Transforming the High Cost of Low Performance. PMI.org. Accessed July 8, 2020. https://www.pmi.org/-/media/pmi/documents/public/pdf/learning/thought-leadership/pulse/pulse-of-the-profession-2017.pdf 

Article
The 1, 2, 3s of establishing your PMO priorities

Read this if you are a state Medicaid agency, state managed care office, or managed care organization (MCO). 

The COVID-19 pandemic and resulting economic downturn has led to increased Medicaid member enrollment and has placed a strain on state budgets to support Medicaid and other health and human services programs. It has also impacted traditional Medicaid utilization patterns and has challenged provider reimbursement models, forcing managed care programs and supporting MCOs to:

  • rethink the control of program costs, 
  • seek MCO program flexibilities to expand coverage such as telehealth, and 
  • make operational changes to support their growing member populations.

Managed care opportunities

While COVID-19 has created many challenges, at the same time it has given managed care programs the opportunity to restructure their delivery of services not only during the public health emergency, but for the longer term. Flexibilities sought this year from the Centers of Medicare & Medicaid Services (CMS) put in place through waivers and state plan amendments have helped expand services in areas such as the delivery of COVID-19 testing, medical supplies, and behavioral health services via telehealth. 

These flexibilities have relieved the administrative burden on Medicaid programs, such as performance and reporting requirements outlined under federal law and 42 CFR §438. Although these flexibilities have helped managed care programs expand services during the pandemic, the benefits are temporary and will require MCOs to make programmatic changes to meet the demands of its population during and after the public health emergency.

A recent study by Families USA cited 38 states reporting 7% growth in member enrollment since February. As the Medicaid population continues to grow in 2020 and beyond, managed care programs have numerous opportunities to consider: 

Managing care coordination and establishing efficiencies with home- and community-based services (HCBS)

The increased risk of adverse health outcomes from COVID-19 due to older age and chronic illness, and the demands on providers and medical supplies, has forced Medicaid programs to seek waiver flexibilities to expand HCBS. As part of HCBS delivery, MCOs may focus on the sickest and most costly of their member populations to control costs and preserve quality. 

MCOs will most likely monitor cost drivers such as chronic conditions, catastrophic health events, and frequent visits to primary care providers and hospitals. MCOs have the opportunity to establish efficiencies and improve transitions across different providers and multiple conditions to better manage the over-utilization of services for members in skilled nursing facilities, and for those who receive HCBS and outpatient services.

Adjusting and monitoring Value-Based Payment (VBP) models

With the continued transition to VBP models, Medicaid programs face the challenge of added costs and adapting plan operations and services to address pandemic-related needs, chronic conditions, and comorbidities. 

Building on the latest guidance to state Medicaid directors from CMS on value-based care, Medicaid programs can look at COVID-19 impacts on provider reimbursement prior to the rollout of VBP models. Medicaid programs can continue establishing payment models that improve health outcomes, quality, and member experience. States can adjust contracts and adherence to local and state public health priorities and national quality measures to advance their VBP strategy. Managed care programs may need to consider a phased rollout of their VBP models to build buy-in from providers transitioning from traditional fee-for-services payment models, and to allow for refinements to current VBP models.

Continued stratification and the assessment of risk

By analyzing COVID-19’s impact on the quality of care and member experience, improved outcomes, and member and program costs, managed care programs can improve their population stratification methodologies factoring as population demographic analysis, social determinants of health, and health status. Adjustments to risk stratification during and after the COVID-19 pandemic will inform the development of provider networks, provider payment models, and services. Taking into account new patterns of utilization across its member population, managed care programs may need to refine their risk adjustment models to determine the sickest and most costly of their populations to project costs and improve the delivery of services and coordination of care for Medicaid members.

Telehealth

As providers transition back to their traditional structures, MCOs can continue to expand telehealth to improve service delivery and to control costs. Part of this expansion will require MCOs to balance the mentioned benefits of the telehealth model with the risk of over-utilization of telehealth services that can lead to inefficiencies and increased managed care program costs. In addition, because of the loosening of federal restrictions on telehealth, managed care programs will most likely want to update program integrity safeguards to reduce the risk of fraud, waste, and abuse in areas such as provider credentialing, personal identifiable information (PII), privacy and security protocols, member consent, patient examinations, and remote prescriptions. 

Continued focus on data improvement and encounter data quality

Encounter data quality and data improvement initiatives will be critical to successfully administer a managed care program. As encounter data drives capitation rates for MCOs, a continued focus on encounter data quality will likely enable Medicaid programs to better leverage actuarial services to establish sound and adequate managed care program rates, better aligning financial incentives and payments to their MCOs. 

States have pursued a number of flexibilities to establish a short-term framework to support their managed care programs during the COVID-19 pandemic. However, the current expansion of services and the need for MCOs to rapidly identify additional areas for operational improvements during the pandemic have allowed Medicaid programs to further analyze longer-term needs of the populations they serve. These developments have also helped programs increase their range of services, to expand and manage their provider networks, and to mature their provider payment models. 

If you would like more information or have questions about opportunities for adjustments to your managed care program, please contact MedicaidConsulting@BerryDunn.com. We’re here to help.
 

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COVID-19 and opportunities to reboot managed care

Read this if you are a member of a State Medicaid Agency’s leadership team or Program Integrity (PI) unit. 

In March 2020, the Centers for Medicare and Medicaid Services (CMS) suspended PERM cycle activities in response to Secretary Azar’s public health emergency (PHE) declaration. The suspension of the PERM cycle activities provided states with an opportunity to direct resources to the state’s PHE response. In August 2020, CMS released the suspension of PERM cycle activities to allow CMS and states to complete the PERM cycles that were either in progress or in the process of starting up.

While the PERM cycle suspension was in place, CMS released an updated PERM Manual in May 2020. You can access the updated PERM Manual here. The update primarily consists of the addition of guidelines related to the return of the eligibility reviews to the PERM cycle, as defined in the PERM Final Rule published by CMS in July 2017. The manual updates include adding regulation on the CMS Eligibility Review Contractor (ERC) to perform the eligibility reviews. 

Another topic receiving significant updates in the manual was the sample guidelines. Some of the updates included:

  • Sampling units related to Third-Party Liability (TPL)
  • CMS and its contractors must be granted systems access for the review process
  • Sampling timeframes updated for each cycle

There are more updates in the manual, which states will not want to miss. BerryDunn has prepared a summary of the updates included in CMS’ May 2020 release of the PERM manual. View the summary.

While state resources are busy addressing the current PHE, the states should be tracking and documenting waiver activity, as many of the flexibilities provided by waivers will expire at the end of the PHE or soon after. Provider claims for services rendered during the PHE are eligible for the PERM cycle review, and states will need to give the PERM reviewers the flexibilities honored by the state. 

For questions or to find out more information about the PERM Cycle, contact Dawn Webb

Article
Keeping the PERM Manual update in focus during the PHE

Read this if you are a member or leader of a policing agency. 

Due to recent events, community members have taken to the streets nationwide to demand what they deserve from the police as a starting point: social and procedural justice. 

Social justice is an essential component of healthy, effective communities. It is based on a fair and just relationship between individuals and society. Social justice demands that those in the community feel safe—including feeling safe from the police. Feeling safe starts with procedurally-just policing. Procedural justice in policing is the principle that forms the foundation of the community’s willingness, individually and aggregately, to accept the actions of the police, obey laws, participate in the criminal justice system, and partner with law enforcement to reduce crime and disorder, and is dependent on the community’s acceptance of policing actions as fair and equitable. Procedural justice consists of four primary pillars:

  1. FAIRNESS
    Being fair in processes
  2. VOICE
    Providing the opportunity for voice 
  3. TRANSPARENCY
    Being transparent in actions
  4. IMPARTIALITY
    Being impartial in decision-making

Achieving social and procedural justice within policing requires meaningful change and reform that must extend beyond prior efforts. 

Across the United States, communities are calling for revised policies, targeted training, increased accountability, and better screening of police candidates. All of these efforts are important and should be explored. However, these same efforts have been pursued since community-oriented policing (COP) became popular in the 80s and 90s, and even as COP gained additional interest and momentum following a series of high-profile excessive-force incidents that trace back nearly a decade. Despite substantial focus on these areas within the law enforcement industry, concerns over systemic racism, biased policing, and a lack of trust between the police and the community continue to persist.

Community Co-production Policing: The crucial next step

The current policing environment calls for broad and deep reforms in the operations and collaborative culture of police agencies. This level of reform requires a coordinated effort to reframe the police department as a community-owned resource, and can be accomplished through engaging a Community Co-production Policing (CCPP) model. Implementation of the CCPP model, developed by BerryDunn in collaboration with practitioners and community members across the country, merges and unifies police agencies and communities through multiple collaborative pathways, resulting in shared responsibilities in areas such as guidance, oversight, and the development of policies, operational strategies, public safety priorities, and other shared goals.  

Co-production expands the focus of traditional COP and includes a greater level of community participation and involvement in key policing strategies that affect the community. The key distinction is that while COP is informative, interactive, allows for community input, and is often collaborative with regard to problem solving, co-production involves a greater level of influence and involvement by the community regarding the overarching policing strategies and priorities that ultimately affect those being served by the police agency.  

Building trust and confidence with the community

From a co-production policing perspective, influence and involvement from the community form the foundation for trust and confidence in the police agency and agreement in the processes, procedures, and practices used in pursuit of public safety for those who live in or visit the community. This level of involvement serves as a persistent external accountability process, which helps ensure consistent alignment between community desires and expectations and the actions the police use to meet them. 

Co-production is a collaborative process, not an oversight process. It involves working together to cooperatively co-produce public safety, in a respectful and thoughtful manner that places value on mutuality.

Below, the goals and predicted outcomes of the CCPP model are outlined. Accomplishing the CCPP goals is expected to produce the predicted outcomes, and these new positive outcomes address the longstanding negative outcomes that remain unresolved within the policing industry.

CCPP Goals and Predicted Outcomes
CCCP GOALS PREDICTED OUTCOMES
Reducing fractionalism: The inharmonious separation which has occurred between the community and those responsible for policing it. Increased community trust: Because the community shares decision-making authority in substantive policing matters, they will have shared ownership over the results.
Creating transparency: There can be no more secrecy in accountability or policymaking, or in determining strategies to address and reduce crime and disorder. Enhanced public safety: Trust is the cornerstone to solving crimes, and when trust is established, people will more readily assist in public safety matters affecting them.
Balancing power: Those who police the community must have the authority to do so, however, police department governance should be a shared responsibility. Improved racial/diversity equity: Diverse partnerships lead to greater understanding, which in turn, changes perspectives, beliefs, and behaviors.


The public outcry for police reform provides cities, towns, and counties with a rare opportunity to affect how their communities are policed in the future. This opportunity involves transforming policing towards a collaborative model where the police departments of the future are increasingly community-based and community-operated. BerryDunn’s CCPP model can help communities achieve this level of reform and transformation. 

For more information

Mitch Weinzetl and BerryDunn’s Justice and Public Safety (J&PS) team are leading this unique service. Our independence and objectivity enables a facilitation-based approach to engaging stakeholders across the community with the goal of collaborating on a future policing model that addresses the need for public safety in a way that is informed and inspired by the community that the police departments serve. 

To learn more about how the CCPP model can help reconnect your police department and your community, contact Mitch Weinzetl.
 

Article
Policing in America: Time for a change

Read this if your company is considering outsourced information technology services.

For management, it’s the perennial question: Keep things in-house or outsource?

For management, it’s the perennial question: Keep things in-house or outsource? Most companies or organizations have outsourcing opportunities, from revenue cycle to payment processing to IT security. When deciding whether to outsource, you weigh the trade-offs and benefits by considering variables such as cost, internal expertise, cross coverage, and organizational risk.

In IT services, outsourcing may win out as technology becomes more complex. Maintaining expertise and depth for all the IT components in an environment can be resource-intensive.

Outsourced solutions allow IT teams to shift some of their focus from maintaining infrastructure to getting more value out of existing systems, increasing data analytics, and better linking technology to business objectives. The same can be applied to revenue cycle outsourcing, shifting the focus from getting clean bills out and cash coming in, to looking at the financial health of the organization, analyzing service lines, patient experience, or advancing projects.  

Once you’ve decided, there’s another question you need to ask
Lost sometimes in the discussion of whether to use outsourced services is how. Even after you’ve done your due diligence and chosen a great vendor, you need to stay involved. It can be easy to think, “Vendor XYZ is monitoring our servers or our days in AR, so we should be all set. I can stop worrying at night about our system reliability or our cash flow.” Not true.

You may be outsourcing a component of your technology environment or collections, but you are not outsourcing the accountability for it—from an internal administrative standpoint or (in many cases) from a legal standpoint.

Beware of a false state of confidence
No matter how clear the expectations and rules of engagement with your vendor at the onset of a partnership, circumstances can change—regulatory updates, technology advancements, and old-fashioned vendor neglect. In hiring the vendor, you are accountable for oversight of the partnership. Be actively engaged in the ongoing execution of the services. Also, periodically revisit the contract, make sure the vendor is following all terms, and confirm (with an outside audit, when appropriate) that you are getting the services you need.

Take, for example, server monitoring, which applies to every organization or company, large or small, with data on a server. When a managed service vendor wants to contract with you to provide monitoring services, the vendor’s salesperson will likely assure you that you need not worry about the stability of your server infrastructure, that the monitoring will catch issues before they occur, and that any issues that do arise will be resolved before the end user is impacted. Ideally, this is true, but you need to confirm.

Here’s how to stay involved with your vendor
Ask lots of questions. There’s never a question too small. Here are samples of how precisely you should drill down:

  • What metrics will be monitored, specifically?
  • Why do the metrics being monitored matter to our own business objectives?
  • What thresholds must be met to notify us or produce an alert?
  • What does exceeding a threshold mean to our business?
  • Who on our team will be notified if an alert is warranted?
  • What corrective action will be taken?

Ask uncomfortable questions
Being willing to ask challenging questions of your vendors, even when you are not an expert, is critical. You may feel uncomfortable but asking vendors to explain something to you in terms you understand is very reasonable. They’re the experts; you’re not expected to already understand every detail or you wouldn’t have needed to hire them. It’s their job to explain it to you. Without asking these questions, you may end up with a fairly generic solution that does produce a service or monitor something, but not necessarily all the things you need.

Ask obvious questions
You don’t want anything to slip by simply because you or the vendor took it for granted. It is common to assume that more is being done by a vendor than actually is. By asking even obvious questions, you can avoid this trap. All too often we conduct an IT assessment and are told that a vendor is providing a service, only to discover that the tasks are not happening as expected.

You are accountable for your whole team—in-house and outsourced members
An outsourced solution is an extension of your team. Taking an active and engaged role in an outsourcing partnership remains consistent with your management responsibilities. At the end of the day, management is responsible for achieving business objectives and mission. Regularly check in to make sure that the vendor stays focused on that same mission.

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Oxymoron of the month: Outsourced accountability

Read this if you are a state Medicaid or CHIP agency.

The Centers for Medicare & Medicaid Services (CMS) has temporarily suspended all Payment Error Rate Measurement (PERM) improper payment-related engagement/communication and data requests to providers and state agencies as a result of the COVID-19 nationwide public health emergency declaration. 

CMS has also adopted a temporary policy of relaxed enforcement regarding activities related to Medicaid Eligibility Quality Control (MEQC) until further notice.

CMS continues to provide state Medicaid and Children’s Health Insurance Program (CHIP) agencies with a number of methods to assist in each state’s approach and response to the COVID-19 pandemic. Some flexibilities offered to state Medicaid and CHIP agencies include:

  • Eligibility and enrollment 
  • Benefits 
  • Cost-sharing 
  • Financing 
  • Managed care 

While this has been communicated with state Medicaid and CHIP agencies, you should take some important steps to manage these flexibilities to ensure you don’t encounter issues when PERM and MEQC review activities resume. Reviews are conducted according to state and federal policies and regulations in force at the time of service on the sampled claims under review. 

CMS has issued guidance to identify whether or not each of the flexibilities requires an approved state plan amendment (SPA), waiver, or whether simply providing documentation in the individual case file will provide the required support when PERM and MEQC activities resume. 

Additionally, it is equally important to ensure the “pre-COVID” processes and procedures resume immediately upon expiration of the public health emergency declaration in order to remain in compliance with state and federal regulations. 

Here are a few key considerations to help reduce the number of errors identified once PERM resumes:

  • Management of new state-specific policies and procedures in effect during the COVID-19 pandemic is critical. You need to ensure all processes requiring CMS approval or notification have been enacted and that these temporary processes revert back to pre-COVID processes immediately upon termination of the public health emergency.
  • Continued training and guidance to Medicaid and CHIP staff during this time to ensure understanding of expectations and adherence to new processes. Applying and understanding eligibility and enrollment flexibilities for both members and providers is vital to meet all expectations and documentation requirements.

New updates continue to be announced by CMS to ensure Americans have access to the care they need during this time. This requires remaining diligent to the expectations of these flexibilities and preparing for the impact of PERM and MEQC outcomes when these activities resume. This is key to reducing improper payment error rates. 

For additional detailed information regarding the identified flexibilities above, please refer to the PERM cycle preparation tool we have prepared.

If you have questions regarding relaxed requirements or you would like to have an in-depth conversation with our PERM experts, please contact the team.
 

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PERM is suspended―key considerations during COVID-19