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What vendors want: Vendor decision process in answering requests for services

By: Julie Allen, Marnie Hudson,

Mary Corley has worked with Medicaid fiscal agent services for almost 30 years as a claims supervisor, documentation specialist, business analyst, and contract compliance analyst. She has more than 25 years of experience in all aspects of the RFP process including go/no-go analysis, content development, including managing all written content  from multiple team members and compiling into one document, proofreading, formatting, and production/delivery.

Mary Corley,

Misha Mosher is an experienced legal professional with proven project management, research, and analysis skills. She brings knowledge of the legal industry, trade publications, government regulations, procurement, intellectual property, technology licensing, privacy and security, and risk management.

Misha Mosher
10.09.20

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

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

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

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

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

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BerryDunn experts and consultants

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

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

  • Relationship with this state/entity―Is this a state or client that we have worked with before? Do we understand their business and their needs?

    A continuing relationship allows us to understand the client’s culture and enables us to perform effectively and efficiently. By establishing a good relationship, we can assure the client that we can perform the services as outlined and at a fair cost.
  • Terms and conditions, performance bonds, or service level agreements―Are any of these items unacceptable? If there are concerns, can we request exceptions or negotiate with the state?

    When we review a request for services our legal and executive teams assess the risk of agreeing to the state’s terms and compare them against our existing contract language. States might consider requesting vendors provide exceptions to terms and conditions in their bid response to open the door for negotiations. Not allowing exceptions can result in vendors assuming that all terms are non-negotiable and may limit the amount of vendor bid responses received or increase the cost of the proposal.

    The inclusion of well-defined service level agreements (SLAs) in requests for proposals (RFPs) can be an effective way to manage resulting contracts. However, SLAs with undefined or punitive performance standards, compliance calculations, and remedies can also cause a vendor to consider whether to submit a bid response.

    RFPs for states that require performance bonds may result in significantly fewer proposals submitted, as the cost of a performance bond may make the total cost of the project too high to be successfully completed. If not required by law that vendors obtain performance bonds, states may want to explore other effective contractual protections that are more impactful than performance bonds, such as SLAs, warranties, and acceptance criteria.
  • Mandatory requirements―Are we able to meet the mandatory requirements? Does the cost of meeting these requirements keep us in a competitive range?

    Understanding the dichotomy between mandatory requirements and terms and conditions can be challenging, because in essence, mandatory requirements are non-negotiable terms and conditions. A state may consider organizing mandatory requirements into categories (e.g., system requirements, project requirements, state and federal regulations). This can help potential vendors determine whether all of the mandatory requirements are truly non-negotiable. Typically, vendors are prepared to meet all regulatory requirements, but not necessarily all project requirements.
  • Onsite/offsite requirements―Can we meet the onsite/offsite requirements? Do we already have nearby resources available? Are any location requirements negotiable?

    Onsite/offsite requirements have a direct impact on the project cost. Factors include accessibility of the onsite location, frequency of required onsite participation, and what positions/roles are required to be onsite or local. These requirements can make the resource pool much smaller when RFPs require staff to be located in the state office or require full-time onsite presence. And as a result, we may decide not to respond to the RFP.

    If the state specifies an onsite presence for general positions (e.g., project managers and business analysts), but is more flexible on onsite requirements for technical niche roles, the state may receive more responses to their request for services and/or more qualified consultants.
  • Due date of the proposal―Do we have the available proposal staff and subject matter experts to complete a quality proposal in the time given?

    We consider several factors when looking at the due date, including scope, the amount of work necessary to complete a quality response, and the proposal’s due date. A proposal with a very short due date that requires significant work presents a challenge and may result in less quality responses received.
  • Vendor available staffing―Do we have qualified staff available for this project? Do we need to work with subcontractors to get a complete team?

    We evaluate when the work is scheduled to begin to ensure we have the ability to provide qualified staff and obtain agreements with subcontractors. Overly strict qualifications that narrow the pool of qualified staff can affect whether we are able to respond. A state might consider whether key staff really needs a specific certification or skill or, instead, the proven ability to do the required work.

    For example, technical staff may not have worked on this particular type of project, but on a similar one with easily transferable skills. We have several long-term relationships with our subcontractors and find they can be an integral part of the services we propose. If carefully managed and vetted, we feel subcontractors can be an added value for the states.
  • Required certifications (e.g., Project Management Professional® (PMP®), Cybersecurity and Infrastructure Security Agency (CISA) certification)―Does our staff have the required certifications that are needed to complete this project?

    Many projects requests require specific certifications. On a small project, maybe other certifications can help ensure that we have the skills required for a successful project. Smaller vendors, particularly, might not have PMP®-certified staff and so may be prohibited from proposing on a project that they could perform with high quality.
  • Project timeline―Is the timeline to complete the project reasonable and is our staff available during the timeframe needed for each position for the length of the project?

    A realistic and reasonable timeline is critical for the success of a project. This is a factor we consider as we identify any clear or potential risks. A qualified vendor will not provide a proposal response to an unrealistic project timeline, without requesting either to negotiate the contract or requesting a change order later in the project. If the timeline is unrealistic, the state also runs the risk that the vendor will create many change requests, leading to a higher cost.

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

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

Article
What vendors want: Other factors that influence vendors when considering responding to a request for services

Read this if you are subject to SOC examinations.

In late October 2022, the American Institute of Certified Public Accountants’ (AICPA’s) Assurance Services Executive Committee (ASEC) released an update to the System and Organization Control (SOC) 2 reporting guide. Significant updates have been made to the Description Criteria implementation guidance and the Trust Services Criteria points of focus. Overall, the changes provide clarity around several recent and emerging industry topics and continue to promote reporting quality and consistency.

Summary of changes

Available for use now, the AICPA updates for SOC 2 examinations are significant and may require additional time and attention from companies who currently have a SOC 2 report or are planning on working toward compliance. High-level updates include incorporating new attestation standards (e.g., SSAE-20 and SSAE-21):

  • Updates to the Description Criteria implementation guidance for additional clarity regarding certain disclosure requirements, guidance on disclosure of how controls meet the requirements of a process or control framework, and guidance on disclosure of information about the risk assessment process and specific risks
  • Updates to the points of focus that support the application of the Trust Services Criteria that better reflect the ever-changing technology, legal, regulatory, and cultural risks, data management requirements, particularly related to confidentiality, and differentiating between a data controller and a data processor for privacy engagements
  • Incorporating, where appropriate, updates included in the AICPA Guide Reporting on Controls at a Service Organization Relevant to User Entities’ Internal Control over Financial Reporting (SOC 1 guide)
  • Incorporating, where applicable, additional guidance included in the AICPA Guide Reporting on an Examination of Controls Relevant to Security, Availability, Processing Integrity, Confidentiality, or Privacy in a Production, Manufacturing, or Distribution System (SOC for supply chain guide), particularly related to the risk assessment guidance

Additional updates

Other updates from the AICPA include, but are not limited to, the following:

  • Making qualitative materiality assessments (from the AICPA whitepaper on materiality)
  • Considering the service organization’s use of software applications and tools (from the SOC Tools FAQ)
  • Considering the operation of periodic controls that operated prior to the period covered by the examination
  • Considering management’s use of specialists
  • Performing and reporting in a SOC 2+ engagement (including an updated illustrative service auditor’s report)
  • Addressing considerations when the service organization has identified a service commitment or system requirement related to meeting the requirements of a process or control framework (such as HIPAA, ISO, or NIST)
  • Supplements and several appendices were removed and will be replaced with links to the appropriate documents on the AICPA website

If you currently have or will be working toward a SOC 2 report, it’s essential to understand the impact to the SOC 2 reporting process. Early preparation will help your organization stay ahead of the curve when it comes to achieving compliance. It is also essential to help ensure that frameworks are aligned and controls are in place to effectively guard against cybersecurity risks and protect sensitive data. If you have questions about SOC audits, or your specific situation, please contact our SOC Audits team. We’re here to help.

Article
Navigating changes to the SOC 2 guide

Read this if you are interested in well-being. This will be the first of two articles. This first article will focus on awareness. 

When the United States Surgeon General, Dr. Vivek Murthy, recently announced five priority areas of focus that represented “the most pressing public health issues of our time,” workplace well-being was one of the areas identified. According to the Current Priorities of the US Surgeon General website, the priority on workplace well-being aims to address the “numerous and cascading impacts for the health of individual workers and their families, organizational productivity, the bottom-line for businesses, and the US economy.” 

US Surgeon General current priorities:

  1. Workplace well-being
  2. Address the impacts of COVID-19
  3. Health misinformation
  4. Health worker burnout
  5. Youth mental health

Worker stress a growing challenge to employee well-being in many areas

The Surgeon General’s workplace well-being framework discusses many dimensions of well-being, with a focus on mental health. Research cited in the report suggests that worker stress levels grew from 2020 to 2021. In a different 2021 survey of 1,500 US adult workers across for profit, not-for-profit, and government sectors, 84% of respondents reported at least one workplace factor (e.g., emotionally draining work, challenges with work-life balance, or lack of recognition) that had a negative impact on their mental health. In most cases, the workplace factors contributing to stress can be managed or mitigated by integrating well-being into organizational planning and workforce development. 

Another study conducted by Mental Health America surveyed 11,000 workers across 17 industries in the US in 2021. It found that 80% of respondents felt that their workplace stress negatively affected their relationships with friends, family, and coworkers. The study also found that only 38% of those who know about their organization’s mental health services would feel comfortable using them. Statistics like this underscore the need for more deliberate efforts on the part of employers to provide services that support employees’ well-being. 

Well-being and human needs

At the core of the Surgeon General’s framework are five essentials of well-being and their associated “human need” components, all of which center around worker voice and equity. 

Well-being essential Human need
Protection from harm Safety
Security
Connection and community Social support
Belonging
Work-life harmony Autonomy
Flexibility
Mattering at work Dignity
Meaning
Opportunity for growth Learning
Accomplishment

As Dr. Murthy wrote in the introduction to the report, “We have the power to make workplaces engines for mental health and well-being. Doing so will require organizations to rethink how they protect workers from harm, foster a sense of connection among workers, show them that they matter, make space for their lives outside work, and support their long term professional growth.”

Parallels with BerryDunn’s well-being consulting approach

BerryDunn’s well-being approach aligns with the framework suggested by the Surgeon General. Today’s most effective well-being programs are multi-dimensional and emphasize a culture-first approach. In our experience, the most successful well-being programs are those that emphasize well-being as both a personal responsibility and a shared value that is promoted through policies, benefits, and cultural norms. 

For more information on how your organization can create and deliver a program that supports employees in the various aspects of well-being, or if you have other questions specific to your organization, please contact our Well-being consulting team. We’re here to help.

Article
Surgeon General identifies workplace well-being as a 2023 priority

Read this if you use QuickBooks Online.

Let's talk about where records for products and services are used in QuickBooks Online.

To create a product or service record, you hover your mouse over Sales in the left vertical pane on the main page and click Products and services. Click New in the upper right corner and open a blank record for an Inventory or Non-inventory part, a Service, or a Bundle (assembly). Once you complete a record and save it, it will appear in the list back on the Product and services page.

Working with products and services

That’s where we’ll start today, on the Products and services screen. This is a comprehensive table, a dashboard (or home page) for your products and services. It displays real-time information about your items’ pricing and inventory levels, as well as their type and tax status. At the top of the page, you’ll see big, colorful buttons that provide a total of the number of items that are low on stock or out of stock. When you click on one, a list of those products appears.

QuickBooks Online’s Products and services page displays inventory levels and warns you when your stock is low and at zero.

Each row on this screen contains details about the item listed there, like Description, Sales Price and Cost, and Qty On Hand. If you look down at the end of the row, you’ll see options for several types of Actions: Edit, Make inactive, Run report, and Duplicate. Click the gear icon above the table to modify the columns in the table. 

The More menu at the top of the screen contains more options: Manage categories, Run reports, and Price rules. If you want to know what actions you can take on multiple items simultaneously, check the box in front of each and click the Batch actions menu, over to the right (Adjust quantity, Reorder, etc.).

Warning: Be very careful using the Adjust quantity option. There are legitimate reasons for employing it, but you need to make very sure that you understand how this will affect other areas of your accounting. Please ask us if you’re unsure.

Using products and services in transactions

Once you start using product and service records in transactions, you’ll see why we suggested that you create those early on and make them as comprehensive as possible. While you can add products and services in the process of creating an invoice, for example, it’s much easier if you have them ready to go.

Let’s look at a sales receipt to see how this works. Click +New in the upper right corner and select Sales receipt. Select a Customer in the first field and verify that the related fields on the form were filled out correctly. Check and make any changes necessary in the Sales receipt date, Payment method, and Deposit to fields. 

Once you’ve built up a list of products and services, they’ll be available when you create transactions.

Enter the Service Date, and then click the down arrow in the field under Product/Service. The top of the list has an entry labeled +Add new. Click it if you need to add a product or service on the fly, or just select the existing one that you want. QuickBooks Online will fill in the Rate, Amount, and Tax (status). You only have to enter the Qty (quantity) that you’re selling. 

If you have more items or services to add, you can do so on the next line(s). When you’re done, check the numbers in the lower right and save the transaction. QuickBooks Online will adjust your inventory to account for any items you just sold. You can see this change by going back to the Products and Services screen. Or you can run reports, including:

  • Sales by Product/Service
  • Product/Service List
  • Inventory Valuation Detail
  • Physical Inventory Worksheet

Supply chain woes?

It seems that the serious supply chain problems we were experiencing in previous months have eased up some, but you may still be having trouble stocking some items. We hope this isn’t affecting you too much. 

QuickBooks Online, though, can help ensure that you know ahead of time when you must reorder. Its inventory-tracking capabilities can also alert you to items that aren’t selling well, so you don’t get overstocked on anything. And the ability to pull up product and service records when you’re creating transactions saves time and keeps your inventory levels accurate. Please let the Outsourced Accounting team know if you need assistance with this element of your accounting or any of QuickBooks Online’s other tools.

Article
How QuickBooks Online tracks products and services

Read this if you are responsible for cybersecurity at your organization.

Cybersecurity threats aren’t just increasing in number—they’re also becoming more dangerous and expensive. Cyberattacks affect organizations around the globe, but the most expensive attacks occur in the US, where the average cost of a data breach is $9.44 million, according to IBM’s 2022 Cost of a Data Breach Report. The same report shows that the cost of a breach is $10.10 million in the healthcare industry, $5.97 million in the financial industry, $5.01 million in the pharmaceuticals industry, and $4.97 million in the technology industry.

Cyber threat actors are a serious danger to your company, and your customers, stakeholders, and shareholders know this. They expect you to be prepared to defend against and manage cybersecurity threats. How can you demonstrate your cybersecurity controls are up to par? By obtaining a SOC for cybersecurity report.

What is a SOC for cybersecurity report?

It provides an independent assessment of an organization’s cybersecurity risk management program. Specifically, it determines how effectively the organization’s internal controls monitor, prevent, and address cybersecurity threats.

What’s included in a SOC for cybersecurity report?

The report is made up of three key components:

  1. Management’s description of their cybersecurity risk management program, aligned with a control framework (more on that below) and 19 description criteria laid out by the AICPA.
  2. Management’s assertion that controls are effective to achieve cybersecurity objectives.
  3. Service auditor’s opinion on both management’s description and management’s assertion.

Why should you consider a SOC for cybersecurity report?

A SOC for cybersecurity report offers several important benefits for your organization, which include:

  • Align with evolving regulatory requirements. The cybersecurity regulatory environment is constantly evolving. In particular, the SEC’s cybersecurity guidelines are becoming stricter over time. A SOC for cybersecurity report can demonstrate you’re aligned with these guidelines. If you’re a public company or are considering going public in the future, you need to be prepared to meet not just the SEC’s guidelines of today, but their evolved guidelines in the future.
  • Keep your board of directors informed. Your board is responsible for ensuring the business is effectively addressing and mitigating risks—and that includes cyber risk. A SOC for cybersecurity report offers your board a clear and practical illustration of your organization’s cybersecurity risk management controls.
  • Attract and retain more customers. It’s becoming increasingly common for companies to require that their vendors have a SOC for cybersecurity report. Even for companies that don’t require such a report, it’s important to know their vendors are keeping their data safe. Having this report differentiates you from vendors who have not prepared one.
  • Improve your cybersecurity posture. A SOC for cybersecurity report can identify current gaps in your cybersecurity risk management program. Once you’ve addressed these gaps, you can show your customers, stakeholders, and shareholders that you’re continuously improving and evolving your cybersecurity risk management approach.

How do I prepare for my SOC for cybersecurity assessment?

There are several steps you should take to prepare for your assessment.

  1. Choose your control framework. You have several options, including the NIST Cybersecurity Framework, ISO 27002, and the Secure Controls Framework (SCF). There are multiple online resources to help you choose the framework that’s right for your organization.
  2. Determine who your key internal stakeholders are for your cybersecurity risk management program. You’ll need to select a point person to be responsible for ensuring the independent services auditor has all the documentation they need to complete their assessment and act as liaison across internal and external stakeholders.
  3. Collect all cybersecurity-related documentation in one location. Make sure you have an organizational system that makes sense to your point person so it’s easy for them to pull the appropriate materials to give to the independent services auditor.
  4. Conduct a readiness assessment. You can work with an independent services auditor to conduct such an assessment which will identify gaps you can address before performing the attestation.
  5. Select an independent services auditor to perform the attestation. SOC for cybersecurity services are provided by independent CPAs approved by the AICPA. Ideally, you’ll want to select a firm that is experienced in your industry, has a diverse and robust team of cybersecurity professionals, and is accessible when and where you need them.

As always, if you have questions about your specific situation or would like more information about SOC for cybersecurity services, please contact our IT security experts. We’re here to help.

Article
Yes, you need a SOC for cybersecurity report—here's why

Read this if you are at a Medicaid agency.

After attending this year’s NASHP Conference, I realized Seattle wasn’t the only gem I found. The city welcomed a record number of NASHP attendees, including many first timers, who brought with them a passion for the vital work they do to support Medicaid and health and human services agencies across the nation. Executive Director Tewarson led her first conference with finesse, and the entire conference exemplified her team’s passion and dedication to state health policy. 
 
The 35th annual conference was full of fresh ideas and a collaborative spirit. As I reflect over the three days of the conference, some ideas I am taking back to my team include:

  • Workforce challenges are here to stay—and are only becoming more severe, requiring states to rethink hiring, training, and staffing among healthcare providers at all levels. Actions to consider:
    • Work to help ensure we allocate appropriate funding for behavioral health and clinical staff. 
    • Encourage more diversity in the field. This means having more representation in the workforce for new hires to identify with, including recruiting and training staff, so they feel welcome and encouraged to join.
    • Increase support for highly skilled jobs like CNAs and childcare workers. Our system cannot work without these staff, and the skills they bring to the table are crucial to the field, developed over time, and indispensable.
    • Start planning now to address the potential loss of childcare dollars to avoid exacerbating the workforce shortage challenges.
    • Identify other ways to help the workforce with benefits and support that can go a long way toward recruiting and retaining experienced caregivers. 
  • Disparities in health equity were always there, and the pandemic laid them bare. 
    • We need to assess the impact of all initiatives to help ensure they aren’t creating additional health inequities and develop strategies to rectify existing barriers.
    • We should bring those experiencing health inequities to the table, listen to their struggles, and let them lead us to solutions.
    • We need to build a diverse workforce that will bring more voices and ideas into the room in this arena.
  • There is a lot of innovative work going on in child behavioral health that can impact outcomes:
    • Providing youth mental health first-aid training and trauma-informed training to school-based, nonclinical staff is crucial to addressing the children’s behavioral health crisis. Children spend so much time at school and build trust in teachers, bus drivers, custodians, and administrative staff.
    • Training school staff on the use of mobile crisis units to avoid children inappropriately becoming involved in the juvenile justice system or being treated in emergency rooms.
    • Putting clinical staff in schools, even via telehealth or part-time, has shown positive outcomes for child behavioral health.
  • We may not know when the Public Health Emergency will end. Still, we can spend this time developing and improving our plans for unwinding, setting consistent expectations with our members and meeting them where they are, developing strategies to make successful emergency provisions permanent, and engaging our legislatures now to prepare for the upcoming federal funding gap.
  • The most significant success factor in every session I attended was breaking down silos across health and human services agencies. We need to continue working across programs, agencies, and states to help ensure we are innovating, growing, and providing the best care for those our policies and programs serve.
  • Lastly, as a foster-adopt mom, I was heartened to hear the speakers consistently bring the topic back to focus on some of our most vulnerable youth: children in foster and kinship care and our justice-involved youth. The call to collaboration and partnerships across child welfare, juvenile justice, public health, county health departments, and Medicaid agencies to impact change was not lost on me, and I found my passion for improving our foster care system invigorated by the passion of those around me.

I am thankful for organizations like NASHP that help us come together to innovate and collaborate on the biggest problems facing our industry today. NASHP’s mission to support the development of policies that promote and sustain healthy people and communities, advance high-quality and affordable health care, and address health equity is needed now more than ever. The 2022 conference allowed us to collaborate and share innovations that can be used to help propel us in our essential work to improve the health and lives of the individuals we serve.
 
My biggest takeaway was that we are stronger when we work together. I’m excited to hear what your biggest takeaways were this year. It has energized me to continue this critical work to help Medicaid agencies improve the health and lives of our residents. I do not doubt that this group will take back all the lessons and work to improve the lives of the residents of their states, and we will all gather in Boston next year, excited to hear of all the new successes. See you next year!

Article
NASHP meets the Emerald City

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

Between 2015 and 2020, one in four fatal police shootings involved a person with a mental illness, and an estimated 44% of people incarcerated in jail and 37% of people incarcerated in prison had a mental health condition. In addition, the recent COVID-19 pandemic has adversely impacted the mental health situation in the country. 

Many people experiencing mental health distress call 911 because it is a widely known emergency number and easy to use. Recent data has shown that people using 911 to get help with serious mental illness do not get the right care at the right time and some even end up in law enforcement custody, rather than being seen by a mental health professional.

The 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) is the new three-digit, nationwide phone number that is locally operated and offers 24/7 access via call, text, and chat to trained crisis counselors who can help individuals experiencing mental health-related distress. Mental health-related distress can include substance use crisis, suicidal thoughts, depression, or any emotional distress. The 988 Suicide & Crisis Lifeline is also available for individuals worried about a loved one who might need crisis support services. Its goal is to provide accessible and immediate crisis intervention and support to every individual in need. 

988 state implementation and top challenges

As of August 2022, 23 states have passed legislation to facilitate the implementation of the 988 Suicide & Crisis Lifeline. Colorado, Nevada, and Washington enacted legislation with user fees to support 988 operations and provide financial sustainability for the system. Several states have established advisory groups or planning committees with representatives from state agencies, health providers, law enforcement, emergency medical services, and other partners to better coordinate the system and identify policy levers. 

Implementing a three-digit number for behavioral health emergencies in every state and providing 24/7 primary coverage through in-state call centers have presented certain challenges to states across the nation. As states prepare to launch the 988 hotlines, they have encountered key issues around infrastructure, workforce, 911 integration, readiness of the crisis care continuum, cultural competence, and performance management.  

Solutions for state agencies

To address these key issues, states should consider the following to aid in the successful implementation of the 988 Suicide & Crisis Lifeline:

Assess the states’ needs to successfully implement the 988 Suicide & Crisis Lifeline

Despite meeting baseline requirements for the implementation of the 988 Suicide & Crisis Lifeline, state agencies are struggling to implement the 988 Suicide & Crisis Lifeline. 

By performing a structured needs assessment, state agencies can evaluate their infrastructure, policies and procedures, funding, and workforce needs to better understand their readiness to implement and capability to sustain the 988 Suicide & Crisis Lifeline. This assessment provides insight for state agencies to understand their strengths, challenges, and areas of opportunity, and it should evaluate: 

  • State infrastructure
    Behavioral health leaders acknowledge that infrastructure supports are necessary to make the 988 Suicide & Crisis Lifeline work across the continuum of care. It is important to assess the infrastructure across the crisis care continuum to help ensure a smooth transition for individuals who need care quickly. Successful implementation should take certain considerations into account during the planning process, such as including all the interested parties representing diverse populations.
  • Workforce
    In the current labor market, workforce availability and retention are top concerns for sustainable and effective 988 Suicide & Crisis Lifeline operations. States are struggling to hire the extra staff needed to launch the 988 Suicide & Crisis Lifeline as well as to recruit qualified persons. To realistically implement the system, innovative workforce development and supporting wages to recruit and retain a specialized workforce are critical considerations for the states. Critical components to include in the assessment should include, but are not limited to:
    • Training
      Staff training and proper supervision will be crucial to effectively manage the 988 Suicide & Crisis Lifeline, and states need best practices models for how to best train crisis responders and the call center staff. States should assess the existing training infrastructure to identify ways early on to support the mental health of their 988 Suicide & Crisis Lifeline counselors to reduce the risk for burnout and post-traumatic stress disorder. 
    • Capacity
      Adequate capacity is a key factor to workforce. The assessment should identify the number of qualified workforce available for in-person staffing. In the current labor market, it will also be important to consider including the identification of the number of qualified staff able to work remotely. If states would like to consider remote capabilities for the call centers, it will also be important to assess the available technology necessary, as well as the development of standards and expectations, including strong communication. 
  • Readiness of the crisis care continuum
    Apprehension about the readiness of the crisis care continuum (e.g., mobile crisis teams through diversion services and lower levels of care) exist. Federal officials have stated they expect up to 12 million calls/texts/chats in the first year of the 988 Suicide & Crisis Lifeline, and research suggests approximately 20% of those calls/texts/chats will require some level of in-person response. States are questioning whether mobile crisis teams are prepared for the increased demand while also identifying connections and access to upstream services. In addition, states can consider the needs and experiences of the system’s end users to help address equity. The assessment can help to assess the readiness of the various components across the crisis care continuum.

Establish a strategic plan of action to implement the 988 Suicide & Crisis Lifeline 

With the implementation of the 988 Suicide & Crisis Lifeline, state agencies have an opportunity to strengthen crisis care. The best way to begin strengthening crisis care is to develop and implement strategic plans that optimize the 988 Suicide & Crisis Lifeline and the following services. Building on the strengths and opportunities identified in the needs assessment and the associated recommendations, strategic plans can establish priorities and identify sustainable solutions that build capacity, promote equitable access to care, and promote continuous quality improvement. Collaborating with key stakeholders to develop a strategic plan can help identify a roadmap for how the state should approach the implementation, maintenance, and sustainability of the 988 Suicide & Crisis Lifeline, including, but not limited to, the following areas:

  • Data and performance management
  • Stakeholder engagement
  • Health equity
  • Voice of the customer
  • Financial sustainability

Maximize available funding streams

Historically, behavioral health has not had sufficient funding to adequately address mental health and substance use disorder prevention, treatment, and recovery services across the continuum of care. The COVID-19 pandemic exacerbated behavioral health challenges for many individuals struggling and highlighted the challenges with the infrastructure and workforce. In the last couple of years, the federal administration has continued to allocate additional funding to supplement existing and ongoing federal funding. States should begin by evaluating the existing federal funding opportunities to support the implementation of the 988 Suicide & Crisis Lifeline. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 988 Convening Playbook for States, Territories, and Tribes, below are a few examples of funding sources that can be leveraged for the implementation of the 988 Suicide & Crisis Lifeline. 

  • SAMHSA 
    • Transformation Transfer Initiative
    • Community Mental Health Services Block Grant
    • Substance Abuse and Treatment Block Grant
    • Mental Health Block Grant Set-aside
    • State Opioid Response Grant
    • Tribal Opioid Response Grants
  • American Rescue Plan Act (ARPA) of 2021—for Mobile Crisis and Crisis Line Services
  • Medicaid
    • Early, Periodic, Screening, Diagnosis, and Treatment (known as EPSDT)
    • 1915(a) waivers
    • 1915(b) waivers
    • 1115 SMI/SED Service Delivery Waiver

The implementation of the 988 Suicide & Crisis Lifeline is critical to supporting the community and meeting their needs at a time where they need community support the most. If you have any questions, please contact BerryDunn’s behavioral health consulting team. We’re here to help.

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Components of successful implementation of the 988 Suicide & Crisis Lifeline

On the first episode of the Let’s Talk Parks with BerryDunn podcast, we spoke with Shane Mize, the Director of Parks and Recreation for the City of Pflugerville, Texas, and members of the BerryDunn Parks, Recreation, Libraries team about innovative ways to plan, engage, and serve their communities.

For those not familiar with Pflugerville, the city is situated between Austin and Round Rock, Texas. It has been listed as one of the fastest growing cities in the nation. They have a population of roughly 80,000 and their parks and recreation system is made up of over 55 miles of trails, with over 900,000 visits to their park system annually.

On the podcast, Shane talks about the challenges and opportunities of being surrounded by cities that have great parks and recreation departments. Never one to be upstaged, Shane uses innovation in his program, to increase community engagement and ensure the highest level of service to Pflugerville. The end goal: Being the best parks and recreation department in the country.

So let’s take a look at five innovative things the department is doing:

1. Rethinking the master plan

Shane told us that he's not a huge fan of how typical master plans are done. When he realized that he needed one to qualify for grants, he agreed, but on his own terms.

Shane shared his experience in seeking a consulting firm to help with the process, “I just decided that we were going to do things differently and was fortunate to find a firm [in BerryDunn] that … had enough park and rec professionals on it …and was young enough in some of their philosophies.”

He continued, “I think I was in the right place at the right time to push my agenda, which was to have a master plan that looked 100% different than any of the master plans I'd ever seen, and to feel confident and comfortable, not only standing before council, but standing before anybody in my industry.”

BerryDunn’s Jason Genck, the project manager on the master plan project, said, “They expect a high level of service, and they want us to push the envelope quite a bit, and I'm particularly excited about this project because I tend to be attracted to projects that are really creative, certainly innovative, and pushing the envelope.”

When starting the process, Shane told Jason that he wanted the plan to be “the most creative and engaged master planning process the country has ever seen.” Jason and his team completely agreed with this philosophy for Pflugerville and could see applications for other cities and towns.

Jason said, “I think this planning process is disrupting the traditional way of planning because the entire project team is constantly adjusting and re-thinking approaches to maximize the benefits to the Pflugerville community. Yes, we have our standard practices, but, we are having a lot of fun while being inspired to really push innovation in everything we do. While the Pflugerville team and the consultant team are true partners and everyone has such great expertise, we are also learning together how to help create the most vibrant future possible for the community.”

2. Going beyond benchmarking

Shane’s vision for the plan included local feedback as well as feedback from around the country. Jason Genck explained how this is different from what is typically done, “It's not just doing benchmarking, for example. Benchmarking is very common in a planning process, to look at how one organization might be performing against other, similar size, similar scoped organizations—and of course, we do that, and it's always an interesting discussion to reflect on what that is—but in the case of Pflugerville, that wasn't enough.”

“It was, 'Hey, let's take that benchmarking, let's get a think tank together. And you know what? We don't want a think tank of just local leaders. We’d also like you to do a think tank of regional and state leaders. Oh, and by the way, let's actually do a think tank of the best minds of the nation.' And that's just one example of many instances throughout the team's planning processes that are really just taking the traditional services that you might expect to another level.”

3. Constantly evaluating satisfaction

As the team started the master planning process, at the top of the list was getting feedback from the community, which was nothing new to the Pflugerville team. Proactively seeking customer satisfaction is something they do regularly. Another creative example:

Shane shared, “I actually have a staff member that pulls Yelp, Google, and Wedding Wire [reviews] for our wedding event site, and they pull those numbers quarterly and we can see if we've dipped up or down in every single park in the last quarter and any new comments are captured.”

4. Bringing in celebrity voices

This one is for all the fans of the TV show Parks and Recreation. As a way to gain visibility for the master planning process and to get the attention of their constituents, the Pflugerville team had a creative idea. Using the social tool Cameo, they hired actor Jay Jackson, who played character Perd Hapley on the show, for a brief “in character” video message (which you can see on Pflugerville’s Facebook page here). Here’s the message:

Perd: And hello there everyone. Jay Jackson here, aka Perd Hapley. And welcome to, 'You Heard with Perd!' We have some breaking news right now. And that news that is breaking is this: Right now, Pflugerville wants to hear from you as they develop a 10-year parks and recreation master plan. Your participation is very important, so go to pflugervilletx.gov/parksplan to learn more about it. And now that you heard, get involved. I'm Perd Hapley.

The video was widely shared and gained nearly 10,000 views—getting the master planning message out to potentially new audience members.

5. Meeting people where they are – on the road or online

On the podcast, BerryDunn’s Jason Genck described one of his favorite outreach vehicles (literally) that Pflugerville is using to engage citizens all over the city. “Let's pull a 15-foot-wide chalkboard all over the community, which has logged over 120 miles to date, to get into every nook and cranny in the community to make sure everyone knows what's going on with the future parks and recreation and has the opportunity to provide input.” Community members were encouraged to finish the sentence, “Parks matter because…” on the mobile chalkboard as a way to gather feedback on what was important to park users.

The chalkboard is just one way that the team is gathering feedback. Their website has a master planning section, linked to an engagement platform hosted by BerryDunn, where community members can provide ideas and vote for ideas from others. Meeting constituents where they are is helping make this project one of the most engaged planning processes the BerryDunn team has seen.

What’s next? Robots?

Well, maybe! The Pflugerville team has been looking at robots for lining their sports fields, so it can save their staff time and their employees can get back to doing what they do best. Nothing is off the table!

Shane explained that to be successful at innovation, you have to take some risks. He said, “If you're waiting until it's somewhat successful in the public sector, you've missed the mark of innovation. You've missed the mark of doing anything new.”

Listen to the full podcast here:

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How Pflugerville and BerryDunn are pushing the envelope on parks and recreation innovation

Read this if you are at a state Medicaid agency.

The uncertainty surrounding the end date of the COVID-19 Public Health Emergency (PHE) has made it difficult for state Medicaid agencies to plan and prepare to transition to pre-pandemic operations. Upon the federal declaration of the PHE, states and territories were forced to react quickly to reduce the impact on the Medicaid program and its enrollees. Many states and territories took advantage of the emergency authorities through the Centers for Medicare and Medicaid Services (CMS) to implement temporary policy changes such as the removal of prior authorization requirements, increased payments to providers, removal of cost-sharing, and the expansion of telehealth services. 

While many of the emergency authorities will terminate on or around the end of the PHE, states and territories may elect to make those temporary changes permanent due to the positive impact for both enrollees and providers. Take telehealth, for example. The broad flexibilities allowed during the PHE permitted providers to meet the healthcare needs of enrollees in a time where in-person visits were not recommended, nor available. To increase access to testing and vaccinations in pharmacies, pharmacy technicians and interns were permitted to administer COVID-19 vaccinations when supervised by an immunizing pharmacist.

So what comes next for states and territories once the PHE ends? Taking a proactive approach to plan out next steps will assist states and territories to be better prepared upon conclusion of the PHE. The US Department of Health and Human Services (HHS) has committed to providing at least a 60-day notice prior to the official end date of the PHE. CMS encourages states and territories to communicate changes to enrollees, managed care plans, counties, providers, and other stakeholders.

As we await the declared end date of the PHE or notification of another extension, states and territories can begin taking actions to prepare for the resumption of normal operations. We have learned new ways to prevent disruptions in meeting the needs of enrollees, developed enhanced methods of communication to stay in touch, and used technology to its fullest capacity. While our new normal is very different than pre-pandemic times, we can all use what we have learned to strengthen our tactics for any future PHEs. BerryDunn is here to assist and support states and territories as they prepare for the eventual end of the PHE.

If you have questions or would like to discuss further, please contact the Medicaid consulting team. We're here to help. You can also read more BerryDunn articles on the PHE unwinding here.

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Looking beyond the Public Health Emergency: What's next for states