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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read this if you are in the senior living industry.

The COVID-19 pandemic wreaked havoc on the country and created challenges across the labor force, and senior living facilities weren’t spared. For senior living, the pandemic contributed to the widening of the care cost shortfall, by decreasing the available workforce pool through voluntary resignations and a demand for higher wages. That situation has remained, and senior living facilities are faced with many challenges, including rising labor costs. Of note: 

  • Across the nation, contract nursing labor utilization continues to increase, with an average 35% increase in contract agency hours used per patient day from 2020 to 2021.1 
  • Occupancy has been declining nationwide, driven by both diminishing referrals (infection control concerns, reduction of elective procedures, such as joint replacements, and hospital capacity limitations), and the ability of facilities to accept patients (suspension of admissions due to inadequate staffing).
  • Rising costs and diminishing occupancy have resulted in an average SNF $178.65 per patient day cost of care increase, from 2020 to 2021.
  • Nationally, the US Bureau of Labor Statistics2 (BLS) reports nursing and residential care facility employment declined 5% from 2019 to 2020, and further 5.7% from 2020 to 2021. Competition for workers resulted in noticeable wage increases, 10.4% in 2020, and 5.6% in 2021 (Table 1). 

Table 1: Employment and wages, 2019 – 2021

The first quarter of 2022 reveals a continuing reduction of employment coupled with continuing wage increases in the industry. The first quarter of 2022 showed an 11.4% increase in average weekly wage for nursing and residential care facilities over that same period in 2021, and continuing decline in employment (Table 2). 

Table 2: Employment and wages, Q1 2022

COVID-19 related staff burnout, lack of childcare or school schedule disruptions, infection control requirements, such as mandatory masking or vaccinations, and other factors resulted in a rapid and significant reduction of clinical staff available for work. 

Additional factors, such as migration of clinical staff from facility-based employment to a temporary contract agency, may have also contributed to the reduction of workforce in clinical occupations. CMS SNF Provider Information3 data comparison between August 2021 and August 2022 shows that all US regions reported a decline in average case-mix adjusted direct care hours per patient day (Figure 3) within a year. On average, 7.89% reduction in total hours reported, or 0.32 hours of services less per patient day. It is important to note that utilization of unlicensed staff (nursing assistants) has not changed significantly (57.2% in 2021 and 57.7% in 2022), indicating that nationwide availability of both licensed (RN, LPN) and unlicensed staff has decreased. 

Table 3: Average case-mix adjusted direct care hours per patient day – August 2021 and August 2022 comparison

Our interviews with long-term care facilities across the US have revealed that a number of facilities had to suspend admissions for a period of time, or close a portion of the facility, due to limited or inadequate staffing levels. Due to the nature of services, it mostly affects short stay rehabilitation unit admissions. For the majority of facilities, short stay revenue sources (such as Medicare) are more favorable and normally more profitable than long-term stays. The decrease in census (Table 4) drives the per diem costs up, and the loss of short-stay revenue continues to negatively impact the bottom line. Additionally, with a significant reduction of short stay rehabilitation volume, some highly trained employees of the facilities (such as therapists, clinical directors, dieticians, and others) may be less utilized, and potentially harder to retain. 

Table 4: Average Medicare-certified facility occupancy, 2019 – 2021

The increased cost of labor is one of the major per diem cost increase drivers for senior living facilities. The tight labor market has led to higher labor costs, increased utilization of contract labor, as well as reductions or suspensions in admissions due to lack of staffing. 

Table 5: Average Medicare-certified facility direct care labor cost per patient day (wages, benefits, contract labor), 2019 – 2021

Table 6: Average Medicare-certified facility direct care contract wages, 2019 – 2021

Many states facilitate labor-related programs aimed at increasing labor pool and staff retention through innovative programs, as well as considering waivers related to staff certification and delegation of duties requirements. Due to timing, the job outlook could not be forecasted with the effects of the new initiatives, as there is no data yet available on effectiveness of these programs.
If you would like more information, or have questions about your specific situation, please contact our senior living and long-term care team. We’re here to help.

HCRIS as filed SNF Medicare (full utilization) cost reports, 2019 – 2021
Bureau of Labor Statistics, 2022
The Centers for Medicare & Medicaid Services, 2022

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Current senior living industry trends and challenges—spotlight on labor costs

Read this if you are a plan sponsor of employee benefit plans.

Employee Retention Credit (ERC)

There is still time to claim the Employee Retention Credit, if eligible. The due date for filing Form 941-X to claim the credit is generally three years from the date of the originally filed Form 941. 

The ERC is a refundable payroll tax credit for wages paid and health coverage provided by an employer whose operations were either fully or partially suspended due to COVID-related governmental orders or that experienced a significant reduction in gross receipts. 

The amount of the credit can be substantial. For 2020, the credit is 50% of the first $10,000 of qualified wages per employee for the qualifying period beginning as early as March 12, 2020, and ending December 31, 2020 (thus the max credit per employee is $5,000 in 2020). For 2021, the credit is 70% of the first $10,000 of qualified wages per employee, per qualifying quarter (thus the potential max credit is $21,000 per employee in 2021). 

For 2021, employers with 500 or fewer full-time employees in 2019 may include all wages and health plan expenses as qualified wages. For 2020, employers with 100 or fewer full-time employees in 2019 may include all wages and health plan expenses as qualified wages while employers with more than 100 full-time employees in 2019 may only claim the credit for qualified wages paid to employees who did not provide services. For purposes of determining full-time employees, an employer only needs to include those that work 30 hours a week or 130 hours a month in the calculation. Part-time employees working less than this would not be considered in the employee count.

There is additional interplay between claiming the ERC and the wages used for PPP loan forgiveness that will need to be considered. 

Student loan repayment programs

One of the benefits younger employees would like to receive from their employer is assistance with student loan repayments. A recent study indicated an employee would commit to working for an employer for at least five years if the employer assisted with student loan payments. Some employers have been providing such a benefit and, until 2020, any student loan payments made by the employer would have been considered taxable income. 

Beginning in 2020 and through 2025, at least for now, employers are permitted to provide tax-free student loan repayment benefits to employees. In order to receive tax-free payments, such a plan must be in writing and must be offered to a non-discriminatory group of employees. In addition, the tax-free benefit must be limited to $5,250 per calendar year. Now may be the time to consider offering student loan repayment benefits to help retain and attract employees.

Automatic enrollment for employee deferrals in 401(k)/403(b) plan

Most employers offer an employer-sponsored retirement plan such as a 401(k) plan or 403(b) plan to their employees. However, the federal government and several state governments are concerned that employees are either not saving enough for retirement and/or do not have access to an employer-sponsored retirement plan. Some states are mandating the establishment of an employer-sponsored retirement plan, or mandatory participation in a state-sponsored multiple employer plan (MEP). Other states are mandating that employers who do not sponsor a 401(k) or 403(b) plan provide automatic employee payroll deductions into a state-sponsored Individual Retirement Account (IRA) type vehicle sponsored by the state. If you do not already sponsor a 401(k) or 403(b) plan you should confirm if your state has any requirements.

For those employers who do sponsor a 401(k) or 403(b) plan, you should consider implementing an automatic enrollment provision if you have not done so already. Automatic enrollment requires a certain percentage of an employee’s wages to be withheld and deposited into the 401(k) or 403(b) plan each pay period, unless the employee elects otherwise. While the current law does not require an employer to use automatic enrollment, there is pending legislation that would require an automatic enrollment provision in any new retirement plan. Even though existing plans would be grandfathered under the pending legislation, it may be worth implementing an automatic enrollment provision in the 401(k) or 403(b) plan to help and encourage employees to save for retirement. 

If you have questions about any of these or other employee benefit topics, please contact our Employee Benefits Audit team. We're here to help.

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Employee benefit plan updates: The Employee Retention Credit and student loan repayment programs

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