NYSHFA Files Joint Legal Challenge to Case Mix Methodology Change

Esq. Stephen B. Hanse in Legal

The New York State Health Facilities Association (“NYSHFA”), together with five other associations and approximately 190 named skilled nursing facilities, filed a legal action this morning in New York State Supreme Court in Albany challenging the State’s proposed retroactive change to its case mix methodology. Included within our litigation is a request to the Court for an injunction enjoining the State from implementing its new case mix methodology. Attached is the Affidavit submitted to the Court by Stephen Hanse in support of our litigation. 

Generally speaking, our litigation challenges the State’s proposed retroactive change to its case mix methodology on the following grounds: (1) the State adopted its changes to the case mix methodology without CMS approval; (2) the State imposed its changes in the case mix methodology without first considering the recommendations of the Residential Health Care Facility Case Mix Adjustment Workgroup as established by law in the 2019-20 enacted State Budget; (3) the State disregarded a mandatory “circuit-breaker” in their regulations which limits case mix adjustments (up or down) to 5% prior to an OMIG audit; (4) the State altered its established data analysis processes to impose case mix rate adjustments in contravention of statutory and regulatory requirements; and (5) the State’s changes to its case mix methodology pose an immediate threat to nursing home residents and employees. 

“All nursing homes throughout New York share a collective mission to provide essential care to the State’s most fragile and vulnerable individuals,” stated Stephen Hanse, President & CEO of the New York State Health Facilities Association. “This mission is driven in partnership with the State of New York,” added Hanse. “However, in slashing Medicaid reimbursement to nursing homes by over $250 million dollars, New York is violating this partnership and turning its back on nursing home residents and the working men and women who provide vital care 24-hours a day, 365 days a year,” continued Hanse. “It is my sincere hope that the Court in this matter will put a stop to the State’s devastating cuts and protect nursing home residents, providers and their staff throughout New York,” concluded Hanse. 

Procedurally, the Court has scheduled a return date to hear formal arguments on Friday, November 1st. I will continue to keep you updated as this matter proceeds.

NYSHFA/NYSCAL CONTACT:

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11