Issue: November 7, 2019

Published on November 7, 2019

Articles in this issue:

Case Mix Cut Litigation Update – Preliminary Injunction Granted

Author: Esq. Stephen B. Hanse* Published in Legal

I am pleased to report that the Court granted our request for a Preliminary Injunction to halt the State’s implementation of its Medicaid case mix cut pending a final determination of our litigation on the merits. In its Order, the Court enjoined the State from implementing the new case mix methodology adopted for the 7/1/19 rates and directed the State to use the prior methodology for calculating Medicaid case mix rates.

NYSHFA will continue to keep you updated as this matter progresses.


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

PDPM Claim Guidance Released

Author: Carl J. Pucci* Published in Finance & Reimbursement

CMS has released guidance on claims payments under the newly implemented PDPM model. Below is the AHCA bulletin with further details:

Earlier today, the Centers for Medicare and Medicaid Services (CMS) announced an update on claims payments under the newly implemented Patient-Driven Payment Model. As CMS has undertaken the implementation of the Patient Driven Payment Model (PDPM), they are holding a limited number of Skilled Nursing Facility (SNF) claims while they make further refinements to their claims processing system. 

Specifically, CMS is holding claims with:

Typically, SNFs bill these claims on monthly cycles. Claims with single HIPPS codes were previously being held but are now being released for processing. CMS anticipates releasing the remaining held claims in late November, once they complete systems testing to ensure accurate and timely payment. As of November 1, less than 50 claims are being held.  

This is extremely positive news. In addition to what CMS has shared, there are some specific actions members must take in order for payments to go through.

    1. CMS will begin the 14-day floor for claims processing from the date of submission. Therefore, when the fix goes into place the third week of November, your claims will be processed at that time - not 14 days later which would be the case if you wait until the third week in November. 
    2. If the November fix timeframe slips, having an accurate assessment of the number of outstanding multi-HIPPS code claims on hold will help to rapidly move forward with an alternative payment fix.

If you have questions, suggestions or concerns, please contact


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

Deadline Extended for the Quality Award Intent to Apply

Author: Lisa Volk

Due to technical difficulties with the Quality Award Portal, AHCA/NCAL is extending the National Quality Award Intent to Apply (ITA) deadline to Thursday, November 21st. Submissions must be received before 8 pm ET on November 21st.

For those members who were impacted by the payment error, Quality Award staff will contact you with instructions on submitting the payment.

As a reminder, the ITA payment is not mandatory, however applicants who submit an ITA payment will save money on their overall application. No paperwork is needed to submit the ITA.

You can access help documents for the Quality Award Portal here, or if you need additional assistance please email

The National Quality Award Program is excited for the 2020 program cycle and looks forward to your applications. We sincerely apologize for this inconvenience and thank you for your patience as we work through this technical issue.


Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Survey Tips & Trends 2019 Audio Conference- December 6th

Author: * Published in Education

Join NYSHFA/NYSCAL on December 6th at 10am for Survey Tips & Trends 2019 Audio Conference. In this audio conference, the presenter will review current survey trends in New York State, including Health, Life Safety and Emergency Preparedness. Attendees will learn tips for systems enhancement and quality improvement that can be implemented in their facilities to reduce the likelihood of deficient practices being identified. A regulatory update, including the status of the full implementation of the Requirements of Participation, will be provided.

Click here for additional details. 








Save the Date! 71st Annual Conference & Expo

Author: Scott Jackson* Published in Education

Registration information coming early 2020!

38th Annual Summer Leadership Conference

Author: Scott Jackson* Published in Education

Register now for the 38th Annual Summer Leadership Conference. The conference will be held July 20-24, 2020.

Additional details can be found by clicking here! Don't miss out on this great educational experience!