Cash Receipts Assessment Program
December 6, 2005
Dear Administrator/Controller:
In my letter dated November 3, 2005, you were provided with the Department's implementation plan regarding outstanding
collections due for the above referenced assessment program. The plan addressed the filing of delinquent
reports and payments covered by the current statutorily authorized amnesty
period (i.e., January 2003 through February 2005), payment of the additional
required 1% assessment retroactive to April 1, 2005, and, required payments at
the 6% assessment rate for the November 2005 and subsequent report months. Enclosed is the revised reporting form which should be used for November 2005, and subsequent report month
submissions. Also enclosed is an Addendum Report which identifies your actual payments made at the previously
authorized 5% assessment rate for the April 2005 through October 2005 report
months. Based on this information, this Addendum Report also identifies what we believe is the outstanding balance due
at the 6% rate for these affected prior months. To retroactively pay the additional 1% assessment for months previously
paid at the 5% assessment rate, please submit the additional amount due (total
of April through October 2005 payments) with your November 2005 report and
payment. Complete the Addendum Report and transfer the additional amount due to Line 9, Other Adjustments, on the
Assessment Report and indicate that it is for the additional 1%. All outstanding monthly reports and payments for the January 1, 2003
through November 30, 2005 period, submitted by December 31, 2005, will be
processed by Department's Pool Administrator no later than the first week in
February. Any remaining delinquencies for these report months will be billed shortly thereafter, with applicable
interest and penalty. You will be provided 7 days from receipt of this subsequent delinquency notice to resolve
these remaining outstanding liabilities. Estimates will be used when unpaid actual reported assessment
obligations are unavailable. If outstanding obligations are not resolved after this final notice, the Office of
Medicaid Management will be notified to immediately initiate recoupment
procedures against your facility's Medicaid claims until the liability is fully
satisfied. If you should have any questions concerning your
outstanding reports and payments, please contact Ms. Joanne Yaworsky at the
Office of the Assessment Fund Administrator, Excellus BlueCross BlueShield,
Central New York Region, at (315) 671-3800. For all other questions, please contact Mr. Walter Susko or Ms. Jeanne
Wilson of the Bureau of Financial Management and Information Support at (518) 473-4653. Sincerely, Mark H. Van Guysling Enclosures
Assistant Director
Division of Health Care Financing
