New York State Health Care Reform Act (HCRA)

October 30, 2002

Dear Payor:

Re: 2002 Annual Public Goods Pool Reporting Forms - Payors

Enclosed please find reporting forms and instructions for annual filers to use when calculating and remitting payments to the Public Goods Pools for the January 1, 2002 through December 31, 2002, reporting period. The report and payment must be submitted (postmarked) by January 30, 2003. Since annual filers cannot determine their Public Goods Pool liability until sometime following the last day of the respective reporting year, all reports submitted prior to the end of the respective reporting year will be returned.

Payors and TPAs that want to fulfill their Public Goods Pool reporting obligations electronically (via the Internet) must complete the enclosed Attachment 2-W to obtain a secure user ID and password before electronic filing can commence. Payors whose TPA will be filing electronically on their behalf do not need to complete an Attachment 2-W. If you have questions concerning electronic filing, please contact the electronic filing help desk at (315) 671-3800 or via e-mail at webpools@hcrapools.org.

A payor's annual report must be a composite of 1) all patient services payments made during the reporting year, 2) the number of New York State resident covered lives on the payor's membership roles for all or any part of a month summarized for the entire year, 3) all reporting adjustments due to prior reporting errors or omissions, and 4) the related surcharge and assessment amounts. If an annual reporter erroneously submitted monthly reports and payments during the current reporting year, the payor's annual report must be net of the patient services payments and covered lives amounts reported on the monthly reports erroneously submitted.

Payors are required to file the enclosed Payor Certification Form, Payment and Reconciliation Summary, and the 2001 and 2002 portions of the 2002 report, even if there is no activity to report. The 1997 through 2000 portions of the 2002 report are required only when a payor has net patient services payments and/or prior period adjustments to report, which relate to those service years. Payments made during 2002 for surchargeable claims for services rendered during the 1997 through 2000 service years must be reported on the appropriate service year's form. Additionally, adjustments necessary to information previously reported for such service years must be reported on the appropriate service year's form. The 1997 through 2000 portions of the 2002 report have not been included in this mailing, but are available on the WEB at: www.health.state.ny.us/regulations/hcra/reports/annual/atable.htm

If you are a payor represented by a TPA, be advised that we are forwarding all revised reporting forms and instructions, and all other correspondence relating to your Public Goods Pools payment and reporting obligations, to you as well as your TPA. The primary responsibility of insuring that the reporting forms are timely filed rests with the electing payor. If reports are not filed, or not timely filed, any penalties and interest would be imposed on the electing payor. If you have an agreement with a TPA whereby the TPA is preparing and/or submitting reporting forms on your behalf, it is your responsibility to insure that your TPA files all appropriate report forms in compliance with the instructions in this transmittal.

Section 2807-t(6) of the Public Health Law requires that prospective adjustments be made to Professional Education Pool (PEP) covered-lives assessments to reconcile PEP regional under/over funding for a prior period. The law specifies that such adjustments be made in "...the year next following the calculation of the reconciliation". Since funding of the 2000 PEP is now considered complete, the Department has finalized the level of under/over funding within each region and incorporated this amount in the calculation of the year 2002 regional covered lives assessments. Please note that these 2002 regional covered lives assessment amounts are reflected on the 2002 portion of the Report of Covered Lives Assessment.

Reports must be completed and submitted in accordance with the enclosed instructions. If, upon review, a report is deemed unacceptable, the report may be returned and a delinquency notice issued. Repeated late payments, failure to remit correct amounts, or to provide adequate certification of the accuracy of surcharge payments can result in the revocation of an electing payor's direct pay status potentially subjecting them to higher surcharges. Additionally, untimely filing of reports and payments can result in the imposition of interest and penalties determined in accordance with the provisions of Section 2807-j(8) of the Public Health Law (PHL). Furthermore, PHL Section 2807-j(7)(c) authorizes the Commissioner to assess civil penalties for certain reporting delinquencies.

If you use a TPA, we suggest that you contact them directly concerning any questions you may have regarding this notice. Others having questions regarding the foregoing, or the enclosed forms, should contact a HCRA representative at (518) 474-1673.

Sincerely,

Mark H. Van Guysling
Assistant Director
Division of Health Care Financing

Enclosures