New York State Health Care Reform Act (HCRA)

December 15, 2003

Dear Administrator/Controller:

Re: 2004 Public Goods Pool Reporting Forms for Hospitals

Enclosed please find reporting forms and instructions for designated providers to use when calculating and remitting payments to the Public Goods Pools. If you have changed your facility name and/or address, please complete the enclosed Name/Address Change Form.

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. Failure to comply with the reporting provisions provided in Sections 2807-j and 2807-s of the Public Health Law (PHL) may result in the recoupment of the facility´s estimated monthly assessment liability, along with interest and/or penalty, from various third party payments pursuant to Section 2807-j(6) of the Public Health Law. Additionally, PHL Section 2807-j(7)(c) authorizes the Commissioner to assess civil penalties for certain reporting delinquencies.

As a result of modifications to the New York Health Care Reform Act (HCRA) enacted by Chapter 62 of the Laws of 2003, designated providers of services are required to submit reports electronically for periods on and after January 1, 2005. Providers are encouraged to submit reports electronically on a voluntarily basis prior to that date. Before electronic filing can commence, the enclosed Attachment 2-W must be completed to obtain a secure user ID and password. If you have any questions concerning electronic filing, please contact the electronic filing help desk at (315) 671-3800 or via e-mail at webpools@hcrapools.org.

Should you have any questions concerning the foregoing or the enclosed forms, please contact a HCRA representative at (518) 474-1673.

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

Enclosures