Additional Statutory Change to New York Health Care Reform Act (HCRA) of 2000

December 23, 2011

Dear Payor/TPA/Provider:

This provides a summary of an additional statutory change made to the HCRA as part of the 2011-2012 State Fiscal Year Budget. The change is as follows:

  • HCRA Surcharge Exemption on Revenue Received for Discretely Billed Physician Services

Effective for dates of service April 1, 2011, and after, §2807-j of the Public Health Law exempts HCRA surcharges on all revenue received for discretely billed physician practice or faculty practice plan physician services. This includes revenue received for services rendered by employed physicians. Therefore, any payments made for these services are not subject to the surcharge. The physician services must be discretely billed and thus excluded from the billing provider´s institutional rates for services rendered. Please note that for dates of service prior to April 1, 2011, only revenue received from physician practice or faculty practice plan discrete billings for private practicing physician services is exempt from the HCRA surcharges.

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

Sincerely,

John E. Ulberg, Jr.
Medicaid Chief Financial Officer
Division of Finance and Rate Setting