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

June 20, 2012

Dear Payor/TPA/Provider:

This provides a summary of statutory changes made to the HCRA as part of the recently enacted 2012-2013 State Fiscal Year Budget. The changes are as follows:

  • Statute of Limitations: Public Health Law (PHL) §2807-j(8-a)(a) and §2807-t(10)(a) have been amended to include the language underlined below:

    "...shall be subject to audit by the commissioner for a period of six years following the close of the calendar year in which such payments and reports are due, after which such payments shall be deemed final and not subject to further adjustment or reconciliation, including through offset adjustments or reconciliations made by designated providers of services or by third-party payors with regard to subsequent payments, provided, however, that nothing herein shall be construed as precluding the commissioner from pursuing collection of any such payments which are identified as delinquent as a result of an audit..." "to make such payments directly to the commissioner or the commissioner´s designee, or from conducting an audit of payments made prior to such six year period which are found to be commingled with payments which are otherwise subject to timely audit pursuant to this section."

    To clarify these changes, there can be no revisions or adjustments made to any Public Goods Pool reporting period that are beyond the six year period as described above. Any such revisions will be subject to audit. Secondly, if during the performance of an audit, it is determined that payments and/or credits for periods beyond the six year limitation (for either the auditee or a related company) are found to be commingled with payments and credits within the six year limitation, then those payments and/or credits are not precluded from audit.

  • Mandatory Electronic Signature: PHL §2807-j(7) has been amended to require that effective on and after July 1, 2012, all Public Goods Pool reports must be certified electronically (e-signature).

  • Payor/TPA Rescission: PHL §2807-j(5)(a)(ii) has been amended to allow electing payors and TPAs to now rescind their election from the Public Goods Pool on a monthly basis, rather than on a quarterly basis. The rescission will be effective on the first day of the next month provided that notification is postmarked at least 20 days prior to the beginning of such month.

Further information concerning the foregoing may be obtained from contacting a HCRA representative at (518) 474-1673.


John E. Ulberg, Jr.
Medicaid Chief Financial Officer
Division of Finance & Rate Setting
Office of Health Insurance Programs