Dear Chief Executive Officer: GME Regional Covered Lives Assessment Rates
November 8, 2012
This notice is being sent to you because your organization is a payor of health care services and has filed an election application to pay certain health care services surcharges directly to the HCRA Public Goods Pools. If you use a third party administrator (TPA) for claims processing, we suggest that you contact your TPA directly concerning any questions you may have regarding this notice.
Section 2807-t (6) of the Public Health Law (PHL) requires that prospective adjustments be made to Covered Lives Assessments (CLA) to reconcile CLA regional over/under 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 2011 CLA is now considered complete, the Department has finalized the level of over/under funding within each region. Consequently, the 2013 Regional CLA have been established to incorporate these mandated revisions.
Please be reminded that Section 2807-s (2)(c)(iv) of the PHL stipulates that the alternative inpatient HCRA Public Goods Pool surcharges for periods after July 1, 2007, applicable to affected non-electing third-party payors, be established at the same regional percentage allowances calculated for the period January 1, 2006 through June 30, 2007.
The enclosed schedule provides the 2013 Regional CLA and alternative inpatient surcharges. These amounts will be reflected in the 2013 service year portion of the Payor Report of Covered Lives Assessment and the Hospital Report of Patient Services Revenues for Inpatient Services.
If you use a TPA, we suggest that you contact your TPA directly concerning any questions you may have regarding this notice. Others having questions regarding the foregoing, should contact a HCRA representative at (518) 474-1673.
John E. Ulberg, Jr.
Medicaid Chief Financial Officer
Division of Finance and Rate Setting
Office of Health Insurance Programs