Annual Reporting Notification for TPAs
October 29, 2015
Dear Third Party Administrator:
Re: New York Health Care Reform Act of 2000 (HCRA)
HCRA 2000 provides that the Commissioner may permit payors, who have at least one full year of pool payment experience and whose annual liability is not expected to exceed $25,000, to submit Public Goods Pool reports and related surcharge and covered lives assessment obligations on an annual basis. The Department has set the following criteria for payors to be eligible for annual filing for 2016:
- A payor´s election must have been effective on or before July 1, 2014;
- A payor must have filed at least twelve monthly reports through the June 2015 report period; and
- A payor´s average annual pool payment liability must not exceed $25,000 based on reports filed through the above referenced period.
There is no application process. The Department has determined which payors meet the above-referenced criteria and has notified them directly. Payors that prefer to submit twelve monthly reports, rather than one annual report, for the aforementioned period, must notify the Office of Pool Administration (OPA) either electronically or in writing by December 31, 2015. Additionally, please note that those payors who are monthly filers for 2016 also have the option to establish their covered lives enrollment obligations for the 2016 calendar year on membership units enrolled as of the last day of the month. If payors choose this option, they must notify the OPA either electronically or in writing by December 31,2015. Your clients have been provided the information on how to submit both notifications.
Third Party Administrators (TPA) are not permitted to make the decision on behalf of their clients. Additionally, TPAs are not permitted to endorse the hardcopy forms or electronically make the choice on behalf of their clients.
Please note that a payor's change of TPAs or change of payor status (e.g. changing from self-insured to fully insured) during 2016 does not change a payor's filing designation. A payor who is designated as a 2016 annual filer will remain an annual filer, subject to the annual reporting requirements prescribed in this notice, for the entire January 1, 2016 through December 31, 2016, reporting period. Consequently, each TPA filing a 2016 report on behalf of such payor is required to submit an annual report electronically on the OPA's Web site at: www.hcrapools.org. If one or more monthly report filings are made by, or on behalf of, such payor, submission of an annual report will still be required. If such payor, or their TPA, fails to file an annual report, the payor will be considered delinquent for the entire annual reporting period, even though one or more monthly reports may have been filed.
Notification has been forwarded to clients that according to the records of the OPA, are linked to your organization, and who qualify for annual filing for 2016, with a request that they notify their TPA of their 2016 filing preference. To view your client listing, which includes the preliminary 2016 filing status for your electing clients, visit the OPA's Web site. Since these preliminary filing statuses may change, the final 2015 filing statuses will be available on the OPA's Web site by February 2, 2016. Further, please note that beginning February 2, 2016, each payor's final 2016 filing status will also be noted on the HCRA Elector List which is posted each month to our Web site at: www.health.ny.gov/regulations/hcra/elector/about.htm. A current year filing designation column will denote the Department´s final determination.
If you have any questions concerning the foregoing, please contact the Office of Pool Administration at (315) 671-3800.
Sincerely,
Ann Foster
Deputy Director
Division of Finance and Rate Setting
Office of Health Insurance Programs
