New York State Health Care Reform Act (HCRA)
August 31, 2006
Re: New York Health Care Reform Act (HCRA) of 2000
This is to notify you of upcoming changes to the Public Goods Pool electronic reporting application. These changes will be implemented beginning with the January 2007 monthly payor and provider reports and will also apply to the annual payor report for 2007 and forward. The changes are detailed below:
Changes That Affect Both Provider and Payor Reports:
- The electronic reporting application will eliminate the ability to submit a report unless all required pool years are filed for each reporting submission. Users will no longer have the ability to file only one service year portion of their Public Goods Pool report if both service years are required.
Changes That Affect Payor Reports:
- For each reporting submission, affected payors, or third party administrators (TPA) filing on behalf of their clients, will no longer have the ability to submit the Report of Patient Services Payments and Surcharge Obligations separately from the Report of Covered Lives Assessment (applicable to specified third party payors as defined in Section 2807-s of the New York Public Health Law). The electronic application will only accept a payor report for a reporting period if all required portions of the Public Goods Pool report are submitted. This change will affect not only those payors or TPAs that submit sections of a report at different times, but also those payors that have previously coordinated with their TPAs to calculate and file one portion of the report while their TPA calculates and files the other portion. Although the application will no longer allow two parties to submit portions of the report at separate times for a given reporting period, the Certification Page will be modified to accommodate two signatures for those payors and TPAs that wish to continue to attest to separate portions of the report submission. Payors and TPAs in this situation are strongly encouraged to begin now to establish coordinated procedures to effectuate this change in reporting.
- Payors, or TPAs filing on their behalf, will be required to report if they have no statutory covered lives obligation through use of a check box that has been added to the report. A description of "specified third party payors" statutorily obligated to submit the Report of Covered Lives Assessment and related payments will be available within the application.
To assist you further, the User Documentation for Payors/TPAs/Providers located at www.hcrapools.org will be updated to provide specific instructions needed in completing reports beginning January 2007.
We anticipate that you will find these necessary revisions user friendly with minimum adjustment to your current reporting procedures. Should you have any questions concerning the above, please contact Ms. Phyllis Stanton or Ms. Dawn LaPointe of my staff at (518) 474-1673.
Mark H. Van Guysling
Division of Health Care Financing