XI. Election Process


Question 1: Can TPAs use a Power of Attorney to elect to pay directly into the PGP on behalf of the organizations they represent?

Question 2: How long after payor or third party administrator election applications are submitted does an organization become effective as an elector with the Public Goods Pool?

Question 3: How does an electing payor notify the Public Goods Pool of a change to their status?

Question 4: How does an electing TPA/ASO notify the Public Goods Pool of any changes to their list of covered organizations?

Question 5: As a new elector with the Public Goods Pool, what data is to be reported on the Public Goods Pool reports?



Question 1: Can TPAs use a Power of Attorney to elect to pay directly into the PGP on behalf of the organizations they represent?

Answer 1: A TPA may provide a Power of Attorney consent from a represented organization to elect on their behalf to pay directly into the Public Goods Pool as long as the Power of Attorney specifically authorizes the TPA to make the election on behalf of the represented organization. A general Power of Attorney which does not specifically reference the HCRA election would not be legally acceptable.

For example, the Department suggests that the following powers be included in the Power of Attorney consent:

  • Execution and delivery of any and all documents or instruments necessary or appropriate in connection with compliance within the provisions of the HCRA. "The power hereby granted to the attorney-in-fact includes, but is not limited to, the execution and delivery of any and all documents or instruments necessary or appropriate in connection with the election regarding direct payment of surcharges and the covered lives assessment provided for in New York´s Public Health Law (PHL) §2807-j and §2807-t."
  • "By executing this Power of Attorney, the undersigned hereby specifically ratifies any action undertaken by the attorney-in-fact prior to the date hereof in connection with the election provided for in §2807-j and §2807-t of the PHL and hereby expressly consents to such election and the conditions enumerated in §2807-j(5)(a)(iii) and §2807-t(3)(a)."
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Question 2: How long after payor or third party administrator election applications are submitted does an organization become effective as an elector with the Public Goods Pool?

Answer 2: An election application received from any payor or third party administrator shall begin on the first day of the month following the date the application was received, unless a future date is specified on the form. For instance, an election application with a received date of March 5th will have an effective date of April 1. In order for the application to be processed, form DOH-4399, Payor Election Application, or form DOH-4400, TPA/ASO Election Application, must be accompanied by form DOH-4264, Electronic Filing User ID Application.

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Question 3: How does an electing payor notify the Public Goods Pool of a change to their status?

Answer 3: Each electing payor is obligated to notify the Public Goods Pool of any changes in their status. The type of status change will dictate which form is required:

  • DOH-4402 (Payor Status Change) is submitted by electing payors that have become fully insured, closed, gone out-of business or have filed for bankruptcy.
  • DOH-4403 (TPA/ASO Status Change) is submitted by electing payors that added or changed their TPA or ASO.
  • DOH-4406 (Merger-Acquisition) is submitted by electing payors who have acquired, been acquired, and/or merged with another payor.
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Question 4: How does an electing TPA/ASO notify the Public Goods Pool of any changes to their list of covered organizations?

Answer 4: The TPA/ASO would be required to submit one of the following, either electronically via the hcrapools.org website, or hard copy form:

  • DOH-4401 (TPA/ASO Client List Addendum-Additions) for TPAs/ASOs to notify the Public Goods Pool of new clients for which they will responsible to file Public Goods Pool reports on behalf of.
  • DOH-4411 (TPA/ASO Client List Addendum-Deletions) for TPAs/ASOs to notify the Public Goods Pool of electing clients that are no longer clients of theirs.
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Question 5: As a new elector with the Public Goods Pool, what data is to be reported on the Public Goods Pool reports?

Answer 5: For all electing payors, and in particular newly elected payors, the surcharge portion of the Public Goods Pool reports is a summary of the surchargeable claims you paid that period (for new electors, this will be a monthly report initially). However, this only includes claim payment data with dates of service that occur on or after the effective date of the election. Any claims with dates of service prior to the effective date must be paid directly to the provider, and when billed, will include the surcharge percentage rate applicable to non-electing payors, plus, on an inpatient claim, a regional GME percentage, if applicable.

The second part of the report, Report of Covered Lives Assessment, is a summary of the number of insureds covered by your plan/policy, for which you cover inpatient coverage for, segregated by the regions in NYS where the insured lives, segregated by individual or family coverage provided. The covered lives region is always determined by where the primary insured resides.

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