New York State Health Care Reform Act (HCRA)

December 22, 1997

Re:1998 Public Goods Pool Reporting Forms - Payors

Dear Payor:

Enclosed please find reporting forms and instructions for electing payors to use when calculating and remitting payments to the Public Goods Pools for reporting periods January 1, 1998 through December 31, 1998. Beginning with the report for the month of January 1998, which must be submitted (postmarked) by March 2, 1998, payors are required to use the enclosed forms. The reporting forms are required to be filed monthly even if there is no activity to report.

If you are a self-insured fund represented by a TPA, be advised that we are forwarding all revised reporting forms and instructions, and all other correspondence relating to your Public Goods Pools payment and reporting obligations, to you as well as your TPA. The primary responsibility of insuring that the monthly reporting forms are timely filed by any electing self-insured fund rests with the self-insured fund. If reports are not filed, or not timely filed, any penalties and interest would be imposed on the fund.

If you have an agreement with a TPA whereby the TPA is preparing and/or submitting reporting forms on your behalf, it is your responsibility to insure that your TPA files all appropriate monthly report forms in compliance with the instructions in this transmittal.

The major changes to the instructions have been highlighted to assist you in identifying those that may affect your monthly reporting submittal. Following are issues which deserve special mention:

  • Pursuant to the New York State Health Care Reform Act of 1996, each service year´s pool receipts are dedicated to specific purposes and in specific amounts. As a result monthly reports filed by payors during 1998 must be segregated for patient service payments into 1997 and 1998 service year portions. These service year portions may not be combined. In essence, all instructions previously issued apply to each service year.
  • Similar to the patient service payments discussed above, the covered lives portion of the reports are service year specific. Thus, the only amounts to be reported on the 1997 covered lives portion of the monthly reports are prior period adjustments, since the December 1997 monthly report (due January 30, 1998) would have represented the final payment of covered lives for the 1997 service year, except for positive or negative adjustments necessary for correction of enrollment data unknown at the time the 1997 monthly reports were completed.
  • As previously stated, each service year must be segregated on the monthly report therefore, any prior period adjustments must be disclosed on the report for the service year to which they apply. For example, a correction of an amount reported for service year 1997 must be reported as a prior period adjustment on the 1997 portion of the monthly report.
  • A summary page has been added to the 1998 reporting form. This will allow for easy identification of the separate service year surcharge amounts.
  • Payors that apportion the cost of their covered lives assessments with another payor must report the covered lives subject to apportionment and their respective apportionment percentage on Page 9, lines C through H of the Report of Covered Lives Assessment for the 1998 service year. The report must be completed even if, as a result of that apportionment agreement, the payor´s covered lives liability is zero.
  • Payment in the form of one check should be submitted and made payable to the "Public Goods Pool". This check which will account for the combined 1997 and 1998 surcharge and covered lives liabilities should agree with the amount shown on Line 7 of the summary page. It should be noted that if a liability exists for one service year and a credit exists for the other service year, the two amounts should be netted and one check submitted for the net amount. The payment check should be mailed with the applicable reporting forms via:

Regular Mail:

Mr. Jerome Alaimo, Pool Administrator
Office of Pool Administration
Excellus BlueCross BlueShield,
Central New York Region
P.O. Box 4757
Syracuse, New York 13221-4757

-OR-

Express or Overnight Mail:

Mr. Jerome Alaimo, Pool Administrator
Office of Pool Administration
Excellus BlueCross BlueShield,
Central New York Region
344 South Warren Street
Syracuse, New York 13202-2008

  • As was the case for 1997, Attachment 2 has been included in 1998 for the use of those third-party administrators representing self-insured funds and other payors that have no Public Goods Pool liability or credit for a reporting month or that are submitting the reporting forms separately on their own behalf. In these instances only, TPAs may complete Attachment 2 rather than submit separate reports for such payors. Note that a payor can only be included on Attachment 2 if no liability or credit exists for the reporting month for both service years, 1997 and 1998. If a liability or credit exists for either of the service years, the entire report must be completed in accordance with the instructions. Further, do not list payors that have no covered lives liability for the report month due to an apportionment on Attachment 2. Payors that apportion the cost of their covered lives assessment with another payor must report the covered lives subject to apportionment and their respective apportionment percentage on Page 9, Lines C through H of the Report of Covered Lives Assessment, even when the payor´s apportionment percentage is zero.
  • You may wire transfer your monthly Public Goods Pool payment to the Department´s Pool Administrator. We have enclosed a Wire Transfer Instructions Form DOH-4075, (Page 13 of the report) for your use when processing Federal or Automated Clearing House (ACH) wire transfers. (Please see the last page of this transmittal and follow closely the instructions listed at the bottom of such form).

A schedule of report and payment due dates for the months of January through December 1998 is provided on the first page of the instructions. Note also that the first report, covering the month of January 1998, must be submitted (postmarked) by March 2, 1998.

Since payors cannot determine their monthly Public Goods Pool liability until sometime following the last day of the respective reporting month, all monthly reports submitted prior to the end of the respective reporting month will be returned. For example, although an out-of-state self-insured company may expect that it will not have a Public Goods Pool liability for a particular month since all it´s covered employees reside outside New York State, the company cannot make that determination until sometime following the last day of the report month since it is conceivable that an employee or an employee´s dependent could require the services of a designated provider while traveling or attending school in New York State.

Reports must be completed and submitted in accordance with the enclosed instructions. If, upon review, a report is deemed unacceptable and corrections are not submitted when required, the report may be returned and a delinquency notice issued. You are reminded that a payor may be denied the opportunity to remit the HCRA surcharges directly based on repeated late payments, failure to remit correct amounts, or failure to provide adequate certification of the accuracy of surcharge payments. Additionally, failure to timely file reports and payments will result in interest and penalties being applied in accordance with the provisions of Section 2807-j(8) of the Public Health Law.

Should you have any questions concerning the foregoing or the enclosed forms, please contact Mr. Richard Pellegrini, Director of the Bureau of Financial Management and Information Support at (518) 473-4653.

Sincerely,

Mark H. Van Guysling
Assistant Director
Division of Health Care Financing

Enclosures