New York State Health Care Reform Act (HCRA)

December 19, 1998

Re: 1999 Public Goods Pool Reporting Forms - Hospitals

Dear Administrator/Comptroller:

Enclosed please find reporting forms and instructions for designated providers to use when calculating and remitting payments to the Public Goods Pools for reporting periods January 1, 1999 through December 31, 1999. Beginning with the report for January 1999, which must be submitted (postmarked) by March 2, 1999, providers are required to use the enclosed forms. The reporting forms are required to be filed monthly even if there is no activity to report.

The following are issues which deserve special mention:

  • Section 2807-t(6) of the Public Health Law requires that prospective adjustments be made to Professional Education Pool (PEP) covered-lives assessments and alternative inpatient surcharges to reconcile PEP regional under/over funding. The law specifies that such adjustments be made in "...the year next following the calculation of the reconciliation". Since funding of the 1997 PEP is now considered complete, we have calculated the level of under/over funding within each region and incorporated such adjustment in established 1999 regional covered lives assessments and alternative inpatient surcharge rates. Please note that these 1999 rates are reflected on the 1999 service year portion of the Inpatient Hospital report.
  • 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 providers during 1999 MUST be segregated into 1997, 1998 and 1999 service year portions. These service year portions may NOT be combined. Consequently, all instructions previously issued apply to each service year.
  • Required 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 1998 MUST be reported as a prior period adjustment on the 1998 portion of the monthly report.
  • During the 1999 reporting year only, providers must submit a completed 1997 service year portion of the 1999 monthly report only when they have received 1997 service year patient services revenues during the report month and/or have 1997 service year prior period adjustments to report for the month. Therefore, when a provider has no 1997 service year patient services revenues and no 1997 service year prior period adjustments to report for the month, the 1997 service year portion of the 1999 report should not be submitted. However, the 1998 and 1999 service year portions of the 1999 monthly report must be submitted each month, even if there is no activity for the report month.
  • The summary page of the 1999 reporting form (Page 2 of the report) summarizes the amount of surcharge liabilities due, by service year. Line 1 of the summary page MUST agree with the amount of 1997 service year liability reported on Page 14, Line 18 of the report, while Line 2 of the summary page MUST agree with the amount of 1998 service year liability reported on Page 6, Line 18 of the report and Line 3 of the summary page MUST agree with the amount of 1999 service year liability reported on Page 10, Line 18 of the report. 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, 1998 and 1999 surcharge liabilities MUST agree with the amount shown on Line 4 of the summary page. The facility´s Operating Certificate number must be entered onto the payment check and reporting forms. It should be noted that if a liability exists for one or more service years and a credit exists for the other service year(s), the net amount should be reflected in a single payment. This 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 prior years, Attachment 2 has been included in the 1999 reports used by third-party administrators representing self-insured funds and other payors that have no Public Goods Pool liability or credit for a reporting month or who 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 service years, 1997, 1998 AND 1999. If a liability or credit exists for any 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 agreement 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 10, Lines C through H of the Report of Covered Lives Assessment. This must be done 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 16 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 1999 is provided on the first page of the instructions. Note also that the first report, covering the month of January 1999, must be submitted (postmarked) by March 2, 1999.

Reports must be completed and submitted in accordance with the enclosed instructions. If, upon review, a report is deemed unacceptable, the report may be returned and a delinquency notice issued. Failure to comply with the reporting provisions provided in Sections 2807-j and 2807-s of the Public Health Law may result in the recoupment of the facility´s estimated monthly assessment liability, along with interest and/or penalty, from various third party payments pursuant to Section 2807-j(6) 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