New York State Health Care Reform Act (HCRA)

December 10, 1998

Re:1999 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, 1999 through December 31, 1999.Beginning with the report for the month of January 1999, which must be submitted (postmarked) by March 2, 1999, 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:

  • 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 the established 1999 regional covered lives assessments and alternative inpatient surcharge rates. Please note that these 1999 regional covered lives assessment amounts are reflected on the 1999 service year portion of the Report of Covered Lives Assessment.
  • Pursuant to the New York State Health Care Reform Act of 1996, each year´s pool receipts are dedicated to specific purposes and in specific amounts. As a result, monthly reports filed by payors during 1999 MUST segregate patient service payments and the related surcharges into 1997, 1998 and 1999 service year portions. These service year portions may NOT be combined. Consequently, all instructions previously issued separately apply to each service year.
  • Similar to the patient service payments discussed above, the covered lives portion of the reports must also be segregated into 1997, 1998 and 1999 portions. Thus, the only amounts to be reported on the 1997 and 1998 covered lives portions of the monthly reports are prior period adjustments to 1997 and 1998 covered lives payments previously made.
  • Required prior period adjustments must be disclosed on the portion of the monthly report relating to the year to which they apply. For example, a correction of an amount reported for 1998 MUST be reported as a prior period adjustment on the 1998 portion of the monthly report.
  • 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 10, lines C through H of the Report of Covered Lives Assessment for the 1999 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, 1998 and 1999 surcharge and covered lives liabilities should agree with the amount shown on Line 10 of the summary page. It should be noted that if a liability exists for one or more years and a credit exists for the other year(s), the net amount should be reflected in a single payment check. 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. 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

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. Repeated late payments, failure to remit correct amounts, or to provide adequate certification of the accuracy of surcharge payments can result in the revocation of an electing payor´s direct pay status potentially subjecting them to higher surcharges. Furthermore, untimely filing of reports and payments can result in the imposition of interest and penalties determined 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