New York State Health Care Reform Act (HCRA)

January 11, 2002

Dear Administrator/Comptroller:

Re: Monthly Public Goods Pool Reporting Forms for Hospitals

Enclosed please find reporting forms and instructions for designated providers to use when calculating and remitting payments to the Public Goods Pools.

Providers are required to file the enclosed Provider Certification Form, Payment Summary, and the two most recent service year portions of the Report of Patient Services Revenue and Surcharge Obligations monthly, even if there is no activity to report. Prior service year portions of the report are required only when a provider has net patient services revenue and/or prior period adjustments to report which relate to those service years. Revenue received during the month for surchargeable claims for services rendered during a prior service year must be reported on the appropriate service year´s form. Additionally adjustments necessary to information previously reported for such service years must be reported as prior period adjustments on the appropriate service year´s form. The report forms are available on the WEB under the menu selection entitled "Public Goods Pool Reporting Forms and Instructions" at: www.health.ny.gov/regulations/hcra/index.htm

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 (PHL) 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. Additionally, PHL Section 2807-j(7)(c) authorizes the Commissioner to assess civil penalties for certain reporting delinquencies.

Should you have any questions concerning the foregoing or the enclosed forms, please contact a HCRA representative at (518) 474-1673.

Sincerely,

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

Enclosures