New York State Health Care Reform Act (HCRA)

December 15, 2003

Dear Payor:

Re: 2004 Monthly Public Goods Pool Reporting Forms - Payors

Enclosed please find reporting forms and instructions for electing payors to use when calculating and remitting monthly payments to the Public Goods Pools. The reporting forms must be filed monthly, even if there is no activity to report. Please refer to the appropriate Schedule of Report and Payment Due Dates for information concerning the specific forms payors must submit each month. 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.

As a result of modifications to the New York Health Care Reform Act (HCRA) enacted by Chapter 62 of the Laws of 2003, all electing monthly payors and all electing TPAs are required to file electronically for reporting periods on and after July 1, 2004. However, payors whose elections are effective on or after January 1, 2004, will be subject to mandatory electronic filing only after one full year of pool payment experience which results in them being a monthly filer.

Before electronic filing can commence, the enclosed Attachment 2-W must be completed to obtain a secure user ID and password. Payors whose TPA will be filing electronically on their behalf do not need to complete an Attachment 2-W. If you have questions concerning electronic filing, please contact the electronic filing help desk at (315) 671-3800 or via e-mail at webpools@hcrapools.org.

If you are a payor 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 rests with the electing payor. If reports are not filed, or not timely filed, any penalties and interest would be imposed on the electing payor. 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 reporting forms in compliance with the instructions in this transmittal.

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

If you use a TPA, we suggest that you contact your TPA directly concerning any questions you may have regarding this notice. Others having questions regarding the foregoing, or the enclosed forms, should contact a HCRA representative at (518) 474-1673.

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

Enclosures