November 23, 2004
Notice to Electing Payors and TPAs Concerning Eligibility for Annual Reporting for 2005
Sections 2807-j (5-a)(a), 2807-j (7)(b), and 2807-t (5)(a) of the Public Health Law provide that the Commissioner may permit payors, who have at least one full year of pool payment experience and whose annual liability is not expected to exceed $25,000, to submit Public Goods Pool reports and related surcharge obligations on an annual basis. The Department has established the following criteria for payors to be eligible for annual filing for 2005:
- A payor's election must have been effective on or before July 1, 2003;
- A payor must have filed at least twelve monthly reports through the June 2004 report period; and
- A payor's average annual pool payment liability must not exceed $25,000 based on reports filed through the above referenced period.
There is no application process. Notification letters have been mailed to payors who meet the above criteria for annual filing and their respective third party administrators (TPAs). The notification letter to payors includes a form which eligible payors can endorse and submit to the Office of Pool Administration if they want to continue to report on a monthly basis. The Department requires that this form be endorsed by the eligible payor (not their TPA) that chooses to continue to file twelve monthly reports instead of just one annual report. This form must be postmarked to the Office of Pool Administration no later than December 15, 2004. Eligible payors that filed the appropriate form to remain monthly filers for 2004 must renew such application to remain monthly filers for 2005. Eligible payors that fail to submit a properly endorsed form timely and proceed to file one or more monthly reports for the January 1, 2005, through December 31, 2005, report period, will still be required to submit an annual report for the entire period, reconciling any monthly amounts previously reported for the period. A qualifying payor that fails to file an annual report, who has not endorsed a timely submitted form, as prescribed, to continue monthly filing, will be considered delinquent for the entire annual reporting period, even though one or more monthly reports may have been filed.
Beginning with the February 2005 posting, each payor's 2005 filing designation will be noted on the electors list posted each month on this WEB site. A current year filing designation column will denote the Department's final determination of each payor's filing status for the January 1, 2005, through December 31, 2005, reporting period.
The notification letter provides pertinent phone numbers for questions relating to annual filing.