New York State Health Care Reform Act (HCRA)
Dear Chief Executive Officer:
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IMPORTANT NOTE! This notice is being sent to you because your organization is a payor of health care services and has filed an election application to pay certain health care services surcharges directly to the HCRA Public Goods Pools. If you use a third party administrator (TPA) for claims processing, we suggest that you contact your TPA directly concerning any questions you may have regarding this notice. |
Section 2807-t (6) of the Public Health Law (PHL) requires that prospective adjustments be made to Professional Education Pool (PEP) covered-lives assessments to reconcile PEP regional under/over funding for a prior period. The law specifies that such adjustments be made in ...the year next following the calculation of the reconciliation. Since funding of the 2002 PEP is now considered complete, the Department has finalized the level of under/over funding within each region. Consequently, the 2004 regional covered lives assessments have been adjusted to incorporate these mandated revisions. The assessments are also being adjusted to reflect the requirement under section 4 of part A3 of chapter 62 of the laws of 2003 to collect an additional $35 million in aggregate statewide in the PEP.
Please be reminded that Section 2807-s (2)(c) of the PHL stipulates that the alternative inpatient PEP surcharges for periods on and after July 1, 2003, applicable to affected non-electing third-party payors, be established at the same regional percentage allowances calculated for the period January 1, 1999 through December 31, 1999, increased by 8.19%.
The enclosed schedule provides the 2004 regional covered lives assessments and alternative inpatient surcharges. These amounts will be reflected in the 2004 service year portion of the Payor Report of Covered Lives Assessment and the Hospital Report of Patient Services Revenues for Inpatient Services.
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, should contact a HCRA representative at (518) 474-1673.
| Sincerely, | |
| Mark H. Van Guysling Assistant Director Division of Health Care Financing |
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| Enclosures | |