Dear Payor/Third Party Administrator: 2008-2009 Supplemental GME Regional Covered Lives Assessment Rates

August 15, 2008

Dear Payor/Third Party Administrator:

Re: New York State Health Care Reform Acts of 1996 and 2000 (HCRA)

As previously stated in our May 29, 2008, letter, Section 15 of Part B of Chapter 58 of the Laws of 2008 added Public Health Law (PHL) Section 2807-s (6) (a) (xiii) requiring an additional $64.2 million of Professional Education Pool (PEP) covered lives assessments funding for the October 1, 2008, through March 31, 2009, period. We have enclosed the schedule of the additional supplemental regional covered lives assessment per diems that were previously mailed with the May 29, 2008, letter.

This law requires that the additional assessment be reported separately and paid in six monthly installments by the 10th day of each affected month. Initial payments are to be based on each payor´s monthly enrollment count for the preceding month, and subsequently reconciled on a month to month basis to reflect actual enrollment counts for each applicable month. Therefore, in addition to filing monthly reports for the October 2008 through March 2009 periods, a report for April 2009 will also be required to be submitted to allow for reconciliation of the March 2009 enrollment data.

This assessment is required to be submitted electronically on a separate report entitled, "Covered Lives Supplemental Report". The first report is due October 10, 2008. For your information, we have posted a copy of the Supplemental Report, the instructions, and the Schedule of Report and Payment Due Dates to the Department's website:

For payors who use a third party administrator (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.


John E. Ulberg, Jr.
Division of Health Care Financing