Letter to Electing Payors and TPAs Concerning Eligibility for Annual Reporting for 2009
November 13, 2008
Important Note: This notice is being sent to you because your organization:
- is a payor of health care services;
- has filed an election application to pay certain health care services surcharges directly to the HCRA Public Goods Pools; and
- has been deemed eligible to file an annual report, rather than monthly reports, for the January 1, 2009, through December 31, 2009, reporting period.
If you use a third party administrator (TPA) for claims processing and your TPA files Public Goods Pool reports on your behalf, please advise your TPA that you have received this notice.
HCRA 2000 provides 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 and covered lives assessment obligations on an annual basis. The Department has set the following criteria for payors to be eligible for annual filing for 2009:
- A payor's election must have been effective on or before July 1, 2007;
- A payor must have filed at least twelve monthly reports through the June 2008 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.
Based on these criteria, you have been deemed eligible to submit an annual Public Goods Pool report, rather than monthly reports, to fulfill your Public Goods Pool reporting obligations for the January 1, 2009, through December 31, 2009, reporting period. If you prefer to submit twelve monthly reports, rather than one annual report, for the aforementioned period, you must complete the enclosed 2009 Payor Monthly Reporting Option form and submit it to the Office of Pool Administration (OPA) at the address indicated on the form by December 15, 2008.
Filing the aforementioned form by the filing deadline is the only method that a qualifying payor may use to change its filing designation from annual to monthly for 2009. Eligible payors that filed the appropriate form to remain monthly filers for a prior year must renew such application in accordance with the form completion instructions to remain monthly filers for 2009. This form must be endorsed by the qualifying payor. It cannot be endorsed and filed on the qualifying payor's behalf by the qualifying payor's TPA. If the form is not received in the manner prescribed, an annual report will be required to be filed by the qualifying payor (or by the qualifying payor's TPA) to report activity for the entire applicable reporting year. If one or more monthly report filings are made by, or on the behalf of, such qualifying payor for the applicable reporting year, submission of an annual report will still be required. If such payor, or their TPA, fails to file an annual report, the payor will be considered delinquent for the entire annual reporting period, even though one or more monthly reports may have been filed.
If you do not provide timely written notification using the enclosed form to convey your intention to submit monthly reports for 2009, you will be expected to submit an annual report electronically by accessing the OPA's Website at www.hcrapools.org. If you decide to take advantage of the ability to submit one annual report, you do not need to respond to this notification letter. If you use a TPA for claims processing, and your TPA files Public Goods Pool reports on your behalf, you must notify your TPA of your filing preference.
Please note that to electronically submit reports, access pertinent information to your election, request/view delinquencies, and view HCRA designated providers by Federal Employer Identification Number through the OPA's website mentioned above, you will need to have a User ID/Password on file. If you do not have one on file, we encourage you to complete the enclosed Electronic Filing User ID Application (DOH-4264). In addition, the e-mail address that you provide on this form will be used to send you important information regarding the HCRA and your election.
A payor's change of TPAs or change of payor status (e.g. changing from self-insured to fully insured) during 2009 does not change a payor's filing designation. A payor who is designated as a 2009 annual filer will remain an annual filer, subject to the annual reporting requirements prescribed in this notice, for the entire January 1, 2009, through December 31, 2009, reporting period. Consequently, each TPA filing a 2009 report on behalf of such payor is required to submit an annual report. If you have changed TPAs or had a change of payor status, the forms that must be used to report such occurrences are available on our Website at www.nyhealth.gov/regulations/hcra/forms.htm.
Beginning February 1, 2009, each payor's final 2009 filing designation will be noted on the elector list that is posted each month to our Website mentioned above. A current year filing designation column will denote the Department's final determination.
If you use a TPA, you should contact them directly with any questions you may have regarding this notice. Payors having questions that are not represented by a TPA should contact the Office of Pool Administration at (315) 671-3800.
John E. Ulberg, Jr.
Division of Health Care Financing