New York State Health Care Reform Act (HCRA)

November 16, 2006

Dear Payor/Third Party Administrator (TPA):

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

This is to inform you of recent changes made to HCRA election forms, status change forms and instructions, as detailed below:

  • Forms are no longer referenced as Attachments. All election forms have new form numbers and names. A Cross-Reference Index outlining the new form numbers and names that correspond to the original forms has been enclosed for your reference.
  • The instructional packet for completing Attachments 2 through 2.6 no longer exists. Each form has its own set of instructions.
  • Payors electing into the Public Goods Pool no longer submit Attachments 2, 2.1, 2.2 and 2.3. They must now complete a Payor Election Application (DOH-4399) and an Electronic Filing User ID Application (DOH-4264).
  • TPA's electing into the Public Goods Pool are required to complete a TPA/ASO Election Application (DOH 4400), which combines Attachments 2.4 and 2-T, and an Electronic Filing User ID Application (DOH-4264).
  • Attachment 2.5, now known as the Payor Status Change (DOH-4402) form, has been modified to include Closed/Out of Business and Bankruptcy status changes.

Updated forms are now available on the HCRA website at Effective April 1, 2007, original versions of these forms will no longer be accepted. Therefore, you are encouraged to begin using these new forms immediately.

If you have questions regarding these changes, please contact a HCRA representative at (518) 474-1673.


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

Enclosure - Cross-Reference Index for HCRA Forms