New York State Health Care Reform Act (HCRA)

October 29, 2004

Dear Payor:

Re: 2004 Annual Public Goods Pool Reporting Forms - Payors


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 them directly concerning any questions you may have regarding this notice.

If you have had a status change and are no longer a payor of medical claims (i.e., no longer self-insured, closed, or merged) or have switched from/to utilizing a TPA, please complete either the enclosed Attachment #2.5 or Attachment #2.8. If you have switched TPAs or have added a TPA, please complete the enclosed Attachment #2.6. If you have changed your company name and/or address, please complete the enclosed Attachment #2.9, Payor Name/Address Change Form.

Enclosed please find reporting forms and instructions for annual filers to use when calculating and remitting payments to the Public Goods Pools for the January 1, 2004, through December 31, 2004, reporting period. The report and payment must be submitted (postmarked) by January 31, 2005. The reporting forms must be filed even if there is no activity to report. Since annual filers cannot determine their Public Goods Pool liability until sometime following the last day of the respective reporting year, all reports submitted prior to the end of the respective reporting year will be returned.

If you are a payor represented by a TPA that files reports on your behalf, be advised that we are not forwarding a copy of the revised reporting forms and instructions to your TPA since electing TPA's are required to file electronically for periods on and after July 1, 2004. The primary responsibility of insuring that the reporting forms are timely filed rests with the electing payor. If reports are not filed, or not timely filed, any penalties and interest would be imposed on the electing payor. If you have an agreement with a TPA whereby the TPA is preparing and/or submitting reporting forms on your behalf, it is your responsibility to insure that your TPA files all appropriate reporting forms in compliance with the instructions in this transmittal.

Section 2807-t(6) of the Public Health Law 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 and incorporated this amount in the calculation of the year 2004 regional covered lives assessments. Please note that these 2004 regional covered lives assessment amounts are reflected on the 2004 portion of the Report of Covered Lives Assessment.

Reports must be completed and submitted in accordance with the enclosed instructions. If, upon review, a report is deemed unacceptable, the report may be returned and a delinquency notice issued. Repeated late payments, failure to remit correct amounts, or to provide adequate certification of the accuracy of surcharge payments can result in the revocation of an electing payor's direct pay status potentially subjecting them to higher surcharges. Additionally, untimely filing of reports and payments can result in the imposition of interest and penalties determined in accordance with the provisions of Section 2807-j(8) of the Public Health Law (PHL). Furthermore, PHL Section 2807-j(7) (c) authorizes the Commissioner to assess civil penalties for certain reporting delinquencies.

Please note that if you report on your own behalf, you are encouraged to electronically submit the Annual 2004 report on a voluntary basis, rather than submit the enclosed hard copy reporting forms. However, before electronic filing can commence, the enclosed Attachment 2-W must be completed to obtain a secure user ID and password. If you have questions concerning electronic filing, please contact the electronic filing help desk at (315) 671-3800 or via e-mail at

If you use a TPA, we suggest that you contact them directly concerning any questions you may have regarding this notice. Others having questions regarding the foregoing, or the enclosed forms, should contact a HCRA representative at (518) 474-1673.


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