The Health Care Reform Act (HCRA) is a major component of New York State's Health Care financing laws which governs hospital reimbursement methodologies and targets funding for a multitude of health care initiatives. Under HCRA, payers (i.e., self-insured plans and their administrators, health insurers and managed care organizations) are required to pay covered lives assessments and surcharges for plan participants who live in New York State. Those assessments and surcharges are paid into the Professional Education Pool (PEP), which funds graduate medical education (GME), and the Public Goods Pool, which funds indigent care and other critical health care initiatives.
The assessment applies if the group has/had a self-funded plan with any New York residents, for the period in question.
Most payors must pay an annual payment, due the following January. So, for 2022, the payment would be due January of 2023. If they want to pay on a monthly basis rather than annually, they can do that but would have had to file a form with the Pool no later than 12/31/21.
If they stay with the annual payment, which is the default, payment will be based on the number of covered lives as of the end of the calendar year. If they choose the monthly payment option, they can either base their payment on the number of covered lives enrolled during all or any portion of
the month or use the number of applicable units, i.e. the number of individuals and family units enrolled, as of the last day of each month. Payors choosing to use the last day of the month option file this form https://www.health.ny.gov/forms/doh-4459.pdf with the Department of Health by December 31 of the preceding year (2017) to become effective for the upcoming calendar year (2018). This form, once processed, becomes effective January 1, 2018 and will remain in effect for the whole calendar year.
The notice and other information can be found here:https://www.health.ny.gov/regulations/hcra/letters/2017/2017-11-02_tpas_annual-2018.htm
For more information, contact the Office of Pool Administration at 315-671-3800.
Resources:
https://www.health.ny.gov/regulations/hcra/einfo/index.htm
Questions and Answers (ny.gov)
Important Notice to Annual Public Goods Pool Report Filers and Monthly Filers (ny.gov)