Jan. 3, 2019

Let Us Know About 2019 NY Health Care Reform Act Reporting Changes

Applies to: ASO Groups

The New York Health Care Reform Act (NYHCRA) of 1996 requires ASO accounts to pay and report two surcharges for members living in New York. One is required when services are provided and the other is based on the number of residential lives. These surcharges can be reported annually or monthly.

As the designated third-party administrator (TPA), Blue Cross and Blue Shield of Texas (BCBSTX) is responsible for filing these surcharge reports on behalf of our ASO clients who have members with New York addresses on file.

Reminder of New 2019 Notices
The New York Office of Pool Administration recently informed us about three new reporting change notices they sent to electing payors in November 2018:
 

• Eligibility for Annual Reporting for 2019
• Sent to groups currently set up to file annually for the 2019 calendar year, but can file monthly if they prefer.
• Included information about changing from annual to monthly filing by submitting form DOH-4486 by Dec. 31, 2018.
   
• Ineligibility for Annual Reporting for 2019
• Sent to groups that filed annually for 2018 but will be required to file monthly for the 2019 calendar year because they’re no longer eligible for annual reporting.
   
• Covered Lives Enrollment Option
• Sent to groups that will file monthly for the 2019 calendar year.
• Included information on how groups can change their covered lives enrollment obligations for the 2019 calendar year based on enrollment as of the last day of the month, instead of the entire month.
• Information about selecting this option by submitting form DOH-4459 by Dec. 31, 2018 was also included.

Do You Need to Notify Us?
Here is a summary of the reporting changes to help determine if groups are required to send us a notification:
 

• No Action Needed for ASO Groups:
• Who have not made any changes to their funding status or TPA designation
• Who did not make any of the changes listed above

• Action Needed for ASO Groups:
• Who have made changes to their TPA designation or funding status
• Who made any of the changes listed above. They are required to notify us and the New York Office of Pool Administration. Failure to notify the New York Office of Pool Administration when changes are made may result in penalties as mandated in the NYHCRA.

Direct your ASO accounts to the NYHCRA Administration website for more details.

If you have any questions, please contact your account representative.

This communication is intended for informational purposes only. It is not intended to provide, does not constitute, and cannot be relied upon as legal, tax or compliance advice. The information contained in this communication is subject to change based on future regulation and guidance.