Sec. 10.25.10.11. Equitable Payment Under the Fund

A. Disbursement from the Fund is subject to the availability of funds.

B. The Commission shall adjust reimbursement formulas used for Medicaid trauma services, uncompensated care trauma services, on-call payments, and standby payments to an out-of-State pediatric trauma center to preserve the distribution of monies in the Fund.

C. Revenue; Payments.

(1) On or before May 1 of each year, the Commission shall determine appropriate levels of payment that can be sustained for the upcoming fiscal year beginning July 1, given the expected revenue in the Fund.

(2) If expected revenue in the Fund is insufficient to meet expected payments, the Medicaid differential payments, uncompensated care shortfall payments, trauma center on-call payments, and standby payments to an out-of-State pediatric trauma center shall be adjusted by the same rate to maintain solvency in the Fund.

(3) The Commission shall maintain a sufficient balance in the Fund to assure equitable payments across a fiscal year.

(4) If Fund payments require adjustment, the Commission shall report to the trauma centers and the trauma physicians listed on trauma center rosters the expected payment levels for the upcoming State fiscal year by June 30.

D. If the Commission estimates that operating shortfalls will occur during a fiscal year and that those shortfalls will be sufficiently large that the annual update process cannot be used, the Commission shall use the following conventions:

(1) On-call payments for the next semiannual reporting period shall be adjusted to preserve solvency in the Fund;

(2) Priority for meeting the funding needs of Level III trauma centers to maintain physicians shall be maintained;

(3) The Commission may not change Medicaid reimbursement during a fiscal year, unless a 4-month notice is provided to the Medicaid program and the uncompensated care and on-call payments have already been halted; and

(4) The Commission shall adjust Medicaid reimbursements during subsequent annual update processes to adjust for any inequities that arise due to implementation of §D(3) of this regulation during the preceding fiscal year.