LD 130
pg. 11
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LR 241
Item 1

 
C.__Expenditures from the fund are authorized for the
following purposes:

 
(1)__One percent of the budget of the fund for health
promotion and injury, disease and disability prevention
programs;

 
(2)__Payments to participating providers for health
care services rendered pursuant to section 372,
subsection 4;

 
(3)__Payments to nonparticipating providers for health
care services rendered pursuant to section 372,
subsection 4;

 
(4)__Payments for capital expenditures approved
pursuant to chapter 103-A;

 
(5)__Payments to the Small Business Hardship Fund;

 
(6)__Payments for administration of the fund and the
plan;

 
(7)__Payments for the operations and expenditures of
the agency, the council and any advisory committees
authorized by law or appointed by the agency; and

 
(8)__Other payments made pursuant to law.

 
2.__Requirements for expenditures.__The agency shall adopt
rules setting the requirements for expenditures from the fund.__
Rules adopted pursuant to this subsection are routine technical
rules as defined in Title 5, chapter 375, subchapter 2-A.__The
agency shall perform quarterly reviews of expenditures within the
open plan and organized delivery systems to determine whether
expenditures are within the budget of the agency.__The
requirements include:

 
A.__For organized delivery systems, rates that are based on
capitation, that utilize risk adjustment and that are set to
reflect whether a region is underserved or has low income
and utilization rates;

 
B.__For participating providers in the open plan, rates that
are set to reflect costs, volume and relative value of
services and that may be based on contracts and capitation;

 
C.__For institutional providers and hospitals, rates that
are based on global budgets; and


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