(a) Subject to the availability of funds, the department shall expend the annual required distribution solely for the allowable perpetuity fund expenditures authorized under this section. The allocation of purpose-dedicated shares and annually required distribution expenditures shall seek to achieve the percentage targets for support, grants and awards specified in this section. Upon a written recommendation of the advisory committee, the department may materially deviate from the percentage targets specified in this section to the extent necessary to meet documented need and demonstrated demand for the support, grants and awards specified in this section. (b) Forty and seven-tenths percent (40.7%) of the annual required distribution shall be allocated for the critical access hospital basic incentive (CAHB) program. Under this program, the department shall provide incentive payments to hospitals that elect to participate and that meet service delivery requirements, subject to all of the following: (i) A participating hospital shall operate a staffed twenty-four (24) hour emergency department with stroke and trauma imaging capability, provide or operate ground ambulance services within its service area, provide basic labor and delivery services if annual births exceed a threshold established by the department and participate in the statewide health information exchange; (ii) Incentive payments under this subsection may include tiered payments, one (1) time grants, medical debt relief for Wyoming residents and ongoing payments to offset fixed costs. (c) Twenty-six and nine-tenths percent (26.9%) of the annual required distribution shall be allocated for emergency medical service regionalization. After the submission of a statewide emergency medical services response time model to the joint labor, health and social services interim committee as provided in paragraph (i) of this subsection, the department shall provide incentive payments to emergency medical service providers that elect to participate and that meet regionalization requirements established by rule of the department, subject to the following: (i) The department shall not require or implement emergency medical service regionalization under this subsection unless it first submits to the joint labor, health and human services interim committee a statewide emergency medical service response time model demonstrating no increase in emergency response times, staffing projections including volunteer impacts, inter-county governance and authority agreements and full cost estimates of regionalization, including long-term maintenance costs; (ii) Eligibility for incentive payments under this subsection shall be limited to joint applications submitted by two (2) or more ground ambulance providers serving a contiguous rural or frontier region; (iii) Joint applicants shall submit a regionalization plan to the department demonstrating maximization of revenue sources, integration with public safety answering points, use of interoperable equipment and technology, reduction of administrative overhead and commitment to community emergency medical services and tele-crisis stabilization services; (iv) Incentive payments under this subsection shall include ongoing payments to offset fixed readiness costs and grants for ambulances, interoperability equipment and implementation of regional medical dispatch. (d) Twenty-one and six-tenths percent (21.6%) of the annual required distribution shall be allocated for workforce education individual support. The department shall administer awards to individual persons for health care workforce education and training costs, including tuition, fees and stipends, subject to the following: (i) Awards under this subsection shall be used to pay allowable education and training costs for eligible applicants pursuing credentials in one (1) or more of the following fields: (A) Nursing, including certified nursing assistant, licensed practical nurse, registered nurse and advanced practice registered nurse programs; (B) Emergency medical services, including emergency department technician, emergency medical responder, emergency medical technician and paramedic programs; (C) Clinical behavioral health professions; (D) Physician education, including undergraduate medical education. (ii) As a condition of receiving an award under this subsection, an applicant shall agree to provide health care services in Wyoming for a minimum of five (5) years following completion of the approved program, under terms and conditions established by the department; (iii) An applicant who fails to satisfy the service obligation required under paragraph (ii) of this subsection shall be required to repay to the department all or a prorated portion of the award, together with any applicable interest, as determined by rule of the department. (e) Ten and eight-tenths percent (10.8%) of the annual required distribution shall be allocated for physician post- graduate medical education (GME) individual support. The department shall administer awards to individuals for physician medical education, including residency and fellowship training costs, subject to the following: (i) In awarding funds under this subsection, the department shall prioritize awards to applicants in programs that will increase the supply of family medicine physicians and that provide training in obstetrics or other high-demand specialties, as determined by the department; (ii) As a condition of receiving an award under this subsection, an applicant shall agree to provide health care services for a minimum of five (5) years in one (1) or more underserved counties within the state, under terms and conditions established by rule of the department.
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