A.__The administrator shall negotiate with providers or provider associations to determine reimbursement rates for services covered under the plan.__As appropriate, the administrator shall use the federal resource-based, relative-value scale as a fee schedule, adjusted as appropriate for the plan.__The administrator may not agree to reimburse participating providers at a rate that, based upon projections approved by the authority, would cause health care expenditures to exceed the global budget set by the authority pursuant to section 9810;

B.__All professional provider associations may participate in reimbursement negotiations.__All providers within a category are bound by the results of the negotiations between the administrator and the association representing that category of provider recognized by the authority pursuant to section 9806; and

C.__In the event that negotiations with providers__are not concluded in a timely manner, the authority may set rates, fees and prices for services reimbursed under the plan.__A provider aggrieved by a rate, fee or price set by the authority pursuant to this subsection, upon the production of credible evidence that the rate, fee or price is confiscatory, is entitled to a hearing as provided under section 9813.

3.__Caps on reimbursement.__Notwithstanding the provisions of subsection 2, the administrator shall establish a limit on the aggregate annual payment to an individual participating provider.__ An individual provider whose billing volume or distribution suggests the possibility of impropriety is subject to investigation by the administrator or the board and may be subject to exclusion or other penalties.

4.__Prior year expenditures.__The administrator shall reduce total reimbursement to participating providers by the amount that the prior year's total expenditures exceeded the global budget or increase total reimbursement to participating providers by the amount that the prior year's total expenditures were less than the global budget.__For the purposes of this subsection, "prior year" means the most recent year for which the board can determine total expenditures.__The administrator may reduce or increase reimbursement pursuant to this section on a sector-by- sector basis, as appropriate.