Joining Mississippi’s trauma care network is no longer voluntary. The state Board of Health on Wednesday approved new regulations requiring all hospitals to participate in the system or pay to opt out.

The change, which affects about 100 hospitals and starts Sept. 1, has two purposes: To generate funds for an anemic network some say has been underfunded for years; and to improve care and reduce travel time for severely injured patients.

In August the hospitals will begin receiving application forms to evaluate their services and determine which trauma level they should offer. Mississippi has a tier method for trauma care, and Level 1 is the top.

The annual fee for opting out ranges from $423,500 to $1.5 million, depending on the level of the facility. Seventy-four hospitals currently participate, officials said.

Hospitals also will be required to keep a trauma registry updated monthly to give officials a clearer picture of the state’s medical needs.

“No other state has a system like this,” said state Health Officer Ed Thompson. “This is an extraordinary act.”

Bill Oliver, president of Forrest General Hospital in Hattiesburg, a Level 2 facility, told the Board of Health that the revamped system is “a good start as far as funding. We do believe there will be challenges.”

Oliver said the coordination of several new providers in the system and the regular submission of trauma care data could be a problem.

The mandatory participation and increased fees for various violations were part of a bill passed by lawmakers in the 2008 regular session to bolster a network that had been deteriorating and struggling with uncompensated care.

A report released earlier this year said many hospitals have chosen not to participate because of the uncompensated care costs and the difficulty recruiting and retaining specialized physicians. The report found the state only spent $8 million a year to reimburse hospitals for treating uninsured patients, but the system needed at least $40 million.

The changes approved Wednesday may have put Mississippi on course to become a model for the nation, said Connie Potter, executive director of the National Foundation for Trauma Care, a trade organization.

Potter said Texas is the only other state that comes close to making participation in a trauma system mandatory. She said if a Texas hospital doesn’t participate, its Medicaid funding is limited.

“If it works and if it functions as expected, it could be a model because it’s funded, has mandatory participation, coupled with reporting requirements,” Potter said. “I think Mississippi could very well take a leadership role. The question will always remain ’How do you measure it?”’

Potter said the state would have to look at whether mortality rates drop, something that could take years to calculate.

The University of Mississippi Medical Center in Jackson is the only Level 1 trauma care facility in the state. A Level 1 facility has research and academic medical centers with specialists present 24 hours a day. Another Level 1 facility in the state’s network is the Regional Medical Center at Memphis in Tennessee, which accepts patients from north Mississippi.

There are only three full-time Level 2 hospitals in Hattiesburg, Tupelo and Columbus.