Common use of Review of Call Groups Clause in Contracts

Review of Call Groups. (a) If, after April 1, 2019, a Health Authority or a physician group considers that, based on those factors identified in Attachment C of the Final MOCAP Report, things have changed in a manner requiring a review of the assigned level of call, a Health Authority or a physician group can bring an application to the PMRC (which will determine its procedures to consider such applications) to initiate such a review, following which: (i) The PMRC will consider such applications. (ii) Any changes in the payment level for call groups arising from such a review will be effective after 90 days’ written notice is provided to physicians in accordance with the terms of existing MOCAP contracts. (iii) This process for review of call levels will continue until March 31, 2022. (b) If after April 1, 2019, a physician group wishes to dispute either the nature of the call or a Health Authority decision that certain physicians do not need to provide on-call services under MOCAP, they must first provide notice to the Health Authority. Such notice must be in writing and include the facts, upon which the physician or physician group relies, an outline of argument supporting the physician(s)’s position and the remedy sought. In the event that the physician group and Health Authority are unable to reach agreement, the physician group may refer the dispute to the PMRC (which will determine its procedures to consider such applications) for binding adjudication, following which: (i) The PMRC will consider such applications. (ii) In considering the dispute, the PMRC must only determine only whether the process of establishing the call group, and establishing the nature of call were consistent with the MOCAP principles listed at Section 17.5 above and the applicable provisions of the PMA. (iii) The PMRC will not be entitled to disturb a final decision of a Health Authority that certain physicians do not need to provide on-call services under MOCAP unless MOCAP principles referenced in paragraph (ii) above are breached.. (iv) In the event the PMRC disturbs a final decision of a Health Authority under (iii) above, such financial consequences will be effective in the subsequent fiscal year but will, at the discretion of the PMRC, have a retroactive effect that that time back to the date of the adjudication. (v) Any changes in the nature of call for call groups arising from such a PMRC adjudication process will be effective 90 days’ after written notice is provided to physicians in accordance with the terms of existing MOCAP contracts.

Review of Call Groups. (a) IfIf a Health Authority can demonstrate to the PMRC that it is necessary to maintain or establish a particular call group or an assigned level of call in a manner inconsistent with the application of those factors identified in Attachment C of the Final MOCAP Report, after April 1, 2019, they may seek approval from the PMRC that an exception may be created for the call group. The PMRC will only review requests based on the issue of providing a necessary service where the application of Attachment C of the Final MOCAP Report does not justify the assigned level of call on a normal basis. (b) If a Health Authority or a physician group considers that, based on those factors identified in Attachment C of the Final MOCAP Report, things there have changed been material changes impacting the provision of patient care in a manner requiring a review of the assigned level of call, or in the case of a newly established call group, that the factors identified in Attachment C of the Final MOCAP Report have been incorrectly applied, a Health Authority or a physician group can bring an application to the PMRC (which will determine its procedures to consider such applications) to initiate such a review, following which: (i) The PMRC will consider such applications. (ii) Any changes in the payment level for call groups arising from such a review will be effective after 90 days’ written notice is provided to physicians in accordance with the terms of existing MOCAP contracts. (iii) This process for review of call levels will continue until March 31, 2022. (bc) If after April 1, 2019, a physician group wishes to dispute either the nature of the call or a Health Authority decision that certain physicians do not need to provide on-call services under MOCAP, they must first provide notice to the Health Authority. Such notice must be in writing and include the facts, upon which the physician or physician group relies, an outline of argument supporting the physician(s)’s position and the remedy sought. In the event that the physician group and Health Authority are unable to reach agreement, the physician group may refer the dispute to the PMRC at XXXX.xxxxxxxxxxx@xxx.xx.xx (which will determine its procedures to consider such applications) for binding adjudication, following which: (i) The PMRC will consider such applications. (ii) In considering the dispute, the PMRC must only determine only whether the process of establishing the call group, group and establishing the nature of call were consistent with the MOCAP principles listed at Section section 17.5 above and the applicable provisions of the PMA. (iii) The PMRC will not be entitled to disturb a final decision of a Health Authority that certain physicians do not need to provide on-call services under MOCAP unless MOCAP principles referenced in paragraph (ii) above are breached.. (iv) In the event the PMRC disturbs a final decision of a Health Authority under (iii) above, such financial consequences will be effective in the subsequent fiscal year but will, at the discretion of the PMRC, have a retroactive effect that that time back to the date of the adjudication. (v) Any changes in the nature of call for call groups arising from such a PMRC adjudication process will be effective 90 days’ after written notice is provided to physicians in accordance with the terms of existing MOCAP contracts.

Review of Call Groups. ‌ (a) If, after April 1, 2019, a Health Authority or a physician group considers that, based on those factors identified in Attachment C of the Final MOCAP Report, things have changed in a manner requiring a review of the assigned level of call, a Health Authority or a physician group can bring an application to the PMRC (which will determine its procedures to consider such applications) to initiate such a review, following which: (i) The PMRC will consider such applications. (ii) Any changes in the payment level for call groups arising from such a review will be effective after 90 days’ written notice is provided to physicians in accordance with the terms of existing MOCAP contracts. (iii) This process for review of call levels will continue until March 31, 2022. (b) If after April 1, 2019, a physician group wishes to dispute either the nature of the call or a Health Authority decision that certain physicians do not need to provide on-call services under MOCAP, they must first provide notice to the Health Authority. Such notice must be in writing and include the facts, upon which the physician or physician group relies, an outline of argument supporting the physician(s)’s position and the remedy sought. In the event that the physician group and Health Authority are unable to reach agreement, the physician group may refer the dispute to the PMRC (which will determine its procedures to consider such applications) for binding adjudication, following which: (i) The PMRC will consider such applications. (ii) In considering the dispute, the PMRC must only determine only whether the process of establishing the call group, and establishing the nature of call were consistent with the MOCAP principles listed at Section 17.5 above and the applicable provisions of the PMA. (iii) The PMRC will not be entitled to disturb a final decision of a Health Authority that certain physicians do not need to provide on-call services under MOCAP unless MOCAP principles referenced in paragraph (ii) above are breached..‌ (iv) In the event the PMRC disturbs a final decision of a Health Authority under (iii) above, such financial consequences will be effective in the subsequent fiscal year but will, at the discretion of the PMRC, have a retroactive effect that that time back to the date of the adjudication. (v) Any changes in the nature of call for call groups arising from such a PMRC adjudication process will be effective 90 days’ after written notice is provided to physicians in accordance with the terms of existing MOCAP contracts.