In
Copyright Since September 11,
2000
This
web site is
in no manner
affiliated with any Kaiser entity and the for profit Permanente
Permission
is granted to mirror this web site -
Please acknowledge where the material was obtained.
| ABOUT US |
CONTACT
|
MCRC
Kaiser
Permanente
MEDICAL SERVICE AGREEMENT
ARTICLE I
Term and Termination
Section I-1.
Term
This Agreement will continue in effect until
terminated (a) by mutual agreement, or (b) as provided in this Article
I. If at any time it appears probable that this Agreement
will be
terminated as provided in this Article I, then Health Plan and Medical
Group will cooperate to limit Medical Group's continuing
responsibilities
under this Article I, insofar as practical under the
circumstances.
Consistent with the foregoing, Health Plan will advise Medical Group in
writing at least once each week from the date the First Notice (as
defined
below) is given until the end of the Interim Period (as defined below)
the date or expected date of termination of any Membership Contract,
any
change in the number of Members expected to be enrolled under any
Membership
Contract (including date of the expected change) and any other
information
that Health Plan acquires relating to the number of expected Members,
so
that Medical Group may adjust its staffing in order to provide
appropriate
levels of service to Members through the end of the Interim Period.
Section I-2.
Termination
(a) Exclusive
Procedure for Termination
Unless
terminated by mutual consent, this Agreement may be terminated only as
provided in this Section.
(b) Purpose
of Article
The
purpose of this Article is to provide for winding down the Medical Care
Program in a manner that ensures that Members are appropriately served,
that Medical Group is appropriately compensated, and that Health Plan
is
appropriately protected against unnecessary cost during the period of
winding
down (the "Interim Period"). The Interim Period will be at
least
3 calendar months but not more than 15 calendar months.
(c) First
Notice
Either
Health Plan or Medical Group may initiate commencement of the Interim
Period
by giving the other party a written notice ("First Notice") specifying
the date ("First Notice Effective Date") that the Interim Period will
begin.
The First Notice must (i) give at least one calendar month's notice of
the First Notice Effective Date, and (ii) specify a First Notice
Effective
Date that is the first day of a calendar month.
(d) Second
Notice
Health
Plan (but not Medical Group) may terminate the Interim Period by giving
Medical Group a written notice ("Second Notice") specifying the
date
("Second Notice Effective Date") that the Interim Period will
end.
The Second Notice must (i) give at least one calendar month's notice of
the Second Notice Effective Date, and (ii) specify a Second Notice
Effective
Date that (A) is the last day of a calendar month, and (B) provides an
Interim Period of at least 3 calendar months (counting both
the First
Notice Effective Date and the Second Notice Effective Date.)
(e) Automatic
Termination of Interim
Period
If
Health Plan does not give Medical Group a Second Notice specifying a
Second
Notice Effective Date that occurs earlier than the last day of the 15th
month of the Interim Period, the Interim Period shall then end.
Section I-3
Agreement Continues in
Effect.
During the Interim Period, all provisions of
this Agreement will remain in effect, except that the provisions of
Articles
J and K will be superseded by the compensation provisions in Section
I-4
hereof, and Health Plan will not seek to recover any amount from any
individual
Physician on account of breach by Medical Group of any provision of
this
Article I. Articles J and K will apply on a prorated basis
for any
part of the calendar year prior to the Interim Period.
Upon termination of the Interim Period, neither
Health Plan nor Medical Group will have any obligation to the other by
virtue of this Agreement with respect to matters or events occurring
after
the Interim Period, but each party will retain and satisfy all
obligations
it has to the other arising out of events occurring during the term of
this Agreement, including the Interim Period. Health Plan
will indemnify
Medical Group and Physicians against any Claim any Member asserts
against
Medical Group or any Physician for the cost of Medical Services
obtained
by the Member after the Interim Period.
Section I-4.
Compensation
During the Interim Period, Medical Group will
be compensated as provided in this Section I-4. Medical
Group's compensation
during the Interim Period will consist of Basic Compensation, Special
Fund
Compensation and Incentive Compensation, as defined and described in
this
Section, reduced by Medical Group revenue (attributable to services
performed
during the Interim Period) in the following categories:
- Revenue
attributable to Nonmember and Workers' Compensation Medical
SErvices; plus
- Other
Revenue; plus
- Any
other revenue of a type previously agreed to by Health Plan
and Medical Group pursuant to Section J-3 (b) (iii) hereof.
Compensation
payable hereunder shall be paid on the last day of each month during
the
Interim Period. If any amount payable hereunder cannot be
fixed in
amount by the payment date therefor, it will be reasonable
estimated
by Health Plan, and the payment will be adjusted when the correct
amount
is known so that total payments by Health Plan to Medical Group during
the Interim Period will be as computed under this Article I.
Health
Plan also will make the payments referred to in Sections J-3 (a)
(i)
(including amounts to fund any retirement plan), J-3(a)(ii) and J-3 (c)
for the Interim Period.
(a) Basic Compensation
(i) First 3.5 months
During
each of the first 3 calendar months (and if the Interim Period is
longer than 3 calendar months, the first half of the fourth calendar
month)
of the Interim Period, Health Plan will pay Medical Group, and Medical
Group will pay each Physician and each Medical Group non-physician
employee
employed by Medical Group on the date that the First Notice is given
(collectively
"First Notice Employees:) the regular monthly compensation ("Basic
Compensation")
of each First Notice Employee who continues to provide Medical SErvices
to Members. Basic Compensation does not include any amount
that represents
a share of profits, year end bonus or other form of special
compensation
in excess of the First Notice Employees full-time basic rate.
(ii) After First 3.5 Months
"Payment
Month" means the period beginning on the 16th day of a calendar
month (beginning with the 16th day of the fourth calendar month of the
Interim Period), and ending on the 15th day of the next calendar month,
except that the last Payment Month will be the last half of the
calendar
month that is the last calendar month of the Interim Period, and Basic
Compensation for that half month will be fifty percent of the amount
otherwise
payable under this Section I-4 (a) (ii).
If the Interim Period continues for more than
3 calendar months, then for each Payment Month Health Plan will pay
Medical
Group, and Medical Group will pay each First Notice Employee designated
by Medical Group, Basic Compensation for providing Medical Services to
Members, except that the number of full-time equivalent Physicians
("FTE
Physicians") and full-time equivalent Medical Group non-physician
employees
("FTE Employees") for whom payment will be made under this Section I-4
(a) (ii) for any Payment Months will not exceed the number of FTE
Physicians
(or 110% of the number of FTE employees) that is in the same proportion
to the number of FTE Physicians (and the number of FTE Employees),
respectively,
employed by Medical Group on the date the First Notice is given, as the
number of Members for the calendar month ("Measuring Month")
immediately
next preceding the calendar month in which the Payment Month commences
bears to the number of Members on the First Notice Effective Date.
In addition to the information regarding Members
and Membership Contracts to be provided by Health Plan to Medical Group
under Section I-1, on or before the 15th day of each month, beginning
on
the 15th day of the fourth calendar month of the Interim Period, Health
Plan will advise Medical Group in writing if the number of Members
during
the immediately next preceding calendar month (the first Measuring
Month
will be the third calendar month of the Interim Period), and such
number
of Members will provide the basis for computation of Basic Compensation
under the preceding sentence for the next succeeding Payment Month,
which
begins the next day.
(iii) Limitation on Basic Compensation
Basic Compensation under Section I-4(a)(i)
and (ii) will be paid only for Medical Services actually performed, and
no First Notice Employee's rate of compensation reimbursable under this
Section I-4(a) may exceed his or her rate of compensation on the date
the
First Notice is given. Work schedules of First Notice
Employees may
be changed by Medical Group, but the total amount of Basic Compensation
during any calendar month of the Interim Period may not exceed the
amount
that would be payable if work schedules remained the same as they were
when the First Notice was given.
(b)
Special Fund Compensation
Health
Plan will (i) make available an amount ("Special Fund") equal to one
full
month's Basic Compensation of Physicians employed by Medical Group on
the
date the First Notice is given (on the basis of their actual rate of
compensation
and work schedule on that date) to provide additional compensation to
be
paid pursuant to arrangements between Medical Group and individual
Physicians
to induce Physicians to (A) remain in Medical Group's employ, or (B)
leave
Medical Group's employ, and (ii) reimburse Medical Group in an
aggregate
amount no greater than the amount of the Special Fund for all payments
made by Medical Group pursuant to any such arrangement, subject to the
requirements that (A) such arrangements will be negotiated by Medical
Group
with individual Physicians in good faith and at arm's length, and (B)
no
arrangement will be made by Medical Group with (and no payment will be
made from the Special Fund to) a Medical Group officer or director,
without
Health Plan's written approval.
(c)
Incentive compensation
(i)
Establishment of Outside Cost Budget
Health Plan and Medical Group will calculate the per Member per month
amount
("Outside Per Capita Cost") for the 6 complete calendar months prior to
the date the First Notice is given of the sum of (A) the amount paid to
non-Medical Care Program providers of health care (including inpatient,
outpatient and ancillary care of all kinds) for covered services to
Members,
plus (B) the amount of all Reimbursement and Service Claims for
Members.
The "Outside Cost Budget" is an amount equal to 135% of the Outside Per
Capita cost multiplied by Member months during the Interim Period, and
"Outside Cost" is the sum of the amounts referred to in Section
I-4(c)(i)(A)
and (B) incurred during the Interim Period.
(ii)
Application of Outside Budget to Outside cost
Health
Plan will pay all Outside Cost, and the amount of Outside Cost (but not
any cost in excess of $50,000 for any one Member during the Interim
Period),
will e charged to the Outside Cost Budget..
(iii)
Calculation of Incentive Compensation
Incentive
Compensation is an amount equal to 50% of the sum of (A) the
unexpended portion, if any, of the Outside Cost Budget (but not more
than
the amount paid or payable as Basic Compensation pursuant to Section
I-4
(a)(i) during the first 2 calendar months of the Interim Period), plus
(b) the uncommitted portion of the Special Fund referred to in Section
I-4(b).
(iv) Distribution of Incentive Compensation
As
soon as reasonably practicable after Outside Cost for the Interim
Period
is calculated, but not more than four calendar months after the end of
the Interim Period, Health Plan will pay each Physician employed by
Medical
Group on the date that the First Notice is given that proportion of
Incentive
Compensation as his or her Retirement Plan Credit bears to the
Retirement
Plan Credit of all such Physicians. "Retirement Plan Credit"
for
any Physician means the amount of retirement income payable to the
Physician
at age 65 on a life-only basis under any defined benefit retirement
plan
the cost of which is paid by Health Plan to Medical Group that covers
Physicians
(ignoring any vesting requirement), based upon service through the
Interim
Period, except that (A) no payment will be made to any Physician who
voluntarily
terminates Medical Group service after being asked by Medical Group to
continue serving Members during all or a portion of the Interim Period,
or who dies after the First Notice is given but prior to the end of the
Interim Period, and (B) the maximum payment from Incentive Compensation
to any Physician will be the lesser of (1) 200% of the average payment
from Incentive Compensation to all such Physicians, or (2) the maximum
amount permitted by law.
Section I-5
Ancillary Personnel
The number of full-time equivalent non-physician
personnel of the type referred to in Section C-1(a) engaged or arranged
by Health Plan and available to Medical Group during the Interim Period
will be at least that number that is in the same proportion to such
full-time
equivalent non-physician personnel available to Medical Group on the
date
the First Notice is given as the number of Members for the calendar
month
immediately next preceding the calendar month in question bears to the
number of Members on the First Notice Effective Date.
|