Suspension, Termination, or Nonrenewal of Physician Contract

60.4 - Suspension, Termination, or Nonrenewal of Physician Contract (Rev. 24, 06-06-03) Advance Notice for Suspension or Termination An MA organization and a contracting provider must provide at least 60 days written notice to each other before terminating a contract without cause. Reporting of Suspensions or Terminations Due to Quality Deficiencies An MA organization that suspends or terminates a contract with a physician because of deficiencies in the quality of care must give written notice of that action to licensing or disciplinary bodies or to other appropriate authorities. Suspension, Termination, or Nonrenewal of Physician Contracts Specific requirements for an MA organization that operates a coordinated care plan or network MSA plan providing benefits through contracting physicians and that suspends, terminates, or non-renews a physician’s contract are as follows: 1. The MA organization must give the affected physician written notice of the reasons for the action, including, if relevant, the standards and profiling data used to evaluate the physician and the numbers and mix of physicians needed by the MA organization. 2. The MA organization must allow the physician to appeal the action, and give the physician written notice of his/her right to a hearing and the process and timing for requesting a hearing. 3. The MA organization must ensure that the majority of the hearing panel members are peers of the affected physician. Preamble to the February 17, 1999, final rule responded to public comment that notice and appeal requirements apply regardless of whether suspension or termination of the physician contract is due to quality deficiencies or not, unless the physician voluntarily agreed to leave the organization’s network. In addition, it was clarified that these requirements apply to nonrenewal of contracts. An MA organization that operates an MA plan through subcontracted physician groups must provide that these procedures apply equally to physicians within those subcontracted groups. (Source: 42 CFR 422.202(c) and (d) and preamble of February 17, 1999, rule.)