Add a reconciliation-status data element as extension to the Attribution List / Patient List. The data type would be code with values of "draft | final". The producer can create a list with a reconciliation status of final. When the list has a status of final, member-add / member-remove operations will be rejected by the producer. For Step 5 to indicate the end of the reconciliation process a new operation would be introduced.  The operation name is $confirm-list which is invoked on a specific Group instance.  The operation when invoked indicates that the Consumer has no more changes to propose.  A Producer can determine if the list is "final" or not even if a consumer says that the reconciliation is complete and there are no more changes using the operation $confirm-list. The diagram will be updated to use the above descriptions for Step 5 to indicate the completion of a reconciliation process.