Common use of Monitoring and Managing the Available Amount Clause in Contracts

Monitoring and Managing the Available Amount. 13.1 On behalf of the Commission, the MSP will track Total Claims Cost against the Available Amount at the conclusion of each month and the Commission will make a forecast concerning the adequacy of the Available Amount. The results will be immediately forwarded to the BCMA. The Commission will give the BCMA written notice when the Commission's projections indicate that the Available Amount will be exceeded immediately after such a projection is accepted by the Commission. The notice will include the specific date on which the Available Amount is projected to be exceeded. 13.2 If the Commission concludes on the basis of a reasonable forecast that the total cost of claims for a fiscal year is likely to exceed the Available Amount, the Chair of the Commission shall immediately call a meeting of the Commission and, prior to that meeting, the Commission will forthwith consult with the BCMA and the Ministry on the matter. Immediately following the Commission meeting, the Commission will report to the Minister and the BCMA: (a) the fact of the forecast that the Available Amount may be exceeded; (b) the apparent reasons for the forecast overrun of the Available Amount; and (c) in consultation with the BCMA, the Commission's suggestions for preventing the overrun of the Available Amount. 13.3 Reconciliation of the MSC Total Claims Cost with the Available Amount shall take place and be concluded by October 31 of the following fiscal year. In the event the reconciliation identifies that the Available Amount was still exceeded after the implementation of all measures contemplated by this Article 13, the amount of the excess will be recovered by, and in order of priority, the use of the Reserve Account, and, where the Reserve Account is insufficient to recover the amount of the excess, the Commission will determine the mechanisms for recovering the remaining difference. 13.4 It is agreed and understood that the Commission has a responsibility to manage Total Claims Cost to stay within the Available Amount. (a) The parties further agree that the Commission must exercise this responsibility through the use of all reasonable methods within its jurisdiction, subject to the specific provisions of any Working Agreement, and this Agreement. An integral part of that management process will be the development of protocols and billing guidelines. The BCMA will participate in the development of those protocols and guidelines and the medical profession will make every effort to adhere to such protocols and guidelines once implemented. (b) It is agreed and understood that insured benefits are medically required services which fall within defined, approved protocols and practice guidelines and those medically required services where no protocols or practice guidelines exist. 13.6 In recognition of the need for all parties to this Agreement to be satisfied that the Commission continues to be effective in managing the Available Amount, the Chair of the Commission will meet with the Liaison Committee at regular intervals as required to assess the management process. The parties will report the results of these meetings to the Minister, the Commission and the Board of Directors of the BCMA on a timely basis.