Purpose

(a) The Department shall examine the quality of an HMO's health care services within the first 12 months of member enrollment. This review is for the purpose of confirming that all required processes, systems and protocols are in place and are being implemented pursuant to 36 O.S. Section 6907. (b) The Department may conduct the examination or the Department may require the HMO to contract for the examination pursuant to 36 O.S. Sections 6907(E) and 6919(B). If the Department requires the HMO to contract for the examination, the HMO shall select an independent quality examiner that has been approved by the Department.