Independent quality examiner

(a) The Department shall maintain a list of approved independent quality examiners who have demonstrated conformity to the following requirements: (1) The examiner has written criteria and standards for assessing the quality of clinical care and the availability, accessibility and continuity of care; (2) The examiner limits clinical judgements to physicians with experience in the delivery of health care in an HMO setting, and all final conclusions, opinions and recommendations shall be made or endorsed by physicians; (3) The examiner has a training program for review team members to ensure uniform application of standards; (4) The examiner ensures the confidentiality of medical and health care information; and (5) The examiner institutes reasonable measures to ensure that review team members and their families have no financial interest in the HMO being examined or in any HMO operating in the geographic service area covered by the HMO being examined. (b) Any person may file a request to be included on the Department's list of approved independent quality examiners. The request shall be in writing and shall demonstrate conformity to the requirements in (a) of this Section. The Department shall respond in writing within thirty (30) days after receiving the request. The Department at any time may remove approval status 3 OAC 310:659 OKLAHOMA STATE DEPARTMENT OF HEALTH from an examiner for failure to maintain compliance with (a) of this Section, or for providing to or accepting from an HMO any gift or favor other than a reasonable and usual charge for the performance of a quality examination. (c) The examination process shall include: (1) Preliminary reviews to familiarize the examiner with the requirements of this Chapter and the HMO; (2) A site visit to review records and to interview HMO officers, the medical director, members of the governing body, members of the quality assurance committee, the patient care coordinator, a customer service representative, other providers, and HMO personnel; (3) An on-site summation; and (4) Written preliminary and final reports. (d) The HMO and the quality examiner shall provide the Department access to observe record reviews, interviews, and the on-site summation.