A. 1. The Oklahoma Health Care Authority shall develop standard contract terms for contracted entities to include, but not be limited to, all requirements stipulated by this act. The Authority shall oversee and monitor performance of contracted entities and shall enforce the terms of capitated contracts as required by paragraph 2 of this subsection. 2. The Authority shall require each contracted entity to meet all contractual and operational requirements as defined in the requests for proposals issued pursuant to Section 3 of this act. Such requirements shall include but not be limited to reimbursement and capitation rates, insurance reserve requirements as specified by the Insurance Department, acceptance of risk as defined by the Authority, operational performance expectations including the assessment of penalties, member marketing guidelines, other applicable state and federal regulatory requirements, and all requirements of this act including, but not limited to, the requirements stipulated in this section. B. The Authority shall develop methods to ensure program integrity against provider fraud, waste, and abuse. C. The Authority shall develop processes for providers and Medicaid members to report violations by contracted entities of applicable administrative rules, state laws, or federal laws.
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