§ 7-2071.02 — Establishment of the Health Care and Public Benefits Ombudsman Program.

District of Columbia § 7-2071.02

• Jurisdiction: District of Columbia
• Title 7: Human Health Care and Safety.
• Ch. 20A: Health Care Ombudsman Program.

Text

(a) DHCF shall establish the Health Care and Public Benefits Ombudsman Program by contracting with a qualified private, community-based, nonprofit corporation, organization, or consortia of organizations, with offices located in the District, to operate the program. If DHCF is unable to contract with a qualified corporation, organization, or consortia of organizations that meets the requirements of subsection (c) of this section, DHCF shall operate the Ombudsman Program.

(1) The Ombudsman Program shall be administered by the Health Care and Public Benefits Ombudsman, who shall be appointed by the Deputy Mayor of Health and Human Services, and who shall be an individual with management experience and substantive experience in the fields of health care, health benefits plans, health care advocacy, or public benefits program and advocacy.

(2) Unless DHCF is operating the program, the Health Care and Public Benefits Ombudsman shall be an employee of the nonprofit corporation, organization, or consortia of organizations selected by DHCF to operate the program.

(c) DHCF shall establish selection criteria for the qualified, private, nonprofit corporation, organization, or consortia of organizations that will perform the functions of the Ombudsman Program. The criteria shall include:

(1) A public interest mission;

(2) Qualified staff and organizational expertise in health care and health benefits plans, public education and community outreach, and problem resolution;

(3) No direct involvement in the licensing, certification, or accreditation of a health care facility, a health benefits plan, or a provider of a health benefits plan, or with a provider of a health care service;

(4) No direct ownership or investment interest in a health care facility, health benefits plan, or any health service;

(5) No participation in the management of a health care service, health care facility, or health benefits plan; and

(6) No agreement or arrangement with an owner or operator of a health care service, health care facility, or health benefits plan that could indirectly or directly result in remuneration, in cash or in kind, to the organization.

(d) The Ombudsman Program may subcontract with advocacy organizations that are affiliated with health providers that exclusively represent the interests of consumers and do not represent the health care entity in any disputes.

(e) DHCF shall accord preference in the selection process to corporations or organizations that:

(1) Have a board of directors with significant representation from District consumers;

(2) Have experience in serving District residents or have staff with experience in serving District residents; or

(3) Have expertise in health benefits plans.

(f) The Ombudsman Program may use volunteers with appropriate training and supervision to assist with counseling, outreach, and other tasks.

Legislative History

Apr. 12, 2005, D.C. Law 15-331, § 3, 52 DCR 1981; Mar. 2, 2007, D.C. Law 16-191, § 35, 53 DCR 6794