The Ombudsman Program shall provide the following accessible services:
(1)Assist consumers in resolving problems concerning health care bills, health coverage, access to health care, and public benefits by referring consumers to appropriate regulatory agencies when their problems are within an agency's jurisdiction, guiding consumers through existing complaint and appeal processes, and assisting consumers in informally resolving problems through discussions with their public benefits programs and health benefits plans, the HealthCare Alliance, or other providers;
(2)Assist consumers in understanding their rights and responsibilities as public benefits applicants and recipients, health benefits plan members, HealthCare Alliance members, or members of other provider plans, including appe
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The Ombudsman Program shall provide the following accessible services:
(1) Assist consumers in resolving problems concerning health care bills, health coverage, access to health care, and public benefits by referring consumers to appropriate regulatory agencies when their problems are within an agency's jurisdiction, guiding consumers through existing complaint and appeal processes, and assisting consumers in informally resolving problems through discussions with their public benefits programs and health benefits plans, the HealthCare Alliance, or other providers;
(2) Assist consumers in understanding their rights and responsibilities as public benefits applicants and recipients, health benefits plan members, HealthCare Alliance members, or members of other provider plans, including appeal processes and how to use them, and how to access appropriate medical information;
(3) Educate consumers about health benefits plans, managed care health plans, and their health benefits plan options, or other health care options available for uninsured consumers;
(3A) Educate consumers about the District's public benefits programs and options;
(4) Comment on behalf of consumers on related health care or public benefits policy legislation and regulations in the District;
(5) Help uninsured District residents access Medicaid or other health care options;
(5A) Help District residents access public benefits options;
(6) Identify, investigate, and help resolve complaints on behalf of consumers and assist consumers with the filing, pursuit, and resolution of formal and informal complaints and appeals through existing processes, including internal reviews conducted by health benefits plans, grievance and appeals processes for the HealthCare Alliance, fair hearings available to Medicaid and public benefits consumers, external reviews before independent review organizations, and any other administrative appeals that may be available under District or federal law;
(7) Refer consumers, when appropriate, to other existing organizations for assistance and work jointly with other consumer organizations, as appropriate;
(8) Work with health care providers, consumer advocacy organizations, and legal service providers to develop working relationships that enhance coordination and referrals;
(9) Make appropriate referrals, including to the Department of Insurance, Securities, and Banking, the Office of Fair Hearings in the Department of Health Care Finance, the Office of Administrative Hearings, the Grievance and Appeals Office of the Department of Health, Health Care Fraud Units, the Long-Term Care Ombudsman, the Health Insurance Counseling and Assistance Program serving District Medicare beneficiaries, the Center for Health Dispute Resolution, and the Office of Program Review, Monitoring, and Investigation; and
(10) Provide information to the public, government agencies, the Council, and others regarding problems and concerns of consumers and make recommendations for resolving those problems and concerns.