| The Greater Washington Partnership for Palliative and End-of-Life Care |
E-Newsletter
The District of Columbia Ombudsman Office*
In an effort to achieve greater accountability for the DC Medicaid Program, the
District of Columbia has established an Ombudsman Office that will work to
ensure the safety and well-being of Medicaid beneficiaries in need of care and
services to which they are entitled, as well as promote excellence and
confidence in the DC Medicaid program.
The Ombudsman will investigate complaints by beneficiaries and providers
against the District government, serve as a neutral mediator in dispute
resolution, and provide recommendations on how problems should be
redressed or prevented. However, the Ombudsman will not have the authority
to make or reverse a decision. The Ombudsman will conduct work objectively
and without influence from representatives and administrators of the DC
government.
The Ombudsman's tasks will include:
All investigations will be managed by a multi-disciplinary team. Investigators
will possess a broad range of education and experience applicable to child
welfare, safety, and public health. Prior to the completion of an investigation,
the entire investigative team will participate in the analysis of case facts,
findings, and conclusions. Recommendations developed in specific cases will
derive from a mutual decision of all team members. Annual reports will be
published to provide documentation and raise awareness of the activities,
cases, and outcomes of the DCOO.
*(This information is cited from a PowerPoint Presentation on the Development of the District of Columbia
Ombudsman Office that was presented to the DC Coalition for Long-Term Care by Maude Holt).
In an effort to achieve greater accountability for the DC Medicaid Program, the
District of Columbia has established an Ombudsman Office that will work to
ensure the safety and well-being of Medicaid beneficiaries in need of care and
services to which they are entitled, as well as promote excellence and
confidence in the DC Medicaid program.
The Ombudsman will investigate complaints by beneficiaries and providers
against the District government, serve as a neutral mediator in dispute
resolution, and provide recommendations on how problems should be
redressed or prevented. However, the Ombudsman will not have the authority
to make or reverse a decision. The Ombudsman will conduct work objectively
and without influence from representatives and administrators of the DC
government.
The Ombudsman's tasks will include:
- Advocating for low-income children and families
- Recommending changes in law, policy, and practice to enhance the DC
Medicaid program - Identifying, investigating, and assisting in resolving consumers' complaints
- Assisting consumers with the filing of formal and informal complaints and
appeals through existing processes - Assisting with internal reviews conducted by health benefit plans, grievance and
appeal processes for the HealthCare Alliance, fair hearings available to
Medicaid consumers, external reviews before independent organizations, and
any other administrative appeals available under District or federal law - Making referrals to appropriate government agencies and institutions
- Engaging in level of care reviews for nursing homes
- Educating consumers about health benefits, plans, and health care options
available for the uninsured - Commenting on behalf of consumers on health care policy legislation and
regulations in the District - Assisting uninsured District residents with accessing Medicaid or other health
care options - Working with health care providers to enhance coordination and referrals
- Assisting consumers in resolving problems pertaining to their health care
coverage, health care bills, and access to health care. - Assisting consumers in informally resolving problems through discussions with
their health benefits plan or other providers - Assisting consumers in understanding their rights and responsibilities as health
benefits plan member, HealthCare Alliance members, or members of other
provider plans.
All investigations will be managed by a multi-disciplinary team. Investigators
will possess a broad range of education and experience applicable to child
welfare, safety, and public health. Prior to the completion of an investigation,
the entire investigative team will participate in the analysis of case facts,
findings, and conclusions. Recommendations developed in specific cases will
derive from a mutual decision of all team members. Annual reports will be
published to provide documentation and raise awareness of the activities,
cases, and outcomes of the DCOO.
*(This information is cited from a PowerPoint Presentation on the Development of the District of Columbia
Ombudsman Office that was presented to the DC Coalition for Long-Term Care by Maude Holt).
The Greater Washington
Partnership for Palliative
and End-of-Life Care:
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Partnership for Palliative
and End-of-Life Care:
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