(a) The Department shall establish the Health Care 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 the Department is unable to contract with a qualified corporation, organization, or consortia of organizations that meets the requirements of subsection (c) of this section, the Department shall operate the Ombudsman Program.
(b) The Ombudsman Program shall be administered by the Health Care Ombudsman, who shall be appointed by the Director of the Department. The Health Care Ombudsman shall be an individual with management experience and substantive experience in the fields of health care, health benefits plans, or health care advocacy. Unless the Department is operating the program, the Health Care Ombudsman shall be an employee of the nonprofit corporation, organization, or consortia of organizations selected by the Department to operate the program.
(c) The Department 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) The Department 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.
Effect of Amendments
D.C. Law 16-191 validated previously made technical corrections in the subsection designations.