§3174-V.__Medicaid managed care ombudsman program

1.__Program established.__The department shall establish and maintain the Medicaid Managed Care Ombudsman program until such time as Medicaid services are no longer provided to certain Medicaid recipients on a risk-based or case management basis.__ Ombudsman program services for these recipients must be made available to persons enrolled in any system using utilization review, risk-based capitation or case management. To the extent that the Medicaid managed care program is extended to persons receiving long-term care or home health care services, the department shall include in the ombudsman program the following organizations: the long-term care ombudsman program, the Health Insurance Counseling and Assistance Program of Legal Services for the Elderly, the 5 area agencies on aging and the Disability Rights Center.

2. Powers and duties.__The ombudsman program may:

A.__Provide advocacy services to individual citizens in matters relating to those Medicaid managed care services provided by and under the jurisdiction of the State;

B.__Review and evaluate, on a continuing basis, state and federal policies and programs relating to the provision of Medicaid managed care services conducted or assisted by any state departments or agencies for the purpose of identifying and addressing patterns or recurrent problems with the State's Medicaid managed care program;

C.__Receive, investigate and resolve inquiries, complaints, problems or requests for information and assistance regarding the State's Medicaid managed care program;

D.__Serve as a liaison for communication between individuals;

E.__Coordinate information and make referrals for services to relevant state agencies or other organizations when appropriate;