Tuesday, April 23, 2024
4/23/2024
The State of California requests $5,791,815 under the Demonstration Ombudsman Programs to continue supporting the Cal MediConnect Ombudsman Program. As part of former Governor Brown’s Coordinated Care Initiative (CCI), Cal MediConnect (CMC) will coordinate care for as many as 395,000 enrollees as approved under a Federal Memorandum of Understanding signed March 27, 2013. In granting this funding, the Federal government will ensure that California has the resources to conduct and maintain beneficiary outreach and advocacy, increase access to health coverage, expand the knowledge of consumer rights and the availability of assistance, and secure data collection from various systems from many local entities. The participating Ombudsman Services Provider (OSP) is an advocacy organization independent of state governance servicing the seven CCI participating counties of Los Angeles, Orange, Riverside, San Mateo, San Diego, Santa Clara, and San Bernardino. This organization is highly trained, unbiased, experienced, and fully understands the goals, policies, and procedures of the CMC program, including the rights of and consumer protections for the enrolled beneficiaries. The OSP was selected through an open competitive process conducted by Department of Managed Health Care (DMHC) in 2013. Services provided by the OSP will continue to be free to enrollees and conducted in a manner that is person-centered, fully accessible (by phone, website, or email, and have the ability to provide in-person service when necessary), and linguistically and culturally competent. The CMC Ombudsman Program contracts with the OSP to provide independent, systematic oversight of complaints related to CMC plans, with a focus on the need for plan compliance with principles of community integration, independent living, and person-centered care. The primary goal of the CMC Ombudsman Program is to resolve issues between CMC enrollees and CMC plans, support individual advocacy, and conduct impartial investigations of member complaints about those plans. DHCS will continue working with the OSP to resolve any barriers the beneficiaries might face while enrolled in a CMC plan. DHCS will continue to act as the administrative oversight organization, ensuring that OSP is providing quality service, in compliance with the principles of the Cal MediConnect Ombudsman Program. DHCS has developed a comprehensive reporting system that accurately and securely collects data from submitted complaints and issues to the CMC Ombudsman Program. This data is analyzed for trends, recorded, and shared with Centers for Medicare & Medicaid Services (CMS) and other demonstration states. DHCS’ experience verifies the state has the capacity to continue the Cal MediConnect Ombudsman Program. By working with third party advocates, the Cal MediConnect Ombudsman program ensures that enrollees have an independent voice that speaks for them. Nothing in this application interferes or changes existing enrollee rights regarding grievances, appeals, and fair hearings.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
