The State of Rhode Island and Providence Plantations, Executive Office of Health and Human Services (EOHHS, seeks to continue its existing Ombudsman program in collaboration with sister state agencies, Rhode Island Parent Information Network (RIPIN), and other community stakeholders. EOHHS’s mission is to transform the healthcare delivery system through the purchasing of person-centered, comprehensive, coordinated, quality health care and support services that promote and enhance the ability of dually eligible and Medicaid-only recipients to maintain a high quality of life and live independently in the community.
Consistent with Rhode Island’s Financial Alignment Demonstration (FAD), the continued goal of EOHHS’s Ombudsman program is to ensure Demonstration beneficiaries, caregivers and authorized representatives have person-centered assistance that supports the resolution of Demonstration-related issues and concerns. The objectives of the Ombudsman program under this grant award will continue to: a) offer beneficiaries accessible, credible, culturally appropriate, linguistically appropriate, confidential and skillful conflict-free resources to assist beneficiaries in matters related to services received under the Demonstration; b) address beneficiary concerns through education, self-help skills and empowerment; c) offer beneficiaries an advocacy resource that is authorized to access needed information to investigate and resolve complaints in a HIPAA compliant manner; d) employ data-driven investigations of complaints with an emphasis on successful resolution of issues; e) coordinate Ombudsman services with other entities across Rhode Island in order to resolve beneficiary issues effectively and efficiently; f) conduct outreach and educational activities throughout the state geared to reach all dually eligible individuals; and g) identify trends and promote data-driven program improvements based on the identified trends and tracking of information regarding inquiries and complaints.
The estimated cost of this program is $1,056,306.73 over a four-year period. The Ombudsman program will serve the entire state of Rhode Island and target an estimated 47,330 dually eligible persons living in the state.
