DLTC INFO MEMO 2008-13
STATE OF WISCONSIN
Department of Health Services
Division of Long Term Care
DLTC Info Memo Series 2008-13
Date: December 23, 2008
Index Title: Cooperation with Ombudsman
To:
Listserv
For:
Family Care Managed Care Organization Directors
Aging and Disability Resource Center Directors
From:
Sinikka Santala, Administrator, Division of Long Term Care
Subject:
Cooperation with Ombudsman Programs
Document Summary
This memo details the Department's expectations for the working
relationship between Managed Care Organizations (MCOs), Aging and
Disability Resource Centers (ADRCs), and ombudsman services provided
through the Board on Aging and Long Term Care Ombudsman Program and
Disability Rights Wisconsin's (DRW) Family Care Ombudsman Program. This
memo is intended to further interpret and implement the language of
Wis.Adm.Code § HFS 10.57.
Background
As of October 1, 2008 the Department of Health Services has contracted
with Disability Rights Wisconsin (DRW) for Ombudsman services to current
or potential enrollees of the Family Care and Family Care Partnership
programs, or to their families or guardians, as required by Wis. Stats. §
46.281(1n)(e) (2007-8).
The new Family Care Ombudsman program at DRW will be in addition to the
existing Ombudsman Program through the Wisconsin Board on Aging and Long
Term Care (BOALTC). Both of these Ombudsman programs are available to the
current or potential enrollees of the Family Care and Family Care
Partnership programs or to their families or guardians. The DRW Family
Care Ombudsman program serves current or potential enrollees who are age
18-59 and the BOALTC Ombudsman program serves current or potential
enrollees who are age 60 and older.
Regional Ombudsmen are available to respond to current or potential
enrollees' concerns in a timely fashion. Both Ombudsmen programs will
assist current or potential enrollees in navigating the programs and
resolving issues using informal negotiations, whenever possible. Some of
the ombudsman services include:
- Assistance with ensuring quantity and quality of services
- Complaint investigation
- Mediation and resolution of conflicts
- Provision of information and education on current and potential
enrollees' rights and benefits
- Assistance with preparation for and representation at appeals,
grievances and fair hearings
Cooperation with Ombudsman
It is the Department's expectation that each ADRC and MCO informs
current and potential enrollees of their rights to ombudsman services, and
shall cooperate with any Ombudsman under this program selected by an
enrollee or potential enrollee. As provided in the rule, below,
cooperation does not allow the unauthorized release of enrollee
information or abridge the enrollee's right to confidentiality.
HFS 10.57 Cooperation with advocates.
(1) DEFINITIONS. In this section:
(a) "Advocate" means an individual or organization whom a
client has chosen to assist him or her in articulating the client's
preferences, needs and decisions.
(b) "Cooperate" means:
- To provide any information related to the client's eligibility,
entitlement, cost sharing, care planning, care management,
services or service providers to the extent that the information
is pertinent to matters in which the client has requested the
advocate's assistance.
- To assure that a client who requests assistance from an advocate
is not subject to any form of retribution for doing so.
(2) COOPERATION WITH ADVOCATES. The department and each resource
center and CMO shall cooperate with any advocate selected by a client.
Nothing in this section allows the unauthorized release of client
information or abridges a client's right to confidentiality.
Information related to services or service providers includes contract
language between the managed care organization and service providers. The
contract language between the Department and a managed care organization
is available online for the Ombudsman.
If an Ombudsman under this contract is requesting information that
falls within the definition of protected health information (PHI) under
HIPAA, the ADRC and/or the MCO should explain their local policies and
procedures related to release of protected member information.
The Department is pleased to have Ombudsman programs available for all
current and potential enrollees. The Ombudsman programs along with the
MCOs' Member Rights Specialists are integral to protecting the enrollees'
rights and ensuring quality.
Ombudsman Programs Contact Information:
Per the Department contract with the Managed Care Organizations, the
Ombudsman Programs contact information should appear in each Managed Care
Organization's member handbook and notice of action form.
- Disability Rights Wisconsin (DRW) Ombudsmen from this agency provide
advocacy to Family Care and Partnership members age 18-59.
131 W. Wilson St., Suite
700
Madison, WI 53703
608-267-0214
TTY: 888-758-6049
Fax: 608-267-0368
Madison Toll-free:
800-928-8778
Milwaukee Toll-free:
800-708-3034
Rice Lake Toll-free:
877-338-3724
http://www.disabilityrightswi.org
(includes contact information for other locations)
- Wisconsin Board on Aging and Long Term Care Ombudsmen from this
agency provide advocacy to Family Care and Partnership members 60 and
older.
Board on Aging and Long
Term Care
1402 Pankratz Street, Suite
111
Madison, WI
53704-4001
Toll-free:
800-815-0015
Fax: 608-246-7001
http://longtermcare.state.wi.us
DHS CENTRAL OFFICE CONTACT:
Rebecca Murray
1 W. Wilson, Rm. 518
Madison, WI 53703
Email: Rebecca.Murray@dhs.wisconsin.gov
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
cc: All DLTC Councils and
Committees
Disability Rights
Wisconsin
Board on Aging and Long Term
Care
Wisconsin Council of
Independent Living Centers
Independent Living Council of
Wisconsin
Grass Roots Empowerment
Program
People First
ARC Wisconsin
Wisconsin Homes and Services
for the Aging
OFCE staff
Area Administrators / Human
Services Area Coordinators
Last Revised: September 13, 2010 |
