CMS Funds Ombudsmen Program to Watchdog Dual Eligibles

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As states test new models for providing care for dual eligibles, the Centers for Medicare and Medicaid Services CMS will sponsor tests of advocacy programs for those who enroll in these demonstrations.

CMS is offering funding to states to create ombudsmen programs designed to help “beneficiaries in the demonstration have a positive care experience,” according to the CMS press release.

“Ombudsman programs have proven to be a valuable resource for consumers,” said ACL Administrator Kathy Greenlee in the statement. “These experts bring skills in problem-solving and knowledge that empower consumers and their families through education and support. This ombudsman program will be critical to safeguarding consumer rights and maximizing the success of the program.”

Five states are testing a capitated model for managing dual eligibles and one state has received permission to test a managed fee-for-service model. According to the statement, these six states will be eligible to create ombudsmen programs that “will provide beneficiaries with access to new resources and person-centered assistance in answering questions and resolving issues related to the demonstration,” according to the press release. “They will also carefully monitor the beneficiary experience, and offer recommendations to CMS, the states, and participating plans on how the initiative could be improved.”

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Posted in Denials Management, Medical Receivables, Patient Experience, Patient Financial Services .

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