A. Medicaid Ombudsman services are an alternative service available to Medicaid beneficiaries to address and resolve their concerns and problems related to: 1. Access to medical and behavioral health care; 2. Quality of medical and behavioral health care; or 3. Coverage for medical and behavioral health care. B. Medicaid Ombudsman services shall be provided to Medicaid beneficiaries participating in the Hawaii QUEST Integration Program listed in Section 30.300. C. Medicaid Ombudsman services will provide information and assistance to Medicaid beneficiaries regarding rights and obligations, and dispute resolution relating to health care services delivered by the providers participating in the QI and FFS programs. D. Medicaid Ombudsman services shall not be a replacement for the grievance and appeals process for the QI and FFS programs, nor do they replace the right of a Medicaid beneficiary to request an Administrative Appeal with DHS.
