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Ombudsman Services for Medicaid Managed Care


Location
Hawaii
Publication Date
06/24/2020 08:32 AM EDT
Closing Date
07/02/2020 08:00 PM EDT
Issuing Organization
State of Hawaii - Department of Human Services
Solicitation Number
Description

Specifications include, but are not limited to: Department of Human Services, Med-QUEST Division (MQD) requests the vendor bid on the following scope of work. MQD requires the work be conducted in the Task Areas listed below, including providing Ombudsman services to eligible Medicaid Managed Care beneficiaries and Providers and assisting them to navigate the managed care health plans’ grievance and appeal process in the resolution of issues/concerns about access to, quality of, or limitations to, health care services in the QUEST Integration (QI) program. Task Area #1 General Responsibilities:  At each contact or encounter, the vendor shall confirm the identity, address, and telephone number for each Medicaid beneficiary and the Provider requesting assistance.  Respond within two (2) business days of receiving contact and conduct a followup contact within two (2) weeks of the issue being resolved in order to ensure that the Medicaid beneficiary's concerns are fully resolved, and the Provider’s concerns were addressed.  Keep all protected personal health information and personally identifiable information provided by beneficiaries and providers confidential in accordance with State and federal laws, rules and regulations.  Complete a monthly management report with the report template provided by MQD.  Transfer all pending Ombudsman calls and follow up information to the new Ombudsman contractor, within one (1) week, after the implementation of a new Ombudsman contract.  Information on health plans’ grievance and appeal contact and State Administrative Appeal Office (AAO) will be provided after the award of this task order.

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