{"data":{"id":"us-dc/d.c.-code-7-1131.19","jurisdiction":"us-dc","citation":"D.C. Code § 7-1131.19","heading":"Behavioral Health Ombudsman Program.","body":"(a)\nAs of October 1, 2012, there is established within the Department a Behavioral Health Ombudsman Program (“Ombudsman Program”) to provide District residents with assistance in accessing behavioral health programs and services.\n\n(b)\n(1)\nPursuant to its power set forth in § 7-1131.04(15) and subject to paragraph (2) of this subsection, the Department may contract with a qualified private, community-based, nonprofit corporation, organization, or consortia of organizations, with offices located in the District, to operate the Ombudsman Program. The Department shall establish the criteria that an entity must meet to be selected to operate the Ombudsman Program; provided, that the criteria include:\n(A)\nA public interest mission;\n(B)\nQualified staff and organizational expertise in:\n(i)\nBehavioral health services;\n(ii)\nBehavioral health coverage under health benefits plans;\n(iii)\nPublic education and community outreach; and\n(iv)\nConflict resolution;\n(C)\nNo direct involvement in the licensing, certification, or accreditation of a behavioral health facility, a health benefits plan, or with a provider of a behavioral health service;\n(D)\nfacility, health benefits plan, or any behavioral health service;\n(E)\nNo participation in the management of a behavioral health facility, health benefits plan, or any behavioral health service; and\n(F)\nNo agreement or arrangement with an owner or operator of a behavioral health service, a behavioral health facility, or health benefits plan that could directly or indirectly result in remuneration, in cash or in kind, to the entity.\n(2)\nIf the Department is unable to contract with an outside entity that meets the criteria described in this section, or determines it to be in the best interests of the District, the Department shall operate the Ombudsman Program.\n\n(c)\n(1)\nThe Ombudsman Program shall be administered by the Behavioral Health Ombudsman, who shall be appointed by the Director of the Department of Mental Health.\n(2)\nThe Ombudsman shall be a person:\n(A)\nWith substantive experience in the fields of behavioral health and patient advocacy; and\n(B)\nWho is an employee of the nonprofit corporation, organization, or consortia of organizations contracted to operate the Ombudsman Program; provided, that this subparagraph shall not apply if the Department operates the Ombudsman Program pursuant to subsection (b)(2) of this section.\n\n(d)\nThe Ombudsman Program may use volunteers with appropriate training and supervision to assist with counseling, outreach, and other tasks.\n\n(e)\nThe Ombudsman, or his or her designee, shall:\n(1)\nAssist consumers in resolving problems concerning behavioral health providers, behavioral health facilities, and access to behavioral health care services and programs by referring consumers to appropriate regulatory agencies when their problems are within an agency’s jurisdiction, guiding consumers through existing complaint processes, and assisting consumers in informally resolving problems through discussions with their providers.\n(2)\nEducate District residents about behavioral health coverage under:\n(A)\nHealth benefits plans;\n(B)\nManaged care health plans; and\n(C)\nAny other behavioral health services options.\n(3)\nRefer individuals, when appropriate, to other District agencies or organizations for assistance with behavioral health services and programs;\n(4)\nWork jointly, when appropriate, with other District agencies or organizations to promote greater access to behavioral health services and programs;\n(5)\nProvide information regarding problems and concerns of consumers of behavioral health services and make recommendations for resolving those problems and concerns to:\n(A)\nThe public;\n(B)\nGovernment agencies;\n(C)\nThe Council of the District of Columbia; and\n(D)\nAny other person or entity that the Ombudsman considers appropriate;\n(6)\nImplement innovative strategies and adopt tools to maximize outreach to District residents;\n(7)\nIdentify and help resolve complaints on behalf of consumers and assist consumers with the filing, pursuit, and resolution of formal and informal complaints and appeals through existing processes, including:\n(A)\nInternal reviews conducted by health benefits plans;\n(B)\nGrievance and appeals processes for the HealthCare Alliance and Medicaid; and\n(C)\nExternal reviews before independent review organizations, and the Department of Mental Health; and\n(8)\nComment on behalf of District residents on related behavioral health policy legislation and regulations in the District.\n\n(f)\nWithin 30 days of the end of each fiscal year, the Ombudsman shall submit a report to the Department, the Council, and the Mayor, and make it available to the public upon request, regarding the activities of the Ombudsman Program during the prior fiscal year, including:\n(1)\nAn accounting of all activities undertaken;\n(2)\nAn evaluation and analysis of the Ombudsman Program’s performance;\n(3)\nA complete fiscal accounting;\n(4)\nIssues of concern to District residents; and\n(5)\nAny recommendations to improve access to behavioral health services.\n\n(g)\n(1)\nThe Ombudsman shall establish an Advisory Council to consist of members representing at least:\n(A)\nConsumers;\n(B)\nThree consumer advocacy organizations;\n(C)\nThe Department of Mental Health;\n(D)\nThe Department of Health Care Finance;\n(E)\nThe Addiction Prevention and Recovery Administration;\n(F)\nThe Child and Family Services Agency;\n(G)\nThe Department of Youth Rehabilitation Services;\n(H)\nHealth benefits plans;\n(I)\nHealth care facilities;\n(J)\nThe Health Care Ombudsman Program;\n(K)\nHealth professionals with expertise in a person’s overall social, emotional, and psychological well-being and development;\n(L)\nThe District of Columbia Public Schools; and\n(M)\nThe Public Charter School Board.\n(2)\nThe Advisory Council shall meet quarterly to perform, at a minimum, the following functions:\n(A)\nAdvise the Ombudsman on program design and operational issues;\n(B)\nRecommend changes in the Ombudsman Program; and\n(C)\nReview data on cases handled by the Ombudsman Program and make recommendations based on that data.\n\n(h)\n(1)\nThe Ombudsman may review the records of a health-benefits plan, or other provider, pertaining to an individual’s medical records; provided, that the Ombudsman received the appropriate consent from the individual or his or her legal representative.\n(2)\nThe Ombudsman shall maintain the confidentiality of the records in accordance with all federal and state confidentiality and disclosure laws.\n(3)\nNo information or records maintained by the Ombudsman Program shall be disclosed to the public unless the individual or individual’s legal representative has provided the appropriate consent for the release of the information or records.\n\n(i)\nThe Ombudsman Program shall enter into a business associate agreement with the Department of Health Care Finance to allow the Ombudsman Program access to information about the Medicaid eligibility status of consumers whom it serves and that requires the Ombudsman Program to safeguard that information pursuant to the Privacy Rule (45 C.F.R. §§ 160 and 164) adopted pursuant to HIPPA.\n\n(j)\nThe Ombudsman shall request and promptly receive, with reasonable notice, the cooperation, assistance, and data from other District agencies, as necessary to enable the Ombudsman Program to investigate a resident’s complaint under District or federal law.\n\n(k)\nNo employee, subcontractor, designee, or representative of the Ombudsman Program shall be held liable for the good-faith performance of responsibilities under this section; except, no immunity shall extend to criminal acts or other acts that violate District or federal law.\n\n(l)\nNo person, agency, provider, or facility shall obstruct the Ombudsman, or his or her designee, from the lawful performance of any duty or the exercise of any power.\n\n(m)\nNothing in this section shall prohibit a corporation, organization, or consortia of organizations contracted to operate the Ombudsman Program from raising private money through foundation resources to supplement government funds for the Ombudsman Program.”.","path":["Title 7. Human Health Care and Safety.","Chapter 11B. Department of Mental Health Establishment."],"source_url":"https://code.dccouncil.gov/us/dc/council/code/sections/7-1131.19","current_through":"2026-08-20 (D.C. Law 26-175)","vintage":"","retrieved_at":"2026-08-29T05:44:07Z","sha256":"1c2fa169b61805c45d8c8b7d8f07bf08e22b1d0572681e87b3e6cb4d68dbf4d9","source_id":"us-dc","stale":false,"prev":"us-dc/d.c.-code-7-1131.18","next":"us-dc/d.c.-code-7-1131.20"},"notice":"GroundRules: Original legal text. Not legal advice."}