Role of the Ombudsman
The Ombudsman helps Kansas consumers enrolled in a KanCare Plan. He especially helps people in the HCBS waiver programs or people who get other long-term care services through KanCare. The Ombudsman helps KanCare consumers with problems in getting KanCare services. The Ombudsman provides information about the KanCare grievance and appeal process. The process is available through the KanCare health plans and the state fair hearing process. He also helps KanCare consumers with any problems they have dealing with their KanCare plan.
Here’s a complete list of Ombudsman duties:
- Help people with service problems when other help isn’t available directly through a provider or health plan.
- Help people understand their bills and what to do with them.
- Help people learn where to take their problems with KanCare, such as the grievance and appeals process of the KanCare plan and the state fair hearing process.
- Help people get answers when they feel their rights have been violated.
- Help people understand their KanCare plan and how to use their benefits.
- Help people contact the right people in charge.
- Give information, help and referrals to people who have problems that the Ombudsman can’t take care of.
While the Ombudsman will be trained on how people can get benefits, the state does not expect the Ombudsman to be the first phone call for those questions. The State’s enrollment workers, health plan call centers, state case workers and the Aging and Disability Resource Center (ADRC) are good places to start. Also, while the Ombudsman will help people with their rights to the grievance and appeals process, the Ombudsman is not expected to file or speak for the person in the grievance or appeal. The Ombudsman will help in those cases that cannot be handled by state case workers, hotline workers or the ADRC. People can get help filing a grievance or appeal. They can also get help when they are not happy with how the grievance or appeal was handled.
The KanCare Ombudsman's office is in the Kansas Department for Aging and Disability Services (KDADS) building in Topeka. The Ombudsman works separately from the KDADS commissions that handle Medicaid. The Ombudsman will get some help from the Office of the Secretary in KDADS.
James Bart, the Ombudsman was hired in December 2012. James Bart is a Lawrence attorney. He was picked from a group of people interested in the job.
Help for the Ombudsman:
The Ombudsman focuses on the new groups of people going into managed care who get HCBS services. The Ombudsman may need extra help to take care of everyone who contacts him. These extra resources can be added if they are needed:
Up to five workers to help the Ombudsman: These people can be moved from other programs to help provide information. They can also suggest services to consumers who need help with issues. These workers could get information from people who know about the waiver programs. These extra workers may send cases to the Ombudsman.
Help related to the law: The Ombudsman gets help from lawyers. These lawyers will come from the Office of the Secretary of KDADS. The lawyers can look things up for the Ombudsman.
The Ombudsman gets the help he needs within five days. The Ombudsman also works with volunteers to get help with other cases.
Program and Training:
The Ombudsman has learned about the grievance and appeals process. He learned about how it works for the three KanCare health plans and the state fair hearing process. He knows about the utilization management policies and procedures that the KanCare companies have. He has also learned about the state Medicaid rules and the state agreement with the KanCare plans.
He knows how people get KanCare. He also knows about what KanCare covers and about care coordination in KanCare.
He works with consumers and providers to get information to people about how he can help them. That information is given to people through the state, by calling the KanCare phone number, and through other information that comes in the mail. People can also get information at the ADRC.
Policy and Advocacy:
The Ombudsman works to make sure people are treated right. He helps them every step of the way. Also, the Ombudsman helps explain KanCare to consumer councils and focus groups. These are KanCare groups. He also gives the Secretary help with ideas to change rules and make it better for KanCare consumers. The Ombudsman talks to the Kansas Legislature several times a year. He tells lawmakers about the work he has done. He talks about big issues. And he tells lawmakers how to fix problems to help KanCare consumers.
Making sure things are done right:
An Interagency Monitoring Team makes sure rules are working in KanCare. The team has different workers on it from KDADS and KDHE. The team makes sure the Ombudsman can do his job. The team also makes sure KanCare consumers get help.
Meet the KanCare Ombudsman
Dear KanCare Consumers:
I am writing to tell you how I can help KanCare consumers. I’m the new KanCare Ombudsman.
My name is James Bart. I live in Lawrence. I have helped persons with disabilities for many years.
I’m happy to work for the State of Kansas because of what I’ve been through. I have spent a lot of time learning about Kansas Medicaid. I now know what works and what doesn’t. My 19-year-old son Jacob has significant developmental disabilities. As his father, I work every day to help him. I make sure he has what he needs. I also make sure he gets the help from Kansas he should get.
I will use what I know about Medicaid to help others. I will also use my passion to get people answers to their questions.
Although KanCare is a big change for many Kansas families such as my own, I am sure it’s a good program. It will help the State’s money problems. And it will help people get the services they need.
I will make sure people are treated the way they want to be treated. I will work to find people the help they need. KanCare will help people live a better life.
Please call me to talk about KanCare.
Contact the Ombudsman
To contact the Office of KanCare Ombudsman call toll-free at 855-643-8180 or email the office at KanCare Ombudsman
- New KanCare Ombudsman Appointed, 12/12/12
- Ombudsman Presentation to Joint Health Committee – Jan. 23, 2013
- Ombudsman Presentation to Senate Public Health and Welfare Committee – Jan. 16, 2013