- (a) The Health Care and Public Benefits Ombudsman may review the records of a health benefits plan, the HealthCare Alliance, or other provider, pertaining to a consumer or the consumer’s medical records, or records pertaining to the consumer's public benefits, if the consumer or the consumer’s legal representative has provided written consent. The confidentiality of the records shall be maintained by the Ombudsman Program in accordance with all federal and state confidentiality and disclosure laws.
- (b) No information or records maintained by the program shall be disclosed to the public unless the consumer or the consumer’s legal representative has consented in writing to the release of the information or records.
- (c) Each District agency shall provide cooperation, assistance, and data to the Health Care and Public Benefits Ombudsman, as requested and upon reasonable notice, necessary to enable the Ombudsman Program to investigate a consumer’s complaint under applicable District or federal law.
- (d) DHCF shall enter into a “business associate” agreement with the Ombudsman Program that gives the program access to information about the Medicaid eligibility status of consumers whom it serves and requires the program to safeguard that information pursuant to the Health Insurance Portability and Accountability Act Privacy Regulation (45 C.F.R. Parts 160 and 164).
History
Apr. 12, 2005, D.C. Law 15-331, § 8, 52 DCR 1981
Dec. 6, 2025, D.C. Law 26-55, § 5212(f)
Emergency Legislation
For temporary (90 days) amendment of this section, see § 5212(f) of Fiscal Year 2026 Budget Support Emergency Act of 2025 (D.C. Act 26-146, Sept. 3, 2025, 72 DCR 9623).
For temporary (90 days) amendment of this section, see § 5212(f) of Fiscal Year 2026 Budget Support Congressional Review Emergency Act of 2025 (D.C. Act 26-210, Nov. 24, 2025, 72 DCR 13514).