OFFICE OF MANAGED CARE OMBUDSMAN

• Assists managed care health insurance consumers with plan selection, complaint and appeal filing, and understanding their rights and responsibilities under managed care plans.

• Monitors laws and regulations that impact health insurance consumers, recommends changes it deems necessary, and provides information to legislators and the public concerning problems of health insurance consumers.

• Publishes a list of consumer complaints against managed care companies in conjunction with the insurance department.

• Pursues administrative remedies on behalf and with consent of health insurance consumers and refers violations of utilization review company, preferred provider network, and unfair practices laws to the insurance commissioner.

• A six-member advisory committee meets with the office and the ombudsman four times a year to review and assess their performance. It sends an annual evaluation to the governor and the legislature’s public health and insurance committees. Advisory committee members are appointed one each by the Senate president pro tempore, House speaker, Senate majority leader, House majority leader, Senate minority leader, and House minority leader.

NOMINEE QUESTIONS

1. The managed care ombudsman position was created under the state’s 1999 managed care reform act. Explain the role of the ombudsman as you understand it.

2. If confirmed, what are your short- and long-term goals as ombudsman.

3. Describe your expertise and experience in health care, health insurance, and consumer rights advocacy.

4. By statute, the ombudsman cannot have served as a director or officer of a managed care organization within two years of appointment and cannot have any conflicts of interest. Do you meet these restrictions?

5. The General Assembly enacted managed care reforms in 1997 (PA 97-99) and 1999 (PA 99-284). Do these laws provide adequate protections for the state’s managed care consumers or are changes needed?

6. Eighteen states have passed laws or regulations requiring plans to implement quality assurance programs that monitor, evaluate, and initiate actions to improve health promotion activities and indicators (e. g. , use of preventive care services such as immunizations, screenings, and prenatal care). Should Connecticut consider requiring managed care plans to implement quality assurance programs?

JLK: ts