(1) (a) There is hereby created in the office of the executive director the office of the ombudsman for behavioral health access to care for the purpose of assisting Coloradans in accessing behavioral health care.
(b) The office and the department shall operate pursuant to a memorandum of understanding between the two entities. The memorandum of understanding contains, at a minimum:
A requirement that the office has its own personnel rules;
A requirement that the ombudsman has independent hiring and termination authorityover office employees;
A requirement that the office must follow state fiscal rules;
A requirement that the office of behavioral health shall offer the office limited support with respect to:
Personnel matters;
Recruitment;
Payroll;
Benefits;
Budget submission, as needed;
Accounting; and
Office space, facilities, and technical support; and
(V) Any other provisions regarding administrative support that will help maintain the independence of the office.
(c) The office shall operate with full independence and has complete autonomy, control, and authority over operations, budget, and personnel decisions related to the office and the ombudsman.
By November 1, 2018, the governor shall designate an ombudsman for behavioralhealth access to care, who shall serve as director of the office. The ombudsman shall serve as a neutral party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, including coverage that is not subject to state regulation, and health care providers, acting on their own behalf, on behalf of a consumer with the consumer's written permission, or on behalf of a group of health care providers, navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders.
The ombudsman shall:
Interact with consumers and health care providers with concerns or complaints tohelp the consumers and providers resolve behavioral health care access and coverage issues;
Identify, track, and report to the appropriate regulatory or oversight agency concerns,complaints, and potential violations of state or federal rules, regulations, or statutes concerning the availability of, and terms and conditions of, benefits for mental health conditions or substance use disorders, including potential violations related to quantitative and nonquantitative treatment limitations;
Receive and assist consumers and providers in reporting concerns and filing complaints with appropriate regulatory or oversight agencies relating to inappropriate care, an emergency procedure under section 27-65-105, a certification for short-term treatment under section 27-65-107, or a certification for long-term care and treatment under section 27-65-109;
Provide appropriate information to help consumers obtain behavioral health care;
Develop appropriate points of contact for referrals to other state and federal agencies;and
Provide appropriate information to help consumers or health care providers file appeals or complaints with the appropriate entities, including insurers and other state and federal agencies.
The ombudsman, employees of the office, and any persons acting on behalf of theoffice shall comply with all state and federal confidentiality laws that govern the department with respect to the treatment of confidential information or records and the disclosure of such information and records.
In the performance of his or her duties, the ombudsman shall act independently of theoffice of behavioral health. Any recommendations made or positions taken by the ombudsman do not reflect those of the department or office of behavioral health.
Source: L. 2018: Entire part added, (HB 18-1357), ch. 252, p. 1549, § 1, effective August 8.