Slide 1: One Care Implementation Council Motions – July 2021
No content on this slide
Slide 2: Introduction to the Motions
The contract as currently written does not provide the level of detail needed to support One Care members nor does the contract have sufficient enforcement or transparency. The motions address several key areas: 
•	Motion #1: Increased Knowledge of My Ombudsman 
•	Motion #2: Adequate Support for Grievances and Appeals Processes
•	Motion #3: Increased Member Engagement with IC
•	Motion #4: Increased IC Collaboration with Plan CACs
•	Motion #5: Hospital Access

Care plans should include the member’s preferred form of communication whether it be text, email, direct call, or other format in addition to federally mandated written form. Contract language needs to be clear that while paper mail is a requirement of CMS, all information must be communicated in a person-centered format, per the One Care model. 
Slide 3: Motion #1: Increased One Care member knowledge of My Ombudsman
Current One Care Plan processes for communication about My Ombudsman do not seem effective. We therefore request that Plans enhance outreach to members of the My Ombudsman program to ensure they fully understand their rights. 
•	Outreach must include notifying members of My Ombudsman services any time there is a modification in their care plan, medical necessity, determination of need, prior authorization processes, prescription medications, or anything the disrupts or modifies a person’s care or changes care structure, such as care coordinator turnover, without member consent.
•	Member-preferred form of communication should include, but is not limited to:
•	Quarterly messages to members about their right to communicate with My Ombudsman with complaints, questions, or to support their appeals and grievances (complaint) process
•	Text messaging
•	Website / Plan portal (with a hotlink to My Ombudsman)
•	Newsletter highlights
•	Determining person-centered outreach (care coordinator, member services) must be done at the initial assessment.  
Slide 4: Motion #2: Grievances (Complaints) and Appeals
•	Communication should be provided in a way that reaches the member by their preferred form of communication when there is an appeal or grievance (complaint). 
•	Care coordinators must provide information to the member about their role in the appeals and grievances (complaints) processes.
•	Plans will require care coordinators to contact members in their preferred method of communication when:  
o	A member has received a modification or denial of any kind
o	A member is engaged in either appeals or grievances (complaints) processes to provide ongoing support and education to members.
•	The care coordinator should assist the member with all aspects of the grievance and appeal process including helping them understand why the service changed, clarifying the process for appeals and grievances, and helping the member contact the My Ombudsman office, if requested.
Slide 5: Motion #3: Increasing Involvement of Plan Members in the Implementation Council
Plans will be responsible for increasing:
•	Engage with the Council and inform agenda and priorities. 
•	Member knowledge and opportunity for engagement with the One Care Implementation Council activities such as virtual town hall meetings and regular Council meetings by providing real time information and outreach.

Outreach must be provided in member-preferred format, using a variety of communication technologies as evidenced by COVID-19-related outreach, which includes, but is not limited to:
•	Robocalls
•	Text messages
•	Emails

Slide 6: Motion #4: CAC Engagement with the Implementation Council
Plans will be required to: 
•	Increase Consumer Advisory Committee (CAC) member knowledge of and opportunity for engagement with the One Care Implementation Council activities, such as virtual town hall meetings and regular Council meetings. 
•	Provide opportunities for IC members to attend quarterly meetings, including scheduling time for an Implementation Council member to report on Council activities to the CACs on a quarterly basis and for the Implementation Council representative to hear directly from the CACs about CAC activities. 
Slide 7: Motion #5: Increasing Hospital Access
The following is in response to concerns raised over hospital access at past Implementation Council meetings. 
With the assistance of MassHealth, the plans will be required to: 
•	Provide and maintain access to all Massachusetts hospitals for One Care members, regardless of the complexity of the member’s needs and whether they are medical or psychiatric.
•	Provide information to members so they understand their rights to access all Massachusetts hospitals.