Slide 1: My Ombudsman Slides for Non-Medical Transportation
December 10, 2019
Jennifer Lynne Morazes, PhD
Director-My Ombudsman
Slide 2: Mission
My Ombudsman is operated by an independent non-profit organization and empowers individuals, including their families and caregivers, to access their services provided by MassHealth and its managed care plans.
Slide 3: Non-Medical/Social Transportation Ombudsman Cases (One Care)*
•	Care Coordinator Failed to Submit Transportation Re-Authorization or Failed to Update Care Plan As Needed for Authorization (5 cases)
•	Scheduling Issue Occurred (i.e. transportation did not arrive) but Reason was Unknown (5 cases)
•	Communication Issues Between Care Coordinator, Transportation, Member Services and/or Vendor Caused Problem with Ride Scheduling (4 cases)
•	Ride Request/Location Denied (3 cases)
•	Accessibility - Related Issue (2 cases)

*Includes 19 closed complaints representing 14 people, from July 2018 to October 2019.  Overall complaint volume for One Care for this period was 659 complaints, with non-medical transportation representing approximately 3%.
Slide 4:  Examples of Requests for Non-Medical Transportation
Requests for Transportation to:
•	Chiropractor
•	Court
•	Day Program
•	Culturally-Focused Food Store 
•	Event at ILC
•	Grocery
•	Gym
•	Laundromat
•	Pharmacy
•	Sport
•	Veterinarian for Service Animal
Slide 5: Potential Themes from Cases
•	Confusion About the Role of the Care Coordinator in the Non-Medical Transportation Request Process
•	Lack of Clarity on Communication Protocol Between Care Coordinator, Plan Transportation Services, Member Services, Vendor, and Member
•	Reasons for Schedule Lapses Not Always Clear
•	Accessibility - Related Issues
•	Lack of Clarity or Communication About Plan Policies and/or Policy Changes
Slide 6: Case Example One
Member’s Care Coordinator authorized non-medical rides to the grocery store 4 times per month. Member stated that they called the plan’s transportation department to schedule a ride to the grocery store for the upcoming weekend. The plan Transportation Department representative informed the member that the ride could not be booked because the member did not have any rides remaining for the month. Member said they had only gone grocery shopping twice that month and realized that the plan was counting each non-medical round-trip as 2 rides. Member also mentioned that a plan representative told them they no longer provide non-medical rides to the laundromat, which is a service the member had been using.
Slide 7: Outcome for Example 1
Member reported that their Care Coordinator was frustrated by the lack of communication about the policy change and how it impacted the member.  Although the Care Coordinator authorized additional rides, the Transportation Department relayed to the member that the rides were not approved per the ride limit.  Through contacting the Plan Liaison, My Ombudsman was able to resolve the case for the member.  The Care Coordinator was allowed to authorize rides to the grocery store and laundromat.
Slide 8: Case Example Two
Member booked a round-trip non-medical ride to court. Return trip was set as will-call, meaning the member would call when they were ready for pick-up. Member got out of court in the afternoon and reported that they spent three hours trying to call the plan Transportation Department to get their ride home. Member then believed that the transportation line was closed and could not wait at the courthouse any longer and so took the T home despite having severe physical pain. 
Slide 9: Outcome for Example Two
My Ombudsman relayed information to the Plan Liaison.  Upon review, My Ombudsman was informed (and told the member) that the return trip was booked with instructions to initiate the ride through a ride sharing service (as relayed to the member in a notification call). The member expressed confusion as they stated they did not know this information about the ride share.  Member stated they now prefer not to use their plan’s transportation due to this experience and other adverse experiences with medical transportation.

Slide 10: Case Example Three
Member had a medical condition with strict dietary restrictions and had scheduled a ride through their plan to the grocery store, and the ride did not come.  Member called the plan’s Transportation Department and Member Services to ascertain why the ride did not come.  According to the member, there was confusion between Member Services, the Transportation Department and the Care Coordinator as to why the authorization had not been sent/received and why the trip was not scheduled in the system. Member stated that they were on the phone for 2 hours trying to figure out why the ride had not come, and was hung up on several times. 
Slide 11: Outcome for Example Three
Member reported this complaint to My Ombudsman and emphasized the importance of the trip given their medical condition.  Member then called the Clinical Response Unit on their own accord. A nurse was able to send an email to the transportation supervisor who sent the member a ride-share to go to the grocery store. Member stated that they wanted to file a complaint about their experience, but has since been unresponsive.
Slide 12: Case Example Four
Member stated that plan’s Transportation Department denied them a ride to bring their service animal to a vet appointment as the plan deemed it not medically necessary.  The member stated that they do not go anywhere without their service animal and believes that the animal is a medical support given that they are visually impaired. 
Slide 13: Outcome for Example Four
My Ombudsman investigated this issue.  The Ombudsman found out that the member’s Care Coordinator had left their position and the pre-authorization had not been sent.  Member was assigned a new Care Coordinator who put in the request as non-medical transportation, and 8 more rides had been approved. However, the member filed a grievance, as they believe the rides should be considered medical transportation.  This grievance has not yet been addressed. 
Slide 14: How to contact My Ombudsman
Hot Line (855) 781-9898
Videophone (339) 224-6831
Email us at info@myombudsman.org 
My Ombudsman website (www.myombudsman.org)
We speak Spanish, French, Portuguese, and Cantonese.
We use ASL.
Address: 
11 Dartmouth Street, Suite #301 
Malden, MA 02148 
Office Hours:  Monday – Friday, 9am-4pm
Walk in hours:  Mondays: 1pm-4pm; Thursdays: 9am-12pm