Slide 1: My Ombudsman – MassHealth Health Plans
Leslie Diaz – Director
May 11, 2021
Slide 2: Our Mission
My Ombudsman is operated by an independent non-profit program (the Disability Policy Consortium). At My Ombudsman, we empower individuals, including their families and caregivers, to exercise their rights and access the services provided by MassHealth and its managed care plans.

We ensure that individuals can exercise their rights and access the benefits they have as a MassHealth member. 
Slide 3: Overview
•	Review of Quarter 1 data for One Care plans
o	Inquiries and Complaints received January 1, 2021 – March 31, 2021
o	Individuals Assisted
o	Examples of common complaints
•	Outreach data
•	Questions and comments
Slide 4: One Care Health Plan Inquiries
Quarter 1: January 1, 2021 – March 31, 2021
Note: the following information was shown in a table on this slide.

Inquiry Subject
•	Benefits/Access
o	Number of Inquiries: 3
•	Care Coordination/Care Manager	
o	Number of Inquiries: 3
•	LTSS
o	Number of Inquiries 2
•	General Information
o	Number of Inquiries: 2
•	DME
o	Number of Inquiries: 1
•	Enrollment/Disenrollment
o	Number of Inquiries: 1
•	Pharmacy/Medication
o	Number of Inquiries: 1
•	Physician/Hospital
o	Number of Inquiries: 1
•	Transportation
o	Number of Inquiries: 1
TOTAL INQUIRIES*: 15

*This number represents a total of 15 inquiries received from 15 unique individuals.

Slide 5: One Care Health Plan Complaints
Quarter 1: January 1, 2021 – March 31, 2021

Note: the following information was shown in a table on this slide.

Complaint Subject
•	DME
o	Number of Complaints: 13
•	Benefits/Access
o	Number of Complaints: 10
•	Care Coordination/Care Manager
o	Number of Complaints: 10
•	Claim/Payment
o	Number of Complaints: 9
•	Pharmacy/Medication
o	Number of Complaints: 6
•	LTSS
o	Number of Complaints: 5
•	Behavioral Health
o	Number of Complaints: 4
•	Physician/Hospital
o	Number of Complaints: 4
•	Transportation
o	Number of Complaints: 3
TOTAL INQUIRIES*: 69**

*This number represents a total of 69 complaints received from 57 unique individuals
**Total includes complaints fewer than 2 each, not included in this table: Appeals/Grievance Process, CLAS/Accessibility, and Enrollment/Disenrollment complaints
Slide 6: One Care Individuals Assisted
•	Quarter 1
o	15 individuals submitted 15 inquiries
o	57 individuals submitted 69 complaints

o	22 out of the 72 individuals were first-time users of MYO services
Slide 7: Commonalities in Top Q1 Complaints
Among the DME, Care Coordination, and Benefits/Access complaints
•	Members needed support finding in-network providers or vendors
•	Some vendors were not responding to requests or questions from member/care team in a timely fashion
•	Members weren't kept up to date on the status of their requests for DME or LTSS
•	Members needed guidance on how to proceed with the appeals process

In most of these cases, My Ombudsman was able to connect members to their care teams for additional support. In situations where care teams were unable to help further, MYO contacted the health plan to request their intervention and assistance.
Slide 8: Outreach

How Members Heard About My Ombudsman (>10% or > 3 individuals)

Quarter 1
•	Plan Customer Service
o	Percent of Individuals 30%
•	Care Team Member
o	Percent of Individuals: 15%
•	MassHealth CSC
o	Percent of Individuals: 12%
Slide 9: Member Feedback
•	“I’d say I think that your people fought for it [a resolution to the issue]. I don’t think it was entirely within your control to get things approved but you fought for it.”
•	“I appreciated everything your department did. I didn’t achieve what we sought but it wasn’t the ombudsman’s fault.”
•	“Your staff was outstanding. I was very satisfied.”
Slide 10: Member Highlights
•	A One Care member was prescribed DME that required in-home installation. The member’s landlord and local housing authority stated that in-home installations were not possible due to the pandemic unless there was proof of medical necessity. MYO connected the member’s Care Partner to the Director of the housing authority to provide proof of medical necessity. The member was then able to have their DME installed.

•	A One Care member called MYO because their home hospital bed was broken, and they had not heard back from their care team about how to resolve the issue. MYO contacted the care team and asked them to reach out to the member. MYO also asked the plan liaison to reach out to the care team. The care team called the member the same day, and the bed was repaired 24 hours later. 
Slide 11: Contact Us
My Ombudsman – MassHealth Health Plan

•	Phone: 855-781-9898
•	Videophone: 339-224-6831
•	Email: info@myombudsman.org
•	Web: www.myombudsman.org
Nosotros hablamos Español
Nós Falamos Português
我们说中文 
We use ASL
We use an interpreter phone service for many other languages as needed

Slide 12: Thank you! 
Questions or comments?