Slide 1: Implementation Council Proposed Motions

May 11, 2021

Slide 2: This presentation contains motions from the Council and recommendations brought to MassHealth for oversight.

Below is a set of motions and oversight requests to MassHealth based on:
•	Feedback we received from Council members and larger disability community
•	Changes in communication technology accelerated by COVID-19 
•	National concerns about misuse of algorithms and telemedicine by insurance plans or providers

Footnote:  These requests are being made in recognition of the changes made regarding the use of technology that were implemented to address COVID-19 and how this will affect processes going forward. 

Slide 3: Motion #1: Increased One Care enrollee knowledge of My Ombudsman

Plans will enhance outreach to enrollees on the My Ombudsman program to ensure members fully understand their rights. Outreach must include: 
•	Member-preferred form of communication, which includes but is not limited to:
o	Text messaging
o	Website / plan portal
o	Newsletter highlights
•	Person-centered outreach (care coordinator, member services)

Slide 4: Motion #2: Enhancing enrollee education about the Implementation Council

Plans will be responsible for increasing: 
•	enrollee 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. 
•	Consumer Advisory Committee (CAC) 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. 

Outreach must be provided in member-preferred format, which includes but is not limited to:
•	Robocalls
•	Text messages
•	Emails

Footnote: (such as have been used since the start of the COVID pandemic) . Not contained in this motion is the requirement that CAC members must participate in Implementation Council on a quarterly basis at a minimum and must participate in virtual Town Hall meetings.

Slide 5: Motion #3: Grievances and Appeals

Plans will require care coordinators to contact enrollees in their preferred method of communication when:
•	An enrollee has received a modification or denial of any kind.
•	An enrollee is engaged in either appeals or grievances processes to provide ongoing support and education to enrollees.
o	Why the claim was denied or modified; 
o	The appeals and grievances processes, as needed by the enrollee;
o	The support provided to enrollees when choosing to file an appeal or grievance, and;
o	The role of My Ombudsman and, if requested by the enrollee, how the Plan will provide a warm handoff to My Ombudsman.

Slide 6: MassHealth Oversight

What specific protections and oversight requirements is MassHealth putting in place to protect enrollees from misuse of algorithms and telemedicine by plans or providers that will lead to:
•	Disparities in access to care, quality of life etc.,
•	Gouging public dollars and providing less equitable care, 
•	Misalignment of plan short-term ROI earnings goals and enrollee needs,
•	Expansion of use of opaque bundled services,
•	Use of nontransparent off-the-shelf “efficiency”-based technology?
How will MassHealth include Council members and the larger disability community in developing oversight strategies of plan use of telemedicine and algorithms?

Slide 7: The Implementation Council requests an update on the following motions, passed unanimously on May 8, 2018:

A motion was made to request MassHealth require that Plans create a communication access coordinator position (for Deaf and Hard of Hearing members). It will be the job of the coordinator to support the onboarding of Deaf and Hard of Hearing members identified as needing communication access services and to provide ongoing coordination of the members’ communication access needs at the members’ choice. The coordinator will work in collaboration with the member and the member’s care coordinator. In hiring the coordinator, the plans will work with MCDHH and DHILs as part of the hiring and training of the coordinator.

A motion was made to request MassHealth require that Plans create a communication access coordinator position (for Deaf and Hard of Hearing members). It will be the job of the coordinator to support the onboarding of Deaf and Hard of Hearing members identified as needing communication access services and to provide ongoing coordination of the members’ communication access needs at the members’ choice. The coordinator will work in collaboration with the member and the member’s care coordinator. In hiring the coordinator, the plans will work with MCDHH and DHILs as part of the hiring and training of the coordinator.

A motion was made that representatives from the One Care Implementation Council meet with representatives from MCDHH, representatives from the One Care plans, and MassHealth to develop a budgeting process to be implemented by plans. The budget should include funding for a dedicated communication access coordinator (name to be determined) and communication access services (ASL interpreters, VRI, other) and other costs associated with providing communication access as needed.

Footnote:  The IC is concerned about the use of algorithms to drive health care decisions rather than person centered care planning.   Algorithms have potential to discriminate against high needs populations and minority groups.  We want to know how MH will provide oversight to protect enrollee rights
•	Telemedicine
•	Communication that fits the needs of the member (IC wants to follow up on older motion)