Slide 1: One Care Ombudsman
A Partnership between:
•	Disability Policy Consortium
•	Health Care For All
•	Consumer Quality Initiatives

Slide 2: What is an Ombudsman? 
•	The One Care Ombudsman (OCO) helps individuals, including their significant others and representatives, to address concerns or conflicts that may interfere with their enrollment in One Care or their access to One Care health benefits and services.
•	OCO services are free.

Slide 3: Independent Agent
The One Care Ombudsman office is an independent program that is not connected to any health insurance company or plan.

Slide 4: Help Find Solutions 
The OCO works with MassHealth and each of the three One Care plans to help resolve concerns to ensure that persons with disabilities can receive their benefits and exercise their rights in One Care.

Slide 5: Provide Information
The OCO helps people get answers to their questions about One Care - from the enrollment process to specific benefits and rights. 

Slide 6: Make Referrals
The OCO can refer individuals to information, problem resolution resources, including formal grievance and appeal processes and legal services.

Slide 7: Investigate
OCO staff dig a little deeper to understand the problem and find potential solutions 

Slide 8: Discuss Options
The OCO helps individuals find and consider options for resolving problems. 

Slide 9: Mediate
The OCO can bring together people who want to discuss potential solutions. 

Slide 10: The grievance/appeal process
While the OCO cannot represent individuals in grievance or appeal proceedings, our staff can help individuals find representation and understand what to expect during the process.

Slide 11: Identify System-Wide Issues
The OCO identifies and tracks concerns and problems. 
We discuss big picture issues with MassHealth and One Care plans in order to improve existing services.

Slide 12: Listen
OCO staff listen in order to understand an issue from all sides.

Slide 13: Maintain Confidentiality
The OCO will not reveal personal information without the individual’s permission unless there is a serious and imminent threat to health and safety of the individual or others. 

Slide 14: Remain Neutral
OCO staff will not judge or decide who is right or wrong.

Slide 15: The OCO must maintain a neutral and independent role.
•	We do not serve in any other role that would compromise our neutrality.
•	We do not participate in formal investigations.
•	We do not play any role in a formal issue resolution process, such as the One Care grievance or appeal processes. 
•	We do not make binding decisions or mandate policies.

Slide 16: Who operates the OCO program?
The One Care Ombudsman is an independent program operated in partnership by 3 disability and health care advocacy organizations: 
•	The Disability Policy Consortium
•	Health Care For All
•	Consumer Quality Initiatives 

Slide 17: One Care Ombudsman Statewide Coverage
This slide displays a map of the Commonwealth of Massachusetts, at the county level of detail, color-coded as follows: 
•	Barnstable (white)
•	Berkshire (white)
•	Bristol (white)
•	Dukes (white)
•	Essex (red) 
•	Franklin (tan) 
•	Hampden (tan)  
•	Hampshire (tan)  
•	Middlesex (red)  
•	Nantucket (white)
•	Norfolk (red)  
•	Plymouth (red)  
•	Suffolk (red)  
•	Worcester (tan)  
A map key explains the color-coding:
•	Red: counties served by the OCO’s Boston (Malden) office
•	Tan: counties expected to be served by the OCO’s Worcester office, beginning May 2014
•	White: counties in which One Care is not available

Slide 18: One Care Ombudsman Service Delivery
This slide displays a flow chart that illustrates the respective roles of HFCA, CQI, and the One Care Ombudsman:
Box: HCFA HelpLine Ombudsman. Triage (Intake, Information, Referral):
•	Contact Info
•	Type of Inquiry
•	Type of Complaint
•	Action Taken
•	Follow-up
Box: One Care Ombudsman. Investigation (Mediation, Resolution, Guidance):
•	Program Specific:
o	MassHealth
o	One Care Plans (CCA, FTC, NH)
•	Action Taken
o	Conference call
o	Mediation
o	Investigation
o	Grievance/appeal advised
o	Referral to legal sources
•	Follow-up
Box: CQI. Data Analysis.
Arrows point from the box labeled “HCFA HelpLine Ombudsman” to boxes labeled “CQI. Data analysis” and “One Care Ombudsman Investigation: Mediation, Resolution, Guidance.” 
An arrow points from the box labeled “One Care Ombudsman” to a box labeled “CQI. Data analysis.”
An arrow points from the “CQI. Data analysis” box to a box labeled “State Reporting.”

Slide 19: OCO Staff
•	Director - Ombudsman
•	Deputy Director Ombudsman
•	Central / Western Ombudsman (May 2014 to July 2015)
•	Spanish Bilingual Ombudsman (May 2014)
•	Deaf At-Large Ombudsman
•	Administrative Assistant

Slide 20: Office Information
Hours of Operation
8:30 am to 4:30 pm, Monday – Friday 
Accessibility
•	Our offices are wheelchair accessible
•	Please call 1.855.781.9898 (MassRelay – dial 711) to
o	Arrange interpreter services in your preferred language and for the Deaf
o	Request OCO informational materials in Spanish, Braille, large print, or electronically (PDF or Word document)

Slide 21: Contact Information
Office:	11 Dartmouth Str., Ste. 301
	Malden, MA 02148
Phone:	1.855.781.9898 – toll free
	1.617.307.7775 – office
	Dial 711 – MassRelay 
Email:	help@onecareombuds.org
Website:	onecareombuds.org