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

Slide 2: What is an Ombudsman?
•	An Ombudsman assists with the fair and expeditious resolution of concerns and complaints in an independent, impartial and confidential manner. 
•	These services are free.

Slide 3: Independent Agent
The One Care Ombudsman program is an independent program that helps individuals, their significant others and representatives address concerns or conflicts that may interfere with their enrollment in One Care  or their access to One Care health care benefits and services. 

Slide 4: Help Find Solutions
The One Care Ombudsman works with MassHealth as well as the three One Care plans (Commonwealth Care Alliance, Fallon Total Care and Network Health) to help resolve concerns or conflicts so that persons with disabilities can receive the benefits and exercise the rights to which they are entitled in One Care. 

Slide 5: Provide Information
The One Care Ombudsman (OCO) staff 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 appeals programs and legal services.

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

Slide 8: Discuss Options
The One Care Ombudsman helps individuals identify and evaluate options for resolving problems.

Slide 9: Mediate
The OCO can bring together the parties of your choosing in order to identify and discuss potential solutions. 

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

Slide 11: Identify System-Wide Issues
The One Care Ombudsman 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 listens in order to understand the issue from all perspectives, including the individual and the organization. 

Slide 13: Maintain Confidentiality
The One Care Ombudsman will not reveal personal information without an individual’s permission, unless there is an imminent threat to self or others.

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

Slide 15: The OCO must maintain a neutral and independent role.
What the OCO does not do.
•	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 serve in any other role that would compromise our neutrality
•	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
Graphic: State of Massachusetts depicting Counties covered by One Care Ombudsman
Boston Office – Counties served
•	Essex
•	Middlesex
•	Norfolk
•	Plymouth
•	Suffolk

Worcester Office (May 2014) – Counties served
•	Franklin
•	Hampshire
•	Hampton
•	Worcester

No One Care Plan 
•	Berkshire
•	Bristol
•	Barnstable
•	Dukes 
•	Nantucket

Slide 18: One Care Ombudsman Service Delivery
Graphic: Depicting workflow of Ombudsman Service Delivery
HCFA Helpline Ombudsman leads triage efforts including: Intake, Information and Referral
•	During this process data collected includes: Contact info, Type of Inquiry, Type of Complaint, Action Taken, Follow-up)
•	 CQI conducts data analysis
One Care Ombudsman leads investigations, including mediation, resolution, and guidance
•	During investigation data collected includes: Program specific information (MassHealth and One Care plans), action taken (including: conference call, mediation, investigation, grievance/appeal advised, referral to legal sources), follow-up
•	CQI conducts data analysis which will be included in 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
o	Our offices are wheelchair accessible
o	Please call 1.855.781.9898 (MassRelay – dial 711) to:
•	Arrange for interpreter services 
•	Request OCO informational materials in Braille, large print or electronic format (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