The Massachusetts One Care Initiative, which aims to better coordinate care and services for dually eligible individuals ages 21-64, officially launched the One Care Ombudsman program (OCO). Home health agencies involved in One Care should be aware of this new resource.
According to a notice sent by the state, the OCO:
- Is an independent program operated by the Disability Policy Consortium (contracted by EOHHS) and its partners, Health Care For All (HCFA) and Consumer Quality Initiatives (CQI);
- Addresses concerns and helps resolve conflicts regarding members’ enrollment in One Care or access to covered benefits and services so they can receive the benefits and exercise the rights they are entitled to in One Care; and
- Works with members and their representatives, as well as MassHealth and the three One Care plans, to find resolutions to members’ concerns or complaints.
The OCO does not duplicate or replace other resources that are already available to help people with One Care (such as the SHINE program, the One Care plans’ member services, and MassHealth Customer Service). The OCO is an additional resource to support members who need or request independent problem-resolution assistance beyond what is available now. The OCO provides three main types of services:
- Informing individuals – Upon receiving a question or complaint, OCO helps provide individuals with information needed to resolve the matter.
- Complaint investigation and resolution – If an individual needs further assistance, the OCO investigates by collecting additional information, and may mediate to assist in resolution of the issue. In its investigations, the OCO’s role is that of a neutral fact-finder. The OCO seeks to resolve individuals’ complaints informally when possible and appropriate, before referring the individual to formal complaint resolution procedures.
- Systems analysis and recommendations – The OCO tracks trends in questions and complaints, identifies such trends to MassHealth, and makes recommendations to MassHealth and the One Care plans for improving the One Care program overall.
- The OCO accepts drop-ins at their location in Malden. Office hours are 8:30 am – 4:30 pm.
- People can schedule an appointment by calling the toll-free number (855-781-9898).
- The OCO will arrange interpretation services for appointments. Individuals needing interpretation services please schedule an appointment in advance by calling the toll-free number.
MassHealth will be posting information about the OCO on the One Care website (www.mass.gov/masshealth/onecare). A poster and a brochure about the OCO are also in development and will be shared with stakeholders when finalized.
Return to www.thinkhomecare.org.