A Division of: Disability Policy Consortium

What is ? What is the ? One Care Ombudsman Office

One Care Ombudsman Office

What is One Care? One Care is a new health care insurance option for some adults with disabilities living in Massachusetts who are eligible to receive both Medicare and MassHealth services. One Care is designed to improve the quality of health care while better managing overall costs. One Care Ombudsman Office

One Care Coverage One Care covers all of the services a person gets with Medicare and MassHealth. This includes medical, prescription drug, behavioral health and community support services. One Care Ombudsman Office

One Care Services Provides a range of services, including:  Behavioral health  Medical equipment  Care coordination  Peer supports  Community-based  PCA  Dental services  Substance use  Home care  Vision services  Long term supports  Wellness supports  And other services… One Care Ombudsman Office

One Care Plans Medicare and MassHealth have joined together with two health plans to offer One Care. These plans are: Commonwealth Care Alliance Tufts Health Plan One Care Ombudsman Office

One Care Ombudsman Office

For more information on One Care go to: http://www.mass.gov/eohhs/consumer/insurance/one-care/ One Care Ombudsman Office

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. One Care Ombudsman Office

Independent Agent The One Care Ombudsman is an independent agent that is not connected to any health insurance company or plan. One Care Ombudsman Office

Help Find Solutions The OCO works with One Care members, each of the One Care plans and MassHealth to help resolve concerns; ensuring that persons with disabilities receive their benefits and exercise their rights in One Care. One Care Ombudsman Office

Provide Information OCO staff helps people get answers to their questions about One Care - from the enrollment process to specific benefits and rights. One Care Ombudsman Office

Make Referrals The OCO can refer individuals to information, problem resolution resources, including formal grievance and appeal processes and legal services. One Care Ombudsman Office

Investigate OCO staff dig a little deeper to understand the problem and find potential solutions. One Care Ombudsman Office

Listen OCO staff listen in order to understand an issue from all sides. One Care Ombudsman Office

Discuss Options The OCO helps One Care plan members resolve their problems by finding and reviewing their options. One Care Ombudsman Office

Mediate OCO staff often brings people together to identify and discuss potential solutions to One Care plan problems. One Care Ombudsman Office

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. One Care Ombudsman Office

Remain Neutral OCO staff will not judge or decide who is right or wrong. One Care Ombudsman Office

The OCO stays neutral 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. One Care Ombudsman Office

The Grievance/Appeal Process While the OCO cannot represent individuals in grievance or appeal proceedings, OCO staff can help One Care plan members find representation and understand what to expect during each step of the process. One Care Ombudsman Office

Identify System-Wide Issues The OCO identifies and tracks concerns and problems. The OCO discusses big picture issues with MassHealth, One Care plans and the Implementation Council in order to improve existing services. One Care Ombudsman Office

Who operates the OCO program? The One Care Ombudsman is an independent office is a division of the Disability policy Consortium, a health care advocacy organization. One Care Ombudsman Office

One Care Ombudsman Office

One Care Ombudsman Office

OCO Staff Director / Ombudsman Deputy Director / Ombudsman Spanish Bilingual Ombudsman Outreach Coord. / Ombudsman Administrative Assistant One Care Ombudsman Office

OCO Contact Information Office: Malden, MA Phone: 1.855.781.9898 – toll free Dial 711 – MassRelay 1.617.307.7775 – Office Website: onecareombuds.org Email: help@onecareombuds.org One Care Ombudsman Office

OCO Office Malden, MA 11 Dartmouth, Ste. 301 Malden, MA 02148 Walk-in hours: Monday 1-4 | Thursday 9-12 And by appointment One Care Ombudsman Office

Accessibility MassRelay – dial 711 (Deaf / hard of hearing) to: The OCO office is wheelchair accessible Please call 1.855.781.9898 or MassRelay – dial 711 (Deaf / hard of hearing) to: Arrange interpreter services in your preferred language and for the Deaf Request OCO informational materials in Spanish, Braille, large print or electronically (PDF or Word document) One Care Ombudsman Office