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A Partnership between: Disability Policy Consortium Health Care For All

A Partnership between: Disability Policy Consortium Health Care For All Consumer Quality Initiatives. What is an Ombudsman ?. An Ombudsman assists with the fair and expeditious resolution of concerns and complaints in an independent , impartial and confidential manner .

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A Partnership between: Disability Policy Consortium Health Care For All

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  1. A Partnership between: Disability Policy Consortium Health Care For All Consumer Quality Initiatives

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

  3. Independent Agent The One Care Ombudsman program is an independent program that helpsindividuals, 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.

  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.

  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

  6. Make Referrals The OCO can refer individuals to information, problem resolution resources, including formal grievance and appeals programs and legal services.

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

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

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

  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.

  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.

  12. Listen OCO staff listens in order to understand the issue from all perspectives, including the individual and the organization.

  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.

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

  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

  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

  17. 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

  18. 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 • Arrange for interpreter services • Request OCO informational materials in Braille, large print or electronic format (Word document)

  19. 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

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