Happy 2nd Anniversary OCO!
Since its launch in March 2014, the OCO has handled more than 831 inquiries and complaints. Of the 201 One Care complaints handled by the OCO to-date, OCO staff have achieved a 91% success rate in ensuring member access to services and benefits. OCO ombudsman services have also improved the way healthcare insurance companies evaluate and respond to the delivery of healthcare services.
Additionally, during the past two years, the OCO has reached more than 4,700 persons with information about One Care and the OCO. Target audiences have varied from potential One Care enrollees (including traditionally un-and underserved populations) to Centers for Independent Living to the general public through MassHealth and One Care plan events, disability conventions, ADA celebrations, social media and broadcast outlets such as CBS news and public access television programs.
To further OCO educational efforts, the OCO also produced an educational video series ,“Basic Healthcare Access Rights” (BHAR), for persons with disabilities. The series is composed of ten short educational videos which describe the specific healthcare access rights of: 1. Persons with behavioral health impairments, 2. Persons who are blind or visually impaired, 3. Persons who are Deaf, hard of hearing and deaf-blind, 4. Persons with intellectual disabilities, 5. Persons with mobility impairments, and 6. Persons who use service animals.
Additional videos provide information on a) Relevant State and Federal laws, b) Additional legal and healthcare rights resources, and c) Internet resources. The entire BHAR video series is free online and is available on the OCO website and on the OCO YouTube channel in six languages: English, ASL, Spanish, Chinese, Portuguese and Haitian-Creole.
One of the major roles of the OCO is to facilitate communications between the One Care plan member and their Care Team. OCO staff regularly handle issues such as:
Confusion regarding Care Team and member roles
Communications problems between the One Care Member and their Care Managers and LTSS coordinators affecting care coordination and service access delays
Disagreements as to the course of treatment, and
Problems with intake assessments including utilization of old assessment information and delays beyond the 90-day Continuity of Care Period
While individual results vary on a case-by-case basis, here are some examples of how the OCO continues to help One Care enrollees:
The OCO helped an individual seeking in-patient treatment for behavioral health issues through their Appeals and Grievance process. The OCO was able to get the denial of services of overturned so an alternate treatment option could be utilized by the member.
The OCO helped a One Care plan member who had been struggling over three months to receive a new power wheelchair. Problems related to incorrect customization of the chair triggering billing errors and caused substantial delays. Following OCO intervention, an appropriately customized power wheelchair was delivered within a week.
The OCO help a family member secure intensive behavioral health and LTSS services for a loved one. The OCO worked with MassHealth customer service to resolve MassHealth eligibility issues and enroll in a One Care plan. Following enrollment, the OCO worked with the member and their Care Team to ensure the member’s care plan included the requested services.
I’m impressed with the work and effort that federal and state personnel, One Care plans and consumer-based advocacy organizations have achieved with One Care. It is an outstanding model of healthcare for Medicare and MassHealth eligible adults with disabilities who have complex healthcare needs.
I am also very proud of my OCO staff and the quality of the working relationship they have established with the One Care plans, MassHealth, CMS, CBOs and others; finding resolutions for the kinds of issues which plague every new program in order to ensure that Massachusetts’ Financial Alignment Initiative is the best it can be.
Together, with all of our partners and stakeholders, the OCO has accomplished a great deal, well-served the needs of One Care enrollees, conducted expansive outreach, all with minimal staff and resources. Happy 2nd Anniversary OCO!
Improving Healthcare through Housing Advocacy
By Bill Henning and Allegra Stout, Boston Center for Independent Living
Housing. Housing. Housing.
What’s that got to do with One Care? With health care?
The fact is, the biggest need reported to the One Care plans, outside of enrollee health concerns, is the shortage of affordable and accessible housing. Without suitable places to live, people with disabilities are forced to enter nursing homes, live on the streets, go into a nursing home, live in an inaccessible unit, or sleep on a couch. None of these scenarios is remotely conducive to good health. One Care and other innovative health programs have the potential to transform healthcare for the better, but they can only succeed if people’s basic needs are met.
Shared space with strangers is a ticket to possibly shared flu virus or colds or worse. Inaccessible units may mean not being able to get outside—no fresh air or social interaction, as you’re virtually imprisoned in your own home. Couch sleeping can mean bad rest and slow, passive, but nonetheless serious harm to your body. Living on the streets or in other unstable situations can make it impossible to use PCA or visiting nurse services or take advantage of preventive care on a consistent basis.
The answers to the state’s housing crisis are not simple, because there must be more units as the population grows, and landlords, trying to boost their incomes, are boosting rents all over the place. But one part of the answer is getting more subsidies for people with disabilities. One great way to do this is through the Alternative Housing Voucher Program (state budget line item 7004-9030). The Alternative Housing Voucher Program (AHVP) is for low-income people with disabilities under age 60, and it provides subsidies so that voucher holders can rent private market apartments and have most of the rent paid by the state. The program serves people with a wide range of disabilities who need housing for whatever reason.
AHVP started in 1996 with 800 vouchers, but budget cuts, inflation, and skyrocketing rents have cut that number nearly in half over the years. The Boston Center for Independent Living and many other housing and disability advocacy organizations have been fighting to restore the original 800 vouchers. Last year the state increased funding for AHVP by $1.05 million, to a total of $4.6 million, which created 120 new vouchers. There are now 554 vouchers available statewide, and we are continuing the campaign to get funding for AHVP up to $7.1 million, to get back to 800 vouchers.
We need you to be part of this effort so that all people with disabilities can have the stable homes they need to be healthy. Please ask your state senator and state representative to support increasing AHVP funding to $7.1 million! One great opportunity to tell your legislators why this matters to you is at Independent Living Education Day at the State House, next Thursday, March 10, 11am-3pm. Join hundreds of others from the statewide disability community to advocate for AHVP and other disability rights priorities. Check out the Facebook event here, and learn more about the five priorities for the day at this link. Please RSVP to your local Independent Living Center. (If you’re in the Boston area, RSVP to Allegra Stout at firstname.lastname@example.org or 617-338-6665.)
An individual needing more intensive behavioral health and LTSS services for a family member contacted the OCO after encountering multiple difficulties establishing MassHealth eligibility. The OCO worked with MassHealth customer service to resolve eligibility issues. Following enrollment, the OCO worked with the member and Care Team to ensure the member’s care plan included the requested services.
One Care Plans