Rights & Responsibilities

Members are informed of their rights and responsibilities through the Member Handbook. Arkansas Total Care network providers are also expected to respect and honor member’s rights.

Arkansas Total Care (ARTC) members have the following rights:

• Receive information in accordance with § 438.10, which includes, but is not limited to:
  • An oral interpretation in all languages and written translation available in each prevalent non-English language, including written materials with taglines in the prevalent non-English languages in Arkansas (as identified on the first page of this handbook).
  • Large print availability of explaining written translations or oral interpretation to understand the information provided.
  • Written materials that are critical to obtaining services, including this member handbook, appeal and grievance notices, and denial and termination notices, are available in the prevalent non-English languages in Arkansas.
  • Written materials must also be made available in alternative formats upon request at no cost.
  • Auxiliary aids and services available upon request at no cost.
  • Written materials including taglines in the prevalent non-English languages in Arkansas, as well as large print, of written translation or oral interpretation (large print printed in a font size no smaller than 18 point).
  • Interpretation services are available, free of charge, including oral interpretation, and the use of auxiliary aids such as TTY and American Sign Language.
  • To choose a participating provider for any service the member is eligible and authorized to receive under his or her PCSP, including a PCP.
  • Execute an advance directive without discrimination in the provision of care or otherwise.
  • Live in an integrated and supported setting in the community and have control over aspects of their lives.
  • Be protected in the community.
  • To be treated with respect and with due consideration for their dignity and privacy.
  • Receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand.
  • Participate in decisions regarding his or her healthcare, including the right to refuse treatment.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in other Federal regulations on the use of restraints and seclusion.
  • The right to request and receive a copy of your medical records, and to request that they be amended or corrected.
  • The right to exercise your rights without Arkansas Total Care treating you adversely.
  • The right to be provided written notice of a change in your care coordination provider within seven (7) calendar days.
  • The right to a Member Handbook and referral network directory within a reasonable amount of time after attribution.
  • You can ask for any of the following information about Arkansas Total Care at no cost.
    • How Arkansas Total Care works.
    • Arkansas Total Care’s quality scores and performance measures tracked by DHS or CMS.
    • Arkansas Total Care’s non-discrimination policies and those responsible for overseeing those policies. You can also ask for accessibility and discrimination claims made against Arkansas Total Care.
    • A list of any counseling or referral services not provided by Arkansas Total Care because of moral or religious objections, and how you, as a member, may obtain that information.

Arkansas Total Care members have the following responsibilities:

• To be familiar with Arkansas Total Care procedures to the best of their abilities.
• To contact Arkansas Total Care to get information and have questions answered.
• To give providers accurate and complete medical information.
• To follow care prescribed by the provider or to let the provider know why treatment cannot be followed as soon as possible.
• To keep appointments and follow-up appointments.
• To access preventive care services.
• To live healthy lifestyles and avoid behaviors known to be harmful.
• To understand their health problems and participate in developing mutually agreed upon treatment goals, to the degree possible.
• To give accurate and complete information needed for care to Arkansas Total Care and all their healthcare and support providers.
• To make their primary care provider aware of all other providers who are treating them. This is to ensure communication and coordination in care. This also includes behavioral health providers.
• To ask questions of providers to learn the risks, benefits, and costs of treatment options. To make care decisions after carefully weighing all factors.
• To follow Arkansas Total Care’s grievance process outlined in this Member Handbook if there is a disagreement with a provider.
• To choose a primary care provider (PCP).
• To treat providers and staff with dignity and respect.

Grievance & Appeals

Grievance Process

Arkansas Total Care wants to take care of any problems or concerns. A grievance is any complaint or dispute, other than an organization determination, that tells us about your unhappiness with how Arkansas Total Care provides healthcare services. Members can file a grievance if they had a problem with things such as:

• Quality of care
• Being able to reach someone by phone
• Ease of getting information

Arkansas Total Care will not treat you differently if you file a grievance. Filing a grievance will not affect your healthcare services. For Arkansas Total Care to completely review your concern, please provide:

• Your first and last name
• Arkansas Total Care Member ID Number
• Phone number
• What you are unhappy with
• What you would like to happen when contacting us to file a grievance

The member, member’s authorized representative, or member’s provider may file a grievance orally or in writing. We will help you fill out any forms to file a grievance. This includes, but is not limited to, providing interpreter services and telephone assistance.

We will let you know in writing within five (5) business days that we have received your oral grievance.

Grievance Timeline

Each grievance is different and will be given the time it deserves. Most grievances should be resolved 30 calendar days from the day we receive the initial oral or written grievance.

Up to 14 more days may be added to this timeframe if:

• The member requested additional time.
• Arkansas Total Care needs more information to resolve the grievance.
• It is in the member’s best interest to extend the timeframe.

Arkansas Total Care will notify you of the grievance resolution in writing within two (2) business days of the resolution. The notice of resolution shall include:

• The results of the resolution process.
• The date it was completed.
• Further appeal rights, if any.

To file a grievance, please contact us at:

Arkansas Total Care Quality Department
P.O. Box 25010
Little Rock, Arkansas 72221
Phone: 1-866-282-6280 (TTY: 711)

Appeal Process

An appeal of an action is a request for Arkansas Total Care to review the action of concern, existing or additional documentation, and make an appeal decision. You can request this review by phone or in writing.

If Arkansas Total Care refuses to pay for a service, you will get a letter telling you so. If you disagree with the decision, you can appeal the decision.

Your request for appeal must go to Arkansas Total Care’s Appeals Office. It is very helpful if you also send a copy of the letter you received from us telling you of our appeal determination.

The letter we sent notifying you of our appeal determination will have a date on it. You have 60 days from that date to request an appeal. Your request for an appeal will be denied if the Arkansas Total Care’s Appeals Office does not get your appeal request within 60 days.

If we are going to reduce or stop a service we had approved in the past, you have the right to request to keep getting the service until we make our decision if:

1. We approved you to get the service from the provider.
2. And the time limit that we approved hasn’t ended.

To keep getting this service, you must ask to keep getting the service and file an Appeal on or before ten (10) days of receiving this notice or the effective date of the action. If you Appeal the action and keep getting this service, you may have to pay for the service if we deny your Appeal.

Send your request for an appeal to:

Arkansas Total Care Quality Department
P.O. Box 25010
Little Rock, Arkansas 72221
Phone: 1-866-282-6280 (TDD/TTY: 711)
Fax: 866-811-3255

Fair Hearings

You will receive a letter if Arkansas Total Care upholds their denial of a service. If Arkansas Total Care’s denial is upheld, you will have the right to a State Fair Hearing before an Arkansas Department of Human Services hearing officer.

If you are a member who would like a Fair Hearing, send your request to the DHS Office of Appeals and Hearings. For providers who would like a Fair Hearing, send your request to the ADH Office of Medicaid Provider Appeals.

It is very helpful if you also send a copy of the letter you received from Arkansas Total Care telling you that payment for a service has been denied to the Office of Appeals and Hearings (or the ADH Office of Medicaid Provider Appeals).

You have 30 days from the date on your Arkansas Total Care appeal determination letter to request a Fair Hearing. Your request for a Fair Hearing may be denied if the Office of Appeals and Hearings or ADH Office of Medicaid Provider Appeals does not get your Fair Hearing request within 30 days of the date of the Arkansas Total Care letter notifying you that our denial has been upheld on appeal.

You should ask for a hearing if you believe:

• It was wrong to deny your application or request for service.
• It is taking too long to decide about your application.
• You did not receive enough help.
• You asked for a service and did not get it.
• Someone forced you to accept a service you did not want.
• Someone discriminated against you.

To ask for a State Fair Hearing, send a letter asking for a hearing to:

DHS Office of Appeals and Hearings
P.O. Box 1437, Slot N401
Little Rock, AR 72203-1437
Phone: 501-682-8622
Fax 501-404-4628