Urgent care

AZ | AZBH | CA | CO | CT | DE | DC | FL | FLMH | HI | HIBH | IL | IN | IA | IABH | KS | KY | ME | MD | MA
MABH | MI | MN | MO | MT | NEBH | NV | NJ | NM | NY | NC | ND | OH | OK | OR | ORMH | PA | PABH
RI | SC | TN | TX | UT | UTMH | VA | WA | WV

"19. APPOINTMENT STANDARDS
The Contractor shall have procedures in place that ensure the following standards are met: ...
b. Urgent care PCP appointments - within two days of request...

For specialty referrals, the Contractor shall be able to provide: ...
b. Urgent care appointments - within 3 days of referral..." Arizona Contract, page 29.

AZBH

"12. APPOINTMENT STANDARDS...
In a Title XIX member needs medically necessary transportation, ADHS or its subcontracted RBHA shall provide transportation and ensure that the member arrives no sooner than one hour before the appointment; does not have to wait more than one hour after making the call to be picked up, and does nit have to wait for more than one hour after the conclusion of the appointment for transportation home." Arizona Behavioral Health Contract, page 18.

"6.5.7.3 Urgent Care
The Contractor will ensure that a Member needing Urgent Care will be seen within 48 hours upon request." California Contract, page 98.

"XIV. SERVICE DELIVERY.
4. Scheduling and wait times: The Contractor shall establish clinically appropriate scheduling guidelines for various types of appointments necessary for the provision of primary and specialty care including but not limited to: well-child checks, routine physicals, prenatal care, diagnosis and treatment of acute pain or injury, and follow-up appointments for chronic conditions. The Contractor shall endure that the following minimum standards are met including: ...
c. Urgent Care provided within 48 hours of notification of the Primary Care Physician or Contractor." Colorado Contract, pages 46-47.

"EXHIBIT E
MEMBER HANDBOOK REQUIREMENTS
To inform Members of their rights and responsibilities, the Plan shall publish and distribute to all Members a Member Handbook that shall include but is not limited to the following information: 13.Maximum number of days between appointment request and actual visit with appropriate provider, as follows: ...
a. Urgent care within forty-eight (48) hours..." Colorado Contract, Exhibit E, page 1.

"3.13 PCP and PCD Scheduling and Capacity
a. The MCO shall ensure that the PCPs and PCDs in its network adhere to the following PCP scheduling practices:
...
2. Urgent cases shall be seen within 48 hours of PCP notification." Connecticut Contract, page 23.

"9.3.1 General Procedures
The MCO shall have procedures in place that ensure: ...
(c) Urgent care PCP appointments are available within two (2) calendar days (e.g., persistent rash, recurring high grade temperature, nonspecific pain, fever)...

9.3.2 Specialty Referral Procedures
For specialty referrals arrangements and provisions, the MCO shall be able to provide: ...
(b) Urgent care appointments available within forty-eight (48) hours of referral." Delaware RFP, page II.59.

"2. Service Timelines
a. In furnishing care under this contract Provider shall adhere to the following timelines: ...
(2) urgent care services, as defined in Article XXII, shall be furnished within 24 hours..." District of Columbia Contract, page 29.

"B. Manner Of Service Provision
1. Availability/Accessibility of Services...The plan must assure that primary care physician services and referrals to specialty physicians are available on a timely basis, to comply with the following standards: urgent care - within one day..." Florida Contact, page 10.

FLMH

"2.5 Minimum Staffing and Access Standards...
A.3. The maximum amount of time between an enrollee's request for mental health services and the first point of service shall be as follows: ...
b. For persons initially perceived to need emergency mental health services, but upon assessment do not meet the criteria for emergency care, they are deemed to require crisis-support and services must be provided within twenty-three hours..." Florida Mental Health RFP, page 28.

"30.430 Availability of Providers...
The health plan shall have a sufficient network to ensure members can obtain needed health services within the acceptable wait times. The acceptable wait periods are: ...
*Appointments within 24 hours for urgent care." Hawaii RFP, page 10.

"GUIDELINES FOR ONE MONTH WAITING PERIOD...
Urgent care for medical and behavioral health problems including office visits and related services such as laboratory and x-ray services for diagnostic purposes, prescription drugs (includes new and renewals of proscription drugs) shall not be subject to the waiting period. Follow-up visits related to the urgent or emergent conditions should also not be subject to the waiting period.

Pre-natal care is considered to be urgent care and therefore, not subject to a waiting period. Termination of a pregnancy is also not subject to the waiting period." Hawaii RFP, Appendix G, page 1.

HIBH

"30.420 Availability and Accessibility of Providers
The BHMC plan shall have a sufficient provider network statewide to ensure members can access needed behavioral health services consistent with the member's degree of risk, as set forth below:..

Urgent problem visits are available within 24 hours." Hawaii Behavioral Health RFP, page 16.

"(4) Appointments
The Contractor shall encourage Beneficiaries to be seen by appointment, except in emergencies. Time specific appointments for routine, preventive care shall be made available within five weeks from the late of request for such care: ...Beneficiaries with more serious or urgent problems not deemed emergencies shall be triaged and provided same day service, if necessary..." Illinois HMO Contract, page 44.

"APPENDIX III
CLINCIAL ADVISORY COMMITTEE AND QUALITY IMPROVEMENT COMMITTEE APPOINTMENT STANDARDS...

Hoosier Healthwise Quality Improvement Committee
Appointment Standard Recommendations

Type***Time Frame...
*Urgent/Emergency Care Triage***24 hrs/day...
Urgent Care***48 hrs/day..." Indiana RFP, Appendix III, unnumbered pages.

"1.3 Definitions...
- Urgent Medical Condition - medical condition manifesting itself by acute symptoms that are of lesser severity (including severe pain) than that recognized for Emergent Medical Condition...

The HMO must arrange for necessary care within 24 hours by either providing it or referring and authorizing another appropriate provider to provide care." Iowa Contract, pages 6, 10-11.

IABH

"Accessibility Standards...
For mental health services, the access shall be measured by: ...
* acuity of need: persons with urgent non-emergency needs must be seen within 1 hour of presentation at a service delivery site or within 24 hours of telephone contract with provider or contractor...

For substance abuse treatment services, the access shall be measured by:
1. Acuity of need: .Eligible persons with urgent non-emergency needs must be seen within 1 hour of presentation at a service delivery site or within 24 hours of telephone contact with provider or contractor." Iowa Behavioral Health Contract, page 88.

"Appointment Standards.
The HMO shall have procedures in place that ensure: ...

Urgent primary care provider appointments are available within forty-eight (48) hours (e.g., persistent rash, recurring low grade temperature, nonspecific pain, fever).

For specialty referrals, arrangements and provisions, the HMO shall be able to provide: ...

Urgent specialty care appointments available within three days of referral." Kansas General Service, pages 19-20.

"D. Services to Be Provided...
2. Accessibility
The Contractor shall make services, service locations, and services sites available and accessible to Members as specified in Section 7.7.2 and Attachment V of the RFA." Kentucky Contract, page 21.

"7.7.2 Provider Program Capacity Demonstration...
Urgent care services by any provider in The Partnership's Program shall be made available within 48 hours of request." Kentucky RFA, page 48.

"E. PCP AND SPECIALIST ACCESS...
3. Timely Access to Health Care Services. The Contractor shall contractually require its network providers to make Health Plan services accessible on a timely basis in accordance with medically appropriate guidelines, and consistent with generally accepted standards of care... Providers shall schedule appointments at reasonable times and in accordance with the following requirements:
a. Enrollees must be able to get an appointment for routine medical services within.For urgent care, Enrollees should have access within twenty-four (24) hours...
c. Once a referral has been made by their PCP, Enrollees must be able to get an appointment with a specialty provider within twenty-four (24) hours for urgent care..." Maine Contract, pages 27-28.

"10.09.66.07...
(3) Appointment Guidelines.
(b) An MCO shall effect procedures that result in an interval between the enrollee's request for an appointment and the actual appointment time being consistent with the following standards: ...
(iv) Individuals requesting urgent care shall be scheduled to be seen within 48 hours of the request..." Maryland COMAR 10.09.66.07.

"Section 2.6 Access...
B. Waiting Time
1. The Contractor shall ensure that Enrollees have access to MCO Covered Services as provided below: ...
b. Urgent Care - within 48 hours of the Enrollee's request." Massachusetts Contract, pages 47-48.

"Section 2.12 Behavioral Health Program Services...
D. BH Program Access and Availability

The Contractor shall: ...
3. Ensure that Enrollees' access to BH Services is consistent with the degree of urgency, as set forth below: ...

b. Urgent Care - must be available within 48 hours." Massachusetts Contract, pages 68-74.

MABH

"4.0 ACCESS AND AVAILABILITY
The Contractor shall: ...
4.01.02 Ensure that Enrollees' access to services is consistent with the degree of urgency, as set forth below:
b. urgent care - must be provided within 48 hours..." Massachusetts MH/SAP Contract, Appendix B, page 27.

"II-M CONTRACTOR ORGANIZATIONAL STRUCTURE, ADMINISTRATIVE SERVICES, FINANCIAL REQUIREMENTS AND PROVIDER NETWORKS...
6. Provider Network in the CHCP...
(i) PCP Standards...

The Contractor will ensure that there is a reliable method and system for providing 24 hour access to urgent care...7 days a week... Provisions must be available for obtaining urgent care 24 hours a day. Urgent care may be provided directly by the PCP or directed by the Contractor through other arrangements." Michigan Contract, pages 32, 35, 39

"Section 6.1.13. Medical Emergency, Post-Stabilization Care, and Urgent Care Services. Medical Emergency Services, Post-Stabilization Care Services and Urgent Care Services must be available 24 hours per day, seven days per week, including a 24-hour per day number for Enrollees to call in case of a Medical Emergency.

The HEALTH PLAN shall not require Prior Authorization as a condition of providing a Medical Emergency Service. Nor shall the HEALTH PLAN require an Enrollee to receive a Medical Emergency or Post-Stabilization Care Service within the HEALTH PLAN's network. See Section 6.22.1." Minnesota Contract, pages 48-49.

"6.24.2. Request for Urgent Services. If the need for services is urgent or required to prevent institutionalization, the HEALTH PLAN must evaluate the request for services and communicate its decision to the Enrollee or authorized representative and the provider within an expedited time frame appropriate to the type of service and the need for service that has been requested by the Enrollee or requested on the Enrollee's behalf." Minnesota Contract, pages 48-49.

"2.13.4 Appointment Standards: ...
a. The health plan shall have procedures in place that ensure: ...
3) Urgent care primary care provider appointments are available within two (2) calendar days (e.g. persistent rash, recurring high grade temperature, nonspecific pain, fever).

b. For specialty referrals arrangements and provisions, the health plan shall be able to provide: ...
2) Urgent care appointments available within two (3) calendar days of referral." Missouri RFP, page 68.

"2.6.5 Comparability/Accessibility of Services...
The CONTRACTOR must have procedures for the scheduling of appointments for enrolled RECIPIENTS that are appropriate to the reason for the visit...
* An ENROLLEE with urgent symptoms must be seen within one day of contacting the PARTICIPATING PROVIDER." Montana Contract, page 49.

NEBH

"12.3 Goal: To provide the NHC client an `adequate' network of MH/SA providers...
At a minimum, the PHP shall meet the following requirements to demonstrate `adequacy': ...
3. Immediate access for clients with urgent, symptomatic conditions for triage and crisis intervention.." Nebraska Behavioral Health Contract, pages 74, 76.

"B. PCP Standards. The Contractor shall have procedures in place that ensure: ...
2. Urgent care PCP appointments are available within two calendar days.
C. Specialty Standards. For specialty referrals to physicians, therapists, behavioral health services, vision services and other diagnostic and treatment health care providers the Contractor shall provide: ...
2. Urgent care appointments within three (3) calendar days of referral..." Nevada Contract, pages 39-40.

"Provider Network Requirements...
F. Accessibility Measures/Appointment Scheduling Standards.
5. Scheduling time for urgent care - same day, less than 12 hours." New Jersey Contract, pages 195-199.

"10.11 The contractor shall comply with the appointment availability guidelines below.
B. For urgent care: on basis of medical need, but within twelve (12) hours." New Jersey Contract, page 57.

"2.A.4.c Non-Emergency Access Standards...
2.A.4.c.iv Primary medical, including behavioral health, and dental care outpatient appointments for urgent conditions will be available within 24 hours.
2.A.4.c.v For specialty outpatient referral and/or consultation appointments, including behavioral health, the request-to-appointment time will be consistent with the clinical urgency but no greater than 21 days, unless the member requests a later time." New Mexico Contract, pages 13-14.

"15. ACCESS REQUIREMENTS
15.1 Appointment Availability Standards
The Contractor shall comply with the following appointment availability standards...
b) For urgent care: within twenty-four (24) hours of request." New York Contract, page 15-1.

"6.5 Appointment Availability
The Plan must ensure that appropriate services are available as follows: ...
b. Urgent care - within twenty-four (24) hours." North Carolina Contract, page 9.

"2.7 24-Hour Coverage
Qualified medical personnel must be accessible 24 hours each day, seven days a week, to provide direction to patients in need of urgent or emergency care...
Enrollees must have access to a live voice. to handle medical problems during non-office hours and qualified medical personnel must respond to enrollees within 60 minutes." North Dakota Contract, Attachment C, page 11.

"2.9 Comparability/Accessibility of Services...
(2) The Contractor must have procedures for the scheduling of appointments for enrollees that are appropriate to the reason for the visit.
(a) An enrollee needing urgent care must be seen within one day of contacting the participating provider." North Dakota Contract, Attachment C, pages12-13.

"5101:3-26-031 Managed care plan: Availability and access to services...
(D) The PCP sites must have ODHS-approved written triage procedures that address the following:
(2) Enrollees with urgent care needs must be triaged and treated within one hour of presentation at the PCP site." Ohio RFP, Appendix E, OAC 5101:3-26-031, pages 1-2.

"2.8.4 Days to Appointment
2.8.4.1 Physical Health/Dental/Vision
Health Plan must provide appointments from the date of request as follows:

Urgent medical problems within 24 hours." Oklahoma RFP, page 42.

"(13) Contractor shall define access requirements in the following way: ... Members... shall be seen within 48 hours for urgent care." Oregon Contract, page 14.

ORMH

"2. In addition to access and continuity of care standards specified in the rules above in Subsection D.1, Contractor shall establish standards for access to Covered Services and Continuity of Care which at a minimum include the following:
a. For Urgent Services.Contractor shall assure that 98% it's OMAP Members receive an initial face-to-face or telephone screening within 15 minutes of contact to determine the nature and the urgency of the situation.

c. For Urgent Services, Contractor shall assure that 95% of its OMAP Members receive timely services within time frames identified by the urgent and emergency response screening or within 48 hours of request, whichever is shorter." Oregon Mental Health Contract, page 24.

"J. SERVICE ACCESSIBILITY STANDARDS...
3. Appointment Standards
The HMO shall have PCP scheduling procedures in place that ensure: ...

Urgent cases must be scheduled within twenty-four (24) hours." Pennsylvania RFP, page 68.

PABH

"5. Service Access
a. The MCO provider network must to provide face-to-face intervention.within 24 hours for urgent situations..." Pennsylvania Behavioral Health RFP, page 63.

"2.09.04 Days To Appointment For Non-Emergency Services
Contractor agrees to make services available within twenty-four (24) hours for treatment of an urgent medical problem including a mental health or substance abuse condition." Rhode Island RFP, page 39.

"4.10.2 Scheduling/Appointment Waiting Times
The Contractor shall ensure that its subcontractors/network providers have an appointment system for covered core benefits and/or expanded services which are in accordance with prevailing medical community standards but shall not exceed the following requirements: ...

4.10.2.2 Urgent, non-emergency visits within forty-eight (48) hours; and...
Walk-in patients with urgent needs should be seen within forty-eight (48) hours." South Carolina Contract, page 27.

"ATTACHMENT IX - TERMS AND CONDITIONS FOR ACCESS
(d) Appointment/Waiting Times: Usual and customary practice (see definition below), not to exceed...48 hours for urgent care. Waiting times shall not exceed 45 minutes." Tennessee Contract, pages 137-138.

"ARTICLE VII PROVIDER NETWORK REQUIREMENTS
7.1 PROVIDER ACCESSIBILITY...
7.1.3 Timeframes for Access Requirements. HMO must have sufficient network providers and establish procedures to ensure Members have access to routine, urgent, and emergency services; telephone appointments; advice and Member service lines. These services must be accessible to Members within the following timeframes:
7.1.3.1 Urgent Care within 24 hours of request." Texas Contract, page 54.

"D. Access...
2. Specific Provisions...
d. Waiting Time Benchmarks
The CONTRACTOR will adopt benchmarks for waiting times for physician appointments as follows:

Waiting time for Appointments...
1) Primary Care Providers: ...

within 2 days for urgent, symptomatic, but not life-threatening care (care that can be treated in the doctor's office)..." Utah Contract, Attachment B, pages 28-30.

UTMH

"B. Performance Standards...
1. The CONTRACTOR will provide timely Covered Services to Enrollees who seek services in accordance with the following time frames: ...
b. If it is determined during the initial Contact that the Enrollee requires Urgent Care, the CONTRACTOR will provide face-to-face Covered Services within a maximum of five working days of the Initial Contact." Utah Mental Health Contract, page 12.

"11. Appointment Standards
a. The Contractor must arrange to provide care according to each of the following appointment standards: ...
ii. Appointments for an urgent medical condition shall be made within twenty-four (24) hours of the enrollee's request." Virginia Contract, pages 66-67.

"E. ACCESSIBILITY OF SERVICES [QI 5]
The contractor must establish mechanisms to assure the accessibility of primary care services, urgent care services, and member services.
3. The contractor must establish standards for appointments that are no longer than the following:
c) urgent, symptomatic office visit must be available within 24 hours. An urgent, symptomatic visit is associated with the presentation of medical signs that require immediate attention, but are not life threatening..." Washington Contract, QIP-2000 Standards, page 6.

"III-1 AVAILABILITY AND ACCESSIBILITY...
The MCO must have standards for timeliness of access to care and member services that meet or exceed such standards as may be established by the Bureau for Medical Services, continuously monitor its provider network's compliance with these standards, and take corrective actions as necessary...
Current BMS standards for timeliness state that...
* Urgent cases must be seen within 48 hours." West Virginia Contract, Exhibit F, page 12.

"3.4.2.1 Appointment Scheduling
MCPs must meet the following appointment scheduling standards: ...
b) Urgent cases must be seen within 48 hours...

Urgent care circumstances are such that the individual requires prompt medical attention for the care and management of a significant physical or mental disorder, but there is no immediate threat to the individual's life." West Virginia RFA, pages 18-19.