Emergency care
AL | CA | FL | GA | NC | WA"Section Five: PMP Functions and Duties
Responsibilities of PMPs include the following: ...
D. Provide or arrange for PMP coverage for services, consultation, or referrals twenty-four (24) hours a day, seven (7) days a week. This includes making available twenty-four (24) hours, seven (7) days a week access by telephone to (1) a live voice, either the PMP, an employee of the PMP or answering service personnel who will immediately page an on-call medical professional who has been authorized to make referrals or give information about accessing services or (2) an answering machine or other electronic device which directs the recipient to the telephone number to use to contract the after hours medical professional. If option 2 is utilized, the person receiving the phone call must be knowledgeable about Patient 1st requirements and can take responsibility for the patient.The 24-hour access includes the Patient 1st enrollee or a medical professional being able to contact the PMP or his/her on-call medical professional without charge for the after hours phone call. The monthly case management fee paid to the PMP is for the purpose of managing the health care needs of his/her Patient 1st enrollees, and telephone access to the PMP is part of the case management...
G. Authorize treatment for certified emergency care in accordance with Patient 1st provisions relating to those services. Authorization doses not have to be given prior to treatment being rendered, but it must be approved within 24-48 hours of the service being rendered." Alabama PMP, pages 9-10.
"E. Availability and Accessibility of Services
Ensure that primary and specialized covered services and case management are readily available and accessible to each member, including the following elements: ...
3. Emergency services will be available and accessible within the service area twenty-four hours a day, seven days a week...5. Contractor will provide accessibility to medically required specialists who are certified or eligible for certification by the appropriate specialty board, through staffing, contracting, or referral..." California Contract, page 18.
"3. Twenty-Four Hour Coverage. It is agreed that the MediPass provider will provide or arrange for coverage for services, consultation, or approval for referrals 24 hours per day, seven days per week. This coverage must consist of an answering service, call forwarding, provider call coverage or other customary means approved by the Agency. The chosen method of 24-hour coverage must connect the caller to someone who can render a clinical decision or reach the MediPass provider for a clinical decision. The after-hours coverage must be accessible using the medical office's daytime telephone number." Florida Agreement, page 7.
"8. Maintain accessibility to GBHC members during office and non-office hours (24 hours, 7 days per week, 365 days a year) by means of telephone. The telephone must be answered by live voice (an employee of the PCP or an answering service), or if during non-office hours, an answering machine...
Members requiring emergency services should be immediately directed to an appropriate emergency medical facility..
Telephone calls made by hospital emergency rooms to the PCP for purposes of medical consultation and obtaining medical history must be returned by the PCP or other designated qualified medical professional within one (1) hour from the time the call was made." Georgia Agreement, page IX-2.
"As a quality assurance initiative, the Carolina ACCESS Physician Advisory Committee has recommended the following program standards for appointment availability. The following standards have been approved by the Carolina ACCESS program:
STANDARDS
Emergency: Immediately upon presentation or notification ...
Telephone medical advice: 24 hours a day with one hour response time after office hours." North Carolina Agreement, Appointments."The Clinic agrees to:
A. Provide the following PCCM services to its enrollees using Primary Care providers (PCP) including physicians, physicians assistants (PA), and/or advanced registered nurse practitioners (ARNP): ...
6) Provide reasonable and adequate hours of operation, including providing or arranging for the 24-hour availability of information, referrals, and treatment with respect to medical emergencies." Washington State Healthy Options, pages 1-2.