Chapter 7: Coverage for Medical Emergencies During and After Hours

In this chapter:

• Authority
• Requirements
• Demonstrating Compliance
• Related Considerations

Authority

Section 330(b)(1)(A)(IV) and Section 330(k)(3)(A) of the PHS Act; and 42 CFR 51c.102(h)(4), 42 CFR 56.102(l)(4), 42 CFR 51c.303(a), and 42 CFR 56.303(a)

Requirements

• To assure continuity of the required primary health services of the center, the health center must have:
  • Provisions for promptly responding to patient medical emergencies during the health center’s regularly scheduled hours; and
  • Clearly defined arrangements for promptly responding to patient medical emergencies after the health center’s regularly scheduled hours.

Demonstrating Compliance

A health center would demonstrate compliance with these requirements by fulfilling all of the following:

1. The health center has at least one staff member trained and certified in basic life support present at each HRSA-approved service site (as documented on Form 5B: Service Sites to ensure the health center has the clinical capacity to respond to patient medical emergencies¹ during the health center’s regularly scheduled hours of operation.²
2. The health center has and follows its applicable operating procedures when responding to patient medical emergencies during regularly scheduled hours of operation.
3. The health center has after-hours coverage operating procedures, which may include formal arrangements³ with non-health center providers/entities, that ensure:
   • Coverage is provided via telephone or face-to-face by an individual with the qualification and training necessary to exercise professional judgment in assessing a health center patient's need for emergency medical care;
   • Coverage includes the ability to refer patients either to a licensed independent practitioner for further consultation or to locations such as emergency rooms or urgent care facilities for further assessment or immediate care as needed; and
   • Patients, including those with limited English proficiency,⁴ are informed of and are able to access after-hours coverage, based on receiving after-hours coverage information and instructions in the language(s), literacy levels, and formats appropriate to the health center’s patient population needs.
4. The health center has documentation of after-hours calls and any necessary follow-up resulting from such calls for the purposes of continuity of care.⁵

Related Considerations

The following points describe areas where health centers have discretion with respect to decision-making or that may be useful for health centers to consider when implementing these requirements:

• The health center determines the means by which after-hours coverage is provided to health center patients. Examples include: telephone coverage by health center providers, primary care services after hours to address urgent medical conditions on an extended or 24-hour basis at certain service sites, after-hours phone coverage arrangements with other community providers,⁶ or “nurse call” lines.
• The health center determines how to make patients aware of the availability of, and procedures for, accessing professional coverage after hours. Examples include after-hours instructions that are: integrated into an automated message on the health center’s main phone line explaining how to access after-hours coverage, posted on the door of all health center service sites, provided as part of the initial patient registration process, posted on the health center’s website, and/or provided as patient brochures or cards.

Footnotes

^1. Medical emergencies may, for example, include those related to physical, oral, behavioral, or other emergent health needs.

^2. See Chapter 6: Accessible Location and Hours of Operation for more information on hours of operation.

^3. See Chapter 12: Contracts and Subawards for more information on oversight over such arrangements.

^4. Under Section 602 of Title VI of the Civil Rights Act and the Department of Health and Human Services implementing regulations (45 CFR Section 80.3(b)(2)), recipients of Federal financial assistance, including health centers, must take reasonable steps to ensure meaningful access to their programs, services, and activities by eligible limited English proficiency (LEP) persons. See Office of Civil Rights: Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons -Summary for further guidance on translating vital documents for LEP persons.

^5. See Chapter 8: Continuity of Care and Hospital Admitting for more information on continuity of care.

^6. Health centers that are deemed under the Federal Tort Claims Act (FTCA) should ensure that they are familiar with the applicable restrictions on FTCA coverage for services provided to non-health center patients. Review the FTCA Health Center Policy Manual (PDF - 406 KB) for further information.