Urgent care: Definition


AZ | CA | CO | CT | DC | FL | HI | HIBH | IL | IA | KS | KY | MA | MN | MT | NH | NJ | NY


NC | ND | OH | OK | ORMH | PABH | RI | SC | TX | UTMH | VA | WV
 
 

AZ

"19. APPOINTMENT STANDARDS
For purposes of this section, 'urgent' is defined as an acute but not necessarily severe disorder, which, if not attended to, could endanger the patient’s health…"  Arizona Contract, page 29.

CA

"ARTICLE II - DEFINITIONS...
U2. Urgent Care means services required to prevent serious deterioration of health following the onset of an unforeseen condition or injury (i.e., sore throats, fever, minor lacerations, and some broken bones)."  California Contract, pages 2, 15.

CO

"I. DEFINITIONS
The following terms as used in this Contract shall be construed and interpreted as follows unless the context otherwise expressly requires a different construction and interpretation: …

BV.  'Urgently Needed Services' shall mean any Covered Services (while temporarily outside the Service Area) for an injury or illness of a less serious nature than those described under Emergency Care which:
  a.  are required in order to prevent a serious deterioration in the Member's health;
  b.  cannot be delayed until the Member returns to the Service Area;
  c.  and could not have been reasonably foreseen prior to leaving the Service Area."  Colorado Contract, page 11.

CT

"Part II:  General Contract Terms for MCOs
1.  Definitions...
UU.  Urgent Cases:  Illnesses or injuries of a less serious nature than those constituting emergencies but for which treatment:
  *  is required to prevent a serious deterioration in the Member's health; and
  *  cannot be delayed --without imposing undue risk on the Member's well-being--until the Member is able to secure services from his/her regular physician(s)…"  Connecticut Contract, pages 11-15.

DC

"ARTICLE XXII - DEFINITIONS...
J.  The term 'urgent medical condition' shall mean a condition which, if not treated within 24 hours could lead to serious impairment of bodily function or serious dysfunction of any bodily organ or part."  District of Columbia Contract, pages 48, 50.

FL

"86. Urgent Care- those problems which, though not life-threatening, could result in serious injury or disability unless medical attention is received (e.g., high fever, animal bites, fractures, severe pain) or do substantially restrict a member's activity (e.g., infectious illnesses, flu, respiratory ailments, etc.)."  Florida Contract, page 160.

HI

"Urgent care - the diagnosis and treatment of medical conditions which are serious or acute but pose no immediate threat to life and health but which requires medical attention within 24 hours."  Hawaii RFP, Appendix A, page 6.

"Emergency and Urgent Services
A.  For Adults...
4.  Urgent services for medical conditions which are serious but pose no immediate threat to life and health but which may be life threatening or a serious danger to health if not treated within 24 hours…" Hawaii RFP, Appendix F, page 17.

HIBH

"Urgent care - the diagnosis and treatment of medical conditions which are serious or acute but pose no immediate threat to life and health but which requires medical attention within 24 hours.'  Hawaii Behavioral Health RFP, page A10.

IL

"Urgent Care means health care needed for a condition that does not require Emergency Care but for which, based on medical appropriateness, treatment must be provided within 24 hours and should not wait for a normally scheduled appointment."  Illinois HMO Contract, page 6.

IA

"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, such that a prudent layperson, who possesses an average knowledge of health and medicine could reasonably expect the illness or injury to result in:
1.  Placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child in jeopardy,
2.  Impairment to bodily functions, or
3.  Dysfunction of any bodily organ or part.
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 10-11.

KS

"Urgent Services - covered services required in order to prevent a serious deterioration of a member's health that results from unforeseen illness or an injury.  Services that can be foreseen are not considered Urgent Services."  Kansas Contract, Appendix E, page 7.

KY

"Urgent Care means care for a condition not likely to cause death or lasting harm but for which treatment should not wait for a normally scheduled appointment."  Kentucky Contract, page 16.

MA

"SECTION 1. DEFINITION OF TERMS...
Urgent Care - medical services required promptly to prevent impairment of health due to symptoms that a prudent lay person would believe require immediate attention, but are not life-threatening and do not pose a high risk of permanent damage to an individual's health.  Urgent care is appropriately provided in a clinic, physician's office, or in a hospital emergency department if a clinic or physician's office is inaccessible.  Urgent care does not include Emergency Services or Primary Care…"  Massachusetts Contract, pages 6-15.

MN

"Section 2.62.  Urgent Care means acute, episodic medical services available on a 24-hour basis that are required in order to prevent a serious deterioration of the health of an Enrollee."  Minnesota Contract, page 16.

MT

"URGENT CARE- medical care necessary for a condition that is not life threatening but that requires treatment that can not wait for a regularly scheduled clinical appointment because of the prospect of the condition worsening without timely medical intervention"  Montana Contract, page 30.

NH

"Article I
Definitions...
1.38  The term 'Urgent Care' means a medical problem that does not put the Enrollee's life in danger but requires treatment within twenty-four (24) hours."  New Hampshire General Service Agreement, page 6.

NJ

"1.120 'Urgent Care' means treatment of a condition that is potentially harmful to a patient's health and for which his/her physician determined it is medically necessary for the patient to receive medical treatment within 12 hours to prevent deterioration."  New Jersey Contract, page 24.

NY

"1.  DEFINITIONS
'Urgent Medical Condition' means a medical or behavioral condition other than an emergency condition, manifesting itself by acute symptoms of sufficient severity that, in the assessment of a 'prudent lay person', possessing an average knowledge of medicine and health, could reasonably be expected to result in serious impairment of bodily functions, serious dysfunction of a bodily organ, body part, or mental ability, or any other condition that would place the health or safety of the Enrollee or another individual in serious jeopardy in the absence of medical or behavioral treatment within twenty-four (24) hours…"  New York Contract, pages 1-1-1-5.

NC

"APPENDIX I
DEFINITION OF TERMS...
1.71  Urgent Conditions - A medical condition that warrants medical attention and intervention within 12-24 hours.  If medical care is not rendered, the 'urgent' condition could seriously compromise the patient's condition and outcome for a full recovery."  North Carolina Contract, Appendix I.

ND

"Urgent Care - Medical care necessary for a condition that is not life threatening, but that requires treatment that cannot with for routine care by a regularly scheduled clinical appointment because of the prospect of the condition worsening without timely medical intervention."  North Dakota Contract, Attachment C, page 7.

OH

"5101:3-26-01  Managed care plan:  Definitions.
As used in Chapter 5101:3-26 of the Administrative Code: …
(XXX)  'Urgent care services,' otherwise known as 'urgent nonemergency services,' are services provided for conditions due to illness or injury which are not life-threatening but require prompt attention and/or treatment to prevent complication to or deterioration of the enrollee's condition."  Ohio RFP, Appendix E, OAC 5101:3-26-01, page 6.

OK

"1.4  Definitions
Each of the following terms shall have the indicated meanings unless the context clearly requires otherwise: ...

76. URGENT MEDICAL CONDITION means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse), such that a reasonably prudent lay person could expect that the absence of medical attention within twenty-four (24) hours could result in:

Placing the health of the individual (or with respect to a pregnant woman the health of the woman or her unborn child) in serious jeopardy; or serious impairment to bodily function; or a serious dysfunction of any bodily organ or part…"  Oklahoma RFP, pages 5, 12.

ORMH

"DEFINITIONS
With the following exceptions and additions, the terms in this agreement have the same definitions as those terms appearing in Oregon Administrative Rules(OARs)...
Urgent Care:  Care which is necessary within 48 hours to prevent a serious deterioration In an OMAP Member's mental health.

Urgent Situation:  A situation requiring attention within 48 hours to prevent a serious deterioration in an OMAP Member's mental health."  Oregon Mental Health Contract, Appendix K, pages K1, K22.

PABH

"Request for Proposals (RFP) Definitions
For the purpose of this Health Choices behavioral health services RFP, the definitions set forth shall apply...

Urgent - Any illness or sever condition which under reasonable standards of medical practice would be diagnosed and treated within a twenty-four (24) hour period and if left untreated, could rapidly become a crisis or emergency situation.  Additionally, it includes situations such as when a person's discharge from a hospital will be delayed until services are approved or a person's ability to avoid hospitalization depends upon prompt approval of services"  Pennsylvania Behavioral Health RFP, pages 3, 8.

RI

"ARTICLE I:  DEFINITIONS...
1.31  URGENT MEDICAL CONDITION
Urgent Medical Condition means a medical (physical or mental) condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of medical attention within twenty-four (24) hours could reasonably be expected to result in:
-  Placing the patient's health in serious jeopardy;
-  Serious impairment to bodily function; or
-  Serious dysfunction of any bodily organ or part…"  Rhode Island RFP, pages 1, 6.

SC

"Urgent Care - Medical conditions that require attention within forty eight (48) hours.  If the condition is left untreated for 48 hours or more, it could develop into an emergency condition."  South Carolina Contract, Appendix A, page 10.

TX

"Urgent behavioral health situations means conditions which require attention and assessment within 24 hours but which do not place the Member in immediate danger to themselves or others and the Member is able to cooperate with treatment.

Urgent condition means a health condition, including an urgent behavioral health situation, which is not an emergency but is severe or painful enough to cause a prudent layperson, possessing the average knowledge of medicine, to believe that his or her condition requires medical treatment evaluation or treatment within 24 hours by the Member’s PCP or PCP designee to prevent serious deterioration of the Member’s condition or health."  Texas Contract, page 13.

UTMH

"Article I
DEFINITIONS...
'Urgent Care' means Covered Services provided to an Enrollee when the report of the Enrollee or his or her agent during the initial Contact does not indicate dangerousness, but the Enrollee's functioning is seriously impaired and symptoms are moderate to server."  Utah Mental Health Contract, page 2.

VA

"ARTICLE I - DEFINITIONS…
Urgent Medical Condition - A medical (physical, mental or dental) condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of medical attention within twenty-four (24) hours could reasonably be expected to result in:
a.  Placing the patient's health in serious jeopardy;
b.  Serious impairment to bodily function; or
c.  Serious dysfunction of any bodily organ or part."  Virginia Contract, pages 7-13.

WV

"2.2 Emergency Care...
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, page 13.