To ensure compliance with Chapter 7 (Coverage for Medical Emergencies during and After-Hours) of the Health Resources and Services Administration (HRSA) Health Center Compliance Manual (Compliance Manual Chapter 7), health centers must have arrangements in place for responding to medical emergencies outside of the health center’s regularly scheduled hours of operation.  This may include having formal written arrangements with non-health center providers and/or entities, such as a nurse triage service.  Regardless of the arrangements in place, health centers must ensure the following:

• After-hours 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 patient’s need for emergency medical care;
• After-hours coverage includes the option to refer patients either to a Licensed Independent Practitioner (LIP) for consultation, or to locations including urgent care or hospital emergency rooms;   
• After-hours coverage addresses notification and ensuring access to the Limited English Proficiency (LEP) patient population. 

Many health centers utilize a nurse triage service to provide after-hours coverage as it alleviates additional stress on health center providers.  Nurse triage services hire individuals who are appropriately credentialed and privileged and have the certification to assess care needs and provide direction to patients.  Despite this, it is essential for the nurse triage service to have an LIP to consult with and refer patients to, if necessary, in order to mitigate risk. Many nurse triage services include “provider back-up” as part of their service line, while some health centers utilize their own providers to fulfill this need.  If contracting with a nurse triage service, the health center should ensure the formal written contract includes language to support appropriate credentialing and privileging of service providers and should address any “provider back-up” that is included in the scope of services.

Health Centers can view other requirements for this chapter and evaluate compliance by answering the questions in the “Coverage for Medical Emergencies During and After-Hours” section of the HRSA Site Visit Protocol (Site Visit Protocol Medical Emergencies).