As Urgent Care Centers Increase, Licensing Authority Falling Under State Health Agencies

October 11, 2018|11:42 a.m.| ASTHO Staff

The number of urgent care centers in the United States is rapidly growing. According to an urgent care trade association, the number of centers grew by five percent between 2016 and 2017, from 7,271 to 7,639. Additionally, the number of private insurance claim lines for urgent care centers (i.e., the individual procedures listed on an insurance claim) increased by 1,725 percent between 2007 and 2016, more than seven times the growth of emergency room claim lines in the same period. Poor access to primary care, overburdened primary care providers, and emergency room wait times and overcrowding are seen as contributing factors to the increase in urgent care centers over the last five years. 

Urgent care centers are medical clinics equipped to diagnose and treat a variety of non-life and limb threatening illnesses and injuries. They are enhanced by on-site radiology and laboratory services and operate in locations distinct from a freestanding or hospital-based emergency department. Urgent care centers accept unscheduled, walk-in patients seeking medical attention during hours of operation.

Urgent care centers have the potential to increase timely and convenient access to low-cost, high-quality care for patients. They also reduce avoidable emergency room visits and have a role in enhancing healthcare access for underserved populations. For example, claim lines at urgent care centers in rural areas increased by 2,308 percent from 2007 to 2016, compared with 1,675 percent for urban areas.

In the past, most states regarded urgent care centers as something similar to doctors’ offices and left them largely unregulated. Early state regulation primarily focused on defining “urgent care” through naming conventions, explanation of included services, and accreditation standards. However, as the number of urgent care centers continues to grow, states are beginning to broaden oversight. Below is an overview of current state law and recent legislation to provide state health agencies or other state agencies with licensing authority over urgent care centers.

State Statutory and Legislative Landscape

A handful of states currently give state health agencies the authority to license urgent care centers. Others have proposed legislation that would give this authority to the state health agency. In Arizona, the department of health services has authority to license free-standing urgent care centers. In 2017, Connecticut passed a law giving the department of public health authority to license urgent care centers as outpatient clinics (see Sec. 674 and 675 of SB 1502). Currently, in Massachusetts, all providers of ambulatory care, including those offering what is described as “urgent care,” must be licensed as a clinic or hospital satellite by the department of public health, unless exempt from facility licensure requirements based on provider ownership. In 2018, the Massachusetts legislature introduced a bill (HB4605) defining “urgent care services” and “urgent care center” and giving the department of public health the authority to issue licenses to maintain an urgent care center.

In February 2018, the Colorado legislature introduced a bill to create a new license, referred to as a “freestanding emergency department license” for the department of public health and environment to issue to a health facility that offers emergency or primary and urgent care services. Florida gives the agency for healthcare administration the authority to license healthcare clinics. In Florida, the application for a healthcare clinic license lists “urgent care center” as one of the clinic types that can be selected.

Delaware law requires the department of public health to license “free standing emergency centers,” which are defined in regulation as facilities physically separate from a hospital, which use in their titles or advertising the words “urgent care.” New Hampshire requires the department of health and human services to license “non-emergency walk-in care centers,” which are defined in regulation as medical facilities where a patient can receive medical care that is not of an emergency or life-threatening nature, without making an appointment and without the intention of developing an ongoing care relationship with the licensed practitioner. This term includes such facilities that are self-described as urgent care centers, retail health clinics, and convenient care clinics.

In some states, urgent care centers are not specifically called out in statute or regulation but are determined to fall within the definition of those facilities requiring licenses by the state health agency. In Nebraska, the division of public health has authority to license healthcare clinics, which are facilities where advice, counseling, diagnosis, treatment, surgery, care, or other services related to the preservation or maintenance of health are provided on an outpatient basis. This includes public health clinics. The Rhode Island State Department of Health licenses healthcare facilities, which include organized ambulatory care facilities that are not part of a hospital but are organized and operated to provide healthcare services to outpatients. This includes diagnostic centers, outpatient clinics, infirmaries and health centers, school-based health centers, and neighborhood health centers.

The continued growth and increased visibility of urgent care centers as an option for accessible low-cost care, especially for underserved and rural populations, will continue to attract the attention of lawmakers and regulators. Legislators may see the state health agency as the natural regulatory authority of urgent care centers, especially if those agencies already license other healthcare facilities. ASTHO will continue to monitor and update members on legislative activity that addresses regulatory authority and oversight of urgent care centers by state health agencies.

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