MISSISSIPPI LEGISLATURE

2021 Regular Session

To: Public Health and Human Services

By: Representatives White, Stamps

House Bill 1302

(As Passed the House)

AN ACT TO AMEND SECTION 73-19-1, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE STATE BOARD OF OPTOMETRY SHALL DEFINE THE PRACTICE OF OPTOMETRY; TO AUTHORIZE OPTOMETRISTS WHO HAVE SUFFICIENT EDUCATION AND PROFESSIONAL COMPETENCE AS DEFINED BY THE BOARD TO EXAMINE, DIAGNOSE, MANAGE AND TREAT CONDITIONS AND DISEASES OF THE EYE AND EYELID, AND TO USE LOCAL ANESTHESIA BY INJECTION IN PERFORMING CERTAIN PROCEDURES; TO PROVIDE THAT OPTOMETRISTS PRACTICING UNDER THE AUTHORITY OF THIS SECTION SHALL BE HELD TO THE SAME STANDARD OF CARE AS THAT OF OTHER PHYSICIANS PROVIDING SIMILAR SERVICES; TO AMEND SECTION 73-19-27, MISSISSIPPI CODE OF 1972, TO DELETE PROVISIONS THAT PROHIBIT OPTOMETRISTS FROM TREATING OR DIAGNOSING DISEASES OF OR INJURIES TO THE HUMAN EYE AND FROM USING DRUGS OR MEDICINES FOR THE TREATMENT OR EXAMINATION OF THE HUMAN EYE; TO AMEND SECTION 73-19-157, MISSISSIPPI CODE OF 1972, TO AUTHORIZE OPTOMETRISTS TO USE AND PRESCRIBE CERTAIN PHARMACEUTICAL MEDICATIONS THAT ARE RATIONAL AND APPROPRIATE FOR THE EXAMINATION, DIAGNOSIS, MANAGEMENT OR TREATMENT OF VISUAL DEFECTS, ABNORMAL CONDITIONS OR DISEASES OF THE EYE AND/OR EYELIDS; TO PROVIDE THAT THE BOARD SHALL ESTABLISH A THREE-YEAR PILOT PROGRAM FOR NO MORE THAN TWENTY OPTOMETRISTS TO PERFORM OPHTHALMIC LASER CAPSULOTOMY PROCEDURES; TO PROVIDE THE QUALIFICATIONS FOR OPTOMETRISTS TO PARTICIPATE IN THE PILOT PROGRAM; TO CREATE NEW SECTION 73-19-161, MISSISSIPPI CODE OF 1972, TO PROVIDE A REPEALER ON ALL OF THE SECTIONS OF LAW APPLICABLE TO THE PRACTICE OF OPTOMETRY; TO BRING FORWARD SECTIONS 73-19-151 THROUGH 73-19-155 AND 73-19-159 THROUGH 73-19-165, MISSISSIPPI CODE OF 1972, WHICH RELATE TO THE USE OF THERAPEUTIC PHARMACEUTICAL AGENTS BY CERTIFIED OPTOMETRISTS, FOR THE PURPOSES OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES.

     BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

     SECTION 1.  Section 73-19-1, Mississippi Code of 1972, is amended as follows:

     73-19-1.  (1)  The practice of optometry * * *is shall be defined * * * to be by the State Board of Optometry and shall include:  

          (a)  The application of optical principles, through technical methods and devices in the examination of human eyes for the purpose of ascertaining departures from the normal, measuring their functional powers and adapting or prescribing optical accessories, including spectacles, contact lenses and low-vision devices, for the aid thereof, including, but not limited to, the use of computerized or automated refracting devices, lenses and prisms, vision therapy and low-vision rehabilitation therapy * * *.;

          (b)  * * * The practice of optometry shall include The prescribing and use of therapeutic pharmaceutical agents by optometrists certified under Sections 73-19-153 through 73-19-165 * * *.; and

          (c)  * * *The practice of optometry shall not include the performing of any invasive surgery including laser surgery, but shall not preclude The removal of superficial foreign bodies from the eye or other noninvasive procedures. 

     Nothing in this section or any other provision of law shall be construed to prohibit optometrists who have been certified under Sections 73-19-153 through 73-19-165 from providing postophthalmic surgical or clinical care and management with the advice and consultation of the operating or treating physician.

     (2)  One who is engaged in the practice of optometry as a profession as defined in subsection (1) of this section and who has sufficient education and professional competence, as defined by the State Board of Optometry, shall be authorized to examine, diagnose, manage and treat conditions and diseases of the eye and eyelid, including the following:

          (a)  The administration and prescribing of pharmaceutical agents rational to the diagnosis and treatment of conditions or diseases of the eye or eyelid;

          (b)  The performance of primary eye care procedures rational to the treatment of conditions or diseases of the eye or eyelid as determined by the board;

          (c)  The performance and ordering of procedures and laboratory tests rational to the diagnosis of conditions or diseases of the eye and eyelid;

          (d)  The use of a local anesthetic in conjunction with the primary care treatment of an eyelid lesion; however, no optometrist shall use a local anesthetic for this purpose unless the optometrist has met the certification requirements set forth by the board for the administration of pharmaceutical agents in the performance of primary eye care procedures.  Nothing in this subsection (2) shall be construed as allowing an optometrist to perform any reconstructive surgical procedure on the eyelid; and

          (e)  The use of local anesthesia by injection in performing the following procedures:

              (i)  Needle drainage of an eyelid abscess, hematoma, bulla and seroma;

              (ii)  Excision of a single epidermal lesion without characteristics of malignancy, no larger than five (5) millimeters in size and no deeper than the dermal layer of the skin;

              (iii)  Incision and curettage of a nonrecurrent chalazion;

              (iv)  Simple repair of an eyelid laceration no larger than two and one-half (2-1/2) centimeters and no deeper than the orbicularis muscle and not involving the eyelid margin or lacrimal drainage structures; and

              (v)  Removal of foreign bodies in the eyelid not involving lid margin, lacrimal drainage structures, and extending no deeper than the orbicularis muscle.

     (3)  Optometrists shall not perform cataract surgery or any other surgical procedure requiring general anesthesia.

     (4)  An optometrist may perform laser capsulotomies as authorized under Section 4 of this act if he or she has been credentialed by the State Board of Optometry under that section to perform optometric laser procedures.

     (5)  Optometrists practicing under the authority of this section shall be held to the same standard of care as that of other physicians providing similar services.  No optometrist shall practice under this section unless the optometrist has submitted to the State Board of Optometry evidence of satisfactory completion of all education requirements and the board has certified the optometrist as educationally qualified.

     ( * * *26)  Nothing in Laws of 2005, Chapter 404, shall be construed or interpreted to allow any optometrist to treat systemic diseases and/or conditions.

     SECTION 2.  Section 73-19-27, Mississippi Code of 1972, is amended as follows:

     73-19-27.  Nothing in this chapter shall be construed as conferring on the holder of any certificate of licensure issued by said board the title of oculist, ophthalmologist, or any other word or abbreviation indicating that he is engaged in the practice of medicine or surgery * * *, or the treatment or the diagnosis of diseases of, or injuries to, the human eye, or the right to use drugs or medicines in any forms for the treatment or examination of the human eye.  However, optometrists who have been certified by the board under the provisions of Sections 73‑19‑101 through 73‑19‑109 may use diagnostic pharmaceutical agents in the practice of optometry in accordance with the requirements of Sections 73‑19‑101 through 73‑19‑109, and optometrists who have been certified by the board under the provisions of Sections 3 through 9 of this act may use therapeutic pharmaceutical agents in the practice of optometry in accordance with the requirements of Sections 3 through 9 of this act.  Nothing contained in Chapter 303, Laws of 1991, shall be construed as expanding the scope of practice of a licensed optometrist beyond that authorized prior to July 1, 1991.

     SECTION 3.  Section 73-19-157, Mississippi Code of 1972, is amended as follows:

     73-19-157.  * * *Any optometrist certified to prescribe and use therapeutic pharmaceutical agents under Sections 73‑19‑153 through 73‑19‑165 is authorized to examine, diagnose, manage and treat visual defects, abnormal conditions and diseases of the human eye or eyelids, including:

  (a)  Topical pharmaceutical agents;

  (b)  Over‑the‑counter medications;

  (c)  The administration and prescribing of all noninjectible medications listed in the current annual edition of the "Physicians Desk Reference for Ophthalmic Medicines" which are rational and appropriate for the examination, diagnosis, management or treatment of visual defects, abnormal conditions or diseases of the eye and/or eyelids for proper optometric practice;

  (d)  The administration and prescribing of oral pharmaceutical agents to treat glaucoma; oral antibiotic medications; oral nonsteroidal anti‑inflammatory (NSAIDS) medications; over‑the‑counter allergy medications; and oral medications to treat viral infections, all of which must be used solely for the rational and appropriate examination, diagnosis, management or treatment of visual defects, abnormal conditions of the eye and/or eyelids for proper optometric practice; and Optometrists shall be authorized to use and prescribe the following:

          (a)  Over-the-counter medications;

          (b)  All pharmaceutical medications that are rational and appropriate for the examination, diagnosis, management or treatment of visual defects, abnormal conditions or diseases of the eye and/or eyelids as authorized by Section 73-19-1.  These medications shall not include any drug or substance listed in Schedules I and II of the Uniform Controlled Dangerous Substances Law;

          ( * * *ec)  The administration of an auto injection or epi-pen to counteract anaphylactic reaction, followed by immediate referral of the patient to the nearest emergency medical facility * * *.; and

          (d)  The administration of inoculations for systemic health reasons in a public health emergency when authorized by the State Health Officer.

     SECTION 4.  (1)  The State Board of Optometry shall establish a three-year pilot program for no more than twenty (20) optometrists to perform ophthalmic laser capsulotomy procedures.

     (2)  The board shall seek applications from interested optometrists to participate in the pilot program.

     (3)  An optometrist licensed in Mississippi who is selected to participate in the pilot program shall be credentialed to perform authorized ophthalmic laser capsulotomy procedures if the applicant:

          (a)  Provides proof of holding a Mississippi license to practice therapeutic optometry and is in good standing;

          (b)  Provides proof of satisfactory completion of a course of instruction as approved by the board. Those graduating from an accredited school or college of optometry within five (5) years after the effective date of this act may be excluded from course completion requirement, provided that the candidate has successfully passed appropriate coursework to fulfill requirements as determined by the board.  The board-approved course of instruction shall be:

              (i)  Provided by an accredited optometry, osteopathy or medical school;

              (ii)  A minimum of thirty-two (32) clock hours in length; and

              (iii)  Sponsored by an organization approved by the board;

          (c)  Satisfactorily completes a written test approved by the board on aspects pertaining to authorized ophthalmic laser capsulotomy procedures;

          (d)  Passes a clinical skills assessment approved by the board;

          (e)  Participates in eight (8) additional hours of working under a preceptor who is either an ophthalmologist or licensed credentialed optometrist. The preceptor must be licensed to perform the ophthalmic laser capsulotomy procedures, and the training shall occur within the state in which the preceptor is licensed to perform such procedures; and

          (f)  Such other requirements as may be directed by the board.

     (4)  An optometrist licensed in another state who is selected to participate in the pilot program who applies for licensure by endorsement in Mississippi shall be credentialed to perform authorized ophthalmic laser capsulotomy procedures if the applicant provides proof that:

          (a)  The applicant holds an active license in good standing by another state; and

          (b)  The applicant is credentialed by that state to perform ophthalmic laser capsulotomy procedures; and

          (c)  The requirements in the state of licensure for performing ophthalmic laser capsulotomy procedures meet or exceed the requirements in Section 1 of this act; or

          (d)  The applicant has satisfactory outcome data from prior ophthalmic laser capsulotomy procedures.

     (5)  Optometrists participating in the pilot program who have met the requirements to perform authorized ophthalmic laser capsulotomy procedures shall report to the board the outcome of every authorized ophthalmic surgery procedures performed in such form as required or directed by the board.

     (6)  The board shall develop a method for recording outcomes of ophthalmic laser capsulotomy procedures performed during the pilot program and shall periodically share such information with the Joint Legislative Committee on Performance Evaluation and Expenditure Review (PEER).  The PEER Committee shall report outcomes to the Legislature at least annually.

     SECTION 5.  The following shall be codified as Section 73-19-161, Mississippi Code of 1972:

     73-19-161.  Sections 73-19-1 through 73-19-45, 73-19-61 through 73-19-65, 73-19-101 through 73-19-111, and 73-19-151 through 73-19-165 shall stand repealed on July 1, 2024.

     SECTION 6.  Section 73-19-151, Mississippi Code of 1972, is brought forward as follows:

     73-19-151.  (1)  Persons lawfully engaged in the practice of optometry in the State of Mississippi may prescribe and use therapeutic pharmaceutical agents in the practice of optometry after being authorized to use such agents under the provisions of Section 73-19-153.

     (2)  The designated members of the State Board of Medical Licensure and the State Board of Pharmacy provided for in Section 73-19-103 shall advise and consult with the State Board of Optometry on matters specified in Sections 73-19-153 through 73-19-165.

     SECTION 7.  Section 73-19-153, Mississippi Code of 1972, is brought forward as follows:

     73-19-153.  (1)  Any optometrist certified to use diagnostic pharmaceutical agents as provided in Section 73-19-105 also may be certified to use therapeutic pharmaceutical agents when he has satisfactorily completed the following:

          (a)  A course consisting of a minimum of sixty-four (64) hours of didactic education as defined by rule or regulation of the State Board of Optometry with the advice and consultation of the designated members of the State Board of Medical Licensure and the State Board of Pharmacy, with particular emphasis on the examination, diagnosis and treatment of conditions of the eye and adnexa.  Such course shall be provided by an institution accredited by a regional or professional accreditation organization that is recognized or approved by the Council on Postsecondary Accreditation of the United States Department of Education, or its successor, and approved by the State Board of Optometry with the advice and consultation of the designated members of the State Board of Medical Licensure and the State Board of Pharmacy; and

          (b)  A minimum of eighty (80) hours of supervised clinical training as it applies to optometry with particular emphasis on the examination, diagnosis and treatment of conditions of the human eye and adnexa, by an institution accredited by a regional or professional accreditation organization that is recognized or approved by the Council on Postsecondary Accreditation of the United States Department of Education, or its successor, and approved by the State Board of Optometry with the advice and consultation of the designated members of the State Board of Medical Licensure and the State Board of Pharmacy; and

          (c)  Such other requirements as may be determined by the board.

     (2)  Upon the successful completion of all specified educational and clinical requirements provided by an institution accredited by a regional or professional accreditation organization that is recognized or approved by the Council on Postsecondary Accreditation of the United States Department of Education, or its successor, and approved by the State Board of Optometry with the advice and consultation of the designated members of the State Board of Medical Licensure and the State Board of Pharmacy, any optometrist who desires certification to prescribe and use therapeutic pharmaceutical agents shall satisfactorily pass a written examination approved by the State Board of Optometry, with the advice and consultation of the designated members of the State Board of Medical Licensure and the State Board of Pharmacy.  The applicant for certification must achieve a score equal to or greater than a score that is generally accepted in medical schools as a passing score for the same subject areas of examination, as determined by the State Board of Optometry.  All examinations and scores shall be made available for inspection to the State Board of Medical Licensure and the State Board of Pharmacy through their designated members.

     SECTION 8.  Section 73-19-155, Mississippi Code of 1972, is brought forward as follows:

     73-19-155.  (1)  Within thirty (30) days after July 1, 1994, and annually thereafter, the State Board of Optometry with the advice and consultation of the designated members of the State Board of Medical Licensure and the State Board of Pharmacy, shall develop rules and regulations requiring the satisfactory completion of the educational requirements, clinical training, and examinations required under the provisions of Sections 73-19-153 through 73-19-165, regarding those optometrists seeking to become certified to prescribe and use therapeutic pharmaceutical agents.

     (2)  Any optometrist using therapeutic pharmaceutical agents shall maintain accurate and current medical records concerning the procurement and use of such agents in the same form and manner as required for medical doctors, in addition to any records required to be kept or otherwise necessary to keep in the practice of optometry.  All of these medical records shall be available for inspection at any time by representatives of the State Board of Optometry, and all such records shall be made available for inspection to the State Board of Medical Licensure and the State Board of Pharmacy through their designated members.

     SECTION 9.  Section 73-19-159, Mississippi Code of 1972, is brought forward as follows:

     73-19-159.  Any optometrist who is certified to prescribe and use therapeutic pharmaceutical agents shall be held to the same standard of care in the prescription and use of such agents, and in diagnosis and treatment, as is common to a licensed medical doctor.

     SECTION 10.  Section 73-19-161, Mississippi Code of 1972, is brought forward as follows:

     73-19-161.  If a patient of any optometrist who is certified to prescribe and use therapeutic pharmaceutical agents is not responding to the prescribed treatment within the normal response time for the condition being treated, in the optometrist's professional judgment, the optometrist shall immediately refer such patient to a licensed physician for such additional treatment as may be needed.

     SECTION 11.  Section 73-19-163, Mississippi Code of 1972, is brought forward as follows:

     73-19-163.  Any optometrist who is certified to prescribe and use therapeutic pharmaceutical agents shall be provided by the State Board of Optometry a certificate reflecting such certification, and such certification shall be prominently displayed in the optometrist's office.

     SECTION 12.  Section 73-19-165, Mississippi Code of 1972, is brought forward as follows:

     73-19-165.  Any pharmacist licensed under the laws of the State of Mississippi is authorized to fill and dispense to patients those therapeutic pharmaceutical agents specified in Section 73-19-157 for any optometrist certified by the State Board of Optometry to use such agents.

     SECTION 13.  This act shall take effect and be in force from and after July 1, 2021.