MISSISSIPPI LEGISLATURE
2018 Regular Session
To: Public Health and Human Services
By: Representative Aguirre
AN ACT TO AMEND SECTION 73-25-18, MISSISSIPPI CODE OF 1972, TO AUTHORIZE CERTAIN LICENSED MEDICAL PROFESSIONALS WHO ARE IN GOOD STANDING TO ENTER INTO AGREEMENTS WITH THE APPLICABLE LICENSING AGENCY OF THE MEDICAL PROFESSIONAL FOR PURPOSES OF PROVIDING FREE SERVICES TO INDIGENT AND NEEDY PERSONS; TO PROVIDE IMMUNITY FROM CIVIL ACTION FOR THOSE SERVICES; TO AMEND SECTION 73-25-19, MISSISSIPPI CODE OF 1972, TO AUTHORIZE CERTAIN NONRESIDENTS LICENSED MEDICAL PROFESSIONALS TO PROVIDE TEMPORARY HEALTH SERVICES IN THIS STATE THROUGH A SPONSORING ORGANIZATION REGISTERED WITH THE DEPARTMENT OF HEALTH; TO AMEND SECTION 73-25-38, MISSISSIPPI CODE OF 1972, WHICH PROVIDES IMMUNITY TO MEDICAL PROFESSIONALS WHO VOLUNTARILY PROVIDE HEALTH CARE, TO CONFORM TO THE PRECEDING PROVISIONS; TO AMEND SECTION 73-15-20, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE PRECEDING PROVISIONS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 73-25-18, Mississippi Code of 1972, is amended as follows:
73-25-18. (1) (a) There is established a special volunteer medical license for physicians who are retired from active practice, or are currently serving on active duty in the Armed Forces of the United States or in the National Guard or a reserve component of the Armed Forces of the United States, or are working as physicians for the Department of Veterans Affairs, and wish to donate their expertise for the medical care and treatment of indigent and needy persons or persons in medically underserved areas of the state. The special volunteer medical license shall be issued by the State Board of Medical Licensure to eligible physicians without the payment of any application fee, examination fee, license fee or renewal fee, shall be issued for a fiscal year or part thereof, and shall be renewable annually upon approval of the board.
(b) A physician must meet the following requirements to be eligible for a special volunteer medical license:
(i) Completion of a special volunteer medical license application, including documentation of the physician's medical school or osteopathic school graduation and practice history;
(ii) Documentation that the physician has been previously issued an unrestricted license to practice medicine in Mississippi or in another state of the United States and that he or she has never been the subject of any medical disciplinary action in any jurisdiction;
(iii) Acknowledgement and documentation that the physician's practice under the special volunteer medical license will be exclusively and totally devoted to providing medical care to needy and indigent persons in Mississippi or persons in medically underserved areas in Mississippi; and
(iv) Acknowledgement and documentation that the physician will not receive any payment or compensation, either direct or indirect, or have the expectation of any payment or compensation, for any medical services rendered under the special volunteer medical license.
(2) (a) There is established a special volunteer license for physician assistants who are retired from active practice, or are currently serving on active duty in the Armed Forces of the United States or in the National Guard or a reserve component of the Armed Forces of the United States, or are working as physician assistants for the Department of Veterans Affairs, and wish to donate their expertise for the care and treatment of indigent and needy persons or persons in medically underserved areas of the state. The special volunteer physician assistant license shall be issued by the State Board of Medical Licensure to eligible physician assistants without the payment of any application fee, examination fee, license fee or renewal fee, shall be issued for a fiscal year or part thereof, and shall be renewable annually upon approval of the board.
(b) A physician assistant must meet the following requirements to be eligible for a special volunteer physician assistant license:
(i) Completion of an application for a special volunteer physician assistant license, including documentation of the physician assistant's educational qualifications and practice history;
(ii) Documentation that the physician assistant has been previously issued an unrestricted physician assistant license in Mississippi or in another state of the United States and that he or she has never been the subject of any disciplinary action in any jurisdiction;
(iii) Acknowledgement and documentation that the physician assistant's practice under the special volunteer physician assistant license will be exclusively and totally devoted to providing care to needy and indigent persons in Mississippi or persons in medically underserved areas in Mississippi; and
(iv) Acknowledgement and documentation that the physician assistant will not receive any payment or compensation, either direct or indirect, or have the expectation of any payment or compensation, for any services rendered under the special volunteer physician assistant license.
(3) (a) Any licensed physician, physician assistant, dentist, dental hygienist, optometrist, nurse or certified nurse practitioner (hereinafter "medical professional") whose license is in good standing may donate their expertise for the medical care and treatment of indigent or needy persons under a written agreement with the applicable licensing agency of the medical professional (hereinafter "applicable agency"). The applicable agency may contract with county health departments or qualified nonprofit organizations with expertise and experience in providing free or charitable health care to indigent or needy persons (hereinafter "contractor") to administer the program for the applicable agency.
(b) Pursuant to Section 73-25-38(1), any licensed medical professional who voluntarily provides medical care and treatment to indigent or needy persons without expectation of payment shall be immune from liability for any civil action arising out of any act or omission resulting from the provision of those services unless the act or omission was the result of the medical professional's gross negligence or willful misconduct.
(c) The agreement entered into by and between the medical professional and the applicable agency shall provide that:
(i) The agreement applies only to volunteer health care services delivered by the medical professional to indigent or needy persons.
(ii) The identity of the parties to the agreement, including the medical professional's Mississippi license number.
(iii) The medical professional agrees that he or she will not receive any payment or compensation, either direct or indirect, or have the expectation of payment or compensation, for any medical services provided to indigent and needy individuals under the agreement.
(iv) Pursuant to Section 73-25-38(1), the medical professional shall be immune from liability for any civil action arising out of any act or omission resulting from the rendering of medical services under the agreement unless the act or omission was the result of the medical professional's gross negligence or willful misconduct. The medical professional understands that the immunity provided applies only to noncompensated services rendered to indigent or needy individuals under the terms of the agreement and shall not apply to any other services rendered by the medical professional.
(v) The medical professional shall submit annual reports to the applicable agency and/or contractor listing the number of hours of donated care, the number of qualified indigent or needy patients served, and the estimated value of care donated under this section. The applicable agency and/or contractor shall have the right to review the record of any patient served by the medical professional under the agreement to verify the accuracy of reported information. All patient medical records and identifying information contained in annual reports submitted to the applicable agency and/or contractor are confidential.
(vi) Any adverse incidents and information regarding treatment outcomes must be reported by the medical professional to the applicable agency and/or contractor, if incidents and information pertain to a patient treated under the agreement. The applicable agency shall review the incident report to determine whether the incident involves conduct by the medical professional that is subject to disciplinary action. All patient medical records and identifying information contained in adverse incident reports and treatment outcomes obtained by the applicable agency and/or contractor are confidential.
(vii) The applicable agency and/or contractor shall have the right to terminate the agreement with the medical professional with appropriate cause.
(1.) In terminating the agreement, the applicable agency and/or contractor shall provide the medical professional with written notice of its intent to terminate the agreement, and reasons for that decision, at least ten (10) business days in advance of the termination date.
(2.) The applicable agency and/or contractor shall establish an appeals process for medical professionals terminated under this section.
(viii) The medical professional is subject to oversight and inspection by the applicable agency and/or contractor with respect to services rendered under the agreement.
(4) Any medical professional who voluntarily provides medical care and treatment to any person without expectation of payment as authorized in this section may fulfill one (1) credit hour of continuing education for each sixty (60) minutes of providing voluntary health services. The applicable agency shall permit the medical professional to satisfy up to one-third (1/3) of the medical professional's continuing education requirement by providing services to persons without expectation of payment as authorized by this section.
SECTION 2. Section 73-25-19, Mississippi Code of 1972, is amended as follows:
73-25-19.
(1) A nonresident licensed * * *physician, physician assistant, dentist, dental
hygienist, optometrist, nurse or certified nurse practitioner (hereinafter
"medical professional") not
holding a license from * * * this state shall not be permitted to
practice, * * *
unless he or she: (a) practices * * * in the
state for less than * * * fifteen (15) days per calendar
year; (b) is called in consultation by a licensed medical professional residing
in this state; (c) practice in an area that is under a state or federal
declaration of emergency; or (d) is providing temporary volunteer health
services in the state through a sponsoring organization registered with the
Department of Health as provided in this section. * * *
This section shall not apply to any nonresident physician who holds a temporary license to practice medicine at a youth camp issued under the provisions of Section 75-74-8 and Section 73-25-17.
(2) (a) Notwithstanding any provision of law to the contrary, no additional license or certificate otherwise required by state law is necessary for a licensed medical professional who:
(i) Lawfully practices under an exception to the licensure or certification requirements of any state, territory, district, or possession of the United States, provided that the medical professional does not and will not regularly practice in the State of Mississippi; and
(ii) Donates his or her time and expertise solely for the purpose of providing temporary health services in this state through a sponsoring organization registered with the Department of Health.
(b) The provisions of paragraph (a) shall not apply to:
(i) Any person whose license or certificate is suspended or revoked under disciplinary proceedings in any jurisdiction; or
(ii) A licensed medical professional who renders services outside the scope of practice authorized by the person's licensure, certification, or exception to that licensure or certification.
(3) With regard to a person who donates his or her time and expertise to provide temporary health services and who is covered by the provisions of subsection (2)(a) of this section, all requirements regarding display of a license or certificate shall be satisfied by the presentation for inspection, upon request, of a photocopy of the applicable license, certificate, or statement of exemption.
(4) Any nonresident medical professional providing temporary volunteer health services in this state through a sponsoring organization shall be immune from liability for any civil action arising out of any act or omission resulting from the provision of those services unless the act or omission was the result of the nonresident medical professional's gross negligence or willful misconduct.
(5) (a) An organization that wishes to provide volunteer health care services in this state shall register with the Department of Health before providing any services in this state by filing a registration form and submitting an annual registration fee of Fifty Dollars ($50.00). The registration form shall contain:
(i) The name of the sponsoring organization;
(ii) A statement of the sponsoring organization's mission or purpose;
(iii) The names of the principal officers of the organization or individuals responsible for the operation of the organization;
(iv) The address, including street, city, state, zip code, and county, of the sponsoring organization's principal office;
(v) The telephone number for the sponsoring organization's principal office and the business telephone number of the individual filing the application on behalf of the sponsoring organization; and
(vi) The sponsoring organization shall notify the department in writing of any pertinent change in information provided under this subsection within thirty (30) days of the change.
(b) The sponsoring organization shall file quarterly volunteer services reports with the department listing the names of all licensed nonresident medical professionals who provided voluntary health care services in this state during the previous quarter as well as the dates, places, and types of services provided during the previous quarter.
(c) The sponsoring organization shall maintain a file on each medical professional who provides temporary volunteer health services through the organization. For each medical professional, the organization shall maintain a copy of a current license, certificate, or statement of exemption from licensure or certification. Files shall be maintained for five (5) years following the most recent date that the medical professional provided health care services in this state through the sponsoring organization.
(d) The sponsoring organization shall furnish all records maintained under this section to the department upon request.
SECTION 3. Section 73-25-38, Mississippi Code of 1972, is amended as follows:
73-25-38. (1) Any licensed
physician, physician assistant, dentist, dental hygienist, optometrist,
nurse or certified nurse practitioner who voluntarily provides needed
medical or health services to any person without the expectation of payment due
to the inability of such person to pay for * * * those services shall be immune from
liability for any civil action arising out of the provision of * * * those medical or health services
provided in good faith on a charitable basis. This section shall not extend
immunity to acts of willful or gross negligence. Except in cases of rendering
emergency care * * *
in which the provisions of Section 73-25-37 apply, immunity under this
section shall be extended only if the physician, physician assistant,
dentist, dental hygienist, optometrist, nurse or certified nurse
practitioner and patient execute a written waiver in advance of the rendering
of * * * those
medical services specifying that * * * those services are provided without
the expectation of payment and that the licensed physician, physician
assistant, dentist, dental hygienist, optometrist, nurse or certified nurse
practitioner shall be immune as provided in this subsection. The immunity from
liability granted by this subsection also shall extend to actions arising from
a church-operated outpatient medical clinic that exists solely for the purpose
of providing charitable medical services to persons who are unable to pay for * * * those services, provided that the
outpatient clinic receives less than Forty Thousand Dollars ($40,000.00)
annually in patient payments.
(2) Any licensed physician, physician assistant, dentist, dental hygienist, optometrist, nurse or certified nurse practitioner assisting with emergency management, emergency operations or hazard mitigation in response to any emergency, man-made or natural disaster, who voluntarily provides needed medical or health services to any person without fee or other compensation, shall not be liable for civil damages on the basis of any act or omission if the physician, physician assistant, dentist, dental hygienist, optometrist, nurse or certified nurse practitioner was acting in good faith and within the scope of their license, education and training and the acts or omissions were not caused from gross, willful or wanton acts of negligence.
(3) Any physician who voluntarily renders any medical service under a special volunteer medical license authorized under Section 73-25-18 without any payment or compensation or the expectation or promise of any payment or compensation shall be immune from liability for any civil action arising out of any act or omission resulting from the rendering of the medical service unless the act or omission was the result of the physician's gross negligence or willful misconduct. In order for the immunity under this subsection to apply, there must be a written or oral agreement for the physician to provide a voluntary noncompensated medical service before the rendering of the service by the physician.
(4) Any licensed physician, or any physician who is retired from active practice and who has been previously issued an unrestricted license to practice medicine in any state of the United States or who has been issued a special volunteer medical license under Section 73-25-18, shall be immune from liability for any civil action arising out of any medical care or treatment provided while voluntarily serving as "doctor of the day" for members of the Mississippi State Legislature, legislative or other state employees, or any visitors to the State Capitol on the date of such service. This subsection shall not extend immunity to acts of willful or gross negligence or misconduct.
SECTION 4. Section 73-15-20, Mississippi Code of 1972, is amended as follows:
73-15-20. (1) Advanced practice registered nurses. Any nurse desiring to be certified as an advanced practice registered nurse shall apply to the board and submit proof that he or she holds a current license to practice professional nursing and that he or she meets one or more of the following requirements:
(a) Satisfactory completion of a formal post-basic educational program of at least one (1) academic year, the primary purpose of which is to prepare nurses for advanced or specialized practice.
(b) Certification by a board-approved certifying body. Such certification shall be required for initial state certification and any recertification as a registered nurse anesthetist, nurse practitioner or nurse midwife. The board may by rule provide for provisional or temporary state certification of graduate nurse practitioners for a period of time determined to be appropriate for preparing and passing the National Certification Examination. Those with provisional or temporary certifications must practice under the direct supervision of a licensed physician or a certified nurse practitioner or certified nurse midwife with at least five (5) years of experience.
(c) Graduation from a program leading to a master's or post-master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills.
(2) Rulemaking. The
board shall provide by rule the appropriate requirements for advanced practice
registered nurses in the categories of certified registered nurse anesthetist,
certified nurse midwife and * * * advanced practice registered
nurse.
(3) Collaboration. An advanced practice registered nurse shall perform those functions authorized in this section within a collaborative/consultative relationship with a dentist or physician with an unrestricted license to practice dentistry or medicine in this state and within an established protocol or practice guidelines, as appropriate, that is filed with the board upon license application, license renewal, after entering into a new collaborative/consultative relationship or making changes to the protocol or practice guidelines or practice site. The board shall review and approve the protocol to ensure compliance with applicable regulatory standards. The advanced practice registered nurse may not practice as an APRN if there is no collaborative/consultative relationship with a physician or dentist and a board-approved protocol or practice guidelines.
(4) Renewal. The board shall renew a license for an advanced practice registered nurse upon receipt of the renewal application, fees and protocol or practice guidelines. The board shall adopt rules establishing procedures for license renewals. The board shall by rule prescribe continuing education requirements for advanced practice nurses not to exceed forty (40) hours biennially as a condition for renewal of a license or certificate. Up to one-third (1/3) of the continuing education requirements may be satisfied as provided in Section 73-25-18(4).
(5) Reinstatement. Advanced practice registered nurses may reinstate a lapsed privilege to practice upon submitting documentation of a current active license to practice professional nursing, a reinstatement application and fee, a protocol or practice guidelines, documentation of current certification as an advanced practice nurse in a designated area of practice by a national certification organization recognized by the board and documentation of at least forty (40) hours of continuing education related to the advanced clinical practice of the nurse practitioner within the previous two-year period. The board shall adopt rules establishing the procedure for reinstatement.
(6) Changes in status. The advanced practice registered nurse shall notify the board immediately regarding changes in the collaborative/consultative relationship with a licensed physician or dentist. If changes leave the advanced practice registered nurse without a board-approved collaborative/consultative relationship with a physician or dentist, the advanced practice nurse may not practice as an advanced practice registered nurse.
(7) Practice requirements. The advanced practice registered nurse shall practice:
(a) According to standards and guidelines of the National Certification Organization.
(b) In a collaborative/consultative relationship with a licensed physician whose practice is compatible with that of the nurse practitioner. Certified registered nurse anesthetists may collaborate/consult with licensed dentists. The advanced practice nurse must be able to communicate reliably with a collaborating/consulting physician or dentist while practicing.
(c) According to a board-approved protocol or practice guidelines.
(d) Advanced practice registered nurses practicing as nurse anesthetists must practice according to board-approved practice guidelines that address pre-anesthesia preparation and evaluation; anesthesia induction, maintenance, and emergence; post-anesthesia care; peri-anesthetic and clinical support functions.
(e) Advanced practice registered nurses practicing in other specialty areas must practice according to a board-approved protocol that has been mutually agreed upon by the nurse practitioner and a Mississippi licensed physician or dentist whose practice or prescriptive authority is not limited as a result of voluntary surrender or legal/regulatory order.
(f) Each collaborative/consultative relationship shall include and implement a formal quality assurance/quality improvement program which shall be maintained on site and shall be available for inspection by representatives of the board. This quality assurance/quality improvement program must be sufficient to provide a valid evaluation of the practice and be a valid basis for change, if any.
(g) Nurse practitioners may not write prescriptions for, dispense or order the use of or administration of any schedule of controlled substances except as contained in this chapter.
(8) Prescribing controlled substances and medications. Certified nurse midwives and certified nurse practitioners may apply for controlled substance prescriptive authority after completing a board-approved educational program. Certified nurse midwives and certified nurse practitioners who have completed the program and received prescription authority from the board may prescribe Schedules II-V. The words "administer," "controlled substances" and "ultimate user," shall have the same meaning as set forth in Section 41-29-105, unless the context otherwise requires. The board shall promulgate rules governing prescribing of controlled substances, including distribution, record keeping, drug maintenance, labeling and distribution requirements and prescription guidelines for controlled substances and all medications. Prescribing any controlled substance in violation of the rules promulgated by the board shall constitute a violation of Section 73-15-29(1)(f), (k) and (l) and shall be grounds for disciplinary action. The prescribing, administering or distributing of any legend drug or other medication in violation of the rules promulgated by the board shall constitute a violation of Section 73-15-29(1)(f), (k) and (l) and shall be grounds for disciplinary action.
SECTION 5. This act shall take effect and be in force from and after July 1, 2018.