DRAFT - Administrative Code | Mississippi State Board of Medical Licensure

Title 30: Professions and Occupations

The Mississippi Administrative Code, Title 30, contains the rules and regulations adopted by the Mississippi State Board of Medical Licensure. Select a Part to expand its chapters and rules.

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Part 2601

Chapter 1: Licensure Rules Governing the Practice of Allopathic Physicians,

Rule 1.1 | Scope

Rule 1.2 | Definitions

For the purpose of these rules, the following terms have the meanings indicated:

A. Board means the Mississippi State Board of Medical Licensure. B. Physician means any person with a valid doctor of medicine, doctor of osteopathy or doctor of podiatry degree. C. LCME means the Liaison Committee on Medical Education, the organization recognized by the American Medical Association for accrediting American medical schools. D. ACGME means Accreditation Council of Graduate Medical Education. E. RCPSC means Royal College of Physicians and Surgeons of Canada. F. CCFP means College of Family Physicians of Canada. G. ABMS means American Board of Medical Specialties. H. AMA means the American Medical Association. I. FSMB means the Federation of State Medical Boards. J. FLEX means the Federation Licensing Examination administered through the FSMB. K. NBME means National Board of Medical Examiners. L. USMLE means United States Medical Licensing Examination administered jointly through the FSMB and NBME. M. SPEX means the Special Purpose Examination administered through the FSMB. N. NBOME means the National Board of Osteopathic Medical Examiners. O. COMLEX means the Comprehensive Osteopathic Medical Licensing Examination administered through the NBOME. P. COMVEX means the Comprehensive Osteopathic Medical Variable-Purpose Examination administered through the NBOME. Q. AOA means American Osteopathic Association. R. LMCC means Licentiate of the Medical Council of Canada. S. APMA means American Podiatric Medical Association. T. ABPM means American Board of Podiatric Medicine. U. ABPS means American Board of Podiatric Surgery.

V. FPMB means Federation of Podiatric Medical Boards. W. CPME means Council on Podiatric Medical Education. X. NBPME means National Board of Podiatric Medical Examiners. Y. APMLE means American Podiatric Medical Licensing Examination administered through the NBPME. Z. NPDB means National Practitioner Data Bank. AA. ECFMG means the Education Commission for Foreign Medical Graduates. BB. Foreign Medical School means any medical college or college of osteopathic medicine located outside the United States, Canada or Puerto Rico. CC. IMED means International Medical Education Directory. DD. Good Moral Character as applied to an applicant, means that the applicant has not, prior to or during the pendency of an application to the Board, been guilty of any act, omission, condition or circumstance which would provide legal cause under Sections 73-25-29 or 73-25-83, Mississippi Code, for the suspension or revocation of medical licensure.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.3 | Duty to Obtain License

Chapter 2: Effect of Application

Rule 2.1 | Effect of Application

The submission of an application for licensing to the Board shall constitute and operate as an authorization by the applicant to each educational institution at which the applicant has matriculated; each state or federal agency to which the applicant has applied for any license, permit, certificate or registration; each person, firm, corporation, clinic, office or institution by whom or with whom the applicant has been employed in the practice of medicine; each physician or other health care practitioner whom the applicant has consulted or seen for diagnosis or treatment and each professional organization or specialty board to which the applicant has applied for membership, to disclose and release to the Board any and all information and documentation concerning the applicant which the Board deems material to consideration of the application. With respect to any such information or documentation, the submission of an application for licensing to the Board shall equally constitute and operate as a consent by the applicant to disclosure and release of such information and documentation and as a waiver by the applicant of any privilege or right of confidentiality which the applicant would otherwise possess with respect thereto.

By submission of an application for licensing to the Board, an applicant shall be deemed to have given his or her consent to submit to physical or mental examinations if, when and in the manner so directed by the Board and to waive all objections as to the admissibility or disclosure of findings, reports or recommendations pertaining thereto on the grounds of privileges provided by law. The expense of any such examination shall be borne by the applicant.

The submission of an application for licensing to the Board shall constitute and operate as an authorization and consent by the applicant to the Board to disclose and release any information or documentation set forth in or submitted with the applicant's application or obtained by the Board from other persons, firms, corporations, associations or governmental entities pursuant to Part 2601, Chapter 2, Rule 2.1 paragraphs 1 and 2, to any person, firm, corporation, association or governmental entity having a lawful, legitimate and reasonable need therefore, including, without limitation, the medical licensing authority of any state; The FSMB; the AMA and any component state and county or parish medical society, including the Mississippi State Medical Association and component societies thereof; the AOA and any component state and county or parish osteopathic medical society, including the Mississippi Osteopathic Medical Association and component societies thereof; the U.S. Drug Enforcement Administration; the Mississippi State Bureau of Narcotics; federal, state, county or municipal health and law enforcement agencies and the Armed Services. It is the intent and purpose of this rule to authorize release of only that licensure information not prohibited from release under Section 73-52-1, Mississippi Code.

Upon submission of an application for licensure to the Board, the applicant shall promptly provide all information deemed necessary by the Board to process the application, including, but not limited to certification of graduation from medical school, photograph of applicant, internship certification and birth certificate. The Board shall have a reasonable period of time within which to collect and assimilate all required documents and information necessary to issue a medical license. If, after submitting an application for medical license, an applicant has failed to respond or make a good faith effort to pursue licensure for a period of three (3) months, the application will be considered null and void, and applicant will have to reapply for licensure, including, but

not limited to, all fees, application, and certifications. Additionally, if after one year from the date of receipt of application, applicant has not received a medical license, the application will be considered null and void, and applicant will have to reapply for licensure, including, but not limited to, all fees, application, and certifications.

Amended October 1, 2023.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Part 2605

Chapter 1: Licensure Requirements for the Practice of Allopathic Physicians and

Rule 1.1 | Licensure by Credentials

The licensure requirements for licensure by credentials are as follows:

A. Applicant must be twenty-one (21) years of age and of good moral character. B. Present a diploma from a reputable medical college or college of osteopathic medicine, subject to the following conditions: 1. If the degree is from a medical college or a college of osteopathic medicine in the United States or Puerto Rico, the medical college must be accredited at the time of graduation by the LCME, a Joint Committee of the Association of American Medical Colleges (AAMC) and the AMA or the College of Osteopathic Medicine which must be accredited by the AOA. 2. If the degree is from a Canadian medical school, the school must be accredited at the time of graduation by the LCME and by the Committee on Accreditation for Canadian Medical Schools. 3. If the degree is from an international medical school, the medical school must be in the World Directory of Medical Schools or its equivalent. A graduate from an international medical school must either (i) possess a valid certificate from the ECFMG or (ii) document successful completion of a Fifth Pathway program and be currently board certified by a specialty board recognized by the ABMS. The Board will accept for licensure only those individuals completing Fifth Pathway Programs by December 31, 2009. Credentialing via Fifth Pathway Programs will be considered on an individual basis. 4. Any diploma or other document required to be submitted to the Board by an applicant which is not in the English language must be accompanied by a certified translation thereof into English.

C. If a graduate from a medical college or college of osteopathic medicine in the United States, Canada or Puerto Rico, applicant must present documentation of having completed at least one (1) year of postgraduate training in the United States accredited by the ACGME or by the AOA; or training in Canada accredited by the RCPSC or CCFP. D. Applicants who graduated from an international medical school must present documentation of having completed either: 1. three (3) or more years of ACGME-approved postgraduate training in the United States or training in Canada approved by the RCPSC or CCFP; or

2. one (1) year of ACGME-approved postgraduate training in the United States or training in Canada approved by the RCPSC or CCFP, be currently board certified by a specialty board recognized by the ABMS and must have approval by the Board or Executive Director.

E. An applicant who otherwise possesses all of the qualifications for licensure by credentials, but has not taken a medical proficiency examination or licensure examination within ten (10) years prior to filing his or her application, must pass the SPEX or COMVEX*, unless the applicant: 1. Submits satisfactory proof of current certification by an ABMS and participating in Maintenance of Certification (MOC) or AOA approved specialty board and participating in Osteopathic Continuous Certification (OCC); or 2. Submits proof that the applicant's sole purpose for seeking licensure is to serve as the Dean, Chairman of the Department or Faculty of an ACGME or AOA approved training program. In such case, a license shall remain in effect so long as licensee is a member of the faculty of the ACGME or AOA approved training program.

F. Submit certified copy of either (i) a birth certificate or (ii) a valid passport. G. Submit certified copy of legal name change, if applicable. H. Complete an application for medical license and submit it to the Board in a manner prescribed by the Board with a recent passport type photograph. I. Submit fee prescribed by the Board. J. Submit fingerprints for state and national criminal history background checks.

* SPEX (SPECIAL PURPOSE EXAMINATION) is a cognitive examination assisting licensing jurisdictions in their assessment of current competence requisite for general, undifferentiated medical practice by physicians who hold or have held a valid license in a U.S. jurisdiction. SPEX is made available through the Federation of State Medical Boards.

COMVEX-USA (COMPREHENSIVE OSTEOPATHIC MEDICAL VARIABLE EXAMINATION) is the evaluative instrument offered to osteopathic physicians who need to demonstrate current osteopathic medical knowledge. COMVEX-USA is made available through the National Board of Osteopathic Medical Examiners.

Adopted September 13, 1979; amended July 1, 1981; amended January 24, 1985; amended July 29, 1985; amended July 17, 1986; amended August 18, 1986; amended November 19, 1987; amended April 19, 1988; amended October 25, 1993; amended February 16, 2000; amended March 8, 2007; amended January 24, 2008; amended March 13, 2009; amended September 17, 2009; amended October 13, 2009; amended March 20, 2015; and amended October 1, 2023.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.2 | Waiver

Rule 1.3 | Licensure Examinations

Rule 1.4 | Licensure via the Interstate Medical Licensure Compact – Supplemental Information

Chapter 2: Licensure Requirements for the Practice of Podiatrists

Rule 2.1 | Licensure by Credentials

If the original license of an applicant was obtained by state board examination, the applicant must have the state board where original license was obtained by written examination submit a certified copy of the examination directly to the Board.

The Board may grant licenses to Diplomates of the NBPME. If a Diplomate of the NBPME, the applicant must have certification of endorsement from that Board submitted directly to the Board. Applicants graduating podiatry school on or after January 1, 2010, must take and pass all three (3) parts of the APMLE.

In addition to the above, an individual shall meet the following requirements:

A. Applicant must be twenty-one (21) years of age, and of good moral character. B. Applicant must have had at least four (4) years high school and be graduate of same; he or she shall have at least one (1) year pre-podiatry college education. C. Present a diploma from a college of podiatric medicine recognized by the Board as being in good standing, subject to the following conditions. 1. Any diploma or other document required to be submitted to the Board by an applicant which is not in the English language must be accompanied by a certified translation thereof into English. 2. No college of podiatry or chiropody shall be accredited by the Board as a college of good standing which does not require for graduation a course of study of at least four (4) years (eight and one-half [8½] months each) and be accredited by the CPME at the time of graduation.

D. Present proof of completion of one (1) year of APMA-approved postgraduate training in the U.S. or Canada. If the podiatrist graduated from an accredited college of podiatric medicine prior to 1990, has continuously practiced for the past ten (10) years and has held unrestricted license(s) to practice podiatry, the one (1) year of APMA-approved postgraduate training may be waived at the Board’s discretion. E. Submit certified copy of birth certificate or valid passport. F. Submit a certified copy of legal name change, if applicable. G. Complete an application for podiatry license and submit it to the Board in the manner prescribed by the Board with a recent passport type photograph.

H. Submit fee prescribed by the Board. I. Submit fingerprints for state and national criminal history background checks.

Amended November 19, 1987; amended February 19, 2003; amended March 8, 2007; amended May 17, 2007; amended January 24, 2008; amended November 20, 2008; amended March 20, 2015; amended November 13, 2015; amended March 16, 2017; and amended October 1, 2023.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Chapter 3: Temporary Licensure

Rule 3.1 | Temporary Licensure

A. Mississippi temporary medical or podiatric licenses may be issued to applicants for licensure in Mississippi under the following conditions:

1. A restricted temporary medical or podiatric license may be issued upon proper completion of an application to an applicant who otherwise meets all requirements for licensure except successful completion:

a. of the postgraduate training requirements provided in Part 2605, Chapter 1, Rule 1.1 or Chapter 2, Rule 2.1; and/or

b. of Step 3 of USMLE, Level 3 of COMLEX, or Part 3 of the APMLE.

Such restricted temporary license shall entitle the physician to practice medicine or podiatric medicine only within the confines of an ACGME, AOA or APMA approved postgraduate training program in this state and may be renewed annually for the duration of the postgraduate training for a period not to exceed five (5) years.

Residents typically practice within the confines of an ACGME, AOA or APMA approved postgraduate training program which may be located in another state, and which meets all requirements as described above. These programs sometimes have affiliated institutions (i.e., hospitals or clinics) located in Mississippi which are not ACGME, AOA or APMA approved sites, but in which the resident needs to rotate as part of their otherwise approved training program. Programs may petition the Board, via its Executive Committee, to approve those affiliated Mississippi locations such that residents of those programs may apply for a temporary license in order to rotate at those facilities.

B. The Board may issue a temporary license to practice medicine for a period not to exceed 90 days at a youth camp licensed by the State Department of Health to any nonresident physician who is not licensed to practice medicine in this state or to any resident physician who is retired from the active practice of medicine in this state while serving as a volunteer at such camp.

1. Nonresident Physician

a. must have favorable references from two physicians with whom the applicant has worked or trained within the last year;

b. must have written certification from the medical licensing authority in the state in which he or she holds a currently valid license to practice medicine; and

c. must submit fee prescribed by the Board.

2. Retired Resident Physician

a. must be in good standing with the Board, and b. must submit fee as prescribed by the Board.

C. Any licensee issued a temporary license to practice medicine who prescribes controlled substances must have and utilize their own, individual controlled substance registration certificate issued by the U.S. Drug Enforcement Administration.

Adopted September 13, 1979; amended July 1, 1981; amended March 16, 1995; amended May 17, 2007; amended March 20, 2015; amended January 22, 2019; amended August 27, 2021; and amended October 1, 2023.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 3.2 | Limited Institutional Licensure

A. Pursuant to Section 73-25-23, Mississippi Code, a limited institutional license is available only to graduates of Board-approved international medical schools who are employed or are being considered for employment to practice medicine in one or more Mississippi state-supported institutions located in the same county. B. Graduates of international medical schools holding a limited institutional license, and who are employed by and enrolled in an approved ACGME or AOA postgraduate training program in a state-supported institution, shall be authorized to participate only in such approved postgraduate educational program or affiliated training program sites. C. An application for limited institutional licensure may be accepted by the Board only upon the written request of the state-supported institution which has employed or is considering employing a graduate of an international medical school to practice medicine. D. A limited institutional license may be issued for a period of one (1) year for practice in a particular institution after a review and favorable recommendations by a majority of the following: 1. President or Secretary, Board of Trustees of Institution 2. Director of Institution 3. President or Secretary, Local Chartered Medical Society in area in which institution is located 4. Member, Board of Trustees, Mississippi State Medical Association in area in which institution is located 5. Member, Mississippi State Board of Medical Licensure from district in which institution is located 6. Executive Officer, Mississippi State Board of Medical Licensure

E. In addition to the above requirements for a limited institutional license, an applicant shall meet the following requirements: 1. Must be at least twenty-one (21) years of age and of good moral character. 2. Must submit copy of diploma and certification of completion from a medical school listed in the World Director of Medical Schools or its equivalent. 3. Must submit certified copy of valid certificate from the ECFMG or its successor. 4. Must submit an application completed in every detail with recent passport type photograph. 5. Must submit fee prescribed by the Board. 6. Submit fingerprints for state and national criminal background checks.

F. Pursuant to Section 73-25-23, Mississippi Code, a limited institutional license must be renewed annually, after such review as the Board considers necessary. A graduate of an international medical school so licensed may hold such limited institutional license no longer than five (5) years. G. A limited institutional license shall become void immediately upon termination of employment of the licensee at the institution, or institutions, at which practice is authorized under the license. H. An annual renewal fee shall be prescribed by the Board.

Amended November 19, 1998; amended March 8, 2007; amended May 17, 2007; amended March 20, 2015; amended March 16, 2017; and amended October 1, 2023.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 3.3 | Temporary Training License for Out-of-State Residents

Rule 3.4 | Short-Term Training for Out-of-State Physicians

The Board is aware that there are Mississippi physicians assisting out-of-state physicians in expanding professional knowledge and expertise by offering short-term training to the out-of-state physician. The Mississippi physician wishing to offer this training to the unlicensed out-of-state physician(s) must have their short-term training program approved by the Board.

The Mississippi physician must submit a detailed letter stating the purpose of the short-term training program, the objectives of the course, approximately how long the course will last, and any supporting documentation that would assist the Board in determining the approval status of the program.

An individual wishing to attend the Board approved short-term training is not required to obtain a permanent Mississippi medical license; however, the individual must submit the following to the Board:

A. A completed information form which has been supplied by the Board. B. A letter from the mentor of the Board approved training program stating that the applicant is going to be participating in the short-term training program and the duration. C. Verification of a current unrestricted permanent license from the state in which the individual is currently practicing. D. A permit fee in the amount of $25.

The individual may not participate in the short-term training program until a valid training permit has been issued. The permit will be effective the date the individual is to begin the training and will become null and void the day the individual completes the training.

A short-term training permit is typically valid for two to three days; however, it can be issued up to fifteen (15) days. If during the duration of the training, it is determined that the physician may stay longer than fifteen (15) days, the temporary training permit may be renewed for an additional (15) days. Under no circumstances will the permit be renewed after thirty (30) days. An individual anticipating training for a period longer than thirty (30) days will be required to obtain a permanent Mississippi medical license.

Adopted July 12, 2007, and amended October 1, 2023.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Chapter 4: Expedited Licensure

Rule 4.1 | Military Applicants

A. Pursuant to MS Code Ann. Section 73-50-1, the Board of Medical Licensure is authorized to issue an expedited license to a military-trained applicant to allow the applicant to lawfully practice medicine in Mississippi. In order to receive the expedited license, the following requirements must be satisfied: 1. Complete an application for medical license and submit it to the Board in the manner prescribed by the Board with a recent passport type photograph. 2. Submit documentation that applicant has been awarded a military occupational specialty. 3. Submit documentation of completion of a military program of medical training.

4. Submit evidence that the applicant either (i) is currently on active duty with medical corps or (ii) has separated honorably from the military within the 6 months prior to the time of application.

5. Submit verification of a completed licensing examination as described in Rule 2.3.

6. Have two references submit letters regarding applicant’s performance in the practice of medicine.

7. Submit verification that at least two of the past five years preceding the date of submission of the application applicant has engaged in the active practice of medicine.

8. Submit certification that applicant has not committed any act in any jurisdiction that would have constituted grounds for refusal, suspension or revocation of a license to practice medicine in Mississippi at the time the act was committed. Applicants may participate in the Board’s routine fingerprint background check, at the applicant’s expense, in lieu of certification.

9. Submit fingerprints for state and national criminal history background checks.

10. Submit licensure fee prescribed by the Board.

B. Pursuant to MS Code Ann. Section 73-50-1, the Board of Medical Licensure is authorized to issue a license to a military spouse to allow the military spouse to lawfully practice medicine in Mississippi. In order to receive the expedited license, the following requirements must be satisfied: 1. Complete an application for medical license and submit it to the Board in the manner prescribed by the Board with a recent passport type photograph. 2. Submit certification of a current license from another jurisdiction, in which that jurisdiction's requirements for licensure are substantially equivalent to or exceed the requirements for licensure of the Board. 3. Submit verification that at least two of the past five years preceding the date of submission of the application applicant has engaged in the active practice of medicine. 4. Submit certification that applicant has not committed any act in any jurisdiction that would have constituted grounds for refusal, suspension or revocation of a license to practice medicine in Mississippi at the time the act was committed. Applicant may participate in the Board’s routine fingerprint background check, at the applicant’s expense, in lieu of certification. 5. Submit verification that applicant is in good standing and has not been disciplined by the agency that had jurisdiction to issue the license.

6. Submit licensure fee prescribed by the Board. 7. Submit fingerprints for state and national criminal history background checks.

C. All relevant experience of a military service member in the discharge of official duties or, for a military spouse, all relevant experience, including full-time and part-time experience, regardless of whether in a paid or volunteer capacity, shall be credited in the calculation of years of practice in the practice of medicine as required under subsection A or B of this section. D. A nonresident licensed under this section shall be entitled to the same rights and subject to the same obligations as required of a resident licensed by the Board. E. The Board may issue a temporary practice permit to a military-trained applicant or military spouse licensed in another jurisdiction while the military-trained applicant or military spouse is satisfying the requirements for licensure under subsection A or B of this section if that jurisdiction has licensure standards substantially equivalent to the standards for licensure of the Board. The military-trained applicant or military spouse may practice under the temporary permit until a license is granted or until a notice to deny a license is issued in accordance with rules adopted by the Board.

Adopted July 10, 2014; and amended March 16, 2017.

Source: Miss. Code Ann. §73-25-19 (1972, as amended).

Chapter 5: The Practice by Unlicensed Nonresident Physicians

Rule 5.1 | Scope

Rule 5.2 | Purpose

Rule 5.3 | Notification to Board Required

Rule 5.4 | Intent

Rule 5.5 | Exclusion

Rule 5.6 | Effective Date of Regulation

Part 2610

Chapter 2: CME Requirements

Rule 2.1 | Basic Requirement

Every Mississippi physician licensee must earn or receive not less than forty (40) hours of Category 1 continuing medical education in a two-year cycle as a condition precedent to renewing his or her license for the next fiscal year. Additionally, all licensees who maintain a U.S. Drug Enforcement Administration Controlled Substances Registration must complete the training required by Section 303 of the Controlled Substances Act.1 Excess hours may not be carried over to another two-year cycle. For the purpose of this regulation, the two-year period begins July 1, 2024, and every two years thereafter.2

1 21 U.S.C. 823, Sec. 303

2 e.g., July 1, 2026, through June 30, 2028; July 1, 2028, through June 30, 2030, etc.

A. Category 1 continuing medical education shall mean those programs of continuing medical education designated as Category 1 which are sponsored or conducted by those organizations approved by the Mississippi State Medical Association, American Medical Association or by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor or conduct Category 1 continuing medical education programs. B. Programs of continuing medical education designated as Category 1-A, which are sponsored or conducted by organizations or entities accredited by the American Osteopathic Association to sponsor or conduct Category 1-A continuing medical education for osteopathic physicians. C. Programs of continuing medical education designated as a “prescribed hour” that are sponsored or conducted by organizations or entities accredited by the American Academy of Family Physicians to sponsor or conduct “prescribed hours” of continuing medical education. D. Programs of continuing medical education designated as “cognates” which are sponsored or conducted by organizations or entities that are accredited by the American College of Obstetrics and Gynecology to sponsor or conduct approved cognates on obstetrical and gynecological-related subjects. E. Programs of continuing medical education designated as Category 1-A which are sponsored or conducted by organizations or entities accredited by the Council on Podiatric Medical Education to sponsor or conduct Category 1-A continuing medical education for podiatrists.

Source: Miss. Code Ann. §§ 73-25-14 and 73-43-11 (1972, as amended).

Rule 2.2 | Persons Affected

Rule 2.3 | Exemption for Initial Licenses

Rule 2.4 | Record Keeping Requirement

Every licensee shall maintain records of attendance or certificates of completion demonstrating compliance with the minimum continuing medical education requirements. Documentation adequate to demonstrate compliance with the minimum continuing medical education requirements of this and other regulations shall consist of certificates of attendance, completion certificates, proof of registration, or similar documentation issued by the organization or entity sponsoring or conducting the continuing medical education program.

Licensees are required to create an account with a Board-approved CME management and tracking system. A list of all board-approved systems is available on the board’s webpage. However, physicians who maintain board certification with a board recognized by the American Board of Medical Specialties (ABMS) are exempt from this requirement. All required documentation shall be uploaded immediately upon receipt to the CME management and tracking system selected by the licensee.

All information submitted and required shall be subject to examination by representatives of the Board upon request. Compliance review will be conducted by the Board via random computer- generated selection, or otherwise at the discretion of the Board. If a licensee is on a hospital medical staff, it is recommended these certificates and hours also be recorded with the primary hospital medical staff records.

With his or her annual renewal application, every licensee must certify the completion of the minimum continuing medical education requirement established under these rules. Failure to maintain records documenting that a licensee has met the minimum continuing medical education requirement, and/or failure to provide such records upon request to the Board or the CME tracking system, is hereby declared to be unprofessional conduct and may constitute grounds, within the discretion of the Board, for the suspension of the Licensee’s ability to practice medicine.

Source: Miss. Code Ann. §§ 73-25-14, 73-71-43, 73-27-12, 73-26-3, 41-58-5, and 73-43-11 (1972, as amended).

Rule 2.5 | Annual Renewal

Rule 2.6 | Waiver

Part 2615

Chapter 1: The Practice of Physician Assistants

Rule 1.1 | Scope

Rule 1.2 | Definitions

For the purpose of Part 2615, Chapter 1 only, the following terms have the meanings indicated:

A. Board means the Mississippi State Board of Medical Licensure.

B. Physician Assistant means a person who meets the Board’s criteria for licensure as a physician assistant and is licensed as a physician assistant by the Board.

C. Supervising Physician means a doctor of medicine or a doctor of osteopathic medicine who holds an unrestricted license from the Board who practices within the state of Mississippi for a minimum of twenty (20) hours per week or eighty (80) hours per month (does not include telemedicine or chart review), whose practice or prescriptive authority is not limited as a result of voluntary surrender or legal/regulatory order, and who has been approved by the Board to supervise physician assistants. Exceptions to the in-state practice requirement may be granted by the Board, by and through the Executive Committee, in cases demonstrating good cause. Additionally, temporary permission may be granted by the Executive Director until the request can be heard before the Executive Committee.

D. Supervise or Supervision means overseeing and accepting responsibility for the medical services rendered by a physician assistant.

E. Primary Office means the usual practice location of a physician and being the same location reported by that physician to the Mississippi State Board of Medical Licensure and the United States Drug Enforcement Administration.

F. NCCPA means the National Commission on Certification of Physician Assistants.

G. PANCE means the Physician Assistant National Certifying Examination.

H. ARC-PA means the Accreditation Review Commission on Education for the Physician Assistant.

I. Predecessor or Successor Agency refers to the agency responsible for accreditation of educational programs for physician assistants that preceded ARC-PA or the agency responsible for accreditation of educational programs for physician assistants that succeeded ARC-PA.

J. Primary Care means specialty practice that is limited to, or defined as, Family Practice, General Internal Medicine, Mental Health, Women’s Health, and/or General Pediatrics.

Source: Miss. Code Ann. §73-26-5 (1972, as amended).

Rule 1.3 | Qualifications for Licensure

Rule 1.4 | Temporary License

Rule 1.5 | Requirement of Protocol - Prescribing/Dispensing

Physician assistants shall practice according to a protocol which has been mutually agreed upon by the physician assistant and the supervising physician. Each protocol shall be prepared taking into consideration the specialty of the supervising physician and must outline diagnostic and therapeutic procedures and categories of pharmacologic agents which may be ordered, administered, dispensed and/or prescribed for patients with diagnoses identified by the physician assistant.

Each protocol shall contain a detailed description of back-up coverage if the supervising physician is away from the primary office. Although licensed, no physician assistant shall practice until they have reported their supervisor and practice information to the Board via the Medical Enforcement and Licensure System (MELS) online gateway or successor system.

Except as hereinafter provided in below, physician assistants may not write prescriptions for or dispense controlled substances or any other drug having addiction-forming or addiction-sustaining liability. A physician assistant may, however, administer such medications pursuant to an order by the supervising physician if in the protocol.

Prescribing Controlled Substances and Medications by Physician Assistants

A. Scope

Pursuant to these rules, authorized physician assistants may prescribe controlled substances in Schedules II through V.

B. Application for Authority to Prescribe Controlled Substances

1. Physician assistant applicants applying for controlled substance prescriptive authority must complete a Board approved educational program prior to making application.

2. In order to obtain the authority to prescribe controlled substances in any schedule, the physician assistant shall submit an application approved by the Board.

C. Incorporation of Physician Rules Pertaining to Prescribing, Administering and Dispensing of Medication

For the purpose of directing the manner in which physician assistants may prescribe controlled substances, the Board incorporates Administrative Code Part 2640, Chapter 1 Pertaining to Prescribing, Administering and Dispensing of Medication as applied to physicians, including but not limited to all Definitions, Maintenance of Records and Inventories, Use of Diet Medication, Use of Controlled Substances for Chronic (Non- Terminal) Pain, and Prescription Guidelines. All physician assistants authorized to prescribe controlled substances shall fully comply with these rules. As stated herein, it is understood Physician Assistants may not dispense medications.

D. Registration for Controlled Substances Certificate Prescriptive Authority

1. Every physician assistant authorized to practice in Mississippi who prescribes any controlled substance must be registered with the U. S. Drug Enforcement Administration in compliance with Title 21 CFR, Part 1301 Food and Drugs.

2. Pursuant to authority granted in Mississippi Code, Section 41-29-125, the Board hereby adopts, in lieu of a separate registration with the Board, the registration with the U.S. Drug Enforcement Administration as required in Part 2615, Rule 1.5.D.1, provided, however, where a physician assistant already possesses a controlled substances registration certificate for a practice location in another state or jurisdiction, the physician assistant may not transfer or otherwise use the same registration until he or she meets the training requirements set forth in Part 2615, Rule 1.5.B.1. In the event, however, a physician assistant has had limitations or other restrictions placed upon his or her license wherein he or she is prohibited from handling controlled substances in any or all schedules, said physician assistant shall be prohibited from registering with the U. S. Drug Enforcement Administration for a Uniform Controlled Substances Registration Certificate without first being expressly authorized to do so by order of the Board.

3. The registration requirement set forth in these rules does not apply to the distribution and manufacture of controlled substances. Any physician assistant who engages in the manufacture or distribution of controlled substances or legend drugs shall register with the Mississippi State Board of Pharmacy pursuant to Mississippi Code, Section 73-21-105. For the purposes herein, “distribute” shall mean the delivery of a drug other than by administering, prescribing, or dispensing. The word “manufacture” shall have the same meaning as set forth in Mississippi Code, Section 73-21-105(q).

E. Drug Maintenance, Labeling and Distribution Requirements

Persons registered to prescribe controlled substances may order, possess, prescribe, administer, distribute or conduct research with those substances to the extent authorized by their registration and in conformity with the other provisions of these rules and in conformity with provisions of the Mississippi Uniform Controlled Substances Law, Mississippi Code, Sections 41-29-101 et. seq., except physician assistants may not receive samples of controlled substances. A physician assistant may receive and distribute pre-packaged medications or samples of non-controlled substances for which the physician assistant has prescriptive authority.

Source: Miss. Code Ann. §73-26-5 (1972, as amended).

Rule 1.6 | Supervision

Supervision means overseeing activities of, and accepting responsibility for, all medical services rendered by the physician assistant. Except as described in the following paragraph, supervision must be continuous, but shall not be construed as necessarily requiring the physical presence of the supervising physician.

New graduate physician assistants and all physician assistants whose Mississippi license is their initial license require the on-site presence of a supervising physician for one hundred twenty (120) days or its equivalent of 960 hours. If a physician assistant’s clerkship was completed with their supervising physician, the 120 days or 960 hours may be reduced.

The physician assistant’s practice shall be confined to the primary office or clinic of the supervising physician, or any hospital(s), clinic(s) or other health care facilities within 75 miles of where the primary office is located, wherein the supervising physician holds medical staff privileges or that otherwise serves as an extension of the physician and physician assistant(s) practice. Exceptions to this requirement may be granted, on an individual basis, provided the location(s) of practice are set forth in the protocol.

Before any physician assistant shall practice in a location greater than 75 miles, the physician assistant must present to the Board a duly executed protocol and obtain approval to practice. Excluded from this requirement are physician assistants who practice within a licensed hospital, state health department facility, federally qualified community health clinic, or volunteer clinic. Protocols will be forwarded to the Board’s Physician Assistant Advisory Committee for their review and recommendation prior to disapproval. The facts and matters to be considered by the Committee when reviewing a protocol or supervision arrangement shall include, but are not limited to, how the supervising physician and physician assistant plan to implement the protocol, the method and manner of supervision, consultation, referral, compatibility of practice, and liability.

Physician Assistants practicing in primary care shall have no mileage restrictions placed on the relationship between the supervisory physician and the physician assistant if the following conditions are met:

1. The protocol is between a primary care physician and a primary care physician assistant. 2. The physician is in a compatible practice (e.g., same specialty, treat the same patient population) with the physician assistant. 3. The physician and physician assistant utilize electronic medical records (EMR) in their practice, has direct access to the EMR utilized by the PA, and also utilize EMR in the formal quality improvement program. 4. The physician practices within the State of Mississippi for a minimum of twenty (20) hours per week or eighty (80) hours per month (does not include telemedicine).

The supervising physician must provide adequate means for communication with the physician assistant. Communication may occur through the use of technology which may include, but is not limited to: radio, telephone, fax, modem, or other telecommunication device.

Each primary supervisory relationship shall include and implement a formal quality improvement program which must be maintained on site and must be available for inspection by representatives of the Mississippi State Board of Medical Licensure. The quality assurance/quality improvement program shall consist of:

A. Review by a supervisory physician of a random sample of charts that represent 10% or 20 charts, whichever is less, of patients seen by the physician assistant every month. Charts should represent the variety of patient types seen by the physician assistant. Patients that the physician assistant and a supervising physician have consulted on during the month will count as one chart review.

B. The physician assistant shall maintain a log of charts reviewed which include the identifier for the patient’s charts, reviewers’ names, and dates of review.

C. Each physician assistant shall meet face to face, either in person or via video conferencing, with a supervisory physician once per quarter for the purpose of quality assurance, and this meeting must be documented.

Source: Miss. Code Ann. §73-26-5 (1972, as amended).

Rule 1.7 | Termination

Rule 1.8 | Duty to Notify Board of Change of Address

Rule 1.9 | Continuing Education

Rule 1.10 | Identification

Rule 1.11 | Physician Liability

Rule 1.12 | Renewal Schedule

The license of every person licensed to practice as a physician assistant in the state of Mississippi shall be renewed annually.

On or before May 1 of each year, the State Board of Medical Licensure shall notify every physician assistant to whom a license was issued or renewed during the current licensing year the process of licensure renewal. The notice shall provide instructions for obtaining and submitting applications for renewal. The applicant shall obtain and complete the application and submit it to the Board in the manner prescribed by the Board in the notice before June 30 along with the renewal fee of an amount established by the Board. The payment of the annual license renewal fee shall be optional with all physician assistants over the age of seventy (70) years. Upon receipt of the application and fee, the Board shall verify the accuracy of the application and issue to applicant a certificate of renewal for the ensuing year, beginning July 1 and expiring June 30 of the succeeding calendar year.

A physician assistant practicing in Mississippi who allows his or her license to lapse by failing to renew the license as provided in the paragraph above may be reinstated by the Board upon completion of a reinstatement form and payment of the renewal fee for the current year, and shall be assessed a fine of Twenty-five Dollars ($25.00) plus an additional fine of Five Dollars ($5.00) for each month thereafter the license renewal remains delinquent.

Any physician assistant not practicing in Mississippi who allows his or her license to lapse by failing to renew the license as provided in the paragraph above may be reinstated by the Board upon completion of a reinstatement form and payment of the arrearage for the previous five (5) years and the renewal fee for the current year.

Any physician assistant who allows his or her license to lapse shall be notified by the Board within thirty (30) days of such lapse.

Any person practicing as a physician assistant during the time his or her license has lapsed shall be considered an illegal practitioner and shall be subject to the same penalties as provided in Mississippi Code, Section 73-25-14.

Source: Miss. Code Ann. §73-26-5 (1972, as amended).

Rule 1.13 | Disciplinary Proceedings

A. Grounds for Disciplinary Action Against Physician Assistants

For the purpose of conducting disciplinary actions against individuals licensed to practice as physician assistants, the Board hereby incorporates those grounds for the non-issuance, suspension, revocation, or restriction of a license or the denial of reinstatement or renewal of a license, as set forth in Mississippi Code, Sections 73-25-29 and 73-25-83. As a basis for denial, suspension, revocation or other restriction, the Board may initiate disciplinary proceedings based upon any one or more of those grounds as set forth in Sections 73-25- 29 and 73-25-83, and may make provision for the assessment of costs as provided therein.

B. Hearing Procedure and Appeals 1. No individual shall be denied a license or have his or her license suspended, revoked or restriction placed thereon, unless the individual licensed as a physician assistant has

been given notice and opportunity to be heard. For the purpose of notice, disciplinary hearings and appeals, the Board hereby adopts and incorporates by reference all provisions of the “Rules of Procedure” now utilized by the Board for those individuals licensed to practice medicine, osteopathic medicine, and podiatric medicine in the state of Mississippi. C. Reinstatement of License 1. A person whose license to practice as a physician assistant has been revoked, suspended, or otherwise restricted may petition the Mississippi State Board of Medical Licensure to reinstate his or her license after a period of one (1) year has elapsed from the date of the revocation or suspension. The procedure for the reinstatement of a license that is suspended for being out of compliance with an order for support, as defined in Section 93-11-153, shall be governed by Sections 93-11-157 or 93-11-163, as the case may be. 2. The petition shall be accompanied by two (2) or more verified recommendations from physicians or osteopaths licensed by the Board of Medical Licensure to which the petition is addressed and by two (2) or more recommendations from citizens each having personal knowledge of the activities of the petitioner since the disciplinary penalty was imposed and such facts as may be required by the Board of Medical Licensure.

The petition may be heard at the next regular meeting of the Board of Medical Licensure but not earlier than thirty (30) days after the petition was filed. No petition shall be considered while the petitioner is under sentence for any criminal offense, including any period during which he or she is under probation or parole. The hearing may be continued from time to time as the Board of Medical Licensure finds necessary.

3. In determining whether the disciplinary penalty should be set aside and the terms and conditions, if any, which should be imposed if the disciplinary penalty is set aside, the Board of Medical Licensure may investigate and consider all activities of the petitioner since the disciplinary action was taken against him or her, the offense for which he or she was disciplined, his or her activity during the time his or her certificate was in good standing, his or her general reputation for truth, professional ability and good character; and it may require the petitioner to pass an oral examination.

Source: Miss. Code Ann. §73-26-5 (1972, as amended).

Rule 1.14 | Impaired Physician Assistants

Part 2620

Chapter 1: The Practice of Radiologist Assistants

Rule 1.1 | Scope

Rule 1.2 | Definitions

Rule 1.3 | Qualifications for Licensure

Rule 1.4 | Supervision

Rule 1.5 | Supervising Physician Limited

Rule 1.6 | Termination

Rule 1.7 | Duty to Notify Board of Change of Address

Rule 1.8 | Continuing Education

Rule 1.9 | Identification

Rule 1.10 | Physician Liability

Rule 1.11 | Renewal Schedule

The license of every person licensed to practice as a radiologist assistant in the state of Mississippi shall be renewed annually.

On or before May 1 of each year, the State Board of Medical Licensure shall notify every radiologist assistant to whom a license was issued or renewed during the current licensing year the process of licensure renewal. The notice shall provide instructions for obtaining and submitting applications for renewal. The applicant shall obtain and complete the application and submit it to the Board in the manner prescribed by the Board in the notice before June 30 with the renewal fee of an amount established by the Board. The payment of the annual license renewal fee shall be optional with all radiologist assistants over the age of seventy (70) years. Upon receipt of the application and fee, the Board shall verify the accuracy of the application and issue to applicant a certificate of renewal for the ensuing year, beginning July 1 and expiring June 30 of the succeeding calendar year. Such renewal shall render the holder thereof a licensed radiologist assistant as stated on the renewal form.

A radiologist assistant practicing in Mississippi who allows his or her license to lapse by failing to renew the license as provided in this rule may be reinstated by the Board upon completion of a reinstatement form and payment of the renewal fee for the current year, and shall be assessed a fine of Twenty-five Dollars ($25.00) plus an additional fine of Five Dollars ($5.00) for each month thereafter that the license renewal remains delinquent.

Any radiologist assistant not practicing in Mississippi who allows his or her license to lapse by failing to renew the license as provided in this rule may be reinstated by the Board upon completion

of a reinstatement form and payment of the arrearage for the previous five (5) years and the renewal fee for the current year.

Any radiologist assistant who allows his or her license to lapse shall be notified by the Board within thirty (30) days of such lapse.

Any person practicing as a radiologist assistant during the time his or her license has lapsed shall be considered an illegal practitioner and shall be subject to the same penalties as provided at Mississippi Code, Section 73-25-14.

Source: Miss. Code Ann. §41-58-7 (1972, as amended).

Rule 1.12 | Disciplinary Proceedings

A. Grounds for Disciplinary Action Against Radiologist Assistants

For the purpose of conducting disciplinary actions against individuals licensed to practice as radiologist assistants, the Board hereby incorporates those grounds for the non-issuance, suspension, revocation, or restriction of a license or the denial of reinstatement or renewal of a license, as set forth in Mississippi Code, Sections 73-25-29 and 73-25-83. As a basis for denial, suspension, revocation or other restriction, the Board may initiate disciplinary proceedings based upon any one or more of those grounds as set forth in Sections 73-25- 29 and 73-25-83, and may make provision for the assessment of costs as provided therein.

B. Hearing Procedure and Appeals

No individual shall be denied a license or have his or her license suspended, revoked or restriction placed thereon, unless the individual licensed as a radiologist assistant has been given notice and opportunity to be heard. For the purpose of notice, disciplinary hearings and appeals, the Board hereby adopts and incorporates by reference all provisions of the “Rules of Procedure” now utilized by the Board for those individuals licensed to practice medicine, osteopathic medicine, and podiatric medicine in the state of Mississippi.

C. Reinstatement of License 1. A person whose license to practice as a radiologist assistant has been revoked, suspended, or otherwise restricted may petition the Mississippi State Board of Medical Licensure to reinstate his or her license after a period of not less than one (1) year has elapsed from the date of the revocation or suspension. The procedure for the reinstatement of a license that is suspended for being out of compliance with an order for support, as defined in Section 93-11-153, shall be governed by Sections 93-11-157 or 93-11-163, as the case may be. 2. The petition shall be accompanied by two (2) or more verified recommendations from physicians or osteopaths licensed by the Board of Medical Licensure to which the petition is addressed and by two (2) or more recommendations from citizens each having personal knowledge of the activities of the petitioner since the disciplinary penalty was imposed and such facts as may be required by the Board of Medical Licensure.

including any period during which he or she is under probation or parole. The hearing may be continued from time to time as the Board of Medical Licensure finds necessary.

Source: Miss. Code Ann. §41-58-7 (1972, as amended).

Rule 1.13 | Impaired Radiologist Assistants

Part 2621

Chapter 1: Limited X-Ray Machine Operator

Rule 1.1 | Scope. Pursuant to Mississippi Code §41-58-3, an individual who applies ionizing

Rule 1.2 | Definitions.

Rule 1.3 | Limitations. Limited x-ray machine operators may not perform fluoroscopy, both

Rule 1.4 | Requirements. Each limited x-ray-machine operator who is employed to apply ionizing

Rule 1.5 | Renewal. Each limited x-ray machine operator permit will expire June 30 two years

Rule 1.1 | Scope of Practice

Rule 1.2 | Definitions

Rule 1.3 | Physician Acupuncture Licensure Requirements

Rule 1.4 | Non-Physician Qualifications for Licensure.

Applicants for acupuncture licensure must meet the following requirements:

A. Satisfy the Board that he or she is at least twenty-one (21) years of age and of good moral character. B. Satisfy the Board that he or she is a citizen or permanent resident of the United States of America. C. Submit an application for license on a form supplied by the Board, completed in every detail with a recent photograph (wallet-size/passport type) attached. A Polaroid or informal snapshot will not be accepted. D. Pay the appropriate fee as determined by the Board. E. Present a certified copy of birth certificate or valid and current passport. F. Submit proof of legal change of name if applicable (notarized or certified copy of marriage or other legal proceeding). G. Provide information on registration or licensure in all other states where the applicant is or has been registered or licensed as an acupuncturist. H. Provide favorable references from two (2) acupuncturists licensed in the United States with whom the applicant has worked or trained. I. Provide proof, directly from the institution, of successful completion of an educational program for acupuncturists that are in candidacy status or accredited by ACAHM or its predecessor or successor agency that is at least three (3) years in duration and includes a supervised clinical internship. Any foreign applicant must complete the NCCAOM foreign education route for certification, as this ensures that applicants with education outside the US are recognized. J. Possess current and active NCCAOM Diplomate status in Acupuncture or Oriental Medicine. K. If the applicant is a graduate of an international educational program, provide proof that the applicant has demonstrated proficiency in English by one of the following: 1. Passage of the required NCCAOM examinations taken in English.

2. Passage of the TOEFL (Test of English as a Foreign Language) with a score of 580 or higher on the paper-based test (PBT) or with a score of 90 or higher on the computer-based test (iBT). 3. Passage of the TSE (Test of Spoken English) with a score of 50 or higher. 4. Passage of the TOEIC (Test of English for International Communication) with a score of 785 or higher.

L. Provide proof of current cardiopulmonary resuscitation (CPR) certification from either the American Heart Association or the American Red Cross. M. Provide proof of malpractice insurance with a minimum of $1 million dollars in coverage. N. Submit fingerprints for state and national criminal history background checks.

Source: Miss. Code Ann. §73-71-13 (1972, as amended).

Rule 1.5 | Practice Standards

Rule 1.6 | Patient Records

Rule 1.7 | Informed Consent

Rule 1.8 | Duty to Notify Board of Change of Address

Rule 1.9 | Continuing Education.

A. Every acupuncturist must earn or receive not less than thirty (30) hours of acupuncture related continuing education courses as precedent to renewing their license for the next fiscal year. This thirty (30) hours is per two-year cycle. Excess hours may not be carried over to another two-year cycle. For the purpose of this regulation, the two-year period

begins July 1, 2010, and every two years thereafter. Continuing education courses must be sponsored and/or approved by one of the following organizations:

1. Mississippi Council of Advisors in Acupuncture 2. Mississippi Oriental Medicine Association 3. American Society of Acupuncturists 4. National Certification Commission for Acupuncture and Oriental Medicine 5. American Acupuncture Council 6. The Acupuncture and TCM Board of Reproductive Medicine 7. Future NCCAOM approved CEU organizations

B. All persons licensed as acupuncturists must comply with the following continuing education rules as a prerequisite to license renewal. 1. Acupuncturists receiving their initial license to perform acupuncture in Mississippi after June 30 are exempt from the minimum continuing education requirement for the two-year period following their receiving a license. The thirty (30) hour continuing education certification will be due within the next two-year cycle. 2. The approved hours of any individual course or activity will not be counted more than once in a two (2) year period toward the required hour total regardless of the number of times the course or activity is attended or completed by any individual. 3. The Board may waive or otherwise modify the requirements of this rule in cases where there is illness, military service, disability or other undue hardship that prevents a license holder from obtaining the requisite number of continuing education hours. Requests for waivers or modification must be sent in writing to the Executive Director prior to the expiration of the renewal period in which the continuing education is due. 4. Submission of current four-year cycle NCCAOM recertification may count as sufficient in fulfilling the two-year cycle CE requirements in Mississippi, at the discretion of the Executive Director of the board.

Source: Miss. Code Ann. §73-71-13 (1972, as amended).

Rule 1.10 | Violations

Rule 1.11 | Renewal Schedule

The license of every person licensed to practice as an acupuncturist in the state of Mississippi shall be renewed annually.

On or before May 1 of every year, the Board shall notify every acupuncturist who is currently licensed of the forthcoming annual renewal of license. The notice shall provide instructions for obtaining and submitting applications for renewal. The applicant shall obtain and complete the application and submit it to the Board in the manner prescribed by the Board in the notice before June 30 with the renewal fee of an amount established by the Board. The payment of the annual license renewal fee shall be optional with all acupuncturists over the age of seventy (70) years. Upon receipt of the application and fee, the Board shall verify the accuracy of the application and issue to the applicant a license of renewal for the ensuing one (1) year period, beginning July 1 and expiring June 30 of the succeeding licensure period.

An acupuncturist practicing in Mississippi who allows a license to lapse by failing to renew the license as provided in the foregoing paragraph may be reinstated by the Board on satisfactory explanation for such failure to renew, by completion of a reinstatement form, and upon payment of the renewal fee for the current year. If the license has not been renewed within ninety (90) days after its expiration, the renewal shall be assessed a late fee of $200.

Any acupuncturist who allows a license to lapse shall be notified by the Board within thirty (30) days of such lapse.

Any acupuncturist who fails to renew a license within four (4) years after its expiration may not renew that license. The license will become null and void and the acupuncturist will have to apply for and obtain a new license.

Any person practicing as an acupuncturist during the time a license has lapsed shall be considered an illegal practitioner and shall be subject to Mississippi Code Sections 73-71-33 and 73-71-35.

Source: Miss. Code Ann. §73-71-13 (1972, as amended).

Rule 1.12 | Professional Ethics

Rule 1.13 | Disciplinary Proceedings

A. Hearing Procedure an Appeals

No individual shall be denied a license or have a license suspended, revoked or restriction placed thereon, unless the individual licensed as an acupuncturist has been given notice and opportunity to be heard. For the purpose of notice, disciplinary hearings and appeals, the Board hereby adopts and incorporates by reference all provisions of the “Rules of Procedure” now utilized by the Board for those individuals licensed to practice medicine in the state of Mississippi.

B. Reinstatement of License 1. A person whose license to practice as an acupuncturist has been revoked, suspended, or otherwise restricted may petition the Board to reinstate their license after a period of one (1) year has elapsed from the date of the revocation or suspension. The procedure for the reinstatement of a license that is suspended for being out of compliance with an order for support, as defined in Section 93-11-153, shall be governed by Sections 93- 11-157 or 93-11-163, as the case may be. 2. The petition shall be accompanied by two (2) or more verified recommendations from physicians or acupuncturists licensed by the Board to which the petition is addressed and by two (2) or more recommendations from citizens each having personal knowledge of the activities of the petitioner since the disciplinary penalty was imposed and such facts as may be required by the Board.

The petition may be heard at the next regular meeting of the Board but not earlier than thirty (30) days after the petition was filed. No petition shall be considered while the petitioner is under sentence for any criminal offense, including any period during which he or she is under probation or parole. The hearing may be continued from time to time as the Board finds necessary.

3. In determining whether the disciplinary penalty should be set aside and the terms and conditions, if any, which should be imposed if the disciplinary penalty is set aside, the Board may investigate and consider all activities of the petitioner since the disciplinary action was taken against him or her, the offense for which he or she was disciplined, their activity during the time their license was in good standing, their general reputation for truth, professional ability and good character; and it may require the petitioner to pass an oral examination.

Source: Miss. Code Ann. §73-71-13 (1972, as amended).

Rule 1.14 | Impaired Acupuncturists

Rule 1.15 | Use of Professional Titles

Rule 1.16 | Acupuncture Advertising. Misleading or Deceptive Advertising

Rule 1.17 | Sale of Goods from Practitioner’s Office

Part 2630

Chapter 1: Collaboration with Nurse Practitioners

Rule 1.1 | Scope

Rule 1.2 | Definitions

For the purpose of Part 2630, Chapter 1 only, the following terms have the meanings indicated:

A. Physician means any person licensed to practice medicine or osteopathic medicine in the state of Mississippi who holds an unrestricted license, whose practice or prescriptive authority is not limited as a result of voluntary surrender or legal/regulatory order, and who practices within the state of Mississippi for a minimum of twenty (20) hours per week or eighty (80) hours per month (does not include telemedicine or chart review). Exceptions to the in-state practice requirement may be granted by the Board, by and through the Executive Committee, in cases demonstrating good cause. Additionally, temporary permission may be granted by the Executive Director until the request can be heard before the Executive Committee. B. Primary Care Physician means a physician whose practice is limited to, or defined as, Family Practice, General Internal Medicine, Mental Health, Women’s Health, and/or General Pediatrics. C. Extended Mileage Collaboration means a collaborative relationship wherein patients are treated by a nurse practitioner who is located more than seventy-five (75) miles away from the collaborative physician. Excluded from this definition are all licensed hospitals, state health department facilities, federally qualified community health clinics, and volunteer clinics.

D. Primary Office means the usual practice location of a physician and being the same location reported by that physician to the Mississippi State Board of Medical Licensure

and the United States Drug Enforcement Administration as his/her primary practice location.

E. Collaborating/Consulting Physician means a physician who, pursuant to a duly executed protocol, has agreed to collaborate/consult with a nurse practitioner.

F. Nurse Practitioner or APRN means any person licensed to practice nursing in the state of Mississippi and certified by the Mississippi Board of Nursing to practice in an expanded role as a nurse practitioner.

G. Federal Facility means any medical facility that conducts patient care on federal property and is operated directly by the federal government (e.g., the Veteran’s Administration hospitals and clinic system).

H. Protocol or Collaborative Agreement is a contractual document which sets forth the expectations, practice permissions and boundaries of the relationship between the physician and the APRN.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.3 | Duty to Report Collaborative Relationships

Rule 1.4 | Extended Mileage Collaboration and Board Review

Rule 1.5 | Primary Care Extended Mileage

Rule 1.6 | Backup and Emergency Coverage

Rule 1.7 | Billing for Collaborative Oversight

Rule 1.8 | Quality Improvement

Rule 1.9 | Violation of Rules

Rule 1.10 | Federal Facilities

Chapter 2: The Supervision of Pharmacists

Rule 2.1 | Preamble. To optimize the favorable professional working relationship that already

Rule 2.2 | Scope. These rules apply to all individuals licensed to practice medicine or osteopathic

Rule 2.3 | Definitions. For the purpose of Part 2630, Chapter 2 only, the following terms have the

Rule 2.4 | Board Review - Protocol Format.

A. Before any physician shall execute a protocol to supervise a pharmacist in the care or consultation with a patient, or initiation and/or modification of prescription drug therapy, and/or ordering lab work, the supervising physician must jointly execute a written guideline or protocol with the pharmacist and thereafter file the same with the Mississippi State Board of Medical Licensure. B. No protocol agreement authorizing the care or consultation with a patient, or initiation and/or modification of prescription drug therapy shall be executed by a physician unless the protocol shall meet at a minimum the following requirements: 1. Identifies the physician who agrees to supervise the pharmacist and the scope of the physician’s active practice. 2. Describes the specific responsibilities authorized by the supervising physician. 3. Describes the method the pharmacist shall use to document decisions or recommendations the pharmacist makes to the supervising physician. 4. Describes the patient activities the supervising physician requires the pharmacist to monitor. 5. Describes the types of reports the supervising physician requires the pharmacist to report and the schedule by which the pharmacist is to submit these reports. 6. Includes a statement of the medication categories and the type of initiation and modification of drug therapy that the supervising physician authorizes the pharmacist to perform. 7. Describes the procedures or plan that the pharmacist shall follow if the pharmacist exercises initiation and modification of drug therapy. 8. Indicates the date the supervising physician’s supervision ends. The duration of the protocol agreement shall not exceed one (1) year. 9. Be dated and signed by the pharmacist(s) and the supervising physician. If more than one physician agrees to supervise the pharmacist(s), each physician and pharmacist(s) shall sign and date the protocol. 10. Includes a statement that stipulates that the patient has been notified by the pharmacist(s) and the supervising physician that a protocol agreement exists. 11. Includes a statement which certifies that the physician(s) has advised their respective malpractice liability carriers concerning the protocol and supervisory relationship, and that any potential liability that may ensue as a result of implementing the protocol

agreement, shall be covered by the malpractice liability insurance policies or endorsements thereto. C. No protocol agreement authorizing the ordering of lab work by a pharmacist shall be executed by a physician unless the protocol shall meet at a minimum the following requirements: 1. Identifies the physician who agrees to supervise the pharmacist and the scope of the physician’s active practice. 2. Describes the specific responsibilities authorized by the supervising physician, including the type of lab tests the supervising physician authorizes the pharmacist to order. 3. Describes the method the pharmacist shall use to document decisions or recommendations the pharmacist makes to the supervising physician. 4. Describes the patient activities the supervising physician requires the pharmacist to monitor. 5. Describes the types of reports the supervising physician requires the pharmacist to report and the schedule by which the pharmacist is to submit these reports. 6. Describes the procedures or plan that the pharmacist shall follow if the pharmacist orders lab tests. 7. Describes the process which the physician employs to periodically monitor the pharmacist’s interpretation of the lab tests. 8. Indicates the date the supervising physician’s supervision ends. The duration of the protocol agreement shall not exceed one (1) year. 9. Be dated and signed by the pharmacist(s) and the supervising physician. If more than one physician agrees to supervise the pharmacist(s), each physician and pharmacist(s) shall sign and date the protocol. 10. Includes a statement that stipulates that the patient has been notified by the pharmacist(s) and the supervising physician that a protocol agreement exists. 11. Includes a statement which certifies that the physician(s) has advised their respective malpractice liability carriers concerning the protocol and supervisory relationship, and that any potential liability that may ensue as a result of implementing the protocol agreement, shall be covered by the malpractice liability insurance policies or endorsements thereto.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 2.5 | Supervising Physician Limited. No physician shall be authorized to supervise a

Rule 2.6 | Termination or Changes in the Protocol. Any physician desirous of termination or

Rule 2.7 | Violation of Rules/Disapproval of Supervision. Any violation of the rules as enumerated

Rule 1.1 | Scope. The following regulation sets forth the policies of the Mississippi State Board of

Rule 1.2 | Definitions. For the purpose of Part 2635, Chapter 1 only, the following terms have the

Rule 1.3 | Informed Consent. The responsibility for medical and surgical diagnoses is that of the

Rule 1.4 | Post-Surgical Care. The management of post-surgical care is the responsibility of the

Rule 2.1 | Scope. This regulation sets forth the policies of the Mississippi State Board of Medical

Rule 2.2 | Definitions. For the purpose of Part 2635, Chapter 2 only, the following terms have the

meanings indicated:

A. Surgery is defined as any operative procedure, including the use of lasers, performed upon the body of a living human being for the purposes of preserving health, diagnosing or curing disease, repairing injury, correcting deformity or defects, prolonging life, relieving suffering or any elective procedure for aesthetic, reconstructive or cosmetic purposes, to include, but not be limited to: incision or curettage of tissue or organ; suture or other repair of tissue or organ, including a closed as well as an open reduction of a fracture; extraction of tissue including premature extraction of the products of conception from the uterus; insertion of natural or artificial implants; or an endoscopic

procedure. The use of local, general or topical anesthesia and/or intravenous sedation is the prerogative of the surgeon. B. Surgeon is defined as a licensed physician performing any procedure included within the definition of surgery. C. Implicit within the use of the term “equipment” is the requirement that the specific item named must meet current performance standards. D. Office surgery is defined as surgery which is performed outside a hospital, an ambulatory surgical center, abortion clinic, or other medical facility licensed by the Mississippi State Department of Health or a successor agency. Physicians performing Level II or Level III office based surgery must register with the Mississippi State Board of Medical Licensure. A copy of the registration form is attached hereto (Appendix A). E. A Surgical Event for the purpose of this regulation is recognized as a potentially harmful or life-threatening episode related to either the anesthetic or the surgery. Any “Surgical Event” in the immediate perioperative period that must be reported are those which are life-threatening, or require special treatment, or require hospitalization, including, but not limited to the following: (1) serious cardiopulmonary or anesthetic events; (2) major anesthetic or surgical complications; (3) temporary or permanent disability; (4) coma; or (5) death.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 2.3 | General Requirements for Office Surgery. For all surgical procedures, the level of

sterilization shall meet current OSHA requirements.

The surgeon must maintain complete records of each surgical procedure, including anesthesia records, when applicable and the records on all Level II and Level III cases shall contain written informed consent from the patient reflecting the patient’s knowledge of identified risks, consent to the procedure, type of anesthesia and anesthesia provider.

The surgeon must maintain a log of all Level II and Level III surgical procedures performed, which must include a confidential patient identifier, the type of procedure, the type of anesthesia used, the duration of the procedure, the type of post-operative care, and any surgical events. The log and all surgical records shall be provided to investigators of the Mississippi State Board of Medical Licensure upon request.

In any liposuction procedure, the surgeon is responsible for determining the appropriate amount of supernatant fat to be removed from a particular patient. Using the tumescent method of liposuction, the surgeon must fully document the anticipated amount of material to be removed in a manner consistent with recognized standards of care. Post-operatively, any deviation from the anticipated amount, and the reason for deviation, should be fully documented in the operative report. Morbidly obese patients should have liposuction performed in the hospital setting unless the surgeon can document significant advantage to an alternative setting.

A policy and procedure manual must be maintained in the office and updated annually. The policy and procedure manual must contain the following: duties and responsibilities of all personnel, cleaning and infection control, and emergency procedures.

The surgeon shall report to the Mississippi State Board of Medical Licensure any surgical events that occur within the office based surgical setting. This report shall be made within 15 days after the occurrence of a surgical event. A suggested form for reporting is attached hereto (Appendix B). The filing of a report of surgical event as required by this rule does not, in and of itself, constitute an acknowledgment or admission of malpractice, error, or omission. Upon receipt of the report, the Board may, in its discretion, obtain patient and other records pursuant to authority granted in Mississippi Code, Section 73-25-28.

The surgeon must have a written response plan for emergencies within his or her facility.

In offices where Level II and Level III office based surgery is performed, a sign must be prominently posted in the office which states that the office is a doctor’s office regulated pursuant to the rules of the Mississippi State Board of Medical Licensure. This notice must also appear prominently within the required patient informed consent.

Office surgery facilities should adhere to recognized standards such as those promulgated by the American Society of Anesthesiologists’ Guidelines for Office-Based Anesthesia or American Association of Nurse Anesthetists’ Standards for Office Based Anesthesia.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 2.4 | Level I Office Surgery.

A. Scope 1. Level I office surgery includes, but not limited to, the following: i. Minor procedures such as excision of skin lesions, moles, warts, cysts, lipomas, Loop Electrosurgical Excision Procedures (LEEP), laser cone of cervix, laser/cautery ablation of warts or other lesions, and repair of lacerations or surgery limited to the skin and subcutaneous tissue performed under topical or local anesthesia not involving drug-induced alteration of consciousness. ii. Incision and drainage of superficial abscesses, limited endoscopies such as proctoscopies, flexible sigmoidoscopies, hysteroscopies, skin biopsies, arthrocentesis, paracentesis, dilation of urethra, cystoscopy procedures, and closed reduction of simple fractures or small joint dislocations (i.e., finger and toe joints). iii. Procedures requiring only topical, local or no anesthesia. Only minimal or no preoperative sedation should be required or used. No drug-induced alteration of respiratory effort or consciousness other than minimal pre-operative tranquilization of the patient is permitted in Level I Office Surgery. iv. Chances of complication requiring hospitalization are remote. 2. Standards for Level I Office Surgery i. Training Required

The surgeon's continuing medical education should include management of toxicity or hypersensitivity to local anesthetic drugs. The surgeon’s continuing medical education shall include Basic Life Support Certification.

ii. Equipment and Supplies Required

Oral airway, positive pressure ventilation device, epinephrine (or other vasopressor), corticosteroids, antihistamines and atropine, if any anesthesia is used. The equipment and skills to establish intravenous access must be available if any other medications are

administered. The equipment and supplies should reflect the patient population, i.e., pediatrics, etc.

iii. Assistance of Other Personnel Required

No other assistance is required, unless the specific surgical procedure being performed requires an assistant.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 2.5 | Level II Office Surgery.

A. Scope 1. Level II Office Surgery is that in which perioperative medication and sedation are used orally, intravenously, intramuscularly, or rectally. If perioperative or intraoperative medication is administered, intraoperative and postoperative monitoring is required. Such procedures include, but are not limited to: hernia repair, hemorrhoidectomy, reduction of simple fractures, large joint dislocations, breast biopsies, dilatation and curettage, thoracentesis, and colonoscopy. 2. Level II Office surgery also includes any surgery in which the patient is sufficiently sedated to allow the patient to tolerate unpleasant procedures while maintaining adequate cardiorespiratory function and the ability to respond purposefully to verbal command and/or tactile stimulation. Patients whose only response is reflex withdrawal from a painful stimulus are sedated to a greater degree than encompassed by this definition. 3. Any procedures that may yield an excessive loss of blood should be covered under Level II. B. Transfer Agreement Required

The surgeon must have a written transfer agreement from a licensed hospital within reasonable proximity. The transfer agreement should also include physician coverage of transferred patients if the physician does not have privileges at the hospital.

C. Level of Anesthetic

Local or peripheral nerve block, including Bier Block, plus intravenous or intramuscular sedation, but with preservation of vital reflexes.

D. Training Required

To perform office-based surgery, the physician must be able to document satisfactory completion of surgical training such as Board certification or Board eligibility by a Board approved by the American Board of Medical Specialties or American Board of Osteopathic Specialties. The certification should include training in the procedures performed in the office setting. Alternative credentialing for procedures outside the physician’s core curriculum must be applied for through the Mississippi State Board of Medical Licensure and reviewed by a multi-specialty board appointed by the Director. In addition to the surgeon, there must be at least one assistant certified in Basic Life Support present during any Level II or III procedure. There should be at least one person certified in Advanced Cardiac Life Support present during any Level II or III procedure unless there is an anesthesiologist or certified registered nurse anesthetist to manage the anesthetic.

E. Equipment and Supplies Required 1. Full and current crash cart at the location the anesthetizing is being carried out.

The crash cart must include, at a minimum, the following resuscitative medications, or other resuscitative medication subsequently marketed and available after initial adoption of this regulation, provided said medication has the same FDA approved indications and usage as the medications specified below:

i. Adrenalin (epinephrine) Abboject 1mg-1:10,000; 10ml ii. Adrenalin (epinephrine) ampules 1mg-1:1000; 1ml iii. Atropine Abboject 0.1mg/ml; 5ml iv. Benadryl (diphenhydramine) syringe 50mg/ml; 1ml v. Calcium chloride Abboject 10%; 100mg/ml; 10ml vi. Dextrose Abboject 50%; 25g/50ml vii. Dilantin (phenytoin) syringe 250mg/5ml viii. Dopamine 400mg/250ml pre-mixed ix. Heparin 10,000 units/ml; 1 ml vial x. Inderal (propranolol) 1mg/ml; 1 ml ampule xi. Isuprel (isoproterenol) 1mg/5ml; 1:5000 ampule xii. Lanoxin (digoxin) 0.5 mg/2ml ampule xiii. Lasix (furosemide) 40 mg/4ml vial xiv. Lidocaine Abboject 2%; 100mg/5ml xv. Lidocaine 2 grams/500ml pre-mixed xvi. Magnesium sulfate 50%; 20ml vial (1g/2ml) xvii. Narcan (naloxone) 0.4mg/ml; 1ml ampule xviii. Pronestyl (procainamide) 100mg/ml; 10ml vial xix. Romazicon 5ml or 10 ml (0.1mg/ml) xx. Sodium bicarbonate Abboject 50mEq/50ml xxi. Solu-medrol (methylprednisolone) 125mg/2ml vial xxii. Verapamil syringe 5mg/2ml

The above dosage levels may be adjusted, depending on ages of the patient population.

2. Suction devices, endotracheal tubes, laryngoscopes, etc. 3. Positive pressure ventilation device (e.g., Ambu) plus oxygen supply. 4. Double tourniquet for the Bier Block procedure. 5. Monitors for blood pressure/EKG/Oxygen saturation and portable approved defibrillator. 6. Emergency intubation equipment. 7. Adequate operating room lighting with onsite backup sufficient to supply required equipment perioperative equipment and monitors for a minimum of two (2) hours. 8. Sterilization equipment or facilities meeting Joint Commission requirements. 9. IV solution and IV equipment. F. Assistance of Other Personnel Required

In addition to the surgeon there must be at least one assistant certified in Basic Life Support present during any Level II or III procedure. There should be at least one person certified in Advanced Cardiac Life Support present during any Level II or III procedure unless there is an anesthesiologist or certified registered nurse anesthetist to manage the anesthetic.

A registered nurse may only administer analgesic doses of medications on the direct order of a physician. An assisting anesthesia provider, including nurse providing sedation, may not function in any other capacity during the procedure. If additional assistance is required

by the specific procedure or patient circumstances, such assistance must be provided by a physician, registered nurse, licensed practical nurse, or operating room technician.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 2.6 | Level III Office Surgery.

A. Scope 1. Level III Office Surgery is that surgery which involves, or might foreseeably require, the use of a general anesthesia or major conduction anesthesia and perioperative sedation. This includes the use of: i. Intravenous sedation beyond that defined for Level II office surgery; ii. General Anesthesia: loss of consciousness and loss of vital reflexes with probable requirement of external support of pulmonary or cardiac functions; or iii. Major Conduction anesthesia.

2. Only patients classified under the American Society of Anesthesiologist’s (ASA) risk classification criteria as Class I, II, or III are appropriate candidates for Level III office surgery. For ASA Class III patients, the surgeon must document in the patient’s record the justification for an office procedure rather than other surgical venues. The record must also document precautions taken that make the office a preferred venue for the particular procedure to be performed. B. Transfer Agreement Required

The surgeon must have a written transfer agreement from a licensed hospital within reasonable proximity. The transfer agreement must include physician coverage of transferred patients if the physician does not have privileges at the hospital. Level of Anesthetic

1. General Anesthetic: loss of consciousness and loss of vital reflexes with probable requirement of external support of pulmonary or cardiac functions. 2. Major Conduction: epidural, spinal, caudal or any block of a nerve or plexus more proximal than the hip or shoulder joint including visceral nerve blocks. C. Training Required 1. To perform office based surgery, the physician must be able to document satisfactory completion of surgical training such as board certification or board eligibility by a board approved by the American Board of Medical Specialties or American Board of Osteopathic Specialties. The certification should include training in the procedures performed in the office setting. Alternative credentialing for procedures outside the physician’s core curriculum must be applied for through the Mississippi State Board of Medical Licensure and reviewed by a multi-specialty board appointed by the Executive Director. 2. In addition to the surgeon there must be at least one assistant certified in Basic Life Support present during any Level II or III procedure. There should be at least one person certified in Advanced Cardiac Life Support present during any Level II or III procedure unless there is an anesthesiologist or certified registered nurse anesthetist to manage the anesthetic. 3. Emergency procedures related to serious anesthesia complications should be formulated, periodically reviewed, practiced, updated, and posted in a conspicuous location.

D. Equipment and Supplies Required 1. Equipment, medication and monitored post-anesthesia recovery must be available in the office. If anesthetic agents include inhaled agents, other than nitrous oxide, medications must include a stock of no less than 12 vials of Dantrolene. 2. The facility, in terms of general preparation, equipment, and supplies, must be comparable to a free standing ambulatory surgical center, including, but not limited to, recovery capability, and must have provisions for proper record keeping. 3. Blood pressure monitoring equipment; EKG; end tidal CO2 monitor; pulse oximeter, precordial or esophageal stethoscope, emergency intubation equipment and a temperature monitoring device must be available for all phases of perioperative care. 4. Table capable of Trendelenburg and other positions necessary to facilitate the surgical procedure. 5. IV solutions and IV equipment. 6. All equipment and supplies listed under Part 2635, Rule 2.5, Level II. E. Assistance of Other Personnel Required

An anesthesiologist or certified registered nurse anesthetist must administer the general or regional anesthesia and a physician, registered nurse, licensed practical nurse, or operating room technician must assist with the surgery. The anesthesia provider may not function in any other capacity during the procedure. A licensed physician or a licensed registered nurse with post-anesthesia care unit experience or the equivalent, and credentialed in Advanced Cardiac Life Support, or in the case of pediatric patients, Pediatric Advanced Life Support, must be available to monitor the patient in the recovery room until the patient has recovered from anesthesia.

Effective Date of Rules. The above rules pertaining to office based surgery shall become effective September 1, 2001.

Adopted July 31, 2001. Amended April 18, 2002, with a June 1, 2002, effective date. Amended September 19, 2002. Amended March 16, 2017.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Part 2635

Chapter 5: Practice of Telemedicine

Rule 5.1 | Definitions

For the purpose of Part 2635, Chapter 5 only, the following terms have the meanings indicated:

A. Provider means any physician or physician assistant who holds an unrestricted license to practice medicine in the state of Mississippi. B. Telemedicine is the practice of medicine by a licensed healthcare provider using HIPAA-compliant telecommunication systems, including information, electronic, and communication technologies, remote monitoring technologies and store-and-forward transfer technology. These technologies may be used to facilitate, but are not limited to, provider to patient or provider to provider interactions. The technology must be capable of replicating the interaction of a traditional in-person encounter between a provider and a patient. This definition does not include the practice of medicine through postal or courier services. C. Emergency Telemedicine is a unique combination of telemedicine used in a consultative interaction between a physician board certified, or board eligible, in emergency medicine, and an appropriate skilled health professional (nurse practitioner or physician assistant).

D. Primary Center is any facility providing telemedicine services to Satellite Centers, as defined in definition ‘G’. E. Remote Monitoring is defined as the use of technology to remotely track health care data for a patient released to his or her home or a care facility, usually for the intended purpose of reducing readmission rates. F. Real-Time Telemedicine is defined as real-time communication using interactive audio and visual equipment, such as a video conference with a specialist, also known as ‘synchronous communication.’ G. Satellite Center is any facility receiving telemedicine services from a Primary Center, as defined in definition ‘D’. H. Store-and-Forward Transfer Technology is defined as technology which facilitates the gathering of data from the patient, via secure email or messaging service, which is then used for formulation of a diagnosis and treatment plan, also known as ‘asynchronous communication.’

Source: Miss. Code Ann. §73-25-34 (1972, as amended).

Rule 5.2 | Licensure

Rule 5.3 | Informed Consent

Rule 5.4 | Physician Patient Relationship

Rule 5.5 | Examination

Rule 5.6 | Medical Records

Rule 5.7 | Consultative Physician Limited

Rule 5.8 | Reporting Requirements

Rule 5.9 | Automated Dispensaries

Chapter 8: Medical Expert Activities by Physicians

Rule 8.1 | Authority and Purpose. The Mississippi State Board of Medical Licensure (hereinafter

Rule 8.2 | Scope. These rules apply to any physician who performs medical expert activities

Rule 8.3 | Definition of Medical Expert Activities. For the purposes of these rules only, the

Rule 8.4 | Licensure and Qualification Requirements. Except as otherwise provided by law, rule

Rule 8.5 | Professional Standards. Any physician who performs medical expert activities must:

Rule 8.6 | Professional Accountability for Violation of Rules. Any physician who performs medical

Rule 8.7 | Complaint Procedure, Investigation, Due Process, and Actions Available to the Board.

Any person who has reason to believe that any physician may have failed to comply with any part of these rules in the performance of medical expert activities may make a complaint to the Mississippi State Board of Medical Licensure on a complaint form that is furnished by the Board.

Any physician, whether or not licensed to practice medicine in Mississippi, who performs medical expert activities in the context of a legal matter regarding any person, facility, entity, or event located within the state of Mississippi may be subject to an investigation by the Mississippi State Board of Medical Licensure upon the receipt of a complaint regarding the physician’s conduct or practice. Any such physician shall be afforded the due process procedures of the law and Board rules. The Board, in its sole discretion, may refer the complaint to the medical licensure authority of another state, or to any other appropriate legal authority.

Any physician may request, or may be summoned by the Board, to appear before the Board at a hearing to consider the physician’s compliance with these rules. Any physician’s failure to appear when summoned to a hearing may be deemed by the Board to be a waiver of the physician’s due process opportunity to appear before the Board and may result in a finding by the Board that the physician is out of compliance with these rules in absentia.

In disciplining a physician licensed to practice medicine in Mississippi or otherwise holding any physician professionally accountable pursuant to these rules and to the statutes, rulings, and other rules and provisions of Mississippi law, the actions that the Mississippi State Board of Medical Licensure may take include, but are not limited to, one or more of the following:

A. Denying, suspending, restricting, or revoking a Mississippi license to practice medicine. B. Administering a public or private reprimand to a Mississippi licensed physician. C. Assessing up to $10,000 of the reasonable investigation costs expended by the Board in investigating a Mississippi licensed physician. D. Moving for an injunction in Chancery Court to prohibit any physician’s further performance of medical expert activities. E. Petitioning the Chancery Court to cite any noncompliant physician for contempt of court. F. Referring the matter to another medical licensure authority or other legal authority for action regarding any physician. G. Any other action regarding any physician that the Board may deem proper under the circumstances (e.g., issuing an advisory letter of concern; issuing a notice of warning; issuing a cease and desist notice; or adopting a resolution of disapproval of any physician’s medical expert activities).

Any physician who is found by the Mississippi State Board of Medical Licensure to have failed to comply with any part of these rules may be reported by the Board to any person or organization appropriate under the circumstances in order to enforce or comply with the law or to protect the public, including, but not limited to, the National Practitioner Data Bank, the U.S. Department of Health and Human Services Office of the Inspector General, the Centers for Medicare and Medicaid Services, the Federation of State Medical Boards, the medical licensure authority or state medical association in any state in which the physician is licensed to practice medicine, the American Board of Medical Specialties and any of its member specialty boards, the Mississippi Attorney General or District Attorney, the United States Attorney, any state or federal court or administrative agency, any national or state professional organization or medical specialty association, and any other appropriate person, government agency, healthcare entity, or legal authority.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 8.8 | Compliance Policy and Exemptions. In assuring compliance with these rules, the duty

shall be on the physician, not on the party who engaged the physician to perform medical expert activities and not on any other person or entity, to ensure that his or her medical expert activities comply with these rules. Any physician who claims to be exempt from these rules shall have the burden of proving to the Board that the exemption is valid.

Amended May 20, 2010.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

References.

Mississippi Code, Sections 11-1-61, 73-25-27, 73-25-29, 73-25-30, 73-25-33, 73-25-34, 73-25- 83, 73-25-87, 73-43-11, 73-51-1, et al

Mississippi Rule of Evidence 702

“Rules, Laws, and Policies of the Mississippi State Board of Medical Licensure.” Published by the Mississippi State Board of Medical Licensure and available at Internet address www.msbml.ms.gov

Hall v. Hilbun, 466 So. 2d 856 (Miss. 1985)

Code of Medical Ethics, Current Opinions with Annotations. Published by the Council on Ethical and Judicial Affairs of the American Medical Association, 2006-07 edition.

“The Role of Licensing Boards in the Evaluation and Discipline of the Expert Witness.” Authored by William J. Wenner, Jr., M.D., J.D. Published in the Journal of Medical Licensure and Discipline, Vol. 90, No. 3, 2004, Pp. 15-20 (collecting cases and scholarly publications)

Findings of Fact adopted by the Mississippi State Board of Medical Licensure on May 18, 2006.**

**COMMENT: Based on information presented to the Board at a public hearing on this matter on March

9, 2006, and on May 18, 2006, and on research and analysis of information obtained by Board members and its staff and attorneys, and also on comments received from numerous sources, including the Board’s Consumer Health Committee, leaders of the medical and legal professions, former judges, officials from the Federation of State Medical Boards, and members of the public, the Mississippi State Board of Medical Licensure makes the following Findings of Fact:

1. A physician’s professional practice, conducted pursuant to the privilege of possessing a medical license, historically has been subject to regulation by other members of the medical profession, by methods such as peer review, performance evaluation, quality assurance monitoring, and other methods of regulation. However, there is a problem in Mississippi with the lack of regulation of medical expert activities by physicians. This lack of regulation causes the performance of medical expert activities to be vulnerable to fraud, abuse, dishonesty, deception, incompetence, and other forms of unprofessional, dishonorable, and unethical conduct by physician experts, all of which are harmful to the public.

2. A physician’s performance of medical expert activities involves a lawful part of a physician’s practice that is historically an area of state concern and that the Board has the statutory authority and duty to regulate in order to protect the public.

3. A physician’s medical expert activities involve practices that are likely to affect the health, safety, rights, remedies, and general welfare of persons in Mississippi.

4. In keeping with the public policy and provisions of law in Mississippi, the performance of medical expert activities, regardless of the physician expert’s location or state(s) of medical licensure, is a lawful practice that requires a qualified physician, and is therefore subject to regulation by, and professional accountability to, the Mississippi State Board of Medical Licensure.

5. Due to its physician membership and statutory authority, the Mississippi State Board of Medical Licensure is uniquely able to establish and enforce licensure requirements, qualification requirements, and Professional Standards related to the performance of medical expert activities by physicians, especially with regard to ethical conduct and competent practice.

6. Regardless of a physician’s state(s) of medical licensure, a physician who performs medical expert activities in a legal matter has an ethical duty to practice according to the standards of medical professionalism, to perform all medical expert activities in an honest and competent manner, and to strive to report to appropriate entities any physician who is deficient in character or competence or who engages in fraud or deception.

7. In keeping with the public policy and provisions of law in Mississippi and principles of medical ethics, it is unprofessional, dishonorable, and unethical for a physician to willfully state an opinion or a material fact as a medical expert in the context of a legal matter that the physician knows or should know is false, or that a reasonable person could objectively conclude was a misrepresentation or other distortion of the truth, or was intended by the physician to mislead or deceive a judge, juror, lawyer, litigant, other expert, hearing officer, administrative body, investigator, legal authority, or any finder of fact.

8. In adopting these rules, the Mississippi State Board of Medical Licensure has attempted to tailor these rules as closely as possible to the current provisions of Mississippi law, in order to regulate medical expert activities for the legitimate government purpose of protecting the public and to further other legitimate government purposes in the public interest.

9. In adopting these rules, the Mississippi State Board of Medical Licensure states that its intent is only to regulate the conduct and practice of physicians who perform medical expert activities in Mississippi. The Board does not intend for these rules to be subverted or misused by participants in legal proceedings as a procedural weapon to intimidate or harass a physician expert or to delay or otherwise complicate the administration of justice.

The Mississippi State Board of Medical Licensure shall provide a copy of these rules, with these Comments appended, to the Mississippi Supreme Court, the Mississippi Court of Appeals, the respective conferences of the Mississippi Circuit, Chancery, and County Judges, the Administrative Office of the Courts, the Mississippi Attorney General, the United States District Courts and United States attorneys located in Mississippi, the Mississippi Workers’ Compensation Commission, the Mississippi Bar Association, the Mississippi State Medical Association, the Federation of State Medical Boards, and any other appropriate person or organization at the discretion of the Board’s Executive Director, with the request that those organizations give notice to their members or other interested parties of the existence of these rules.

Part 2635 Chapter 9 Community-Based Immunization Programs

Rule 9.1 | Scope. The administration of vaccinations constitutes the practice of medicine, as

Rule 9.2 | Position. It is the position of the Mississippi State Board of Medical Licensure that

Chapter 10: Maintenance, Production, and Release of Medical Records

Rule 10.1 | Definitions. For the purpose of Part 2635, Chapter 10 only, the following terms have

Rule 10.2 | Medical Records - Property of Licensee. Medical records, as defined herein, are and

Rule 10.3 | Record Retention

Rule 10.4 | Regulatory and Legal Requests

Rule 10.5 | Transfer of Patient Records to Another Licensee

Rule 10.6 | Release of Patient Records to Patient

Rule 10.7 | Narrative Summary of Medical Record

Rule 10.8 | Duplication and Administrative Fees

Rule 10.9 | Exclusion

Rule 10.10 | Violation of Rules

Chapter 12: Physician Advertising

Rule 12.1 | Scope. The following rule on physician advertising applies to all individuals licensed

Rule 12.2 | Definitions. For the purpose of Part 2635, Chapter 12 only, the following terms have

Rule 12.3 | Requirements.

A. Subject to the requirements set forth herein below, any advertisement by a physician may include: 1. The educational background or specialty of the physician. 2. The basis on which fees are determined, including charges for specific services.

3. Available credit or other methods of payment. 4. Any other non-deceptive information. B. A physician may publicize himself or herself as a physician through any form of advertisement, provided the communication, (i) shall not be misleading because of the omission of necessary information, (ii) shall not contain any false or misleading statement, or (iii) shall not otherwise operate to deceive. C. Because the public may be deceived by the use of medical terms or illustrations that are difficult to understand, physicians should design the advertisement to communicate the information contained therein to the public in a readily comprehensible manner. D. It is unethical to advertise in such a manner as to create unjustified medical expectations by the public. The key issue is whether advertising or publicity is true and not materially misleading. E. In addition to the above general requirements, any advertisement or other form of public communication shall comply with the following specific requirements: 1. All advertisements and written communications pursuant to these rules shall include the name of at least one (1) physician responsible for its content. In the case of office signage at least one sign in reasonable proximity to the main entrance must bear the name of the responsible physician. 2. Whenever a physician is identified in an advertisement or other written communication, the physician should not be identified solely as “Doctor” or “Dr.” but shall be identified as M.D. for medical doctors, D.O. for osteopathic physicians and D.P.M. for podiatric physicians. 3. A physician who advertises a specific fee for a particular service or procedure shall honor the advertised fee for at least ninety (90) days unless the advertisement specifies a longer period; provided that for advertisements in the yellow pages of a telephone directory or other media not published more frequently than annually, the advertised fee shall be honored for no less than one (1) year following publication. 4. A physician shall not make statements which are merely self-laudatory or statements describing or characterizing the quality of the physician's services. 5. No physician shall advertise or otherwise hold himself or herself out to the public as being “Board Certified” without, (i) a complete disclosure in the advertisement of the specialty board by which the physician was certified, and (ii) can submit proof of current certification by a specialty board recognized by the American Board of Medical Specialties or the American Osteopathic Association. The term “Board Certified” frequently appears in conjunction with a list of services that the physician or clinic provides. The general public could easily be misled into thinking that the physician is certified in all of those services. 6. No physician shall hold himself or herself out as a specialist in a particular field unless that physician has either, (i) completed a residency program recognized by the Accreditation Council for Graduate Medical Education, by the American Osteopathic Association or by the American Podiatric Medical Association and can submit proof that such training was completed, or (ii) can submit proof that the licensee was “grandfathered” into a specialty by board certification by a recognized specialty board of the American Board of Medical Specialties or the American Osteopathic Association.

7. No physician shall compare his or her service with other physicians' services, unless the comparison can be factually substantiated; this precludes the use of terms such as “the best,” “one of the best,” or “one of the most experienced” or the like. 8. Where an advertisement includes a consumer-endorser's experience (i.e., patient testimonials), the advertisement must contain clear and prominent disclosure of (a) what the generally expected outcome would be in the depicted circumstances, and (b) the limited applicability of the endorser's experience. Although testimonials and endorsements are authorized under this rule, compliance will be strictly monitored as endorsements and testimonials are inherently misleading to the lay public and to those untrained in medicine. 9. Any claims of success, efficacy or result (i.e., cure) must have scientific evidence in substantiation of such claims. 10. Any claims that purport to represent “typical” results (results that consumers will generally achieve) must be based on a study of a sample of all patients who entered the program, or, if the claim refers to a subset of those patients, a sample of that subset. 11. Any claim made regarding the safety of a medical procedure or drug must also disclose the risk of adverse medical complications. 12. No physician shall claim to have any drug or medication or use of a drug or medication for a specific ailment or condition unless such drug or medication has an F.D.A. approved indication for such purpose. 13. Any claim that improvements can be achieved through surgery in a specified time period must also include disclosure of the typical recovery time. F. Consistent with federal regulatory standards which apply to commercial advertising, a physician who is considering the placement of an advertisement or publicity release, whether in print, radio or television, should determine in advance that the communication or message is explicitly and implicitly truthful and not misleading. These standards require the advertiser to have a reasonable basis for claims before they are used in advertising. The reasonable basis must be established by those facts known to the advertiser, and those which a reasonable, prudent advertiser should have discovered. G. The above rules do not prohibit physicians or clinics from authorizing the use of the physician's name or clinic name in medical directories, HMO directories, preferred provider agreements or other communications intended primarily for referral purposes.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 12.4 | Violation of Rules. The above rules on physician advertising shall not be interpreted to

Chapter 13: Complementary and Alternative Therapies

Rule 13.1 | Scope and Purpose

Rule 13.2 | Definitions

Rule 13.3 | Alternative Medicine Practices

The Board is aware that a growing number of licensees and patients are both implementing and seeking complementary and alternative medicine in their health care. Further, the Board recognizes that innovative practices that could benefit patients and improve care should be given reasonable and responsible degrees of latitude.

In reviewing this subject, the Board is also aware of the fact that consumer fraud occurs across the country, and, unfortunately, not infrequently in the practice of medicine. If consumer protection means anything, it should protect people weakened by illness from the dangers attendant to unsound, invalidated, and/or otherwise unsubstantiated practices. Licensees should never agree to perform invalidated or unsound treatments or therapies.

The Board feels that licensees may incorporate alternative therapies if research results are promising, and only if the methods utilized are reasonably likely to benefit patients without undue risk. A full and frank discussion of the risks and benefits of all medical practices is expected, and is in the patient’s best interest.

Licensees should practice pursuant to informed and shared decision making when determining the utilization of complementary therapies. This style of process is conducive to openly weighing the risks and benefits of the therapies under consideration. While this process is ideal, the licensee is ultimately responsible for the decision-making process.

Where evidence is unavailable for a particular treatment in the form of clinical trials or case studies, licensees must only proceed with an appropriate rationale for the proposed treatment, and justification of its use, in relation to the patient’s symptoms or condition. Novel, experimental, and unproven interventions should only be proposed when traditional or accepted proven treatment modalities have been exhausted. In such instances, there must still be a basis in theory or peer- acknowledged practice. The burden rests solely on the licensee in regard to the substantiation supporting the use of a particular therapy. Licensees should be prepared to support any claims made about benefits of treatments or devices with documented evidence, for example with studies published in peer-reviewed publications.

Licensees must refrain from charging excessive fees for treatments provided. Further, licensees should not recommend, provide, or charge for unnecessary medical services, nor should they make intentional misrepresentations to increase the level of payment they receive.1

1 American Medical Association, Code of Medical Ethics, Opinion 11.3.1.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 13.4 | Informed Consent

Rule 13.5 | Evaluation

Rule 13.6 | Treatment Plan

Rule 13.7 | Medical Records

Rule 13.8 | Education

Rule 13.9 | Advertising

As to the advertising of alternative therapies, data purportedly supporting unproven interventions commonly undermines information about risks and overemphasizes information about benefits. Information presented in advertising, including but not limited to clinic websites and social media,

shall be represented accurately and come from reputable peer-reviewed publications or respected external organizations.

Even where an appropriate informed consent process seems to be in place, deceptive or fraudulent information contained within practice advertising, websites, and other marketing materials could mislead patients into consenting to treatment, thereby invalidating the informed consent process.

Treatment options described and accompanied by supporting information in the form of journal articles, patient testimonials, claims of partnerships with academic institutions, mentions of affiliations with professional societies or networks, statements regarding receipt of FDA approval or explicit mention of exemption from FDA oversight, listings of patents granted, statements that clinical trials of investigational interventions are being conducted, and accolades related either to the practice itself or its affiliated physicians and researchers, which serve to exaggerate, inflate, or misrepresent information derived from legitimate or questionable sources, shall be deemed a violation of the Board’s advertising regulations1 and unprofessional conduct likely to deceive, defraud, or harm the public.2

1 Title 30, Part 2635 Chapter 12: Physician Advertising

2 Miss. Code Ann., §73-25-29(8)(d)

Although not all-encompassing, the following represents instances of improper or misleading advertising practices which the Board would consider unprofessional and deceptive in nature:

1. Asserting certification of products or practices by international standards organizations or claiming training certification, in order to legitimize alternative therapies; 2. Convening scientific or medical advisory boards featuring prominent business leaders and academic faculty members in order to legitimize alternative therapies; 3. Registering trials whose apparent purpose is solely to attract patients willing to pay to participate in them; 4. Using the statement or impression of “ethics review” to convey a sense of legitimacy to products or procedures; 5. Renting of laboratory or business space within a legitimate scientific or government institution in order to legitimize alternative therapies; 6. Using membership in established academic or professional societies to suggest legitimacy by association; 7. Publication of open-ended voluntary monitoring data sets rather than undertaking controlled clinical trials; 8. Suggesting that patent applications or grants indicate clinical utility rather than initiation of an application process or recognition of novelty and inventiveness; 9. Publishing research and commentary in journals with limited anonymous peer review; 10. Citing preclinical and other research findings to justify clinical application without sufficient efficacy testing in humans;

11. Forming organizations to self-regulate in ways that support premature commercialization; and 12. Providing expert opinions or celebrity comments on unsupported clinical uses or standing of the provider.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 13.10 | Violation of Rules

Rule 14.1 | Scope and Purpose

Rule 14.2 | Definitions

Rule 14.3 | Athletic Team Physicians

Rule 14.4 | Violation of Rules

Chapter 15: Hospice Practice

Rule 15.1 | In-Home Hospice Good Faith

Recognizing the unique team-based approach utilized when treating in-home hospice patients, the following represents four factors required to establish a proper physician-patient relationship:

i) The medical director must receive an order from the treating/referring physician requesting the patient be admitted for hospice care. Self-referral by the physician medical director may be necessary, and on those occasions, a second physician must be consulted to affirm the decision for hospice admission. Physician Medical Directors who self-refer a patient to their hospice, or to any hospice with whom the director has a contractual relationship, must obtain informed consent from the patient. Additionally, Physician Medical Directors must disclose to the primary care provider for the patient, in writing, that the patient has been admitted to hospice;

ii) That the treating hospice physician or medical director has thoroughly reviewed the medical records of the patient, as provided by the referring physician, has documented the review, and has determined just cause exists for hospice admission (expected death in six months or less), with documented follow-up review at every certification period thereafter;

iii) That the actions of the physician are deemed within the course of legitimate professional practice, as defined by the Centers for Medicare and Medicaid Services (CMS); and

iv) That an evaluation of the patient occurs no later than thirty (30) days after the admission of the patient to hospice. The evaluation shall consist of either a face to face with the physician, face to face with a mid-level provider (PA or APRN), or a telemedicine visit by the medical director with nursing support in the home. Regardless of how the evaluation is accomplished, the author of any controlled substance prescriptions must have evaluated the patient within the thirty (30) day time-period.

It shall be considered unprofessional conduct for a medical director to participate in active recruitment for patient admission to hospice. For the purposes of this regulation, the term “active recruitment” shall mean any unsolicited interaction with a patient for the purposes of convincing a patient to enroll in hospice. As an example: having hospice staff or affiliates visit nursing home patients, with whom the physician has no prior relationship, for the ultimate purpose of soliciting their enrollment in hospice.

It shall be considered unprofessional conduct for physicians to document participation at Inter- Disciplinary Group (IDG)1 meetings when they did not attend the meeting(s).

1 As defined in The Social Security Act, Title 18, §1861 (dd)(2)(B), as amended.

Nothing in this section shall preclude a hospice physician from fulfilling their duties to provide physician services as needed to hospice patients.

Adopted February 3, 2020.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Chapter 16: Medical Examiners

Rule 16.1 | Scope and Purpose

Rule 16.2 | Definitions

Rule 16.3 | Temporary Practice

Rule 16.4 | Violation of Rules

Part 2640

Chapter 1: Rules Pertaining to Prescribing, Administering and Dispensing of

Rule 1.1 | Scope.

Rule 1.2 | Definitions.

For the purpose of Part 2640, Chapter 1 only, the following terms have the meanings indicated:

A. Administer, Controlled Substances, and Ultimate User shall have the same meaning as set forth in Mississippi Code, Section 41-29-105, unless the context otherwise requires. B. Board means the Mississippi State Board of Medical Licensure. C. Physician means any person licensed to practice medicine, osteopathic medicine or podiatric medicine in the state of Mississippi. D. Physician Assistant means any person meeting the requirements of licensure in the state of Mississippi as required by Part 2617, Chapter 1. E. Licensee means any person licensed by this Board who has prescriptive authority. F. Prescriptive Authority means the legal authority of a professional licensed to practice medicine in the state of Mississippi to prescribe, administer, or dispense legend drugs. Licensees holding or possessing certain license types and training, such as Medical Doctors

(MD) and Doctors of Osteopathic Medicine (DO) for example, are conferred prescriptive authority by virtue of their training and licensure by the board. G. Prescribe means to designate or order by means of either a written or oral prescription the delivery of a controlled substance or legend drug to an ultimate user. H. Dispense means to deliver a controlled substance or legend drug other than by administering or prescribing to an ultimate user or research subject including the packaging, labeling, or compounding necessary to prepare the substance for that delivery. I. For the purpose of enforcement of the labeling requirements set forth in this chapter, Part 2640, Rule 1.7.B, Dispensing Physician means any physician who dispenses to a patient for the patient's use any controlled substance, legend drug or other medication where such medication is purchased by the physician for resale to a patient whether or not a separate charge is made. As stated in Part 2615, it is understood that Physician Assistants may not dispense medications. J. Prescription Drug or Legend Drug means a drug required under federal law to be labeled with the following statement prior to being dispensed or delivered; “Caution: Federal law prohibits dispensing without prescription,” or a drug which is required by any applicable federal or state law or regulation to be dispensed on prescription only or is restricted to use by licensees only. K. Pain Management Practice means a public or privately-owned practice for which 50% or more of the patients are issued, on a regular or recurring basis, a prescription for opioids, barbiturates, benzodiazepines, carisoprodol, butalbital compounds, or tramadol for the treatment of chronic non-cancerous/non-terminal pain. Included in this definition is any practice that advertises and/or holds itself out to provide pain management services. Patients who are treated for pain resulting from a terminal illness do not count against the percentage stated herein. L. Inpatient means a patient in a hospital, nursing home, long term care facility, inpatient (not home-bound) hospice, or any other facility wherein medications are dispensed to a patient by a third party who is duly licensed and/or certified to dispense medications in a healthcare or related facility.

Amended April 16, 2024.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.3 | Registration for Controlled Substances Certificate.

Every licensee who prescribes, administers or dispenses any controlled substance within Mississippi or who proposes to engage in the prescribing, administering or dispensing of any controlled substance within Mississippi must be registered with the U.S. Drug Enforcement Administration in compliance with Title 21 CFR Part 1301 Food and Drugs.

Each individual who is licensed by the Mississippi State Board of Medical Licensure and has prescriptive authority must be registered with the Mississippi Prescription Monitoring Program (MPMP). Every licensee who provides medical care in a pain management practice as defined in Rule 1.2 (K) must review the MPMP at each patient encounter in which a prescription for a controlled substance is issued. Every licensee, regardless of practice specialty, must review the MPMP at each patient encounter in which an opioid is prescribed for acute and/or chronic non-

cancerous/non-terminal pain. Those licensees whose practice is not a pain management practice as defined previously must actively utilize the MPMP upon initial contact with new patients and at least every three (3) months thereafter on any and all patients who are prescribed, administered, or dispensed controlled substances other than opioids. Licensees who issue a prescription for Lomotil, Lyrica, Testosterone, Pseudoephedrine, or Amphetamines prescribed to pediatric patients under the age of sixteen (16) for the treatment of ADHD, are not required in that instance to utilize the MPMP as stated herein.

Reports generated on such patients should span the length of time from the previous review of the MPMP so that adequate information is obtained to determine patient compliance with treatment. Documentation, such as a copy of the report itself and/or reflection in the chart dictation and/or notes, must be kept within the patient’s record and made available for inspection upon request. As allowed by the Mississippi Board of Pharmacy and the MPMP, properly registered designees of the licensee may run/obtain the report for the licensee’s review as required herein.

Utilization of the MPMP as stated herein is not required when treating inpatient; however, upon discharge from said inpatient setting with a prescription for a controlled substance, the MPMP must be reviewed as required herein.

Pursuant to authority granted in Mississippi Code, Section 41-29-125, the Mississippi State Board of Medical Licensure hereby adopts, in lieu of a separate registration with the Board, the registration with the U.S. Drug Enforcement Administration as required in the above paragraph. In the event, however, a licensee has had limitations or other restrictions placed upon his or her license wherein he or she is prohibited from ordering, dispensing, or prescribing controlled substances in any schedule, said licensee shall be prohibited from registering with the U.S. Drug Enforcement Administration for a Uniform Controlled Substances Registration Certificate without first being expressly authorized to do so by order of the Mississippi State Board of Medical Licensure.

Persons registered to prescribe, administer, dispense or conduct research with controlled substances may order, possess, prescribe, administer, dispense or conduct research with those substances to the extent authorized by their registration and in conformity with the other provisions of these rules and in conformity with provisions of the Mississippi Uniform Controlled Substances Law, Mississippi Code Section 41-29-101 et seq.

The registration requirement set forth in these rules does not apply to the distribution and manufacture of controlled substances. Any licensee who engages in the manufacture or distribution of controlled substances or legend drugs must register with the Mississippi State Board of Pharmacy pursuant to Mississippi Code, Section 73-21-105 and will be subject to all applicable federal statutes and regulations controlling such practices. For the purposes herein, “distribute” means the delivery of a drug other than by administering, prescribing or dispensing. The word “manufacture” has the same meaning as set forth in Mississippi Code, Section 41-29-105(q).

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.4 | Maintenance of Records and Inventories.

Every licensee shall maintain inventories, logs, and records prescribed in this rule.

A. Controlled substances inventory record. All controlled substances classified under Schedules II, IIN, III, IIIN, IV and V which are purchased by the licensee must be inventoried at least every two (2) years. All inventory records for controlled substances in Schedules II and IIN must be maintained separately from the inventory records for Schedules III, IIIN, IV and V controlled substances. To insure the reliability of an inventory, the physician must maintain a readily retrievable record of controlled substances purchased, including a copy of all purchase invoices identifying the name, quantity and strength/dose of the controlled substance purchased, the supplier and the date purchased. Controlled substances inventory must also meet all applicable federal statutes and regulations. B. Controlled substances dispensation/administration record. Every licensee who dispenses or administers, Schedules II, IIN, III, IIIN, IV and V controlled substances must maintain a separate readily retrievable record of all such substances dispensed or administered. This requirement does not apply to Schedules III, IIIN, IV and V prepackaged samples and starter packs. All dispensation/administration records for controlled substances in Schedules II and IIN must be maintained separately from the dispensation/administration records for Schedules III, IIIN, IV and V controlled substances. The record must contain the following information: A. The date the controlled substance was dispensed or administered. B. The name, quantity and strength/dose of the controlled substance dispensed or administered. C. The method of administration of the controlled substance, i.e. oral, IV or subcutaneous. D. The name and address of the patient to whom the controlled substance was dispensed or administered. E. For all Schedules II and III amphetamines, amphetamine-like anorectic drugs, or sympathomimetic amine drugs dispensed in the treatment of narcolepsy, hyperkinesis, brain dysfunction, epilepsy, or depression, the dispensing or administration records must include the diagnosis and the reason for use of the Schedules II and III controlled substances.

Controlled substances dispensation/administration records must also meet all applicable federal statutes and regulations.

Patient Record - A licensee who prescribes, dispenses or administers a legend drug or controlled substance must maintain a complete record of his or her examination, evaluation and treatment of the patient which must include documentation of the diagnosis and reason for prescribing, dispensing or administering any legend drug or controlled substance; the name, dose, strength, quantity of the legend drug or controlled substance and the date that the legend drug or controlled substance was prescribed, dispensed or administered. The record required by this rule must be maintained in the patient's medical records. If medical records are maintained at the office of the licensee, the records must be available for inspection by the representatives of the Mississippi State Board of Medical Licensure.

Licensees must not prescribe, administer or dispense any legend drug; any controlled substance; or any drug having addiction-forming or addiction-sustaining liability without a good faith prior

examination and medical indication. A determination as to whether a “good faith prior examination and medical indication” exists depends upon the facts and circumstances in each case. One of the primary roles of a physician is to elicit detailed information about the signs and symptoms which a patient presents in order that he or she may recommend a course of treatment to relieve the symptoms and cure the patient of his or her ailment or maintain him or her in an apparent state of good health. In order for a licensee to achieve a reasonable diagnosis and treatment plan, a history and physical examination consistent with the nature of the complaint are necessary. The importance of these aspects of proper medical practice cannot be over emphasized. The paramount importance of a complete medical history in establishing a correct diagnosis is well established. Standards of proper medical practice require that, upon any encounter with a patient, in order to establish proper diagnosis and regimen of treatment, a licensee must take three steps: (a) take and record an appropriate medical history, (b) carry out an appropriate physical examination, and (c) record the results. The observance of these principles is an integral component of the “course of legitimate professional practice.”

Some of the factors used in determining the presence or absence of “good faith” may include, but are not limited to:

1. the quality and extent of the documented history and physical exam, which may also be accomplished through appropriate telemedicine as defined in Part 2635 Rule 5.5;

2. the extent to which the prescribed therapy is supported by documented history and physical exam;

3. the licensee's permitting the patient to name the drug desired;

4. a licensee dispensing or prescribing drugs to patients having no medical need, when the licensee knew or should have known that the patients were addicts or abusing/misusing substances; 5. repeated refills over relatively short periods of time or the issuance of prescriptions at a time when the patient should not have been finished taking the same medication from a prior prescription had the prescription directions been properly followed or the correct dosage taken; 6. general remarks of the licensee indicating his or her experience with non-therapeutic uses of the drug; 7. a licensee prescribing contraindicated medication such as amphetamines and depressants in a manner which results in therapeutic conflicts.

The aforementioned is of particular importance in cases in which controlled substances are to play a part in the course of treatment. It is the responsibility of the licensee to dispense, prescribe or administer all therapies with proper regard for the actual and potential dangers. This fact has been established in a number of closely related administrative and criminal cases, United States v. Bartee, 479 F.2d 484 (10th Cir. 1973) (No physical examination prior to issuance of prescriptions for controlled substances); United States v. Greene, 511 F.2d 1062 (7th Cir. 1975); Arthurs v. Board of Registration of Medicine, 418 N.E. 2d 1236 (MA 1981) (failure to record in patient file prescriptions for controlled substances issued or failure to record patient visit); Brainard v. State Board of Medical Examiners, 157 P2d 7 (Ca. 1945); Dannerberg v. Board of Regents, 430 N.Y.2d 700 (1980) (issuance of three prescriptions for sleeping pills to an undercover agent without a physical examination; Widlitz v. Board of Regents of New York, 429 N.Y. 2d 794 (1980) (issuance of Desoxyn to patients whom physician knew were drug addicts without conducting physical examination); United States v. Rosenberg, 515 F.2d 190 (9th Cir. 1975) (no

physical examination, evidences that prescriptions were not in course of professional practice); and United States v. Hooker, 541 F.2d 300 (1st Cir. 1976), (little more than cursory physical examination, frequent neglect to inquire as to past medical history, little or no exploration of the type of problem the patient allegedly had “indicates that the minimal professional procedures followed were designed only to give an appearance of propriety to appellant's unlawful distributions”).

A determination of proper “medical indication” requires examination of the nature of the therapy and all circumstances surrounding its implementation. Use of any therapy should be supported by standards of medical practice, reasonable scientific evidence or consensus and documented in the medical record. Case law developed by the courts in connection with controlled substances criminal violations and administrative decisions further illustrates several indications of lack of good faith. See United States v. Greene, 511 F.2d 1062 (7th Cir. 1975) and United States v. Rosenburg, 515 F.2d 190 (9th Cir. 1975). One of primary importance is the failure to follow at least the minimal professional procedures. Some of the factors used in determining the existence of “good faith” may include, but are not limited to: (a) the physician's permitting the patient to name the drug desired; (b) a physician dispensing drugs to patients having no medical need, when the physician knew or should have known that the patients were addicts; (c) repeated refills over relatively short periods of time or the issuance of prescriptions at a time when the patient should not have been finished taking the same medication from a prior prescription had the prescription directions been properly followed or the correct dosage taken; (d) general remarks of the physician indicating his or her experience with non-therapeutic uses of the drug; (e) a physician prescribing contraindicated medication such as amphetamines and depressants in a manner which results in therapeutic conflicts

A licensee must not sell or trade any medication which he or she receives as prepackaged samples or starter packs, whether or not said samples are controlled substances, legend drugs or other medication.

The Controlled Substances Inventory, Controlled Substance Dispensation/Administration Record, and Patient Record required by these rules must be maintained in accordance with Part 2635, Chapter 10 Maintenance, Production, and Release of Medical Records. Record retention for Controlled Substances Inventory, Controlled Substance Dispensation/Administration Records, and Patient Records must also meet all applicable federal statutes and regulations.

A licensee may use a data processing system or a manual record-keeping system for the storage and retrieval of Controlled Substances Dispensation/Administration Records. If a licensee utilizes a data processing system, it must provide immediate retrieval of all dispensation/administration records of controlled substances.

Whether maintained manually or in a data processing system, all records of dispensation/administration of controlled substances must be readily retrievable. If a data processing system is utilized, a hard-copy printout of the records of dispensation/administration must be made at regular intervals, not to exceed seven (7) days. Such hard-copy printouts must be maintained for a period of five (5) years and must be made available for inspection and copying by investigators of the Mississippi State Board of Medical Licensure.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.5 | Use of Diet Medication.

Pursuant to Mississippi Code, Section 41-29-139(e), it is unlawful for any licensee to prescribe, dispense or administer any medication classified as Schedule II, pursuant to Section 41-29-115, for the exclusive treatment of obesity, weight control, or weight loss.

Prescribing or dispensing a controlled substance for weight reduction or the treatment of obesity should be based on accepted scientific knowledge and sound clinical grounds. All such prescribing and dispensing must be in compliance with applicable state and federal laws.

The licensee providing comprehensive treatment of obesity must be present at the facility when he or she prescribes or dispenses1 controlled substances for the purpose of weight reduction or the treatment of obesity. A licensee may administer, order, dispense or prescribe controlled substances for the purpose of weight loss or the treatment of obesity only as an adjunct to a clearly documented comprehensive program of behavior modification, comprehensive nutritional education, and exercise or physical therapy intervention. The licensee must comply with all of the following conditions:

1 Part 2640, Rule 1.9, controls in all cases. Physician assistants are not permitted to dispense medication.

A. An initial comprehensive evaluation is to be conducted by and thoroughly recorded by the prescribing licensee prior to the prescribing, ordering, dispensing or administering of any drug. Such evaluation should include a thorough history and thorough physical exam of the patient to include at a minimum: 1. Past medical history, past surgical history, social history, family history, weight history, dietary history, gynecological history, review of systems, allergies and medications. 2. A physical exam to include height; weight; blood pressure; pulse; % body fat or waist circumference/weight hip ratio; lungs; heart; abdomen; and extremities. 3. Appropriate testing related to medical weight loss (CBC, comprehensive metabolic profile, lipid panel, thyroid panel, EKG, if prior or present history of cardiac disease, hypertension, diabetes, dyslipidemia, or strong family history of cardiac disease age >60 4. The licensee must determine and record the patient’s Body Mass Index (“BMI”). No patient should receive anorexic medications unless the patient has (i) a BMI of ≥ 30.0 in a normal otherwise healthy patient, or (ii) a BMI ≥ 27.0 in an individual with at least one associated co-morbidity, or (iii) current body weight ≥ 120 percent of a well- documented, long standing healthy weight that the patient maintained after the age of 18, or (iv) body fat ≥ 30% in females, or body fat ≥ 25% in males, or (v) waist-hip circumference such that the individual is known to be at increased cardiovascular and/or co-morbidity risk because of abdominal visceral fat, or presence of a co- morbidity condition or conditions aggravated by the patients excessive adiposity. The indication for anorexic therapy must be documented in the record and re-evaluated at each visit or with each prescription refill.

5. Absolute contraindications of Schedule III or IV anorectic drugs for purposes of weight loss management are pregnancy, breast feeding, or severe allergic reactions to these medications. Relative contraindications of Schedule III and IV anorectics for the purpose of weight loss management are uncontrolled bipolar, uncontrolled epilepsy, uncontrolled hypertension, episodic tachyarrhythmia, excessive stimulation, history of substance abuse, severe anticholinergic effects, such as, extreme dryness of mouth or unmanageable constipation should be addressed with licensee prior to starting weight loss medications. Schedule III and IV anorectics can be used in conjunction with any other medications deemed safe by the licensee.

B. The licensee must not utilize any Schedules III, IV or V controlled substance when he or she knows or has reason to believe an absolute contraindication exists or relative contraindication exists that would be harmful to the patient. C. A licensee is not permitted to prescribe, order, or dispense controlled substances for the purpose of weight reduction or treatment of obesity greater than a 30-day supply. Exempted from this requirement are those licensees defined in Rule 1.2(M) and those licensees treating patients resulting from a referral to those licensees defined in Rule 1.2(M). D. A patient continued on a controlled substance for the purpose of weight reduction or the treatment of obesity must undergo an in-person re-evaluation once every 30 days; however, those licensees defined in Rule 1.2(M) may re-evaluate patients once every 90 days. A recording of weight, BMI, blood pressure, pulse, and/or any other test which may be necessary for monitoring potential adverse effects of drug therapy should be completed at each visit. Once medically established goals have been met for an individual patient, the need for ongoing medication should be re-evaluated and documented in the record. E. Continuation of the prescribing, ordering, dispensing, or administering of controlled substances should occur only if the patient has continued progress toward achieving or maintaining medically established goals and has no significant adverse effects from the medication. F. A licensee must not utilize a schedule III, IV or V controlled substance or legend drug for purposes of weight loss unless it has an FDA approved indication for this purpose and then only in accordance with all of the above enumerated conditions. The purpose of this rule is to prohibit the use of such drugs as diuretics and thyroid medications for the sole purpose of weight loss.

Off-label use of any medication that does not have Food and Drug Administration approval for use in the treatment of weight loss is prohibited if administered solely for the purpose of weight loss. Thyroid hormone, diuretics, vitamin B12, B1, B2, B6, methionine, choline, inositol, chromium picolate and human chorionic gonadotropin are examples of medications that may not be used in this manner. This prohibition does not apply to FDA categories of nutritional supplements sold without prescription.

Licensees may request the Board waive the FDA requirements set forth in Rule 1.5(F) on a per-medication or class of medications basis, for good cause. Temporary waiver may be approved by the Executive Director until the request can be heard before the Board.

Amended October 1, 2023.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.6 | Bariatric Medicine, Medical Weight Loss, or Weight Management Practice [Repealed]

Rule 1.7 | Use of Controlled Substances for Chronic (Non-Cancer/Non-Terminal) Pain.

The following rules are not intended to supersede or exempt licensees from the requirements heretofore stated in Rule 1.4 Maintenance of Records and Inventories.

A. Definitions

For the purpose of Part 2640, Rule 1.7 only, the following terms have the meanings indicated:

1. Chronic Pain is a pain state in which the cause of the pain cannot be removed or otherwise treated and which in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts including, but not limited to, evaluation by the attending licensee and one or more licensee specializing in the treatment of the area, system, or organ of the body perceived as the source of the pain. Further, if a patient is receiving controlled substances for the treatment of pain for a prolonged period of time (more than three months), then they will be considered for the purposes of this regulation to have “de facto” chronic pain and subject to the same requirements of this regulation. “Terminal Disease Pain” should not be confused with “Chronic Pain.” 2. Terminal Disease Pain is pain arising from a medical condition for which there is no possible cure and the patient is expected to live no more than six (6) months. 3. Acute Pain is the normal, predicted physiological response to an adverse chemical, thermal, or mechanical stimulus and is associated with surgery, trauma and acute illness. Acute pain is generally self-limited and is responsive to therapies, including controlled substances. 4. Addiction is a neurobehavioral syndrome with genetic and environmental influences that results in psychological dependence on the use of substances for their psychic effects and is characterized by compulsive use despite harm. 5. Physical Dependence is a physiological state of neuroadaptation to substance which is characterized by the emergence of a withdrawal syndrome if the use of the substance is stopped or decreased abruptly, or if an antagonist is administered. Withdrawal may be relieved by re-administration of the substance. 6. Substance Abuse is the use of any substance for non-therapeutic purposes; or use of medication for purposes other than those for which it is prescribed. 7. Tolerance is a physiological state resulting from regular use of a drug in which an increased dosage is needed to produce the same effect or a reduced effect is observed with a constant dose. Tolerance occurs to different degrees for various drug effects, including sedation, analgesia and constipation. Analgesic tolerance is the need to increase the dose of opioid to achieve the same level of analgesia. B. A licensee may order, prescribe, administer, or dispense controlled substances, or other drugs having addiction-forming and addiction-sustaining liability to a person for the treatment of chronic pain.

C. The ordering, prescribing, administration, or dispensation of controlled substances, or other drugs having addiction-forming or addiction-sustaining liability for the treatment of chronic pain should be done with caution. A licensee may order, administer, dispense or prescribe said medications for the purpose of relieving chronic pain, provided that the following conditions are met: 1. Before initiating treatment with a controlled substance, or any other drug having addiction-forming or addiction-sustaining liability, the licensee must conduct a risk/benefit analysis by reviewing records of prior treatment. The risk/benefit analysis should weigh in favor of treatment and indicate the need for controlled substance therapy. Such a determination must take into account the specifics of each patient’s diagnosis, past treatments, suitability for long-term controlled substance, with the need for other treatment modalities. The results of this analysis must be clearly entered into the patient medical record and must include supporting documentation such as consultation or referral reports and efforts to determine the underlying etiology of the chronic pain. 2. Documentation in the patient record must include a complete medical history and physical examination and supporting studies and reports of consultation. 3. The diagnosis must demonstrate the presence of one or more recognized medical indications for the use of controlled substances. 4. Documentation of a written treatment plan which must contain stated objectives as a measure of successful treatment and planned diagnostic evaluations, e.g., psychiatric evaluation or other treatments. The plan must contain an informed consent agreement for treatment that details relative risks and benefits of the treatment course. The consent must also include specific requirements of the patient, such as using one licensee and pharmacy, urine/serum medication level monitoring when requested, pill counts, and the grounds for which the treatment may be terminated (e.g., ‘doctor shopping’ behavior, adverse urine/serum screens, etc.). 5. Periodic review and documentation of the treatment course is conducted no less frequently than every 3 months. The licensee’s evaluation of progress toward the stated treatment objectives must support all changes in therapy. This should include referrals and consultations as necessary to achieve those objectives. D. No licensee shall order, administer, dispense or prescribe a controlled substance or other drug having addiction-forming and addiction-sustaining liability that is non-therapeutic in nature or non-therapeutic in the manner the controlled substance or other drug is administered, dispensed or prescribed. E. No licensee shall order, administer, dispense or prescribe a controlled substance for treatment of chronic pain to any patient who has consumed or disposed of any controlled substance or other drug having addiction-forming and addiction-sustaining liability other than in strict compliance with the treating licensee’s directions. These circumstances include those patients obtaining controlled substances or other drugs having addiction- forming and addiction-sustaining liability from more than one licensee or healthcare provider and those patients who have obtained or attempted to obtain new prescriptions for controlled substances or other drug having addiction-forming and addiction-sustaining liability before a prior prescription should have been consumed according to the treating licensee’s directions. This requirement will not be enforced in cases where a patient has legitimately temporarily escalated a dose due to an acute exacerbation if the treating

licensee documents that the escalation was due to a recognized indication and was within appropriate therapeutic dose ranges. Repetitive or continuing escalations should be a reason for concern and a re-evaluation of the present treatment plan must be undertaken by the licensee. F. No licensee shall order, prescribe, administer, or dispense any controlled substance or other drug having addiction-forming or addiction-sustaining liability for the purpose of “detoxification treatment” or “maintenance treatment” and no licensee shall order, prescribe, administer, or dispense any narcotic controlled substance for the purpose of “detoxification treatment” or “maintenance treatment” unless the licensee is registered in accordance with Section 21 U.S.C. 823(g). Nothing in this paragraph shall prohibit a licensee from administering narcotic drugs to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment. Nothing in this paragraph shall prohibit a licensee from ordering, prescribing, administering, or dispensing controlled substances in a hospital to maintain or detoxify a person as an incidental adjunct to medical or surgical treatment of conditions other than addiction. G. When initiating opioid therapy for chronic pain, the licensee must first run a MPMP on the patient. The licensee must prescribe the lowest effective dosage. While there is no single dosage threshold identified below which the risk of overdose is eliminated, licensees must strive to keep daily opioid doses less than or equal to 50 mg of morphine equivalence (mEq), as dosages larger than 50 mEq per day increases risk without adding benefits for pain control or function. Licensees must avoid dosages greater than or equal to 90 mg of morphine equivalence per day and must provide significant justification for exceeding the 90 mg ceiling stated herein. If the licensee determines that a patient requires greater than 100 mg of morphine equivalence per day, the licensee must refer the patient to a pain specialist for further treatment. H. When opioids are prescribed for acute pain, the licensee must prescribe the lowest effective dose of immediate release opioids, as the use of long acting opioids for acute non- cancer/non-terminal pain is prohibited. Licensees must prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Licensees are discouraged from prescribing or dispensing more than a three (3) day supply of opioids for acute non-cancer/non-terminal pain, and must not provide greater than a ten (10) day supply for acute non-cancer/non-terminal pain. Licensees may issue an additional ten (10) day supply if clinically necessary, but said supply must be issued in accordance with Title 21 CFR § 1306.12 Refilling prescriptions; issuance of multiple prescriptions (i.e., the prescription must be dated on the date of issuance with ‘do not fill until’ noting the date the prescription may be filled), and such need for an additional ten (10) day supply must be documented in the chart to evidence that no other alternative was appropriate or sufficient to abate the acute pain associated with that medical condition. Additional ten (10) day supplies, with one (1) refill, may be issued if deemed medically necessary and only if supported by additional clinical evaluation. I. As stated in Rule 1.3, every licensee must review an MPMP report at each patient encounter in which a Schedule II medication is prescribed for acute pain or chronic non-cancer/non- terminal pain. MPMP reports may be obtained by designees of the licensee as allowed by the MPMP program.

J. When prescribing opioids for either chronic or acute pain, it is a relative contraindication (black box warning) to prescribe opioids concurrently with Benzodiazepines and/or Soma. However, opioids and benzodiazepines may be prescribed concurrently on a very short term basis, and in accordance with section H of this rule, when an acute injury requiring opioids occurs. The need for such concurrent prescribing must be documented appropriately in the chart. Patients who are currently on an established regimen of concomitant opioids and benzodiazepines may be allotted a reasonable period of time to withdraw from one or both substances. Caution and care should be taken to prescribe the lowest effective dose of each medication if unable to discontinue one or the other completely. Clinicians involved in managing a patient’s care should document communication regarding the patient’s needs, goals, risks and coordination of care. Prescribing of opioids concurrently with benzodiazepines and/or Soma may be allowed only under very limited circumstances in which the combination is used to treat very specific chronic medical conditions for which there is no other treatment modality available. K. When a licensee treats chronic non-cancerous/non-terminal pain and/or psychiatric conditions outside the definition of a pain management practice (Rule 1.2) (K) the licensee must actively utilize the MPMP upon initial contact with a new patient and every 3 months thereafter on any and all patients who are prescribed, administered, or dispensed controlled substances. Reports generated on patients must span the length of time from the previous review of the MPMP so that adequate information is obtained to determine the patient’s compliance for and with treatment. Documentation, such as a copy of the report itself and/or reflections in the charts dictation and/or notes must be kept within the patient’s record and made available for inspection upon request. L. In-office drug testing must be done at least three (3) times per calendar year when Schedule II medication is written for the treatment of chronic non-cancer/non-terminal pain. In- office drug testing and MPMP review, as described in Rule 1.7 (K), must be done at least three (3) times per calendar year for patients prescribed benzodiazepines for chronic medical and/or psychiatric conditions which are non-cancer/non-terminal. In-office drug testing must test, at a minimum, for opioids, benzodiazepines, amphetamines, cocaine, and cannabis. Inpatient treatment, as defined in Rule 1.2(L), is exempt from this requirement. Further, all hospice treatment is exempt from in-office drug testing requirements stated herein. M. The use of Methadone to treat acute non-cancer/non-terminal pain is prohibited. The use of Methadone for the treatment of chronic non-cancer/non-terminal pain is permissible within a registered Pain Management Practice, as defined in Rule 1.2(K), or when resulting from a referral to a certified pain specialist. If Methadone is prescribed to treat chronic non- cancer/non-terminal pain, the initial prescription must be written by a physician.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.8 | Drug Maintenance Requirements.

Rule 1.9 | Requirements for Dispensing Physicians.

Rule 1.10 | Prescription Guidelines–Controlled Substances.

It is the responsibility of the licensee to determine the type, dosage, form, frequency of application and number of refills of any controlled substances prescribed to a patient. The following requirements apply to all prescriptions for controlled substances written by a licensee with controlled substance prescriptive authority:

A. All prescriptions for controlled substances must be written in strict compliance with Mississippi Code, Sections 41-29-101 through 41-29-311 and Title 21 of U.S. Code of Federal Regulations, Part 1306. B. On all prescriptions of controlled substances wherein refills are permitted, licensees must indicate the appropriate refills, not to exceed five (5), or mark “none.” C. Each licensee must insure that the complete name and address of the patient to whom the licensee is prescribing the controlled substance appears on the prescription. D. A licensee must not permit any prescription for controlled substances to be signed by anyone in the place of or on behalf of the licensee. E. A licensee must not pre-sign prescription pads or order forms. F. A licensee must not utilize prescription pads or order forms upon which the signature of the licensee has been affixed by any means other than manual signature. This prohibition includes the e-mailing of any controlled substance prescription. A hard copy prescription generated from an electronic prescription system must contain a manual signature unless: (i) the prescription is printed on security paper that ensures it is not subject to copying or alteration, and (ii) an electronic or digital signature is affixed. Electronic transmission of Schedule III-V controlled substance prescription information is limited to computer to facsimile (fax) transmissions or traditional fax to fax transmissions. Electronic transmission of Schedule II controlled substance prescription information is permitted under limited circumstances. Requirements for fax prescription orders and systems utilized for faxing prescriptions are as follows: 1. The prescription order must contain the date, time, telephone number and location of the transmitting device. Prescription blanks utilized in this manner must bear a pre- printed heading that indicates the blank is a “Fax Prescription Form.” Fax prescription orders must contain a manual or authenticated electronic/digital signature of the prescriber. Only Schedule II narcotic substances that are to be prepared or compounded for the direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intra spinal infusion may be transmitted by the licensee or the licensee’s agent to a pharmacy of the patient’s choice by facsimile. All original hardcopy faxed prescriptions must immediately be voided after successfully completing the fax transmission by writing across the face of the prescription from corner to corner the notation “faxed.” The original prescription (or copy) must be retained in the licensee’s patient file with additional information included on the back

of the prescription as to the date it was faxed, the name or initials of the person faxing the prescription and the name/location of the pharmacy receiving the fax transmission.

In addition to filing the original prescription (or copy) in the patient file, a perpetual, chronological logbook of fax transactions must be established and maintained. Such a logbook would serve to protect the prescribing licensee in the event the original prescription is somehow lost or misfiled. The information contained in such a logbook must include the patient’s name and address, date of issuance, name, strength and quantity of the drug prescribed and the name and fax number of the receiving pharmacy and a personal identifier of the person faxing the prescription. Such logs must be maintained in the licensee’s clinic in a readily retrievable manner, and be kept in accordance with Part 2635, Chapter 10 Maintenance, Production, and Release of Medical Records. The requirements set forth in this rule are in addition to documentation required in Part 2640, Rule 1.4.

2. When prescribing any controlled substance for a resident of a Long-term Care Facility (LTCF)(as defined in Section 1301.01(25), Code of Federal Regulations), such prescription may be transmitted by the licensee or the licensee’s agent to the dispensing pharmacy by facsimile. The licensee or the licensee’s agent must note on the prescription that the patient is a resident of a LTCF. The original prescription (or copy) and fax transaction log will be prepared and maintained in the same manner as described in Part 2640, Rule 1.10.F.1. 3. When prescribing any controlled substance for a patient residing in a hospice certified by Medicare under Title XVIII or licensed by the state, such prescription may be transmitted by the licensee or the licensee’s agent to the dispensing pharmacy by facsimile. The licensee or the licensee’s agent must note on the prescription that the patient is a hospice patient. The original prescription (or copy) and fax transmission log will be maintained in the same manner as described in Part 2640, Rule 1.10.F.1.

G. No more than one (1) controlled substance shall be issued on a single prescription blank. H. Prescriptions for Benzodiazepines must be limited to a one (1) month supply, with no more than two (2) refills, or a ninety (90) day supply with no refills. The MPMP must be checked each time a prescription for benzodiazepines is authorized and evidence of such check must be noted within the patient file.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.11 | Prescription Guidelines - All Medications.

In addition to any other requirements set forth in these rules pertaining to the issuance of prescriptions of controlled substances, the following additional requirements apply to all prescriptions, whether or not said prescriptions are for controlled substances, legend drugs or any other medication:

A. Prescriptions may not be written outside of a valid licensee-patient relationship. While not all of the elements in subsection A are necessary each time a prescription is authorized (e.g., via appropriate telemedicine as defined in Rule 5.5 of Part 2635, calling in refills, taking call for a practice partner for short term care, etc.), all initial encounters, and at reasonable intervals thereafter, should conform to this rule and be done pursuant to a valid licensee-patient relationship. The elements of this valid relationship are:

1. verify that the person requesting the medical treatment is in fact who they claim to be; 2. conducting an appropriate history and physical examination of the patient that meets the applicable standard of care, which as previously stated may also be accomplished through appropriate telemedicine as defined in Part 2635 Rule 5.5; 3. establishing a diagnosis through the use of accepted medical practices, i.e., a patient history, mental status exam, physical exam and appropriate diagnostic and laboratory testing; 4. discussing with the patient the diagnosis, risks and benefits of various treatment options to obtain informed consent; 5. insuring the availability of appropriate follow-up care; and 6. maintaining a complete medical record available to patient and other treating health care providers.

B. Electronic prescription transmission is permitted provided the transmission meets applicable state and federal standards for transmission. E-prescribing is the electronic entry of a prescription by a licensee, the secure electronic transmission of the prescription to a pharmacy, the receipt of an electronic message by the pharmacy and E-prescription renewal requests sent electronically by the pharmacy to the practitioner. C. Every written prescription delivered to a patient, or delivered to any other person on behalf of a patient, must be manually signed on the date of issuance by the licensee. This does not prohibit the transmission of electronic prescriptions and telefaxed prescriptions (but not e- mail) for non-controlled drugs to the pharmacy of the patient’s choice. Such telefaxed or electronic prescriptions must be authorized by a written or electronic signature and must be issued in accordance with all other provisions of this rule. No prescriptions for any form or compound containing nalbuphine HCl, carisoprodol, butalbital compounds, or tramadol HCl shall be telefaxed. D. Electronic prescriptions for controlled substances are permitted if a practitioner has complied with the DEA requirements and is using a certified electronic prescribing system for the transmission of control substances prescriptions. E. All written prescriptions must be on forms containing two lines for the licensee's signature. There must be a signature line in the lower right-hand corner of the prescription form beneath which must be clearly imprinted the words “substitution permissible.” There must be a signature line in the lower left corner of the prescription form beneath which must be clearly imprinted with the words “dispense as written.” The licensee's signature on either signature line must validate the prescription and designate approval or disapproval of product selection. Each prescription form must bear the pre-printed name of the licensee or the licensee must clearly print his or her name on the prescription form, in addition to the licensee’s original signature. In the event that the prescription form bears the pre- printed name of more than one licensee, the licensee must clearly indicate the name of the licensee writing the prescription. In the case of a prescription that is electronically generated and transmitted, the licensee must make an overt act when transmitting the prescription to indicate either “dispense as written” or “substitution permissible”. When done in conjunction with the electronic transmission of the prescription, the prescriber’s overt act indicates to the pharmacist that the brand name drug prescribed is medically necessary.

F. If a prescription form which does not contain two signature lines required in Part 2640, Chapter 1, Rule 1.11.D is utilized by the licensee, he or she must write in his or her own handwriting the words “dispense as written” thereupon to prevent product selection.

Every written prescription issued by a licensee for a legend drug should clearly state whether or not the prescription should be refilled, and if so, the number of authorized refills and/or the duration of therapy. Licensee s should avoid issuing prescriptions refillable on “prn” basis. If a licensee chooses to issue a prescription refillable “prn”, the life of the prescription or time limitation must clearly be set forth on the prescription. In no case shall a prescription which is refillable on a “prn” basis be refilled after the expiration of one (1) year. Regardless of whether a prescription is refillable on a “prn” basis or the prescription expressly states the number of authorized refills, the use of said medication should be re- evaluated on at least an annual basis. Upon the expiration of one (1) year, a prescription becomes invalid, regardless of the number of refills indicated or “prn” designation.

G. Every written prescription issued by a licensee, bearing more than one non-controlled medication, must clearly indicate the intended refill instructions for each medication. Lack of clearly indicated refill instructions prohibit the refilling of the medications. All unused lines on a multi-line prescription blank must be clearly voided by the issuing licensee. H. A prescription will no longer be valid after the occurrence of any one of the following events: 1. Thirty (30) days after the death of the issuing licensee. 2. Thirty (30) days after the issuing licensee has moved or otherwise changed practice location resulting in termination of the licensee patient relationship. Termination of the licensee patient relationship results when a patient is no longer able to seek personal consultation or treatment from the issuing licensee. 3. Immediately after loss of DEA Controlled Substances Privilege by the issuing licensee if the prescription is for controlled substances. 4. Immediately upon revocation, suspension or surrender of the licensee's license.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.12 | Freedom of Choice.

Rule 1.13 | Security of Controlled Substances.

Rule 1.14 | Pain Management Medical Practice.

A. A pain management medical practice must have, at all times, a majority ownership (more than 50%) by a physician or group of physicians licensed by the Board, and/or a hospital or health care entity registered with the Secretary of State to do business in the state of Mississippi. The physician or physician owners must practice an annual average of at least 20 hours per week within the state of Mississippi. B. Any physician who is practicing, or intends to practice, in a pain management medical practice must register with the Board. C. Each physician owner of a pain management medical practice must meet the requirements set forth below.

D. Each licensee who serves as medical director, manager, or employee or who provides care in a pain management medical practice must meet the requirements set forth below.

A physician owner of a pain management medical practice, as defined in R.1.2, must:

1. maintain documents demonstrating proof of ownership or alternative documents with a written request for special consideration; 2. maintain ownership or investment interest information in any other pain management facility operating within the state of Mississippi that includes the name and address of the other pain management facility(ies) in which the physician has ownership or vested interest;

3. maintain documentation which identifies all individuals with prescriptive authority who are employed or contracted in any capacity at each facility; and 4. in addition to requirements set forth in section N of this rule, provide any documentation requested by the Board or its agents related to these requirements.

E. All physician owners and operators are required to register with the Board. Each practice shall be entered into the physician’s online licensure gateway. F. Physician owners or operators may not operate a pain management practice in Mississippi unless the practice is owned or operated by a hospital or healthcare entity registered with the Secretary of State to do business in the state of Mississippi, or by a physician who: 1. practices at least 20 hours per week providing direct patient care; and 2. holds an active unrestricted medical license G. No physician owners or operators of a pain management practice, nor any physician, nor any physician assistant, nor any medical director, manager, or employee or any physician or physician assistant who provides care may: 1. have been denied, by any jurisdiction, a certificate permitting the licensee to order, prescribe, dispense, administer, supply or sell a controlled substance or the other listed medications under definitions; 2. have been issued, by any jurisdiction, a limited certificate to order, prescribe, dispense, administer, supply or sell a controlled substance or the other listed medications under definitions; 3. have been denied a certificate issued by the Drug Enforcement Administration (DEA) permitting the licensee to order, prescribe, dispense, administer, supply or sell a controlled substance or the other listed medications under definitions; 4. have been issued a limited certificate by the Drug Enforcement Administration (DEA) permitting the licensee to order, prescribe, dispense, administer, supply or sell a controlled substance or the other listed medications under definitions; 5. be currently subject to an order by any licensing entity prohibiting the practice of pain management; or 6. have been terminated from Mississippi’s Medicaid Program, the Medicaid program of any other state, or the federal Medicare program, unless eligibility has been restored. H. No physician or physician assistant may own, operate, or practice in a pain management medical practice who has been convicted of, pled nolo contendere to or received deferred adjudication for: 1. an offense that constitutes a felony; or 2. an offense that constitutes a misdemeanor, the facts of which relates to the illegal distribution or sale of drugs or controlled substances. I. All physician owners or operators or any physician who serves as medical director, manager, or employee or who provides care in pain management medical practice must meet the qualifications set forth in subsections (1) through (5) below. All physicians prescribing or dispensing controlled substance medications in pain management practices registered by the Board must meet one (1) of the following qualifications: 1. successful completion of a residency program in physical medicine and rehabilitation, anesthesiology, neurology, or neurosurgery and approved by the ACGME or the AOA; 2. board certification by a specialty board recognized by the American Board of Medical Specialties (ABMS) or the American Board of Addiction Medicine (ABAM) and hold a subspecialty certification in pain medicine;

3. board certification by a specialty board recognized by the American Osteopathic Association Bureau of Osteopathic Specialists (BOS) in pain management; 4. board certification in pain medicine by the American Board of Pain Medicine (ABPM);

5. successful completion of 100 hours of inter-active live participatory, either in person or via video conferencing, AMA or AOA Category 1 CME courses in pain management.

Upon qualifying under any of the 5 subsections above, physicians must also complete thirty (30) hours of Category 1 CME each year for continued registration with the board. CME must have emphasis in the specific areas of pain management, addiction, or prescribing of opiates, and CME may be included with the forty (40) hour requirement for licensure renewal. Excess hours may not be carried over to another two-year cycle. For the purpose of this regulation, the two-year period begins with the fiscal year July 1, 2014, and every two years thereafter to be concurrent with the licensure requirements.

J. Physicians and physician assistants practicing in a registered pain management medical practice must be registered with the Mississippi Prescription Monitoring Program (MPMP). A report from the MPMP must be obtained on the initial visit for each patient. Subsequent reports must be obtained for each patient at every visit. K. Physician assistants must meet the following qualifications prior to practicing in a registered pain management practice: 1. A Board approved protocol in the practice of pain management as required by Part 2615, Chapter 1, Rules 5 and 6, with a physician who holds a license that is not designated as limited, restricted, retired, temporary, or in-training; 2. Physician assistants with approved prescriptive authority must obtain the normal hours required in Pt. 2615, R.1.10 Continuing Education plus an additional 5 hours of Category 1 CME related to prescribing and pain management for every two year CME cycle the physician assistant is practicing in a pain management medical practice; 3. Physician assistants with prescriptive authority must be familiar with and adhere to the Administrative Rule Pertaining to Prescribing, Administering and Dispensing of Medication, Part 2640, Chapter 1; and 4. Physician assistants with prescriptive authority must be registered with the Mississippi Prescription Monitoring Program (MPMP).

L. A physician who is a current participant in the Mississippi Professionals Health Program (MPHP) may not be the primary physician owner of a pain practice. This does not prohibit a MPHP participant from working in a pain practice. M. Prior to the initial prescription for the treatment of chronic non-cancer/non-terminal pain, each patient in a pain management practice must have an in-person evaluation by a licensed provider in a registered pain management practice medically directed by a physician having the necessary credentials as set forth by the Board. Thereafter, the patient must be seen and evaluated by a pain management physician within the next ninety (90) days. N. The Board has the authority to inspect a pain management medical practice. During such inspections, authorized representatives of the Board, who may be accompanied by investigators from state or federal law enforcement agencies, may inspect documents and medical records to ensure compliance with any applicable laws and rules.

O. If the Board finds that a licensee registered to practice in a pain management practice no longer meets any of the requirements to operate within a pain practice, the Board may immediately revoke or suspend the licensee’s ability to practice in a pain management medical practice. The licensee shall have the right to an administrative hearing before the Board at the next available and scheduled meeting of the Board. Further, the Board has the discretion to lift the suspension when the licensee demonstrates compliance with applicable rules and regulations.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.15 | Violation of Rules.

Rule 1.1 | Scope

Rule 1.2 | Definitions

For the purposes of Part 2640, Chapter 2, the following terms have the meanings indicated:

A. Bona fide practitioner-patient relationship means:

(i) A practitioner and patient have a treatment or consulting relationship, during the course of which the practitioner, within his or her scope of practice, has completed an in-person assessment of the patient’s medical history and current mental health and medical condition and has documented their certification in the patient’s medical file;

(ii) The practitioner has consulted in person with the patient with respect to the patient’s debilitating medical condition; and

(iii) The practitioner is available to or offers to provide follow-up care and treatment to the patient.

B. Cannabis means all parts of the plant of the genus cannabis, the flower, the seeds thereof, the resin extracted from any part of the plant and every compound, manufacture, salt, derivative, mixture or preparation of the plant, its seeds or its resin, including whole plant extracts. Such term shall not mean cannabis-derived drug products approved by the federal Food and Drug Administration under Section 505 of the Federal Food, Drug, and Cosmetic Act.

C. For the purposes of this Chapter, Practitioner means a physician or physician assistant who is licensed to prescribe medicine under the licensing requirements of the Boards and the laws of this state. In relation to a nonresident cardholder, the term means a physician or physician assistant who is licensed to prescribe medicine under the licensing requirements of their respective occupational boards and under the laws of the state or territory in which the nonresident patient resides. For registered qualifying patients who are minors, “practitioner” shall mean a physician or doctor of osteopathic medicine who is licensed to prescribe medicine under the licensing requirements of the Board and the laws of this state.

D. Chronic pain means a pain state in which the cause of the pain cannot be removed or otherwise treated, and which in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts by the certifying practitioner.

E. Debilitating medical condition means:

(i) Cancer, Parkinson’s disease, Huntington’s disease, muscular dystrophy, glaucoma, spastic quadriplegia, positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), hepatitis, amyotrophic lateral sclerosis (ALS), Crohn’s disease, ulcerative colitis, sickle-cell anemia, Alzheimer’s disease, agitation of dementia, post-traumatic stress disorder (PTSD), autism, pain refractory to appropriate opioid management, diabetic/peripheral neuropathy, spinal cord disease or severe injury, or the treatment of these conditions; (ii) A chronic, terminal or debilitating disease or medical diagnosis, or its treatment, that produces one or more of the following: cachexia or wasting syndrome, chronic pain, severe or intractable nausea, seizures, or severe and persistent muscle spasms, including, but not limited to, those characteristic of multiple sclerosis; or

(iii) Any other serious medical condition or its treatment added by the Mississippi Department of Health, as provided for in Section 41-137-17.

F. Medical use includes the acquisition, administration, cultivation, processing, delivery, harvest, possession, preparation, transfer, transportation, or use of medical cannabis or equipment relating to the administration of medical cannabis to treat or alleviate a registered qualifying patient's debilitating medical condition or symptoms associated with the patient's debilitating medical condition. The term "medical use" does not include:

(i) The cultivation of cannabis unless the cultivation is done by a cannabis cultivation facility; or (ii) the extraction of resin from cannabis by mechanical or chemical extraction unless the extraction is done by a cannabis processing facility.

G. Qualifying Condition means any condition as described and defined in Section 41-137- 3(r) and R.1.2(E) of this Chapter.

H. Qualifying Patient means a person who has been diagnosed by a practitioner as having a debilitating medical condition as described and defined in Section 41-137-3(r)(1) and has been issued a written certification, or who is eligible to receive such certification, under Section 41-137-5.

I. Scope of practice means the defined parameters of various duties, services or activities that may be provided or performed by a physician as authorized under Section 73-25-33, or by a physician assistant under Section 73-26-5, and the rules and regulations adopted by the Board for those practitioners.

J. Written Certification means a form approved by the Mississippi State Department of Health, signed and dated by a practitioner, certifying that a person has a debilitating medical condition. A written certification shall include the following:

(i) The date of issue and the effective date of the recommendation;

(ii) The patient's name, date of birth and address;

(iii) The practitioner's name, address, and federal Drug Enforcement Agency number; and

(iv) The practitioner's signature.

Source: Miss. Code Ann. § 73-43-11 (1972, as amended); Miss. Code Ann. § 41-137-3 (2022, as amended March 27, 2023).

Rule 1.3 | Certification

A. Certification Generally

(i) Practitioners must be authorized and registered with the Mississippi State Department of Health to certify patients as eligible to obtain cannabis for medical use. No person shall be authorized to use medical cannabis in this state unless the person (a) has been diagnosed by a practitioner, with whom the person has a bona fide practitioner-patient relationship within his or her scope of practice, as having a debilitating medical condition for which the practitioner believes, in his or her professional opinion, that the person would likely receive medical or palliative benefit from the medical use of medical cannabis to treat or alleviate the person’s debilitating medical condition or symptoms associated with the person’s debilitating medical condition, (b) has received a written certification of that diagnosis from the practitioner, and (c) has been issued a registry identification card from the MDOH under Section 41-137-23. A person who has been diagnosed by a practitioner as specified in paragraph (a) of this subsection shall be a qualifying patient, and the practitioner who has diagnosed the patient shall document that diagnosis with a written certification. However, nothing herein shall require a practitioner to issue a written certification.

(ii) A written certification shall: (i) Affirm that it is made in the course of a bona fide practitioner-patient relationship; (ii) Remain current for twelve (12) months, unless the certifying practitioner specifies a shorter period of time; (iii) Be issued only after an in-person assessment of the patient by the certifying practitioner;

(iv) Only be issued on behalf of a minor when the minor’s parent or guardian, as defined in the Act, provides signed consent; and (v) Be limited to the allowable amount of cannabis in a thirty-day period.

After a practitioner has issued a written certification to a qualifying patient, a practitioner may assist the patient in registering for a registry identification card with the Department of Health, in a manner provided by regulations of the Department of Health.

After a qualifying patient receives a written certification from a practitioner, the patient shall be required to make a follow-up visit with the practitioner not less than six (6) months after the date of issuance of the certification for the practitioner to evaluate and determine the effectiveness of the patient’s medical use of medical cannabis to treat or alleviate the patient’s debilitating medical condition or symptoms associated with the patient’s debilitating medical condition. Qualifying patients may make a follow-up visit with a different practitioner than the practitioner who originally issued their written certification, provided that such practitioner is otherwise registered and acting within their scope of practice and the provisions of this chapter.

B. Pediatric Certifications

Only physicians (Medical Doctors [MD] or Doctors of Osteopathic Medicine [DO]) may issue

written certifications to registered qualifying patients who are minors (younger than eighteen (18)

years of age).

A certifying practitioner may not issue a written certification to a qualifying patient who is younger than eighteen (18) years of age unless:

(a) The qualifying patient's practitioner has explained the potential risks and benefits of

the medical use of medical cannabis to the custodial parent or legal guardian with responsibility for health care decisions for the qualifying patient; and

(b) The custodial parent or legal guardian with responsibility for health care decisions for

the qualifying patient consents in writing to:

(i) Acknowledge the potential harms related to the use of medical cannabis;

(ii) Allow the qualifying patient's medical use of medical cannabis;

(iii) Serve as the qualifying patient's designated caregiver; and

(iv) Control the acquisition of the medical cannabis, the dosage and the frequency of the use of medical cannabis by the qualifying patient.

C. Young Adult Certifications

Notwithstanding any other provision to the contrary, a patient with a qualifying condition who is between eighteen (18) years to twenty-five (25) years of age is not eligible for a medical cannabis registry identification card unless two (2) practitioners from separate medical practices have diagnosed the patient as having a qualifying condition after an in-person consultation. One (1) of these practitioners must be a physician (Medical Doctor [MD] or Doctor of Osteopathic Medicine [DO]).

If one (1) of the recommending practitioners is not the patient's primary care practitioner, the recommending practitioner shall review the records of a diagnosing practitioner. The requirement that the two (2) practitioners be from separate medical practices does not apply if the patient is homebound or if the patient had a registry identification card before the age of eighteen (18).

Source: Miss. Code Ann. § 73-43-11 (1972, as amended); Miss. Code Ann. § 41-137-5 (2002, as amended March 27, 2023); Miss. Code Ann. § 41-137-9 (2022, as amended March 27, 2023); Miss. Code Ann. § 41-137-23 (2022, as amended March 27, 2023).

Rule 1.4 | Patient Record

Rule 1.5 | Continuing Medical Education (CME)

Rule 1.6 | Violations

Part 2645

Chapter 1: Rules of Procedure

Rule 1.1 | Scope. The following Rules of Procedure apply to all individuals licensed to practice

Rule 1.2 | Definitions. For the purpose of Part 2645, Chapter 1 only, the following terms have

Rule 1.3 | Complaint/Investigation. An investigation of alleged violation(s) of the Mississippi

Rule 1.4 | Initiation of Disciplinary Action. Upon conclusion of an investigation, the results shall

be presented to the Board’s Executive Director to determine if there is proper jurisdiction and violation of the Mississippi Medical Practice Act. The Board’s Executive Director may then authorize the issuance of a summons and affidavit, naming the accused licensee as a respondent in the proceedings.

A. The summons, signed by the Board's Executive Director, shall set forth: 1. The style of the action. 2. The name and address of the accused respondent. 3. The address, date, and time at which the respondent is summoned to appear before the Board. 4. The specific rules of the Mississippi Medical Practice Act which the respondent is charged with violating. 5. The actions which the Board has the authority to take, including placing the physician on probation, the terms of which may be set by the Board, suspending his or her right to practice medicine for a time deemed proper by the Board, revoking his or her license, or taking any other action in relation to his or her license as the Board may deem proper under the circumstances.

B. The affidavit, signed by the investigating officer, shall set forth, in numbered paragraphs, a concise statement of the material facts and allegations to be proven, including: 1. Facts giving rise to the Board's jurisdiction. 2. Facts constituting legal cause for administrative action against the respondent. 3. The statutory provisions alleged to have been violated by the respondent.

The summons and affidavit shall be delivered to the respondent, either through certified mail or by personal service.

The summons shall name a date for hearing not less than thirty (30) days or more than sixty (60) days from the date of the mailing or service of the summons.

The summons and affidavit shall bear the name, address, and telephone number of complaint counsel.

All pleadings, motions or other papers permitted or required to be filed with the Board in connection with a pending disciplinary proceeding shall be filed by personal delivery at or by mail to the office of the Board. A copy of all papers filed with the Board shall be delivered by certified mail or personally served on opposing counsel of record.

All pleadings, motions or other papers shall be submitted on plain white, letter size (8 ½" x 11") bond, with margins of at least one inch on all sides and text double spaced except as to quotations and other matter customarily single spaced; shall bear the style and caption of the case as it appears on the summons and shall include the certificate of the attorney or person making the filing that service of a copy of the same has been effected in the manner prescribed in the above paragraph.

The Board may refuse to accept for filing any pleading, motion or other paper not in conformity with the requirements of this rule.

Within fifteen (15) days of service of the summons and affidavit, or such longer time as the Board, on motion of the respondent may permit, the respondent shall answer the summons and affidavit, admitting or denying each of the separate allegations of fact and of law set forth therein. Any matters admitted by the respondent shall be deemed proven and established for purposes of adjudication. Any matters or allegations not specifically denied are admitted for the purposes of the hearing. In the event that respondent does not file a response to the affidavit, all matters asserted therein shall be deemed admitted.

Any respondent may be represented before the Board by an attorney at law who (i) is admitted to practice in the state of Mississippi, or (ii) has been given express permission by the Board to appear on behalf of respondent.

Upon service of a summons and affidavit pursuant to the above, a respondent who is represented by legal counsel with respect to the proceeding shall personally or through such counsel, give written notice to the Board of the name, address and telephone number of such counsel. Following receipt of proper notice of representation, all further notices, affidavits, subpoenas, orders or other process related to the proceeding shall be served on respondent through the designated counsel of record.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.5 | Subpoenas. For the purpose of disciplinary hearings, the Board acting by and through

Rule 1.6 | Discovery.

A. Upon written request by a respondent or his or her counsel, complaint counsel of the Board shall disclose and permit respondent or his or her counsel to inspect, copy or photograph the following information and material, which is in the possession, custody, or control of the Board, or the existence of which is known to the complaint counsel: 1. Names and addresses of all witnesses proposed to be called in complaint counsel's case in chief, together with a copy of the contents of any statement, written, recorded, or otherwise preserved, of each such witness. 2. Copy of any written or recorded statement of respondent and the substance of any oral statement made by the respondent. 3. Copy of any criminal record of a respondent, if proposed to be used. 4. Any written reports or statements of experts, if proposed to be offered as evidence in connection with the particular case. 5. All records, documents, physical evidence or photographs which may be offered as evidence in complaint counsel's case in chief. 6. Any exculpatory material concerning the respondent. The Board shall charge a respondent a reasonable fee, not to exceed 50 cents per copy, payable in advance of delivery of copied documents. B. The Board may deny disclosure authorized by the preceding paragraph if it finds that there is a substantial risk to any person of physical harm, intimidation, bribery, economic reprisals, or unnecessary embarrassment, resulting from such disclosure, which outweighs any usefulness of the disclosure to respondent or his or her counsel. C. Upon written request by complaint counsel, respondent or his or her counsel shall promptly disclose to complaint counsel and permit him or her to inspect, copy or photograph, the following information and material which is in the possession, custody, or control of respondent or his or her counsel, or the existence of which is known to respondent or his or her counsel:

1. Names and addresses of all witnesses proposed to be called in respondent's defense, together with a copy of the contents of any statement, written, recorded, or otherwise preserved, of each such witness. 2. All records, documents, physical evidence or photographs which may be offered as evidence in respondent's defense. 3. Any written reports or statements of experts, if proposed to be offered as evidence in connection with the particular case. D. No depositions shall be taken in preparation for matters to be heard before the Mississippi State Board of Medical Licensure.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.7 | Amendment of Pleadings. The complaint counsel of the Board may amend a summons

Rule 1.8 | Pre-Hearing Motions. All pre-hearing motions shall be filed not later than fifteen (15)

Rule 1.9 | Continuances. Hearings shall be held before the full Board at the time and place

designated in the summons, unless a continuance is granted for just cause by the Board. A motion for a continuance must be filed with the Board at least fifteen (15) days prior to the scheduled hearing, or upon a showing of good cause, at any time prior to the hearing.

It must be recognized that the Board consists of nine (9) practicing physicians representing various regions of the state. Unlike the judiciary, Board members are not in the business of conducting hearings, therefore hearings will be held only during regularly scheduled meetings or other date established by order of the Board. Attorneys representing physicians should take this fact into consideration. A scheduled hearing may be continued if the respondent shows substantial, legitimate grounds for continuing the hearing, based on the balance of:

A. The right of respondent to a reasonable opportunity to prepare and present a defense. B. The Board's responsibility to protect the public health, safety and welfare.

Where the counsel for respondent has a scheduling conflict on the initial hearing date, continuances will be liberally granted. However, respondent's counsel must submit written proof of the

scheduling conflict. Thereafter, no further continuances will be granted based solely on scheduling conflicts.

So that counsel for the respondent and complaint counsel shall be able to adequately prepare for hearing, any motion for a continuance filed within the time limitations specified above, will be immediately considered by the Board's President, who shall have the authority to grant or deny said motion. If granted, the order will be presented to the Board at the scheduled hearing date at which time the order will be formally entered and the rescheduled hearing date set.

It is the responsibility of the respondent to make a prompt decision as to whether to appear before the Board “pro se” (without counsel) or retain counsel for this purpose. Unless due to extraordinary circumstances, the Board will not consider as a valid ground for continuance, the respondent's last-minute decision to retain counsel.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.10 | Informal Settlement, Pre-Hearing Stipulations, Consent Orders.

A. All disciplinary proceedings initiated by the Board shall be brought to a final resolution through one of three means: 1. Disciplinary hearings before the full Board. 2. Acceptance by the Board of a mutually agreeable Consent Order in lieu of hearing. 3. Dismissal of the case. B. As to disciplinary proceedings duly noticed and docketed for hearing, counsel for respondent and complaint counsel may agree, or the Board's President may require, that an Informal Settlement Conference be held for the purpose of possible resolution, simplifying the issues for hearing or promoting stipulations as to facts and proposed evidentiary offerings which will not be disputed at hearing. C. The Informal Settlement Conference shall be conducted by respondent and/or his or her counsel and the complaint counsel and Executive Director. Other parties who may attend as necessary to assure fair and just outcomes while protecting public safety. Board members shall not participate in the Informal Settlement Conference, other than to approve a Consent Order as hereinafter provided. D. Discovery or exchange of information may be accomplished during the Informal Settlement Conference. E. The Informal Settlement Conference may result in: 1. Dismissal of the case. 2. Return of the case for further investigation. 3. Preparation of a proposed Consent Order as a resolution of the matter. 4. Proceed with the scheduled hearing. F. Any action which the Board may take following a full disciplinary hearing may be taken in lieu thereof by Consent Order, duly executed by the respondent. Because of the lengthy dockets before the Board, Informal Settlement Conferences must be held in sufficient time to allow consummation of negotiations of a Consent Order at least ten (10) working days prior to the scheduled hearing date. After the terms of a Consent Order have been prepared, the Board's Executive Director shall have the authority to accept, reject or modify the terms of a Consent Order. When a mutually acceptable Consent Order has been accepted by the Board's Executive Director, it shall be binding on the Board, but not effective until full Board approval. Notwithstanding, it is still the responsibility of the respondent to

personally appear before the Board on the scheduled hearing date to answer any questions which the Board may have prior to full Board approval. G. If the parties to the Informal Settlement Conference are unable to reach a mutually agreeable Consent Order and the matter is to proceed to a full Board hearing, the parties shall agree in writing by stipulation, to the following: 1. Any undisputed claims, facts, testimony, documents or issues. 2. Evidence to be introduced without objection. 3. An estimate of the time required for the hearing.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.11 | Formal Hearing.

A. At a disciplinary hearing, opportunity shall be given to complaint counsel and respondent to present evidence on all issues of fact and argument on all issues of law and policy involved, to call, examine, and cross-examine witnesses, and to offer and introduce documentary evidence and exhibits as may be required for full and true disclosure of the facts and disposition of the matter. B. All testimony and other proceedings shall be recorded by a certified stenographer who shall be retained by the Board. C. During the disciplinary hearing, the Board's President, acting as the presiding officer, or his or her designee, shall rule on all evidentiary questions, but in his or her discretion may consult with the entire panel in executive session. At such hearing, the Board may be assisted by the Mississippi Attorney General, or his or her designee, who shall not have been involved in any way with the case otherwise. The Board's presiding officer may delegate ruling on procedural and evidentiary issues to the Attorney General or his or her designee. D. In all disciplinary hearings before the Board, the record of the case shall include: 1. The summons and affidavit issued. 2. The Respondent's answer to the summons and affidavit. 3. All pleadings, motions, and rulings issued. 4. Evidence received or considered at the hearing. 5. Offers of proof, objections, and rulings thereon. 6. The Board's order or other disposition made by the Board. E. Disciplinary hearings before the Board shall be conducted in the following order: 1. Opening statements. 2. Complaint counsel's case in chief. 3. Respondent's case in chief. 4. Complaint counsel's rebuttal. 5. Closing statements. F. Questioning of witnesses shall be conducted in the following order: 1. Direct examination. 2. Cross-examination. 3. Redirect examination. G. Upon conclusion of the hearing, the Board shall conduct its deliberations in Executive Session, outside the presence of the parties. The Board shall then render its Determination and Order, setting forth Findings of Fact, Conclusions of Law and Order. Although the Board's decision may be announced immediately following deliberations, the Board shall

be provided adequate time for preparation of the written determination and order. A copy of such determination and order shall be sent by certified mail, or served personally upon the respondent. The decision of the Board revoking, suspending or otherwise disciplining respondent shall become final thirty (30) days after so mailed or served unless within said period the respondent appeals the decision to the Chancery Court, as provided by law.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.12 | Reinstatement of License. The procedural requirements enumerated above shall also

Chapter 2: Preservation and Certification of Electronic Records

Rule 2.1 | Scope. This regulation applies to all records that come into the Board’s possession. The

Rule 2.2 | Definitions. The following terms have the meanings indicated:

Rule 2.3 | Electronic storage permitted. In addition to, or instead of, Source Documents in paper,

Rule 2.4 | Designation of supervisory official. For the purposes of this regulation, the Executive

Rule 2.5 | General requirements. The following procedures must be followed by the person who

maintains records on behalf of the Board:

A. Classification of records. The custodian shall classify all documents that are electronically stored. Hash values, or unique numerical identifiers, shall be used as a distinguishing trait. Hash values shall be assigned consistently to a file or a group of files based on a standard algorithm. B. When Source Documents are placed in Electronic Storage. The Source Document, if any, for electronically stored information may be place in electronic storage at any time when deemed necessary by the Board’s executive director. Notwithstanding, no records which have been introduced into evidence before the Board in a licensure or other administrative hearing shall be placed in electronic format if the actions of the Board are still pending, subject to an appeal or other court action. C. Time for destruction of Source Documents. The Source Document, if any, for electronically stored information may be destroyed after a period of six months, but until such time, must

be separately stored. Prior to destruction of any records, the Board Executive Director shall determine that the records have no legal or administrative value. D. Access. Access to electronic storage media shall be limited to properly authorized personnel. E. Protection from information loss. The electronically stored information shall be protected against information loss by backup and recovery. The use of floppy disks or other forms of magnetic media not specifically designed for the purpose of long term storage shall be avoided. F. Protection from damage. Provide reasonable protection from damage by fire, flood, and other hazards for records. Safeguard records from unnecessary exposure to deterioration from excessive humidity, dryness, or lack of proper ventilation. G. Index of records. The electronically stored copies shall be indexed and maintained for ready reference and inspection. H. Maintenance of Records. Regular copying, reformatting, and other necessary maintenance shall be performed to ensure the retention of electronic records. I. Retrieval. Utilize a formal and timely retrieval process to permit standardized retrieval. J. Reproduction. Any reproduction of a non-electronic original record on electronic storage media shall be complete, true, and legible.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 2.6 | Authenticating Electronic Evidence in Board Proceedings.

Part 2650

Chapter 1: Administrative Rules

Rule 1.1 | Method of Operation. Scope

This regulation is promulgated pursuant to Mississippi Code, Section 25-43-2.104 of the Mississippi Administrative Procedures Law.

Description of the Mississippi State Board of Medical Licensure

A. Reference is made to Title 73, Chapter 43 of the Mississippi Code, which establishes the Mississippi State Board of Medical Licensure (“the Board”) and sets forth its composition, general powers and duties. Further reference is made to the following additional provisions of Mississippi law: 1. Title 73, Chapter 25, which sets forth the Board’s specific powers and duties in relation to licensure and discipline of physicians and osteopaths. 2. Title 73, Chapter 26, which sets forth the Board’s specific powers and duties in relation to licensure and regulation of physician assistants. 3. Title 73, Chapter 27, which sets forth the Board’s specific powers and duties in relation to licensure and discipline of podiatrists. 4. Title 41, Chapter 58, which sets forth the Board’s specific powers and duties in relation to licensure and regulation of radiologist technicians and assistants. 5. Title 41, Chapter 29, which sets forth the Board’s specific powers and duties in relation to investigations of potential violations of the Mississippi Controlled Substance Laws.

B. Rules adopted by the Board pursuant to the various authorities cited above are referred to as the Rules and Regulations of the Mississippi State Board of Medical Licensure. Pursuant to Mississippi Code, Section 73-43-13, the Board employs an Executive Director. The Board’s staff is organized into two (2) divisions: Licensure, which addresses matters related to the licensure of physicians, osteopaths, physician assistants, podiatrists, and radiologist technicians and assistants; and, Investigations, which investigates matters or allegations related to the potential violation of any state statute or regulation under the Board’s jurisdiction.

Where and How to Obtain Public Information

The text of all Board rules, as well as information regarding pending rules, schedules of meetings and the like may be obtained by visiting the Board’s website at www.msbml.ms.gov. Requests for Declaratory Opinions may be made pursuant to Part 2650, Rule 1.3. Otherwise, requests for information may be made pursuant to and in accordance with the Mississippi Open Records Act by submitting written request to the Board’s current mailing address.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.2 | Oral Proceedings on Proposed Rules.

A. Scope

This rule applies to all oral proceedings held for the purpose of providing the public with an opportunity to make oral presentations on proposed new rules and amendments to rules before the Mississippi State Board of Medical Licensure (“the Board”) pursuant to Mississippi Code, Section 25-43-3.104.

B. When Oral Proceedings Will Be Scheduled on Proposed Rules

The Board will conduct an oral proceeding on a proposed rule or amendment if requested by a political subdivision and agency or ten (10) persons in writing within twenty (20) days after the filing of the notice of the proposed rule. The Board may also schedule an oral proceeding on a proposed rule on its own motion.

C. Request Format

Each request must be printed or typewritten, or must be in legible handwriting. Each request must be submitted on standard business letter-size paper (8 ½” by 11"). Requests may be in the form of a letter addressed to the Board and signed by the requestor(s).

D. Notification of Oral Proceeding

The date, time and place of all oral proceedings shall be filed with the Secretary of State’s office and mailed to each requestor. The oral proceedings will be scheduled no earlier than twenty (20) days from the filing of this information with the Secretary of State.

E. Presiding Officer

The President of the Board shall preside at the oral proceeding on a proposed rule.

F. Public Presentations and Participation 1. At an oral proceeding on a proposed rule, persons may make oral statements and make documentary and physical submissions, which may include data, views, comments or arguments concerning the proposed rule. 2. Persons wishing to make oral presentations at such a proceeding shall notify the Board at least one business day prior to the proceeding and indicate the general subject of their presentation. For good cause shown, the presiding officer in his or her discretion may allow individuals to participate that have not previously contacted the Board. 3. At the proceeding, all those who participate shall indicate their names and addresses, identify any persons or organizations they may represent, and provide any other information relating to their participation deemed appropriate by the presiding officer. 4. The presiding officer may place time limitations on individual oral presentations when necessary to assure the orderly and expeditious conduct of the oral proceeding. To encourage joint oral presentations and to avoid repetition, additional time may be provided for persons whose presentations represent the views of other individuals as well as their own views. 5. Persons making oral presentations are encouraged to avoid restating matters that have already been submitted in writing. 6. There shall be no interruption of a participant who has been given the floor by the presiding officer, except that the presiding officer may in his or her discretion (i) recognize Board members for questions of the participant, or (ii) interrupt or end the participant’s time where the orderly conduct of the proceeding so requires. Should the presiding officer recognize a member of the Board for questions during the participant’s presentation, additional time will be afforded the participant in making his or her presentation. G. Conduct of Oral Proceeding 1. Presiding Officer

The presiding officer shall have the authority to conduct the proceeding in his or her discretion for the orderly conduct of the proceeding. The presiding officer shall:

i. Call the proceeding to order. ii. Give a brief synopsis of the proposed rule, a statement of the statutory authority for the proposed rule, and the reasons provided by the Board for the proposed rule. iii. Call on those individuals who have contacted the Board about speaking on or against the proposed rule. iv. Recognize Board members for questions of any participant during their presentation. v. Allow for rebuttal statements following all participants’ comments. vi. Adjourn the proceeding. 2. Physical and Documentary Submissions

Submission presented by participants in an oral proceeding shall be submitted to the presiding officer. Such submissions become the property of the Board and become subject to the Open Records Act.

3. Recording

The Board will record oral proceedings by stenographic means.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Rule 1.3 | Declaratory Opinions.

A. Scope

This regulation sets forth the rules of the Mississippi State Board of Medical Licensure (“the Board”) governing the form and content of requests for declaratory opinions, and the Board’s procedures regarding such requests, as required by Mississippi Code, Section 25- 43-2.103. This regulation is intended to supplement and be read in conjunction with the provisions of the Mississippi Administrative Procedures Law, and may contain additional information regarding the issuance of declaratory opinions. In the event of any conflict between this rule and the Mississippi Administrative Procedures Law, the latter will control.

B. Persons Who May Request Declaratory Opinions

Any person with a substantial interest in the subject matter may request a declaratory opinion from the Board by following the procedures set forth in this rule. For purposes of this rule, “substantial interest in the subject matter” means the individual, business, group or other entity making the request is directly affected by the Board’s administration of the laws, rules within its jurisdiction. To be a substantial interest, the interest affected by the statute, rule or regulation must be different from the interest of the general public in that same statute, rule or regulation.

C. Subjects Which May Be Addressed in Declaratory Opinions

The Board will issue declaratory opinions regarding the applicability to specified facts of: (i) a statute administered or enforced by the Board; or (ii) a rule or regulation promulgated by the Board.

D. Written Request Required

E. Where to Send Requests

All requests must be mailed, hand-delivered or transmitted via facsimile to the Board’s current mailing address or current facsimile number.

F. Question Presented

Each request shall contain the following:

1. A full, complete and accurate statement of all relevant facts on which the opinion is requested, presented in a clear and concise manner. 2. A citation to the statute, rule or regulation at issue. 3. The question(s) sought to be answered in the opinion, stated clearly. 4. A suggested proposed opinion from the requestor, stating the answers desired by the petitioner and a summary of the reasons in support of those answers.

5. The identity of all other persons known to the requestor who may be involved in or impacted by the described factual situation, including the relationship of each to the facts, name, mailing address and phone number. 6. A statement that the person seeking the opinion has a substantial interest in the subject matter, and sufficient information to support that statement. G. Name, Address and Signature of Requestor

Each request must include the full name, telephone number and mailing address of the requestor. All requests must be signed by the person filing the request, who shall attest that the request complies with the requirements set forth in this regulation.

H. Circumstances in Which Declaratory Opinions Will Not Be Issued

The Board may, for good cause, refuse to issue a declaratory opinion. The circumstances in which declaratory opinions will not be issued include, but are not limited to:

1. The request is not made with sufficient clarity to facilitate the rendering of a declaratory opinion, or the request does not provide a complete or accurate statement of all relevant facts. 2. There exists pending or anticipated litigation, or a pending administrative or disciplinary action, or other adjudication, which has as its subject the precise question presented to the Board for declaratory opinion, the conclusion of which will resolve the question. 3. The statute or rule on which a declaratory opinion is sought is clear and not in need of interpretation to answer the question presented by the request. 4. The facts presented in the request are not sufficient to answer the question presented. 5. The request fails to contain information required by this regulation or the requestor failed to follow the procedures established by this regulation. 6. The request seeks to resolve issues which have become moot, or are abstract or hypothetical such that the requestor is not substantially affected by the statute, rule or regulation on which a declaratory opinion is sought. 7. The facts, whether existing or anticipated, do not support that the requestor will be substantially affected by the application of the statute, rule or regulation. 8. The question presented by the request concerns the legal validity of a statute, rule or regulation. 9. The request is not based upon facts calculated to assist the requestor in the planning of future conduct, but is instead based on past conduct of the requestor in an attempt to determine the effect of the statute, rule or regulation on that past conduct. 10. No clear answer is determinable. 11. The question presented by the request may involve the application of a criminal statute or presents a set of facts which may constitute a crime. 12. The answer to the question presented would require the disclosure of information which is privileged or otherwise protected by law from disclosure. 13. The question is currently the subject of an Attorney General’s opinion request or has been answered by an Attorney General’s opinion. 14. A similar request is pending before the Board or any other agency or a proceeding is pending on the same subject matter before any agency, administrative or judicial tribunal, or where such an opinion would constitute the unauthorized practice of law.

15. Where issuance of a declaratory opinion may adversely affect the interests of the state of Mississippi, the Board or any of their officers or employees in any litigation which is pending or may reasonably be expected to arise. 16. The question involves eligibility for a license, permit, certificate or other approval by the Board or some other agency, and there is a statutory or regulatory application process by which eligibility for said license, permit, certificate or other approval would be determined. I. Time for Board’s Response

Within forty-five (45) days after the receipt of a request for a declaratory opinion which complies with the requirements of this regulation, the Board shall, in writing:

1. Issue a declaratory opinion regarding the specific statute, rule or regulation as applied to specific facts presented in the request. 2. Decline to issue a declaratory opinion, stating the reasons for its action. 3. Agree to issue a declaratory opinion by a specific time not later than ninety (90) days after receipt of the written request.

The forty-five (45) day period shall begin running on the first regular business day after the request is received by the Board, excluding legal holidays and weekends.

J. Effective Date of Declaratory Opinions

A declaratory opinion shall not become final until the expiration of sixty (60) days after its issuance. Prior to the expiration of sixty (60) days, the Board may, in its discretion, withdraw or amend the declaratory opinion for any reason which is not arbitrary or capricious. Reasons for withdrawing or amending an opinion include, but are not limited to, a determination that the request failed to meet the requirements of these rules or that the opinion issued contains a legal or factual error.

K. Notice to Third Parties

The Board may give notice to any person, agency or entity that a declaratory opinion has been requested and may receive and consider data, facts, arguments and opinions from individuals, agencies or entities other than the requestor.

L. Public Availability of Requests and Declaratory Opinions

Declaratory opinions and requests for declaratory opinions shall be available for public inspection and copying in accordance with the Mississippi Public Records Act. All declaratory opinions and requests shall be indexed by name of requestor and subject. Declaratory opinions and requests which contain information which is confidential or exempt from disclosure under the Mississippi Public Records Act or other laws shall be exempt from this requirement and shall remain confidential.

M. Effect of a Declaratory Opinion

The Board will not pursue any civil, criminal or administrative action against a person who issued a declaratory opinion from the Board and who, in good faith, follows the direction of the opinion and acts in accordance therewith unless a court of competent jurisdiction holds that the opinion is manifestly wrong. Any declaratory opinion rendered by the Board shall be binding only on the Board and the person to whom an opinion is issued. No declaratory opinion will be used as a precedent for any other transaction or occurrence beyond that set forth by the requesting person.

Adopted November 9, 2006.

Source: Miss. Code Ann. §73-43-11 (1972, as amended).

Chapter 2: Public Records

Rule 2.1 | Authority and purpose. “It is the policy of the Legislature that public records must be

available for inspection by any person unless otherwise provided by this act. Furthermore, providing access to public records is a duty of each public body and automation of public records must not erode the right of access to those records.” Section 25-61-1, Miss. Code of 1972.

“[A]ll public records are hereby declared to be public property, and any person shall have the right to inspect, copy or mechanically reproduce or obtain a reproduction of any public record of a public body in accordance with reasonable written procedures adopted by the public body concerning the cost, time, place and method of access, and public notice of the procedures shall be given by the public body.” Section 25-61-5, Miss. Code of 1972.

The act defines "public record" to include "all books, records, papers, accounts, letters, maps, photographs, films, cards, tapes, recordings or reproductions thereof, and any other documentary materials, regardless of physical form or characteristics, having been used, being in use, or prepared, possessed or retained for use in the conduct, transaction or performance of any business, transaction, work, duty or function of any public body, or required to be maintained by any public body.” Section 25-61-3(b).

The purpose of these rules is to establish the procedures the Board of Medical Licensure will follow in order to provide full access to public records. These rules provide information to persons wishing to request access to public records of the Board of Medical Licensure and establish processes for both requestors and the Board of Medical Licensure staff that are designed to best assist members of the public in obtaining such access.

The purpose of the act is to provide the public full access to public records concerning the conduct of government. These rules will be interpreted in favor of disclosure. In carrying out its responsibilities under the act, the Board of Medical Licensure will be guided by the provisions of the act describing its purposes and interpretation.

Source: Miss. Code Ann. §73‐43‐11 (1972, as amended).

Rule 2.2 | Public body description--Contact information--Public records officer.

Rule 2.3 | Availability of public records.

Rule 2.4 | Processing of public records requests – General.

(1) Providing access. The Board acknowledges that “providing access to public records is a duty” and that “any person shall have the right to inspect, copy or mechanically reproduce or obtain a reproduction of any public record” in accordance with these policies. Sections 25-61-1 and 25-61-

5. The public records officer or designee will process requests in the order allowing the most requests to be processed in the most efficient manner.

(2) Acknowledging receipt of request. Within five business days of receipt of the request, the public records officer will do one or more of the following:

(a) Make the records available for inspection or copying;

(b) If copies are requested and payment of a deposit for the copies, if any, is made or terms of payment are agreed upon, send the copies to the requestor;

(d) If the request is unclear or does not sufficiently identify the requested records, request clarification from the requestor. Such clarification may be requested and provided by telephone. The public records officer or designee may revise the estimate of when records will be available; or

(e) Deny the request, stating the reason for the denial in writing.

(3) Consequences of failure to respond. If the Board does not respond in writing within five business days of receipt of the request for disclosure, the requestor should consider contacting the public records officer to determine the reason for the failure to respond.

(4) Records exempt from disclosure. Some records are exempt from disclosure, in whole or in part. If the Board believes that a record is exempt from disclosure and should be withheld, the public records officer will deny the request in writing as set out in Rule 2.4 (2)(d) above, stating the specific exemption. If only a portion of a record is exempt from disclosure, but the remainder is not exempt, the public records officer will redact the exempt portions, provide the nonexempt portions, and indicate to the requestor why portions of the record are being redacted.

(5) Inspection of records.

(a) Consistent with other demands, the Board shall promptly provide space to inspect public records. No member of the public may remove a document from the viewing area or disassemble or alter any document. The requestor shall indicate which documents he or she wishes the public body to copy.

(b) The requestor must claim or review the assembled records within thirty days of the Board’s notification to him or her that the records are available for inspection or copying. The public body will notify the requestor in writing of this requirement and inform the requestor that he or she should contact the public body to make arrangements to claim or review the records. If the requestor or a representative of the requestor fails to claim or review the records within the thirty- day period or make other arrangements, the Board may close the request and refile the assembled records. Other public records requests can be processed ahead of a subsequent request by the same person for the same or almost identical records, which can be processed as a new request.

(6) Providing copies of records. After inspection is complete, the public records officer or designee shall make the requested copies or arrange for copying.

(7) Providing records in installments. When the request is for a large number of records, the public records officer or designee will provide access for inspection and copying in installments, if he or she reasonably determines that it would be practical to provide the records in that way. If, within thirty days, the requestor fails to inspect the entire set of records or one or more of the installments, the public records officer or designee may stop searching for the remaining records and close the request.

(8) Completion of inspection. When the inspection of the requested records is complete and all requested copies are provided, the public records officer or designee will indicate that the Board has completed a diligent search for the requested records and made any located nonexempt records

available for inspection.

(9) Closing withdrawn or abandoned request. When the requestor either withdraws the request or fails to fulfill his or her obligations to inspect the records or pay the deposit or final payment for the requested copies, the public records officer will close the request and indicate to the requestor that the Board has closed the request.

(10) Later discovered documents. If, after the Board has informed the requestor that it has provided all available records, the Board becomes aware of additional responsive documents existing at the time of the request, it will promptly inform the requestor of the additional documents and provide them on an expedited basis.

Source: Miss. Code Ann. §73‐43‐11 (1972, as amended).

Rule 2.5 | Processing of public records requests – Electronic records.

Rule 2.6 | Exemptions. The Public Records Act, as well as other statues and court decisions,

provide that a number of types of documents are exempt from public inspection and copying. In addition, other statutes or rules of law, such as various privacy restrictions, may prohibit disclosure. Requestors should be aware of the following exemptions, outside the Public Records Act, that restrict the availability of some documents held by the Board for inspection and copying:

Academic records exempt from public access, see § 37-11-51.

Appraisal records exempt from access, see § 31-1-27.

Archaeological records exempt from public access, see § 39-7-41.

Attorney work product, examination, exemption, see § 25-1-102.

Birth Defects Registry, see § 41-21-205.

Bureau of vital statistics, access to records, see § 41-57-2.

Charitable organizations, registration information, exemption from public access, see § 79-11-527.

Concealed pistols or revolvers, licenses to carry, records, exemption, see § 45-9-101.

Confidentiality, ambulatory surgical facilities, see § 41-75-19.

Defendants likely to flee or physically harm themselves or others, see § 41- 32-7.

Environmental self-evaluation reports, public records act, exemption, see § 49-2-71.

Hospital records, Mississippi Public Records Act exemption, see § 41-9-68.

Individual tax records in possession of public body, exemption from public access requirements, see § 27-3-77.

Insurance and insurance companies, risk based capital level requirements, reports, see § 83-5-415.

Judicial records, public access, exemption, see § 9-1-38.

Jury records exempt from public records provisions, see § 13-5-97.

Licensure application and examination records. exemption from Public Records Act, see § 73-52-1.

Medical examiner, records and reports, see § 41-61-63.

Personnel files exempt from examination, see § 25-1-100.

Public records and trade secrets, proprietary commercial and financial information, exemption from public access, see § 79-23-1.

Workers' compensation, access to records, see § 71-3-66.

Records subject to privilege, such as Attorney/Client, Physician/Patient, etc.

Source: Miss. Code Ann. §73‐43‐11 (1972, as amended).

Rule 2.7 | Third Party Information. When any person files or submits documents with the Board

Rule 2.8 | Costs of providing public records.

(1) Costs for paper copies. Section 25-61-7(1), Miss. Code of 1972, reads as follows: “Except as provided in subsection (2) of this section, each public body may establish and collect fees reasonably calculated to reimburse it for, and in no case to exceed, the actual cost of searching, reviewing and/or duplicating and, if applicable, mailing copies of public records.”

A requestor may obtain standard black and white photocopies for fifteen (15) cents per page and color copies for twenty-five (25) cents per page.

Before the Board begins to make the copies, the requestor must pre-pay all reasonably estimated costs of copying all the records selected by the requestor. The public records officer or designee

may also require the payment of the remainder of the copying costs before providing all the records in an installment before providing that installment.

(2) Costs for electronic records. The cost of electronic copies of records shall be ten (10) dollars for information on a CD-ROM. The cost of scanning existing MSBML paper or other non- electronic records is ten (10) cents per page. There will be no charge for e-mailing electronic records to a requestor, unless another cost applies such as a scanning fee or system costs allowed under Section 25-61-7(2), Miss. Code of 1972.

(3) Costs of mailing. The Board may also charge actual costs of mailing, including the cost of the shipping container.

(4) Payment. Payment may be made by cash, check, or money order to the Board.

(5) Charges for searching, reviewing and redacting. The actual cost of searching for and reviewing and, if necessary, redacting exempt information from public records shall be based upon the hourly rate of compensation for the lowest paid agency employee qualified to perform the task, which shall be multiplied by the actual time to complete the task.

(6) The Board may require payment in advance for all costs before providing copies or access to records.

Source: Miss. Code Ann. §73‐43‐11 (1972, as amended).

Rule 2.9 | Review of denials of public records.

(1) Petition for internal administrative review of denial of access. Any person who objects to the initial denial or partial denial of a records request may petition in writing (including e-mail) to the public records officer for a review of that decision. The petition must include a copy of or reasonably identify the written statement by the public records officer or designee denying the request.

(2) Consideration of petition for review. The public records officer must promptly provide the petition and any other relevant information to the Board’s Executive Director. The Executive Director will immediately consider the petition and either affirm or reverse the denial within two business days following the Board’s receipt of the petition, or within such other time as the Board and the requestor mutually agree to.

(3) Review by the Ethics Commission. Pursuant to Section 25-61-13, if the Board denies a requestor access to public records, the requestor may ask the Ethics Commission to review the matter. The Ethics Commission has adopted rules on such requests. They may be found at www.ethics.state.ms.us.

(4) Judicial review. Any person whose request for public records was denied may institute a suit in the chancery court of Hinds County, seeking to reverse the denial, as set forth in Section 25-61- 13.

Source: Miss. Code Ann. §73‐43‐11 (1972, as amended).

Adopted March 19, 2015.

For Office Use Only

Date Received

Reviewed By

APPENDIX A

OFFICE BASED SURGERY REGISTRATION FORM

(For Levels II and III only)

PLEASE PRINT IN INK OR TYPE

Name:

Last

First

Middle

MS License Number

Indicate how credentialed: Board certification Alternative credentialing

Explain:

Primary surgical practice location

Surgical Level(s)

(II and/or III)

List physical address of all locations

List procedures to be performed in office (additional procedures may be listed on a separate page):

Signature Date

RETURN BY MAIL TO:

Mississippi State Board of Medical Licensure 1867 Crane Ridge Drive, Suite 200-B

APPENDIX B

SURGICAL EVENT REPORT FORM

NOTE: Part 2635, Chapter2 of Administrative Code of the Mississippi State Board of Medical Licensure requires surgeons to report any surgical event to the Board within 15 days of the event. A “surgical event” is recognized as a potentially harmful or life threatening episode related to either the anesthetic or the surgery. Any “surgical event” in the immediate perioperative period that must be reported are those which are life-threatening, require special treatment, or require hospitalization, including, but not limited to the following: (1) serious cardiopulmonary or anesthetic events; (2) major anesthetic or surgical complications; (3) temporary or permanent disability; (4) coma; or (5) death.

Date:

Time:

Name and Title of Person Filing Report:

Provider Information

Name of Physician: MS License #:

Specialty: Board Certified? Yes No

Phone: ( )

Address :

Event (Refer to patient by file number only) Patient File Number:

DO NOT SEND PATIENT MEDICAL RECORDS

Age of Patient: Sex: Male Female

Name/Nature of Procedure(s):

sia/Analgesia (include dosage):

Nature of Surgical Event (e.g., anaphylaxis, syncope, infection, rash, etc.):

ent for Event:

Patient Outcome/Disposition: Hospitalized? Yes No

(Additional information may be given on a separate page.)

RETURN BY MAIL TO:

Mississippi State Board of Medical Licensure 1867 Crane Ridge Drive, Suite 200-B

APPENDIX C

ADMINISTRATION/DISPENSATION LOG AND PERPETUAL INVENTORY–SAMPLE

Demerol 50mg/ml Inj. (1ml)

Drug Name and Strength (One drug per page)

Physician Name: Dr. Doolittle

Patient Name or Drug Company and Invoice Number

Patient Address

Date Dispensed/ Order Rec.

Amount Admin./ Dispensed

Amount Ordered & Received

Total On Hand

Comments/method of Disp. IV / IM / PO

Initials

XYZ Drug Company

Invoice #00001

12/1/00

N/A

Initial Inventory of Stock on hand BOB or COB(Beginning of Business or Close of Business)

John Doe

112 Shady Lane, Jackson MS

02/05/01

50mg

N/A

Jane Roe

43 Easy Street, Jackson MS

03/07/01

50mg

N/A

Mo Joe

1004 Foraker Ave., Pearl MS

05/09/01

50mg

N/A

Page _____ of _____

APPENDIX D

ADMINISTRATION/DISPENSATION LOG AND PERPETUAL INVENTORY ______________________________________________ Drug Name and Strength (One drug per page)

Physician Name:

Patient Name or Drug Company and Invoice Number

Patient Address

Date Dispensed/ Order Rec.

Amount Admin./ Dispensed

Amount Ordered & Received

Total On Hand

Comments/method of Disp. IV / IM / PO

Initials

Initial Inventory of Stock on hand

Page _____ of ______

DRAFT - Administrative Code

Title 30: Professions and Occupations

Part 2601

Part 2605

Part 2610

Part 2615

Part 2620

Part 2621

Part 2630

Part 2635

Part 2640

Part 2645

Part 2650

Key Links

For Licensees

For the Public

Board Meetings & Minutes