Update: The MBML withdrew the amendment that is the subject of the story below and submitted a revised one on April 4. The agency stated it withdrew the original amendment due to a "technicality". The revised amendment is posted below.
The battle over allowing nurse practitioners to operate more freely in Mississippi may not be over. Watchdog.org reports the Mississippi Board of Medical Licensure might be changing the terms of an agreement it reached with the legislature this year. Steve Wilson writes:
While the Mississippi Board of Medical Licensure has extended the tether for nurse practitioners from 15 to 75 miles with updated regulations, the Mississippi Association of Nurse Practitioners isn’t exactly popping bottles of celebratory champagne.
Ricki Garrett, executive director of the MANP, said the board violated the terms of its deal with the Mississippi Legislature by changing more than the tether rule. Under the original deal between the Legislature and the board, the Legislature killed a committee substitute offered by state Sen. Terry Burton, R-Newton, in exchange for the board loosening the 15-mile rule regulations. Burton’s bill would’ve allowed nurse practitioners with 3,600 hours of clinical practice to work without an agreement with a collaborating physician.
Garrett said the unwanted changes to regulations included eliminating exemptions to the tether rule for NPs working in free-standing clinics, state health department sites, community health clinics, volunteer clinics and hospitals. Also, nurse anesthetists were placed under the tether rule after not previously being part of it.
“We have been told the legislative leadership is going to get the Board of Medical Licensure to go back to the drawing board and go back to the original agreement for the expansion to 75 miles,” Garrett said. “The problem is they are not deferential to anyone. It’s been a constant battle to keep what they’re doing in the light of day and work with them.”
Dr. Virginia Crawford, interim director of the Board of Medical Licensure, did not return a call for comment.
Even though the deadline has passed for general bills in the Mississippi Legislature, nurse practitioners still have one final chance to unshackle themselves from the licensure board. An amendment to House Bill 41 — which would add Mississippi to the Interstate Medical Licensure Compact that allows physicians to hold medical licenses in multiple states — would stop the board from exercising regulatory power over nurse practitioners and their collaboration agreements with physicians. The bill is headed to a conference committee after the House declined to pass the amended bill.
Garrett said one of the reasons why the board is loathe to allow nurse practitioners to practice independently is the money involved for the collaborating physicians. Under present regulations, the collaborating physician reads 10 percent or 20 of the charts per month (whichever comes first) from the NP under their supervision. This service, Garrett said, ranges from $1,000 to $7,000 per month per nurse practitioner.
“That’s all that physician is doing: Looking over 20 charts at the most every month,” Garrett said. “That’s one reason they (the board) don’t want to lose that. The other is the Board of Medical Licensure wants to be in control.”....
According to the notice filed with Mississippi Secretary of State Delbert Hosemann, the updated regulation would take effect 30 days after it was submitted March 28.
The need for more primary care for Mississippians is great, as the Magnolia State is one of six that has 30 percent or more of its population residing in areas with a primary care shortage, according to a study by the Kaiser Family Foundation. According to a 2015 workforce study by the Association of American Medical Colleges, Mississippi has the lowest number of physicians per 10,000 residents, with 184.7, while the national average is 265.5.
Kingfish note: Update to story. The Board submitted this language on March 28 as part of the amendment:
Advanced Practice Registered Nurse (APRN)” means a person who is licensed or holds the privilege to practice under Miss. Code Ann. §73-15-5, and who is nationally certified as an advanced practice registered nurse or in a specialized nursing practice, including certified nurse midwives (CNM), certified nurse anesthetists (CRNA), clinical nurse specialists (CNS), certified nurse practitioners (CNP) and doctors of nursing practice (DNP).There was no separate definition for "Nurse Practitioner". However, someone must have gotten the Board's attention because the amendment was withdrawn one week later on April 4 and this language was submitted for the definition of Advanced Practice Registered Nurse:
“Nurse Practitioner” 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.The new amendment makes clear distinctions in protocols for the supervision of Nurse Practitioners and Advanced Practice Registered Nurses.
F. “Advanced Practice Registered Nurse” includes all nurse practitioners, certified nurse midwives and certified registered nurse anesthetists.
This is the original amendment.