The Mississippi Board of Medical Licensure has amended a telemedicine proclamation and is limiting access to out-of-state physicians for the service.
The Board issued an amended proclamation Tuesday that limited telemedicine for out-of-state physicians not licensed to practice in Mississippi to only those who have an existing doctor-patient relationship rather than any licensed physician.
On March 15, the board issued a proclamation that said it would not enforce regulations governing out-of-state physicians using telemedicine to treat patients in the state in response to an emergency declaration by Gov. Tate Reeves that urged a reduction of regulations due to the spread of the coronavirus.
The proclamation would also have the board not enforcing its rules requiring physicians to examine patients prior to prescribing medication, including controlled substances, to encourage the use of telemedicine. That part of the proclamation is still in effect.
Under existing regulations, a physician using telemedicine to treat patients must be licensed to practice in Mississippi.
Getting certified to practice in Mississippi is easier thanks to action by the Mississippi legislature, but the number of physicians going through the process to get certified to practice in Mississippi is likely nil with the COVID-19 pandemic.
Mississippi is part of the Interstate Medical Licensure Compact, which has 26 states that have signed up to streamline their normal licensing process for licensed physicians. This provides physicians moving from one compact-participating state to another the ability to get a license in their new state within days rather than weeks or even months.
Those states include: Alabama, Arizona, Colorado, Guam, Idaho, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, North Dakota, South Dakota, Oklahoma, Tennessee, Utah, Vermont, West Virginia, Wisconsin, Wyoming, and Washington.
Georgia, Kentucky, Pennsylvania, and the District of Columbia have passed legislature to participate in the compact but has yet to be implemented. Florida, Missouri and South Carolina have introduced legislation to become part of the compact.
A number of distilleries in Mississippi are producing a new item for sale as the coronavirus spreads and one very essential product is available in limited quantities: hand sanitizer.
This didn’t come from a government mandate on the private sector. It was actually the opposite. The federal government stood in the way, until they reversed a couple regulations. The Alcohol and Tobacco Tax and Trade Bureau waived requirements to obtain permits to legally manufacture hand sanitizer and removed the excise tax for alcohol-based hand sanitizer products. That wasn’t all.
The Food and Drug Administration then had to issue guidance saying they do not “intend to take action against manufacturing firms that prepare alcohol‐based hand sanitizers for consumer use and for use as health care personnel hand rubs during this ongoing public health emergency.”
It makes sense that distilleries would be a natural fit for a product that contains a high amount of alcohol. And numerous Mississippi distilleries, which have had to close their bars and stop providing tours, are taking advantage of the relaxed rules. And if anyone understands overzealous government regulations, it is alcohol producers.
“I'm covered up in it — trying to make as much of the stuff as we can,” said David Rich, owner of Rich Grain Distilling Co. in Canton. Lazy Magnolia Brewery in Kiln is also making hand sanitizer.
In times of crisis, we often look to the government for an initial response. That is understandable. Yet it is the private sector who has always, and will always, respond as they can in times of need. As a new column in the Wall Street Journal outlines, Honeywell and 3M are hiring workers and increasing output for N95 masks. Ford and General Motors are using their global supply chain to make face shields, ventilators, and respirators. It is the private sector that created the technology that streamlined curbside pickup and delivery for grocery stores and restaurants.
And, of course, distilleries are now making hand sanitizer. Since government is no longer in the way.
Gov. Tate Reeves announced today that he will be signing an executive order later today to close restaurant dining facilities in an effort to combat the spread of the coronavirus and to instruct Mississippians not to gather in groups of 10 or more.
Saying he was relying on the advice of health experts in the state, Reeves made the announcement during a news conference at the Governor’s mansion this morning.
The state Department of Health has recommended restaurants close their dining facilities and move to take-out and delivery only. Many local governments have enacted similar bans. This includes: Lafayette county, Oxford, Jackson, Tupelo, Moss Point, Biloxi, Gulfport, Ocean Springs, Forrest county, Hattiesburg, Columbus, Starkville, Hancock county, Bay St. Louis, Diamondhead, Waveland, Vicksburg, Southaven, Olive Branch, Holly Springs, Pontotoc, and New Albany.
Reeves, who yesterday said he wasn’t issuing a stay at home order as a number of other states have done, said he will continue to rely on the advice of experts for the appropriate direction and that he believed most in the state are heeding the call to only leave their house if it is necessary.
Reeves was asked about that today.
“I’m not going to rule anything out at this time,” Reeves said. “We’re going to take every step experts ask us to take. I have not been advised by anyone to enter into a statewide lockdown. There are currently 18 states that have varying degrees of lockdown and what I believe is the majority of Mississippians are heeding the call to take care of themselves. We have some pockets where that has not been the case. But we are telling all Mississippians avoid groups of 10 or more.
“My commitment is to listen to the experts but at this time we don’t see this as the best course of action… The best information I have does not call for a statewide lockdown.”
Mississippi has 320 confirmed cases of coronavirus.
The purpose of healthcare policy during a health crisis, such as the current coronavirus outbreak, is to maximize existing resources to provide high-quality healthcare to as many people as possible.
What does this mean? It means we must be guided by two priorities during the current emergency:
- Increasing the Supply of Healthcare
- Increasing Access to Healthcare
These two priorities, however, should be achieved in a manner that honors our heritage of constitutional government. The question for policymakers thus becomes how to attain these goals while also:
- Respecting Individual Freedom and Responsibility
- Limiting Damage to the Free Market and the Economy
No doubt, various methods can be employed to increase healthcare supply and access. The healthcare economy, for instance, could be nationalized, with the federal and state governments commandeering factories and forcing them to make face masks and respirators. Doctors and nurses could also be conscripted and made to work in localities with the most need.
Such draconian measures should only be employed as a last resort. It is our task to determine whether supply-side, market reforms can meet the current need in a way that maximizes freedom and strengthens the free market. In fact, we are already experiencing the benefits of such an approach. Consider the following:
- Millions more N95 face masks will soon be available after Congress passed a law overriding Food & Drug Administration (FDA) red tape that has been hampering supply.
- Following South Korea’s own experience, the FDA has lifted regulations holding back the supply of testing kits and accessibility.
- Congress has passed legislation waiving restrictions on telemed for Medicare insurance beneficiaries.
Closer to home, Gov. Tate Reeves is pursuing a similar path by encouraging health care providers to consider how regulatory requirements are limiting healthcare access.
- Accordingly, the State Board of Medical Licensure recently suspended a rule that has been suppressing access to telemedicine. Of particular note is allowing physicians licensed in another state to use telemed to treat Mississippi patients.
- Likewise, the State Board of Nursing is allowing APRNs – Advanced Practice Registered Nurses, which include nurse practitioners, clinical nurse specialists and others – to prescribe medications without a prior face-to-face examination. In addition, APRNs that do not hold a Mississippi license may treat Mississippi residents via telemed. Nurses (RNs or LPNs) licensed in another state may also obtain a waiver to practice in Mississippi during the current emergency. It does not appear, however, that the State Board of Medical Licensure has formalized an identical waiver, beyond what is already permissible under temporary licensure guidelines.
- As with Medicare, the state Division of Medicaid is also employing additional telemed options for patients with Medicaid and CHIP insurance.
Clearly, much more needs to be done to cut red tape so that we may more effectively respond to the coronavirus.
Part II of this report will look at additional healthcare reforms that would save lives and increase access during the current emergency.
Gov. Tate Reeves said he is not issuing an order to require residents to stay at home to combat the spread of coronavirus even as some Democratic mayors lash out at the governor.
Reeves made the comments during a Facebook live conference where he fielded comments from Mississippians.
Saying that no one at the Mississippi Department of Health has issued a recommendation for a ‘shelter-in-place’ order, Reeves said the state isn’t going to make a quick decision just because other states are doing it. Reeves also said the federal government is not recommending a lockdown.
Last night, Tupelo became the first municipality in the state to issue such an order. The city is requiring all non-essential businesses and all non-essential residents to stay at home. Residents would still be able to travel to the grocery store, medical facilities, restaurants, hardware stores, daycares, and gas stations, among other places.
Similar orders cover the states of California, Connecticut, Delaware, Illinois, Kentucky, Louisiana, New Jersey, New York, Ohio, and Oregon, as well as a number of large cities nationwide.
The state Department of Health has recommended restaurants close their dining facilities and move to take-out and delivery only. The following local governments have enacted similar restaurant bans: Oxford, Jackson, Tupelo, Moss Point, Biloxi, Gulfport, Ocean Springs, Houston, Forrest county, Hattiesburg, Columbus, Starkville, Hancock county, Bay St. Louis, Diamondhead, Waveland, Vicksburg, Olive Branch, and Southaven.
A statewide ban is not in place.
Before the legislature suspended the session to combat the spread of the coronavirus in the state, both chambers opted against considering legislation that would have allowed those holding an occupational license in another state to receive one in Mississippi without jumping through the traditional hoops.
Senate Bill 2415 was sponsored by Sen. Kevin Blackwell. The bill died in Accountability, Efficiency, Transparency without a vote. House Bill 261 was sponsored by Rep. Becky Currie. It died in Judiciary A without a vote.
As of now, a new state resident who is part of a licensed occupation often has to go through the same process as someone receiving their license for the first time with the subsequent fees and tests.
Mississippi does have limited reciprocity agreements with some states with some occupations to honor their licenses, but new legislation would have ended this practice and allow most new residents to trade in their former state’s license with a new Mississippi one with little hassle.
But as the state copes with COVID-19 and the strain on the healthcare system, we have seen emergency actions to allow out-of-state medical professionals to work in Mississippi. Out-of-state nurses – both RNs and LPNs – are allowed to apply for a temporary license. Additionally, out-of-state doctors and nurse practitioners are allowed to provide telemedicine services courtesy of an order from the Mississippi State Board of Medical Licensure.
This is similar to what many other states are doing. One state that didn't need to issue orders for out-of-state medical professionals to provide care was Arizona. That is because they were the first state in the nation to pass universal recognition of licensing in 2019.
Recognizing occupational licenses from another state is good policy any day of the week. It shouldn’t take a pandemic for us to see it. And it shouldn’t take an emergency declaration to make it occur. That is true regardless of the occupation.
The overarching plan used by the state Department of Health to allocate health care resources under the state’s certificate of need program has a goal to reduce surplus, unused bed capacity at hospitals statewide. Yet as the coronavirus pandemic spreads, the number of available hospital beds is expected to become an issue.
The part of the state’s most recent health plan released in 2018 that dealt with hospital bed capacity said there was an importance to reducing excess bed capacity and that it is not likely to result in problematic consequences. It’s been the policy of the department since 2009.
The same document also said there was a glut of licensed hospital beds statewide despite a decreasing trend nationally since 1999. The state Department of Health urges each hospital to voluntarily reduce the licensed bed capacity.
According to the Henry Kaiser Family Foundation, the state (as of 2018) has four beds per 1,000 population, considerably higher than the U.S. average of 2.4 beds per 1,000 population. In 1999, Mississippi had 4.8 hospital beds per each 1,000 of population (the national average was three).
The plan also says that the “carrying cost” of maintaining unused beds could raise operating costs for hospitals and that such surpluses could retard the introduction of more cost-effective practices and services. The document also said continuing surpluses could create an environment that could invite policy intervention by the legislature and others.
The MSDH determines hospital need under the certificate of need program by multiplying the state’s average annual occupied beds per 1,000 population by the estimated county population to determine the number of beds required.
The state health plan provides guidance for the decisions made by the board when considering certificate of need applications. Mississippi law requires CON approval for all projects that increase the bed complement or a capital expenditure of at least $2 million. CON approval is also required for major medical equipment purchases of more than $1.5 million and is not a replacement for existing equipment. Mississippi is one of 35 states that requires a certificate of need.
Most of those applications for a CON are approved, at least in the last decade. From 2009 to 2018, 91.45 percent of the applications passed the first hurdle of a health department staff review.
During the 2009 to 2018 timeframe, there were 234 analyses performed by department staff for CON applications. The Department of Health recommended authorization on 214 without conditions, two received conditional approval and one received a partial approval.
Only 17 applications were recommended for disapproval (7.26 percent) and most of these were for new providers, largely from out of state, seeking to provide services in the state.
CONs originated from the National Health Planning and Resources Development Act of 1974 that was signed into law by then-President Gerald Ford. This act was intended to reduce annual increases in federal health care spending and one of the cost control measures was to require states to institute CON laws to regulate health care facilities.
Congress later eliminated this requirement, but CONs in some form persist in 35 states.
The Desoto county cities of Southaven and Olive Branch became two of the latest cities in the state to require restaurants to close their dining facilities and move to take-out or delivery services only in an effort to combat the spread of coronavirus transmission.
The city's held emergency meetings on Sunday, according to the Desoto Times-Tribune. The county also issued a proclamation, but it is just a recommendation to close bars and restaurants, similar to the recommendation from the state.
Along with Olive Branch and Southaven, the following local governments have enacted similar restaurant bans: Oxford, Jackson, Tupelo, Moss Point, Biloxi, Gulfport, Ocean Springs, Houston, Forrest county, Hattiesburg, Columbus, Starkville, Hancock county, Bay St. Louis, Diamondhead, Waveland, and Vicksburg.
So far, Tupelo is the only city in the state with a 'shelter-in-place' ordinance requiring all non-essential businesses and all non-essential residents to stay at home. Residents would still be able to travel to the grocery store, medical facilities, restaurants, hardware stores, daycares, and gas stations.
Similar orders cover the states of California, Connecticut, Delaware, Illinois, Kentucky, Louisiana, New Jersey, New York, Ohio, and Oregon, as well as a number of large cities nationwide.
Tupelo Mayor Jason Shelton is looking to enact an order that would close all non-essential businesses and require all non-essential residents to ‘shelter in place’ in response to the spread of coronavirus. He did this while criticizing Gov. Tate Reeves for not taking similar action.
Similar orders cover the states of California, Connecticut, Illinois, New Jersey, New York, and Oregon, as well as a number of large cities nationwide.
According to the Daily Journal, Shelton “will issue an executive order requiring all residents comply with the coronavirus guidelines from the Centers for Disease Control and Prevention, closing all non-essential businesses, requiring all non-essential business employees to “shelter in place” and suspending all utility disconnections, evictions and foreclosures.” Residents would still be able to travel to the grocery store, medical facilities, restaurants, hardware stores, daycares, and gas stations.
At least one Tupelo city councilman, Buddy Palmer, said he thought a shelter in place order was 'ridiculous' at this time.
Multiple cities throughout the state have issued orders closing bars and restaurants, though they haven't been as far reaching as what Shelton is proposing. Tupelo took similar action last week.
Meanwhile, Shelton continues to blast Gov. Tate Reeves and other state leaders for not issuing statewide orders to keep residents at home.
“I mistakenly waited for the state to act,” Shelton said. “I understand that the state is not going to issue any orders to assist the city. So local governments, cities and counties, are going to be on their own….It’s just an abdication of leadership at the highest level of the state of Mississippi, and we’re just not going to wait any longer in the city of Tupelo.”
Yesterday Shelton ordered the Tupelo Police Department and Tupelo Fire Department to break up a large gathering of people at an auction at the Tupelo Furniture Market.